One of the first things that you are asked when you go to an emergency room (if you are conscious) is to rate your pain on a scale of 1 to 10, with 10 being the most agonizing, excruciating pain that you can imagine experiencing. I have never said “ten,” even when I was in so much pain that I could barely muster saying the word “ten,” or the mildly more bearable “nine,” instead holding up eight or so fingers. I say this having had not one but two extraordinarily under-medicated root canals, and dental pain is, in my view, its own kind of pain. I have not used my ten, though I have felt it many times, not in a strictly medical sense. In many ways, I have saved my true ten (“but it goes to eleven…”).
My ten is not, strictly speaking, a medical ailment, though it has a biological predisposition and manifests with a number of physiological symptoms. My great and terrible ten is depression. Depression. Three syllables. So commonly used colloquially, as in, “I wasn’t able to get tickets to the concert, I’m so depressed,” or “Man, that day was depressing. Who needs a drink?” No, that is is not what I am talking about.
The depression gnaws at your soul, eats you from the inside out such that by the time that it becomes visible to your friends and family, the so-called “support system,” you are so far gone that you go from longing for a fix to longing for an end. It is not in itself deadly, but it takes one from the warm embraces of happiness and success to thinking of death as but a dream devoutly to be wished, except that Hamlet stayed alive out of fear of the unknown (the old cliché that the devil you know beats the devil you don’t) and agnostics such as I lack such fears of the afterlife. It isn’t that I haven’t tried – I am open: I read Schindler’s List, I’ve talked with Krishnas, and I dyed Easter Eggs. Those are classic pastimes, right? (Note the Hannah and Her Sisters reference). But you see, none of it ever worked for me, and so I am thus left with this existential void (dare Woody Allen and I say, an empty void), and where following the exit signs to the abyss goes, I find myself wallowing, face to the floor, floundering in my body’s inability to move, let alone remember feelings of joy or perhaps more importantly, hope.
I have many physical health problems, some of which put my pain at a seven and my discomfort at a nine. Being in that kind of pain makes one so much more acutely aware of the body’s many defenses, akin to tales of the blind developing better senses of scent or hearing. Our mind’s cognitive powers are marked with respect to talking us out of agony. We tell ourselves to take deep breaths, to count to ten (or a hundred), to remind ourselves of a happy memory until the pain is gone. When depression preys on those very defenses, there remains the honest question of what is left other than the hollow, vacant shell of what once was (but most definitely no longer is).
There is no romance to it. Do not let any writer, musician, or actor tell you otherwise. For all of the beautiful creativity and despondent but sometimes sanguine public self-reflection, there is misery and despair and hopelessness when the camera lights are off. But lying to others and more importantly to themselves is, as with addiction and other trials, the easy part. The difference is how publicly we let our demons out, and how often we let them into the driver’s seat in our lives.
Saving a depressed person is sometimes, to the person in question, a sadistic aspiration to prolong the seemingly unending pain. It is an insult, a crime but of a well-meaning nature, but one that will only push the depressed person away if friends and family do not tread oh-so-lightly. Because while it is true that suicide is a desire not so much for death but rather for an end to pain and suffering, sometimes those desires appear achievable through one permanent means.
There is a special sadness in realizing that as a patient in the mental health system, one no longer has rank or authority. One is no longer a doctor, a lawyer, an artist, a professor, but rather a patient defined, nay, reduced, narrowly by DSM diagnoses – Axis I depressive an anxiety disorders, Axis II personality disorders and the like. And as people become treated as clusters of symptoms to be managed chemically, so too do they lose sight of who they are or once were, which leaves less to cling to in the way of living.
There is no beauty in the death of lives, of identities, but there is much to be desired in the way of killing that which is killing you, even if the two feel) or become) inseparable from one another. Every fiber in one’s being can know that tomorrow might be better (but what about the next day?), though knowing and believing are not one and the same, nor are feeling things in one’s head versus in one’s heart. Yet for all such glimmers of hope, such Cartesian questions of mind and body can likewise lead one to the desire to do away with one in order to preserve the other. The mind, acutely aware of its torment but too far gone for change, or seemingly so, there is no greater pain – and the ultimate and dreaded ten – than to see one’s own inevitably declining status as staring through a shop window into the inside, an autopsy into the future of what one is becoming, the Dickensian Ghost of Christmas Future.
So what allows some to be strong in those broken places? Some might say faith, though that does not account for much of Hemingway’s life, and death may have grown to be a wistful respite as psychosis sadly hit him. I have always found religion to be foreign, or me foreign to it, unless Springsteen or Our Lady of Perpetual Exemption count, in which case I profess my belief unabashedly and with every fiber of my being that depression has not yet tampered. If it is effort, I will be dismayed, for my struggle is not for lack of effort toward progress, seeming lack of improvement notwithstanding. For all I have known is the lost nights writhing in pain (and yet choosing each day to persist) – my dreaded and sometimes nearly ten – the existential fear of waking out of dreams and into life. And where is that life? Perhaps it is in that kernel of hope that one day, some day, those broken shards we once called life will form again a whole or better yet, breed strength.