Let's be sure that you and I are talking about the same state of mind when we use the word "depression." People sometimes say "I'm depressed" when they refer to a state of mind quite different from the established psychological meaning of the term.
The rock-bottom element in depression is the feeling of sadness. The term "sad" includes without distinction the feelings and moods one might call "melancholy," "blue," "being down," "misery," "grief," "despair," and similar descriptions of negative feeling. The prolonged feeling of sadness, plus the thought "I'm worthless", constitute depression; these two elements are the hallmarks of the depressed person.
A variety of other symptoms are also found in some depressed persons--inability to sleep, disinterest in sex, inability to work, for example. But these other symptoms are by no means universal. If we stick to a definition of depression as sadness plus low self-esteem, we will be clear and unconfused about the subject of this book. And you will find it easy to check yourself against that definition, with the aid of the detailed descriptions of sadness and the sense of worthlessness in the definitions and case histories that follow.
A sense of helplessness, often with a sense of hopelessness, accompanies or is part of the sadness and lack of self-regard in depression. The helpless attitude might be considered part of the core of depression. A rigid set of "ought's" and "musts", and a absence of pleasurable experiences, frequently are important constituents, too.
Prolonged sadness and depression felt to me -- and others have used similar language -- like living in a pool of pain, feeling helpless to escape from it.
Some sadness is inescapable and normal, of course; life without sadness would not be human. But the subject of this book is the state of sadness which does not pass as fast as it "ought" to, and the person who stays sad longer than is "reasonable." The words "ought" and "reasonable" are troublesome, and we'll come to them later. For now let us simply think of depression as a state of sadness sufficiently intense and persistent that the depressed person might consider seeking help to get less sad. And in depression, thoughts of personal worthlessness ("low self- esteem") are more frequent and intense than most people experience.
Similar descriptions of depression--or "melancholia"--have been given from ancient Roman times until now.1
Here are some depression cases as seen and described in capsule by psychotherapists: The depressions are mostly much more severe than you are likely to suffer, but they should be instructive nevertheless.
A young housewife:
Margaret ... was young, about twenty- five and married, as she said, to a very fine man. She held a job which she found fairly interesting and about which she voiced no complaints. In fact there was nothing about her life that displeased her, yet she said she suffered from chronic depression. I would not at the outset have said that Margaret was depressed, because when she came into my office, she always smiled and talked about herself very excitedly in a high-pitched voice. No one meeting her for the first time would guess the nature of her problem unless he was astute enough to see that her manner was a mask. If you ob- served her carefully or caught her off guard, you would notice that at times she became very quiet, and as the smile faded, her face grew blank.
Margaret knew she was depressed. It required an effort of will simply to get up in the morning and go to work...There was an inner emptiness and a lack of real pleasure...Her smile, her volubility and her manner were a facade pretending to the world that everything was all right with her. When she was alone, the facade crumbled and she experienced her depressed state.2
A 25-year-old engineer, who said:
"I feel as though I'm dragging myself down as well as my family. I have caused my parents no end of aggravation. The best thing would be if I dug a hole and buried myself in it. If I would get rid of myself, everybody would be upset for a time but they they would get over it. They would be better off without me."...
After graduating from college, he had had a suc- cession of jobs and had started a small business that failed. He was not doing well in his current position and was certain that he would be fired within a few days. He experienced a gradual loss of self-confidence as his work did not seem to mea- sure up to the expectations of his employer. Two days before his psychiatric consultation he received notice that he would be fired. He became very dis- couraged and experienced a complete loss of appetite and considerable difficulty in sleeping. He thought of various ways of killing himself, such as taking an overdose of pills or throwing himself from a high building.3
A middle-aged single woman:
Anne was an intelligent woman who had been suc- cessful alike in her career and her creative pursuits. With the collapse of her morale, work became difficult and her creative urge diminished. Several other factors contributed to her collapse, but all were related to the loss of the feeling of femininity and womanhood.
When I first saw Anne, she looked collapsed. Her body was flabby, her muscles lacked tone, the skin of her face sagged, her color was poor. She lacked the energy to breathe deeply and her constant comment was "It's no use." When a patient utters these words, what he generally means is, "It's no use trying. I can't make it." But I had the impression that Anne was saying, "It's no use living. I simply can't make it."4
And another woman:
[A]lmost continuously depressed for more than twenty years...That was the story Joan told me when she first consulted me. She was in her early forties, twice married and twice divorced. She had a child from her first marriage who was now away at college. Joan lived alone, but this didn't trouble her. She was disturbed, however, by a lack of desire to do anything and by the loss of interest in her friends. She found it painful to be with people, even those she had known for many years. She felt that her life was empty and meaningless.5
A mother whose children have grown up:
Recently a middle-aged woman presented herself... Every day, she says, is a struggle just to keep going. On her bad days she cannot even bring herself to get out of bed, and her husband comes home at night to find her still in her pajamas, with dinner unprepared. She cries a great deal; even her lighter moods are continually interrupted with thoughts of failure and worthlessness. Small chores such as shopping or dressing seem very difficult and every minor obstacle seems like an impassable barrier. When I reminded her that she is a good-looking woman and suggested that she go out and buy a new dress, she replied, "That's just too hard for me. I'd have to take the bus across town and I'd probably get lost. Even if I got to the store, I couldn't find a dress that would fit. What would be the use anyway, since I'm really so unattractive?"...
Up until last fall she had been vivacious and active, the president of her suburban PTA, a charming social hostess, a tennis player, and a spare-time poet. Then two things happened: her twin boys went away to college for the first time, and her husband was promoted to a position of much greater responsi- bility in his company, a position that took him away from home more often. She now broods about whether life is worth living, and has toyed with the idea of taking the whole bottle of antidepressant pills at once.6
A college girl who "had everything":
Nancy entered the university with a superb high- school record. She had been president and salutator- ian of her class, and a popular and pretty cheer- leader. Everything she wanted had always fallen into her lap; good grades came easily and boys fell over themselves competing for her attentions. She was an only child, and her parents doted on her, rushing to fulfill her every whim; her successes were their triumphs, her failures were their agony. Her friends nicknamed her Golden Girl.
When I met her in her sophomore year, she was no longer a Golden Girl. She said that she felt empty, that nothing touched her anymore; her classes were boring and the whole academic system seemed an oppressive conspiracy to stifle her creativity. The previous semester she had re- ceived two F's. She had "made it" with a suc- cession of young men, and was currently living with a dropout. She felt exploited and worthless after each sexual adventure; her current relation- ship was on the rocks, and she felt little but contempt for him and for herself...
She was majoring in philosophy, and had a marked emotional attraction to Existentialism: like the existentialists, she believed that life is absurd.7
Now here are some autobiographical descriptions of depressive states and personalities. If you have become frustrated by people who have never been depressed pooh-poohing the pain you are suffering - which often happens - show them these descriptions.
Perhaps the most famous depression is that of Hamlet: Oh...that the the Everlasting had not fixed His canon 'gainst self-slaughter! Oh, God! God! How weary, stale, flat, and unprofitable Seem to me all the uses of the world!
The Psalms contain some of the most affecting cries of pain that have been written. Consider Psalm 22, lines 2 and 3:
My God, my God, why has Thou forsaken me, And art far from my help at the words of my cry? O my God, I call by day, but Thou answerest not; And at night, and there is no surcease for me.
Psalm 22, lines 7 and 8:
But I am a worm, and no man; A reproach of men, and despised of the people. All they that see me laugh me to scorn; They shoot out the lip, they shake the head:
Psalm 22, lines 15, 16, 17, 18, and 19:
I am poured out like water, And all my bones are out of joint; My heart is become like wax; It is melted in mine inmost parts. My strength is dried up like a potsherd; And my tongue cleaveth to my throat; And Thou layest me in the dust of death. For dogs have encompassed me; A company of evil-doers have inclosed me; Like a lion, they are at my hands and my feet. I may count all my bones; They look and gloat over me. They part my garments among them, And for my vesture do they cast lots.
Psalm 102, lines 4, 5, and 6:
For my days are consumed like smoke, And my bones are burned as a hearth. My heart is smitten like grass, and withered; For I forget to eat my bread. By reason of the voice of my sighing My bones cleave to my flesh.
And Psalm 13, lines 2, 3, and 4:
How long, O Lord, wilt Thou forget me for ever? How long wilt Thou hide Thy face from me? How long shall I take counsel in my soul, Having sorrow in my heart by day? How long shall mine enemy be exalted over me? Behold Thou, and answer me, O Lord my God; Lighten mine eyes, lest I sleep the sleep of death; Bertrand Russell described his youthful depression:
I was not born happy. As a child, my favorite hymn was: "Weary of earth and laden with my sin." At the age of five, I reflected that, if I should live to be seventy, I had only endured so far, a fourteenth part of my whole life, and I felt the long-spread-out bore- dom ahead of me to be almost unendurable. In adolescence, I hated life and was continually on the verge of suicide, from which, however, I was restrained by the desire to know more mathematics.8
Abraham Lincoln:
I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever be better, I cannot tell; I awfully forebode I shall not. To remain as I am is impossible. I must die or be better, it appears to me.9
An English novelist who had made two serious attempts at suicide:
I don't know how much potential suicides think about it. I must say, I"ve never really thought about it much. Yet it's always there. For me, suicide's a constant temptation. It never slackens. Things are all right at the moment. But I feel like a cured alcoholic: I daren't take a drink because I know that if I do I'll go on it again. Because whatever it is that's there doesn't alter. It's a pattern of my entire life. I would like to think that it was only brought on by certain stresses and strains. But in fact, if I'm honest and look back, I realize it's been a pattern ever since I can remember.
My parents were very fond of death. It was their favorite thing. As a child, it seemed to me that my father was constantly rushing off to do himself in. Everything he said, all his analogies, were to do with death. I remember him once telling me that marriage was the last nail in the coffin of life. I was about eight at the time. Both my parents, for different reasons, regarded death as a perfect release from their troubles. They were very unhappy together, and I think this sunk in very much. Like my father, I have always demanded too much of life and people and relationships--far more than exists, really. And when I find that it doesn't exist, it seems like a rejection. It probably isn't a rejection at all; it simply isn't there. I mean, the empty air doesn't reject you; it just says, 'I'm empty.' Yet rejection and disappointment are two things I've always found impossible to take...When I'm not working, I'm capable of sleeping through most of the morning. Then I start taking sleeping pills during the day to keep myself in a state of dopiness, so that I can sleep at any time. To take sleeping pills during the day to sleep isn't so far from taking sleeping pills in order to die. It's just a bit more practical and a bit more craven. You only take two instead of two hundred...
In the afternoons my mother and father both retired to sleep. That is, they retired to death. They really died for the afternoons...But during those afternoons I used to be alive and lively. It was a great big house but I never dared to make a sound. I didn't dare pull a plug in case I woke one of them up. I felt terribly rejected. Their door was shut, they were absolutely unapproachable. Whatever terrible crisis had happened to me, I felt I couldn't go and say, 'Hey, wake up, listen to me.' And those afternoons went on a long time. Because of the war I went back to live with them, and it was still exactly the same. If I ever bumped myself off, it would be in the afternoon. Indeed, the first time I tried was in the afternoon. The second time was after an awful afternoon. Moreover, it was after an afternoon in the country, which I hate for the same reasons as I hate afternoons. The reason is simple: when I'm alone, I stop believing I exist.10
A California woman:
I am 49 years old. All my life I've been a very functional, active person, totally community-involved. I have three children, aged 20, 23 and 29. I was married for five years and divorced, then married 20 years and divorced and remarried once more.
I was a dancer, an Arthur Murray instructor. I did stitchery. I did mosaics. I attended night courses--psychology, architecture and theater classes, I was totally involved and doing.
In April, l976, I was employed selling real estate in an office where my husband, Eddie, was boss. I was totally functioning and happy. But he hated his job so he resigned. When he resigned they said, "Take Gloria with you. You're a team." That was a blow to my self-esteem at the time. I think that's where the clinical depression, the illness itself, was setting in...
I totally lost myself during this clinical depression. I didn't know who this other person was and felt I was going crazy. Where was Gloria? Where was this once-confident person?...
...The worst for me was sleep disturbance-- the inability to get any rest at all, not even one hour's sleep at night. In regular life, I'm not an eight-hour sleeper, I only need four hours of good sleep.
During the clinical depression I thought my husband should get a divorce and marry a young wo- man and live in a tract house and raise little children. So that's what I told him to do...
As my depression wore on, I stopped talking to my friends. I didn't want to tell them I was depressed because I didn't want them to worry about me.11
An English writer:
My wife, who visited me nobly at least twice a week for the whole eleven months of my confinement ...was the only person to whom I dared confide my horrors, and I tried hard to show my train of rea- soning. Roughly it was that I was a sort of opposite of Jesus Christ. Satan's job had been to catch a man, get him to sell his soul to him completely and utterly, like Faust, and then take him down alive into the pit. That was a sort of necessary counterweight to the resurrection of Jesus and the elect. I was the man. But if I could only kill myself, it might blow up the whole Universe, but at least I would get out of eternal torture and achieve the oblivion and nothing- ness for which my soul craved. I did in fact make three attempts at suicide, the most serious of which was when I tore myself from my attendant and threw myself in front of a car, with my poor wife, who was visiting me, looking on.
Although my attempts at suicide failed, they had one satisfactory effect; the doctors increased my drugs. As long as I was able to attain unconscious- ness at night (with the aid of three or four doses of paraldehyde), and to maintain a fairly soporific state during the day (with anything up to four tablets of allonal), I could just keep the horrors at bay. My whole conscious effort was now directed towards the aim of putting off the moment when I would disappear finally into Hell...
By this time, say four or five months after my arrival, I had evolved a definite technique to help me in this effort of getting through the days and nights. I had frankly admitted my position. God had turned His back on me and left me to Satan, but perhaps I could persuade Satan to put off the evil day a bit. That was all I asked for, and it seemed to me I stood a chance of getting some postponement if I could worship Satan really properly. So I evolved my own little rituals--they incidentally have little to do with genuine Satanism, which is obviously much more closely associated with my manic periods.
Every night I said the Lord's Prayer backwards, letter by letter, smoking three ritual cigarettes as I did so. By that time the drug I had taken used to begin to work, and I always got to sleep before I had finished the prayer...12
A Massachusetts teacher after he voluntarily went to a hospital community for two weeks:
For weeks I had been coming awake every morning with a sick, empty feeling, with a dread of the long hours before I could crawl back in bed. How could I endure yet another day when life seemed so meaningless, so tasteless, that there was nothing I looked forward to doing? This day was the worst yet: I was still the captive of my depression, and I realized where I was. What would I do with myself all day, confined within this tiny hospital ward? Would I ever get well again, or was this just the first of an endless succes- sion of empty days? I writhed under the covers, I groaned; I crouched in a fetal position, I pounded my fists on the pillow.13
Van Wyck Brooks:
There came a time...when my own bubble burst, when the dome under which I had lived crumbled into ruin, when I was consumed with a sense of failure, a feeling that my work had all gone wrong and that I was mistaken in all I had said or thought...
I could no longer sleep. I scarcely sat down for a year...when I napped for an hour or so I dreamed that I was about to be hanged...All my affections and interests fell into abeyance, and it seemed to me that, where normal depressions occasionally sank to zero, mine sank from zero indefinitely down...
I was possessed now with a fantasy of suicide that filled my mind as the full moon fills the sky. It was a fixed idea. I could not expel this fantasy that shimmered in my brain and I saw every knife as something with which to cut one's throat and every high building as something to jump from. A belt was a garotte for me, a rope existed to hang oneself with, the top of a door was merely a bracket for the rope. Every rusty musket had its predestined use for me and every tomb in a graveyard was a place to starve in. I could see an axe only as lethal and every bottle meant for me something to be swallowed in splinters or to slash one's wrists with, while even the winter snow fell in order to give one pneumonia if one spent a night lying on the ground. Meanwhile, every morning, when I began to sleep again, I awoke with my arms folded over my breast. I had been dreaming that I was dead at last and unconsciously arranged my limbs in the posture of a mummy...
In my crise a quarante ans I shrank from all human relations...14
Leo Tolstoy:
It had come to this, that I, a healthy, fortunate man, felt I could no longer live: some irresistible power impelled me to rid myself one way or other of life. I cannot say I wished to kill myself. The power which drew me away from life was stronger, fuller, and more widespread than any mere wish. It was a force similar to the former striving to live, only in a con- trary direction. All my strength drew me away from life. The thought of self-destruction now came to me as naturally as thoughts of how to improve my life had come formerly. And it was so seductive that I had to be wily with myself lest I should carry it out too hastily. I did not wish to hurry, only because I wanted to use all efforts to disentangle the matter. 'If I cannot unravel matters, there will always be time.' And it was then that I, a man favoured by fortune, hid a cord from myself, lest I should hang myself from the crosspiece of the partition in my room, where I undressed alone every evening, and I ceased to go out shooting with a gun, lest I should be tempted by so easy a way of ending my life. I did not myself know what I wanted: I feared life, desired to escape from it; yet still hoped something of it.
And all this befell me at a time when all around me I had what is considered complete good fortune. I was not yet fifty; I had a good wife who loved me and whom I loved, good children, and a large estate which without much effort on my part improved and increased, I was respected by my relations and acquaintances more than at any previous time. I was praised by others, and without much self-deception could consider that my name was famous. And far from being insane or mentally diseased, I enjoyed on the contrary a strength of mind and body such as I have seldom met with among men of my kind; physically, I could keep up with the peasants at mowing, and mentally I could work for eight and ten hours at a stretch without experiencing any ill results from such exertion. And in this situation I came to this-- that I could not live, and fearing death, had to employ cunning with myself to avoid taking my own life.15
Sylvia Plath's fictionalized account of a young author who had already tried suicide and who would soon kill herself:
I was still wearing Betsy's white blouse and dirndl skirt. They drooped a bit now, as I hadn't washed them in my three weeks at home. The sweaty cotton gave off a sour but friendly smell.
I hadn't washed my hair for three weeks, either.
I hadn't slept for seven nights.
My mother told me I must have slept, it was impossible not to sleep in all that time, but if I slept, it was with my eyes wide open, for I had followed the green luminous course of the second hand and the minute hand and the hour hand of the bedside clock through their circles and semi- circles, every night for seven nights, without missing a second, or a minute, or an hour.
The reason I hadn't washed my clothes or my hair was because it seemed so silly.
I saw the days of the year stretching ahead like a series of bright, white boxes, and separating one box from another was sleep, like a black shade. Only for me, the long perspective of shades that set off one box from the next had suddenly snapped up, and I could see day after day after day glaring ahead of me like a white, broad, infinitely desolate avenue.
It seemed silly to wash one day when I would only have to wash again the next.
It made me tired just to think of it.
I wanted to do everything once and for all and be through with it...
That morning I had tried to hang myself.
I had taken the silk cord of my mother's yellow bath- robe as soon as she left for work, and, in the amber shade of the bedroom, fashioned it into a knot that slipped up and down on itself. It took me a long time to do this, because I was poor at knots and had no ideas how to make a proper one.
Then I hunted around for a place to attach the rope.
The trouble was, our house had the wrong kind of ceil- ings.
The ceilings were low, white and smoothly plastered, without a light fixture or a wood beam in sight. I thought with longing of the house my grandmother had before she sold it to come and live with us, and then with my Aunt Libby.
My grandmother's house was built in the fine, nineteenth-century style, with lofty rooms and sturdy chandelier brackets and high closets with stout rails across them, and an attic where nobody ever went, full of trunks and parrot cages and dressmakers' dummies and overhead beams thick as a ship's timbers.
But it was an old house, and she'd sold it, and I didn't know anybody else with a house like that.
After a discouraging time of walking about with the silk cord dangling from my neck like a yellow cat's tail and finding no place to fasten it, I sat on the edge of my mother's bed and tried pulling the cord tight.
But each time I would get the cord so tight I could feel a rushing in my ears and a flush of blood in my face, my hands would weaken and let go, and I would be all right again.
Then I saw that my body had all sorts of little tricks, such as making my hands go limp at the crucial second, which would save it, time and again, whereas if I had the whole say, I would be dead in a flash.
I would simply have to ambush it with whatever sense I had left, or it would trap me in its stupid cage for fifty years without any sense at all. And when people found out my mind had gone, as they would have to, sooner or later, in spite of my mother's guarded tongue, they would persuade her to put me into an asylum where I could be cured.
Only my case was incurable.16
There is a happy conclusion to the grim reports quoted above. Modern psychology and medicine provide rapid relief to most people who develop the sorts of depressions described in those reports. No more does a sufferer simply have to wait until nature takes it course, or until you can yourself can invent a way to successfully reshape your thinking patterns. Cognitive- behavioral therapy can promise relief to most people within a few months, accompanied by long-run protection against relapse by teaching you how to avoid depressing modes of thought. Drug therapy often provides fast relief of the symptoms, too, though without promising that your depression has been cured.
In view of the large number of depression sufferers -- a larger proportion of the population nowadays than ever before -- these advances must rank as among the most beneficial contributions of science to human welfare.
The chapter describes a variety of cases of depression, often in their own words. The rock-bottom element is the feeling of sadness. The term "sad" includes without distinction the feelings and moods one might call "melancholy," "blue," "being down," "misery," "grief," "despair," and similar descriptions of negative feeling. The prolonged feeling of sadness, plus the thought "I'm worthless", constitute depression; these two elements are the hallmarks of the depressed person.
A variety of other symptoms are also found in some depressed persons--inability to sleep, disinterest in sex, inability to work, for example. But these other symptoms are by no means universal.
A sense of helplessness, often with a sense of hopelessness, accompanies or is part of the sadness and lack of self-regard in depression. The helpless attitude might be considered part of the core of depression. A rigid set of "ought's" and "musts", and a absence of pleasurable experiences, frequently are important constituents, too.