By Allie, over at Hyperbole and a Half.
Now, an intro to this post, if you like: Several years ago, I read Peter Kramer’s AGAINST DEPRESSION. Kramer’s a psychiatrist, as you may know, and if I were suffering from any kind of emotional dysfunction, I would probably find out what state he practices in and move there, because his books are amazing.
In particular, AGAINST DEPRESSION persuaded me that clinical depression is a real illness with definable characteristics, that it destroys lives, that antidepressants are crucial lifesavers, and that depression is a huge medical problem. I mean, did you know that depression is so tightly linked to heart disease that it would be one of the biggest killers in the world EVEN IF it was as emotionally neutral as high blood pressure? I mean, who knows that? I had no idea.
One thing I didn’t ever suffer from, though, was any idea that depression somehow offers valuable insight to the tragedy of the human condition, or anything ridiculous like that. I don’t get the “tragedy of the human condition” thing, see. I certainly never, ever granted any credence to the idea that art has to be dark in order to be deep, or that somehow depression grants its sufferers some kind of moral superiority to the healthy. Not hardly. So Kramer’s first chapters were interesting to read, but mostly I found myself saying, Do people really think that depression is alluring and morally uplifting? (Apparently many people do.)
Plus, Kramer’s book made me VERY GRATEFUL that my own family apparently has the great good luck to be genetically protected against depression. It’s a huge extended family, offering plenty of data points, so I’m pretty sure about this. I remind myself of this piece of good fortune when feeling snappish about early-onset osteoarthritis and semi-herniated disks and whatever.
So, so. Evidently Allie suffers, or has been suffering, from a form of depression that Kramer would identify specifically as anhedonia — the inability to feel pleasure in anything. Also a more global flattening of all emotional states. Her post is amazing. With amazing cartoon illustrations. Such as:
I had so very few feelings, and everyone else had so many, and it felt like they were having all of them in front of me at once. I didn’t really know what to do, so I agreed to see a doctor so that everyone would stop having all of their feelings at me.
It’s a wonderful post, one that gets about as close as I can imagine to actually expressing what it feels like to be clinically depressed — a very alien emotional state to those of us who fortunately never experience anything of the kind. And here’s hoping that Allie soon writes another post, one in which she illustrates the phenomenon of complete recovery.
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Yes, yes, yes. I read this post some time ago when I first discovered Hyprbole and a Half, and it really did capture the experience of clinical depression, which as you said is so very hard to understand for those who haven’t experienced it. I hate that there’s still this stigma that exists, blowing off depression as not a real medical problem, or as you stated, some way to gain insight into the human condition. It’s something I’ve personally struggled with, and really the worst/scariest thing I’ve ever gone through.
Oh! And somehow I failed to realize that there is a NEW post on Hyperbole and a Half about her struggle to come back from depression. After such a long silence on that blog, it’s so good to see something new.
I pointed someone I know who suffers anhedonia to it, and that person agreed she captured the experience well. What she caught that I know he’s complained about is the way other people don’t get it, and make ‘helpful’ suggestions that don’t help at all. Even the professionals.
As I understand it, anhedonia is different from clinical depression – maybe related – but from what the person I know has said, antidepressants don’t fix it.
I’m so glad big names in psychiatry are finally pushing to get away from the DSM and work on the biology of the brain and its disorders. It has taken them way too long. It IS biology, not symptom clusters which can look the same in different people, yet respond to wildly different meds. You are very fortunate not to have it in your family. What I’ve noticed is that it is sneaky – people go downhill gradually, and get ‘understood’ as ‘oh, that’s Joe for you.’ It doesn’t stand out as someone needing medical help until it is way far along. And you can’t force someone to get to a doctor because they’re behaving oddly, the way you can when they have a stroke or something overtly physical wrong.
Thanks Rachel. My boyfriend suffers from depression. As someone who has never experienced it myself, I’m constantly looking for ways to try and better understand what life is like for him. That’s a very helpful post.
I think the most important thing I learned from Kramer’s books — which I do very strongly recommend — is that depression is a multifaceted but almost always progressive disorder, and that the ONLY appropriate goal of treatment is full, total resolution of symptoms — and then treatment should be aimed at preventing any return of even partial symptoms. Because otherwise the condition is almost certain to, you know, PROGRESS.
I definitely think clinical depression is right up there in the top ten list of worst/scariest things that can possibly happen to anybody! If only we had treatments available today that always worked — but I know different antidepressants have variable effects on different people, and as far as I’m aware we still don’t know why. And sometimes one medication doesn’t work the first time you try it, and then does work later — again for reasons that really aren’t understood at all. According to Kramer, anhedonia is definitely considered part of the main core of symptoms that belongs to depression, and often antidepressants work to help resolve it and sometimes, alas, they don’t.
And, yes, real depression is definitely all biology, and I know people sometimes feel uncomfortable with the notion of taking antidepressants, but as far as I’m concerned, that’s like a diabetic person feeling uncomfortable taking insulin. It’s a medication your body needs to function appropriately and there should be no stigma whatsoever for any of it.
I think psychiatry is, right now, basically where biology was in, oh, the 1850s — you know, the period when one doctor might say to another, “So, Dr Smith, what do you think causes cholera, an imbalance of bodily humors or a miasma of night air?”
I think in psychiatry today, we hardly know anything, there are lots of popular theories that are wrong, and we are just at the point where a lot of stuff is going to be figured out. It can’t happen too soon!