Feeling low?

Beth  has been working on writing about depression. Depression is something I know a little about. I see people in my office everyday who are depressed and I certainly have my own ups and downs with it the way most of us do- maybe even a bit more so as I work my way through my early fifties, that being a time that lends itself to moodiness. One thing I worry about is that between the media,  prevalence of medication and our own declining ability to self comfort the whole damn world is becoming depressed. The expression “I’m depressed” is becoming meaningless. Nowadays it carries about as much weight as saying, “my seven year old son has ADHD.” Well, he can join the other 85% of his buddies who are also tipping over desks and falling into the drinking fountain every time the bell rings. It will pass.

So, too, with most of our depression. It will pass. I worry that the cute little sad guy cloud on the television commercial, the one who, a pill and moments later, is happily bouncing around like a manic widget-well, I worry that he’s the guy with the mood disorder.

I think that our decreasing tolerance for distress combined with our ever increasing demand for the quick, generally external, fix leaves us feeling entitled to no moods. We’re not even satisfied for life to be a bowl of cherries with pits and a few rotten ones; we want life to be pasteurized cherry yogurt with a shelf life of forever.

But then there is serious, clinical depression. The real deal. The “I would rather not be here and everyone would be better off if I weren’t“ depression. One area of depression that I specialize in is post partum depression. My post graduate training, a thousand years ago, was in infant mental health. People used to ask, “how can you do therapy on a baby?” Well, only by doing therapy with at least mother and baby and sometimes mother, father and baby. One reason little babies come to be at risk for mental health problems or begin to fail to thrive is because their mothers have serious post partum depression.

The first time I witnessed true post partum depression was as an intern in a prehistoric backward of a mental hospital. This was in the early 70s before we turned all the psychotic people out on the street to become today’s ambulatory schizophrenics living in homeless shelters. Anyway, I was a snip, merely 23, and I carried more keys on my waist than I weighed. Every door, elevator and stairway had to be unlocked and locked against escape. Three years later we were dumping these same people wholesale out into the street, begging them to escape and go away.

My job was to take histories from patients- family, social, psychological- to try to put together the puzzle pieces that would help explain their current condition. Most of them weren’t talking because the night before, on admission, they had been so pumped full of drugs they couldn’t sit up, let alone deliver a coherent piece of information. After I took a history, or not,  a resident psychiatrist who had English as a fourth language would interview this poor hapless soul in front of a room full of students, interns, residents and nurses.

The dopey patient would be flopped over in a chair and Dr. Kim would say, “Wa mean ‘it in time say nine?’ ” Blank stare. “Wa mean ‘wowing tone gada no mau?’ ” Blank stare. Whoops! More drugs and three weeks for you.  ( A humorous aside is that at one time we had 3 Dr. Kim Lees,  2 Dr. Lee Kims,  a Dr. Kay Lee, and Dr. Kee Lim on staff. With one Dr. Ronald Johnson who was 89 years old and himself catatonic.)

One day I unlocked and locked my way onto the ward and went into the day room ( no one had any privacy) to interview a young woman who had been admitted overnight. She was in her early 20s, Chinese, tiny and sobbing uncontrollably. This in itself was an unusual display of emotion in this particular place. I also noticed that the entire front of her shirt had wet stains covering her breasts. Her English was almost non-existent but I was able to finally, between some scratchy admission notes and an hour of “fifty questions,” figure out that she had recently moved from China with her husband, leaving behind her entire extended family in the small village where she had lived her all her life. Most importantly, she left behind her mother. Every other sentence was punctuated with a wail for her mother. Eight days before admission she had given birth to a girl (uh-oh). Her husband, a beginning engineer, was absorbed with work 18 hours a day and added to that , he was keenly disappointed to have daughter. This poor woman lived in an apartment building in Wayne, Michigan (uh-oh)  and the baby cried endlessly. Day after day she spoke to no one.

I knew nothing. I was a first year social work intern. She was my fourth ever “patient”.
But I surely did know that she was depressed. I could see it, hear it, feel, it, And as we spoke I had a few ideas about what might help it. She needed her baby with her. She needed someone to sit with her while she nursed her baby to talk with her, comfort her, “nurse” her. She needed someone else to admire that baby and think she was wonderful and beautiful. She REALLY needed her mother with her but that wasn’t going to happen. She needed someone who spoke her language besides an overworked and disappointed husband. She need an interpreter to help bridge the gap between her and her husband, her and the rest of her new world.

I was so full of fresh enthusiastic social worker “do good” that I went back to the basement office I shared with 4 other students and spent the day calling pediatricians, public health nurses,  the Chinese-American Association in the greater Detroit area and her husband. By the end of the day I had a fairly workable plan and I went up to talk with Dr. Lee about it. I was so full of inspiration and energy I looked like that widget on Zoloft.

And at the end of the day, this is what she got: Anti-psychotic drugs. Three weeks observation. No babies allowed in the hospital. At the end of the first week she had stopped speaking,  one breast had dried up, one was still engorged and infected and her husband had flown with the baby back to China.

That was my first real experience with and understanding of true depression. Endogenous (biochemical), situational, institutional,  professional. After that I thought I fully appreciated the concept of depression.

Not so. Seven years later I would suffer a relatively brief but very severe post partum depression following Dan’s birth. The treatment and the outcome for that poor woman and myself would be as different as night and day and my appreciation for true depression would be solidified.

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8 responses to “Feeling low?

  1. I will have to talk to you more about this.

    I have struggled with depression my entire adult life– sometimes very severely, and sometimes only as severely as immobilization (except to get up and teach at the university, when it was at its worst a few years ago– the worst I ever experienced though, was the spring before the winter I left my husband– big surprise).

    I went to my doctor and demanded that he test my thyroid, which he did, but he said, “Jen, you’re depressed.” And I started to cry. And refused medication.

    Until right before COB that Friday. I started Celexa that day, and within a week, I knew who I was again.

    I have tried weaning myself off the Celexa, slowly, four times in the past few years. Each time, I was faced with anxiety, general scatteredness and inability to focus, and the general sense that my psyche has been rubbed raw. After a few weeks or six weeks of this, depending, I started taking my meds again.

    And it helps me be normal and functional, so I have made my peace with being on it, because to be off it means that I have a lot more struggles. I will be sitting on my front porch on a sunny day and have anxiety I can’t place.

    It is possible that a lot of the depression and anxiety have been situational, but after a year of therapy, my therapist’s conclusion was that I didn’t need to talk anymore, I understood what was going on pretty well, but that I might benefit from an anti-depressant (and still, I resisted).

    Diagnosing myself, which I know is not valid, I would say that I am actually a happy person who has some chemical tendencies toward depression. The meds help me. I am very grateful to have them. So, maybe I have ADHD or a mood disorder or anxiety problems rather than actual depression, which, as you said, passes– but regardless of the diagnosis, the cure seems to be the Celexa. It’s working for me, at a very low dose.

  2. Yes, I would say you know what true depression is. I do also. Hit me as soon as I got off prednisone. And its definately not something you can just ‘get over’. There are many different types of depression, and the one I understand – isn’t “real”. Its just your brain being bad. It comes without any reason and sits heavy on the brain for days. Things that you normally wouldnt think about now weigh 1000 lbs., which is hard to deal with because they are strange things and they tear at your heart. Then, one morning, its gone. You’re your old self again and happy as a loon and all is well. You remember you had these depressed thoughts and feelings, but they were from nowhere and mean nothing. You realize that you are in fact sane because you can see this plain as day. And then one day, without notice, it hits again. But because you are a smart strong person, you know its just your stupid brain levels. You are fine and you will get through this. And one thing is certain, drugs make everything worse. Exercise, a healthy diet, meditation, and a strong heart are the only therapy.

  3. Thanks, Spookalot– yes, I remember the first time we compared notes about depression.

    You are braver than I am, living in a world with no meds. I think if I were sure that it would lift in a few days, I would try it, but it doesn’t for me– it is pretty persistent.

  4. I’m going home to recharge so we can continue this discussion. It’s important.

  5. Ahhh Jen. I love you. You and I must have been commenting at the same time!
    PS. My comment was strickly about my own situation. I am very, very happy Celexa has worked for you. My doctor has tried a few times to prescribe things but I have seen how drugs have changed some people I know, and not for the better. They have become so mentally wacked and shake so bad you cant read their handwriting. Not the case with everyone, but it scares me. I believe I had problems as a child growing up, as I was known to say quite often, “my nerves are bothing me” – but that coming off prednisone after 2.5 years started the whole ball rolling, so refuse to take more drugs.

  6. Uh oh. What have we started here? Group therapy?

  7. Thanks, vicki! That’s all I can say, just thanks!

  8. Like an Overheard Story

    There’s this thread going on, this muttering sense, of something not right with how we are as a society..

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