Hey, I'm tired and grouchy, so what the hey...
First up is the
family I just passed on the sidewalk outside. Their small boychild was
outfitted in brightly colored shoes that emit a high-pitched squeal
with every step. It's intentional; it's as if he had a squeaky toy on
each foot. Dogs like squeaky toys; they sound like prey. So it's kind
of like this kid's family put a big sandwich board on him that says,
"FREE LUNCH FOR PITBULLS!" I don't know who's stupider, the
family for
buying this product, or the idiots who designed it.
Next up we have
the American voters. They've finally registered the fact that Dubya is a wee bit
out of touch with their priorities.
"Better late than never" hardly applies when we're stuck with
the
asshat for another 3 1/2 years. Come on people, like you couldn't have
figured this out in, oh, I don't know... sometime before NOVEMBER
2004!?!?
And
finally... we have Carey Tennis, an advice columnist with Salon.com.
Now, Carey is a subject of some disagreement... some like him, some
find him deeply annoying. Normally, I enjoy reading his stuff... it's
kind of like an existential version of Dear Abby. But today, he really
goofed big time.
If
you don't have Salon access, here's the story: a woman wrote to him and
asked what she should do about her brother, who, in the wake of a
series of major personal setbacks, has retreated to his basement
apartment, no longer appears to eat or bathe properly or interact with
the outside world, and exhibits every sign of major depression and
anxiety. The sister also mentions that she has a history of addiction
and depression, and has been taking antidepressents.
So we have: 1)
all the clinical signs of depression and 2) a familial history of
depression.
So
what does Carey advise? He casually tosses out a suggestion that yeah,
maybe taking him to be evaluated by a doctor would be a good idea.
But then he goes off on a really weird tangent...
It could be that
he is clinically depressed. If at all possible, have him examined. The
stress of events may have triggered an episode. But I must be careful
with such speculation; not only am I unqualified to diagnose, but as a
writer, my bias is toward meaning, not pathology. So perhaps this is
not illness at all. Perhaps it is a kind of journey.
What kind of
journey could it be? You say that he is talented and attractive, but
not proactive, and that his success at work was largely due to the
favorable actions of others. You say that in his first relationship he
deferred to the needs of his partner. That leaves the impression that
he is affable and charming but somewhat passive. Perhaps in the past
whenever he faced adversity he would give up until someone came along
to rescue him. This time there is no one to help him to his feet -- not
his dad, not his wife, not his co-workers -- only you, big sister, only
you.
I always look for
signs that the soul is seeking knowledge. The soul seeks knowledge
through adversity. Sometimes that adversity is self-generated. People
break the law and get locked up; we call it acting out; we call it
antisocial, as if in a perfect world none of it would happen. We do not
often pause to consider the value of our dark journeys, the priceless
material we carry back with us when we return, shaken but sobered by
what we have seen.
While we are
sometimes too quick to assume that abnormality is illness, that
deviation is pathology, as I say, I am no kind of doctor. (If I were, I
would be a crazy doctor crawling in the muck, a scary bearded banger of
bells, a gonger, a shouter, a vibrating and unreliable sage. I would be
applauding the insane as they are led away in wagons. I would not be
the kind of doctor you want to mend an arm or fix a tooth.) So, again,
you should have a real doctor find out if he's clinically depressed, if
he needs to be treated. If he is physically in danger, if he becomes
suicidal, then perhaps to save a life a doctor has to intervene.
But perhaps he is
struggling to accept adversity on his own. Perhaps, stricken by grief,
alone in the world for the first time, he is trying to find out what
difference it makes if he smells bad or not, if he answers the phone or
not, if he succeeds or just sits alone in the dark with his dog.
Perhaps he is on a twisted journey toward self-reliance. Perhaps in
this way he is trying to become a man! As much as I want him to be OK,
I also want to honor his decision to descend into a kind of funky, ugly
madness.
I fired off a letter to the editor suggesting that Carey Tennis might
want to
extract his head from his posterior nether regions (not that I put it
in quite those words) and read another
article that appeared in Salon earlier that week, reviewing a book by
the author of Listening to Prozac, Peter Kramer. His view:
depression is a disease, not an artistic journey of discovery into your
deepest self.
...Research in the past decade (since "Listening to Prozac"
was
published) suggests that serotonin and similar neurochemicals may ...
serve a protective function. They help shield the brain from the
negative effects of the stress hormones that prompt the body to respond
to threats. Certain brains are rendered particularly vulnerable to
stress hormones by genetics and sometimes, in addition, early childhood
trauma. This kind of brain loses the ability to protect and heal itself
from the effects of those hormones, and also loses the ability to turn
off the production of the hormones. The stress response system can get
stuck in the "on" position, eventually weakening and diminishing
nerve
cells and further eroding the brain's capacity to cope with the
hormones. This vicious circle results in clinical depression.
The manifestations of the disease include "low mood, apathy,
diminished
energy, poor sleep and appetite, suicidality, loss of the capacity to
experience pleasure, feelings of worthlessness," and so on. Some
depressed people can't sleep; others sleep way too much. Some feel
misery; most feel something closer to emptiness. But the cause, Kramer
maintains, is measurable organic damage to the brain, damage that
prevents the brain from repairing itself and leaves it ever more
susceptible to further damage. This is why often very slight stressors
can incapacitate a depressed person or trigger an episode of
depression, and why a third or fourth episode is harder to treat than
the first.
Rather than seeing depression as arising from a lack of certain
chemicals, Kramer defines it as a deficit in resilience, the ability to
bounce back -- neurologically and emotionally -- from stress. To treat
depression you don't pump the afflicted full of artificial happiness,
you restore their ability to absorb and recover from the unavoidable
bumps, knocks and tragedies of life. That's why, Kramer feels, doctors
should vigorously treat depression (using a combination of medication
and psychotherapy), as soon as possible. Delayed or insufficient
treatment risks further weakening of the brain itself...
...[T]reating depression doesn't consist of changing someone's
personality,
but of restoring it. Genetics and early trauma might have set Margaret
up for depression, by making her brain more vulnerable to stress, but
the depression was not her fundamental self, or a window into buried
feelings -- in fact, it was quite the opposite.
So while the
depressed brother may indeed need to take a journey through his
innermost depths, it's kind of hard to do that with an impaired brain.
If someone wrote
to Dear Abby and said, "Hey, my brother has stopped eating and he
keeps
talking about his stomach hurting, and he's throwing up blood," I'm
reasonably sure Abby would say he needs medical treatment... no
caveats, no "but I'm not a doctor!", no reservations, no
theories about
what psychological trauma might have set off the condition. Just the
recognition that there's some illness at work, and illnesses get worse
if they're not treated. But as usual, when we're talking about the
brain, somehow that's a license to go off into woo-woo territory. It
seems deeply irresponsible to me.
(One last thing
that is stupid: Salon's search engine. I kept trying to find that book
review. I typed in "depression" and then I tried "mental
illness" and
totally failed to find it. I had to go back to an email I'd sent to
myself with the article in it.)
Updated to add: looks like I'm not alone in my assessment of the
column! (http://tabletalk.salon.com/
webx?14@357.9MVjarbiw0M.10@.773a837c/4147)
I was infuriated by Cary's response to today's LW. Debilitating
depression is not some groovy shamanistic state wherein one journeys to
the Dark Gods and returns armed with arcane knowledge. It's a miserable
fucking illness. As with all illnesses -- or other pesky setbacks on
what Cary would probably call the Glorious, Agonizing, and Unknowable
Road of Life -- some people are ultimately able to emerge with
new-found strength and certainties, forged by the Fire of Adversity
into more powerful beings. And many people just get made into toast.
What's next? Hurrah for cancer! Bring on diabetes!
I'm
sorry, this is bullshit adolescent romanticism at its most repellent.
Depression is an illness, and one of its calling-cards is its ability
to persuade those suffering from it that they are doomed to misery,
that brighter lives are not an option, and that all attempts at help,
change, therapy, etc. will be fruitless, irritating, and serve only to
deepen everybody's sense of disappointment...
All
those copies of Bullfinch's Mythology, The Golden Bowl, and R.D. Lang
that Cary has sitting on his desk, marked with jaunty little Post-Its?
They need to be forcibly confiscated. And then he needs to spend a
little time on the locked ward of a county hospital and see just how
much those poor souls and their exhausted, tapped-out caregivers come
in for applause.