Understanding Depression

A blog made me cry yesterday. A legal blog made me cry yesterday. I have been reading this particular blog, Popehat, for a long time and have always found it to be interesting, informative, thought-provoking, and funny. However, for all that I have come to expect undiluted awesome from the good folks at Popehat, I was not prepared for this article. It is titled: “Three Things You May Not Get About the Aaron Swartz Case”. This, for those of you who don't know, refers to one of the architects of the internet, his prosecution, and tragic suicide. I'm not going to go into the case here, but please read up on it. 

The first two-thirds of “Three Things You May Not Get About the Aaron Swartz Case” addresses misconceptions about federal sentencing and the idea that Aaron Swartz was singled out by our government. However, the last third talks about something that those of you who read my blog know I talk about a lot: depression. This is the section I want to focus on.

I want you to know, Dear Reader, that I started crying while reading Ken's description of what it is like to live with depression. To me it is spot-on. I shared it with a friend yesterday and after reading it he expressed a degree of shock that it is really “that bad”. It is hard for anyone who hasn't lived with depression to really grasp how “bad” it can be. I get that. I don't really expect anyone who doesn't live with it to “get” it in the visceral way. That is one of the most isolating and difficult things about living with a mental illness like depression.

However, I know that for me one of the best feelings is the sense that someone, somewhere, “gets” it. It helps me feel less alone and that, that is what I want to share with you all today. I contacted Ken over at Popehat and asked for his permission to re-post the depression section of his article and he kindly said yes. I hope that reading this helps anyone who needs that understanding today as well as those of you who are seeking better idea of what it is like.

What follows are Ken's words, not mine.

“The Third Thing: People Assume They Understand Depression. Most Don't.¹

The third thing people don't get is depression.

People think that the prosecution of Aaron Swartz must have been unusually oppressive and abusive, becausSe only a rare abuse of power could have driven such a brilliant and promising young man to suicide. People saying that may have been depressed at some point in their life — but they haven't experienced the disorder major depression.

I have. I've fought it for fifteen years. People — people of good faith, sensitive people, thoughtful people, smart people — don't tend to fathom major depression if they haven't had it.

Depression is not like sadness. Everyone has been sad. Everyone has been depressed on one occasion or another. But clinical depression is something else entirely.

What is it like?

Forgive me, but I'd like for you to imagine the worst day of your life. Maybe someone you love was killed in an accident. Maybe a loved one got a terrifying diagnosis. Maybe you abruptly lost a job you need to support your family. Maybe you caught your husband or wife cheating on you. Maybe you found out your son or daughter is addicted to drugs. Maybe you experienced some dreadful public humiliation.

Remember how that felt, at the worst part of that day? Now imagine you feel that way most of the time, for months at a time.

Think of the most stressed and worried you have ever been in your life, and then imagine that your stomach feels like that all the time.

Imagine that you are constantly gripped with overwhelming feelings of dread and crushing hopelessness — irrational, not governed by real risks or challenges, but still inexorable.

Imagine that you are often fatigued to the point of weakness and irritability because you can't get to sleep until late at night, or because your mind consistently shakes you awake at four in the morning, racing with worry about the day's activities as your stomach roils and knots.

Imagine that most social interactions become painful, the cause of nameless dread. Imagine that when the phone rings or your computer dings with a new email you get a short, hot, foul shot of adrenaline, sizzling in your fingertips and bitter in your mouth.

Imagine that, however much you understand the causes of these symptoms intellectually, no matter how well you know that you are fully capable of meeting the challenges you face and surviving them, no matter how well you grasp that these feelings are a symptom of a disease, you can't stop feeling this way.

Imagine that you have moments — maybe even minutes — where you forget how you feel, but those moments are almost worse, because when they end and you remember the feelings rush back in like a dark tide that much more painfully.

Imagine that you know you should talk to someone about how you feel — but you can't bring yourself to do so. Have you ever been so nauseated — from illness or from drinking — that you can't bear for someone to touch you or talk to you? Imagine feeling like that — that the human interactions that might ease the pain are too painful to endure, that every word on the subject is a blow.

After a while, this wears you down a bit.

I can't know what was in Aaron Swartz' mind. But I know this: if he suffered from major depression, it may not have been the prospect of federal prison that was intolerable. It might have been the prospect of thinking about the case, about talking about it, about the weight of people's concern for him, about the crawling discomfort of answering their questions, about the brutal fatigue of putting on a game face every day.

If Aaron Swartz had major depression, he might have felt overwhelmed by far less unusual or frightening stimuli. That doesn't exculpate the government. The government is responsible for an unjust prosecution. But the depression may have taken Aaron Swartz' life.

Depression doesn't look like you think it does.

Some people think that Aaron Swartz must have been driven to suicide by extraordinary treatment because he didn't act the way a depressed person at risk of suicide acts. They think, correctly, that Aaron Swartz was an extraordinary man: brilliant, very accomplished at a young age, with a gift for winning people over. That's not what a depressed person looks like, is it? Surely someone in enough pain to take their own life would be more overtly distressed, more visibly unable to cope. Surely someone who finds human interactions so difficult would not be so good at them.

In fact, people with major depression are capable of great things, including great leadership. Consider these:

Abraham Lincoln once wrote, "I am the most miserable man alive. To remain as I am is impossible. I must die or get better." Winston Churchill echoed the same reaction when he told his doctor, "I don't like to stand by the side of a ship and look down into the water. A second's action would end everything. Is much known about worry, Charles?"

This is good, in a way: it means that depression is not an impediment to achieving great things. But it also means this: you might not be able to tell if someone suffers from depression.
People with depression become very adept at maintaining good appearances. Consider what this brave reporter wrote during her paper's series on mental health:

I have been hospitalized twice for “suicidal ideation,” most recently for eight days in 2009 with a diagnosis of “major depressive order and anxiety disorder,” according to my records. I take four medications a day and have my counselor’s name and number in my emergency contacts on my cell phone.

This will be news to most of the people who know me, family members included. That’s because with lots of help from my husband, a lot of exercise (one of my therapies) and medication, I’m able to keep my depression and breakdowns private.

. . . .

Most people with a mental health disorder are able to manage their illness, many so well that our disorders are invisible outside our homes. With the help of counselors, medication, even hospitalizations, we work, raise families, volunteer in our communities, run companies, hold elected office and go to school with little indication of what’s at work inside us.

And even inside their homes . . . even to those closest to them — people with depression can put on a brave face. Aaron Swartz' girlfriend believes that his death was "not caused by depression," in part because he did not show the familiar signs of depression in his last days. I mean her no disrespect — she has my profound sympathy for her grief — but she might not know, even if she knows him better than anyone. She might not fully grasp how he felt. That's not a reflection on her, or on her relationship with Swartz. It's a reflection of depression. Many loved ones will learn to see the subtle signs. For instance, my wife interrogates me when I stop blogging for a while. But being close to someone with depression is not the same as having depression yourself, and doesn't mean you really understand it. My wife is the love of my life and my best friend and a talented and remarkably empathetic clinical psychologist. But she doesn't fully get it, and I pray she never will, because she hasn't experienced it. Not everybody shows overt mood swings. Not everybody retreats from the world. Some people soldier on, their outward face may not reflecting how they feel. Many people with depression don't want to burden loved ones with the depth of their feelings. Many don't want to discuss their feelings because that human interaction is so painful in the depths of depression. And many are ashamed.

Shame is powerful. A ridiculous percentage of the population takes psychotropic medications, but there are still strong social taboos against discussing mental illness, and certainly against admitting to suffering from it. That, too, inhibits people from talking about their feelings. People worry that if they admit to depression, it will be used against them. Indeed, I suspect that this post will be used against me, if not by a litigation opponent than by one of my various stalkers. (Come at me, bro!)

My point is this: it's a mistake to conclude you know about how Aaron Swartz felt because you observe how he acted and what he achieved. It's a mistake to use Aaron Swartz' tragic suicide to measure the nature of the government's prosecution with him. There are many things to condemn in that prosecution, and further inquiry may reveal serious misconduct. But if someone suffers from depression, you can't infer things from their reactions the way you can from someone who doesn't suffer. It's very difficult, if you haven't experienced it, to imagine what it feels like, and even more difficult to imagine how it distorts your reaction to stress. I don't mean to excuse prosecutors. I mean to point out that life is complicated. It's entirely possible that, simultaneously, the government wantonly overreached and that Aaron Swartz' death was driven primarily by a pain that would have tormented him even if he had never been charged.

If people reacted to Aaron Swartz' death by becoming concerned with how the criminal justice system treats everyone, and by being open to discussions of how depression changes people, that would be one more way he left the world better than he found it.

(By the way, I'm just fine. Thanks for asking.)”

1Excerpt from “Three Things You May Not Get About the Aaron Swartz Case” by Ken at Popehat.