Sunday, July 31, 2011

The Difference Between "Sadness" and "Depression": The Pit

The players in the current backlash against brain drugs are asking a lot of very important questions that need to be asked.  Are we, as a society, medicating things that don't need to be medicated?  Are we pathologizing perfectly normal parts of the human experience, like stress over losing a job, or bereavement over losing a loved one?  Has the reliance on medications encouraged people to look for a "quick fix" to their problems??

The short version of my opinion is that we probably are.  Sometimes.  Maybe.

One of the examples of this that's often proffered is that of "normal" sadness being pathologized and medicated as a depressive mental illness.  I haven't done a ton of research on this topic.  I don't know how many people take medications, having been told they're "depressed", when they're really "sad".

I do know the difference, in my own life, between sadness (a feeling) grief (also a feeling, more painful than sadness) and depression (a hideous mental illness, which I experience as The Pit).

Sadness, while unpleasant, is healthy.  It tells me that I am missing or have lost something of value to me.  For example, the saddest time in my life was when I was grieving for three loved ones who had died within the space of 6 months.  Two were friends, one was a close relative.  Two were old, and had lived long, full lives.  One was 29, and died of complications from a bone marrow transplant, leaving behind a young family.  I mourned each of these people deeply.

The grief for this last friend was the sharpest agony of the three.  I grieved for all of the things I would never be able to say to him.  All of the fun times we'd had, that we would never have again.  For the children who would grow up without knowing him.  As I grieved, I do a lot of things that people do when they're "depressed" -- I withdrew from my social life, I didn't enjoy things the way I usually do, I had trouble sleeping, and I cried all the time.  Mourning for my friend hurt.  His illness and death were absolutely the most emotionally painful single event I've ever endured.

Yet, I was nowhere near "depressed".  That horrible, searing grief was a hundred times better than The Pit.  

The Pit is where I go when I am depressed.  This is mental illness.  It is completely different than being sad or anxious, or even having a Consistent Low Mood Over a Period of More Than Two Weeks (tm).  The Pit is dark, lonely, and hellish.  There is no bottom to the pit, only falling into it, falling forever.  Once I stumble into The Pit and start falling, the only thing I can do is to keep falling and flailing until I grab something -- a tree root?  A stone? -- and drag myself out of it, hand over hand.

I spent much of my twenties in this pit, alternately falling and climbing toward the surface.  Climbing toward the surface was unbelievably hard work.  When you're in The Pit, you see, the opening can be so far away you can't even see it.  The excruciating effort is toward a goal that you simply have to take on faith.  Your despair clouds your vision, makes your limbs sluggish, exerts a gravity like that of Jupiter.  It pulls you, it's always pulling you, downward, forever.

Medication helped me start to climb out of the pit.  They helped me to land on a ledge somewhere and find some precarious footing (many people, such as Mo over at Milligrams, speak of medications as giving them a "floor").  Once I had this foothold, this floor, I could see the light at the mouth of The Pit.  Then, I could get my head and shoulders out of it.  After a while, I could even climb out entirely.

But I still couldn't get away from The Pit.  The mouth of The Pit has slippery, sloping sides, and I knew that I could lose my balance and fall at any moment.  Some days, I did fall, but the medications kept me from falling too deeply into The Pit.  I was in therapy by this point, and therapy was teaching me how to chart a course up the side of the mouth of The Pit, how to keep my balance as I followed this course, and how to recognize when I was in danger of losing my balance.

Eventually, there came a time when The Pit was no longer a constant presence in my life.  I hadn't fallen into The Pit in years.  I had finally clambered over its edge, leaving even the mouth of The Pit.  I knew it was there, and always would be there, but I had learned how to keep my distance from it.  One of the ways I knew I was recovering was that, during those terrible six months of death and bereavement, I never felt that I was even coming close to The Pit.

What a victory!  To endure such pain, and to find that it didn't drag me back into a depression!  How did I achieve this?  What were my coping mechanisms?

Well, those bring us full-circle, back to sadness and grief.  I survived my grief by grieving.  I cut back on some of my social activities, but at the same time I reached out to friends for support.  I talked about my loss.  Most importantly, through the worst of the pain, I kept telling myself, this is OK.  It's OK that grief hurts.  It's OK that loss results in sadness.  Crying is cleansing.  Grief, sadness, bereavement -- these are all cathartic.  We feel better when we express them.  These feelings allow us to mourn our loss, and in time, to come to terms with it.

There is no catharsis in The Pit.  There is only anguish, misery, and despair.  There is only falling. 

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