Living With Depression

I'm trying my best to be "cheerful." And, though it takes some energy, I have been succeeding. Sort of....

This is the thing: I am doing "fine" on a certain level. It has been a busy and fun weekend. It's good to be involved with different activities and see people. Really, I enjoy it. I don't need to put on some great act of deception.

Still, this is coping. This is "getting along." Sometimes we do this to hide from ourselves the fact that we need help. That's not good. Often, however, we find ways to "get along" because this is the best we can do in a situation.

This is coping. It does not mean that Depression has gone away. It means we are living with it. 

How strange it is to be a human being. We can stay on the surface of our own psychological awareness. We can even choose to do this, and sometimes we have to in order to survive... in order to live.

Living with Depression.

When you see us, we may be "fine," but we are "walking on the surface" and the surface is an eggshell already full of cracks and always in danger of breaking under our feet. We have developed our survival skills, however, so that we have our eyes on the nearest secure spots and we have learned how to jump to them before the next crack sucks us down.

You don't see any of this.

Often we're not conscious of it ourselves, especially if we've gotten good at it from years of practice. We notice it only in the "in-between times" when the fatigue comes and we try to rest (or sleep) but we feel like ghosts in a world of ghosts. Everything we've been doing with so much exhausting effort shrinks and dissolves. All the words are just noise that fades.

We look at the present moment and our loved ones and the tasks of the day, and everything is evanescent, beyond our reach, lacking solidity. Or perhaps we are the ones who are fading? In my book I described it as "like watching a video of the place where I used to be alive."

Standing sharp, cutting us, however, are all the memories of the things we've screwed up. We fear that this is what defines us. But this is not the same thing as a temptation in the moral sphere. It is more like the overwhelming nature of physical pain. It doesn't present itself as an option of free choice, but as a suffering to be endured.

It is possible, in Depression, to know--objectively--that the distortion of perception and emotion do not represent reality. They are a suffering caused by a complex disease, exacerbated by factors that are beyond our control. It is a great benefit to know this. But it doesn't make Depression go away.

Depression is not a sin. It is not our fault. Let us be clear: Depression, in itself, does not belong to the category of ethics; or perhaps I should say it is essentially no more of an ethical problem than heart disease or kidney disease or Parkinson's.

It is a problem of suffering.

Suffering, of course, presents moral challenges. It is inevitably accompanied by various temptations to discouragement, self-pity, resentment, denial, envy, and despair.

Depression appears to provide a conducive environment to moral temptations to choose discouragement, to choose to give up. The tempter, as we know, takes advantage of available opportunities, as do the inclinations of our broken humanity. Our freedom, however diminished our responsibility may be, does not always do well in the midst of these storms. But freedom, especially through the mysterious working of grace, can choose well, or rise up through sorrow and try again. We can choose to live for truth, goodness, and beauty in reality, to trust in God, to move foward in our journey, even when we are suffering from Depression.

But we cannot cure Depression or make it go away through an act of free choice. Let me repeat that: We cannot cure Depression or make it go away through an act of free choice.

It is not a freely chosen condition, nor is it the consequence of evil choices. It is an affliction. It is an impairment that we have not chosen. That means that we can choose well, even in the darkness, even seemingly against the pain.

It is possible to endure this affliction of darkness and remember that we have value, that we matter. It is possible to grow with understanding and solidarity, to cope through medication and therapy, and even to find healing (or some measure of healing) and to thrive through a mysterious patience and an enlarged compassion.

There is hope. Never give up.

Brain Disorders and Brain Health

In my book Never Give Up I talk about a range of illnesses which are beginning to be classified as neurobiological disorders--these are "mental illnesses" that are rooted (in at least some respect) in chemical imbalances in the brain or the failure of the brain to carry out properly its delicate and complex operations.

We know that neurological disorders can cause people to have chronic "tics" or muscle spasms. Well, it appears that on a more subtle and "invisible" level the same kind of disturbances in brain functioning can cause "mental spasms"--quirks, repetitions, or distortions in the imaging, impressive, and expressive activity of the brain that accompanies our thinking.

Thinking is fundamentally spiritual, but in the human being who is a mysterious union of soul and body it is something that is done in conjunction with (and is therefore affected by) physiological processes. We all know that drinking alcoholic beverages affects the brain and thereby inclines us to perceive things differently and even to "think" differently. Surely it is possible that all kinds of circumstances that we do not yet understand may affect (and afflict) the brain in more subtle ways. These circumstances may even be rooted in genetic factors, which seems to be the case in more obvious, visible disorders.

Certainly all this has become something of a fad in some sectors of the psychiatric field. These kind of problems are overdiagnosed. They are also overmedicated, or many of the medicines made for them are clumsy and ineffective. Having said that, it must be admitted that the great achievement of modern clinical psychiatric medicine has been the discovery of the neurological aspect of many mental illnesses.

Moreover, advanced brain imaging technology is confirming the clinical evidence. We are just beginning to learn the need for careful and attentive medical care for the most important and mysterious organ in our body, the brain.

We have learned that the brain can't be ignored. Psychological therapy has many values, but it won't help a person's liver or kidneys to heal. The brain is also an organic reality. It too requires physiological attention and assistance when necessary.

"Talk treatment" cannot cure a person with Tourette's Syndrome. Now we also know that it won't cure the underlying condition of a person with Obsessive Compulsive Disorder. The same thing can be said for many (though not all) types of depression, anxiety disorders, and that increasingly expanding category of complex conditions called "bi-polar" disorder.

Psychotherapy has its place in facilitating healing in the realm of human experience. It is not irrelevant by any means to neurobiological disorders. It can help build habits of "brain hygiene," help construct and maintain a healthy environment for brain functioning, and address the life damage that comes as a consequence of these complex brain disorders. Certain types of therapy may even help stimulate healing processes within the brain itself. But what we know for certain is that in these situations the brain, as a physiological entity, also needs medical help.

At the same time, we are learning that the brain can't simply be nuked with medications that are designed to counteract artificially its chemical or functional imbalances. "Brain medicine" is a delicate art of integrative health care, and here it is especially clear that it is impossible to be effective without treating the patient as a whole, i.e. as a human person.

It is also worth mentioning here the advances being made in the treatment of brain injuries, e.g. "concussions." If anything good has come out of the recent wars (though, tragically, not good for those who have had to endure them), it is the advancement in the understanding of brain injuries, how they can occur, what permanent damage they may cause, and how they may be related to conditions such as Post Traumatic Stress Disorder. Having suffered and recovered from a major concussion in a car accident in 2005, my personal hunch is that "minor" brain injuries--perhaps even on the internal level--probably happen much more frequently than any of us realize.

The brain is, truly, a remarkable, resilient and durable instrument, for all its complexity and delicacy. I believe there are vast possibilities for healing the brain and supporting the overall health of the brain. We are only beginning to discover them.

Mercy Beyond Our Sight

Georges Rouault, Crown of Thorns

Mental illness is so complicated and so difficult for people to perceive even within themselves, because it afflicts the organic components that are involved with the great human capacities of knowledge, judgment, and freedom. These afflictions touch upon the way we regard ourselves and present ourselves to others.

For this reason, they can be especially destructive. I know this only too well. I know how much my own life has been drawn back from the edge, how often my survival has been a "close call."

I also know -- and still weep for -- people I have loved who didn't survive, whose lives were shattered beyond our sight and beyond this world. Their loss leaves a wound in me, and in others, that will last as long as our journey through this present age.

These wounds will remain open, but their affliction is ultimately made of love, and of a raw hope that the mercy of God really is beyond anything we can imagine or conceive.

This Strange Loneliness: How am I Called to Respond?

The world can look dim and dark and fading. Why?

We live in a world of unimaginable suffering of body, mind, and soul. So much suffering and desperation.

We are all united, all called to a common destiny, all objects of His ineffable but utterly faithful love and mercy. God is faithful, even though so many know only a darkness. So many are broken and shattered and alone, lost, confused, unaware of their own dignity as persons created by God and for God.

So many are weakened and wounded by sicknesses of all kinds.

Affliction spreads by the crushing weight of material poverty. It also spreads by the relentless, unforgiving, monstrous lust for power that drives our "rich" society, that pressures people to "succeed" by manipulating instruments of power and casts aside those who can't hang on.

Cast aside.

If you live in this culture and have a genetic predisposition for depression or some other mental illness, it's probably going to be triggered.

Because ours is a society of trauma and interior wounds that fester and weaken and cripple human beings.

I know these people are suffering. I hear their cries inside of my own suffering. I hear their desperation and their sense of being lost and worthless. Of being alone.

I know that I'm not alone. How blessed I am!

Sometimes I am wounded by loneliness nevertheless. It's part of the disease. It's pain. But that is not all, because I am still a person.

Do I not still have freedom in front of this pain? How am I called to respond? I know that in this strange loneliness I am linked, somehow, to the loneliness of all these other human beings, my brothers and sisters.

I hear their overwhelming cries. So much loneliness!

I can't bear that any person should be alone in this way.

But I'm afraid of my brothers and sisters in anguish. I am a weak human being. Weak because of affliction, yes, but also weak in freedom, weak in love. I'm a selfish man. Selfish! But this pain, our pain, keeps cutting my heart.

I don't know what to do. I offer, I pray, I believe and trust and hope for them and for myself.

They suffer in darkness.

I don't know how to reach them in this darkness, to help us all to find healing for our wounds.

More than thirty years of studying theology. It has given me many things. I don't regret it. It has enabled me to help people, and to teach and write about certain things. It has humbled me, because after all of it I know so little....

I do not know how I, myself, here and now, can reach out to the brokenhearted and accompany them in their search for healing. Their experiences will teach me more about myself, and I am afraid of what I might learn.

How are we all to discover that we are loved by God? Not in a sentimental way, not as a comforting phrase, not as just theology or a pastoral program... but really.

How are we to know that we are really loved by God? Now! In a way that is greater than our pains and that carries a promise....

Dear God, we need this. I need this. Jesus.

Break down the walls of fear.

Mental Illness: The Intimate Reality of Human Affliction

The Almost-Invisible Man?

I mentioned "depression" in a recent post. I'm glad that I did, because it's always good to talk about depression... especially when I'm depressed. It's not really so bad right now. I've been much, much worse before.

There may actually be some fairly new readers of this blog who don't know that I'm disabled. I'm not happy about this, and I prefer to say that I'm "retired" (even better, emeritus, as I have been designated though I'm only 52 years old). I try to be as "able" as possible. If anything, I push myself too hard to do certain things (while, of course, rationalizing my laziness about not doing other things -- because disabled people don't stop being human beings and therefore sinners).

But the basic point remains. A long-misdiagnosed and untreated infection is now in remission but has left permanent physical damage (which is there in spite of the fact that I may "look great" when you see me now). I talk about this in a bit more detail in my book, which has been around now for five years (that time went by fast). The book is still selling because the great subjects of struggling with human illness and human suffering never go out of date. (The most noticeable difference is in my personal stories, above all the fact that the kids are older now. If you read this blog, of course, you know that.)

The greatest challenge, however, has been my lifelong struggle with mental illness. It was more difficult to write about this in my book, but in the end I decided that I really had to bring this out in the open. I knew too much about how hard this is to deal with, how much it remains an ongoing battle, and how poorly understood it is.

Depression. What kind of a name is that for a serious disease? Sometimes I wish it had been discovered by two German scientists with unpronounceable names. Then it might have been called something like Kruezenheimer-Schlotmichenmachers Disease. People would say, "Oh wow. That sounds serious." Instead "depression" sounds like you need air in your tires. People say, "Oh, get outside. Cheer up! Smile." Which is fine, but it's not even the beginning of treatment for the very real disease of "depression."

Ok... best gameface today! ? Maybe...

In fact, you can be outside climbing mountains, and acting cheerfully, and smiling all the time, and still be suffering from major depression. Yes you can.

I have a saying: Mental illness happens to "normal" people. There are people who look "fine on the outside" who have problems you can't begin to imagine. We try to classify this constellation of afflictions: I have Depression and Obsessive-Compulsive Disorder. Because of the episodic and varying nature of symptoms, I'm on what could be called the "bi-polar spectrum."

I know that there is a lot of baloney that passes for psychology and psychiatric medicine. There is also a lot of truth. I have tried in the past (see my book) and I continue to try to articulate and communicate in a comprehensible way something of my own experience of suffering from the real things. But I don't think I can ever really communicate how horrible it is, how relentlessly awful.

I'm very hopeful, however, that the worst of all that horror is behind me. That's why I try to articulate it: I need to speak for the sake of the multitudes of people -- people you know and love -- who are in the middle of it right now. They can't speak, and though I can't really speak for them, I do want to invite others to share in the compassion that I have for them, that I have learned from my own pain.

This is something I am able to do.

Click HERE for my book

It has been a long ride for me. I have been blessed with good doctors and therapists. I know how difficult it can be to find the right medication (or combination of medications) that help stabilize the most essential features of functional living, without intolerable "side-effects." It's hard, but it's important because we must attend to the distinctively physical, neurobiological aspect of these illnesses.

Different treatments and regimens work for different people. Maximizing brain health is a necessary part of treating mental illness, but it is not sufficient. There is no "magic pill" that takes it all away, although we ought not to underestimate the remarkable improvement that medication can provide for many people, that can aid the coping and healing process.

Really, mental illness is teaching us something about the intimate reality of the affliction of the human person. Because it is "close" to the distinctively personal sphere of human life, mental illness is making us more aware of the need to treat the whole person.

The subject of any kind of sickness, pain, or suffering in human life is always a person. Through my own life I am learning how important it is to remember this, both for myself and for others.

Depression: Why I Haven't Blogged About It

Shifting clouds, with some open spaces.

Last week, a celebrity tragedy provoked lively and sometimes intense discussion about depression and mental illness. Television and the standard media outlets gave out a steady stream of commentary, analysis, and speculation. Internet, social media, and the blogosphere also presented a very wide spectrum of opinions.

Some of the things expressed were simply cruel, and/or appallingly ignorant. Others were well-intended but poorly expressed, or clearly emerged from people theorizing abstractly in realms beyond their competence. Others still were conflicted and even disturbing because they came (at least in part) from people's own experiences and sufferings, and their awkward attempts to make sense of personal traumas. Then there were those who wrote good and sympathetic things, and those who honestly opened up about their own vulnerabilities. Finally, as always, there were a few offerings that were remarkable and truly able to educate, clarify or render vivid through personal testimony the objective reality of depression and mental illness.

I watched/read/listened-to a lot of this discussion. With the exception of a couple of brief comments, however, I did not contribute to it.

I found myself at something of a loss for words.

I've been struggling with my own most recent bout of depression in the past several months. I'm working with my doctor. We've tweaked the medications, and I've made some adjustments to my regimen. It's... okay... kind of.

People see me and say, "Oh, you look good!"

Dear friends, it takes an immense amount of energy for me to "look good" during the brief period of time you see me.

Try to imagine this for a moment. I am not here describing a real circumstance that I currently face, but trying to use an analogy to help people understand what it's like to have an "invisible illness." Imagine: what if I had a painful back injury, but I appeared after church on Sunday looking straight in posture, with no apparent pain? I am cordial, even animated in conversation. As far as you can tell, my flexibility is pretty good. I look "fine," basically. Right?

What you don't see, however, is that I'm wearing a back brace under my shirt; something well-concealed but essential for me to spend a few hours in an upright position. I've taken pain medicine. I'm going to be exhausted by the time I get home, take off the brace, and collapse into bed. But you won't see any of that. Do you still think I'm doing "fine"?

That's the analogy. When you've seen me lately, I've been wearing a "mental brace." I'm not doing this to "pretend" I'm okay, but because I really want to be myself for a little while, to communicate, to be with my friends and neighbors. This depression is not so severe as to obscure entirely my interest in life, or my interest in people. Please don't avoid me because you think it will make my life easier. Quite the contrary. I need to "wear the brace" and get out as much as I can manage, not because it's therapeutic or because it's making me get better (because it's not, really... we go over the hills and valleys of chronic illness by using a whole bag of tricks, and sometimes just riding it out). I "get out" from under the cloud (whenever possible, for however long) because I'm a human being. It's worth the effort.

I need the same "mental brace" when I write, which may account for why I am not writing very much lately. It's worth the effort to do whatever I can.

There is a fundamental difference, of course, between the effort to live within my constraints by doing what I can, and the illusion that I can "cure myself" if I just try hard enough. It doesn't work that way. To change the analogy, if I have a broken leg, I have to put it in a cast and let it heal. Meanwhile, if I want to get around, I have to use crutches. The crutches don't heal my leg, but they let me function, somewhat, while nature and the arts of medicine take their course. People with mental illnesses (and also people with chronic illnesses of all kinds) use crutches and props and bandages and whatever they can rig up so that they can live and interact with other people and do valuable work... as much as possible.

The crutch has something of a bad rap in our culture. We are encouraged not to "rely on crutches" but to stand on our own two feet. That makes good sense... unless your feet are broken. Then it's stupid. You can't "stand on your feet." You need help. There is no shame in using crutches when you need them to get around. When the brain and the mind are broken, a person needs a lot of creativity and energy to find ways to keep standing up. Crutches and braces need to be reinvented and adapted to changing circumstances.

If you're around me often enough, you're going to see me pooped. You're going to see the whole mess. Please don't think it's your fault. Or that I wish you would go away. No. Stay. Work with me.

Meanwhile, I don't have it in me to write a coherent blog about all this, nor to address the issues surrounding last week's tragedy. I've finally managed to put on my "mental brace," take up my well-worn crutches and limp over to the blogosphere in order to share pieces of my own experience.