Depression, the secret we share

"The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment." In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression -- only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories. (Filmed at TEDxMet.)

"I felt a Funeral, in my Brain,

and Mourners to and fro

kept treading -- treading --
till [it seemed]

that Sense was breaking through --

And when they all were seated,

a Service, like a Drum --

kept beating -- beating --
till I [thought]

my Mind was going numb --

And then I heard them lift a Box
and creak across my Soul

with those same Boots of Lead, again,

then Space -- began to toll,

As [all] the Heavens were a Bell,
and Being, [but] an Ear,

and I, and Silence, some strange Race,

wrecked, solitary, here --

[And] then a Plank in Reason, broke,

and I fell down and down --

and hit a World, at every plunge,

and Finished knowing -- then --"

We know depression through metaphors.

Emily Dickinson was able
to convey it in language,

Goya in an image.

Half the purpose of art
is to describe such iconic states.

As for me, I had always
thought myself tough,

one of the people who could survive

if I'd been sent to a concentration camp.

In 1991, I had a series of losses.

My mother died,

a relationship I'd been in ended,

I moved back to the United States
from some years abroad,

and I got through all of those
experiences intact.

But in 1994, three years later,

I found myself losing interest
in almost everything.

I didn't want to do any of the things
I had previously wanted to do,

and I didn't know why.

The opposite of depression
is not happiness, but vitality.

And it was vitality

that seemed to seep away
from me in that moment.

Everything there was to do
seemed like too much work.

I would come home

and I would see the red light
flashing on my answering machine,

and instead of being thrilled
to hear from my friends,

I would think,

"What a lot of people that is
to have to call back."

Or I would decide I should have lunch,

and then I would think,
but I'd have to get the food out

and put it on a plate

and cut it up and chew it and swallow it,

and it felt to me
like the Stations of the Cross.

And one of the things that often gets lost
in discussions of depression

is that you know it's ridiculous.

You know it's ridiculous
while you're experiencing it.

You know that most people manage

to listen to their messages and eat lunch

and organize themselves to take a shower

and go out the front door

and that it's not a big deal,

and yet you are nonetheless in its grip

and you are unable to figure out
any way around it.

And so I began to feel myself doing less

and thinking less

and feeling less.

It was a kind of nullity.

And then the anxiety set in.

If you told me that I'd have to be
depressed for the next month,

I would say, "As long I know it'll be over
in November, I can do it."

But if you said to me,

"You have to have acute anxiety
for the next month,"

I would rather slit my wrist
than go through it.

It was the feeling all the time

like that feeling you have
if you're walking

and you slip or trip
and the ground is rushing up at you,

but instead of lasting half a second,
the way that does,

it lasted for six months.

It's a sensation
of being afraid all the time

but not even knowing
what it is that you're afraid of.

And it was at that point
that I began to think

that it was just too painful to be alive,

and that the only reason
not to kill oneself

was so as not to hurt other people.

And finally one day, I woke up

and I thought perhaps I'd had a stroke,

because I lay in bed completely frozen,

looking at the telephone, thinking,

"Something is wrong
and I should call for help,"

and I couldn't reach out my arm

and pick up the phone and dial.

And finally, after four full hours
of my lying and staring at it,

the phone rang,

and somehow I managed to pick it up,

and it was my father, and I said,

"I'm in serious trouble.
We need to do something."

The next day I started
with the medications and the therapy.

And I also started reckoning
with this terrible question:

If I'm not the tough person

who could have made it
through a concentration camp,

then who am I?

And if I have to take medication,

is that medication making me
more fully myself,

or is it making me someone else?

And how do I feel about it
if it's making me someone else?

I had two advantages
as I went into the fight.

The first is that I knew that,
objectively speaking,

I had a nice life,

and that if I could only get well,

there was something at the other end
that was worth living for.

And the other was
that I had access to good treatment.

But I nonetheless emerged and relapsed,

and emerged and relapsed,

and emerged and relapsed,

and finally understood

I would have to be on medication
and in therapy forever.

And I thought,

"But is it a chemical problem
or a psychological problem?

And does it need a chemical cure
or a philosophical cure?"

And I couldn't figure out which it was.

And then I understood that actually,

we aren't advanced enough in either area
for it to explain things fully.

The chemical cure
and the psychological cure

both have a role to play,

and I also figured out
that depression was something

that was braided so deep into us

that there was no separating it
from our character and personality.

I want to say that the treatments we have
for depression are appalling.

They're not very effective.

They're extremely costly.

They come with innumerable side effects.

They're a disaster.

But I am so grateful that I live now
and not 50 years ago,

when there would have been
almost nothing to be done.

I hope that 50 years hence,

people will hear about my treatments

and be appalled that anyone endured
such primitive science.

Depression is the flaw in love.

If you were married
to someone and thought,

"Well, if my wife dies,
I'll find another one,"

it wouldn't be love as we know it.

There's no such thing as love
without the anticipation of loss,

and that specter of despair
can be the engine of intimacy.

There are three things
people tend to confuse:

depression, grief and sadness.

Grief is explicitly reactive.

If you have a loss
and you feel incredibly unhappy,

and then, six months later,

you are still deeply sad,
but you're functioning a little better,

it's probably grief,

and it will probably ultimately
resolve itself in some measure.

If you experience a catastrophic loss,

and you feel terrible,

and six months later
you can barely function at all,

then it's probably a depression
that was triggered

by the catastrophic circumstances.

The trajectory tells us a great deal.

People think of depression
as being just sadness.

It's much, much too much sadness,

much too much grief

at far too slight a cause.

As I set out to understand depression,

and to interview people
who had experienced it,

I found that there were people
who seemed, on the surface,

to have what sounded like
relatively mild depression

who were nonetheless
utterly disabled by it.

And there were other people
who had what sounded

as they described it
like terribly severe depression

who nonetheless had good lives

in the interstices
between their depressive episodes.

And I set out to find out
what it is that causes some people

to be more resilient than other people.

What are the mechanisms
that allow people to survive?

And I went out and I interviewed
person after person

who was suffering with depression.

One of the first people I interviewed

described depression
as a slower way of being dead,

and that was a good thing
for me to hear early on

because it reminded me
that that slow way of being dead

can lead to actual deadness,

that this is a serious business.

It's the leading disability worldwide,

and people die of it every day.

One of the people I talked to
when I was trying to understand this

was a beloved friend
who I had known for many years,

and who had had a psychotic episode
in her freshman year of college,

and then plummeted
into a horrific depression.

She had bipolar illness,

or manic depression, as it was then known.

And then she did very well
for many years on lithium,

and then eventually,
she was taken off her lithium

to see how she would do without it,

and she had another psychosis,

and then plunged into the worst depression
that I had ever seen

in which she sat
in her parents' apartment,

more or less catatonic,
essentially without moving,

day after day after day.

And when I interviewed her
about that experience some years later --

she's a poet and psychotherapist
named Maggie Robbins --

when I interviewed her, she said,

"I was singing 'Where Have
All The Flowers Gone,'

over and over, to occupy my mind.

I was singing to blot out
the things my mind was saying,

which were, 'You are nothing.
You are nobody.

You don't even deserve to live.'

And that was
when I really started thinking

about killing myself."

You don't think in depression
that you've put on a gray veil

and are seeing the world
through the haze of a bad mood.

You think that the veil
has been taken away,

the veil of happiness,

and that now you're seeing truly.

It's easier to help
schizophrenics who perceive

that there's something foreign
inside of them that needs to be exorcised,

but it's difficult with depressives,

because we believe
we are seeing the truth.

But the truth lies.

I became obsessed with that sentence:

"But the truth lies."

And I discovered,
as I talked to depressive people,

that they have
many delusional perceptions.

People will say, "No one loves me."

And you say, "I love you,

your wife loves you,
your mother loves you."

You can answer that one pretty readily,
at least for most people.

But people who are depressed
will also say,

"No matter what we do,
we're all just going to die in the end."

Or they'll say,
"There can be no true communion

between two human beings.

Each of us is trapped in his own body."

To which you have to say,

"That's true,

but I think we should focus right now
on what to have for breakfast."

(Laughter)

A lot of the time,

what they are expressing
is not illness, but insight,

and one comes to think
what's really extraordinary

is that most of us know
about those existential questions

and they don't distract us very much.

There was a study I particularly liked

in which a group of depressed
and a group of non-depressed people

were asked to play a video
game for an hour,

and at the end of the hour,

they were asked how many little monsters
they thought they had killed.

The depressive group was usually accurate
to within about 10 percent,

and the non-depressed people

guessed between 15 and 20 times
as many little monsters --

(Laughter)

as they had actually killed.

A lot of people said, when I chose
to write about my depression,

that it must be very difficult
to be out of that closet,

to have people know.

They said, "Do people
talk to you differently?"

I said, "Yes, people
talk to me differently.

They talk to me differently insofar

as they start telling me
about their experience,

or their sister's experience,

or their friend's experience.

Things are different because now I know

that depression is the family secret
that everyone has.

I went a few years ago to a conference,

and on Friday of the three-day conference,

one of the participants
took me aside, and she said,

"I suffer from depression
and I'm a little embarrassed about it,

but I've been taking this medication,

and I just wanted to ask you
what you think?"

And so I did my best to give her
such advice as I could.

And then she said, "You know,
my husband would never understand this.

He's really the kind of guy to whom
this wouldn't make any sense,

so, you know, it's just between us."

And I said, "Yes, that's fine."

On Sunday of the same conference,

her husband took me aside,

(Laughter)

and he said, "My wife wouldn't think

that I was really much
of a guy if she knew this,

but I've been dealing with this depression
and I'm taking some medication,

and I wondered what you think?"

They were hiding the same medication

in two different places
in the same bedroom.

(Laughter)

And I said that I thought
communication within the marriage

might be triggering
some of their problems.

(Laughter)

But I was also struck

by the burdensome nature
of such mutual secrecy.

Depression is so exhausting.

It takes up so much
of your time and energy,

and silence about it,

it really does make the depression worse.

And then I began thinking

about all the ways
people make themselves better.

I'd started off as a medical conservative.

I thought there were a few
kinds of therapy that worked,

it was clear what they were --

there was medication,

there were certain psychotherapies,

there was possibly
electroconvulsive treatment,

and that everything else was nonsense.

But then I discovered something.

If you have brain cancer,

and you say that standing on your head
for 20 minutes every morning

makes you feel better,

it may make you feel better,
but you still have brain cancer,

and you'll still probably die from it.

But if you say that you have depression,

and standing on your head
for 20 minutes every day

makes you feel better, then it's worked,

because depression
is an illness of how you feel,

and if you feel better,

then you are effectively
not depressed anymore.

So I became much more tolerant

of the vast world
of alternative treatments.

And I get letters,
I get hundreds of letters

from people writing to tell me
about what's worked for them.

Someone was asking me
backstage today about meditation.

My favorite of the letters that I got
was the one that came from a woman

who wrote and said
that she had tried therapy, medication,

she had tried pretty much everything,

and she had found a solution
and hoped I would tell the world,

and that was making
little things from yarn.

(Laughter)

She sent me some of them.

(Laughter)

And I'm not wearing them right now.

(Laughter)

I suggested to her
that she also should look up

obsessive compulsive disorder in the DSM.

And yet, when I went to look
at alternative treatments,

I also gained perspective
on other treatments.

I went through
a tribal exorcism in Senegal

that involved a great deal of ram's blood

and that I'm not going
to detail right now,

but a few years afterwards
I was in Rwanda,

working on a different project,

and I happened to describe
my experience to someone,

and he said,

"Well, that's West Africa,
and we're in East Africa,

and our rituals are
in some ways very different,

but we do have some rituals

that have something in common
with what you're describing."

And he said,

"But we've had a lot of trouble
with Western mental health workers,

especially the ones who came
right after the genocide."

I said, "What kind
of trouble did you have?"

And he said, "Well,
they would do this bizarre thing.

They didn't take people out
in the sunshine

where you begin to feel better.

They didn't include drumming
or music to get people's blood going.

They didn't involve the whole community.

They didn't externalize
the depression as an invasive spirit.

Instead what they did was they took people
one at a time into dingy little rooms

and had them talk for an hour

about bad things
that had happened to them."

(Laughter)

(Applause)

He said, "We had to ask them
to leave the country."

(Laughter)

Now at the other end
of alternative treatments,

let me tell you about Frank Russakoff.

Frank Russakoff had the worst depression
perhaps that I've ever seen in a man.

He was constantly depressed.

He was, when I met him,

at a point at which every month,
he would have electroshock treatment.

Then he would feel
sort of disoriented for a week.

Then he would feel okay for a week.

Then he would have a week
of going downhill.

And then he would have another
electroshock treatment.

And he said to me when I met him,

"It's unbearable to go
through my weeks this way.

I can't go on this way,

and I've figured out
how I'm going to end it

if I don't get better."

"But," he said to me,
"I heard about a protocol at Mass General

for a procedure called a cingulotomy,
which is a brain surgery,

and I think I'm going to give that a try."

And I remember being amazed
at that point to think that someone

who clearly had so many bad experiences

with so many different treatments

still had buried in him,
somewhere, enough optimism

to reach out for one more.

And he had the cingulotomy,
and it was incredibly successful.

He's now a friend of mine.

He has a lovely wife
and two beautiful children.

He wrote me a letter
the Christmas after the surgery,

and he said,

"My father sent me two presents this year,

First, a motorized CD rack
from The Sharper Image

that I didn't really need,

but I knew he was giving it
to me to celebrate

the fact that I'm living on my own
and have a job I seem to love.

And the other present
was a photo of my grandmother,

who committed suicide.

As I unwrapped it, I began to cry,

and my mother came over and said,

'Are you crying because
of the relatives you never knew?'

And I said, 'She had
the same disease I have.'

I'm crying now as I write to you.

It's not that I'm so sad,
but I get overwhelmed,

I think, because I could
have killed myself,

but my parents kept me going,
and so did the doctors,

and I had the surgery.

I'm alive and grateful.

We live in the right time,
even if it doesn't always feel like it."

I was struck by the fact that depression

is broadly perceived to be
a modern, Western, middle-class thing,

and I went to look at how it operated
in a variety of other contexts,

and one of the things
I was most interested in

was depression among the indigent.

And so I went out to try to look

at what was being done
for poor people with depression.

And what I discovered is that poor people

are mostly not being
treated for depression.

Depression is the result
of a genetic vulnerability,

which is presumably
evenly distributed in the population,

and triggering circumstances,

which are likely to be more severe
for people who are impoverished.

And yet it turns out that if you have
a really lovely life

but feel miserable all the time,

you think, "Why do I feel like this?

I must have depression."

And you set out to find treatment for it.

But if you have a perfectly awful life,

and you feel miserable all the time,

the way you feel
is commensurate with your life,

and it doesn't occur to you to think,

"Maybe this is treatable."

And so we have an epidemic in this country

of depression among impoverished people

that's not being picked up
and that's not being treated

and that's not being addressed,

and it's a tragedy of a grand order.

And so I found an academic

who was doing a research project
in slums outside of D.C.,

where she picked up women
who had come in for other health problems

and diagnosed them with depression,

and then provided six months
of the experimental protocol.

One of them, Lolly, came in,

and this is what she said
the day she came in.

She said, and she was a woman,
by the way, who had seven children.

She said, "I used to have a job
but I had to give it up

because I couldn't go out of the house.

I have nothing to say to my children.

In the morning,
I can't wait for them to leave,

and then I climb in bed
and pull the covers over my head,

and three o'clock when they come home,

it just comes so fast."

She said, "I've been taking
a lot of Tylenol,

anything I can take
so that I can sleep more.

My husband has been telling me
I'm stupid, I'm ugly.

I wish I could stop the pain."

Well, she was brought
into this experimental protocol,

and when I interviewed her
six months later,

she had taken a job working in childcare

for the U.S. Navy,
she had left the abusive husband,

and she said to me,

"My kids are so much happier now."

She said, "There's one room
in my new place for the boys

and one room for the girls,

but at night, they're just
all up on my bed,

and we're doing homework
all together and everything.

One of them wants to be a preacher,

one of them wants to be a firefighter,

and one of the girls says
she's going to be a lawyer.

They don't cry like they used to,

and they don't fight like they did.

That's all I need now, is my kids.

Things keep on changing,

the way I dress,
the way I feel, the way I act.

I can go outside not being afraid anymore,

and I don't think
those bad feelings are coming back,

and if it weren't
for Dr. Miranda and that,

I would still be at home
with the covers pulled over my head,

if I were still alive at all.

I asked the Lord to send me an angel,

and He heard my prayers."

I was really moved by these experiences,

and I decided that I wanted
to write about them

not only in a book I was working on,
but also in an article,

and I got a commission
from The New York Times Magazine

to write about depression
among the indigent.

And I turned in my story,

and my editor called me and said,
"We really can't publish this."

And I said, "Why not?"

And she said, "It just is too far-fetched.

These people who are sort of
at the very bottom rung of society

and then they get
a few months of treatment

and they're virtually ready
to run Morgan Stanley?

It's just too implausible."

She said, "I've never even heard
of anything like it."

And I said, "The fact
that you've never heard of it

is an indication that it is news."

(Laughter)

(Applause)

"And you are a news magazine."

So after a certain amount of negotiation,
they agreed to it.

But I think a lot of what they said
was connected in some strange way

to this distaste that people still have
for the idea of treatment,

the notion that somehow if we went out

and treated a lot of people
in indigent communities,

that would be exploitative,

because we would be changing them.

There is this false moral imperative
that seems to be all around us,

that treatment of depression,

the medications and so on,
are an artifice,

and that it's not natural.

And I think that's very misguided.

It would be natural
for people's teeth to fall out,

but there is nobody militating
against toothpaste,

at least not in my circles.

People then say,

"But isn't depression part of what people
are supposed to experience?

Didn't we evolve to have depression?

Isn't it part of your personality?"

To which I would say, mood is adaptive.

Being able to have sadness and fear

and joy and pleasure

and all of the other moods that we have,
that's incredibly valuable.

And major depression

is something that happens
when that system gets broken.

It's maladaptive.

People will come to me and say,

"I think, though, if I just
stick it out for another year,

I think I can just get through this."

And I always say to them,
"You may get through it,

but you'll never be 37 again.

Life is short, and that's a whole year
you're talking about giving up.

Think it through."

It's a strange poverty
of the English language,

and indeed of many other languages,

that we use this same word, depression,

to describe how a kid feels
when it rains on his birthday,

and to describe how somebody feels
the minute before they commit suicide.

People say to me, "Well, is it
continuous with normal sadness?"

And I say, in a way it's continuous
with normal sadness.

There is a certain amount of continuity,

but it's the same way there's continuity

between having an iron fence
outside your house

that gets a little rust spot

that you have to sand off
and do a little repainting,

and what happens if you leave
the house for 100 years

and it rusts through
until it's only a pile of orange dust.

And it's that orange dust spot,

that orange dust problem,

that's the one
we're setting out to address.

So now people say,

"You take these happy pills,
and do you feel happy?"

And I don't.

But I don't feel sad
about having to eat lunch,

and I don't feel sad
about my answering machine,

and I don't feel sad
about taking a shower.

I feel more, in fact, I think,

because I can feel
sadness without nullity.

I feel sad about professional
disappointments,

about damaged relationships,

about global warming.

Those are the things
that I feel sad about now.

And I said to myself, well,
what is the conclusion?

How did those people who have better lives

even with bigger depression
manage to get through?

What is the mechanism of resilience?

And what I came up with over time

was that the people
who deny their experience,

and say, "I was depressed a long time ago,

I never want to think about it again,

I'm not going to look at it

and I'm just going
to get on with my life,"

ironically, those are the people
who are most enslaved by what they have.

Shutting out the depression
strengthens it.

While you hide from it, it grows.

And the people who do better

are the ones who are able to tolerate
the fact that they have this condition.

Those who can tolerate their depression
are the ones who achieve resilience.

So Frank Russakoff said to me,

"If I had a do-over,
I suppose I wouldn't do it this way,

but in a strange way,
I'm grateful for what I've experienced.

I'm glad to have been
in the hospital 40 times.

It taught me so much about love,

and my relationship
with my parents and my doctors

has been so precious to me,
and will be always."

And Maggie Robbins said,

"I used to volunteer in an AIDS clinic,

and I would just talk and talk and talk,

and the people I was dealing with
weren't very responsive, and I thought,

'That's not very friendly
or helpful of them.'"

(Laughter)

"And then I realized,

I realized that
they weren't going to do more

than make those first
few minutes of small talk.

It was simply going to be an occasion

where I didn't have AIDS
and I wasn't dying,

but could tolerate the fact that they did

and they were.

Our needs are our greatest assets.

It turns out I've learned to give
all the things I need."

Valuing one's depression
does not prevent a relapse,

but it may make the prospect of relapse

and even relapse itself
easier to tolerate.

The question is not so much
of finding great meaning

and deciding your depression
has been very meaningful.

It's of seeking that meaning
and thinking, when it comes again,

"This will be hellish,
but I will learn something from it."

I have learned in my own depression

how big an emotion can be,

how it can be more real than facts,

and I have found that that experience

has allowed me to experience
positive emotion

in a more intense and more focused way.

The opposite of depression
is not happiness,

but vitality,

and these days, my life is vital,

even on the days when I'm sad.

I felt that funeral in my brain,

and I sat next to the colossus
at the edge of the world,

and I have discovered
something inside of myself

that I would have to call a soul

that I had never formulated
until that day 20 years ago

when hell came to pay me a surprise visit.

I think that while I hated being depressed

and would hate to be depressed again,

I've found a way to love my depression.

I love it because it has forced me
to find and cling to joy.

I love it because each day I decide,

sometimes gamely,

and sometimes against the moment's reason,

to cleave to the reasons for living.

And that, I think,
is a highly privileged rapture.

Thank you.

(Applause)

Thank you.

(Applause)