What if depression is more than a chemical imbalance? What if depression and suicide are about despair?
By Jacque White Kochak
OK, there’s been an awful lot about depression and suicide in the news lately. That’s good. Maybe talking about these dark subjects will save some lives.
I know something about depression and suicidal ideation. Here’s the thing, though. I don’t think I have a disease, and I’m concerned about the “medicalization” of depression. If depression is nothing more than a chemical imbalance, then of course the cure is medical – pop a pill to get those brain chemicals back in sync, right?
But what if depression is about more than a chemical imbalance? Humor me here. What if depression and suicide are about despair?
I’ve battled spells of depression since my middle teens. I used to wonder whether someone could cut off an appendage, maybe a finger or an arm, and measure the pain. I know what it’s like to feel like I’m wading through molasses to get the simplest task done, and to struggle to get out of bed. I know what hopelessness feels like.
I’ve researched and devised elaborate suicide schemes. I guess I have the cred – and the medical diagnosis, actually. And yes, I’m probably biologically predisposed to depression, just as I’m biologically predisposed to sunburn. I ought to be medicated, I suppose.
But if depression and suicide are about despair, we have the uncomfortable task of looking at this problem in a different way. For one thing, we have to look at conditions in those states where suicide has increased by 30 to 40 percent in the last few years, and we have to look at our own lives and what we can aspire to change. Sometimes, we have to change our own attitudes, ways of looking at the world, and the messages we tell ourselves.
In a shocking recent report on suicides nationwide, researchers from the Centers for Disease Control found that more than half of those who died by suicide did not have a known diagnosed mental health condition. Relationship problems, substance misuse, physical health problems and job, money, legal or housing stresses often contributed, the CDC admitted.
Still, I keep reading personal accounts of people who have suffered from depression, pleading, “I have an illness. Don’t tell me to ‘cheer up.’” I’m pretty sure the brand of tough love I’ve imposed on myself is going to get me branded as insensitive, but let me speak my piece.
When I read accounts of depression I say to myself, “But you do have some control.” I ask myself if these people may have experienced something different from me, and maybe they have. But any mental health professional would likely reaffirm my diagnosis. Many in my extended family take antidepressant medication. Some have been diagnosed as bipolar. At multiple times in my life, I would have hit all the high points on a checklist for major depressive disorder. It hasn’t been easy.
So how can I possibly say I’m not sick, and I have some control? On the “sick” part, I know (and most people would agree) that I’m a lot saner than some people I know. And how can something that is so common really be considered a disease, rather than part of the human condition?
Explaining the “control“ part is more difficult. I began grappling with depression at quite a young age, and it was severe. My life was affected, and I’m sure I would be in a different place than I am today if not for my life-or-death struggle with that black dog. The fight took all my energy and destroyed my confidence, and I don’t want to minimize the pain or the destructive effect on my life. But I survived, and over time I developed coping strategies.
I learned to look around me and realize there were a lot of people who had lives a lot worse than mine. I learned to put problems in perspective. I learned not to grapple too long with an insoluble problem, but instead move on. I learned not to ruminate, to take one step at a time, and see the positive. I learned not to think in black-and-white terms and not to berate myself with negative pronouncements about myself. I learned to identify what specifically was getting me down, and see whether there were solutions.
Here’s an example. At one point in my life my time was completely consumed by a man, and when that relationship ended I was destitute. Anyone would have been devastated, of course; the icing on the cake for a person like me, prone to depression, is that I was convinced I was radioactive, all the fault was mine, and no one would ever want to be my friend, let alone be more.
Then I looked around me and saw that almost everyone, no matter how obnoxious, seemed to have a friend. I realized I probably didn’t have to be alone, so the trick was figuring out where to meet people with whom I might have something in common. I put the plan into effect.
That’s a very, very simple example, and probably not a very good one. Since I have a tendency to severe depression, perhaps I should have sought pharmaceutical relief. At some point, however, I discovered my approach has a name, and that name is “cognitive behavioral therapy,” or CBT.
Briefly, CBT can help to restructure negative thought patterns, to recognize the source of depression, and to change the actions that exacerbate it. Study after study has shown that CBT is about as effective as antidepressants, and somehow, through trial and error, I mapped out my own approach.
Consider this: According to the National Institutes of Health, about 20 to 40 people out of a hundred people noticed improvement in their symptoms within six to eight weeks if they took a placebo. Among those who took an antidepressant, about 40 to 60 out of a hundred people saw improvement in six to eight weeks.
Read that again. If you take a placebo, you’ve got a 20 to 40 percent chance of improvement. If you take an antidepressant, you’ve got a 40 to 60 percent of improvement. Them ain’t great odds if you’re struggling with a demon.
This is not to completely discount medication, but I think of antidepressants as being something like aspirin. Aspirin helps the pain, but doesn’t cure the problem (which might not be a “disease”). One friend describes an antidepressant as a way to “take the edge off,” and another requires a mood stabilizer. Neither is a miracle cure, and neither is really enough. A will to change is also required.
Abe Lincoln is often raised up as an example of someone who struggled with severe, chronic depression, so it’s interesting that people usually forget what he supposedly said: “Folks are usually about as happy as they make up their minds to be.”
That’s not the whole story, but it’s something to think about.