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“I sometimes wonder how all those who do not write, compose, or paint can manage to escape the madness, the melancholia, the panic fear which is inherent in the human situation.”
The first goal of this book is empathy; the second, which has been for me much more difficult to achieve, is order: an order based as closely as possible on empiricism, rather than on sweeping generalizations extracted from haphazard anecdotes.
We would not have the selective serotonin reuptake inhibitors (SSRIs), antidepressants that have saved so many lives, without the companies that sponsored the research.
DEPRESSION IS THE flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair. When it comes, it degrades one’s self and ultimately eclipses the capacity to give or receive affection. It is the aloneness within us made manifest, and it destroys not only connection to others but also the ability to be peacefully alone with oneself.
The only feeling left in this loveless state is insignificance.
depression cannot be wiped out so long as we are creatures conscious of our own selves.
Highly politicized rhetoric has blurred the distinction between depression and its consequences—the distinction between how you feel and how you act in response.
Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.
Grief is a humble angel who leaves you with strong, clear thoughts and a sense of your own depth. Depression is a demon who leaves you appalled.
It is too much grief at too slight a cause, pain that takes over from the other emotions and crowds them out. Such depression takes up bodily occupancy in the eyelids and in the muscles that keep the spine erect. It hurts your heart and lungs, making the contraction of involuntary muscles harder than it needs to be. Like physical pain that becomes chronic, it is miserable not so much because it is intolerable in the moment as because it is intolerable to have known it in the moments gone and to look forward only to knowing it in the moments to come. The present tense of mild depression
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“Jacob went to the window and stood with his hands in his pockets. There he saw three Greeks in kilts; the masts of ships; idle or busy people of the lower classes strolling or stepping out briskly, or falling into groups and gesticulating with their hands. Their lack of concern for him was not the cause of his gloom; but some more profound conviction—it was not that he himself happened to be lonely, but that all people are.”
It is this acute awareness of transience and limitation that constitutes mild depression.
There are two models for depression: the dimensional and the categorical.
Major depression is a birth and a death: it is both the new presence of something and the total disappearance of something.
The birth and death that constitute depression occur at once.
At the worst stage of major depression, I had moods that I knew were not my moods:
Every second of being alive hurt me.
You lose the ability to trust anyone, to be touched, to grieve. Eventually, you are simply absent from yourself.
It is necessary both to cut away that extra thousand pounds of the vines and to relearn a root system and the techniques of photosynthesis.
Rebuilding of the self in and after depression requires love, insight, work, and, most of all, time.
The only way to find out whether you’re depressed is to listen to and watch yourself, to feel your feelings and then think about them. If you feel bad without reason most of the time, you’re depressed. If you feel bad most of the time with reason, you’re also depressed, though changing the reasons may be a better way forward than leaving circumstance alone and attacking the depression. If the depression is disabling to you, then it’s major. If it’s only mildly distracting, it’s not major.
Depression, if it is sufficiently severe to cause stomach cramps, is actually a really bad thing to have wrong with you, and it requires treatment.
The diagnosis—whether something is rotten in your stomach or your appendix or your brain—matters in determining treatment and is not trivial.
Treatment does not alleviate a disruption of identity, bringing you back to some kind of normality; it readjusts a multifarious identity, changing in some small degree who you are.
If time lets you cycle out of a depression and feel better, the chemical changes are no less particular and complex than the ones that are brought about by taking antidepressants.
What is so unattractive is the idea that in addition to all other lines being blurred, the boundaries of what makes us ourselves are blurry. There is no essential self that lies pure as a vein of gold under the chaos of experience and chemistry.
There is no essential self that lies pure as a vein of gold under the chaos of e...
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Depression is not the consequence of a reduced level of anything we can now measure. Raising levels of serotonin in the brain triggers a process that eventually helps many depressed people to feel better, but that is not because they have abnormally low levels of serotonin.
“This serotonin thing,” says David McDowell of Columbia University, “is part of modern neuromythology.” It’s a potent set of stories.
If reality itself is often a relative thing, and the self is in a state of permanent flux, the passage from slight mood to extreme mood is a glissando.
Depression? It’s like trying to come up with clinical parameters for hunger,
depression hits different people in different ways: some are predisposed to resist or battle through it, while others are helpless in its grip.
“There is no such thing as a mood gene,” says Steven Hyman, director of the National Institute of Mental Health. “It’s just shorthand for very complex gene-environment interactions.
It is too often the quality of happiness that you feel at every moment its fragility, while depression seems when you are in it to be a state that will never pass.
Depression is something to do. My grasp tightens and becomes acute in moments of loss: I can see the beauty of glass objects fully at the moment when they slip from my hand toward the floor. “We find pleasure much less pleasurable, pain much more painful than we had anticipated,” Schopenhauer wrote. “We require at all times a certain quantity of care or sorrow or want, as a ship requires ballast, to keep on a straight course.”
about 28 million Americans—one in every ten—are now on SSRIs (selective serotonin reuptake inhibitors—the class of drugs to which Prozac belongs),
“It’s the Lourdes phenomenon,”
It wearies me, you say it wearies you; But how I caught it, found it, or came by it What stuff ’tis made of, whereof it is born I am to learn; And such a want-wit sadness makes of me, That I have much ado to know myself.
We must look for faith (in anything: God or the self or other people or politics or beauty or just about anything else) and structure.
The people of Cambodia live in the compass of immemorial tragedy. During the 1970s, the revolutionary Pol Pot established a Maoist dictatorship in Cambodia in the name of what he called the Khmer Rouge.
common forms of talking therapy (psychoanalytic, interpersonal, and cognitive).
“Welcome this pain,” Ovid once wrote, “for you will learn from it.”
But pain is not acute depression; one loves and is loved in great pain, and one is alive in the experience of it. It is the walking-death quality of depression that I have tried to eliminate from my life; it is as artillery against that extinction that this book is written.
the perennial existential crisis, the forgotten sorrows of a distant childhood, the slight wrongs done to people now dead, the loss of certain friendships through your own negligence, the truth that you are not Tolstoy, the absence in this world of perfect love, the impulses of greed and uncharity that lie too close to the heart—
At one period, in eleventh grade, I became convinced that the building in which I went to classes (which had been standing for almost a hundred years) was going to collapse, and I remember having to steel myself against that strange anxiety day after day. I
the first revelations of human frailty, the first intimations of mortality, are devastating and intemperate.
I became afraid of what is lost through time, and I would lie in bed at night trying to remember things from the day so that I could keep them—an incorporeal acquisitiveness.
Starting in high school, I was aware of a confused sense of sexuality, which I would say was my life’s most impenetrable emotional challenge.
I have occasionally been prone to a mood of intense anxiety about nothing in particular, an odd mix of sadness and fear that springs from nowhere.
Even in the best of spirits, it’s always been as though I wrestle with the present in a vain effort to stop its becoming the past.
