0:00:03.952,0:00:07.814 "I felt a Funeral, in my Brain, 0:00:07.838,0:00:10.216 and Mourners to and fro 0:00:10.240,0:00:13.043 kept treading -- treading --[br]till [it seemed] 0:00:13.067,0:00:15.386 that Sense was breaking through -- 0:00:15.836,0:00:17.581 And when they all were seated, 0:00:17.605,0:00:19.579 a Service, like a Drum -- 0:00:19.603,0:00:23.055 kept beating -- beating --[br]till I [thought] 0:00:23.079,0:00:24.845 my Mind was going numb -- 0:00:25.831,0:00:29.970 And then I heard them lift a Box[br]and creak across my Soul 0:00:29.994,0:00:33.029 with those same Boots of Lead, again, 0:00:33.053,0:00:36.046 then Space -- began to toll, 0:00:36.070,0:00:40.177 As [all] the Heavens were a Bell,[br]and Being, [but] an Ear, 0:00:40.201,0:00:43.260 and I, and Silence, some strange Race, 0:00:43.284,0:00:45.864 wrecked, solitary, here -- 0:00:46.493,0:00:49.646 [And] then a Plank in Reason, broke, 0:00:49.670,0:00:52.987 and I fell down and down -- 0:00:53.011,0:00:55.662 and hit a World, at every plunge, 0:00:55.686,0:00:58.245 and Finished knowing -- then --" 0:01:00.198,0:01:03.012 We know depression through metaphors. 0:01:03.680,0:01:07.365 Emily Dickinson was able[br]to convey it in language, 0:01:07.389,0:01:09.704 Goya in an image. 0:01:10.238,0:01:14.833 Half the purpose of art[br]is to describe such iconic states. 0:01:15.997,0:01:19.851 As for me, I had always[br]thought myself tough, 0:01:19.875,0:01:21.677 one of the people who could survive 0:01:21.701,0:01:24.024 if I'd been sent to a concentration camp. 0:01:24.614,0:01:27.279 In 1991, I had a series of losses. 0:01:27.676,0:01:29.174 My mother died, 0:01:29.198,0:01:31.300 a relationship I'd been in ended, 0:01:31.324,0:01:35.244 I moved back to the United States[br]from some years abroad, 0:01:35.268,0:01:37.982 and I got through all of those[br]experiences intact. 0:01:38.617,0:01:41.516 But in 1994, three years later, 0:01:41.540,0:01:45.282 I found myself losing interest[br]in almost everything. 0:01:46.059,0:01:49.935 I didn't want to do any of the things[br]I had previously wanted to do, 0:01:49.959,0:01:51.419 and I didn't know why. 0:01:51.987,0:01:56.548 The opposite of depression[br]is not happiness, but vitality. 0:01:57.127,0:01:58.571 And it was vitality 0:01:58.595,0:02:01.558 that seemed to seep away[br]from me in that moment. 0:02:02.231,0:02:05.908 Everything there was to do[br]seemed like too much work. 0:02:06.597,0:02:08.034 I would come home 0:02:08.058,0:02:11.386 and I would see the red light[br]flashing on my answering machine, 0:02:11.410,0:02:13.950 and instead of being thrilled[br]to hear from my friends, 0:02:13.974,0:02:15.163 I would think, 0:02:15.187,0:02:17.782 "What a lot of people that is[br]to have to call back." 0:02:18.368,0:02:20.930 Or I would decide I should have lunch, 0:02:20.954,0:02:23.691 and then I would think,[br]but I'd have to get the food out 0:02:23.715,0:02:25.477 and put it on a plate 0:02:25.501,0:02:29.365 and cut it up and chew it and swallow it, 0:02:29.389,0:02:32.723 and it felt to me[br]like the Stations of the Cross. 0:02:33.286,0:02:37.419 And one of the things that often gets lost[br]in discussions of depression 0:02:37.443,0:02:39.501 is that you know it's ridiculous. 0:02:39.801,0:02:42.744 You know it's ridiculous[br]while you're experiencing it. 0:02:42.768,0:02:44.657 You know that most people manage 0:02:44.681,0:02:46.971 to listen to their messages and eat lunch 0:02:46.995,0:02:48.901 and organize themselves to take a shower 0:02:48.925,0:02:50.143 and go out the front door 0:02:50.167,0:02:51.795 and that it's not a big deal, 0:02:51.819,0:02:54.961 and yet you are nonetheless in its grip 0:02:54.985,0:02:58.422 and you are unable to figure out[br]any way around it. 0:02:58.990,0:03:03.212 And so I began to feel myself doing less 0:03:03.236,0:03:05.522 and thinking less 0:03:05.546,0:03:06.861 and feeling less. 0:03:07.829,0:03:09.567 It was a kind of nullity. 0:03:10.049,0:03:12.044 And then the anxiety set in. 0:03:12.567,0:03:16.259 If you told me that I'd have to be[br]depressed for the next month, 0:03:16.283,0:03:19.522 I would say, "As long I know it'll be over[br]in November, I can do it." 0:03:19.546,0:03:20.792 But if you said to me, 0:03:20.816,0:03:24.129 "You have to have acute anxiety[br]for the next month," 0:03:24.153,0:03:26.472 I would rather slit my wrist[br]than go through it. 0:03:26.496,0:03:28.054 It was the feeling all the time 0:03:28.078,0:03:30.282 like that feeling you have[br]if you're walking 0:03:30.306,0:03:33.827 and you slip or trip[br]and the ground is rushing up at you, 0:03:33.851,0:03:36.563 but instead of lasting half a second,[br]the way that does, 0:03:36.587,0:03:38.468 it lasted for six months. 0:03:38.492,0:03:41.421 It's a sensation[br]of being afraid all the time 0:03:41.445,0:03:44.430 but not even knowing[br]what it is that you're afraid of. 0:03:45.057,0:03:47.668 And it was at that point[br]that I began to think 0:03:47.692,0:03:51.452 that it was just too painful to be alive, 0:03:51.476,0:03:54.036 and that the only reason[br]not to kill oneself 0:03:54.060,0:03:56.755 was so as not to hurt other people. 0:03:57.295,0:04:00.176 And finally one day, I woke up 0:04:00.200,0:04:02.397 and I thought perhaps I'd had a stroke, 0:04:02.421,0:04:04.915 because I lay in bed completely frozen, 0:04:04.939,0:04:06.864 looking at the telephone, thinking, 0:04:06.888,0:04:10.427 "Something is wrong[br]and I should call for help," 0:04:10.451,0:04:12.162 and I couldn't reach out my arm 0:04:12.186,0:04:14.428 and pick up the phone and dial. 0:04:14.801,0:04:18.852 And finally, after four full hours[br]of my lying and staring at it, 0:04:18.876,0:04:20.140 the phone rang, 0:04:20.164,0:04:22.543 and somehow I managed to pick it up, 0:04:22.567,0:04:25.495 and it was my father, and I said, 0:04:25.519,0:04:28.965 "I'm in serious trouble.[br]We need to do something." 0:04:29.528,0:04:34.219 The next day I started[br]with the medications and the therapy. 0:04:35.352,0:04:39.555 And I also started reckoning[br]with this terrible question: 0:04:39.579,0:04:41.683 If I'm not the tough person 0:04:41.707,0:04:44.207 who could have made it[br]through a concentration camp, 0:04:44.231,0:04:45.719 then who am I? 0:04:45.743,0:04:47.604 And if I have to take medication, 0:04:47.628,0:04:51.541 is that medication making me[br]more fully myself, 0:04:51.565,0:04:53.783 or is it making me someone else? 0:04:53.807,0:04:57.267 And how do I feel about it[br]if it's making me someone else? 0:04:58.101,0:05:01.005 I had two advantages[br]as I went into the fight. 0:05:01.585,0:05:04.256 The first is that I knew that,[br]objectively speaking, 0:05:04.280,0:05:05.877 I had a nice life, 0:05:05.901,0:05:07.762 and that if I could only get well, 0:05:07.786,0:05:10.986 there was something at the other end[br]that was worth living for. 0:05:11.010,0:05:13.827 And the other was[br]that I had access to good treatment. 0:05:14.343,0:05:17.792 But I nonetheless emerged and relapsed, 0:05:17.816,0:05:20.327 and emerged and relapsed, 0:05:20.351,0:05:23.345 and emerged and relapsed, 0:05:23.369,0:05:25.309 and finally understood 0:05:25.333,0:05:29.254 I would have to be on medication[br]and in therapy forever. 0:05:29.769,0:05:30.936 And I thought, 0:05:30.960,0:05:33.746 "But is it a chemical problem[br]or a psychological problem? 0:05:33.770,0:05:37.703 And does it need a chemical cure[br]or a philosophical cure?" 0:05:37.727,0:05:39.854 And I couldn't figure out which it was. 0:05:39.878,0:05:41.978 And then I understood that actually, 0:05:42.002,0:05:45.989 we aren't advanced enough in either area[br]for it to explain things fully. 0:05:46.013,0:05:49.340 The chemical cure[br]and the psychological cure 0:05:49.364,0:05:51.038 both have a role to play, 0:05:51.062,0:05:55.036 and I also figured out[br]that depression was something 0:05:55.060,0:05:57.284 that was braided so deep into us 0:05:57.308,0:06:00.996 that there was no separating it[br]from our character and personality. 0:06:01.552,0:06:06.014 I want to say that the treatments we have[br]for depression are appalling. 0:06:06.038,0:06:07.641 They're not very effective. 0:06:07.958,0:06:09.728 They're extremely costly. 0:06:09.752,0:06:12.249 They come with innumerable side effects. 0:06:12.273,0:06:13.710 They're a disaster. 0:06:14.027,0:06:18.694 But I am so grateful that I live now[br]and not 50 years ago, 0:06:18.718,0:06:21.638 when there would have been[br]almost nothing to be done. 0:06:21.662,0:06:24.045 I hope that 50 years hence, 0:06:24.069,0:06:26.091 people will hear about my treatments 0:06:26.115,0:06:29.783 and be appalled that anyone endured[br]such primitive science. 0:06:30.885,0:06:34.127 Depression is the flaw in love. 0:06:35.441,0:06:38.558 If you were married[br]to someone and thought, 0:06:38.582,0:06:42.292 "Well, if my wife dies,[br]I'll find another one," 0:06:42.316,0:06:44.565 it wouldn't be love as we know it. 0:06:45.364,0:06:49.931 There's no such thing as love[br]without the anticipation of loss, 0:06:49.955,0:06:55.511 and that specter of despair[br]can be the engine of intimacy. 0:06:56.204,0:06:59.035 There are three things[br]people tend to confuse: 0:06:59.059,0:07:02.148 depression, grief and sadness. 0:07:02.966,0:07:06.305 Grief is explicitly reactive. 0:07:06.329,0:07:09.210 If you have a loss[br]and you feel incredibly unhappy, 0:07:09.234,0:07:10.909 and then, six months later, 0:07:10.933,0:07:14.018 you are still deeply sad,[br]but you're functioning a little better, 0:07:14.042,0:07:15.827 it's probably grief, 0:07:15.851,0:07:19.586 and it will probably ultimately[br]resolve itself in some measure. 0:07:19.610,0:07:22.415 If you experience a catastrophic loss, 0:07:22.439,0:07:23.741 and you feel terrible, 0:07:23.765,0:07:26.554 and six months later[br]you can barely function at all, 0:07:26.578,0:07:29.092 then it's probably a depression[br]that was triggered 0:07:29.116,0:07:31.299 by the catastrophic circumstances. 0:07:31.648,0:07:34.818 The trajectory tells us a great deal. 0:07:35.196,0:07:38.556 People think of depression[br]as being just sadness. 0:07:38.580,0:07:40.751 It's much, much too much sadness, 0:07:40.775,0:07:42.526 much too much grief 0:07:42.550,0:07:44.659 at far too slight a cause. 0:07:45.470,0:07:48.255 As I set out to understand depression, 0:07:48.279,0:07:50.926 and to interview people[br]who had experienced it, 0:07:50.950,0:07:54.743 I found that there were people[br]who seemed, on the surface, 0:07:54.767,0:07:57.980 to have what sounded like[br]relatively mild depression 0:07:58.004,0:08:00.742 who were nonetheless[br]utterly disabled by it. 0:08:01.297,0:08:03.710 And there were other people[br]who had what sounded 0:08:03.734,0:08:06.796 as they described it[br]like terribly severe depression 0:08:06.820,0:08:08.560 who nonetheless had good lives 0:08:08.584,0:08:11.290 in the interstices[br]between their depressive episodes. 0:08:11.885,0:08:15.850 And I set out to find out[br]what it is that causes some people 0:08:15.874,0:08:18.103 to be more resilient than other people. 0:08:18.127,0:08:21.343 What are the mechanisms[br]that allow people to survive? 0:08:21.652,0:08:24.850 And I went out and I interviewed[br]person after person 0:08:24.874,0:08:26.850 who was suffering with depression. 0:08:26.874,0:08:29.065 One of the first people I interviewed 0:08:29.089,0:08:33.943 described depression[br]as a slower way of being dead, 0:08:33.967,0:08:36.301 and that was a good thing[br]for me to hear early on 0:08:36.325,0:08:39.432 because it reminded me[br]that that slow way of being dead 0:08:39.456,0:08:41.736 can lead to actual deadness, 0:08:41.760,0:08:43.717 that this is a serious business. 0:08:43.741,0:08:46.130 It's the leading disability worldwide, 0:08:46.154,0:08:48.236 and people die of it every day. 0:08:49.184,0:08:52.903 One of the people I talked to[br]when I was trying to understand this 0:08:52.927,0:08:56.788 was a beloved friend[br]who I had known for many years, 0:08:56.812,0:09:01.265 and who had had a psychotic episode[br]in her freshman year of college, 0:09:01.289,0:09:04.091 and then plummeted[br]into a horrific depression. 0:09:04.115,0:09:05.754 She had bipolar illness, 0:09:05.778,0:09:08.265 or manic depression, as it was then known. 0:09:08.289,0:09:12.074 And then she did very well[br]for many years on lithium, 0:09:12.098,0:09:15.247 and then eventually,[br]she was taken off her lithium 0:09:15.271,0:09:17.082 to see how she would do without it, 0:09:17.106,0:09:19.057 and she had another psychosis, 0:09:19.081,0:09:23.441 and then plunged into the worst depression[br]that I had ever seen 0:09:23.465,0:09:26.282 in which she sat[br]in her parents' apartment, 0:09:26.306,0:09:29.578 more or less catatonic,[br]essentially without moving, 0:09:29.602,0:09:31.515 day after day after day. 0:09:31.943,0:09:35.427 And when I interviewed her[br]about that experience some years later -- 0:09:35.451,0:09:38.552 she's a poet and psychotherapist[br]named Maggie Robbins -- 0:09:38.576,0:09:41.622 when I interviewed her, she said, 0:09:41.646,0:09:45.165 "I was singing 'Where Have[br]All The Flowers Gone,' 0:09:45.189,0:09:48.086 over and over, to occupy my mind. 0:09:48.555,0:09:51.351 I was singing to blot out[br]the things my mind was saying, 0:09:51.375,0:09:56.135 which were, 'You are nothing.[br]You are nobody. 0:09:56.159,0:09:58.090 You don't even deserve to live.' 0:09:58.691,0:10:01.097 And that was[br]when I really started thinking 0:10:01.121,0:10:02.475 about killing myself." 0:10:03.193,0:10:07.103 You don't think in depression[br]that you've put on a gray veil 0:10:07.127,0:10:10.491 and are seeing the world[br]through the haze of a bad mood. 0:10:11.001,0:10:13.991 You think that the veil[br]has been taken away, 0:10:14.015,0:10:15.619 the veil of happiness, 0:10:15.643,0:10:17.580 and that now you're seeing truly. 0:10:18.247,0:10:21.007 It's easier to help[br]schizophrenics who perceive 0:10:21.031,0:10:25.005 that there's something foreign[br]inside of them that needs to be exorcised, 0:10:25.029,0:10:27.355 but it's difficult with depressives, 0:10:27.379,0:10:30.181 because we believe[br]we are seeing the truth. 0:10:31.040,0:10:32.585 But the truth lies. 0:10:33.987,0:10:35.961 I became obsessed with that sentence: 0:10:35.985,0:10:38.117 "But the truth lies." 0:10:38.435,0:10:40.875 And I discovered,[br]as I talked to depressive people, 0:10:40.899,0:10:43.471 that they have[br]many delusional perceptions. 0:10:43.815,0:10:45.553 People will say, "No one loves me." 0:10:45.577,0:10:46.789 And you say, "I love you, 0:10:46.813,0:10:49.311 your wife loves you,[br]your mother loves you." 0:10:49.335,0:10:52.696 You can answer that one pretty readily,[br]at least for most people. 0:10:53.124,0:10:55.290 But people who are depressed[br]will also say, 0:10:55.314,0:10:59.361 "No matter what we do,[br]we're all just going to die in the end." 0:10:59.385,0:11:01.614 Or they'll say,[br]"There can be no true communion 0:11:01.638,0:11:03.000 between two human beings. 0:11:03.024,0:11:05.408 Each of us is trapped in his own body." 0:11:05.805,0:11:07.425 To which you have to say, 0:11:07.449,0:11:08.928 "That's true, 0:11:08.952,0:11:12.460 but I think we should focus right now[br]on what to have for breakfast." 0:11:12.484,0:11:14.645 (Laughter) 0:11:14.669,0:11:16.314 A lot of the time, 0:11:16.338,0:11:19.312 what they are expressing[br]is not illness, but insight, 0:11:19.336,0:11:21.867 and one comes to think[br]what's really extraordinary 0:11:21.891,0:11:25.023 is that most of us know[br]about those existential questions 0:11:25.047,0:11:27.091 and they don't distract us very much. 0:11:27.428,0:11:29.250 There was a study I particularly liked 0:11:29.274,0:11:33.017 in which a group of depressed[br]and a group of non-depressed people 0:11:33.041,0:11:35.765 were asked to play a video[br]game for an hour, 0:11:35.789,0:11:37.409 and at the end of the hour, 0:11:37.433,0:11:41.043 they were asked how many little monsters[br]they thought they had killed. 0:11:41.067,0:11:45.052 The depressive group was usually accurate[br]to within about 10 percent, 0:11:45.076,0:11:46.647 and the non-depressed people 0:11:46.671,0:11:51.125 guessed between 15 and 20 times[br]as many little monsters -- 0:11:51.149,0:11:52.300 (Laughter) 0:11:52.324,0:11:54.076 as they had actually killed. 0:11:55.945,0:11:59.161 A lot of people said, when I chose[br]to write about my depression, 0:11:59.185,0:12:02.650 that it must be very difficult[br]to be out of that closet, 0:12:02.674,0:12:03.983 to have people know. 0:12:04.007,0:12:06.276 They said, "Do people[br]talk to you differently?" 0:12:06.300,0:12:08.379 I said, "Yes, people[br]talk to me differently. 0:12:08.403,0:12:10.165 They talk to me differently insofar 0:12:10.189,0:12:12.856 as they start telling me[br]about their experience, 0:12:12.880,0:12:14.691 or their sister's experience, 0:12:14.715,0:12:16.356 or their friend's experience. 0:12:16.729,0:12:18.927 Things are different because now I know 0:12:18.951,0:12:23.056 that depression is the family secret[br]that everyone has. 0:12:23.715,0:12:27.341 I went a few years ago to a conference, 0:12:27.365,0:12:29.796 and on Friday of the three-day conference, 0:12:29.820,0:12:32.825 one of the participants[br]took me aside, and she said, 0:12:32.849,0:12:39.098 "I suffer from depression[br]and I'm a little embarrassed about it, 0:12:39.122,0:12:40.964 but I've been taking this medication, 0:12:40.988,0:12:44.102 and I just wanted to ask you[br]what you think?" 0:12:44.126,0:12:46.746 And so I did my best to give her[br]such advice as I could. 0:12:46.770,0:12:51.257 And then she said, "You know,[br]my husband would never understand this. 0:12:51.281,0:12:54.549 He's really the kind of guy to whom[br]this wouldn't make any sense, 0:12:54.573,0:12:56.697 so, you know, it's just between us." 0:12:56.721,0:12:58.273 And I said, "Yes, that's fine." 0:12:58.733,0:13:00.592 On Sunday of the same conference, 0:13:00.616,0:13:02.492 her husband took me aside, 0:13:02.516,0:13:03.830 (Laughter) 0:13:03.854,0:13:05.615 and he said, "My wife wouldn't think 0:13:05.639,0:13:07.950 that I was really much[br]of a guy if she knew this, 0:13:07.974,0:13:11.732 but I've been dealing with this depression[br]and I'm taking some medication, 0:13:11.756,0:13:14.181 and I wondered what you think?" 0:13:14.205,0:13:16.495 They were hiding the same medication 0:13:16.519,0:13:19.894 in two different places[br]in the same bedroom. 0:13:19.918,0:13:21.116 (Laughter) 0:13:21.140,0:13:24.078 And I said that I thought[br]communication within the marriage 0:13:24.102,0:13:26.150 might be triggering[br]some of their problems. 0:13:26.174,0:13:28.666 (Laughter) 0:13:30.593,0:13:32.156 But I was also struck 0:13:32.180,0:13:35.698 by the burdensome nature[br]of such mutual secrecy. 0:13:36.141,0:13:38.002 Depression is so exhausting. 0:13:38.026,0:13:40.972 It takes up so much[br]of your time and energy, 0:13:40.996,0:13:42.527 and silence about it, 0:13:42.551,0:13:44.808 it really does make the depression worse. 0:13:45.276,0:13:46.485 And then I began thinking 0:13:46.509,0:13:48.832 about all the ways[br]people make themselves better. 0:13:48.856,0:13:51.317 I'd started off as a medical conservative. 0:13:51.341,0:13:53.975 I thought there were a few[br]kinds of therapy that worked, 0:13:53.999,0:13:55.444 it was clear what they were -- 0:13:55.468,0:13:56.968 there was medication, 0:13:56.992,0:13:58.659 there were certain psychotherapies, 0:13:58.683,0:14:01.104 there was possibly[br]electroconvulsive treatment, 0:14:01.128,0:14:03.717 and that everything else was nonsense. 0:14:03.741,0:14:05.669 But then I discovered something. 0:14:05.693,0:14:07.326 If you have brain cancer, 0:14:07.350,0:14:10.538 and you say that standing on your head[br]for 20 minutes every morning 0:14:10.562,0:14:11.715 makes you feel better, 0:14:11.739,0:14:14.717 it may make you feel better,[br]but you still have brain cancer, 0:14:14.741,0:14:16.814 and you'll still probably die from it. 0:14:17.387,0:14:19.673 But if you say that you have depression, 0:14:19.697,0:14:22.037 and standing on your head[br]for 20 minutes every day 0:14:22.061,0:14:24.257 makes you feel better, then it's worked, 0:14:24.281,0:14:26.722 because depression[br]is an illness of how you feel, 0:14:26.746,0:14:28.076 and if you feel better, 0:14:28.100,0:14:30.659 then you are effectively[br]not depressed anymore. 0:14:31.112,0:14:33.199 So I became much more tolerant 0:14:33.223,0:14:35.611 of the vast world[br]of alternative treatments. 0:14:35.936,0:14:38.248 And I get letters,[br]I get hundreds of letters 0:14:38.272,0:14:41.082 from people writing to tell me[br]about what's worked for them. 0:14:41.106,0:14:44.671 Someone was asking me[br]backstage today about meditation. 0:14:44.695,0:14:48.367 My favorite of the letters that I got[br]was the one that came from a woman 0:14:48.391,0:14:51.312 who wrote and said[br]that she had tried therapy, medication, 0:14:51.336,0:14:53.166 she had tried pretty much everything, 0:14:53.190,0:14:56.096 and she had found a solution[br]and hoped I would tell the world, 0:14:56.120,0:14:59.692 and that was making[br]little things from yarn. 0:14:59.716,0:15:02.609 (Laughter) 0:15:02.633,0:15:04.169 She sent me some of them. 0:15:04.193,0:15:06.223 (Laughter) 0:15:06.247,0:15:08.112 And I'm not wearing them right now. 0:15:08.136,0:15:09.286 (Laughter) 0:15:09.845,0:15:12.336 I suggested to her[br]that she also should look up 0:15:12.360,0:15:15.766 obsessive compulsive disorder in the DSM. 0:15:16.979,0:15:19.669 And yet, when I went to look[br]at alternative treatments, 0:15:19.693,0:15:22.121 I also gained perspective[br]on other treatments. 0:15:22.605,0:15:25.323 I went through[br]a tribal exorcism in Senegal 0:15:25.347,0:15:27.336 that involved a great deal of ram's blood 0:15:27.360,0:15:29.398 and that I'm not going[br]to detail right now, 0:15:29.422,0:15:31.422 but a few years afterwards[br]I was in Rwanda, 0:15:31.446,0:15:33.343 working on a different project, 0:15:33.367,0:15:35.952 and I happened to describe[br]my experience to someone, 0:15:35.976,0:15:37.135 and he said, 0:15:37.159,0:15:39.617 "Well, that's West Africa,[br]and we're in East Africa, 0:15:39.641,0:15:41.898 and our rituals are[br]in some ways very different, 0:15:41.922,0:15:43.223 but we do have some rituals 0:15:43.247,0:15:46.047 that have something in common[br]with what you're describing." 0:15:46.071,0:15:47.238 And he said, 0:15:47.262,0:15:50.473 "But we've had a lot of trouble[br]with Western mental health workers, 0:15:50.497,0:15:53.115 especially the ones who came[br]right after the genocide." 0:15:53.139,0:15:55.189 I said, "What kind[br]of trouble did you have?" 0:15:55.213,0:15:58.965 And he said, "Well,[br]they would do this bizarre thing. 0:15:58.989,0:16:01.037 They didn't take people out[br]in the sunshine 0:16:01.061,0:16:02.550 where you begin to feel better. 0:16:02.574,0:16:05.726 They didn't include drumming[br]or music to get people's blood going. 0:16:05.750,0:16:07.656 They didn't involve the whole community. 0:16:07.680,0:16:10.916 They didn't externalize[br]the depression as an invasive spirit. 0:16:10.940,0:16:15.953 Instead what they did was they took people[br]one at a time into dingy little rooms 0:16:15.977,0:16:17.358 and had them talk for an hour 0:16:17.382,0:16:19.526 about bad things[br]that had happened to them." 0:16:19.550,0:16:21.593 (Laughter) 0:16:21.617,0:16:24.986 (Applause) 0:16:25.010,0:16:27.439 He said, "We had to ask them[br]to leave the country." 0:16:27.463,0:16:30.405 (Laughter) 0:16:30.429,0:16:33.007 Now at the other end[br]of alternative treatments, 0:16:33.031,0:16:35.126 let me tell you about Frank Russakoff. 0:16:35.150,0:16:40.852 Frank Russakoff had the worst depression[br]perhaps that I've ever seen in a man. 0:16:40.876,0:16:42.845 He was constantly depressed. 0:16:42.869,0:16:44.314 He was, when I met him, 0:16:44.338,0:16:48.144 at a point at which every month,[br]he would have electroshock treatment. 0:16:48.168,0:16:50.719 Then he would feel[br]sort of disoriented for a week. 0:16:50.743,0:16:52.522 Then he would feel okay for a week. 0:16:52.546,0:16:54.640 Then he would have a week[br]of going downhill. 0:16:54.664,0:16:57.254 And then he would have another[br]electroshock treatment. 0:16:57.278,0:16:58.851 And he said to me when I met him, 0:16:58.875,0:17:01.240 "It's unbearable to go[br]through my weeks this way. 0:17:01.264,0:17:02.711 I can't go on this way, 0:17:02.735,0:17:04.845 and I've figured out[br]how I'm going to end it 0:17:04.869,0:17:06.202 if I don't get better." 0:17:06.226,0:17:10.328 "But," he said to me,[br]"I heard about a protocol at Mass General 0:17:10.352,0:17:13.574 for a procedure called a cingulotomy,[br]which is a brain surgery, 0:17:13.598,0:17:15.867 and I think I'm going to give that a try." 0:17:15.891,0:17:19.184 And I remember being amazed[br]at that point to think that someone 0:17:19.208,0:17:22.205 who clearly had so many bad experiences 0:17:22.229,0:17:24.365 with so many different treatments 0:17:24.389,0:17:27.429 still had buried in him,[br]somewhere, enough optimism 0:17:27.453,0:17:29.238 to reach out for one more. 0:17:29.760,0:17:33.957 And he had the cingulotomy,[br]and it was incredibly successful. 0:17:33.981,0:17:35.593 He's now a friend of mine. 0:17:35.617,0:17:38.942 He has a lovely wife[br]and two beautiful children. 0:17:38.966,0:17:41.891 He wrote me a letter[br]the Christmas after the surgery, 0:17:41.915,0:17:43.080 and he said, 0:17:43.104,0:17:45.707 "My father sent me two presents this year, 0:17:45.731,0:17:48.258 First, a motorized CD rack[br]from The Sharper Image 0:17:48.282,0:17:49.680 that I didn't really need, 0:17:49.704,0:17:51.941 but I knew he was giving it[br]to me to celebrate 0:17:51.965,0:17:55.214 the fact that I'm living on my own[br]and have a job I seem to love. 0:17:55.635,0:17:58.876 And the other present[br]was a photo of my grandmother, 0:17:58.900,0:18:00.376 who committed suicide. 0:18:00.955,0:18:03.860 As I unwrapped it, I began to cry, 0:18:03.884,0:18:05.741 and my mother came over and said, 0:18:05.765,0:18:08.757 'Are you crying because[br]of the relatives you never knew?' 0:18:09.162,0:18:12.710 And I said, 'She had[br]the same disease I have.' 0:18:13.242,0:18:15.854 I'm crying now as I write to you. 0:18:15.878,0:18:19.165 It's not that I'm so sad,[br]but I get overwhelmed, 0:18:19.189,0:18:21.386 I think, because I could[br]have killed myself, 0:18:21.410,0:18:24.838 but my parents kept me going,[br]and so did the doctors, 0:18:24.862,0:18:26.692 and I had the surgery. 0:18:26.716,0:18:28.798 I'm alive and grateful. 0:18:29.531,0:18:34.132 We live in the right time,[br]even if it doesn't always feel like it." 0:18:35.856,0:18:37.775 I was struck by the fact that depression 0:18:37.799,0:18:42.805 is broadly perceived to be[br]a modern, Western, middle-class thing, 0:18:42.829,0:18:46.960 and I went to look at how it operated[br]in a variety of other contexts, 0:18:46.984,0:18:49.175 and one of the things[br]I was most interested in 0:18:49.199,0:18:51.114 was depression among the indigent. 0:18:51.138,0:18:52.686 And so I went out to try to look 0:18:52.710,0:18:55.463 at what was being done[br]for poor people with depression. 0:18:55.487,0:18:57.614 And what I discovered is that poor people 0:18:57.638,0:19:00.166 are mostly not being[br]treated for depression. 0:19:00.190,0:19:02.864 Depression is the result[br]of a genetic vulnerability, 0:19:02.888,0:19:06.238 which is presumably[br]evenly distributed in the population, 0:19:06.262,0:19:07.975 and triggering circumstances, 0:19:07.999,0:19:11.753 which are likely to be more severe[br]for people who are impoverished. 0:19:11.777,0:19:15.280 And yet it turns out that if you have[br]a really lovely life 0:19:15.304,0:19:16.886 but feel miserable all the time, 0:19:16.910,0:19:18.696 you think, "Why do I feel like this? 0:19:18.720,0:19:19.989 I must have depression." 0:19:20.013,0:19:22.149 And you set out to find treatment for it. 0:19:22.173,0:19:24.105 But if you have a perfectly awful life, 0:19:24.129,0:19:25.872 and you feel miserable all the time, 0:19:25.896,0:19:28.906 the way you feel[br]is commensurate with your life, 0:19:28.930,0:19:30.785 and it doesn't occur to you to think, 0:19:30.809,0:19:32.346 "Maybe this is treatable." 0:19:32.370,0:19:35.572 And so we have an epidemic in this country 0:19:35.596,0:19:38.254 of depression among impoverished people 0:19:38.278,0:19:40.850 that's not being picked up[br]and that's not being treated 0:19:40.874,0:19:42.822 and that's not being addressed, 0:19:42.846,0:19:44.917 and it's a tragedy of a grand order. 0:19:45.219,0:19:46.819 And so I found an academic 0:19:46.843,0:19:50.068 who was doing a research project[br]in slums outside of D.C., 0:19:50.092,0:19:53.235 where she picked up women[br]who had come in for other health problems 0:19:53.259,0:19:55.014 and diagnosed them with depression, 0:19:55.038,0:19:58.110 and then provided six months[br]of the experimental protocol. 0:19:58.134,0:20:00.439 One of them, Lolly, came in, 0:20:00.463,0:20:02.736 and this is what she said[br]the day she came in. 0:20:03.069,0:20:07.634 She said, and she was a woman,[br]by the way, who had seven children. 0:20:07.658,0:20:10.443 She said, "I used to have a job[br]but I had to give it up 0:20:10.467,0:20:12.682 because I couldn't go out of the house. 0:20:13.134,0:20:15.074 I have nothing to say to my children. 0:20:15.447,0:20:17.929 In the morning,[br]I can't wait for them to leave, 0:20:17.953,0:20:21.155 and then I climb in bed[br]and pull the covers over my head, 0:20:21.179,0:20:23.054 and three o'clock when they come home, 0:20:23.078,0:20:24.520 it just comes so fast." 0:20:24.544,0:20:26.838 She said, "I've been taking[br]a lot of Tylenol, 0:20:26.862,0:20:29.365 anything I can take[br]so that I can sleep more. 0:20:29.389,0:20:33.386 My husband has been telling me[br]I'm stupid, I'm ugly. 0:20:33.410,0:20:36.164 I wish I could stop the pain." 0:20:36.935,0:20:39.531 Well, she was brought[br]into this experimental protocol, 0:20:39.555,0:20:41.746 and when I interviewed her[br]six months later, 0:20:41.770,0:20:45.995 she had taken a job working in childcare 0:20:46.019,0:20:50.069 for the U.S. Navy,[br]she had left the abusive husband, 0:20:50.093,0:20:52.116 and she said to me, 0:20:52.140,0:20:54.395 "My kids are so much happier now." 0:20:54.419,0:20:57.101 She said, "There's one room[br]in my new place for the boys 0:20:57.125,0:20:59.012 and one room for the girls, 0:20:59.036,0:21:01.375 but at night, they're just[br]all up on my bed, 0:21:01.399,0:21:03.987 and we're doing homework[br]all together and everything. 0:21:04.011,0:21:05.685 One of them wants to be a preacher, 0:21:05.709,0:21:07.602 one of them wants to be a firefighter, 0:21:07.626,0:21:10.326 and one of the girls says[br]she's going to be a lawyer. 0:21:10.350,0:21:12.554 They don't cry like they used to, 0:21:12.578,0:21:14.388 and they don't fight like they did. 0:21:15.144,0:21:17.969 That's all I need now, is my kids. 0:21:18.826,0:21:20.771 Things keep on changing, 0:21:20.795,0:21:25.171 the way I dress,[br]the way I feel, the way I act. 0:21:25.909,0:21:29.710 I can go outside not being afraid anymore, 0:21:29.734,0:21:33.222 and I don't think[br]those bad feelings are coming back, 0:21:33.246,0:21:36.182 and if it weren't[br]for Dr. Miranda and that, 0:21:36.206,0:21:39.728 I would still be at home[br]with the covers pulled over my head, 0:21:39.752,0:21:41.605 if I were still alive at all. 0:21:42.097,0:21:45.603 I asked the Lord to send me an angel, 0:21:45.627,0:21:47.404 and He heard my prayers." 0:21:50.308,0:21:53.288 I was really moved by these experiences, 0:21:53.312,0:21:55.827 and I decided that I wanted[br]to write about them 0:21:55.851,0:21:58.668 not only in a book I was working on,[br]but also in an article, 0:21:58.692,0:22:01.271 and I got a commission[br]from The New York Times Magazine 0:22:01.295,0:22:03.414 to write about depression[br]among the indigent. 0:22:03.438,0:22:04.675 And I turned in my story, 0:22:04.699,0:22:08.159 and my editor called me and said,[br]"We really can't publish this." 0:22:08.668,0:22:09.827 And I said, "Why not?" 0:22:09.851,0:22:11.922 And she said, "It just is too far-fetched. 0:22:11.946,0:22:15.609 These people who are sort of[br]at the very bottom rung of society 0:22:15.633,0:22:17.648 and then they get[br]a few months of treatment 0:22:17.672,0:22:20.045 and they're virtually ready[br]to run Morgan Stanley? 0:22:20.069,0:22:21.585 It's just too implausible." 0:22:22.013,0:22:24.594 She said, "I've never even heard[br]of anything like it." 0:22:24.618,0:22:27.071 And I said, "The fact[br]that you've never heard of it 0:22:27.095,0:22:29.198 is an indication that it is news." 0:22:29.907,0:22:33.930 (Laughter) 0:22:33.954,0:22:37.293 (Applause) 0:22:37.317,0:22:39.434 "And you are a news magazine." 0:22:39.950,0:22:43.010 So after a certain amount of negotiation,[br]they agreed to it. 0:22:43.034,0:22:46.920 But I think a lot of what they said[br]was connected in some strange way 0:22:46.944,0:22:50.525 to this distaste that people still have[br]for the idea of treatment, 0:22:50.549,0:22:52.407 the notion that somehow if we went out 0:22:52.431,0:22:55.254 and treated a lot of people[br]in indigent communities, 0:22:55.278,0:22:57.134 that would be exploitative, 0:22:57.158,0:22:58.856 because we would be changing them. 0:22:58.880,0:23:02.687 There is this false moral imperative[br]that seems to be all around us, 0:23:02.711,0:23:04.819 that treatment of depression, 0:23:04.843,0:23:07.118 the medications and so on,[br]are an artifice, 0:23:07.142,0:23:09.465 and that it's not natural. 0:23:09.489,0:23:12.432 And I think that's very misguided. 0:23:12.456,0:23:15.789 It would be natural[br]for people's teeth to fall out, 0:23:15.813,0:23:19.001 but there is nobody militating[br]against toothpaste, 0:23:19.025,0:23:20.495 at least not in my circles. 0:23:21.915,0:23:23.159 People then say, 0:23:23.183,0:23:26.444 "But isn't depression part of what people[br]are supposed to experience? 0:23:26.468,0:23:28.200 Didn't we evolve to have depression? 0:23:28.224,0:23:29.975 Isn't it part of your personality?" 0:23:29.999,0:23:32.438 To which I would say, mood is adaptive. 0:23:32.462,0:23:35.539 Being able to have sadness and fear 0:23:35.563,0:23:37.469 and joy and pleasure 0:23:37.493,0:23:41.248 and all of the other moods that we have,[br]that's incredibly valuable. 0:23:41.272,0:23:43.186 And major depression 0:23:43.210,0:23:46.572 is something that happens[br]when that system gets broken. 0:23:46.596,0:23:48.200 It's maladaptive. 0:23:48.224,0:23:49.839 People will come to me and say, 0:23:49.863,0:23:52.665 "I think, though, if I just[br]stick it out for another year, 0:23:52.689,0:23:54.542 I think I can just get through this." 0:23:54.566,0:23:57.090 And I always say to them,[br]"You may get through it, 0:23:57.114,0:23:59.304 but you'll never be 37 again. 0:23:59.733,0:24:03.442 Life is short, and that's a whole year[br]you're talking about giving up. 0:24:03.982,0:24:05.133 Think it through." 0:24:05.694,0:24:08.342 It's a strange poverty[br]of the English language, 0:24:08.366,0:24:10.450 and indeed of many other languages, 0:24:10.474,0:24:12.844 that we use this same word, depression, 0:24:12.868,0:24:16.582 to describe how a kid feels[br]when it rains on his birthday, 0:24:16.606,0:24:20.965 and to describe how somebody feels[br]the minute before they commit suicide. 0:24:21.495,0:24:24.501 People say to me, "Well, is it[br]continuous with normal sadness?" 0:24:24.525,0:24:27.632 And I say, in a way it's continuous[br]with normal sadness. 0:24:27.656,0:24:29.830 There is a certain amount of continuity, 0:24:29.854,0:24:31.791 but it's the same way there's continuity 0:24:31.815,0:24:34.021 between having an iron fence[br]outside your house 0:24:34.045,0:24:35.465 that gets a little rust spot 0:24:35.489,0:24:38.087 that you have to sand off[br]and do a little repainting, 0:24:38.111,0:24:40.939 and what happens if you leave[br]the house for 100 years 0:24:40.963,0:24:44.762 and it rusts through[br]until it's only a pile of orange dust. 0:24:45.082,0:24:46.935 And it's that orange dust spot, 0:24:46.959,0:24:48.724 that orange dust problem, 0:24:48.748,0:24:51.334 that's the one[br]we're setting out to address. 0:24:52.040,0:24:54.254 So now people say, 0:24:54.278,0:24:56.957 "You take these happy pills,[br]and do you feel happy?" 0:24:56.981,0:24:58.171 And I don't. 0:24:58.594,0:25:01.562 But I don't feel sad[br]about having to eat lunch, 0:25:01.586,0:25:04.427 and I don't feel sad[br]about my answering machine, 0:25:04.451,0:25:06.649 and I don't feel sad[br]about taking a shower. 0:25:07.324,0:25:09.927 I feel more, in fact, I think, 0:25:09.951,0:25:12.357 because I can feel[br]sadness without nullity. 0:25:12.704,0:25:16.910 I feel sad about professional[br]disappointments, 0:25:16.934,0:25:19.218 about damaged relationships, 0:25:19.242,0:25:20.759 about global warming. 0:25:21.114,0:25:23.815 Those are the things[br]that I feel sad about now. 0:25:23.839,0:25:26.549 And I said to myself, well,[br]what is the conclusion? 0:25:26.573,0:25:29.110 How did those people who have better lives 0:25:29.134,0:25:31.664 even with bigger depression[br]manage to get through? 0:25:31.964,0:25:34.115 What is the mechanism of resilience? 0:25:34.583,0:25:36.545 And what I came up with over time 0:25:36.569,0:25:39.395 was that the people[br]who deny their experience, 0:25:39.419,0:25:41.435 and say, "I was depressed a long time ago, 0:25:41.459,0:25:43.230 I never want to think about it again, 0:25:43.254,0:25:44.548 I'm not going to look at it 0:25:44.572,0:25:46.595 and I'm just going[br]to get on with my life," 0:25:46.619,0:25:51.217 ironically, those are the people[br]who are most enslaved by what they have. 0:25:51.241,0:25:53.439 Shutting out the depression[br]strengthens it. 0:25:53.780,0:25:56.470 While you hide from it, it grows. 0:25:57.185,0:25:59.723 And the people who do better 0:25:59.747,0:26:04.300 are the ones who are able to tolerate[br]the fact that they have this condition. 0:26:04.324,0:26:08.196 Those who can tolerate their depression[br]are the ones who achieve resilience. 0:26:08.516,0:26:10.128 So Frank Russakoff said to me, 0:26:10.152,0:26:13.874 "If I had a do-over,[br]I suppose I wouldn't do it this way, 0:26:13.898,0:26:17.366 but in a strange way,[br]I'm grateful for what I've experienced. 0:26:17.390,0:26:20.714 I'm glad to have been[br]in the hospital 40 times. 0:26:21.023,0:26:23.634 It taught me so much about love, 0:26:23.658,0:26:26.579 and my relationship[br]with my parents and my doctors 0:26:26.603,0:26:30.149 has been so precious to me,[br]and will be always." 0:26:30.772,0:26:32.674 And Maggie Robbins said, 0:26:32.698,0:26:35.663 "I used to volunteer in an AIDS clinic, 0:26:35.687,0:26:38.677 and I would just talk and talk and talk, 0:26:38.701,0:26:42.734 and the people I was dealing with[br]weren't very responsive, and I thought, 0:26:42.758,0:26:45.254 'That's not very friendly[br]or helpful of them.'" 0:26:45.278,0:26:46.518 (Laughter) 0:26:46.542,0:26:48.160 "And then I realized, 0:26:48.184,0:26:50.327 I realized that[br]they weren't going to do more 0:26:50.351,0:26:52.834 than make those first[br]few minutes of small talk. 0:26:52.858,0:26:54.897 It was simply going to be an occasion 0:26:54.921,0:26:57.870 where I didn't have AIDS[br]and I wasn't dying, 0:26:57.894,0:27:00.772 but could tolerate the fact that they did 0:27:00.796,0:27:02.011 and they were. 0:27:02.503,0:27:05.646 Our needs are our greatest assets. 0:27:06.202,0:27:10.367 It turns out I've learned to give[br]all the things I need." 0:27:12.160,0:27:16.021 Valuing one's depression[br]does not prevent a relapse, 0:27:16.045,0:27:18.682 but it may make the prospect of relapse 0:27:18.706,0:27:22.219 and even relapse itself[br]easier to tolerate. 0:27:23.004,0:27:26.662 The question is not so much[br]of finding great meaning 0:27:26.686,0:27:29.257 and deciding your depression[br]has been very meaningful. 0:27:29.281,0:27:33.272 It's of seeking that meaning[br]and thinking, when it comes again, 0:27:33.296,0:27:36.613 "This will be hellish,[br]but I will learn something from it." 0:27:37.487,0:27:39.727 I have learned in my own depression 0:27:39.751,0:27:41.949 how big an emotion can be, 0:27:41.973,0:27:45.033 how it can be more real than facts, 0:27:45.057,0:27:47.786 and I have found that that experience 0:27:47.810,0:27:50.678 has allowed me to experience[br]positive emotion 0:27:50.702,0:27:53.601 in a more intense and more focused way. 0:27:54.222,0:27:57.805 The opposite of depression[br]is not happiness, 0:27:57.829,0:27:59.139 but vitality, 0:27:59.163,0:28:02.118 and these days, my life is vital, 0:28:02.142,0:28:04.434 even on the days when I'm sad. 0:28:04.823,0:28:07.938 I felt that funeral in my brain, 0:28:07.962,0:28:12.502 and I sat next to the colossus[br]at the edge of the world, 0:28:12.526,0:28:16.413 and I have discovered[br]something inside of myself 0:28:16.437,0:28:18.501 that I would have to call a soul 0:28:18.525,0:28:22.038 that I had never formulated[br]until that day 20 years ago 0:28:22.062,0:28:25.363 when hell came to pay me a surprise visit. 0:28:26.841,0:28:30.654 I think that while I hated being depressed 0:28:30.678,0:28:33.180 and would hate to be depressed again, 0:28:33.204,0:28:35.267 I've found a way to love my depression. 0:28:35.894,0:28:40.077 I love it because it has forced me[br]to find and cling to joy. 0:28:40.681,0:28:44.270 I love it because each day I decide, 0:28:44.294,0:28:45.683 sometimes gamely, 0:28:45.707,0:28:48.252 and sometimes against the moment's reason, 0:28:48.276,0:28:50.415 to cleave to the reasons for living. 0:28:50.978,0:28:54.655 And that, I think,[br]is a highly privileged rapture. 0:28:55.076,0:28:56.332 Thank you. 0:28:56.356,0:29:00.357 (Applause) 0:29:00.381,0:29:01.532 Thank you. 0:29:01.556,0:29:03.928 (Applause)