Monday, March 24, 2014

Not Your Everyday Depression

Nobody wants to hear they have it.  A lot of people don't even believe it exists.

"Chronic clinical depression."

Technically, the "chronic" part means it's recurring.  "Clinical" means that it's been identified as something that exists.  And we all know what "depression" means - or, at least, we think we do.  The folks who say we're talking about simply having a bad day are the ones who think the whole idea is bogus.

But is it?  I'm one of those people who's been diagnosed with chronic clinical depression, and I've come to understand that the more we understand how these three words represent the problem they're trying to name, then the whole concept of medically treating long-term depression becomes less abstract.

Why?  Well, for starters, I don't just have the blues.  When I was diagnosed, I wasn't upset over the loss of something, like a relationship, a job, or my health.  At the time, I wasn't facing imminent financial peril, although I certainly am now.  Everybody has stressors in their life, and everybody responds to them in different ways, and in various intensities.  We grieve, we fret, we hate, we complain, we worry, we become sad, we become ambivalent.  Sometimes we panic.  Yet "normal" people rarely become crippled by these emotions for long periods of time.  "Normal" people don't dwell on the idea of killing themselves as a way out of these persistent emotions.  These are the differences between having a bad day - or a bad year - and having chronic clinical depression.

When two different evangelical psychiatrists here in the Dallas area both independently confirmed over a several-year period that I indeed have chronic clinical depression, they based their diagnoses on a broader set of quantifiable emotional disorders.  These disorders exhibit deviations from what could be expected from ordinary reactions to ordinary stressors.  For example, these doctors evaluated my history of crippling panic attacks, my pervasive fear of being physically alone, the fact that I used to be on a suicide watch, and several other personal factors which I still want to keep private.  Frankly, I've been such a reluctant patient over the years, I don't recall everything they did to render their diagnoses, but I do remember being satisfied with their explanations, even if I didn't particularly welcome the idea of having chemical problems inside my brain.

Chronic clinical depression, after all, is widely believed to be a medical problem.  Not just an emotional one.  Studies suggest that it involves levels of a chemical called serotonin, a neurotransmitter that helps send messages throughout our brain.  Unfortunately, the fact that science has yet to discover irrefutable proof of this causal factor simply lends more credence to skeptics who deny the reality of chronic clinical depression.

My fears of being physically alone, ironically, coexist with my preference for solitude, and although I've had periods in my life where I'm more socially active than at other times, I have to force myself to work harder at my people skills than is normal.

Which brings us to another problem with having this diagnosis.  What is "normal" for you might not be normal for me, and vice-versa.  To an astonishing degree, we are all unique individuals, and "normalcy" is a state of being that is shaped not only by biology and DNA, but also culture, and social expectations.  Skeptics could claim that people like me are simply being too hard on ourselves - or, not hard enough.  Conformity is one thing, but celebrating our individuality shouldn't be punitive.  Just snap out of it and get on with life!

But if that were as easy as it sounds, wouldn't most of us with this diagnosis already be doing that?  You think this is fun, or rewarding?

Believe me, this isn't a good way to get my ego stroked, or my fretful half-baked brain cosseted with attention.  I may have to work hard at interpersonal relationships, but I seriously doubt that paying a therapist or a psychiatrist to listen to your problems serves as a suitable substitute to having people befriend you without being paid to do so.  I can't remember how many years I spent in therapy, but those were not happy hours that I spent struggling to come to terms with my problems in front of somebody watching the clock.  In fact, finally, my last therapist, an earnest fellow who plied me with scripture during every session, literally threw up his hands and told me I could answer all his questions, and even come up with applicable scripture for my problems as well as he could.  Therapy wasn't helping me, he admitted, and I needed to spend my rapidly-dwindling financial resources on medications we knew worked.  And most of all - we needed to trust God for His sustaining - and hopefully, healing - grace.

I haven't been back to therapy since.

That's another problem with having this diagnosis.  It doesn't have the immediate impact like "you have cancer" can.  With a cancer diagnosis, you may want a second opinion, but not only is there usually no social stigma with it, you can ask all of your friends to pray for you.  You don't need to hide it.  And even if you get a second opinion, you need to act quickly, and decisively, to get the cancer treated.  With clinical depression, things can go on for years - and that's why they call my form of it "chronic."

Yet another problem is that a diagnosis of chronic clinical depression isn't nearly as objective as "you have a broken arm."  With a broken arm, there are x-rays and other obvious diagnostic tests to help confirm why your doctor is saying your arm is broken.  So you have an operation, or your arm gets put in a cast, and as it heals, you can watch its progress.  With clinical depression, unless you have the money to pay for expensive brain scans and high-priced specialists, very little of one's problem is ever visible.

Currently, my prescriptions are being monitored by the family practice doctor I've had since I was a teenager.  He monitors my vital signs through regular check-ups, and he's willing to give me the benefit of the doubt as I trust in my "Higher Power" for help.  So far, this arrangement has established a plateau of sorts that, while not optimal for the sort of productive "normalcy" I'd like to have, has lifted me above what I used to endure.  After all, sometimes progress has to be measured not in what you've done, but what you haven't done.  Like suicide.  Some days I struggle with it more than others, but as time has gone on, I believe God has taught me more about trusting in Him, rather than in my emotions.

Suicide is one of those elephants in the depression room that none of us likes to talk about.  And I'm not going to get too personal here, either, except to give you a little background about how it plays into my diagnosis.  Suffice it to say that I began suffering from bleak, life-ending desires after some particularly troubling emotions were triggered by an unstable domestic situation while I lived in New York City.  I'd never entertained such thoughts before, but they were pervasive, and almost tangible.  I'd stand in the street, a foot or so away from the sidewalk, and marvel at how closely - and how fast! - those lumbering city buses would shoot past the tip of my nose.  Just one more step...!

When I eventually caved, and admitted I needed some sort of help, it was my first therapist - at the time, the only born-again psychotherapist in the entire city of New York - who put me on suicide watch.  I had to call her message service and check-in every morning and every evening for about two weeks.  That was when she told me she would either contact my parents in Texas, saying she was absolving herself of my personal safety, or I would have to go on Prozac.

I'd been fighting her on the Prozac thing - until her ultimatum.  At the time, I thought taking Prozac was akin to admitting I was a heathen unbeliever, because I didn't trust God to deliver me from the sin of panicked fear.  For my prescription, my therapist sent me to a secular psychiatrist on Central Park West, who officed out of the swanky lobby of the building where Arnold Schwarzenegger and Maria Shriver used to own an apartment.  Like most expensive Manhattan apartment buildings, its exterior was drab and unimpressive, while its exclusivity was best conferred to those granted access inside.  In this buildings' case, its lobby reeked of affluence, with spacious hallways lined by glossy brass paneling - I kid you not.  Walking among those panels almost made up for the doormen who looked me up and down whenever I entered and left, knowing looks plastered on their faces:  yeah, that's one of those nut jobs going to see the quack at the other end of the lobby.

I don't know, maybe that doctor was a quack.  He was Jewish, and a self-professing Freud scholar, who kept asking me if I was sexually frustrated, gay, or mourning some unrequited love.  New York City, after all, can wreak havoc on a young person's love life.  Especially if I was gay, he kept hinting?

I'd relay my conversations with this high-dollar shrink to my Christian therapist, back down in her rickety Greenwich Village walk-up, and she'd roll her eyes and apologize - he was the only doctor she could find in the city who was willing to give Bible-based psychotherapy any sort of chance.  Oh well.  I enjoyed those floor-to-ceiling walls of brass panels.  I have to say that I sure felt important entering and exiting that luxury building across from Central Park, even if it was only tourists on the sidewalks along the park who thought I might be somebody!

These days, I understand that Manhattan is oozing with Christian psychiatrists and psychotherapists, thanks in no small part to Tim Keller's Redeemer Presbyterian Church, and the emphasis they've placed on servicing the legions of Millennials and Gen-X'ers who've flocked to Gotham.  That's likely one of the reasons skeptics of clinical depression are skeptical:  it seems as though a cottage industry has sprung up over the past twenty years to treat what appears to be an offshoot of "affluenza," as more and more urban young people want to talk out their fears and frustrations, instead of grinning and bearing them like their forefathers and foremothers had to do.  After all, is clinical depression suddenly some new disease?  Why does it seem like Baby Boomers discovered it, and their kids are the ones suffering the most from it?  Maybe we're all too spoiled rotten for our own good by all of our First-World problems.  It's just the ones who need to blame something - or somebody - else for their personality issues who are trying to validate clinical depression as something genuine.

Believe me - I've had all of those doubts, and more.  Regular readers of mine know that I can be excruciatingly cynical.  How do I know for sure that the Devil isn't just trying to make me some lazy, dithering, good-for-nothing spoiled brat who'd rather worry about his problems than find a good-paying job and working so much that he doesn't have time to worry?

Because I have to admit:  chronic clinical depression is surprisingly debilitating.  And a lot of people - church-goers in particular - think I'm just being lazy.  They peg me as one of those man-boys we're hearing so much about these days, who doesn't want to leave his Mommy and Daddy's comfortable home, and have to try and make his own way in this big, bad world.  I need a swift kick in the seat of my pants so I don't end up as a drain on society.  I say I'm a man of faith?  Well, put your big-boy pants on and just trust in God.  I say I got sick when I lived in New York City?  Well, there's your problem!  You can't make it there!  No big deal; Texas should be right up your sniveling little alley! 


Since I know all the things people are likely saying about me and people like me, where's my incentive to actually prove them right?  I have my pride; otherwise, why would I be concerned about what other people think?  If I couldn't care less if other people think I'm simply lazy, would I care that something seems to be malfunctioning somewhere inside of me that makes people think I'm lazy?  Since I say I'm a born-again follower of Christ, who believes that God loves me and invites me to trust Him implicitly for everything, why don't I just do it, like the Nike commercial says?

That's probably the biggest reason why I don't like having chronic clinical depression.  Nobody can really answer all of those questions.  There is no 12-step recovery process.  There is no magic pill.  Moving away from the big, bad city doesn't cure it.  In fact, living in a place like New York, I could find plenty of compelling diversions to help dull the pain in my brain, and those diversions don't exist in suburbia.  New York City wasn't my main problem.  Something in my brain was - and is.

You can tell me I'm not sick, and I could tell a cancer patient they're not sick, but how does that change anything?

Like they say, some things you simply have to experience for yourself.  Only I hope you won't have to.

Part 3 - My Theology of Chronic Clinical Depression

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