When shall I arise and the night be gone?
– The Book of Job
Job has got to be, in the words of singer-songwriter Sting, the ultimate “king of pain.” I have a little copy of The Book of Job, with sections underlined in different shades of ink, depending on the profound suffering he describes. Charles Frazier, author of Cold Mountain, declares that it contains one of the “greatest and most terse expressions of despair and soul weariness we have.”
Job may have been the first to so clearly articulate the fundamental lament of human suffering: “WHY?” Why have God and Satan colluded in a bet to find a “perfect and upright” man who will keep the faith despite every lousy thing they do to him, including slaughtering all his animals, then his 10 children, then covering him with boils, and throwing him into a heap of ashes. The one thing they leave him with, for a while, is a less than supportive wife, who advises him, “Curse God and die.”
Overwhelmed by his ruin, he cries, “I am afraid of all my sorrows.” Those sorrows take form in powerful words that are both extraordinarily raw and current, a scriptural gift for generations whose suffering is abandoned by the very language that could help at least to define it.
When Job comes to “complain in the bitterness” of his soul, he graphically describes the pain itself, the confusion about why it’s happening, and the isolation it’s caused him. But most of all, he shares his absolute horror at himself. Anyone who’s suffered a severe depression can summon a resonance to the futility in trying to solve the Prisoner’s Dilemma in which he finds himself. Everything he once knew is wrong. The man who felt satisfied with his life never knew it could be so impermanent, so cruel, so impossible to bear: “When I say, My bed shall comfort me, . . . then thou scarest me with dreams and terrifiest me through visions: so that my soul chooseth strangling, and death rather than my life.”
Because I know that severe depression frequently recurs, I keep Job close. In the indignity that comes with suffering, the loss of myself and my words, Job is my guide. In paralyzing sorrow, he’ll always be my guy. I just have to keep finding pens in different colors.
Leah and Martha
With the wonder
and bitterness of someone pardoned
for a crime she did not commit
I come back to marriage and friends
To pink fringed hollyhocks; come back
To my desk, books and chair
– Jane Kenyon,
“Having It Out with Melancholy”
Several years ago, my sister Leah and I were kicked in the teeth by life-threatening illnesses. The difference in our reactions was that Leah desperately wanted to live, and I desperately wanted to die.
In the space of a brief doctor’s call, her world shattered. The news of a band of devious cells in her breast changed her life forever. She was devastated, terrified for herself, for her family, for her future. We siblings were stunned, consumed by fear, and humbled that such an awful thing was in the process of doing battle with our sister.
Leah has always been the kind of woman who can have a spicy salsa pulverizing in the food processor, help an unwilling kid with his math homework, let the dog in, and resolve a work crisis over the phone—simultaneously. She is, as my daughter calls women of a certain level of accomplishment (think Serena Williams), a “beast.” She’s also one of the kindest and most principled people I know.
Breast cancer knocked the wind out of her. She agonized over the suffering she knew to expect and what wasn’t yet in her field of vision: the tests, the surgeries, the chemo, the betrayals of her body. And oh God, her young children.
But Leah was Leah. The one thing she knew was action—and she took it. The irony about the suffering that assaults us is that it denies us any time to respond. Just at the time we should be lamenting and rending our garments, we have to get down to business. If Leah couldn’t cure her cancer, she was at least going to organize the hell out of it. Relying on the help of family and friends, she chose doctors, scheduled procedures, tried to foresee the unforeseeable.
She even had a hair-loss contingency. With the first strands on the shower floor, she planned to call my hairstylist brother to come over “immediately” and shave her head. Annoyed when he was 10 minutes late, she called me with one of those sibling complaints that always begins with “Can you believe x did y?” But she interrupted herself to answer the door, and I heard my sister laugh and cry, almost in concert, at the vision of my brother’s newly shaved head. In the midst of the trials she was coping with, she was still able to be surprised, delighted, vulnerable, and grateful.
She was horribly sick and flattened by fatigue and pain. But she determined that she’d do every single thing to negate a recurrence of that nightmare; even if it promised only a one-percent better survival rate, she did it. And it cost her. But Leah emerged as Leah. She used her strengths and even her vulnerabilities to her advantage, and had no trouble communicating her fears and doubts. She asked for help and got it. She emerged exhausted, a little less innocent about the rightness of her world, and with a sense of herself as vulnerable, yes, but sturdier and prouder. She lost a lot when she tangled with breast cancer, but she never lost herself, and that made all the difference.
I didn’t need a biopsy to know what was wrong with me. I had a relapse of severe depression, a cancer in its own way, in that it sweeps right through and tears you up. It threatens your health, your mind, your soul. It makes you a stranger to the people you always called close. It makes you look kindly on death as a merciful exit from a pain that’s elusive in description, but vicious in effect. Not only do you forget who you were, you’re horrified at the person you’ve become. And there are no promises that this time you’ll get out intact or alive. I often compared myself to my sister, admiring her strength in contrast with my weakened will and energy. People couldn’t comprehend my suffering, and I was totally inept at explaining it.
I felt like I was bypassing sick and heading directly to dying. Unlike Leah, I was horrified that I was crumbling in ways I didn’t understand and could do nothing about. For me, there were no schedules, or tasks, or people to pitch in, no time limits or estimates of cure. And worst of all, there was no me. My self had eroded before it had ever even registered.
Of course, I’d never weigh my sister’s torment against my own. I’ve seen them both up too close. But there was one significant difference. Leah, as a result of who she was and what was needed, was the quarterback in her struggle, whereas I was just some poor slob in the last row of the stadium. By the time I understood what was happening, the game was almost over, and it threatened to be a blowout.
Leah and I are alive. Our memories of where we’ve been are powerful and scary. We consider the future with more caution than we did before.
Yes, she had doctors and treatments and love and support, but in the end, I believe that it was Leah who saved her own life. I had those things, too, but I didn’t learn how to fight until the game was almost over. I never saved my own life from depression. It wouldn’t let me. So, like Job, I just bitched my way through it, and ultimately played out the clock. And even now, with my degrees and my experience and my writing, I still haven’t entirely forgiven myself for it.
The Body’s Betrayal
It will be as if everything
you know were turned
around in your body
– Wendell Berry,
“Song in a Year of Catastrophe”
Depression hits you where you live, annihilating even the basic functions, and graduating to the most complex. Sleeping and eating are early casualties. You feel like you’re inhabiting another person’s skin. Your energy is scarce and compromised. Anxiety—depression’s best friend—may spill over into an almost unbearable agitation. Your eyes are dull, your muscles go slack, and your face holds a gray pallor. Not only must you battle depression, you must cope with the reinforcements called in to fix it. Just like chemotherapy, ECT and other treatments, which can help, can also hurt in their quest to heal.
At its worst, depression extinguishes the pilot light, depriving you of the substrate that makes you feel real. That light is the essence of being awake and alive. More than one writer has asserted that the opposite of depression isn’t happiness: it’s vitality. Vitality is what lets us want to move and be, to reach, to initiate, to react. It greases the wheels of motion, allowing us to be energized and able to protect ourselves if necessary.
Depression can make reconciling the extremes in our behavior difficult. We’re exhausted, but can’t stop moving. We’re calorie deficient, but unable to bear food. We’re fatigued, but can’t sleep. Our minds race and then shut down. These dichotomies confound both sufferer and healer.
As we feel the loss of vitality, a growing dread suggests that without it, we’re nowhere. A friend I made in the hospital suffered cruelly from the double whammy of AIDS and depression. His recognition of that fact was obvious as we lined up for “vital signs,” or as I called them, “signs of life.” When the student nurse lifted his arm to take his pulse, he waved her away, saying, “Oh, don’t bother, honey. I don’t have one.”
Sleep is mentioned often as the area in which sufferers began to sense trouble. Depression betrays the popular belief in sleep as an escape or respite. I envied the guy next door to me in the hospital who slept 23 hours a day. Whether it comes fitfully, or not all, most sufferers find themselves in a constant state of hangover, with the increasing fear of the night when it’s daytime and the morning when it’s night.
Life on an inpatient unit is remarkable just for the fact that so many depressed people are together. In the night when sleep eluded us, we silently did laps around the hall, eerily muted by blue floor light. In our robes and hospital socks, we were ghosts, haunting the place for the prize of well-being.
Waking up meant confronting again and again the fact that you are just where you were when you closed your eyes: in hell. It’s that slow-dawning realization that brings another kind of morning sickness, which for me always began with the lament, “Oh God, I’m still here.” Sometimes I stayed awake all night just to avoid the torture of waking up.
I am a prisoner locked up behind Xanax bars
I have just boarded a plane without a pilot.
And violets are blue, roses are red.
Daisies are yellow, the flowers are dead.
– Lil Wayne,
“I Feel Like Dying”
Depression doesn’t stop at our bodies. It continues its slash-and-burn marches to the essence of who we are. Sufferers complain of living in a fog, unable to think, remember, or focus. One patient described it to me as losing 50 IQ points. You’re hazy and horrified by the signs that you’re disappearing. The qualities that constitute “you” become peripheral. The password has changed, and access is denied. Nothing is funny or engaging or challenging, especially as you consider the “normal people” around you. You can’t figure out how they pull it off. Depression begins to intensify self-hatred as one bears the humiliation of losing so much.
But your mind can still wrap itself around one thing: that you’re horrified. Edvard Munch’s jarring painting of “The Scream” sums up the disturbance of watching your self, your personal North Star, as it disappears into unfathomable darkness. By the end, I was sick to my stomach, barely able to swallow or draw a deep breath. The plea of poet Adrienne Rich, “Teach me how to bear my life,” could’ve been my own. After 16 years of Catholic education, I reverted to fevered, ruminative, pleading prayer. The words of Jesus repeated like Wall Street ticker tape: “My God, my God, why hast thou forsaken me?”
And the ominous backdrop that haunts every thought and feeling? Shame. It comes from the damage the pain wreaks upon even the most mundane aspects of you. Early on, everyone tries to fake it, to hide the internal erosion—until they feel the full weight of the lie and can’t anymore. But for a time, you’re like a secret felon covering up your own shortcomings as you try to master the exhausting charade that nothing is wrong. Faking it forestalls reaching out for help. You become a poor imitation of yourself, and wonder how in hell others can’t tell—which only furthers your isolation.
Other people can exacerbate the problem. They echo with opinions about your demise. Their words imply a total lack of understanding about the agony you feel, with the implication that you got yourself into this mess, so you can get out of it. As you politely nod at their crappy advice, inside you scream, Are you kidding me? Can’t you see me? Can’t you see that it’s possible to lose yourself so completely that even your name feels false?
If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather. . . . It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.
– Stephen Fry
If language is the currency of human relationships, the depression sufferer is broke. Access to language becomes impaired. Sufferers stumble through uncomfortable conversations in which their losses are glaring, and conversations become frayed. There’s no real exchange. Despite the wishes of the people who know us to comfort and understand, we lack an understanding of their words, along with the timing, the fluidity of talking. Also, we don’t want to be known in our current state.
Other people usually take the rap for the many reasons that conversations hit the skids or never happen at all, and some of it is deserved. Smart people have idiots’ views of depression. They believe in the power of their ideas, with a concentration on what has caused and what will remedy your situation. But you’re often so close to mute that you don’t rise in dissent. You just take it.
In one hospitalization, I was assigned a resident who appeared full of enthusiasm for the therapeutic relationship that was about to ensue. Before even introducing himself, he slid a paper in front of me and asked me to rate my depression on a scale. The 10 had a smiley face next to it, and the 1 had a frowny face. I looked at the scale and then at him. Can’t you see there aren’t any numbers for where I am? I wanted to scream. And save your breath, because there aren’t any words either! But I didn’t. I made my mark. And for the next hundred days, before he even crossed the threshold of my room, I called out, “One” in the hope he’d just leave me the hell alone.
There’s another side to the sufferer’s isolation. When you’re in pain and lack the skills to express it, you condemn to death many conversations before they begin. It’s hard to sustain a conversation with a wall. Writer Kay Redfield Jamison observed that the dynamic of tortured communication is that the sufferer is “both frightened and frightening,” increasing the demoralizing chasm.
Another impediment to connection is that the depression makes you extremely self-focused, even when it feels like there’s no self to focus on. It takes so much energy just to “be,” that there isn’t too much left for anyone else. Contrary to arising from an innate selfishness, it’s protective. If a person slams his thumb with a hammer, nothing will exist outside the pain. If he does it again and again, his experience will be solitary and pervasive, with no input allowed. But when there’s a breakthrough in the connection between sufferer and others, it’s not easily forgotten.
During visiting hours, I was always struck by the one-way conversations up and down the halls. As much as I cared for my family members, it was hard to tolerate their visits. Even with clinicians whom I judged warm and competent, it was difficult to share the same space. The only exception was my uncle, who was no stranger to depression. After a few fruitless questions, he became silent. In the silence, he began to cry. I felt my hand moving over his. We said nothing more for the entire visit. It was the first time in a long time that I’d had a real conversation with someone.
The Worst Casualty: Hope
A piece of burned meat
Wears my clothes, speaks
In my voice, dispatches obligation
Haltingly or not at all.
It is tired of trying
To be stouthearted, tired
– Jane Kenyon,
“Having It Out with Melancholy”
The central questions when things get really bad are “How much longer can this last?” and “How much longer can I last?” Existence is a waking nightmare. You died a while ago, but they forgot to pronounce you. You’re drowning in a kind of pain you never imagined possible. You’ve forgotten the person you used to know, and maybe even like. The line between the feeling of craziness and reality is totally obscured. You feel vanquished and alone. You don’t know what to do today or in 10 seconds. You can’t believe how long the days are and how they are killing you. There’s no purpose to you, no comfort, and the truest thing you know is that you won’t last much longer. You have a litany of the deaths you’ve already felt.
As so many assaults continue to attack the sufferer, hope becomes the worst casualty. When every single thing you try works a little but mostly not at all, when time inexorably slogs along, leaving only more evidence of your losses in its wake, when the future is measured in the two seconds that loom between you and the eternal awful that plagues you, when you’re horrified at the person you’ve become and fear you’ll always be, hope is an entirely foreign attitude.
It’s the loss of hope combined with the terror of living that brings people to formalize the death they already feel. It reflects a permanent answer to the insistent choruses that promise an escape, a rest, a favor to loved ones. It’s at once terrifying and comforting to make steps toward suicide. Depression and suicide flock around my extended family like hungry gulls, and to see them seep into the next generation is one of the greatest sorrows I know.
My family’s experience stands in sharp contrast to what the experts taught me. Suicide is not primarily an act of self-hated, aggression turned inward, a great manipulation. Suicide is the period at the end of a long sentence of agony. That’s it.
Some make the final step from nothingness to nothingness. And others don’t. Writer David Foster Wallace weighs in with great wisdom. “The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. . . . And yet nobody down the sidewalk, looking up and yelling, ‘Don’t!’ and ‘Hang on!’ can understand the jump. Not really. You’d have to have personally been trapped and felt the flames to really understand a terror beyond falling.”
The whys of remaining alive are often articulated—courage or the lack of it, religious convictions, connections to loved ones. But for my money, it’s the smallest shred of hope that differentiates the jumper from the one who stands still.
I remember sitting in [my psychiatrist’s] office a hundred times during those grim months and thinking, What on earth can he say that will make me feel better or keep me alive? Well, there never was anything he could say, that’s the funny thing. It was all the stupid, desperately optimistic, condescending things he didn’t say that kept me alive . . . and his granite belief that mine was a life worth living.
– Kay Redfield Jamison,
An Unquiet Mind
I’ve had several therapists who’ve helped me save my life through a number of self-smashing depressions. One of the ironies of surviving a bad episode is that you’re often the last to know that you’re doing better. Sufferers see their progress slowly, but maintain the fear that it will evaporate if they even sneeze wrong.
I began with my current therapist just as I was crawling out of the horrendous year that was my last bad episode. One afternoon, I walked into her office and the first thing I noticed was the color of her clothes. Putting aside my reticence about making inconsequential remarks about someone’s looks, particularly a therapist, I blurted out, “You look really cool.” This from a woman whose clothes preferences had always been divided into tan and black. The tans went in one pile and the blacks, the other. One tan went with another tan, even when it really didn’t. The blacks went with the blacks. Sometimes a tan went with a black, but rarely. I might start the day courageously by putting something on from one pile or the other, after which I often slept in them, and sometimes even wore them for another day. I doubt that this was ever wasted on her.
She named the colors of her clothes. Fuchsia. Turquoise. Chartreuse. I was fascinated. Then she looked me up and down and said kindly but confidently, “You know, Martha, beige isn’t really your color.” My first response was to figure out how offended I should be. But I wasn’t. I was cast back for a moment into the real world, a world where women talk to each other about clothes. Her remarks stayed with me for days. And they bordered on making me happy, as I considered a new wardrobe.
It wasn’t just my ugly, faded clothes I started feeling free of. I wasn’t condemned to an ugly beige life either. Maybe she’d just made a throwaway comment. But maybe it was some unconscious alchemy, where some of the greatest truths are told. Betting on alchemy, I ventured forth.
- - - -
In the few years since my last episode, I’ve lost my father, my uncle and best friend, and to a great extent, my mother. After 43 years of marriage, my husband left me for another woman. I’ve experienced searing grief and heartbreak—but not depression. I’ve had both knees replaced and surrendered my gall bladder. It hurt like hell. I was deeply discouraged, but not depressed. My checkbook has shrunk, and my dress size has expanded. I’m dispirited and ashamed, but not depressed. I’ve developed arthritis, suffered career reversals, and lost dear friends through neglect. I’ve felt sad and scared, but not depressed.
Nietzsche wrote that what doesn’t kill us makes us stronger. In the case of agonizing depression, I’m not sure that’s true. For me, what didn’t kill me didn’t kill me. Depression didn’t do anything for my strength, except test it. I could say it taught me to be grateful, and made me a nicer person. I could say that it made me wiser, or more patient, or more accepting of my vulnerabilities. But it didn’t. The good and bad things about me that were there before are now returning to me intact.
Depression didn’t destroy my self. I think, sensing impending danger, it went underground, where it was immobilized, but safe. When it sensed that the coast was clear, it slowly and cautiously returned. Now my feelings are real again. I can name them. They have contours and edges, even shadows. They delight or challenge or burden me. But they are mine.
When I hear the sound of my own laughter, it startles me for a split second, but then it resonates through my body and my mind. I cherish this return the most. I go the way of Job. I know that I’m restored. I’m whole. I hopscotched over death and finally landed awkwardly, but safely home. And despite the bruises and the fears, I can reassure my shell-shocked self that at least for now, and maybe forever, we’re most definitely back in business.
Martha Manning, PhD, is a writer and clinical psychologist whose books include Undercurrents: A Life Beneath the Surface and The Common Thread: Mothers, Daughters, and the Power of Empathy. Twitter contact: @marthamanning1.
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