As in chronic pain, depression is a signal gone awry. Normally the physiology of grief is a relief--how it felt when I cried at my daughter's viewing and memorial. Tears were cleansing and healing. In depression the body's gone on automatic; behaviors initiated by grief become automatic behaviors. The constant state of ill feeling that accompanies this has been christened "dysphoria" by psychiatrists, roughly the opposite of euphoria.
Normally depressive symptoms should signal a need for change in one's environment or relations; it is a warning that you are headed the wrong way. But in the case of the manic-depressive, depression can strike when all circumstances are good and there's nothing in your life you would change or could change to make it better.
An example: I left my first wife after thirteen years when the marriage had been dead for a good while. I couldn't bear to leave my young daughters but I had to leave for my mental health. When I took that step my depression continued on for maybe eight months, irrespective of the changes for the better in my life. If I were physically able to return to the practice of medicine it would only feed my self-esteem if I were euthymic (normal mood). In times of depression I would think myself incompetent no matter how competent I was. This is why therapy doesn't work for bipolars in general. If they get better, their mood was rising anyway. If they get worse, perhaps it's the wrong therapy. I have a poem about this:
When my soul was sanded so raw
the capillaries couldn't even seep,
I questioned the value of pain.
"You must experience your feelings of abandonment
until you are comfortable with them," you said.
When my suicidal doppelgänger
turned me inside out, pulling my anus
through my mouth, you said,
"Now that you are stripped of defenses
you have a better chance of changing them."
When I called you up one weekend
to say I was terrified of inanimate objects
like doorknobs and tea kettles, you said,
"Stay with it. Globalized fear indicates
a necessary therapeutic regression."
Finally the antidepressants kicked in
and I felt like myself. When I left
you gave me another card
since therapy was “unfinished”
and I might be back
on your couch or another’s.
I gazed at your office figurines,
crystal leopards and pewter trolls,
porcelain ballerinas and kachina dolls,
and imagined the souls of all your patients
trapped inside them-- those, who like me,
sought relief through words
when only medicines would do.
I could have been the glass giraffe.
(published in Poetry Magazine)
Even so I'm open to therapy. Perhaps it might help, it just never has. The most popular and successful therapy in depression is Cognitive Behavioral Therapy, which is a fancy word for cheering someone up with positive thoughts and actions, limiting negative self-talk and the like. But I am cynical about the process; these sorts of things require a kind of blind faith which I lack. I see through the fog of words to the truth: unless one believes in a good God as the basis for loving oneself and others, on what can you base positive thoughts? Because it works, I suppose is the practical answer, though not to date on this patient.
One temptation in depression is thus a mad rush to change things. But I can't think of a single major thing in my life I'd want to change (except for the universal complaint that a little more money would be nice). I do want to be busier. I'm presently training to be a hospice volunteer. Anything that gets me out of the house is welcome.
In my first great depression as an adult, during my last year at UCLA, I worked three jobs and took a full course load just to fill every available waking hour, but it didn't help a bit. Still it is better to be in motion than becalmed. And becalmed is what I feel right now. I don't have enough to do. My back limits how much I can do physically, which isn't much beside walking. It limits how long I can sit at this computer. As I said at the outset, chronic pain is akin to depression. The signal that warns us of injury won't shut down long after the injury is "stable." Pain only concentrates the mind on pain, it doesn't concentrate its powers because of it. As I write I must suppress the signal from my lumbar spine, a deep ache, a gnawing cold, a steady burning.
Although I have been technically disabled since 1996 (I can hardly believe it) I have never psychologically accepted my condition. If I attempt gardening for an hour I am quickly reminded of the severity of my chronic pain and don't recover from the new insult for several days. I make a devil's bargain with pain; the pleasure of an hour's weeding translates into several days of increased suffering. Ah, but I have flowers! Experiences like this ought to convince me but somehow my self concept won't yield to the idea of disability. I always thought my condition would be temporary; I never dreamed I would have gone without money-earning work all this time. It makes me feel guilty for how little I've accomplished: over 500 publications and three books (one edited). You may say that's something and it is, but if a dedicated writer had had this time to write he would have written more, perhaps garnered commercial success and gotten off disability. As my main metier is poetry, it is unrealistic to expect that could ever happen. But I suck at fiction, with the exception of a few short stories. Sure, as a poet I've had minor successes, but I haven't been able to crack the glass ceiling of the best journals. In my present rejection folder I have ten rejections from Poetry. Yes, I've sent out another submission to them.
What am I saying? I wish there were something in my life I could change to escape depression. My experience has taught me that all I can do is wait for the drugs to work, or change the drugs until they do. It's a helpless position. Every organism wants to believe it can save itself somehow but I can't save myself from this disorder.
So I blog. And I'm endeavoring to write a poem a day during poetry month (April). I'll post today's below.
I cannot speak for you any longer
you have worn me out
to say my gullet is straw
would understate the matter
your brains are shielded
I cannot continue to rent your ears for nothing
here is a law I know
one ought not to expect too much
one ought not to invest in impossibilities
like speaking for the human heart
there are many possibilities
witness the runnels carved in desert rock from scarce rains
I wanted to tell you
I wanted to speak with you
but no one listened
my words were superspeciated
to extinction. I sought too hard
to make it all comprehensible, to sugar the pill
nothing to wash it down
take for your audience no one
perfect your art for God
you do not get your name in lights
by sheer force of talent
like some porn star with a big dick
unless you’re also lucky
luck has the power to deliver you
unto the scribes and judges
or celebrate your inevitable talent
your screaming genius
you this week’s anointed flavor, featured fabler
O how I wanted to speak
with you and to you!
but I was not anointed
consigned to honky-tonk
the sawdust floors, vinyl tablecloths
beer bottles heaved at screens, glass sprays the open mic
I pray someone speaks for you,
some poet without jealousy
or concern for himself who manages
to cobble together a voice
from all the technotwitter gabbing garbled
into the ether like drugged birds--how he must simplify!
how he must remind us
that our souls are in God’s keeping
and our lives should demonstrate
muster and meaning, bluster and shock
and a thirst for righteousness
this sort of talk is what turns editors off