Ann Keiffer


Soul Survivor

A View From Behind The Long Black Veil

Excerpted from my article about depression
published in the Stanford Medical Review

Whether doctor, lawyer, corporate chief, pastor, painter, parent or child, at some time or another in our lives we are all likely to encounter the specter of depression, perhaps not personally, but almost certainly in someone we know well, a friend, a client, a colleague, or a loved one. In fact, depression is so prevalent it has been called “the common cold of mental illness.”

What is it like to be depressed? Let us say this at the outset: If you haven’t been there, maybe you cannot know. And if you haven’t been there, it can be misleading to compare depression with what you do know. Depression is not the blues. It is not a down day or two. And it is not merely feeling sad…

It is more like falling into a fathomless, black pit, your mind and body buried in heavy, suffocating quicksand–or more accurately, a deathly slow-sand that leeches out your life, sucking you further under with every ticking, aching hour.

It is a complete loss of vitality, legs that feel like anvils, arms like bags of wet sand, every action arduous, from forcing yourself to get out of bed each morning, to forcing yourself to eat, to forcing yourself to make so much as a phone call.

It is broken sleep…sleeping hours on end, hoping never to face the day…or ragged, jittery sleep you chase endlessly and without solace.

It is feeling isolated, alone, inconsolable, an alien being among “normal” people, unable to be comforted by even those closest to you, no matter how much they may love you or hold you in their hearts.

It is feeling utterly sexless with no more sense of pleasure or libido than a stone.

It is losing your ability to concentrate; finding it hard to read even a can label because your attention span has shriveled to a nanosecond; being so overwhelmed by ordinary decision-making that a trip to the supermarket can leave you standing in the cereal aisle crying.

It is eating solely by rote, because there is no hunger in you and any food you force yourself to take tastes like sawdust. It is hopelessness–and guilt for being hopeless, especially if your feelings don’t make sense, because your life may not look bad from the outside.

It is thinking about death-by-pills, death-by-razor, death-by-knife, or -gun, or -poison, or -car crash, or -plunging from bridge or bell tower, because even that pain seems preferable to living with unending despair, being one of the living dead.

Who Gets Depressed?

Some of us console ourselves with the notion that depression only strikes certain kinds of people, people nothing like us, of course–only certain troubled souls who have low self-esteem, those who are pathologically shy or passive, those who have no drive, those cursed with some character defect that makes them vulnerable. But it just isn’t so. Each year more than 20 million people in the United States suffer from depression–men, women, and children. People just like you. And just like me.

How NOT To Help

What do you say if you are the husband, wife, child, parent, or friend of someone who is suffering so inexplicably? First, I can tell you some things to do: Don’t ignore talk of suicide. Don’t ignore the signs and symptoms of serious depression. If someone you know or love has sleep disturbances, difficulty in concentrating, changes in appetite, changes in libido, irritability, prolonged sadness, or suicidal thoughts, it is time to act.

Depression is a serious disease. According to the American Association of Suicidology, suicide is the ninth leading cause of death in the U.S. each year, claiming more than 30,000 lives. This is the greater tragedy, because depression is a treatable illness. When someone talks of suicide, it is time for friends and family to act, to help the depression-sufferer get the help they need.

Bite your tongue in two before you tell someone who is suffering from depression to buck up or offer them pep talks and platitudes. For those of us waging battle in depression’s trenches, it is more than disheartening to be further embattled by friendly fire, having folks who love us exploding grenades of folk wisdom in our foxholes: You’d be fine if you’d just change your attitude and be more positive…if you’d think of others and stop focusing on yourself…if you’d have more faith (in God, Buddha, Jesus, the Virgin Mary, Positive Thinking, Love, et al)…if you’d pull up your socks and get on with your life…if you’d just learn to relax and have more fun. While some of these ideas may not be entirely bad, would you expect them to cure diabetes or set a broken leg? Of course not.

In response to more easily understood physical conditions, we would usually urge and encourage the “patient” to get a medical evaluation, take advantage of the most useful and necessary physical interventions or procedures, take appropriate prescribed medication, and educate himself or herself about the condition and any changes in lifestyle that will help to nurture health and well-being for the future. Evaluation, intervention, medication, and education…that’s what it takes. Depression is no different. While there may be psychological or attitudinal factors contributing to depression, depression is definitely not “all in our heads.” On a practical, physical level, our bodies are not working right.

I am not a clinician or a doctor, so I’ll say it in terms I understand: For some reason or combination of reasons—stress, genetics, disease, unresolved inner conflict—in depression our body chemistry is out of balance, especially our brain chemistry. And what we need—like any other person who is physically ill—is appropriate evaluation, intervention, medication, and education.

Based on a thorough medical evaluation, we can discover what may be required to get us back on the road to health, including the possible intervention of hospitalization or out-patient treatment, appropriate antidepressant medication, and/or the kind of self-education and new coping skills that can come through talk therapy with a good counselor. Sometimes antidepressant medication or talk therapy alone will be enough to restore us to health and the everyday pleasures of living. But more often, the two approaches work best in tandem. Antidepressants can provide chemical back-up for the body’s own processes until the body is able to restore itself to more normal functioning. They can be life-saving, buying us time, giving us hope, lifting our spirits, relieving us of suicidal thoughts. Therapy with the right counselor can be equally useful. Through the give and take of honest dialogue, we can begin to discover for ourselves some of the roots of our depression and the power of our own healing insights.

Stand By Me

The thing that causes depression-sufferers to give up, what makes us think of suicide as our last best option, is usually—and simply—a lack of hope. If anyone or anything can help us reclaim even the smallest measure of hope, that may be enough to help us get through another day and take one more shaky step back toward life. Depression is a journey hardly anyone takes alone. The whole family, the whole social circle of the sufferer is afflicted. It is important that you do not give up your own life or your hope as you live through the crisis together. Know that you cannot fix the suffering or make it go away. Be as present as you can be with your loved one. And for all depression-sufferers, hold the vision that we are on a journey that can have great meaning, one we can survive, one in which our souls may be made whole in the process.

Surrendering to Gravity

For me, the turning point in my depression came in paradox, in unconditional surrender…when I finally gave myself over to the experience of depression. I don’t mean I succumbed and became its victim. I mean that after months of anguish, I finally accepted I could not make my depression go away, no matter how much I hated it. Depression was a fact in my life, like gravity. And I didn’t get to vote on it. Fighting gravity, being angry at gravity, denying gravity only gets a person battered and bruised.

It must be said that I had every gift and advantage–adequate healthcare, appropriate medication, financial security, and the unstinting love of my husband, my friends and family. Not many are so fortunate. And given the new generations of antidepressants and treatments for depression, most depression-sufferers would gladly, and understandably, choose taking medication over prolonged suffering.

For those of us for whom that prescription doesn’t work, we must make the journey any way we can. For me, it was by desperation and grace that I began to try to embrace what was unembraceable and ask what it might have to teach me. There was no opening sky, no singing of angels, no instantaneous healing. But when I began to choose and work with what I had, I began to heal. This depression was my own. I would find meaning in it. I would become something not in spite of my depression, but because of it. I would allow my depression to transform me.

Because of depression, I learned and I am continuing to learn who I am and toward what my destiny is calling me. Depression helped me rediscover my truest nature and priorities. It made me examine my values. It taught me how to live anchored within the deepest possible context of meaning. Depression, dark and despairing and dangerous as it was, was ultimately one of the richest, most meaningful passages of my life.