A Question of Depression

Since November of last year I have been taking a mild anti-depressant. Zoloft is its trade name, although mine is a fifteen dollar co-pay generic. 50 mgs. The smallest dosage. I was not "diagnosed" with depression. I did not visit a mental health practitioner. After finishing my Masters thesis I became increasingly lethargic. After writing a thesis full of poetry I found I could write none. I had earned the Masters, in part, in hope of teaching part time at the local community college. I thought this was a certainty. Every community college I knew was hungry for adjunct English teachers. I had put together an impressive resume. I had won awards and scholarships. I had been accepted to the prestigious Bread Loaf Writers' Conference. I delivered a paper at the Western Literature Association meeting. But the community college had no interest and after two years in the academic world I found myself back where I started. If the creation of a thesis can be thought of as gestation and birth, then perhaps I had a form of post-partum blues.

In November last year I attended a conference sponsored by my church's medical and pension department. This conference was designed for pastors in mid career and offered a complete "check up" of our physical, spiritual, vocational, and financial well being. The nurse on faculty suggested, upon hearing my story, that I see my doctor. She thought I might need "a little help" as I sorted through the various tugs and pulls of my vocational life.

So I went to my doctor to inquire whether he would recommend medication and he empathetically carried on for thirty minutes or more about these "tough times to be a man", including some personal revelations from his own life. I left the office with a prescription.

And I have felt better. I began work on some of my goals, such as this blog. I have written a fresh batch of poetry. I came off of the ledge somewhat to become a more patient and listening husband and father. So the medication worked. Right?

Not necessarily. At least not according to some things I have been reading. First came the New York Times' report on a study from the Journal of the American Medical Association that claimed anti-depressants are ineffective treatment for anything less than severe and chronic depression. Then came the March 1 issue of the New Yorker in which Louis Menand reviews recent publications on depression and its treatment. One author, Gary Greenberg, a practicing psychologist, believes that statistics concerning the number of depressed Americans are ridiculous. Not because people are not depressed, but because, in most cases, the depression is not a mental illness. It's "a sane response to a crazy world." Greenberg believes taht a pharmaceutical treatment for depression is a "conspiracy to paste a big smiley face over a world that we have good reason to feel sick about." Greenberg rejects the notion that depression is linked to an imbalance in brain chemistry (an idea my own doctor endorsed) and accuses the medical and pharmaceutical fields of taking advantage of the world's unhappiness to make money. As Menand writes, "They invented a disease so that they could sell the cure."

Writer Barbara Ehrenreich agrees. In her book, "Bright-sided", Ehrenreich argues that a conspiracy of "happiness" has been going on for some time in America, much to the misfortune of America. Ehrenreich analyses the "positive thinking" movement as it appears in business, religion, economics, and psychology. Ehrenreich's fear is that in demonizing any negative thought, and immediately trying to mask it with a feel good antidote, we lose the capacity to address what is fundamentally wrong and fundamentally unjust. Despair, she writes, is not the opposite of positive thinking. Ehrenreich argues for realism, a state in which we "get outside of ourselves and see things as they are, or as uncolored as possible by our own feelings and fantasies, to understand that the world is full of both danger and opportunity--the chance of great happiness as well as the certainty of death."

To further complicate the question, we have Kathleen Norris' book, "Acedia and Me". This memoir seeks to find a place for the ancient monastic term acedia amidst the various mood descriptions of the present culture. Acedia is a spiritual malaise, an indifference to the gifts and opportunities God has given. It can look and feel a great deal like depression. Norris admits the line between the two is hard to draw, but offers this possibility. "For despair, participation in the divine nature through grace is perceived as appealing, but impossible; for acedia, the prospect is possible, but unappealing." We should note that the book is also the story of how Norris' husband, David, suffered from severe depression and ultimately took his own life.

As do so many Americans, young and old, rich and poor, famous and unknown. Clearly the presence of suicide in our culture prevents us from too cavalierly dismissing depression as the invention of drug manufacturers. There is something to be said, however, for the role of grief and despair in our lives. It seems true that negative emotions are often the healthy and necessary response to life's situations. I recall an observation made by Scott Peck in his book "The Road Less Travelled". Life is difficult. And in quoting Carl Jung, "Neurosis is always a substitute for legitimate suffering."

So when do we know we have a problem to be fixed? Or are we experiencing the inevitable dark night of the soul that comes with being keenly and frightenly alive?

There has always been a link between the creative artist and the shadow lands. Be they writers, painters, sculptors, poets--there is an obvious toll to be paid for living so perilously close to truth. Perhaps this comes from the ability to live inside so many different skins so convincingly. Can one remain sane while at the same time bringing to life such a depth of expression of the human condition?

In 2008 Johns Hopkins Press published a collection of essays entitled "Poets on Prozec". Sixteen poets wrote of their experiences with mental health treatment and the creative process. Without exception the poets reported being more creative while under treatment and yet there always was this pull back to a place of instability.

So all of this has been grist for the mill as I ponder what my future will be. My current prescription expires in April. Will I renew? I do not know. How can one know, precisely, what makes them the unique human creature they are? Those who take anti-depressants almost unanimously agree they help. But is this, as some suspect, only because we BELIEVE they will help, thus becoming a self-fulfilling prophecy? I have wondered whether the medication has been effective or, perhaps, it was the act of seeking the medication that was helpful. For to seek the help was a life affirming act, an act of self-love which may well have been the key to shaking off the doldrums and getting on with my life.

And what of the causes of depression? Menand writes that "virtually no scientist subscribes to the theory that depression is caused by a lack of serotonin, but many people feel better when taking drugs that affect serotonin. (My medication is serotonin based). Greenberg believes that depression is existential, the result of the collision between one's sensibility and the world. The result of jousting with mortality.

I am existential in my approach to life. I am burdened by a truth that I cannot, and would not want, to medicate out of my life. This truth is that the world is too complicated to be understood completely. That human beings understand this complicated world in ways which are, often, incompatible, which leads to conflict, war, and destruction. Love of neighbor, although ideal, is hard to achieve. Death claims us all whether we wish to dwell upon this or not. There are questions that have no answers, only arguments and assertions. Truth lives in science and in art. There is a place for faith and a place for reason. There is a place for God and a time to ponder the absence of God. There is choice. There is responsibility. There is happiness and there is sadness. There is a time for all things under heaven.

I think of Job. Would one of his friends have suggested an anti-depressant?

In "Poets on Prozac", poet Denise Duhamel writes of her struggles with anxiety and depression. She had a therapist, Rodney, who helped her a lot. From her description, I would have liked to have seen Rodney too. But it is the end of her essay I want to leave you with. Years after she stopped seeing Rodney, Denise learned that he was dying of cancer. She went to visit him and found him slim and emaciated lying on his couch. Rodney said he was mad at God, for now that he was dying he had met someone to love who loved him back. The phone rang. Rodney picked it up, listened for a moment, then set it back down. "Wrong number," Denise asked.

"A telemarketer. I'm dying--hey we're all dying--why waste even one syllable talking bullshit."