Since I began keeping tally after an especially bad patch in late 2009, I have been depressed for 50 of the past 62 months — or roughly eighty per cent of the time. There have been two sustained periods of relief, each six months or so in duration, and both thanks to a drug called Venlafaxine, which, seemingly alone among anti-depressants, is effective for me in short bursts.
In a depressed state, my mood, while resolutely low, isn’t static: some days, I can ride a bike or make a phone call or even attend a dinner party as I did this past New Year’s Eve; on others, the notion that I might be able to do any of those things seems preposterous. I am not actively distraught, or at least not often, because that demands too much energy: the master-switch that governs my emotions is shut off altogether. I am a dead-weight, incapable even of sadness. Author Andrew Solomon points out in The Noonday Demon that depression is not the opposite of happiness, but of vitality — the quality that enables most people to bounce back from disappointments, overcome grief, endure hardship, persevere, survive and find joy.
I see vitality in others, everywhere, all the time, and find it astonishing: in young genocide survivors I worked with in Rwanda who can’t wait to bring children of their own into a world that permitted such suffering; in friends of mine, parents of a 13 year old girl taken by cancer, whose dignity and resilience take my breath away; in another friend, recently HIV positive, who gave himself a weekend, but no longer, to mourn his diagnosis. Even in its most mundane forms — the daily striving of most people in most places — this knack for getting up and getting on with it seems no less impressive to me, or any more attainable, than playing a violin concerto or flying an airliner.
After sixteen years overseas, I tried moving home to New Zealand in May 2014. New York, in all its relentless go-getting, had overwhelmed me for the second time in five years, and I partly blamed the growing duration and severity of my depressions to a strange, static, solitary existence amid Manhattan’s buzz and bustle.
I have been persuaded against making consequential life decisions while depressed, so I used the latest Venlafaxine holiday, in early 2014, to weigh the pros and cons of what I felt, at 43 years old, might be my final move. I had always planned to see out my days in New Zealand, and my failure to make it work in New York despite its many ‘on paper’ advantages made me realise I no longer possess the tool to build a life from scratch anywhere else. I have lived at thirty addresses in 20 years; enough is enough.
It was thus by default, and was with comically low expectations (in essence, that time might pass somewhat tolerably until it stops of its own accord) that I arrived to settle back in Wellington in May last year.
For six weeks or so, the Venlafaxine worked its magic while I bought a car, furnished a house and sketched the outlines of a sensible, settled life. I even looked into getting a dog, as profound a commitment as I could fathom, but common sense prevailed: this can’t last, I told myself — and it didn’t.
It never occurred to me going home might make me happy — I would never set the bar as high — but I thought my mood may benefit from living closer to family in New Zealand’s sedate, almost sedative, embrace. I was wrong. It turns out the pervasive sense of not belonging leads to even greater despondency in places that ought to feel like home.
And so I travel incessantly because I have found that travelling is the slightly less intolerable mode of living available to me. As I write, I am in Vietnam, for no reason beyond its ninety-day tourist visas and low cost of living. I have taken a room in a ramshackle hotel in Sapa in the country’s mountainous northwest. The spectacular views promised to me by the Hanoi tour operator have yet to materialise from behind a thick veil of fog, and there was no electricity for the first 24 hours, but I couldn’t care less. Aside from the occasional eager Scandanvian who passes through between life-affirming adventures, the hotel is gloriously uninhabited, a luxury for which I would happily pay double. After Sapa, it will be Hanoi again, en route to Hue, Hoi An, Saigon, Bangkok, Mandalay — that’s as far as my current plans take me. The scenery will change, but the essential rhythms of my daily existence will remain constant: sleep as long and as often as possible, eat when necessary, read and write as much as I can, which isn’t much, and avoid people. This can’t go on forever. While I can live cheaply — hotel costs aside, on less than ten dollars a day in Vietnam — my savings will run out eventually. I could earn a little through consulting work, theoretically possible in this age of connectivity, but the truth is I am rarely capable of working.
I do not have a restless spirit or an unquenchable yearning for new experiences. Quite the opposite. Wherever I go, I avoid eye contact with the world around me while I replicate the dour rituals that get me from one end of the day to the other.
Before travel, I had booze. For ten years or so after the onset of depression in my mid-20s, I used alcohol to quell feelings of self-loathing, guilt and failure before they could take hold and take over. For a good deal of that time, it worked a treat — and, while I have no intention of picking up a bottle again after eight years sober, there is no question booze was better at ameliorating the day to day symptoms of depression than many of the more respectable therapies. My life as an alcoholic was objectively miserable, but I was a happy drunk. Mental health professionals will tell you, quite rightly, that substance abuse is both a cause and a symptom of depression — but they’ll keep firmly under their hats that it can also offer considerable relief. That’s the heresy that explains why addicts relapse so readily despite the consequences. Aside from its barely concealed religious voodoo, Alcoholics Annonymous lost me when they wanted me to acknowledge that my drinking was a manifestation of insanity. Nonsense. Sure, I drank insane amounts of alcohol and, yes, I would be dead if I hadn’t stopped doing so — but every sip made perfect sense, then and now.
A normally constituted person considers depression an extreme variation of what they — the non depressed person — experience as moods, and that moods come and go like the tides.
At one level, it is commonplace, probably even useful, to experience a depressed mood.
You got out on the wrong side of bed. You’re behind at work. Your relationship is on the rocks. Your kitchen table groans under a pile of unpaid bills. Your cat died. In any life, circumstances will sometimes conspire to leave you feeling sad, downcast, morose — but this surely serves a purpose. How else, except through its absence, would you know happiness when we saw it? Some researchers have come to see periods of depression as an evolutionary adaptation that bolsters cognitive problem solving skills.
But this uncovers a deficiency of language. We have one word to describe two related but distinct phenomena: depression as one of several mood states that shift in and out of ascendancy, often in reaction to life’s vicissitudes; and depression that thrives on its own terms as a more or less permanent state of despair — as Solomon puts it,”random and endogenous, dissociated from life events”.
This is why, whenever I am unable to avoid revealing my depression to someone, I wince in anticipation of the inevitable what happened? It is a well meaning but infuriating question for two reasons: first, there’s never a satisfactory answer and, second, it carries the unmistakable inference that depression should be earned.
In any event, it turns out that what happens through the course of a person’s life has marginal impact on how happy or otherwise we end up being. Take an extreme example: if a person suffers horrific injuries that leave them permanently paralysed from the neck down on the same day their neighbour wins millions in the lottery, research shows that both will return to their normal levels of happiness within a year at most. As Yale psychologist Paul Bloom puts it, we think life events “will have big, permanent and profound effects but they often don’t”. The reason for this, Bloom explains, is that well-functioning human beings are adaptive: they get used to things, good and bad. We’re on what’s called an “hedonic treadmill”: whatever “happens”, we are bound to be as happy — or as desperately unhappy — as we are bound to be. It’s the key to human resilience in most functioning adults — the genocide survivor, the grieving parents — but the same research offers cold comfort for the chronically depressed. If events play little or no part in our state of mind to begin with, it is difficult to avoid the conclusion that nothing is likely to happen to improve it either.
If nothing happens to trigger episodes — and nothing ever does — what explains my depression?
The belief that depression results from a chemical imbalance in the brain has congealed into conventional wisdom since mid last century, particularly since the arrival of the first blockbuster anti-depressant, Prozac, in 1987. The common analogy is diabetes and insulin, and it offers irresistible promise for doctor and patient alike: that highly sophisticated anti-depressants target a deficiency of serotonin levels and restore a patient to mental health. But, much like the now discredited dopamine theory of schizophrenia, decades’ worth of research fail to support the serotonin hypothesis. As Kenneth Kendler, coeditor in chief of Psychological Medicine, bluntly conceded in 2005, “we have hunted for big simple neurochemical explanations for psychiatric disorders and have not found them.”
And yet, however imperfect, anti-depressants help a lot of people, as my own experience with Venlafaxine showed. Few outside the fanatically anti-psychiatry Church of Scientology would dispute that. But as to why these drugs work, and why they often don’t, no-one really knows. Psych meds are blunt tools, and even experienced psychopharmacologists rely on little more than educated guesswork. My psychiatrist in New York, who regards herself a sceptic of the drug paradigm, prescribed multiple drugs, and cocktails thereof, over the course of twelve months in an effort to lift the depression and “create space” for preferred approaches like counselling, cognitive behaviour therapy, meditation, nutrition and exercise. All to no avail.
By its nature, depression is most often suffered in silence. By dint of their condition, most depressed people will hold no-one but themselves to blame for their predicament. This explains the appeal, evidence be damned, of the modern conception of depression as a genetic impairment characterised by malfunctioning neurotransmitters: it’s not your fault, we’re told, there’s nothing to be ashamed of, and you can be treated.
It used to irritate me that public health campaigns peddle myths about depression in the name of awareness. Why not confess what we don’t understand, or at least have the courage to admit what we do? There is no “depression gene”. Chemical imbalance is part myth, part marketing slogan. Anti-depressants may work with some people, but they have the clinical precision of horse tranquillisers.
Anyway, I have come to conclude, who cares? Whatever the truth about the causes of depression — biological or psychological, nature versus nurture — it is unlikely to be settled in my lifetime, so why not construct a public health narrative from flimsy evidence — or medicate with slapdash abandon — in the hope it at least alleviates some suffering in the meantime? There are worse things that hoodwinking people into seeking help.
As I compose this sentence, I take note of my state of mind, and it’s okay. I’m okay. The illusion will surely pass, but life seems manageable: by stringing together tolerable moments, and weaving days into weeks, months into years, it feels as if I might just survive long enough to discover whether survival is everything it’s cracked up to be.