Depression Is a Flaw in Love

I can't say enough about this clip of Andrew Solomon speaking about depression from a TED Talks from December 2013. 

It requires amazing courage to write about one's experience with severe depression, or in his words "an illness of how you feel." 

Nevertheless, it is an illness; he reminds us that it is the leading disability world wide, and people die of it every day.

Here are some extraordinary bits of wisdom I will always want to remember.

• Opposite of depression isn't happiness. Vitality is its opposite. 

• Depression is a flaw in love.
• Quote from another sufferer: Depression is "a slower way of being dead."
• True clinical depression is characterized by delusional perceptions.
• For the depressed, truth lies. An example: We will all die eventually, but it's not necessary that we dwell on it because it keeps us from living.
• Our needs are our biggest assets. I hope to experience this some time soon.
• What are our treatment options for depression? Chemical cure or psychological cure?
  Neither are very effective and inaccessible to the poor, who are more likely to suffer from depression as a result of poverty-created environmental stressors.
• Treatment for depression (talk therapy) is expensive.
• Side effects from antidepressant medications keep people away from its imperfect solution, even though many people do benefit from pharmacotherapy.
• Sadness, grief and depression are often confused. Grief is a reactive response to loss, which resolve over time. Time heals.
• Sadness is sadness. But depression is much too much sadness.
• Depression can be triggered by catastrophic loss.
  
  http://andrewsolomon.com/

Addiction, Depression and Antidepressants

I read with great interest this piece on The Fix called The Dumbest Article You'll See About Addiction, and that's about right. The writer, Maia Szalavitz, is responding to a criticism of her original piece, in which she shares how Zoloft had saved her from a deep depression after kicking a serious heroin and cocaine habit she picked up during college. Twenty years later, while still prescribed Zoloft, she describes how it dramatically improved her mood and the way she responded to the world (depressed people, she says, tend to misread other people's facial expressions), that she has had a successful writing career and a very satisfying life. 

The second writer, critiquing on Slate, says that Szalvitz merely replaced one addiction with another, and asks the astoundingly naive question why we are easier on pill poppers than alcoholics. It's difficult to believe that her editor or anyone else on staff, let slide her ignorance and insensitivity to issues of mental health. While it’s true Big Pharma has integrity issues, the fact is anti-depressant medications and other psychopharmaceuticals dramatically improve, if not save, the lives of many, many people.

Be sure to read the many comments on both pages. It's a serious subject matter that affects many people.

Pain Killing

More women are dying from overdoses of narcotic pain medication than cervical cancer or homicide. They tend to be poor, older white women living in rural areas who are also taking medications for depression and anxiety.

Some of the reasons for this trend are as follows: Pain medications are readily available; women are prescribed pain medication at higher doses; women are diagnosed with depression and treated with medications at a higher rate. Women who are single mothers struggling financially are more likely to experience symptoms of depression and anxiety (duh!).

It’s somehow rational that an unhappy or depressed person would succumb to the quick, narcotic relief delivered in a pill. Why not take a respite from pain when it simply means swallowing a pill, even though taking this short cut can mean dealing with serious consequences such as full-blown addiction and even overdose. One symptom of depression is a shortened sense of time or the inability to consider the future at all; so the depressed person is not likely to consider the risks involved when self-medicating with an opiate.

This phenomenon illustrates the fact that substanceabuse and mental illness are two sides of the same coin. It also shows that personal choices and lack of proper planning can cause stresses later on. At the same time, government policies also create hardship that contribute to poor mental health. And, pharmaceutical industry is guilty of profiting from products that are often abused as a quick fix to escape the hardships.

It also shows us that managing symptoms with medication alone is inadequate because it only cushions our ability to handle anguish. A pill cannot change the facts of a life and its context. Experience of pain can be temporarily delayed but it cannot be erased. Soon or later one must begin the tough work to locate the source or the cause of emotional pain. And, if the source of pain is outside ourselves then we must adapt to it or work on changing the environment.

Sort of a Film Review: Silver Linings Playbook

http://www.kentuckytheater.com

Initially, I was skeptical about Silver Linings Playbook, but it disabused me of the misconception that all rom-coms are silly affairs in which an attractive young woman and man fall in love after overcoming a series of obstacles. SLP, like other movies of the genre, shows us that the quest for love is universal. Its two protagonists, played by Bradley Cooper and Jennifer Lawrence, are very pretty, as you would expect. I had dismissed Bradley Cooper as an exceptionally good-looking comic actor, and I wasn't familiar with Jennifer Lawrence. However, she won me over as the wounded yet feisty and self-aware young woman; I found her character so intriguing I forgave her being so young, talented and beautiful. And, I gained an appreciation for Bradley Cooper as a man with bipolar disorder just released from a long stay in a psychiatric hospital. His performance did not embarrass; he didn’t simply play “crazy.” Instead, he played a man whose capacity for suffering emotional pain was monumentally greater than most people’s because of the illness. 

As a mental health professional, I appreciated how the film treated mental illness with depth, humour and fairness; I am hoping that it can lift the some of the stigma that keeps people from accessing mental health services. 

These are some of the reasons why I recommend Silver Linings Playbook:

1. By no means should Cooper’s character be mistaken for a clinical case study of bipolar disorder, but it portrayed BD's main features in a believable way. Also, his father's (played by Robert DeNiro) compulsive and superstitious dependence on numbers was a lighthearted look at OCD-like behavior, perhaps to suggest that predisposition to mental illness can be hereditary. 

2. The movie shows that character's bizarre behavior of Bradley Cooper's character did not come about in a vacuum (it's important to note that he did not have delusions or hallucinations, symptoms of psychosis). The distress of catching his wife with another man had triggered his hypersensitivity to a full-blown episode of mania and depression (although we did not see his depressive symptoms). His reaction went above and beyond the "functional range" of emotional response, and, as a result, he was hospitalized. Symptoms of mental illness, especially mood disorders, are extreme (pathological) reactions to life’s inevitable ups and downs, and they are disruptive and upsetting to the sufferer and their family and friends. But, the point is that everyone of us have experienced these symptoms to some degree, because this is what it means to be human. 

3. Medication works. It does not “cure” but, under the care of an able psychiatrist, it can manage and control the symptoms and improve the quality of life for the patient and their family. It enables the patient to work, be in relationships and seek talk therapy to complement the pharmacotherapy, which only addresses brain chemistry. The most effective treatment for mental illness is drug therapy with concurrent psychotherapy. 

4. People diagnosed with mental illness have unique personalities and real lives, and they are capable of great achievements. They are more than their symptoms or diagnosis. One can LIVE with mental illness.

5. Mental health professionals are real people. We have real lives that are sometime messy and have interests outside work that may seem incongruent with what we do professionally. However, I am not a fanatical fan of any sports team.