On Chronic Depression and Myth

One of the things that occurs a lot in the mentally ill, especially, thought not exclusively, in the mood disordered, is that a mood episode is treated with medication, and the cycling of moods is stopped, yet the person remains miserable, suicidal, even, and suffers a lingering handicap. In the world of psychiatry, this is the stage in which the doctor says, “There are personality factors at work,” which is code for, “This person is nuts and I have no fucking idea what to do.” The patient is then referred for long-term therapy, which rarely helps.

I know because I experienced this recently.  My acute episode ended – the heavy cardinal signs of depression and mania were gone, yet I remained miserable. The same pattern is readily apparent on many of the blogs on my sidebar (Exact Science, Coloured Mind, PWH). The thing that is last to fade, it seems, is the temptation of suicide.

The doctors never seem to understand this. “We fixed the chemical symptoms, why are you still fucked up? Why can’t you just go back to doing whatever it is that you were doing before you flipped out?”

My partner has been traveling to the Far East a lot lately, and has become interested in Buddhism. I got him a copy of Siddhartha, which I only read in high school and remember not liking that much. I thumbed through some of the coffee table books on Buddhism that he brought back, and one detail of the life of the Buddha struck me: that the hardest part of his journey was not leaving home to seek out new knowledge; it was not the reaching Nirvana, complete insight into the order of the universe, and not spreading his teachings to his disciples.

The hardest part was, after reaching Nirvana, reintegrating into the stream of life, caring about other living beings. He was presented the choice, upon seeing Nirvana, to either remain there for eternity, or to stay and spread his teaching on earth. The Brahma itself (God) had to come and convince him to continue on the path.

This struck me as the crux of the matter, as the reason I continued to be suicidal well after the depression had lifted. It is not the descent into symbolic death that is difficult, nor the ascent out of the underworld. Rather, the most painful and difficult part of the narrative journey is the return to the flow of everyday life after the threshold experience.

Myth studies and Jungian psychology are the types that most move me, interpretation through metaphor, myth, and poetry, seeing each individual as a Hero. It gives strength to people to realize that what they are facing is not mundane, not a result of skewed object relations or personality flaws, or dysfunctional families, but rather a part of what humans have faced since the dawn of time, and helps awaken them to the fact that they will have to call on their own mythic strength to prevail.

Mental illness in its life-threatening forms – suicidality, depression, mania, psychosis – is a liminal experience, one in which, unrequested, people are forced to face the boundaries of normal human experience. Symbolically, suicidal depression is a descent into the underworld, in which all of the trivia of normal life is stripped away.

During my last illness, I considered whether I would live or die, nearly each moment of each day. I made preparations for my death, and saw the world differently, knowing that I might not reside in it much longer. Trivia fell away; the world seemed quieter. Preoccupied with thoughts of high cliffs and nooses, the overwhelming unbearableness of life, other things seemed to fade.

When the episode was treated, under control even, I stayed on the edge of suicidal thoughts. They didn’t go away, even though the misery that had led to them did. And the shrinks never understand why.

But myth does. A classic stage in the monomyth is “the return threshold.” Dying is one threshold, and every hero has to face a symbolic death and descent. The hero is then saved and brought back to life with new understanding, either by his own prescience or a force from without. Though it seems like that should be a central plot moment, it is very short, albeit dramatic.

The true struggle comes after. It is not easy, once one has seen the void and been swallowed by it, to return. Everyday life seems trivial, bland, meaningless. When one has faced the pit, how is one supposed to return to preparing dinner, to cuddling in bed, to laughing? To getting up and going to work, to petting the cat, to doing the million small and seemingly meaningless things that make up life?

The road back is long and not terribly exciting. It is nothing like the symbolic death or the symbolic rebirth. It is arduous, in many ways more painful, and its outcome less certain than the simple death or rebirth. It is natural, easy even, to be faced with this journey and to wish to return to the underworld, where things appeared more certain, if darker, more essential, more stripped down to meaning-and-unmeaning. It may be a horrible place, but it least it is a final one, unlike the slow journey up the mountain to a destination – life – that one hardly remembers, that does not promise to be less frightening than the life that led one to the threshold of death in the first place.

And so we stay suicidal long after the depression has faded. We frustrate our doctors by continuing to talk about death and pain and our wish to be freed long after we have stopped waking up at 3 AM and being restless and wrestling with God.

This part of the journey is much longer and more arduous than crawling out of the grave. We, and our doctors, deceive ourselves by thinking that the gateway out of hell is the end of the struggle, the hardest part, when in fact it is the easiest and shortest part. The only way back, as the Buddha knew, is to immerse oneself in the river of life, and forget the rest, let the questions of life and death fade away, at least until they are back for good.

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17 Comments

  1. It sounds to me like you’re not done being depressed at all, because you should be embracing life now and not be looking for reasons why you are still walking around with these feelings that are pretty hefty. I think once you’re done being depressed, you do not give another serious thought to suicide, nor should you settle for this kind of a cure to your depression. As far as I’m concerned, you are not cured yet.

  2. “Its far harder to stay alive than to commit suicide, your doing the brave thing”. Thats what my old CPN used to say to me all the time. Its that change, that inbetween stage where the crisis as such is over but you still deal with those thoughts. Thoughts that used to plague you all the time and now only some of the time. Because its easy when you can tell yourself that you can kill youself of when you think about it all the time. Its when you have more insight, when you tell yourself its not an option that you are going to take that it becomes more difficult. Goodluck, Hannah X

  3. Sara, how are you?

  4. I’ve been meaning to post, because actually I seem to be doing better, thanks.

  5. I have had bipolar for over ten years, all descriptions of it, and I consider myself lucky to have taken a long term view to the meaning of cure. I think knowledge of all things, including health is very personal, just as our lives are to us, the story that is me is myself and it dies when I am in deep sleep and continues when I shake off the zzz’s of no-mans’ land and remember who I am in awaking – my story changes day by day. This is the same for the psychiatrist, each with their own personal interpretation of events and people, seen as they see things, through their story – this includes you and affects you. Only you know exactly how you see things even if you cannot put that vision into words – though you have. Your attitude to the people treating you sounds like a difference of life view – not in how healthy you are. They may not share your trust in humanity, they are probably being more valid than you, but are you going to see this as a threat to you or a framework for you to use till you have your own. They would like you to use it because it is the accepted standard – where will you go if you do not accept it for now – this is the path that psychiatry created. See this,

    ‘Physician, heal yourself: thus you will heal your patient too. Let his best healing-aid be to see with his own eyes him who makes himself well.

    There are a thousand paths that have never yet been trodden, a thousand forms of health and hidden islands of life. Man and man’s earth are still unexhausted and undiscovered.’ Nietzsche (Thus spoke Zarathustra’)

    I healed myself by watching my CPN, psychiatrist and people – who came looking for the sick me – heal themselves first or leave in haste. I replaced my last pills with glorious home cooked food and knowledge to help myself . In the end there was nothing to report but a new story to be lived – gracefully taken from books written by people not much different from us. The cure is out there and waiting for you.

  6. Thank you. I agree totally.

  7. Thank you too for sharing your examination of your life – it sets-off others to examine theirs and is a lead in real changes all around us.

  8. This is a beautiful entry, and it makes me believe that you would write a unique, intelligent book on mental illness.

    I have recently finished “November of the Soul” about suicidology, and it has me fairly convinced that suicidality is its own illness. The book also explores the possibility that we as a Western society have made suicide “bad” because of our Christian background when in fact it could be quite rational.

    Then there’s the whole “right to die” debate. Alas.

  9. Hi Sara,
    Not all Drs think people who don’t get completely better, or who remain suicidal despite an increase in mood, have personality disorders. I am an example of this. I’ve had numerous depressive episodes throughout my life; this one has lasted more than 9 years. I have tried every medication treatment in the book, ECT and years of therapy (I see my pdoc once a week and for a couple years twice a week for the past 8 years and have seen other therapists prior to that).

    I asked my pdoc straight out if I had a personality disorder , because my family doctor suggestedto me that that was the case. He said, “I have never even considered you to have a personality disorder. There is nothing that would indicate you have a personality disorder”. He does not lie to me, or hide the facts. He believes in honest and open communication between us.

    I agree with him. Some pdocs seem to just give up when things aren’t easy and “personality disordered is an easy catchphrase for “I have no idea how rto help this person”.

    You will get better, you just have not found what you need to help you. I am sure of that.
    hugs,
    …aqua

  10. I am relieved someone else feels the same way. I’ve been in the gutter several times and the thought of never being able to return the the normal state, after facing that, had haunted me for a long time. It’s hard to explain to someone who has not experienced it. But I went on and time helped me heal the wounds. Nothing else, just me and time alone. You can make a full recovery even if you’ve lost all your hopes.

    I’ve noticed the first comment saying you’re not cured. I think you’re on your way there, just by reading your blog entry. Life can be wonderful and it’s just a shame to miss out on it.

  11. 5150 – I’m going to order that book right now.

    Aqua – thanks, again. I’m better since not going to him, that’s for sure.

    Mraw – thanks for stopping by. I agree that it just takes time of normality.

  12. Yo Sarah, I check back here every so often to see if you have written anything more, I hope you are doing well Sarah, I am feeling better from when I found your website. It was so nice to read your website when I was down…I always come back hoping to hear some good news, or any news whatsoever. Thanks for everything Sarah

    Dave

  13. good article. once you realise that all we really have is our man made ego, life doesn’t mean much. some say poor us, i say poor them.

    B

  14. Hi Sarah. Its been a while now since you last posted, just wondering how you are and all that. Hannah X

  15. So-so. Not great and not too bad either…mild depressive symptoms hanging around. Trying a new shrink Wed. We’ll see how that goes. I do need to post sometime. How are you?

  16. Perfectly said. The urge to just stand on the threshold and watch, criticizing the mundane parade for its meaninglessness is so very strong.

  17. missing you, sara. hope the new shrink goes well….


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