Many, if not most, of us have had contact with depression and anxiety and anxiety disorders, either in ourselves or in someone close to us. They can be a source of shame, of fear, of grief, of confusion. Yet almost no one is exempt, including some talented and well known figures, such as Billy Joel, Jim Carrey, Sheryl Crow, Charles Schultz, Virginia Wolfe, David Bowie, Ernest Hemmingway, Howie Mandel, Emily Dickinson, Oprah Winfrey, Vincent Van Gogh and Nathaniel Hawthorne. They have been described as "a graveyard of buried hopes" (L.M. Montgomery), a “shipwreck of the soul” by William Styron, or as French poet Baudelaire put it, "I have felt the wing of the wind of madness." The point of the service today is to open up this topic in order to help each of us recognize depression and anxiety and help ourselves and each other live through them and with them. This is the name of our inherent value as persons and the interconnected nature of life in which we all partake.
I experience depression as solitude in its most isolating, enervating, paralyzing sense. It is as if one is surrounded by the clearest of glass bubbles. We can see through it, we can speak through it, but we cannot touch or be touched. That's the despairing part. If we are the ones depressed, nothing can really get in. Nothing can stop the constant white noise, that eternal, interior pain. If we are the ones trying to be with a depressed person, nothing we say or do seems to penetrate. Nothing we say or do seems to help, or bring about change. On any but a most superficial level, the person is simply not there. That's what is so isolating about depression; it takes away our ability to be present with one another, at precisely the times when we need it the most.
A time I can remember as one of depression came upon me when my mother died. The loss felt profound; at first it was as if something of me went with her. For it did. As my father had died many years before, my mother's departure left me, an only child, with no living parents. At age 38 I was the older generation. I was the only keeper left of my life history. I went through the familiar stages of grief, including denial, anger, bargaining, and so on. I went through them again and again it seemed, grief is a spiral staircase, but I did find acceptance. The clue that I was depressed came as I watched myself gradually fill the stairs in my house with papers. Any papers at all--important mail, junk mail, notes, things to be filed, things to be thrown out. You need to know that I am an organized person who processes paper especially well. You won't find loose piles of paper anywhere in my presence for long. But here I was, filling up a corner of the stairs with unsorted piles of paper, moving on to the next stair when the piles could grow no higher. I worked my way up the entire staircase, a nine month effort, before I had the energy to deal with it and when I did, it took me three months to sort it out. I have never done that, either before or since, and I attribute it to the enervating effects of depression.
Whether you are the one depressed or whether you care for the one who's depressed, it is isolating and painful. Here is some general information about depression. (Check out _www.WebMD.com_ (http://www.WebMD.com) for more details.) Most, if not all, of us have, at times felt down, or depressed, or sad, or blue. Feeling these is a reaction to loss, unwanted change, rejection, a blow to our self-esteem. It’s only natural. What we call depression are feelings of sadness, the blues, etc. that last for long periods of time and prevent us from leading life the way we usually lead it. Symptoms of depression may include change in sleep patterns, loss of appetite, increase in appetite, irritability, loss of energy, feelings of hopelessness, thoughts of suicide, inability to concentrate, and more. According to a report from the National Institute of Mental Health, nearly 18.8 million Americans over the age of 18 suffer from major depression. Suicide, closely linked to depression, is the third leading cause of death in 10- to 24-year-olds. Everybody may feel blue at times but when the feelings and other symptoms last for two weeks or longer, think that depression may have set in. Think about checking it out with your physician or therapist. There are different kinds of depression: major depression, chronic depression, bipolar depression, and seasonal depression (seasonal affective disorder or SAD).
Some think that there is a genetic factor in depression. Others think that the seeds of this illness take root in childhood with a loss of some kind, incompletely mourned or unmourned, leaving us with sorrow and rage and guilt and more vulnerable to losses sustained later on in life. Loss is a touchstone of depression. One often has to deal with an immense loss while at the same time trying to surmount the effects of its devastation. There are other ideas regarding its origins, but in any case depression is probably too complicated to package with any one explanation. Scientists are still studying the various underlying causes and our current understanding of the disease indicates that biological, psychological, and environmental factors are all involved. Advanced studies using the latest brain imaging techniques indicate that the circuits in the brain that regulate mood, thinking, sleep, appetite, and behavior do not function properly in someone with depression, and that the regulation of critical substances called neurotransmitters -- chemical messengers that transport signals from one brain cell to another -- is impaired. There are a number of ways to treat depression and one always has the option of not treating it at all, but rather letting it run its course. Spiritual practices like meditation work for some, especially when combined with exercise. Psychotherapy is another option, either with or without anti-depressants. Drug therapy alone is also productive. For example, lithium can be taken as a preventative of sorts. For cases of clinical depression, ECT, electroconvulsive therapy, is sometimes used. Some studies have shown therapy plus anti-depressants to be the most effective treatment. The good news is that depression does run its course, often regardless of treatment method. As May Sarton, who chose not to do anything about her depression, wrote, "Has it really happened at last? I feel released from the rack, set free, in touch with the deep source that is only good, where poetry lives. . . .It's a real break-through. . . .I can hardly believe that relief from the anguish of these past months is here to stay, but so far it does feel like a true change of mood--or rather, a change of being where I can stand alone. So much of my life here is precarious. I cannot always believe even in my own work. But I have come in these last days to feel again the validity of my struggle . . .” Recognizing depression is key and sometimes the person with depression cannot recognize it for him/herself. We can do each other a kindness by reflecting back changes we might see in one another with some understanding of what they mean. I’ve lived with people who experienced depression and I experienced them as not there, not present, not themselves. At first I took it personally. Perhaps they were angry at me; perhaps they didn’t want me around anymore. After a while one can begin to feel angry and impatient toward someone who is depressed. Remember that song that counsels us to “Pick yourself up, dust yourself off, start all over again?” Or Cher’s words in Moonstruck – “ Snap out of it.” But these reactions, while understandable, miss the mark. A person cannot will him/herself out of depression. What we can do is educate ourselves, offer understanding, facilitate help, and know that depression is, in most cases, a treatable disease.
William Styron wrote: “But one need not sound the false or inspirational note to stress the truth that depression is not the soul's annihilation; men and women who have recovered from the disease--and they are countless--bear witness to what is perhaps its only saving grace: it is conquerable. For those who have dwelt in depression's dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet, trudging upward and upward out of hell's black depths and at last emerging into what he saw as "the shining world." There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair. And so we came forth, and once again beheld the stars.”
And what of anxiety, depression’s distant or not-so-distant relative? Anxiety is a state characterized by mental, bodily, emotional, and behavioral components (Seligman, Walker & Rosenhan, 2001). These components combine to create the feelings that we typically recognize as fear, dread, or panic. The physical part can include heart palpitations, nausea, chest pain, shortness of breath, stomach aches, or headache, trembling, sweating. In our minds we expect a vague and uncertain danger. Our bodies prepare us to deal with such a threat: blood pressure and heart rate increase, sweating increases, blood flow to the major muscle groups increases, and immune and digestive system functions are inhibited. We prepare to escape and avoid the source of our fear. Dealing with anxiety is almost counter-intuitive. For our very avoidance of that which is the cause of our fear only strengthens the fear. I have a great fear of the water and at the same time am so drawn to it. The first time I went snorkeling in the ocean I could not even get in the water because I had such a strong dread that I would not be able to breathe. The leader had to tie me to her with a rope in order to get me to move. Believe me, I held onto that rope for dear life. Toward the end of the session, I pulled on the rope and the other end came floating into my hands. Oh no. Where did she go? I panicked; I jumped up out of the water and flailed around in desperation. Let me tell you, that fear was more real than ever. John George reminds us that “When we're scared of something, . . . we tend to run away from it - avoid it. Our avoiding it, by definition, empowers the fear...legitimizes that it's something we should be scared of. The treatment involves facing it, in a controlled and gradual way - and we then can see that it's not as scary as we thought. The child who won't look in the closet because the Bogey Man is in there stays afraid as long as s/he doesn't look in the closet. Once s/he begins to look in, s/he realizes the Bogey Man isn't really there and s/he can begin to take more control. With this in mind I now do some cognitive behavioral modification in a swimming pool in order to give myself different experiences with water and breathing in water so that my fear can diminish, or at the very least I can handle it better. What kinds of anxiety do you experience? What do you fear? What makes your heart race with dread? What do you avoid? Like the blues, many of us experience anxiety.
Many of us also experience anxiety disorders. Anxiety disorders are long-lasting and interfere with a person's ability to lead a relatively non-anxious life. What is an anxiety disorder? There are several types, including: Panic disorder; Obsessive-compulsive disorder (OCD); Post-traumatic stress disorder (PTSD); Social anxiety disorder; and specific phobias, which are intense fears of a specific object or situation, such as snakes, heights or flying. The level of fear usually does not match the circumstances and may cause the person to avoid common, everyday situations. My mother had a fear of heights that prevented her in later life from walking on a subway platform without assistance because she was afraid she would fall onto the tracks. We first discovered this fear of heights when she took my cousin and me to the Statue of Liberty and had a panic attack while climbing to the crown on an open, spiral-like staircase. We had to be led down by park employees. People with panic disorders have feelings of terror that strike suddenly and repeatedly with no warning. Panic attacks include sweating, chest pain, palpitations, feelings of choking, which may make the person feel like he or she is having a heart attack or "going crazy." I know someone who calls her anxiety attacks “a thousand crazies.”
People with OCD are plagued by constant thoughts or fears that cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions, and the rituals are called compulsions. An example is a person with an unreasonable fear of germs who constantly washes his or her hands. Or one who cannot go to bed without walking around the house checking that all the doors and windows are securely locked lest there be a break-in. If interrupted, he or she will simply begin the entire routine anew. Do you watch the program Monk on TV? He is a detective whose phobias and OCD intensified after the murder of his wife. It’s worth watching because it portrays Monk as a whole person, while not shying away from the OCD.
Post-traumatic stress disorder is a condition that can develop following a traumatic and/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, war, or a natural disaster. People with PTSD often have lasting and frightening thoughts, nightmares, flashbacks and memories, which can be set off by situations that resemble or remind them of the traumatizing ones. We hear about this today with soldiers returning from Iraq, but many of us carry PTSD in our lives.
The exact cause of anxiety disorders is unknown; but like depression, they do not result from personal weakness, character flaws or poor upbringing. Nor do they define a person. I am not my depression. You are not your depression. My mother is not her phobia. Monk is not his OCD. As scientists continue their research, it becomes clear that many of these anxiety disorders are caused by a combination of factors. Studies have shown that severe or long-lasting stress can change the balance of chemicals in the brain that control mood. In addition, anxiety disorders, to a certain extent, run in families, which means that they can be inherited from one or both parents. Moreover, certain life experiences, such as a trauma, may trigger an anxiety disorder in people who have an inherited susceptibility to developing the disorder. Anxiety disorders affect about 19 million adult Americans and most begin by early adulthood. They occur slightly more often in women than in men. Like depression, anxiety and anxiety disorders are treatable. While the specific treatment approach depends on the type of disorder, one or a combination of the following therapies may be used for most anxiety disorders: anti-depressant and/or anti-anxiety medications; psychotherapy which attempts to help people by talking through strategies for understanding and dealing with their disorder; cognitive-behavioral therapy which helps people to learn to recognize and change thought patterns and behaviors that lead to anxious feelings. Therapy also aims to identify possible triggers for panic attacks. Depression, anxiety and anxiety disorders live within us and among us. They are illnesses and we are no more to blame for contracting them than we are for contracting a fever. There is no more shame in going through a depression than there is in breaking a bone. They do not define who we are as people although they can and do affect the quality of our lives. For those of us who have anxiety, anxiety disorder and/or depression, know that they are treatable in many cases through a variety of approaches. For those of us who live with and love people with depression, anxiety and/or anxiety disorder, understanding the nature of these illness will help us cope.
From Auguries of Innocence by William Blake, which inspired the song we sang earlier, “Every night and every morn, Some to misery are born. Every morn and every night, Some are born to sweet delight. Some are born to sweet delight, Some are born to endless night. . . Joy and woe are woven fine, A clothing for the soul divine. Under every grief and pine Runs a joy with silken twine. . . It is right it should be so; Man was made for joy and woe; And when this we rightly know, Thro' the world we safely go.”
May it be so for each of us – through the world we safely go. Despite depression; despite anxiety. With understanding, with courage, with openness. Through the world we safely go.