Sunday, June 6, 2010

I Talk to the Real Experts About Depression (That's You)

From my keynote to the Kansas State DBSA conference in late April ...

Okay. This is going to look like I’m going off on a tangent, but the Yellow Brick Road zig-zags, so bear with me. We’re here, in Kansas, at a DBSA conference. Which means just about all of us here have experienced depression. So - can anyone here give me a one-sentence description for depression?

It sucks.

[More answers ...]

A deep dark hole.

Like having two doberman pinschers waiting for you to get out of bed in the morning. You aren't going anywhere.

It's like you're worthless.

You're on a raft, in the middle of a huge ocean, you can't see any land anywhere, on any horizon, and you're totally becalmed.

It's like trying to walk through mud up to your neck.

And I've got some insights on Kansas mud. Cuz I talk to my mud. I live in southern California where the soil is loose and sandy, and if you get it on your pants and shoes you just go - choot-choot-choot. So three days later, I see some mud from three days ago on my pants, and it's like, "C'mon, mud." And the mud talks back to me - just like skunks - and says, "oh yeh, you people on the left coast, you who eat panini, where do you think the flour from the wheat of that panini comes from? You treat me with respect, and next time you talk to me you address me as sir."

So, that's Kansas mud.

When I'm depressed, I get agitated and angry a lot. I used to joke - because I only got my driver's license two years ago after not driving for 30 years - I get road rage a lot and I don't even drive. Some of you feel like that with your depressions? Okay ...

I just don't want to be here anymore.

I told my doctor a while back, I'm not suicidal; I'm homicidal.

That's me. That's why I'm proud to be crazy. Seriously, I hate these politically correct people who want to take crazy away from me, because that's how I choose to describe myself. Anyway ...

I think especially for a lot of guys, it's withdrawal and grouchiness.

Another one - lack of motivation, total apathy. Okay, we've got a pretty good list here. Now, how many have heard of the DSM, the DSM-IV? Unanimous consent there. Great. Now, as you know, the DSM is a piece of fiction put out by the American Psychiatric Association ... We got a consensus on that.

As you may recall, there is the world famous symptom list. You know, five of nine symptoms. But first, you have to have one of two, okay? So get this - I'm going to read this out - here’s number one, for depression:

“Depressed mood most of the day.”

I'm trying to figure the logic here. Describe depression to me. Depression is - depressed mood most of the day.

Have you ever tried to describe what carrots taste like to someone who hasn't had carrots? Oh, carrots, you know, carrots - they taste like carrots.

Right, that really tells me a lot. I’m depressed. And I’m depressed because - I’m depressed. But what is my state of mind? What are my feelings? What are my emotions? What are my moods?

Well, the DSM does give the example in "depressed most of the day" of feeling sad. But I’m going to put this to the best experts in the world, which is you guys. Does depression equal sad? I mean we've listened to all these other symptoms ... Right.

Well, maybe the other symptoms can help us out. The other one of that "one of two" is loss of pleasure. We're kind of getting there a little bit, but here's four of them in a row:

Weight loss or weight gain. Oh, great, so everyone who goes to Weight Watchers is depressed. 

Insomnia or hypersomnia. That’s not telling us much. Let’s try the next one: Psychomotor agitation. So we walk funny.

What the ...

We’re not through. Fatigue or loss of energy. You get tired at two o'clock. Big deal.

I’m no expert. I’m a patient just like you. But I do know how to count. So we've got nine symptoms on the list, and make that eight because that first one is just too ridiculous for words. So, we've got eight symptoms, and we only need five to cross the diagnostic threshold for a diagnosis.

And four symptoms are physical. We eat too much or too little. Same with sleep. We walk funny. We get tired. Fine fine fine. So does the entire rest of the human race. Tell us something different.

Tell us what friggin’ state our minds are in. Tell us our thoughts, feelings, and emotions.

No wonder no one can help us. No one has even bothered to open up the hood and look in.

So, get this. You people here - turning out on a Saturday, in Kansas - do you want to read out the list here?

It sucks. Deep dark hole. Like two doberman pinschers waiting for you to get out of bed in the morning. You're worthless. On a raft in the middle of the ocean, not going anywhere, totally becalmed. Like walking in mud up to your neck. Just don't want to be here any more. I'm not suicidal, I'm homicidal. Withdrawal and grouchiness.

Is that a better list than the DSM list? Congratulations - you guys have beat the best psychiatrists in the world. Give yourselves a round of applause, here.


Tony the cretin said...

One item to include: you are guilty of every crime and misfortune, so much so that your vile thoughts are broadcast to every passer-by.

John McManamy said...

Hey, Tony. Your descriptive account of the guilt we feel beats the DSM's clinical description hands down.

Consumer of Mental Health said...

Depression isn't the same as sadness for me. It doesn't feel like sadness. Sadness is something that makes you cry. I usually can't cry. Depression has a different quality altogether, and it's hard to describe with the currently available words for emotions. Maybe it has nothing to do with emotions, because emotions are what makes life rich. Depression is the opposite of rich. It's dull. It's blank. It's monotonous. It's the absence of the stuff that makes up life. Still, it is horrendously painful. I feel like I just don't belong in this world.

Cee said...

I measure my depression by how much emotional pain I feel. Regular people can't understand that emotional pain hurts just like physical pain. What makes it worse even, is that they don't believe it is real or that your suffering is justified. Sometimes it is just an undercurrent accompanying all I do in a day, and sometimes it is front and center. I have started taking Lamictal (in addition to the 400mg of buproprion I take already) and so far it seems to be helping. The way I can tell is that there are more and more days (amazingly!) where there is no emotional pain lurking in the background. I don't have to fight as hard to do things or work so hard to hold in the tears. I'm only at 100mg so far so I still have ups and downs. The bad thing is, now that I know what living without emotional pain feels like, it seems twice as bad when I fall into it again. You would think I would be used to it by now; I've been dealing with depression for 42 years. A month and a half ago my diagnosis was changed to bipolar NOS - I don't meet the time requirements, I'm ultradian. What irony if antidepressants triggered underlying bipolar and made me cycle so quickly that it's not even recognized by the DSM.