Living With Depression

Small Comforts for Depression

Martha Manning — Wed, 11 Mar 2009 15:19:12 +0000

This month I took yet another nosedive into the jagged canyons of depression and agitation. I am able to describe the descent quite well.

But I never, ever see it coming. There is usually a 24 hour period - when I have a vague sense of unease. The winds shift ominously and the clouds steal the light. And. then, BAM,

I am knocked down again. In the midst of it, I am deprived of the most basic comforts and pleasures.

I can't converse. I can't read. I can't even watch TV. The agitation and depression vie for supremacy, and I am never able to referee.

One night, in an empty house, I wrestled with my fears about getting through another night. I reached for the remote to travel the endless circuit of possibilities. The vast majority of programs featured people humiliating themselves or each other. In the midst of it all was an island of civility--the Westminster Dog Show. Hours and hours of dogs who basically have to look great and walk a straight line. Aside from having to submit to judges' prodding every orifice, it's not bad. There's no talent requirement-not even sitting or begging or fetching. The smooth announcers volley details about breeds, previous awards, and owner information, which is reduced into a hypnotic hum.

My attraction to the dog show is somewhat remarkable, since I hate dogs. In fact, the only animals I like are the ones on my plate. But I loved the order of it all. It comforted me. I didn't care which dog won. I didn't care if any dog won. In fact, I was more interested in the losers. But even the losers in this competition, had all the markings of show dogs. No, I was waiting for a category that didn't exist: THE MUTTS. I wanted to see the ugly dogs, the ones who became inexplicably unhinged. I needed to see the badly behaved whose ratty hair juts out all over the place, unencumbered by the lacquer of spray cans. They trudge, they balk, they break loose. They refuse to suck up to the judges. Their talents are limited to breathing, drooling and genital sniffing. They are who they are.

The Westminster Dog Show will forever be part of the armamentarium of comfort that I call The Lowest Common Denominator. Lowest Common Denominators are for the emergencies of runaway agony, when one nears the final destination of hell. They are tricks of the trade-ideas, people. They are rituals, blankets, tea, music. They take no energy. Like the Mutts, they don't compete to win. They are companions, not performers. My lowest common denominators include a tape of incredibly depressing songs. I know it should be the opposite--happy, peppy mood elevators. But as I lose my own voice, I find that downer music gives expression to the way I feel. My grandmother's rosary beads. While I am no longer the believe I was for so long, reciting the rosary brings me to an earlier, easier time in my life when there was an answer for everything.

There is no thinking. The order is set and the repetition competes with scary words like "I can't take it." or" I want to die." The beads roll in my fingers, so that I never totally lose count. There are phrases of hope and certainty that my husband says exactly the same way each time.

And now, there is the Westminster Dog show tape, which can comfort me in a long loop of one canine after another. My lowest common denominators do not cure me, they don't even make depression less intense. But they comfort me in excruciating pain. And I am grateful for that.

Where are the depression casseroles?

Martha Manning — Wed, 08 Oct 2008 16:41:01 +0000

The exchange of food has always been a statement of personal connection. Our rituals around food have told us who we are, how to behave, how to contribute, and how to preserve the unique aspects of our culture. The preparation of lavish dishes marks all the happy occasions--births, marriages, achievement and commemorations. Food is the lubricant of celebration.

Sorrow is a different story. The experience of loss. struggle, sickness and death seem antithetical to wolfing down a pan of lasagne. But the food keeps coming. Celebration is best savored in a crowd. Suffering, at its heart, is a more solitary stretch. As friends and loved ones we long to know exactly how to ease another's pain, how to fill their emptiness. And, like celebration, the answer is often the sustenance of food--for both the cook and the consumer. We hope that the food we share makes its way broken hearts and empty bellies. Regardless of
gender, religion, age or politics, we always come bearing food.

Recently a friend was diagnosed with breast cancer. The frequency of breast cancer has led to an impressive stash of information about knowledge and support. Unlike the unspeakable nature of cancer and its treatment 20 years ago, most women understand on some level, the treatment burdens that accompany of a diagnosis. In my friend's case, it was less than a week before another friend found a web site that even contained a form for organizing dinner contributions for a six week course of chemotherapy.

It was amazing how quickly the slots were filled in. I was struck by several things. First, the poultry market must be doing incredibly well, second, the variability of the quality in dinner contributions. I salivated over many a gourmet meal that could have been served in an upscale restaurant. Unfortunately when I compared themto my meals, the contrasts were pretty clear. Over the years I have kept my vow never to stoop so low as the Golden Arches. But I have to admit that the "Colonel" and I have had a secret connection for far to long.

The universal message of everyone's dishes is, "Hey, it's here if you want it." "This is what you need to do with it." "You don't have to interact with me in the slightest." "Let's agree from the start that I don't want you to make contacts about thanking me."

As we were posed to ring my friend's doorbell to deliver a post of soup, my husband turned to me and asked, "Where are the depression casseroles?" Back in the car, we silently tried to digest his dismay. It was a question of great relevance for which we had no answer. We were certainly experts in the area--with a resume of long stretches of horrific depressions, punctuated with arduous hospitalizations. Before the madness really brought me to my knees, the rhythm of our lives was already much too fast. My husband and I were in our mid-thirties. Our daughter was eight. This constellation meant that we were already swept up in our careers, and attending to our child whose schedule went far beyond my childhood in which the day was divided between school and playing in the street.

We have always felt well loved and well blessed. When I became unglued, our families wrapped their arms around us in different ways. But we three were struggling with a relentless illness that we didn't understand. Their confusion and paralysis mirrored out own.

So where were those casseroles? For our part, I think we worked too hard at to make things alright, when they absolutely weren't My husband, a clinical social worker and I, a psychologist, felt a sense of shame. If we were so good at helping people in our offices, how could be so inept at home?

Depression is usually not an illness that craves company. A knock on the door or the blasting insistence of the phone felt like threats to my shaky integrity. I could hardly swallow water, let along the eternity of the dinner table. We didn't ask for help.

Those reasons are only part of the story. Unlike thousands of years of people helping each other, there are few prototypes for reaching out to sufferers of mental illness. We have evolved in the area of knowing how to discuss and support each other in many difficult situations. Be we aren't near there when it comes to depression. Advocacy groups and individuals have made great inroads into mental illness stigma. But lessening those assaults on people is not the same as embracing us in times of challenge and need.

When I am significantly depressed, I can't eat, which is heartbreaking because on so many levels I am starving. Is there a casserole for that?

Building The Bridges of Suffering

Martha Manning — Tue, 19 Aug 2008 15:28:22 +0000

Depression, like many serious illnesses, robs its sufferers of access to a common language,one that fuels our ability to communicate. The bridge of words, incoming and outgoing, is cut off, increasing the weight of isolation. But sometimes, with the "gift" of depression, we are able to join those who also struggle to be heard.

Between the two of us, my father and I were responsible for spending an entire year in the hospital. My brain took one of its wrong turns, catapulting me into a wretched combination of anguished depression and uncontrollable agitation. Salvation lay in the application of electricity, pills, and a near fatal dose of group therapy. During these times it feels like the language of each day changes, and my minimal fluency is diminished further. Over time the agony receded, but it took far longer for the isolation to end. I left the hospital feeling like a pilgrim without a destination. Hollow and lost. Stupid and shabby.

Meanwhile, my father's 82 year old heart began to press for retirement. The solution involved substituting the valve of a pig for his weary one. Aside from the likelihood that my father would never look at a pork chop the same way, his doctors were optimistic about his recovery. At the end of a very long day, the surgeon told us that the operation was a "complete success." There were "no complications" - a statement that strikes me as simply silly when you're reconciling the plumbing of a man and a pig.

Good news always makes the depressive in me nervous. There's nowhere to go but down. His recovery-or lack of it- made a liar of his surgeon. A routine one-nighter in the ICU stretched from mid-September, through October and November. His doctors shared a maddening mantra in the daily submission of my father's condition: "He's not out of the woods." "What woods?" I wanted to scream after several days of this news."How far is he into the woods" "How is it exactly do we get him out of the woods?" In hundreds of years of the study of medicine was it too much to ask for something better than forestry metaphors?

Each day the news grew more alarming and the cardiac team decided to put him into a chemically induced coma. For weeks my father lay stone still, in a state of suspended animation. I found my family's exhortations it my father oddly familiar and disturbing, They were the voices of warriors, athletes and cheerleaders. The melody
was 100% love. I had heard it from them in my own hospitalization. It's what kept me going. But it was the lyrics that seemed foreign. "You have to hang in there." "You have to fight." "Give it all you've got." "Just keep going." "Try." "Push" "Win." At one time those would have my encouragements too. But standing with my father amidst the hissing and pumping, the rythymic beeps and clicks, the tangle of tubes flowing in and out of his poor broken body, I knew in my bones that I had something different to say. "Dad," I whispered,"You are far away right now, but you'll be back. We'll be waiting. Just let yourself rest. It will be alright."

Over several months my father emerged from his coma like an alien plopped down on the wrong planet. When we tried to fill him in on his medical trip from hell, he countered with many interesting accounts of his comatose adventures. Each was a singular experience that he described with clarity, drama and and absolute insistence of its reality. There were priests, con men and prostitutes. There were taxis and a steamer to Sao Paulo.
Following one of my father's unlikely exploits, my mother reached over, patted his hand and said quietly,
"Oh, John, you're just having a little hallucination."

When my father I were alone together he asked if I believed him, if I thought he was crazy. I silently questioned
whatever judgment led him to get a reality check from the offspring who has spent the most amount of time
on psychiatric units.

"It was real," he insisted. "I think I get it Dad. You were on a journey. One that was very personal. One that only you will understand." I wondered why he chose me to share his secrets. We don't usually talk on this kind of level. We were now connected by long periods of pain and uncertainy. Our lives had suddenly turned us upside down. The stranger my father's stories were, the more I was impressed with their wisdom. During the next week
his recountings spanned continents and modes of transportation. They were filled with adventure and adversity. His yearning for my mother was aching and constant. He was perpetually lost and confused, lonely
and homeless. When I asked him why he kept traveling against such difficulty, he shrugged and answered,
"What else was I supposed to do?" At that moment I got it. I'd been listening for his lyrics which I couldn't understand. It the melody that I'd missed.

Weeks later he called. He hadn't talked on the phone before and his voice was gravelly and hoarse. "Vito...
Don Corleone--, is that you?" He got the joke. "Listen, he said urgently, I've got another memory and it can't wait." You'll probably think I'm ready for the nuthouse," (uncomfortable pause) "Well you know what I mean. Right?" Following assurance that the nuthouse crack didn't leave a mark, he launched into his final tale,

He was lying in a hospital, surrounded by people in white coats who kept talking about what was wrong with
him. Finally, a pompous doctor pronouned, "I know what's wrong with him," he said. "He's dead."
They left him in the room covered in a white sheet. For the first time he had complete certainty,
"I'm not dead, he proclaimed. "I just need a second opinion!"

He jumped off the bed and walked to Yale Medical School where a resident assured him that he was very much alive. It was then that he noticed he'd been walking all over the place in his skimpy open backed
hospital gown with his "bare ass hanging out." But Martha, you know what came to me?
My ass may have been hanging out all the way to New Haven. But you know what? I'm not dead!"

My father still has a long way to go. He must tackle the hundreds of baby steps that will restore to him most of those things he never thought he could lose. My road back is also long, requiring similar patience. tenacity and courage. We will speak to each other in a new voice--one born of shared suffering in the past and uncertainly
in the future.

We are still not out of our woods. But I believe that together, we will make our way through the dense cover of trees and negotiate the ancient roots beneath our feet. We will finally stumble into a clearing. And as our eyes adjust to the sunlight, our hospital gowns will flap in the breeze, revealing two big bare butts. But we're out of the woods. And we're definitely not dead.

Stigma in Everyday Life

Martha Manning — Wed, 23 Jul 2008 21:15:55 +0000

Dealing with the stigma of depression is far easier in the abstract than face to face, often when we least expect it. I am a clinical psychologist and I suffer from a mood disorder. Occasionally someone will remark that these dual roles are a winning combination. But sometimes they are just the reverse.

It was a packed Sunday night at the pharmacy. My fellow procrastinators and I gathered to fill prescriptions that were perilously close to the refill deadline. I looked like I'd gotten dressed in the dark-in my husband's faded Redskin's sweatshirt, purple sweatpants and a pair of running shoes that were purchased at the inception of the NIKE brand. My hair had that "should have washed it the day before, but I just didn't feel like it" style, with sections that had clearly seceded from the overall design.

Pharmacy sections are always elevated, making me feel like a supplicant rather than a paying consumer of their products. When the pharmacist looks down from his platform, I feel like I'm petitioning the Great Oz. We procrastinators stand around rolling our eyes about the wait, grudgingly admit our culpabilty for the delay, and vigorously scan for disruptions in the rightful order of service. A voice from on high calls, "Manning." I take a few steps and admit that the name belongs to me. The pharmacist aide asks innocently, but a bit too loudly, "Do you want the Lithium in childproof or regular bottles?" Moments like these make me wish for a trap door beneath my feet in which the sheer power of mortification would trip the exit, allowing me to disappear.

People looked at me differently. Not staring exactly, but sizing me up in light of new information. Now my classification as a total slob looked less like a choice and more like a condition. People may not know exactly what Lithium is for, but most of them know that it is in the mental illness arena, and it's not good. Definitely not in the antibiotic, bunion remover or indigestion classes of medicine.

I am a clinical psychologist. I have written and spoken extensively on the stigma associated with mood disorders. I have enjoined many people to throw off the mantle of shame. I knew exactly what to say to someone else. I would tell them to march right up to the counter and demand to see the pharmacist. I would script the conversation to emphasize that the violation of my privacy was totally inappropriate. I would ask of this was standard operating procedure or a temporary lapse. And I would make them insist that it never, ever happen again.

But I couldn't do it. Because I was embarrassed. Because I was afraid that if I got angry or tearful, my behavior would be filtered through the lens of my illness, and knowledge of my diagnosis would weigh heavy in subsequent interactions. It wasn't just the Sunday night fiasco at the drug store. It happens in many places where people are well meaning, which, in some ways, makes it harder to deal with. It runs rampant on inpatient psychiatric units, where behavior that is "assertive" in other contexts may be labeled as "hostile" or "acting out."

It happened with a teeth cleaning appointment, when the dental assistant reviewed a form which required so much medical detail that I worried they'd require the date of my smallpox vaccination. She sat down next to me and said, "I'm having trouble reading some of your medicines." I should have fled the room right then, but instead I asked, which one?" I was instantly aware that the other people in the waiting room, bored to tears reading old copies of AAA magazines and Golf Digest, were interested in my story. "Now, this one," she said. SAR-OH-QUIL...what's that for?" "Sleep," I answered quickly. "Great," she said. "Now there are a few more..." With each item I responded, "Sleep...sleep...sleep." While my mind was saying, "None of your damn business," my soon to be clean mouth was spouting half-truths.

It is humbling to know how easily I can give advice, rather than take it. I do well in battling stigma in the abstract- with letters and signs and speeches. All on behalf of "other people." But it's time to do the harder work. I have to summon the courage to stand up for myself. In those difficult and not infrequent moments, I'm called to challenge the ignorance that continues to paralyze me. When it comes to facing up to stigma in my own life, I could really use a dose of my own medicine.