There is a special kind of sadness in being reminded that we don’t know the last time that we’ll see people, their smiles, hear their voices, the assumption that “see you later” isn’t merely illusory. I was reminded of that in early January of this year as I scanned my email while at an academic conference and learned of the unexpected passing of a friend with whom I had been making plans to get together only three weeks earlier. I had told her that I was struggling to get out of bed, how much energy everything took for the simple acts of bathing and dressing. She wrote back, “I am in such a strong and bright place so maybe I can be some light for you,” and reminded me of how strong I had seemed to her when I claimed that I had been “faking it” through the days. Perhaps we both were.
There is perhaps a greater sadness in coming to consciousness in a hospital afterwards, a hot pink wristband identifying one’s inability to leave of one’s own accord because a bottle of bills coupled with a bottle of wine and some whiskey failed to garner the intended effect, when realizing that they’re still sticking around despite their best efforts. I learned that four days after I learned of my friend’s passing, my vision blurred and my thoughts foggy, my body now adorned in oversized scrubs into which I had been changed without permission. That this was not my first such attempt exponentiated that sadness. Sadness squared.
I am far from the first to write on the challenges posed by the personal experience of depression and the broader ramifications of its pervasiveness, coupled with persistent stigma and inadequate treatments available. (The worst among us have been deemed “treatment-resistant,” a label that even a doctorate degree cannot help one weasel, or intellectualize, out of). Carrie Fisher, whose writing and perseverance I have long admired, has written extensively on the subject both through the lenses of fiction (Postcards from the Edge) and autobiography (Wishful Drinking) as well as advocacy work on the challenges posed by addiction and bipolar disorder (“If my life wasn’t funny, it would just be true, and that is unacceptable”). Robert Sapolsky delivered an excellent lecture in 2009 on the biochemistry, as well as the psychological experience of depression, characterizing it as “basically the worst disease you can get,” and a medical disease akin to a diagnosis of diabetes. And The End of the Tour (2015) provided a film adaptation of Lipsky’s chronicle of the Infinite Jest book tour of David Foster Wallace, who took his own life in 2008 after a long battle with depression. Wallace’s characterization of suicidality has long haunted me, the notion that while a woman’s fear of jumping from a burning building may not dissipate but may nevertheless pale in comparison to the alternative of enduring the flames that await her otherwise.
And that is just it. Oblivion is rarely the goal in taking pills with bourbon, with standing on the ledge of a bridge and finally letting go, with summoning courage before the arrival of a train at full speed. Indeed, even in my darkest moments I have maintained my adherence to Woody Allen’s amusing quote, “I’m not afraid of dying. I just don’t want to be there when it happens.” Rather, the goal is putting an end to pain when the world is breaking your heart twelve ways to Sunday, when everything hurts and each movement elicits the feeling of having been saddled with lead weights, when like in Sartre’s No Exit, you’re trapped, paralyzed by a nightmare that occurs only during waking hours. And unless there is a marked change in the propensity for this disease to be stigmatized, the silence only perpetuates one’s feeling of isolation and cognitive distortions.
Academia is hardly the only professional field that dramatically exacerbates this disorder – indeed, recent accounts have chronicled medical doctors’ struggles with depression and suicide – though to be sure the field glamorizes all-nighters writing, putting work before spousal or health considerations or other support systems, being scholars before being humans. Burnout is not so much a need for help as it is evidence of hard work, glorified in the way that athletes sometimes boast of their bruises. Moreover, those with whom we work are scholars with whom we will continue to interact for the duration of our careers, encouraging further reticence with respect to these struggles, a self-imposed loneliness that can in some cases be fatal. There are few things more devastating than building a life around a commitment to scholarship and finding that the organ around which we have built our careers and sense of selves is the same one that is failing us. What is left of us? We are trained to muscle our way through problems, intellectualize situations, and dust ourselves off because we must. Letting feelings wash over one is a vulnerability to which many prefer not to subject themselves. And when all faith and identity are concentrated in a single dimension of one’s life, it is not hard to conceive of the ease with which one can fall down the rabbit hole of major depression with only a relatively minor professional setback.
Such pervasiveness of depression and anxiety among academics and other high-powered professionals was perhaps no more apparent to me than in a depression group in Manhattan, with almost every member, regardless of the level of functioning, having at least one degree from an Ivy League institution, and almost all with advanced degrees from prestigious national universities. The toll that such a set of incentives can take on a perfectionistic and high-achieving individual, particularly one predisposed to depression as I am, can be massive, rendering death a consummation devoutly to be wished, each new day a series of hours to endure before bedtime and the respite of sleep or the horror of insomnia, depending on the particular constellation of one’s symptoms. In a population of individuals rarely prone to voluntarily admit what they may view as defeating or in need of assistance that could yield a professional setback, there is reason to suspect that even the high rates of depression self-reported involve some underreporting.
Indeed, the depression screening that my primary care doctor gives me at each of our visits comes with the explicit questions that it asks me to report (e.g., loss of interest, insomnia, thoughts of self-harm), as well as the questions that I ask myself as to how much help I am willing to accept given my responses, the answer of which invariably impacts the results that I provide him. And while by all accounts both have biological components, there is no question that I find it easier to blame fatigue or absence from work on my thyroid than on my depression or trauma from sexual assaults. Even with a growing number of people calling upon us to destigmatize mental illness, many of us remain closeted, confiding in precious few if any colleagues about our struggles within this realm, leaving us with few if any to whom to turn when the call comes in with the destabilizing news of a death. The ripple effects of suicide, often characterized as suicide contagion, are quite real, and to which I admittedly was a near contributor. Insulation against such actions is difficult when we feel compelled to use stoicism as concealer for feelings and cover-up to conceal our scars.
At stake in the primary elections and even more so in the general election this November is the fate of health care in this nation. Marked income losses from depression and medical leaves have been documented, alongside accounts that access to mental health care lags behind other health services in both availability and funding, even as rates of depression and other mental illnesses continue to be high across demographic groups. Indeed, even with the Affordable Care Act’s expansion of mental health services, the number of psychiatrists accepting insurance as in-network providers continue to be low relative to other physicians, thus reducing access to needed services for populations that may have insurance but nevertheless be unable to afford to utilize it, a problem faced by millions of Americans. Amid the ordinary stressors of work and family, coupled with the ineligibility for government programs and the inability to afford self-pay services or large copayments, working class Americans can easily find themselves in vicious cycles of living in conditions ripe for depression and anxiety triggers but without the means to treat them. We have seen this discussion in the context of the ever-present Medicaid gap, and must promote greater discussion in the context of mental health care. Ensuring the election of a president willing to confront and fund these issues – and not merely within the context of gun violence, a frequent parallel that does disservice to the treatment of a patient population that is largely non-violent (at least toward others) – will be imperative.
When sadness turns to sadness squared (or sadness to the n power), it is all too easy to lose the perspective adequate to maintain the will, let alone interest, to persevere. It is at that point that we most need permission and resources to draw on a support system to yank us from that state and remind us that tomorrow needn’t be as bad as today but that we need to stick around in order to find out, to not simply want us to live but to want to live and to understand the difference.