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“HAVING IT ALL” IS NO PROTECTION FROM DEPRESSION: PART 1, DEPRESSION IS NOT THE SAME AS BUMMED OUT!

The suicide of Robin Williams is scary. It makes us feel vulnerable. We like to think that things make sense in this world. In our rational minds it makes sense that if someone has career success, an Oscar, a wife, children, passion, compassion for others and the kind of financial success most of us only dream of–that these are enough to keep the monster of depression and suicide at bay. The sad truth is that they’re not. One of the most difficult aspects of depression is that it attacks the rational mind and makes it as difficult to see the positives in one’s life as if one has a blindfold on. The best advertisement I ever saw for antidepressants was a cartoon of a little person in a cave. He was looking down in the dark and he couldn’t see but we could see that behind him up above was a window with light shining through. That is a great representation of depression and the essence of the difficulty of trying to reach someone once they are in this cave of despair. The truth is that no one is immune from the ravages of severe depression.
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The lack of empathy and understanding that I’ve seen on social media in the wake of this suicide is, I believe, the attempt–by some–to protect and try to distance us all from its fearful reality. Comments like, “What a coward, he had everything to live for,” or, “How selfish, he should have thought of his family,” are appropriate if referring to a person in control of their rational minds who is not mentally ill. People who are depressed are not rational, they’re struggling with an illness–mental illness. Let’s try to really understand what this means. If someone has cancer we don’t expect them to behave as we behave. We understand they have an illness that may impair them significantly. We aren’t surprised that they aren’t running marathons. We see and we understand, or we try to. When we see someone has lost all their hair due to chemotherapy treatments we grasp that there’s a lot we don’t know about other peoples’ experiences. Let’s try that approach with mental illness.

As with discerning a difference between the flu and cancer, we must try to understand the difference between feeling down, as if you’ve had a depressed day or week and severe, possibly recurrent depression. It would be helpful if like how Eskimos have several words for ‘snow,’ we had several words–or maybe qualifiers–for ‘depressed.’

For example,
“It’s raining outside; I feel depressed level 1.”
“My girlfriend broke up with me; I feel depressed level 6.”
“My husband of 50 years died; I feel depressed level 8.”
Or,
“I have severe, recurrent depressive episodes and I feel suicidal;
I am DEPRESSED level CATASTROPHIC and LIFE THREATENING!”

In an ideal state, aside from us all having the same language for degrees of depression, there would be treatment centers like some of the nice drug rehabs out there by the beach or somewhere in nature. A place where insurance covers someone severely depressed or suicidal being in a safe place that is not scary or traumatic. Here teams of professionals assess and treat clients as either inpatient or as outpatients but, regardless there’s individual therapy, group therapy, family support, a psychiatrist prescribing meds as needed–in consultation with the rest of the team. In the safety of this center the proper medication is found and the proper level reached until the crisis of severe depression has passed. When it is time to leave there are safety plans made by all pertinent players involved and care and follow up would continue after going home. Maybe this would decrease the numbers of suicides. It’s hard to pull these pieces together in the real world but it would be best. It would also be helpful if as a society we put our money where our mouths are. We can’t talk about the tragedy of suicide and mental illness and still have people who can’t find or afford therapy or psychiatrists. We can’t have the only option for inpatient treatment for depressed and suicidal people be general mental health wards in hospitals where they are traumatized by psychotic patients with schizophrenia.

And the most disheartening reality of all is that even with my nirvana of treatment facilities in place with all my fellow professionals caring and treating, some people are still going to kill themselves. Someday we will have treatments that take effect immediately but right now we at best have to ask suicidal people to hold on for weeks or months until the medication starts working. This can be almost impossible for the person who has the devil of depression whispering in their ear that they are a burden to those they love. This devil lies and tells people their loved ones will be relieved they are gone, that things will never get better and that bills can never be paid off, that no medication is ever going to help but there is a certain way to end the pain: death. The devil of depression is much louder than we are. I wish I could tell you in some concise, pretty way the exact recipe that will keep someone alive during this dangerous time. I hope that I can be louder than the depression, that there is a sliver of hope to connect to and try to spark. Treatment can do this. And treatment can fail. Sometimes there is no one to blame. Our best hope is to get in there before the depression gets too strong a hold and to try to be prepared so if it comes around again the battle plan can be easily retrieved.

Next, part 2—the Plan.

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