And Then It Got Bad
I was sitting in my two-year-old son’s bedroom. It was an unseasonably sunny day in Vancouver, and the blinds had been pulled aside to let the sun stream in. A cool breeze floated through the open window, and carried the occasional chirps of small birds that flitted between trees outside.
It was a lovely, peaceful setting. The thought came: if I were to suicide, this would be the place I would do it.
Just as quickly as that thought came what followed: grief and the horror that I would think such a thing.
But I had thought it. Somehow I had ended up here, somewhere I never would have thought possible. It had gotten bad. The tears flowed freely. It had gotten really bad.
Depression had been a concern for me for a long time, but for the most part, I considered it “manageable”. The dark, rainy winters of the Pacific Northwest would drag on, and at some point, I would feel the sink, the drag, the inner sound of the machinery of my body grinding to a slower, laborious setting.
I’d gotten better over the years at recognizing the onset of depression, and I could often get in front of it. I discovered through a friend’s story that the occasional trip to the tanning bed could vastly improve seasonal affects. And, in fact, I discovered this was a secret trick of many Canadians: tanning beds used as self-medication, often for short bursts of time that didn’t even result in tanning, but still did the trick for mood. Others popped copious amounts of Vitamin D supplements. And, of course, friends in health-conscious Vancouver would often praise proper nutrition and exercise as being essential to sound mental health.
At different points, I tried all of these, and I found all of them effective at combating depression to varying degrees.
Yet, at some point, all of these things gradually became less effective. I don’t know if I’ve had enough time and perspective to say what tipped the scales. But each year, depression seemed to start sooner, and last longer. Each year I beat it back, often more than once a year, but I still beat it. It was frustrating when I would go through it, but I could deal with it. I knew what I was doing.
I stayed home full-time with my son starting in August 2013. It was blissful. Being a stay-at-home dad was something I had always dreamed of but hadn’t been sure if it was even possible. But, while I found it joyful, something began to take a toll. I started to have panic attacks. I became more desperate for connection, and yet couldn’t seem to make connections with people that were healthy. As I spent more time with my son and he continued to learn and grow and get older, I felt more and more of a sense of impending doom, of something approaching that I didn’t know how to protect him from.
Depression had set in again, but this time, it didn’t go away. It just continued to linger and linger, mild and manageable, but constant.
And then, a year later, what was mild depression suddenly changed to something else.
We had gone to visit a friend of ours in Seattle. I don’t know if it was the stress of navigating through someone else’s space that crested me over the edge, or the knowledge that my wife and son were going to go on a trip for a few days to the Olympic Peninsula with my sister-in-law, and I wouldn’t see my son for a few days. Or maybe it was because my wife asked me if I’d ever had thoughts of suicide. Or maybe my brain just happened to run out of its last piece of fuel, the last bit of serotonin it had been holding on to.
Whatever the reason, the fall was fast, and terrible, and to an order of magnitude that I had never before experienced. The change was so great, the depression so deep and debilitating that I was baffled how I could have ever even called what I had experienced before that point as “depression”.
My brain seemed to fill with a liquid buzz of white noise. Focus became impossible. Even basic cognitive processing was difficult. My head ached on a daily basis, and my moods went wherever they pleased. I wept uncontrollably on the floor for no reason that I could remotely discern. There was no coping mechanism. There was no strategy I could employ that seemed to move the needle. Everything I knew to have at least some effect, some improvement, seemed to have none.
Before this point, for better or worse, I had never had a day of therapy, and I’d always been dismissive of anti-depressants. But it did not take long for my perspective to change. I could not do this on my own. I needed help.
And, while I began to act immediately (with the gracious support of a loving partner), it didn’t mean that access to help was immediate. And in the meantime, I got worse.
I had always thought that feeling suicidal took some kind of steady decline. You got sad, you got sadder, you got sadder still, and eventually you ended up in this ball of self-pity where you felt like you wanted to end it. I realize now that was probably more of my judgement about mental illness than anything else, or perhaps my illusion of control. My idea that, duh, of course that wouldn’t happen to me because I would stop it before it ever got that bad, because of course someone could do something about it.
The thing is: when I started to feel suicidal, I can say with honesty that many times, I didn’t feel sad, or at least not any feeling I identified as sad in the moment. I didn’t necessarily feel despairing. Sometimes I felt perfectly rational as I thought that I could really only put up with this feeling in my head for so long, and that at some point, I might need to choose something different. Sometimes telling myself I could exit if I needed to was enough to calm anxiety so that I could get to sleep. I would run through different suicide possibilities at night, or in the shower, not really planning anything, but you know, just knowing just in case.
I began silently and unconsciously adding “if I’m still alive” to the ends of sentences that related to the future. Kind of like the thing with “in bed” that you do with fortune cookies. Only darker. If my wife mentioned wanting to go on a trip somewhere, I would say, “Sure, that sounds nice” (if I’m still alive). Or: “This will get easier when our son is in day care” (if I’m still alive).
And that’s when I realized how dangerous all of this could get, why people made safety plans (which I did), and had people they could check in with (which I started connecting with), and why there were hotlines where they could call at any time (which I called). Because I wasn’t sad, I was depressed. We think of reality as a constant thing. But our idea of reality is a function of our brain. And because my brain had so radically shifted in state, I had no connection to what I would normally consider reality.
Because my experience of the world was suddenly so different, I began to question the nature of the world itself. The more depressed my brain was, the more I felt like the only world that existed was what I could immediately perceive around me. Was there more world than that? What if this was all a simulation? Was there any way I could even prove otherwise? Did other people exist? Did friends exist? How much was illusion?
The brain does a lot of things we don’t think about, until it stops doing those things as well. For instance, when we communicate with someone over text on our phones, we hold an idea of that person based on memory and experience. But when I struggled to hold the idea or access the memory, I suddenly felt I wasn’t sure who I was talking to. Was my wife in the text conversation really my wife? Couldn’t she be anyone? How could I really know?
I was reminded of something Andrew Solomon said in a powerful TED talk about depression:
I discovered, as I talked to depressive people, that they have many delusional perceptions. People will say, “No one loves me.” And you say, “I love you, your wife loves you, your mother loves you.” You can answer that one pretty readily, at least for most people. But people who are depressed will also say, “No matter what we do, we’re all just going to die in the end.” Or they’ll say, “There can be no true communion between two human beings. Each of us is trapped in his own body.” To which you have to say, “That’s true, but I think we should focus right now on what to have for breakfast.”
A lot of the time, what they are expressing is not illness, but insight, and one comes to think what’s really extraordinary is that most of us know about those existential questions and they don’t distract us very much.
— from the TED talk: “Depression, the Secret We Share”
It’s true: I couldn’t prove the world existed, or prove that in any given moment, it was my wife who was in fact texting me. But that thought had never really bothered me before.
Terrifyingly, all of this rapid decline had happened in a matter of weeks.
Eventually, the medication started to kick in. In online forums about depression, people often describe Celexa as a miracle pill. Many go from debilitating illness to normal human functioning in a matter of weeks or sometimes even days, which is pretty incredible if you think about it, and kind of rare for severe illnesses we treat. Different SSRIs (serotonin specific re-uptake inhibitors) work in varying degrees of success with different people, since brain chemistry is by no means the same between individuals. And it’s also amazing since we don’t know exactly how SSRIs work, just that they seem to. Sure, we have strong theories, but it’s difficult to know what the brain is doing chemically without getting in there and extracting chemicals, and you usually don’t want to do that on a live human if you don’t have to.
For me, it wasn’t quite a “miracle”, as the change seemed excruciating and slow, but, in reality, that was probably more my impaired perspective than anything. After about a month of medication, I was in a much better place from where I started, and I’m still on an upward trend.
In some ways, I feel lucky. Some people have to try several medications before one works. Sometimes it pushes them the other way and they have to be hospitalized. I happened to be amongst the more fortunate in that I was in the larger percentage where the negative side-effects of an SSRI were almost non-existent and the benefits were great.
Am I out of the woods? No. The damage from depression can take a long time to recover from, as can retraining the brain to produce a healthy range of chemicals without the aid of anti-depressants. Some people need anti-depressants for the rest of their life, just like some people take insulin, and some people need eyeglasses. The body is a complex mechanism, and we often assume we’re more in control of it than we actually are.
But I do feel I will be out of the woods someday. And yet I know even when I am, there will still be the need to retrace my steps: to find the traumas and triggers and stressors that kicked me over the edge in the first place. Through therapy, I already know way more than when I started. I know a lot more about what caused the feeling of impending doom, and I have a much better idea of how much was happening unconsciously for the last number of years. (Let’s say around 30+ years.) But there’s still a lot more to know.
However, at the very least, I’m no longer silently adding “if I’m still alive” to the ends of sentences. So, you know, that’s good.
Recently, I had a dream, where I discovered (in a house I was living) a cavernous basement that I never knew existed, that had accumulated piles of rubble and pests, all of which needed to be cleared out in order to restore what was once a beautiful, entertaining space.
In the dream, I knew it could be done, and that I was up to the challenge, but I knew the truth of it: there was a lot of work ahead.
Connect with Matthew Dean on Twitter: @matthewdeaners.
