Tuesday, December 7, 2010

Rerun: Depressed or Thinking Deep - My Take

From Nov, last year. Enjoy ...

Therese Borchard of Beyond Blue always has a way of making me feel that on a planet of six billion strangers I have at least one person I can talk to. Last week, she opened a blog piece this way:

I spent my adolescence and teenage years obsessing about this question: Am I depressed or just deep?

When I was nine, I figured that I was a young Christian mystic because I related much more to the saints who lived centuries ago than to other nine-year-old girls who had crushes on boys. I couldn't understand how my sisters could waste quarters on a stupid video game when there were starving kids in Cambodia. Hello? Give them to UNICEF!

Now I look back with tenderness to the hurting girl I was and wished somebody had been able to recognize that I was very depressed.

See what I mean? I just know that had we been in the same class at grade school, while the other kids played ball during recess, Therese and I would have found a quiet spot to sit under a shade tree, sharing cookies our moms packed and discussing how Augustine of Hippo must have felt after Alaric the Visigoth sacked Rome in 410 AD.

So, what was it? Were Therese and I two sensitive souls waxing philosophical, or two depressives acting strange? Therese cites both Paula Bloom PsyD (from a blog on PBS) and Peter Kramer MD, author of "Against Depression" (from a NY Times piece) in support of the proposition that depression and thinking deep are clearly distinct. Says Dr Kramer:

"We idealize depression, associating it with perceptiveness, interpersonal sensitivity and other virtues. Like tuberculosis in its day, depression is a form of vulnerability that even contains a measure of erotic appeal." First the ancient Greeks, then Renaissance thinkers, and later the Romantic movement assigned spiritual and artistic and even heroic virtues to melancholy. Nonsense, Dr Kramer responds. "Depression is not a perspective. It is a disease."

If I interpret Therese correctly in her blog piece, she found comfort in this. It came as a great relief to her to realize that her capacity to think deep, even at a young age, although unusual, was not pathological.

I, on the other hand, have an entirely different reaction. "Wait!" I want to scream at Dr Kramer. "You mean my depressions have all been for nothing?" My lost hours, lost days, entire lost years, a lost life practically, served no useful purpose whatsoever?

Screw you, Kramer! I want to keep screaming for no logical reason, whatsoever. Something that took so much from me, so much out of my life, I demand some kind of return - Jedi powers, a mystical third eye, roll-over phone minutes, whatever.

Yes, Dr Kramer is right, but so is everyone else. When it comes to the enduring question - Who the hell am I? - we are all struggling to find the truth. Here's what I'm looking at right now:

Proposition One: Any depression that is not part of my temperament sucks - whether mild or severe. Take my depression - please. They throw me off my game, ruin my day, wreck my life. Whether it's a depression that is the equivalent of a mild cold or one that is psychic double pneumonia I seriously don't want to be inside my brain on this planet when my neurons have gone on strike. If this is the disease that Peter Kramer is talking about, I'm behind him one hundred percent.

Proposition Two: At the same time, mild to moderate depression is part of my temperament, my personality (as is hypomania). As opposed to my disease depressions, I'm very comfortable in this state. It is a part of who I am. My energy is down, my thoughts tend to be very dark, but - here's the key difference - I thrive in this state. My neurons are working with me, or perhaps me with my neurons. It's as if I'm calmly sifting through the ideas I rounded up in my hypomanic frenzies, whether I'm lying in bed, at my desk, or taking a walk. If this is Dr Kramer's version of just thinking deep, I would have to respectfully disagree.

What we are talking about is the classic distinction between "state" and "trait." Trait is who we are. State is invasion of the brain snatchers. But no distinctions are ever as clear-cut as they seem.

We tend to get hung up on DSM-IV check lists while ignoring a key DSM injunction - namely that we are only in a state of mental illness when the symptoms interfere with our ability to function (as in work or relationships). So - from my personal perspective - if I am comfortable and not struggling while depressed, then I hardly have an illness that needs treatment.

Now let's flip it. I also get hypomanic, and I've written a lot about this. Here's the test: For Marilyn Monroe to act like Marilyn Monroe (at least when she's up) - that's normal, for Marilyn, anyway. For someone else to act like Marilyn Monroe, on the other hand - that's probably a sign that very bad things are about to happen.

So, back to depression. For me to act like me (when I am down), under most situations that is normal for me. I can handle it, it is healthy. For someone else to act like me, trust me, that is cause to get one's personal affairs in order.

Here's where it gets complicated. When does my productive depression start becoming a nuisance and when does this nuisance seriously start messing me up? Similarly, when does my upbeat hypomania cross over into social embarrassment and in turn morph into something that causes me to make very bad decisions?

It's as if we're turning up the heat. When, in effect, instead of a nice warm soak in the tub, do we find ourselves in hot water? Everyone has different tolerance thresholds, and you can make a good case that we can expand the range of these thresholds to lead healthier lives. Of course, every time I congratulate myself on doing this, God just laughs and throws a psychic lightning bolt in my direction.

So - my normal would probably cause most people to stay in bed for six months, or (in the other direction) have neighbors dialing 911.

One more twist. In her blog, Dr Bloom reported on this confused reaction from a patient: "When I reflected to her that she sounded depressed she said 'I don’t think so, that is just my personality.' So many people confuse depression with just being a lazy, unmotivated person."

So our depressed state tends to give us a wrong read on our baseline traits. Who the hell are we? It's a question I'm still trying to figure out.

Therese is my fellow terminal deep thinker and favorite blogger. Please check her out at Beyond Blue.

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