"The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.” ~ William Styron, Darkness Visible: A Memoir of Madness
When I began my research for this article, I posted a notice on Facebook, inviting anyone who wanted to talk about struggles with depression to send me a private message. Within five minutes I’d heard from a dozen people, and over the next few days I heard from two dozen more.
“I felt such a sense of despair,” wrote one middle-age woman who lives in Chesapeake. “The feeling took over my body and made me feel like I couldn’t live another moment. I couldn’t experience even one moment of peace or joy.”
Others told me that while they’ve learned to cope most of the time, “it’s always there,” as one young woman put it. Still others who had never suffered from it directly reported the devastation of losing friends or family members to suicide.
I was somewhat taken aback by the volume of messages, but I really shouldn’t have been surprised. Reports by the Center for Disease Control and other institutions have documented a sharp increase in depression since the early ’90s. More alarming still is a 2016 report by the CDC indicating that suicide rates increased 24 percent between 1999 and 2014.
Currently, between 7 and 10 percent of Americans suffer from major depression, depending on how that’s measured. But the rate is considerably higher among certain demographic groups. Nearly 11 percent of individuals between the ages of 18 and 25, for example, are afflicted. Moreover, women are more than twice as likely than men to experience a major depressive episode. But millions of men suffer from it as well.
I am among them. While I’ve managed it with the help of a therapist, and function fairly well most of the time, I’ve known firsthand the darkness that my Facebook friends described: the feeling of utter hopelessness to the point where I’ve wondered whether I could go on living—or whether it was worthwhile even to try. During such bouts, even the prospect of doing simple chores—making my bed or doing the dishes—can seem overwhelming.
Some years ago, after I published a personal essay about this, an acquaintance approached me in a local pub and thanked me for writing it.
“I thought I was the only one who felt that way,” he said.
That drove home an important truth about this problem: Despite all of the progress we’ve made as a society in talking more openly about it, depression remains stigmatized in some quarters to the point that many people try to keep it to themselves. As the problem grows, it’s more important than ever to bring it into the light.
John *, a 67-year-old Norfolk resident, agrees.
“I don’t tend to talk about my depression,” he told me recently as we chatted in his living room. “I’m telling you about it in hopes that it will be of some help to other people.”
Born and raised in Memphis, John got into the music business as a promoter and radio deejay when he was still in his teens—and by all outward indications, he was already on the fast track in a career that many people only dream about. But by the time he was approaching his mid 20s, he began to feel that something was not right.
“I was mixed up,” he recalls. “I was doing a lot of drugs and drinking a lot, and I was just kind of drifting around. That’s when I first sought help from a mental health professional. But they didn’t diagnose it as clinical depression. That sort of language was far less common back then. That was even before Prozac came out.”
Increasingly, John found himself thinking about suicide—and one day, he made a concrete plan to kill himself.
“I had the pills—a bunch of Quaaludes,” he recalls. “I was serious about it. But the girl I was living with at the time got to them first—took them and overdosed herself. I wasn’t home when she did it, but fortunately I found her in time and got her to the hospital.”
In 1979, John moved to Norfolk for a new job in broadcasting and things went well for a time—although the depression would still come over him, often out of the blue. To make matters worse, he was drinking heavily—as many depressives do in an effort to feel better for a few hours. In the long run, of course, that compounds the problem.
In the late ’80s, he left the broadcasting job for another opportunity in the music business, but that soon fell apart. “I was crushed,” he says. “That failure haunted me for years.”
For several years thereafter, he worked in another city but wasn’t happy there. The depression got so bad again in 1992 that he made another plan to kill himself.
“I decided I was going to move back to Norfolk and do it there because people knew me. I sold most of what I owned, including a 4,500-volume record collection for 1,500 bucks. Then I bought a gun and some ammunition and made the trip back.
“I had some money, so I didn’t really have to work for a while. For a long time, my day would start with my gun beside my bed and me picking it up with a round in the chamber, clicking the safety off and on.”
When I asked John what ultimately stopped him from pulling the trigger back then, he paused for a moment, then said, “I guess I was able to define some vestiges of things I’d been successful at and feel that I still had something to contribute to the world.”
Nevertheless, the depression lingered, and the drinking got worse still.
“In 1995, I just hit rock-bottom with my drinking. I’d just sold a big video production project, but in the course of trying to put a production plan together, I fell apart and went on a four-day drinking binge. Finally some friends intervened. The police came, took my gun away and put me in the mental ward at DePaul Hospital. After that I went into rehab, and I’ve been sober ever since.”
Sobriety, however, has not caused the depression to disappear.
“Sometimes,” he says, “I’ll go into just this very negative spiral, to the point of paralysis; I’m unable to do anything.”
The worst bout most recently came after John was in a serious motorcycle accident, which laid him up in the hospital for 47 days.
“I was heavily medicated because the pain was so bad, but I was also deeply depressed once again. All I wanted to do was be able to walk well enough so I could get to a gun store, then go home and shoot myself.
“Now, with the help of intensive physical therapy, I know I’ll be able to walk again, so I’ve found some hope to carry on. But I still have bouts of depression. It’s not even a matter of taking things day by day,” he says. “The increments are smaller than that—moment by moment.”
To combat it, John draws on a number of resources.
“What I’ve come to believe with alcoholism and with depression,” he says, “is that recovery is three-fold: it’s physical, it’s mental and it’s spiritual.”
Exercise is known to help in many cases, but because there’s a widespread consensus that victims of depression have a chemical imbalance in their brains, many people also seek medication to help restore the proper balance. John currently takes a low dose of Prozac and says it helps him stay “level,” but he believes that getting the right drug and dose is a “crapshoot.” At one point he was on something else entirely, and it made his depression far worse.
John addresses the mental aspect with a therapist—and that has helped a great deal as well, he says.
“The root of depression, I believe, is fear. And the chemical imbalance makes some of us less able to cope with that. In therapy,” he adds, “stuff just started coming out, and I was able to get in touch with things in my childhood that triggered me being the way I am now. The thing that came out for me is, basically, you’re not good enough; you’re not smart enough. That came from a family environment where there were no expressions of affection, and punishment was always meted out with anger. But what also came out was that one person in my life had consistently shown me love and taught me how to love—my maternal grandmother. I’d never connected those things in my life.”
Finally, there’s the spiritual component.
“I’m not a religious person,” he says, “but I am a spiritual person, and I know that there is some power that’s greater than me. I know one thing—I couldn’t get through this alone. There was a time in my life when I was driving around in a Porsche, wearing a $1,200 watch, wearing an $1,800 suit and $500 shoes and meeting with some corporate executive about some big project. But there’s that thing, it’s still there—you’re still screwed up, depressed John.”
Joni*, a 32-year-old Norfolk resident, believes that her struggles with depression are rooted in childhood as well—especially the trauma of her father dying when she was just 11. But she thinks it started even before that.
“There was always a high drive in my family to succeed,” she says. “When I was 9, I tested into a program for honors students. I remember going to it and loving everything about it. But I felt like I was going to fail. I had this huge amount of pressure on me to be this ‘gifted and talented child,’ so I rebelled. I fought them tooth and nail and finally just refused. My dad was so disappointed.”
Not long afterward, her father became seriously ill from a virus in his brain—and her depression got worse.
“I didn’t know how to deal with it,” she recalled. “My parents were gone a lot to different hospitals out of state, so my aunts and uncles took turns watching us. Not having my mom or dad around, I didn’t know how to operate. The schedule and structure I’d had growing up went out the window.”
Like a lot of young people who suffer from depression, she began cutting herself.
“I remember going to the library and reading books about self injury,” she said. “I got it right away: Something else hurts more than what’s going on inside your head. I still have little scars on the inside of my thigh—places nobody could see. I’ve always been very inward about my pain. That’s why I think people are surprised when I tell them I’ve struggled with depression my whole life—because I don’t seem like that from the outside.”
Soon she was drinking heavily as well, not only to mask the pain but to fit in socially. She’d begun to think of herself as “this awful loser girl who’d lost her father,” and alcohol allowed her to convince people that she was “just this fun party girl.” But the pain didn’t diminish.
Eventually she told her mother that she wanted to see a therapist, but her mother—who was on antidepressants herself by that time—dismissed the idea.
“My mom just got pills from her primary care doctor, so she thought that would work for me too. I tried all different combinations of drugs for both depression and anxiety, but I felt that nobody was listening to me. I was either wired or exhausted. I remember coming home from school at 4 in the afternoon and I could hardly keep my eyes open.”
Joni’s problems grew deeper after her mother remarried—and at 15, she tried to commit suicide.
“My stepdad was mean,” she said. “He was always teasing me in a mean way or screaming at me, and one day he told me I was the reason it was difficult for him to be part of the family. He actually said the family would be better off without me. I was so upset that I went to the medicine cabinet and just started taking a bunch of Tylenol—and all the while he was standing there saying, ‘Do it!’
“I swallowed the whole bottle, then told my mom what I’d done, and she started screaming and crying, then stuck her fingers down my throat. I remember her counting the pills that had come back up. But I begged her not to take me to the hospital. I didn’t want to be that girl who tried to kill herself.”
Meanwhile, she continued to abuse alcohol. By the time she turned 19 she’d been arrested five times—and on the fifth she was placed into a court-ordered recovery program, which included Alcoholics Anonymous.
She also began shopping around for a good therapist but had trouble finding the right fit. One, she recalled, kept focusing on Joni’s drinking as the core problem, but Joni insisted that it was a symptom not the cause. “I got so frustrated,” she recalls.
When she was 21, she began descending into darkness yet again. In an effort to escape her troubled home life, she moved with her boyfriend to Norfolk—only to learn that he'd relapsed as a heroin addict.
“He’d been 8 years clean when I met him,” she says. “That was one of the darkest and most debilitating times of my life.”
Joni eventually ended the relationship. Today she is on an upswing again, finishing college and working as a paralegal, with plans to become a lawyer.
But she still struggles, she says.
“I can go through these periods where everything’s great,” she says, “but I’m always waiting for the other shoe to drop. And when I do feel it coming on, I tend to just check out and not answer the phone. I’ve lost a lot of friends that way.”
In spite of her struggles, she’s no longer on medication because she doesn’t like the way the meds make her feel. “I just didn’t feel like myself,” she says.
Having cast that option aside, she has found help in therapy—especially with a counselor at her university—and writing, which she finds to be very therapeutic.
“I’m trying to not get so caught up in worrying that I’m not going to meet other people’s expectations of me,” she says. “I’ve realized that even if I just show up and be mediocre, and do that repeatedly, that’s better than swooping in and being amazing, then dropping off the face of the earth.”
Joni’s failure to find relief in medications is not unusual, according to Dr. Serina Neumann, a clinical psychologist and associate professor of psychiatry at Eastern Virginia Medical School.
“The current trend I’m seeing in our practice here is that people are more easily being prescribed medications for depression, often in the primary care setting,” she says. “Usually the doctor will prescribe low dose, then make a referral to a psychologist.”
The prescriptions are warranted, she believes, for people who are suffering from severe or even moderate depression. But she added that only 30 percent of people respond to anti-depressant medications adequately.
“Often it helps, but it’s not enough,” she says. “There are still symptoms that they have to cope with.”
With that in mind, she describes prescription of medications as “a beginning phase of recognizing that there’s a depression there, treating symptoms, then bridging them over to a behavioral health specialist.”
The primary value of therapy, she believes, lies in helping patients understand the kinds of thought processes that both John and Joni described.
“Often we create stories and have perceptions that may not have a whole lot of evidence behind them,” Neumann says. “It may be based on people telling them certain things or experiences in life that lead them to believe certain things: I’m inadequate, I’m not good enough or I need to be perfect to be loved. Those are a lot of the core schemas that we work with.
“What we try to do is encourage people to be aware of those thoughts and then consider ways in which they can change those thoughts to be more truthful.”
Her comment resonated with my own experiences. With the help of my therapist, I’ve come to realize that I suffer from what Neumann calls a “negative affectivity bias”—a tendency to blow my problems and failures out of proportion while minimizing or even forgetting about my successes and blessings. Thinking this way over the course of decades literally changes the brain’s circuitry so that the pattern of thinking becomes reinforced.
Why does this happen to some people and not to others?
Many studies have suggested that some people are genetically predisposed to depression. That said, it affects people in different ways at and different times in their lives—sometimes in subtle ways, at first.
A lot of people, Neumann says, start out with a change in their sleeping habits, whether they’re sleeping more than usual and yet feel tired all the time, or sleeping less.
Another symptom is an inability to take pleasure in things that used to be pleasurable. Still others find that they are increasingly irritable and want to isolate themselves as a result.
“A lot of people are on autopilot,” Neumann says. “We don’t pay attention a lot of times to what we’re feeling. But it can snowball on you.”
Paying attention to our emotions and what’s behind them is more difficult than ever, in this age of distraction. Many people are working longer hours just to stay afloat financially. Adding to the stress is an ever-increasing amplification of reports of horrific violence and social hostility. And yet, because of the addictive qualities of social media, it’s hard for many people to extricate themselves from this matrix.
My therapist and I have talked a great deal about the effects of social media, in particular. Like millions of other people, I’ve tended to spend time on social media in an effort to feel less alone. And yet, like excessive drinking, this only compounds the problem. It gives us the illusion of social connection without the soul-satisfying substance.
There are no simple solutions to all of this. But I’ve found three things to be helpful. First, when I’m alone, I try to embrace the solitude fully, in silence, even if that means facing the darkness. Second, small efforts can yield enormous benefits. During my most recent bout of depression, for example, I neglected my guitar, which used to bring me joy. One day, at long last, I opened the case, changed the strings and played a little. It felt as if the sun had come out for a moment after a long spell under gray clouds. Finally, I’ve realized how important it is to fight the urge to isolate myself. Anyone who’s suffered from depression will tell you that social interaction can be exhausting and that the mere thought of it can feel overwhelming. But very often, it’s worth making the effort. We are social creatures, after all, and we need flesh-and-blood interaction. We need, as the poet Rumi put it, to join “the community of spirit … and feel the delight.”
Whatever relief I find in these approaches, I know they won’t be permanent. Nothing in life is. The situation must be met moment by moment, as John observed. The beauty lies in knowing, as Stephen Hawking once put it, that “where there is life, there is hope.”
*Names have been changed.
Read more here on Mental Health in Teens and Steps You Can Take to Help Someone with Mental Illness.