Welcome to the fourth installment of our conversation about clinical depression amongst nine BCC permas. Parts I, II, and III can be found here, here and here. If you haven’t already read the series overview, please do so before proceeding. If you’re experiencing symptoms of clinical depression, contact a health care professional without delay.
So. Rather than spreading our remaining share-able dialogue across a few more posts, I’ve combined it into one. The conversation begins on the subtopic of treating depression, and segues into a discussion of gender issues relating to depression.
Viola: I go back and forth between thinking that my depression is some unexpected hormonal shift or that it’s fueled by the terrible way I sometimes look at the world and myself. I like medication though I’m not convinced it’s the fix-it tool and I feel the same about therapy. I really like the mix of the two and I think I like cognitive-behavior therapy most out of all the treatments I’ve tried.
I felt huge amounts of guilt and shame before I finally realized I had depression. My apathy, anger, sadness, not-doing-enough-good-works, hating church, BYU, myself–I just thought I wasn’t righteous enough. Or something. So in my mid-20s, when I could finally say to myself, I’m depressed, it was actually a relief. It got really embarrassing to me though when it lasted so long (the first go round took a good 6 mos before things got okay and a year before they were any sort of normal). And it became doubly embarrassing when I had my next breakdown, because what about all the stuff I’d learned from the first go round? Hadn’t I learned anything?
Beatrice: I don’t think the social stigma against taking anti-depressants ever affected me that much. I started taking them at a relatively young age (20), and I was just trying to get better. I went off of them for what I felt were righteous reasons (e.g. not wanting to hurt my unborn and nursing children), and I thought I should be able to survive it through my own efforts. I don’t really remember why I thought that, because it sure doesn’t make any sense in retrospect. I really wished that I could take medication, but I felt that I couldn’t–and the fact that every time I broke down and tried to get pharmaceutical support I was thwarted by my inability to find a doctor (and to some extent, my husband’s disapproval), I just took it as a sign that it wasn’t meant to be. (Funny how even after I stopped being religious, I never stopped being superstitious.)
I’d grown up with a manic depressive mother, and I knew there was more shame in being a crazy person than there was in taking medication to stop the crazy. Even when I was going unmedicated and was trying to pull myself out of my own depression, I would hear people make disparaging remarks about Prozac and it would make me very angry. Most of them didn’t know what they were talking about.
Rosencrantz: It was very hard for me to make an appointment to see somebody. He put me on Paxil and also high blood pressure medication. Medication worked for me. Within a few weeks I started caring about stuff again, and I regained my capacity for happiness. For me it was a big relief to realize I’d been depressed. I was so far beyond the point of caring, I just wanted it to stop. And when the Paxil started to kick in, I was even more relieved. The downside of Paxil for me was that it slowed down my metabolism, a lot. I’ve gained a lot of weight. I don’t miss the guy with high blood pressure who was such a hard charger, and it is wonderful to just let stuff roll off my back. But there is definitely a downside.
I’ve learned that I can control much of the problem with moderate exercise, and haven’t used Paxil for 4 or 5 years now, although I do keep a prescription filled, just in case. I think it is kind of funny how just the fear of it coming back motivates me to keep the meds around.
Beatrice: I wasn’t relieved until the drugs kicked in and seeing the difference it made, I finally understood that there was something wrong with my brain that made me feel the way I was feeling. Up until that point, I was like, chemical schmemical. Whatever.
Ophelia: Yeah, until day three when the SSRI’s kicked in and I suddenly felt like a normal person again, I was very skeptical and even disparaging. But after that it was a relief to me to know I had depression. If it was truly my brain chemistry being wacky, it meant I wasn’t a terrible mother, it meant I wasn’t losing my grip on life and it meant I didn’t *really* hate my kids. Definitely a relief.
Mistress Quickly: For me, too. I couldn’t see how deep and wide my depression was until I stepped outside of it. Once I did, I was amazed. It was like removing a lead jumpsuit I’d been wearing for as long as I could remember, physically and emotionally and mentally. For the first time I could recall, it didn’t feel like a burden to be alive. That burden had waxed and waned according to my degree of depression over the years, of course, but it was always there–guilt, fear, sadness, heaviness that was disconnected to any cause or way out of proportion to what the situation warranted. And the most insidious aspect of it all was the way kept me from seeking and accepting help.
Beatrice: I started seeing a psychiatrist in the middle of my sophomore year of college, so I was 20 or 21 before I tried any kind of drug therapy. The psychiatrist diagnosed me as bipolar, probably because my mother was bipolar and also it was apparently the fashion in those days to diagnose young girls with intense feelings as bipolar. I’m not actually bipolar, I’m just depressed, but that’s neither here nor there. It took a while to find the right combination of drugs–because of the bipolar diagnosis I was taking mood stabilizers as well as an anti-depressant–but by the end of my sophomore year I was feeling happy for the first time in my life. It was remarkable.
I had to change my drug cocktail a few times, but I had been on the same combination of drugs for at least 2-3 years when I got pregnant with my first child. I wasn’t intending to get pregnant, but I didn’t understand that anti-depressants would render my birth control pills useless. Once I was pregnant I had trouble getting useful medical advice about my depression. No one wanted to advise me because no one wanted to be responsible for me continuing with my medication and having my child end up with birth defects and no one wanted to be responsible for me going off my medication and committing suicide. They all seemed rather put out that abortion was off the table. It put them in a very inconvenient position. So here I was pregnant, not wanting an abortion and not wanting to give me baby brain damage or extra fingers, and I pretty much had to find my own way. I didn’t quit my medication cold turkey, but I weaned off it on a much tighter schedule than recommended and I didn’t go back on it after the baby was born because I was breastfeeding.
My husband was against me taking anything while I was pregnant or breastfeeding, so there was no point in going on anything while I was trying to get pregnant, but eventually a psychiatrist convinced him that it would be safe for me to take one of the older tricyclics. It had terrible side effects which I will spare you, and it didn’t help my depression, but I was so desperate to do something–and if I went off it for more than a couple days, I got loopy–that I continued taking it for more than a year before I finally realized I was being stupid in addition to insane.
I suffered through a later pregnancy sans medication, but as good fortune would have it, I just happened to have a post-partum breakdown before leaving the hospital–I don’t remember exactly what happened, but I’m pretty sure there was screaming and throwing things involved–and my midwife didn’t let me check out until I’d accepted a prescription for Zoloft and she’d extracted a promise from my husband that he would make me take it. At my post-partum visit I was feeling much better. The Zoloft worked for a few years, and then it stopped working. I’ve tried several different things since then, and what I’m on now seems to be keeping me somewhat stable. At least there is a marked difference from when I am taking nothing.
Okay, that took a long time to say, but you have no idea how much I’m leaving out.
Falstaff: My diagnosis finally came in the form of being taken in for panic attacks caused by post traumatic stress syndrome. It helped to have a name for it and it was a relief because I thought I had lost my mind. It was horrifying. Meds helped but were unsustainable because the only thing that worked where the ultra harsh 1st generation antidepressants which were much more personality nuking and left me so groggy I could not function.
I feel like I am without options. The new drugs don’t seem to work right. I tried some of the new ones like prozac but they do something strange that makes me stop caring about everything, and my creativity goes to zero. Therapy does not seem like an option because those times I’ve tried it, I just have never felt like I could trust the person.
People tell me that if I tried a little harder or looked harder I would find help, but here’s the catch–I don’t have the mental resources to jump those kinds of hoops. I also know that given the right doctor, they could start playing with meds and find the right one or the right combination. So I complain to friends and trust to their grace to lend a shoulder to let me lean on while I pull forward. Running and good fiction seem to make it manageable because it’s the only time my anxiety is relieved and I don’t feel a doom hanging over my head that will fall at any time.
Mistress Quickly’s description here was perfect, “guilt, fear, sadness, heaviness that was disconnected to any cause or way out of proportion to what the situation warranted.’ Part of the guilt is because I know it’s my fault I’m suffering. If I’d just but a little effort into my treatment all would be well. But I don’t and so am blameworthy for my condition. Guilt. It does come and go and there are times of laughter, excitement and hope. But they are imbedded a matrix of constant anxiety, worry and depression. So I pull myself up by my bootstraps and muddle along. I don’t think anyone around me would peg me for being depressed. But inside? Yeah.
Beatrice: In the years when I was going unmedicated, I treated my depression with exercise. It did help, but it was not enough. One year I was pregnant and sick with various illnesses nearly constantly, and this made exercising difficult, but I kept doing it–5-6 times per week–because I was afraid not to. I already felt terrible, physically and mentally. Imagine how much worse I would feel if I stopped doing the one semi-effective, non-pharmaceutical depression treatment I had. Now I have to laugh at how absurd my logic was, but I do remember vividly how much I felt like I was treading water in those days. I just knew that if I stopped moving, I would drown. And then I fell over a waterfall.
Falstaff: Of late, I’ve been trying meditation and seem to find some benefit from that. I think if I got very serious about it, it might provide some relief.
Mistress Quickly: Meditation has helped me greatly in the past–it’s how I survived a pretty serious episode before I started medication. Meditation is how I discovered the state of peace and calmness that I go to when I’m fleeing the mind vortex. It also provided a new foundation for my spiritual life as the old ways were crumbling. I want to get back into the habit.
Ophelia: It was a revelation to me that anger can be as much of a symptom of depression as melancholy or gloom. My OB gave me Lexapro after baby #3, and within days I felt like a normal person again. It was strange, to look back on the smoking wreckage behind me and see it with clear eyes. The medication worked exactly how it was supposed to, and I maintained my original dose for three years.
Recently, I decided to get off of it, and against warnings, I did a short step-down and then went cold turkey. It wasn’t as bad as some experience, but I did get brain-zaps and heart palpitations. I also got all my feelings back, good and bad. My creativity returned, which is what I was seeking. I have also been quicker to anger, shorter of temper and less patient.
I’m struggling with coming to terms with all this. Am I a mean person, but who has tremendous creativity, or am I a mild person who is patient and loving to my family, but who has little impetus to do anything? My writing suffers, my creativity suffers, the parts of me that make me “me” suffer- and yet I’m a kinder, milder parent when I’m medicated. Which one is the real me? Am I not allowed to have both?
So here I sit. Trying to figure out what to do… And wondering if Van Gogh would have posted his ear if SSRI’s were around…
Desdemona: I definitely experience of a loss of a lot of creative impulse when I am feeling well, but in my case I don’t miss it. Actually I should qualify that. When I am at the bottom of depression, I don’t have any creative impulse and even if I did I wouldn’t have the energy to produce anything. But usually as I am coming out of it, I will experience of burst of creativity related to wanting to purge the negativity I have been experiencing. But even thinking about that burst of creativity, I don’t miss not having it. I don’t self-identify as an artist and I would rather be productive in more practical areas than produce tons of stuff that just expresses my pain (writing, bad poetry, etc). I am conscious of being more “flat” and even shallow when I am well but I have decided that I much prefer it. The alternative is too painful.
Beatrice: Unlike the rest of you, I don’t suffer a reduction in creativity when I’m well. I’m much more creative when I’m well. When I’m unwell, I accomplish nothing, creative or otherwise.
Mistress Quickly: I’m more like Beatrice in this regard. My level of productivity and creativity decreases dramatically with my level of depression, although when I’m mildly depressed I do feel more motivated to express myself creatively, but in melancholy ways. I feel a surge of negative emotion that needs an outlet. When I’m at the ideal pitch of depression (in terms of creativity), this negative energy can be harnessed to produce writing that’s edgy and poignant without being maudlin. But as the negativity increases I’m not capable of creating anything other than melodrama, stuff that could only be valued by people in similar states of pain. A few steps past that, and I’m too incoherent to write anything that even depressed people would appreciate. And a few steps past that, I can’t write coherently at all. I can’t form sentences, written or spoken, without extreme effort.
Desdemona: I was reading about Odysseus the other day. Knowing that he won’t be able to trust himself to resist the Sirens, in the clarity before they get close he ties himself to the mast. Lately I’ve been feeling that way. I start getting an inkling that trouble might be brewing, and I want nothing more than to tie my brain to the mast of reality. To snapshot my current view of reality before it slips away, so I can carry the photo with me into crazyland and have something concrete and outside myself to refer to. If only there were a way to do that.
This is my big struggle with every aspect of life [not only before but] after an episode of anxiety or depression. Even after it is “better,” I feel such a distrust of my own thoughts and judgements. Any time I find myself complaining to my husband about something he’s done, I start asking myself, “am blowing this way out of proportion?” And I just don’t know. This also happens with my health, since that is an area that my anxiety monster loves to exploit. I find myself wanting to go get X or Y symptom checked out, and I worry both that the doctor will say, “What the heck? Why did you ignore this for 2 months, are you crazy??” AND that the doctor will say, “What the heck? Why would you bother me with this stupid thing, that happens to everybody?”
Sometimes I think, this must be what it feels like to get really old, or to be a new immigrant in a different place. Where you never know whether you’re getting taken for a ride or not, whether you’re way more worked up than the situation warrants, or not worked up enough, and you have this sneaking suspicion that you’ve frequently erred in both directions. It’s a helpless, frightening, deeply unsettling feeling. I often don’t feel confident advocating for myself in anything, ironically including seeking treatment for the depression/anxiety itself.
Viola: Desdemona, rebuilding my confidence post-depression is so hard. Both times, though this time in particular, making small talk with people, meeting people feels impossible. I feel like I’m terrible at it, awkward and weird. And I used to be really good at it. I could chat up anyone and now I end up staring at my feet. I think, while my skillz are rusty, this is mostly my anxiety about getting back to normal and not being normal. Also, I’m skittish about everything. I’ve been noticing the last few weeks how nervous I am crossing the street! I flinch every time a car is coming to a stop at a stoplight when I’m crossing the road. It’s like I’ve forgotten how traffic works. I type that and it sounds really bizarre but I think I kind of am bizarre for 6mos to a year post major crash.
My other funny anxiety is that I type things wrong all the time and get words mixed up (like in the way an afternoon special dyslexic kid gets them messed up) and I am convinced there’s something wrong with my brain. I probably did all those things before, typing fast everyone makes errors or says/reads things opposite sometimes but I’m sure there’s something crazily wrong with me. But going in to a doctor to say, look, my spelling’s gone to the crapper and I used to be the best speller ever seems like an embarrassing thing to say.
Anyway, post-depression anxiety. I’m right there with you. I don’t know how to manage it and unfortunately it keeps me inside most days. I get scared knowing that 2 depressive episodes means 3 or 4 or 5. The post-episode regret is overwhelming for me and trying to re-kindle the relationships that I let burn out is hard too.
Mistress Quickly: I ‘m trying to focus on the fact that I’m feeling well right now, and I’m extremely grateful. But even so, I can feel the depression waiting for me. It didn’t disappear–rather, it has been restrained behind a barrier in my mind, and I can feel it pressing on me. And certain paths of thought ring me really close to that bulging sea wall, and I have to be really careful to back away from it. Thankfully, I can–most of the time. I break down periodically and just have to release some of the pressure, but I recover pretty quickly–within hours. Without medication it’s a whole different story. There’s a vortex in my mind that sucks me in. Right now I have the choice to ignore that monstrous presence within myself, thank goodness. I wish I could rescue everyone who doesn’t.
Rosencrantz: Even after it gets better, depression can have lasting effects. For whatever reason, I just am unable to handle stress at work the way I used to, so I am incapable of doing the job which used to provide for us. Our income since the onset of my depression is about 40% of what it was before. It doesn’t seem like it should be so hard — this is the kind of thing that guys do, and the feeling of having let my family down and disappointed them is sometimes almost overwhelming.
Mistress Quickly: I’m glad you’re bringing this up. I confess I haven’t though much about depression from a male perspective, particularly a father’s perspective.
Rosencrantz: Well, one of the first questions the guy asked me when I went into therapy was if I had ever added up how much I was worth in life insurance and then did the math on whether my family would be better off with me dead than alive. He told me that how a man responds to that question is a pretty accurate gauge of how far down the spiral he is. When I told him I did it every day, he got out his prescription pad.
This condition has also complicated my relationship with the church. On one hand, I am very grateful for the way our teachings frame this existence as a time of challenge and learning. None of us can reasonably expect to get through mortality without a few scars, and sometimes those scars will be very deep. This is a fallen world and we shouldn’t be surprised when everything doesn’t always come up roses. Expecting things to go back to the way they were might be just a childish wish. So, score one for the gospel. I also appreciate the rhetoric about men having value beyond making money, even though I don’t think anybody really believes that. Nobody — no. body. — wants a man around who isn’t bring home the bacon, even if he is the nicest guy in the world. The way we have now defined a man’s role as that of provider has reduced men to their paychecks solely, and one of the things I really hate about economic downturns is the way they chew men up and spit them out.
I don’t know what the church could do or should do. Obviously they can’t fix everything. But the approach we use now for LDS employment services is completely inadequate. Write a new resume! Learn interviewing and networking skills! I think it is safe to assume that at least 50% of the men who walk through the door at LDS Employment services are clinically depressed — hell, who wouldn’t be? Large families, wife probably opposed to working outside the home, and a religious culture which emphasizes self-reliance and pulling yourself up by your own bootstraps. These men are looking right down the barrel of something that has the power to really, permanently hurt them. Sooner or later many of them will stay up late at night with a calculator figuring out how much better off the family will be with the life insurance money.
Mistress Quickly: For a lot of LDS women, particularly mothers, depression is tied up with anxiety over adequately fulfilling the prescribed gender role, and it becomes a vicious cycle–I’m worlds apart from the “angel mother” paragon we consistently applaud in church culture, and even though I can logically reject that stereotype I still worry I’m a lousy mother, especially when I’m mildly depressed. And those worries increase my depression, and that increase makes me a much more lousy mother than I actually had been at the beginning. It makes sense that something similar would happen with men regarding their role as provider.
I’m realizing how much more difficult it might be for men to identify and treat depression given the fact that it’s stereotyped as a female thing: the weeping, the guilt, the hormones, etc.
Desdemona: Speaking of which, all week I’ve been having these scary feelings, fleeting thoughts of “just giving up,” getting angry at my kids over nothing, all my weird health paranoias came back, fears of irrevocable damnation, inability to get out of bed or give a flying flip about anything, etc. Then today poof! All gone, bright sunny happy day. And blood. (Sorry, men.) So THAT was it, that’s why all this was going down. And that in retrospect all those paranoias were so obviously not real.
I hate that stupid hormones can do this to me. Gah!!!!
Portia: Ah, me too. I have to keep track or I’d kill myself two days before my period every month. And then, yeah, best mood I’m ever in for two days after it starts.
Ophelia: Me too. Last week I thought I was going insane. Then Monday, poof. Butterflies and rainbows. And red. It really is hellish.
Desdemona: The worst was the first pass through my house this morning. I couldn’t imagine what kind of person would live like this. What a slob!!!
Ophelia: At least we are all in the same boat.
Beatrice: Except for the men, who are all trying to forget they ever saw this.
Viola: I still have melt downs but the whole charting my period and the feelings with PMS has helped a little. I expect to be crazy and that makes dealing with it a little better. Still the whole process of it, how can a little progesterone convince me that my whole world is ending? I don’t know, but every month it does.
Portia: Yeah, I can never decide if it’s a relief that the feelings are a hormone-induced mirage, or if that’s the most disturbing, evil part of the whole thing, that I can’t even, you know, cogito ergo sum, because the whole lofty cogito part can be thrown off by .00000000005 cc’s of some obscure chemical.
Rosencrantz: Someday some smart person is going to do some serious thinking about how our endocrine system interacts with our LDS teachings about agency and accountability.
If I may, I’d like to very, very tentatively and cautiously ask a couple of questions.
[sidles towards the door, just in case somebody throws something.]
With regards to hormone-influenced behavior, do you think one of the possible benefits is that we can develop empathy and patience with each other? I realize that may be looking for a silver lining where there is none. Men don’t menstruate, obviously, but we do things under the influence of testosterone that we invariably regret. Is this comparable in any way to what women experience with PMS?
Ophelia: I don’t know. I suppose it’s possible, but I suspect it’s somewhat more random with men. With us, this nightmare comes every 28-34 days, and it really is terrible, feeling so out-of-control for 2-3 days, and only understanding why when it stops suddenly. Because really, that’s why women menstruate- the hormone rises and rises and then BAM, drops off a cliff. And wham-o.
I have no firsthand experience with what testosterone feels like… but if its anything like how I feel on days 27 and 28, I would give a hearty Hell Yes.
Desdemona: I have no good answers for Rosencrantz. But I absolutely feel the ambivalence that Viola describes here. On the one hand, the cyclical variety of depression is so much better because the abrupt end makes it easy to definitively recognize and dismiss the self-loathing paranoia type thoughts as total bullshit. But in another way it is worse because it would be nice to know that if something worries me that much, it has *some* shred of reality. Not even a shred, and had me that worried, now that’s just embarrassing to be that out of control!
Once I met with a counselor in-office and explained the deal. So he had an appointment to call me every 28 days to make sure I was ok. It was a pretty awesome phone call:
“Remember, don’t kill yourself.”
“Making a note of it, thanks.”
Of course, if I’d actually been suicidal that would have been a completely useless exchange, but I wasn’t. I was just panicky due to coming off a birth control pill based thing (the patch) that has since been pulled from the market for being too high dosed. It’s possible that had something to do with it, though obviously it isn’t the only time I’ve had problems.
Ophelia: I had a bad, bad experience with progesterone-based BC that got pulled too. It sent me dooooowwwwn. I ended up hemorrhaging in my hallway one afternoon and woke to the paramedics and firemen loading me into an ambulance. The hormonal mess sent me into a bad, bad place for a long time. Bad things, those hormones.
Norplant, of course, is now off the market.
Mistress Quickly: I’m really sensitive to progesterone myself. Couldn’t use any hormonal form of BC — the pill made me suicidal and even super low doses like what’s in the NUVA ring had a dramatic unpleasant effect. Makes me realize why that first year postpartum was always so damned hard–breastfeeding keeps progesterone levels high.
Portia: And I’m the opposite–progesterone does great things for me. Pregnancy and nursing are my happiest times, and it’s when I wean the babies that the floor falls out. No wonder doctors don’t know what to do!!
Mistress Quickly: Well, you’ve always been odd, Portia.
Desdemona: I dunno what my hormone deal is. First trimester is very anxious. Second ok. Third trimester until 3 weeks after the birth, I must be insufferably obnoxious to be around, like I’m on superhappy drugs. We’re talking 24/7 “Primary voice” and la la sunshine.
Portia: I’m also totally euphoric postpartum, Desdemona, but for longer. It’s probably why I like newborns so much–I’m manic and don’t need much sleep and I’m in a progesterone and oxytocin-induced state in which I could be mistaken for a typical Mormon woman (Primary voice and all).
Rosencrantz: I have a book written by a guy who specialized in treating men for depression. In his first interview, he asks the man what he likes to do for fun. His follow-up question is: “When was the last time you did that?” Most of his patients answer him with a blank stare, and he says that is the giveaway for men suffering from depression. Is it the same for women, too?
Mistress Quickly: Yeah, doing things I Iove can go a long way in taking the edge off mild depression, and perhaps even help keep it from getting worse to some degree. But if a major episode is coming, it’s going to come. And once I’m over the edge, I don’t have the physical or mental wherewithal to do things that usually charge me up
Rosencrantz: The other thing to realize about this is that for men, porn use often accompanies depression. It was really liberating for me to realize that my depressive episodes correlate strongly with the temptation to take a walk on the wild side on the seamier parts of the internet. When I’m doing well, I find pornos about as appealing as reading the phone book would be. So when I start to experience that temptation, it is an early warning sign to do something about my depression.
I talked to a guy at LDS Family Services about this and he said that is very common for Mormon men. For many of the RM, temple-going type, porn use is a symptom of something else, and very often it is severe depression. Solve the other problem and the porn use goes away automatically. Sure, there are plenty of horndogs out there who just like porn, but for lots of us guys, it’s more complicated.
Ophelia: It’s not only men who feel that way. Just so you know. Men are not alone in seeking out the dark side.
Viola: I think addiction is wrapped in self-loathing which if it’s not the source of one’s depression, it definitely contributes to it and perpetuates it. Drugs, alcohol, eating, shopping, sex, porn. When you’re in the right frame of mind, probably all of those are fine, or good, or enjoyable, but then when you can’t feel better and you’re desperate to feel better, your relationship with those things easily turns pathological.
Mistress Quickly: You’re so right, Viola. So often, self-destructive behavior is rooted in an attempt to feel powerful. And of course, those attempts actually make you LESS powerful. But the lure is so strong, you can’t/won’t see it. And I’m not talking about megalomaniac power, of course. Just the basic human need to have some semblance of control, some taste of “cause” instead of only “effect.” Depression blocks our access to true power by clouding our understanding it as well as our motivation and ability to seek it, and we turn to toxic substitutes. It’s like a self-destruct computer virus.
Viola: Here’s my thing I never thought I would say out loud: Depression makes me want to be sexually deviant. I think it’s because I can’t feel anything and I want to feel something.
Luckily, like with suicide, I’m too tired to ever act on these fantasies, but I have them. I get depressed and that’s what I think about. Ugh, that makes me so sad. And it makes me hate myself. Having the fantasies reinforces that I’m a loathsome person.
Ophelia: Viola, fwiw, I don’t think you’re outside of normal with that. Like you said- you want to feel something- anything– when you’re depressed. Fantasizing about things that seem our outside of what you would typically accept is understandable. There a was a time when there was confluence of bad things in my life, and I went out a did all kinds of things. Looking back, I can clearly see that I just wanted to feel something besides the hurt of my life.
Viola: I know it’s normal but still, this is why I hate depression. It’s normal to want to cheat on the one that you love or want to die. I’m just not pleased with my options.
Mistress Quickly: For me, one of the worst effects of depression on sex is that I seek it out to escape loneliness, but usually end up feeling even lonelier than before. That can be really damaging for a single person as well as for a married one (and for her spouse too–nothing like a post-coital crying jag to build confidence in the relationship!).
Ophelia: Or a post-coital “get away from me!” coupled with a shove. Um, not that I would know or anything…
Jack Cade: An important turning point for me was when I began to see that one of the central problems of my closest and most intimate relationships–the fact that I occasionally masturbated and occasionally stimulated that activity with pornography of one form or another (it may not have been the kind of stuff you pay to see in a Marriott hotel room, but material, images, etc., that definitely, ahem, increased bloodflow)–was a symptom, rather than a cause of my depression/alienation. Actually, there’s a self-reinforcing causal circuitry involved: you already loathe yourself, so you don’t really care about the self-loathing that such behavior will induce (especially for a good Mormon boy), lather, rinse, repeat. So for me, changes in relationship–with family in general and in particular with spouse–were a part of both illness and recovery. I was using masturbation as a kind of self-medication–an easy neurochemical fix that I could control without all the horrifying consequences of, e.g., drugs–but, like drugs, there was a kind of artificiality to it, and this meant that the baseline between fixes was lower.
Biologically speaking, sexual pleasure seems to have been designed to reinforce strong pair bonding. The neurochemical processes associated with sex extend well beyond the sheer physical pleasure of orgasm, and include the less intense but still very real neurochemical state that follows orgasm. I’m told that this is associated with an increase in oxytocin levels, resulting in decreased stress and an increased sense of closeness with the people with whom we experience it. Masturbation triggers the same oxytocin release, but in the absence of the partner with whom our evolution has programmed the chemical release to reinforce committment and enduring emotional bonds. This (along with a healthy dose of extreme guilt-promoting anti-pornography discourse) induces profound alienation, though it can, in its own way, reinforce the pair bond by making the ideal association of sexual pleasure with a committed relationship into an absent but painfully experienced reality. You are reminded in a profound way of your aloneness when you masturbate, and that aloneness is reinforced severalfold when accompanied by the belief that you are committing a grievous sin that estranges you from God and cripples you spiritually. The long and short of it is that masturbation is a very, very unhealthy (though obviously not remotely to the degree of, say, heroine use) mechanism for punctuating or compensating for neurochemical lows.
My therapy focused on less extreme, but nevertheless real and healthy ways of manipulating my neurochemical baseline. Focusing on activities that stimulate pleasure–in my case, intimacy (in wide variety but including sexual) with my spouse, playing with my kids, exercise (especially cardio), stimulating intellectual conversation, temple attendance, reading, cooking, watching movies–choosing which ones were most healthy (in terms of not inducing withdrawals as well as strengthening rather than crippling valued relationships), and using them to restructure my leisure routines in a way that promoted, well, a more (healthily) pleasurable lifestyle. Also, this meant avoiding certain activities–not just masturbation but also anxiety and anger triggers (including certain kinds of blog interaction, and protracted arguments, to which I seem constitutionally prone).
This is all a round about way of saying that my relationships with family–particularly with my spouse–have been a pretty accurate barometer of my mental health. They have figured centrally–as seems usual with this disease, in the whole is-it-a-cause-or-a-symptom fashion–in my depressive, unhealthy times, as well as my recoveries and best times.
Thus endeth the conversation between nine friends, for now. Perhaps in time we’ll resume our discussion and share more of it with you. Thank you for being part of this experience with us.
In conclusion, we offer the words of Andrew Solomon once more:
“Let us make no bones about it: We do not really know what causes depression. We do not really know what constitutes depression. We do not really know why certain treatments may be effective for depression. We do not know how depression made it through the evolutionary process. We do not know why one person gets a depression from circumstances that do not trouble another. We do not know how will operates in this context.
“There are few conditions at once as undertreated and overtreated as depression. People who become totally dysfunctional are ultimately hospitalized and are likely to receive treatment . . . A world of people, however, are just barely holding on and continue, despite the great revolutions in psychiatric and psychopharmaceutical treatments, to suffer abject misery . . . Meanwhile, at the other end of the spectrum, people who suppose that bliss is their birthright pop cavalcades of pills in a futile bid to alleviate those mild discomforts that texture every life.
“In my experience, all the medicine in the world can provide no more than a way for you to reinvent yourself. The medicine will not reinvent you. We can never escape from choice itself. One’s self lies in the choosing, every choice, every day. I am the one who chooses to take my medication twice a day. I am the one who chooses to talk to my father. I am the one who chooses to call my brother, and the one who chooses to own a dog, and the one who chooses to get out of bed (or not) when the alarm goes off, and the one who is also sometimes cruel and sometimes self-involved and often forgetful. . . Thinking seems to me less persuasive evidence of being than does choosing.
“The opposite of depression is not happiness but vitality, and my life, as I write this, is vital even when sad. . . . Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping. For a petrifying instant here and there, a lightning-quick flash, I want a car to run me over and I have to grit my teeth to stay on the sidewalk until the light turns green; or I imagine how easily I might cut my wrists; or I taste hungrily the metal tip of a gun in my mouth; or I picture going to sleep and never waking up again. I hate those feelings, but I know they have driven me to look deeper at life, to find and cling to reasons for living. I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely and sometimes against the moment’s reason, to be alive. Is that not a rare joy?”