What Depression Does to Our Minds When It Attacks

After two of my acquaintances died on the same day in the same way-by shooting themselves-I heard various comments:

     “But he was such a strong Christian! How could he do this?”

      “I guess he took the easy (or, ‘the coward’s’) way out.”  

     “He wasn’t thinking about his family at all, that’s for sure!”  

      “Well, I always thought only losers had depression, like people living on the street, or alcoholics and drug addicts – nobody but losers!”

None of the people who said these things understood depression at all or what it can do to anybody.  

I’ve been a journalist, a college teacher in Hong Kong, and-for 22 years-a pediatrician. I was chief of staff and a trustee at a 700-plus bed medical center with 2 campuses and 400 doctors. I am a dedicated Christian, a Presbyterian elder, and a veteran of medical mission trips to the Amazon. I speak fluent Spanish, some Portuguese, a little German, and a bit of Cantonese. When I am thinking rationally, I can see that I am intelligent, witty, well-liked and respected.

I also have battled depression for more than 40 years, and when I am depressed, I do think I am a complete loser.  

I have been so depressed that I have considered killing myself many times. I decided 30 years ago that I could never safely own a firearm because I knew what I would do with it someday. Even so, I have come close to buying a gun. A few years ago, I had extremely severe, treatment-resistant depression-an epoch more than an episode-that lasted several years and steadily worsened despite multiple medicines and weekly visits to my psychiatrist. Eventually, I did go shopping for a pistol. With great difficulty, I chose not to buy it and committed myself to the hospital instead.

I had extreme depression- much more severe than that endured by the great majority of people who become depressed. Most need only counseling and perhaps medicine to become happy once more. They don’t lose their jobs or have to be admitted to hospitals, and they do not come close to killing themselves. Unfortunately, most who are depressed do not seek any help-often because they fear what others will think. This is a mistake, because effective help is available.

I too was afraid of the stigma and of being labeled a loser. Until I entered the hospital for intense treatment, I hid my depression as long as possible. I was afraid others would think me weak instead of strong, think there was something “wrong” with me, that I was broken and could not be “fixed.” I feared they would believe I could not be an effective physician if they knew I had depression.

I also have a stubborn independent streak. I believed that I could “handle it”-a trait common among physicians. We see a problem and we fix it. Before I ended up in the hospital, I (eventually) let only my partners, my pastor, and a few close friends know that I was seeing a psychiatrist and taking medicine. No one in my own family knew. I was too ashamed to tell anyone I had a mental illness.

That severe bout of depression had begun 4 years earlier, while I watched my husband battle renal failure and then cancer. I cared for him until he died, and then I nearly died, too. During the last year of my husband’s life, I never missed a scheduled day of work until 2 days before his death. A week after he died, I went back to work. I never missed another day until I went shopping for that gun 2 years later.

I was determined not to let my illness stop me from doing my job. I decided that no one would say I was weak instead of strong and tough. I continued to work during a depression that was totally debilitating. I couldn’t pay my bills on time. I couldn’t clean my house. I lost 60 pounds in a year without trying because I couldn’t eat. I quit opening my mail and answering my phone. I completely isolated myself, and I often sat at home weeping. (Again, this was an extreme in the spectrum of depression.)

Even so, I made sure to put on a good face whenever I was with other people. I still smiled at my patients, partners, and friends. I went to church every week, and I cracked jokes that made everyone laugh. I was still respected. I hid my problems at all cost.

The time finally came, though, when my illness did affect my performance. I arrived late for office hours. I could not complete my charts. I could not concentrate. I hid in my office crying at times. Sometimes I wrapped my stethoscope tightly around my neck, finding that sadly comforting. Some of my partners even began to wonder whether I was using drugs. Finally, they told me, “You’re going to take two weeks off now and go do whatever you need to do to fix whatever is wrong with you; if you don’t fix it, your job will be in jeopardy.”

I had struggled valiantly just to stay alive, yet I was about to be fired for being depressed. I was devastated. I knew I could not possibly “fix” in 2 weeks the life-threatening illness my doctor and I had been unable to halt during a 4-year battle. I couldn’t take the thought of not being a pediatrician, and I feared I would never work again. Nor could I handle the horror of the public humiliation I was sure would accompany losing my job. At that point I simply could no longer fight the psychic and emotional pain of my severe depression.

So I went shopping for a gun.

And almost 6 years later, I still can feel the its cool smoothness and weight and balance as I stood there at the store counter holding it. It was extremely comforting: I could finally end my suffering.

But I decided to put down the weapon and walk out to my car. I sat there 10 minutes, debating whether or not to buy the gun. I told myself, “OK, Betty, this is it. If you buy it, you die tonight. If you don’t buy it, you go into the hospital.”

I feared the stigma of admission to a psych ward as much as that of being fired. Yet I could no longer bear living as I had been. I longed to die. I even begged God to take me to Heaven to be with him. But I said instead, “I’ll try one more time.” I drove away weeping. I cried not in relief but in the agony of complete despair because I had just denied myself the only way I saw to stop my pain.

I am alive now only because 2 months earlier my father had stood in front of my car and refused to let me leave his home until I promised not to kill myself. Somehow, on that day in the gun store parking lot, I managed to try one more time to keep that promise.

An overpowering foe
Depression is overwhelming and overpowering, and it crushes its prey. Next time, I may not be able to overcome it. I have sunk into despair and hopelessness more times than I can count. So far, I’ve not committed suicide, but I have teetered on the edge many times. I do think that depression might kill me someday.

For people like me who have considered suicide seriously and have even longed for it, suicide is not some horrifying, appalling idea. When we are depressed, it is like an old friend we simply have not yet embraced, and for many of us it seems a bridge home to God. That’s how dangerous and seductive depression can be.

When we are depressed, it is our irrational (or non-rational and untrue) yet inescapable thoughts that can kill us. They completely mutilate our normal thought processes and destroy our well-being. When our depression is truly severe, they hurtle us toward suicide.

When severely depressed, I fiercely bombarded myself with untrue accusations. I continually told myself that I was stupid, worthless, incompetent, unloved and unlovable. My self-hatred grew more and more powerful. I believed my depression would go on forever, without end and with no rescue possible at any time or in any way. I felt completely alone. I became certain that no one wanted me around and that I had ruined not only my own life but also, simply by virtue of my presence, the lives of all who cared about me. I felt overwhelming guilt because I firmly believed that my continuing to live deprived some other, more worthy person of a job, money, and shelter.

Severely depressed persons grow convinced beyond any doubt whatsoever that our families would be better off if we were dead. We believe that only by suicide can we help them salvage whatever remnants of their lives we have not already destroyed, even if we actually have done nothing that would hurt them or anyone else.

I believed that everyone felt and thought this way to some extent. I once explained some of this to one friend, a compassionate and extremely intelligent physician. He looked at me in amazement and said, "You do know, don’t you, how completely foreign everything you just said is to me?"

In fact, learning just that was a real eye-opener for me, "a light-bulb moment."

Those who aren’t depressed don't realize that a vast difference exists between their feeling blue and my being depressed. My brother told me, "I get depressed, too; you just need to do what I do – just put one  foot in front of the other one and keep going." And my sister said to me, “Your life is fine! There’s no earthly reason for you to be depressed, so you just need to snap out of it and move on!”People don’t know how to talk about depression
My partners had seen me struggle years earlier with depression when my husband spent 3 months in an out-of-town hospital while I was working up to 60 hours a week 160 miles away. Fortunately, I recovered from that episode and was healthy until my husband died 8 years later.

Three months before I was hospitalized with severe depression, I finally told my partners that I was having trouble once more. Nobody said a word. Everybody looked anywhere except at me. Then somebody changed the subject. Nobody said one single word to me after I confessed what I believed was a shameful secret. I felt completely rejected.

My partners were decent, caring people and compassionate physicians. But non-depressed people do not know how to tell us that their truth is drastically different from ours . . . that our depression will improve  . . .  and that they want and need us in their lives. Even depressed physicians and their colleagues often don’t know what to say to each other.

How to talk about depression
o People with depression need someone to speak up when we cannot, especially to explain our illness to our loved ones. Most of us are too frightened and ashamed to talk about it. Unless we learn how to be open about depression, the stigma will remain, and people who need treatment will continue to avoid seeking it.

o If you have depression, tell someone you can trust and seek professional help. It is available-and it can help. Depression does not have to last forever; you really can get better with time and treatment.

o If someone you care about is depressed, tell him you do care, that you love him, and that you want to understand and help. Tell her how important she is to you and what you admire about her. Tell him you want him and need him in your life, and that things will get better. Ask her to hang on until they do. Beg him to promise that he won’t do anything to hurt himself, that he will not commit suicide.

You may save the life of someone you love.

This article was originally posted online on 4/3/2014.

Disclosures:

Dr Griffin earned a B.A. in Spanish and journalism at Baylor University and then studied history there. She was a newspaper reporter in Waco, TX, and she taught history and English in Hong Kong. After completing her M.D. degree and her pediatric residency at the University of Mississippi, she practiced in Wilmington, NC, for 18 years. She now works at the Duplin County Health Department in rural North Carolina.