Depression is Not a Choice

Depression is not a choice or a lifestyle problem, it's a hardware fault – a particular bodily organ that doesn’t produce certain chemicals in the proper amounts. And it is high time we as a society, tried to understand that.
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Depression is not a choice or a lifestyle problem, it's a hardware fault – a particular bodily organ that doesn’t produce certain chemicals in the proper amounts. And it is high time we as a society, tried to understand that.
russel crowe

I had to pull over and stop at the summit of the Salmo-Creston highway on the long drive back home from Calgary.  I’d already been on the road for over four hours, and no competent police officer on the planet would have pronounced me fit to drive at that point – being awake for forty hours straight tends to have that effect on one’s ability to safely operate motor vehicles.  It was only after the fourth or fifth time I caught myself gently dozing behind the wheel that I finally admitted to myself that pulling over for a nap was probably a good idea.  I’d refused to pull over up to that point for a number of reasons – wanting to put that miserable drive behind me as quickly as possible, for one, and being too tired to think rationally, for another.  I also had another reason for not wanting to pull over, but I’d been avoiding thinking about it for the whole day, all through packing my truck and handling the last of my business in Calgary (which I’d put off until the very last minute, of course), but now it was decision time – if I proceeded any further in my fatigued condition, I’d be implicitly finalizing a course of action that I was still, after everything, not quite sold on.  So I pulled into a small rest area near the point where the road dove headlong down the mountainside and had a bit of a conversation with myself, one I’d been dreading all through the Rockies.

I was trying to talk myself out of simply driving off the cliff edge of the Salmo-Creston, and letting gravity handle my problems.  I figured a vehicle tumbling down dozens of metres of steep, rocky cliff face, with an occupant who would’ve removed his seatbelt at that point, would have accomplished the job nicely.

That was my close call, the point I came nearest to full surrender.  There had been others before then, and have been others since, but damn if that one doesn’t still wake me up sometimes in a cold sweat.  It really was that close.

I have depression, have for more than two decades now, and I hate everything about it.  I hate the word alone – it’s the ninety-eight pound weakling of the English language.  It describes nothing about the medical condition to which it’s been applied.  Nothing.  It’s pathetically weak and watery and can mean practically anything anyone wants it to mean.  It doesn’t give those who don’t suffer from depression any goddamned idea what it’s like for those who do.  Even the most obtuse prefix- and suffix-laden medical terms generally incorporate some description, at least if one’s willing to decode all the Latin-derived nonsense into the present vernacular.  But not depression – it just sits there, saying nothing, meaning nothing, allowing those who believe that the whole condition is just a sign of “weakness” that it really is nothing.  Nothing major, nothing serious.  Stop being emo, straighten up, find some grit, grow a spine, cheer up, smile, and don’t be a wimp, you moocher you.

To all those who have ever reacted to an admitted diagnosis of depression from another human being with anything remotely resembling such casual contempt (Andrea Peyser, are you listening?), I’m going to take this opportunity to respond on behalf of those who have this illness: fuck you sideways, you oozing infected pustules on the soul of humanity.  You are the living, breathing, walking, talking definitions of Not Helping.  (I may be slightly irritated with individuals who adopt that attitude, by the way.)

To those who, conversely, react with compassion – even without truly understanding what’s really happening – when a depressed person breaks down and asks for help, or admits that something is, indeed, seriously wrong (and that’s not an easy admission to make, believe me), all I can say is thank you, so much.  Words fail, they really do.

A large part of the issue has to do with the nature of mental illness itself.  There are no visible wounds to inspect, no blood tests or biopsies that can identify the source of the problem.  MRIs and other imaging techniques can hint at the cause – the brain of a severely depressed individual looks considerably different under close examination than that of a healthy individual – but getting to the point where medical professionals would even suggest that such diagnostic tools be brought to bear generally means wading through oceans of disinterest, disbelief and outright disparagement.  It’s easy to ignore that which is not immediately visible, after all – and if that doesn’t work, blaming the patient for the disease is much simpler than actually dealing with the disease itself.  After all, if blood isn’t spurting from anywhere, it must just be a question of poor attitude, right?

But the problem is hardware, not software.  As anyone who’s ever had to act as their own tech support knows, when dealing with computer issues, software problems are much easier to handle than hardware problems – if worst comes to worst where software conflicts are concerned, one can always just back up any relevant data and then reformat everything.  But if the problem is defective hardware, just diagnosing the issue becomes maddening, to say nothing of actually fixing it, because it could be the product of practically anything – bad power supply, bad memory, bad motherboard, you name it.  Sometimes it just comes down to a question of components not playing nicely with each other.

Depression is much the same way.  Take it from someone who lives there: life would be so much simpler if the problem were just attitude, or motivation, or detrimental habits.  Those are all software – irritating to deal with, sure, but relatively straightforward.  No surgery or medication needed – I’ve yet to encounter an attitude problem, for example, where it was seriously suggested by medical professionals that electroconvulsive therapy might be of some use (which is still a treatment prescribed for some intractable cases of depression, by the way: it was even considered in my case, though fortunately I managed to avoid it).  But depression isn’t attitude.  It’s not mindset.  It’s not leading an unhealthy lifestyle.  It’s certainly not a question of optimism versus pessimism.  Those are products of the problem, not the problem itself.  It’s a hardware fault – a particular bodily organ doesn’t produce certain chemicals in the proper amounts or function as it would in a healthy individual, and unfortunately the symptoms of that fault can be written off as being caused by, well, practically anything else.

And because people can write off the problem, many of them do, whether out of callousness or mere ignorance.  It’s just an attitude problem, they say.  Laziness.  A dodge.  As if victims of depression are lining up for the exciting opportunity to mess around with their brain chemistry using powerful pharmaceuticals out of a desire to be as non-productive as possible (Big Pharma is a different matter, of course – I’m sure they’d love to have as many people as possible using their products for no reason at all).  Just snap out of it is the response, the easy dismissal.  Tough it out.  It worked for that schizophrenic math guy in that one movie, right?  And if it’s too much for you to handle, just off yourself already – there’s already too much traffic on the roads, and we certainly don’t want to be on the hook for your medical care.

A Beautiful Mind is a movie, not a prescription.  Citing a Hollywood-produced work of fiction – based on a true story or not – as a legitimate method for dealing with a serious illness isn’t a great idea, especially if the method espoused inevitably boils down to “just endure it.”  (I realize that’s the central premise Republicans use for their proposed health care initiatives, but out here in Not-Crazy Land – yes, I’m aware of the all the irony involved in a Canadian hillbilly mental case making that statement – it’s generally accepted that forcing people to just live with disease is a Bad Thing.)  Would you tell someone with cancer to “walk it off”?  Well, maybe if you’re a member of the U.S. House of Representatives, you would, but let’s not dwell – they don’t need us annoying them while they schedule another vote to repeal the Affordable Care Act, after all.  But there’s just something about the blood-brain barrier that seems to encourage people to view diseases that occur on the cerebral side of that divide as false, or cons, or signs of weakness.  Very few people look at, say, malaria, and conclude that the problem lies in the attitude of the afflicted.  But when the defect lies in that mysterious mass of neural tissue between one’s ears?  Well, obviously that’s a sign of weakness and failure.  And then they promptly ignore it – it’s somebody else’s problem.

Ignoring the problem will not make it go away, especially now.  In the U.S. alone, current estimates state that approximately 17% of the population can expect to experience a major depressive episode in their lifetimes.  Better than one in six.  Not happy odds there – if one person in six could expect their fingernails to rot off their hands at some point in their lives, there would be a hell of a lot of public attention focused on the problem.  But if the disease is safely hidden away inside a stranger’s skull?  Oh well – best not to think about it.

Once again, the incredibly wimpy nature of the word “depression” rears its boneless little head.  For the average functional person on the street, depression (as the word applies to mood) just means “a little sad, a little down, a little discouraged.”  It’s an emotional condition, a temporary one: just go out, get drunk, eat a few buckets of ice cream, maybe have a couple one-night stands… it’ll get better, really.

“Depression” the mood disorder doesn’t have a goddamned thing to do with being sad.  It’s not weakness, or the product of moral failings, or a cheap con.  It’s a disease, it’s serious, and it’s not going away.

Maybe it’s time to stop trying to tough it out.