Braving our inner weather

Depression is the disease of loss. Our lives seem pointless because we have lost what is most valuable to us. But communicating what we have lost, in the exact terms specific to ourselves, is almost impossible.

A broken arm is a clearly defined condition, although the subjective experience may vary greatly from one person to another. Broken arms can be treated, people feel safe asking how you did it; the plaster cast becomes a site for get-well messages and schoolyard graffiti.

By contrast, there are as many depressions as there are people to suffer them. The symptoms differ, not just in intensity but in kind, and also in emphasis. One person cries, another is numb. One gives an appearance of normality, another cowers under the bed, unable to move. Some calmly plan their own death; others cannot work out how to take a shower.

Treatments have unexpected, sometimes contradictory, consequences. You take a pill and get better. I take the same pill and nothing happens, or I get worse. Is what you have the same as what I have? How much is in our minds and how much in our brains?


If we think of our minds as experiencing weather, then depression is grey. The actual sensation is difficult to describe—a kind of isolation, but intermixed with the most terrible fear. It is not the same as being sad, because sadness links us to the world; depression, however we try to describe it to ourselves, takes us away from the world.

The sense of a life force drying up, or vanishing, is very strong. The branching dendrites of our brains lack flow, and we feel much as a tree in drought must feel when the ground cracks around it. As the English poet-priest Gerard Manley Hopkins cried to his God, at the end of a sonnet in which he lamented that he could not ‘breed one work that wakes’: ‘Send my roots rain.’

Or we might recall Hamlet, finding that ‘this goodly frame, the earth, seems to me a sterile promontory; this most excellent canopy, the air, look you, this brave o’erhanging firmament, this majestical roof fretted with golden fire, why it appears no other thing to me but a foul and pestilent congregation of vapours’.
Because depression is so common, the experience says something important about being human. In fact, working out how to overcome depression means understanding what it does for you as well as to you, acknowledging the part it plays in the economy of your emotions, and the way you string your thoughts together—the everyday traffic of being ‘you’.

Susan Sontag wrote that any important disease whose physical etiology is not understood, and for which treatment is ineffectual, tends to be awash in significance. Illnesses such as cancer enter everyday language as metaphor, or are themselves conceived in terms of battles, victories and wars. But while the labels of mental illness can be joshingly passed around (as in ‘schizoid’ to denote a contradictory person or situation), they do not lend themselves to metaphor. It is as though mental illness is itself a kind of metaphor, a way of representing the unspoken to ourselves.

Like any illness, depression has multiple layers of meaning. There is the meaning to the individual, there is the socially constructed meaning, and then the professional, or scientifically constructed, meaning. But compared to conditions where we can see a clear pathology, there is something undefinable about depression. We are not talking about a ‘thing’ when we talk about depression, we are talking about ourselves, refracted through many types of perception.

The three layers of meaning are interconnected, at least for the patient. As soon as you go for help, your personal suffering becomes part of, or the object of, current professional understandings of the condition. And these professional understandings shape (and are shaped by) a general, social view about what is, and is not, a mental illness. But the solution to the problem, if you find one, or even if you don’t, is a personal statement, because the mind that suffers the illness must also be the mind that deals with it. Whatever help you seek, whatever treatment you choose, even if you choose to keep what is going on to yourself—all reflect self-understandings that, in turn, have implications for the future.

Ours is a garrulous, even a confessional age, and pain that was previously hidden away is, up to a point, now an acceptable subject for public discussion, at least in the rich countries of the West. There is a real democracy of feeling in all this, as no matter how strange our history, or appalling our woes, there is always someone ‘out there’ who feels just as we do. Even the cult of celebrity is not so much a yearning for a more glamorous life, but a confirmation that the famous are really just like us.

We may be witnessing, too, a reversal of at least some of the stigmatisation of mental illness that accompanied the massive intervention of the state in the 19th and 20th centuries, when large numbers of psychiatric hospitals were built in which the mentally ill could be both treated and sequestered. We now look to government, not so much for control, but supportive treatment and even early intervention to identify kids at risk. And if we are inclined almost to believe everyone has a right to a disability of their own, at least we have a better sense than ever before of the extent of our common human frailty.

Because depression is such a widespread condition, there are dozens of books intended for the general reader, taking every conceivable perspective on the problem. And this ‘talk’ both describes, and contributes to, the way we as a society build up a sense of what it is that is bothering us. (Don’t get me wrong, more communication is almost certainly a good thing—when I first encountered depression as a teenager in the late 1960s, there was virtually nothing available that shed any light on the catastrophe that had hit me.)
There are books by therapists, explaining the latest theories, and including accounts of people they have treated. If they are very practically oriented, they fall into the self-help category. And very useful these books are, too. In fact, some studies suggest that ‘bibliotherapy’ (using a self-help manual to teach yourself techniques to combat depression) produces significant improvement in those who try them.

Then there are books by men and women who have suffered from depression, and want to help others by describing what they have been through. Writing such confessional accounts takes tremendous courage, although each individual journey is so different. I wonder whether there is much comfort there for the sufferer caught in the grip of his or her own illness.

There is the sensation, and then the (self) perception of the sensation. The self-talk does not just shape depression, it is depression. It took me years to realise that the elaborate theories I had constructed about what had happened to me, and why, were the problem, not the solution. But that was only the beginning. I then had to find ways of not listening to my habitual mental lyrics, and the drumbeat of resentment and anxiety that accompanied them. It’s a difficult job, because depression is such a subtle siren song that you can be lured onto the rocks before you have realised what is happening to you.

At the intellectual level, I continue to wonder about causes. The fact that women are twice as likely to experience depression in their lifetimes as men (although much less likely to commit suicide) raises, in sharpened form, the relative importance of biological, social and psychological factors.

Explanations also empower certain kinds of cures, and with certain kinds of cures, certain kinds of knowledge and the practitioners of that knowledge. If the problem is physiological, it would seem logical to look for drug-based interventions, which in turn privilege the medical scientist, and inevitably involve the commercial aspirations of drug companies. Psychology takes us into the arms of counsellors and psychotherapists.

But if we look beyond the politics (the power play) of depression, the problem is more apparent than real, in the sense that our modes of understanding create conflicts and dilemmas where none need exist. From the standpoint of ‘what works’ in treating depression, the physiological, the social and the psychological are not different explanations, but simply alternative windows into a complex, systemic reality.

Which window one chooses is more a consequence of what can be done in any given situation. While modern anti-depressants are certainly more effective than those that were available in the past, they do not work for everyone. (In my own case, over the last 30 years, while my depression was clearly ‘biological’ in the sense that it struck most dramatically at puberty and after childbirth,  I was prescribed the latest anti-depressants to little effect.)

Although the search will undoubtedly continue, I suspect that no ‘magic bullet’ will ever be found for depression. The interaction between genes and biochemistry is simply too complicated, the variations between individuals probably too great, and the side effects too intransigent, for drug therapy to work for everyone.

Perhaps, too, the physiological explanation lets everyone off the hook a little too easily. Unhappy families can ascribe their situation to a dud sequence in the communal gene pool. Individual depressives can ‘blame’ their unfortunate inheritance. And those who are victimised by impossible circumstances can be given a pill to deal with their pain.

Speaking for myself, when I am in the grip of depression I feel even more hopeless (and helpless) if I ascribe my condition to a brace of black genes shared with too many relatives who have succumbed to depression, manic depression, alcoholism and suicide, than if I tell myself that such facts are neither conclusive nor decisive. I can accept that there is an inherited predisposition there, an elevated risk, but my own experience tells me that it can be countered—provided I can find ways of believing that I have the power to do so. Indeed, mental illness, provided we can construct and cling to a frail raft of insight on the turbulent waters of our minds, differs from physical illness in that we can ‘talk’ more directly to our problem than is possible for those, say, who suffer from cancer.

For those who are forced to understand their inner weather, to invent their own form of climate science as a way of surviving, the journey can be the most worthwhile, and the most taxing, they will ever make. It was Carl Jung who said that every personality was the result of a constant interaction between what we know about ourselves and what we don’t. ‘The ego is only a bit of consciousness that floats upon the ocean of dark things.’ We are therefore constantly changing, as a result of the way we intercalate our subjective and objective worlds.

Over a lifetime, we must all come to terms with our inner weather, because very few people are of so even a temperament that they notice no variation at all in their mood, energy and capacity. What we believe about ourselves has a large bearing on what and how we suffer, and our chances of breaking out of it.
Sometimes the explanations we choose give us hope; sometimes they intensify our despair.
Depression is at one end of this spectrum, not entirely self-chosen, because there is clearly a biological component to it, but not ineluctable, either. As Aaron Beck, the psychologist most associated with cognitive theories of depression, put it, ‘An individual’s affect and behaviour are largely determined by the way in which he structures the world.’ In other words, we may not be what we think we are, but we are, most certainly, what we think.     

Jenny Stewart is a Canberra writer and academic.

 

 

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