Accountability and the Grim Facts of Depression

Posted on April 22, 2015 in Anxiety Attitudes Compassion Depression Guilt

The black spiral literally knocked me off my feet. I decided on my own to stop taking Geodon — a horrible drug that left me dizzy for all but the last three to four hours of my waking day — and I crashed and crashed hard. My bedroom was my habitation; my cats my constant companions. I felt the after effects for months — a dimness of the world, a heaviness on the brain, and difficulty forming thoughts. Shortly after I emerged from more than a week of never moving from the bed, I wrote:

I count nine days of nothing but turning on my bed, sleeping on the best of them, just clutching blankets on the worst. I run back and forth writing, thinking, and hiding under the covers for this one. That’s my activity and I need to make more. I’d be at the gym working out except I took two Ativan and do not wish to risk the drive. And it is too hot and unshaded for the walk around the condos that I have made my regimen.

Coming “back” implies seemingly ridiculous victories. Today you brush your teeth. You take one less Ativan. You go for that walk twice at dawn like you should. You write in your journal. You blog. All in between visits to the bed, your teacher and your protector.

Just yesterday, I heeded studies which suggest that spirituality helps those suffering from depression and mixed and remixed the books next to my bed until I found a pocket Buddhist companion. This (translated into the objects of depression) made sense to me:

I am not my depression. My depression is not me. The world is not my depression.

This doesn’t say that I lie under the covers for not discernible cause and it doesn’t say to stop taking the meds as appropriate. It simply separates my disease in the same manner as one might separate the eye or the ear. My eye is not me. I am not my eye. My eye is not the world.

We get into an ownership thing in Western thinking — if not throughout the whole world. We own our body parts and our diseases rather than seeing them as causes. They are neither separate of us nor part of us. They are facts.

This gives me personal relief from this nine day good-riddance if rid of it that I am. And I’d rather not talk more about this. It makes sense to me.

Elsewhere I have written about how one needs to be accountable for what one does in episode. Most of my commandments addressed the issue of mania. Depression posts different challenges, though one must never use the symptoms such as anger as an excuse for the harms we wreaked against other people. We may, however, go beyond mere explanation when we talk about things such as our inability to get out of bed, the blurring of our minds, and our inability to motivate ourselves to do the simplest tasks. Six months after my fall from the grace of stability, my therapist at the time reminded me of a simple fact: my brain had been bruised.

The interior of my head had been squeezed so badly that there is no other way to describe myself than as a victim of my illness. It was an obstacle to my happiness that I could only partially surmount while it lasted. I had little choice but to let it run its course. The things that people recommend to “get over it” just couldn’t be done. Getting out of bed was nigh impossible. My whole body rebelled against exercise: That I was able to walk around the block was a miracle to be sure. I did without self hygiene and ate only begrudgingly. What I could do was muscle the energy to climb the stairs and put on some music. Bach’s Brandenburg Concertos entered my ear and massaged my brain. When in a few days I found myself “conducting”, I laughed and marked the beginning of my recovery from this most drear of episodes.

Sometimes we have to own things that we can’t do much about. Depression is an especially evil entity that I call The Beast. I may not be able to control The Beast, but I can tame it a little and guide it along. The one thing I have learned to do is not to make things worse with my thoughts. The lessons I learned from Cognitive Behavioral Therapy were within my reach as my whole body collapsed on the bed. I reframed my thoughts. Then it was a matter of riding things out. I eventually got better but it took time and the gradual adding of self-care habits as I could manage them.

Even in mania I apply these tricks. I may not be able to do much about the racing thoughts, the pressured speech, the lust, the paranoia, the grandiosity, and the religiosity, but the impulsiveness is something that I can work around. I spent our family into $40,000 of credit card debt; it is not by far the worst story I have heard along these lines. My wife and I have worked out a plan: I hand over my credit cards and work on a cash-only basis. If necessary, I will let her change my Amazon and Paypal passwords. This continues until I am able to make wise decisions. This one small thing prevents much grief.

I knew someone who told his wife that there was nothing she could do to keep him from getting at the family money if he was in episode. The upshot of this was that he frightened his wife and he abdicated any responsibility for how he acted while in mania. His insensitivity was a poor example to set in a support group, but he was lauded for his perspicacity. I think he harmed more people than he helped.

Depression often blindsides us. We can waste a lot of time trying to figure out what caused it. I had a solid reason for my episode in 2006: I went off a med without letting my doctor guide me through titrating down properly. Others own the cause of their blues-from-hell because of their drug and alcohol issue. How often I have sat in support groups, listening to someone hold a pity party about his depression and then reveal that he has self-medicating with alcohol. The worst was a fellow who took 4 mg of Xanax each day and washed it down with “just a little wine”. He claimed that his doctor said it was all right. This man didn’t hold himself accountable for his depression; as long as he wallowed in his denial, no amount of medication or therapy would make him better.

It’s tedious to separate out what we did to bring on the melancholy from what was done to us; and it may not be worth the effort. People fall into depressions for many reasons: they lose their jobs, they break up with their spouse, they are in an accident, they suffer chronic pain. There’s no blaming the woman who was raped for her depression or the soldier back from Iraq. The survivor of incest or physical or emotional abuse or bullying didn’t cause the melancholy that afflicts them. As one of the latter, I own my pain, but I do not blame myself for it or for the times when it sneaks up for no apparent reason.

Yes, I didn’t get out of bed for weeks on end at one time. The illness battered me to the point where I could do little else. But I did what I could to take the edge off and gently ease myself towards the middle ground. My depression wasn’t a failure of my will; but it took will to take my meds as my psychiatrist told me to take them and head off thoughts that threatened to press me even lower in the mud.

The New York Times recently printed a piece by Diane Spechler which took those to task who said that we brought on our own depressions. She, like many of us, has grown tired of the Ronald McDonald’s of this world who insist that if we just consume their happy meal we will snap out of our bleakness.

There are those who will shame us for being stuck in our pain and those who will empower us to claw our way out…. It was late at night, in a cabin in the mountains, and I felt that no one had ever been as far away from anyone as we were from civilization. We had an exchange that I still call on for comfort. Perhaps only its tone sets it apart from Star’s article, but as I remind my writing students, that makes all the difference — tone, the narrator’s attitude toward his subject.

“I can’t handle this,” I told my friend.

“Sure you can,” he said. “What do you do with life every day?”

“I don’t know,” I said.

He opened the front door to let in fresh mountain air. “You handle it,” he said.

That is your charge; not to jump to a happy conclusion — for the real depressive that is impossible — but to muster what you can to get through it no matter how small its contribution seems. Own the Beast. Tame it a little at a time. Don’t use it as an excuse and don’t crucify yourself, either.