Guilt, Laughter, and Moral Responsibility

Like many people dealing with depression, I am prone to intense feelings of guilt and shame. There are many reasons for these feelings, and as they seem to run in a cycle, it's tough to find a logical starting place to discuss them. Do I begin with the non-achievement that accompanies so many depressive episodes? Do I begin with the emotional paralysis that I experience, and the resulting many ways in which I let down family and friends? Or maybe the ways in which I fail to live up to my own past ambitions and present ideals of what I ought to be? How about the inevitable comparisons of myself with other people, and the conclusion that I am less motivated than them and therefore less deserving of love, happiness, or whatever else goes into making up a good human life? Then there is the fact that the brains of depressed people respond more strongly to negative than to positive situations and feedback, with the almost inevitable result that any one of these entry points is going to be the first step in a downward spiral that can last anywhere from a few days to an entire lifetime.

You can pick your own way in, and they are all horrible. For me, the one that comes to mind is paralysis as this seems to lie at the heart of much that follows. I have no way to tell how many times I've lain in bed knowing that I should be doing something--exercising, working, writing, cleaning, socializing--or how many times I've looked at a simple task, such as making a service appointment for a car, or paying a Visa bill, and ended up doing nothing: rolling over, or not even rolling over, and closing my eyes. To an outside observer, the situation would look simple, and the likely conclusion also simple: I knew what needed to be done, and as I didn't do it, obviously, I had chosen not to do it. I am therefore either lazy or, worse, lacking in sufficient commitment, will, or love to overcome my inertia. I therefore become ashamed not only of my actions, or more accurately my inaction, but also of who I am. One effect of this shame and guilt is that they leave me feeling less capable of acting in the future, thus accelerating the downward cycle: paralysis, inaction, guilt, paralysis, inaction, guilt ...

And here again, we bump up against conflicting understandings of the nature of depression. For reasons of simplicity and optimism, let's call them the old school and the current understandings. An old school reaction to the type of situation I've just described might go something like this:

Get off your ass and do it. No one's preventing you. If you wanted to get this done, you'd get it done. You'd make up your mind, muster a little gumption, and at least try. This is all in your head. Snap out of it. We all have free will. We're all responsible for our decisions. You have no one to blame but yourself. 

I suspect that most of you reading this post have either heard or spoken some version of my little fictional diatribe. So let's unpack it. First, there are several common assumptions that need to be examined. One is that a genuine desire to do the thing in question does not exist. This one's important by virtue of often being exactly wrong. Often, when a depressed person is inactive, there is a real desire to do something, or at least a desire that such a desire might exist. Or we may remember wanting things in the past and feel beaten because we can no longer want them now. Where there is indifference, this comes about not through neglect, or interest in other things: it is the product of a very real inability to feel--a deadness inside that no amount of criticism or reasoning can budge.

And as for gumption (I chose an antiquated word deliberately), this assertion sidesteps the fact that, as a brain dysfunction, depression is physical. Whether your particular version of the illness is a problem of insufficient dopamine, insufficient seratonin, insufficient testosterone, or any number or combination of other well documented causes, you need to remember that the brain is no more magical than an engine: if a key part is not working properly, the whole system will not work properly. All the gumption in the world will never ignite a cylinder if the spark plug is too corroded to spark.

Then of course, there's the old assertion that "it's all in your head." Well of course it's all in your head. Where the hell else would it be? And when you have a broken femur, it's all in your leg. So the fuck what? I mean seriously--if that isn't the most useless non-revelation in the entire conversation about mental illness, I don't know what is. Yes. Depression is in your head. It is an effect of your brain not working properly, just as a limp is an effect of your leg not working properly. The main difference is that the brain is immeasurably more complex than the leg. But this complexity is hardly support for the it's-all-in-your-head crowd. The more complex the system, the more ways there are for it to break down, and generally speaking, the harder it is to fix. So yes, my depression is all in my head. This is not a fact with which to bludgeon a person, though, or stare at him or her dumbfounded: it's as good an argument for compassion as I can come up with. So please, have some compassion for yourself or, if a loved on suffers from this illness, let compassion infuse your understanding.

And I guess this brings us to the aardvark in the room (I don't know why, but I've always been fond of aardvarks): free will. It may look as though in both this post and the previous one, I am arguing against free will in an attempt to absolve the depressed person of moral responsibility. I am not. While the brain dysfunction that causes this illness has no moral weight whatsoever, just as a broken femur has no moral weight whatsoever, we are still responsible for our responses to the disease once we have recognized it as such. If, for instance,I find myself with a broken femur, then your suggestion that I should be able to walk up a flight of stair is at best ridiculous and at worst cruel. But if, recognizing that a leg has been injured, I refuse to seek treatment, then I am responsible for the resulting incapacity, and for any effect that this incapacity may have on the people in my life.

I would argue that a similar responsibility exists with depression.

A diagnosis of clinical depression, far from being a source of shame, can actually come as a relief. This was certainly my experience. All those things I had either done or not done in the depths of my many episodes were lifted from my conscience once a genuine incapacity on my own part came to light. I hadn't failed to meet my financial responsibilities because I was a useless asshole: I'd failed to meet them because I was depressed. I hadn't frittered away (another archaic expression) opportunity after opportunity for creative and professional advancement because I was lazy or feeling self-entitled; I had done so because I was depressed. The lifting of those burdens in the early stages of managing my illness was not only rationally defensible; it was practically necessary for any recovery that might follow. So far from shrinking from or hiding it, I embrace the label "depression."  It is a source of hope, a means by which a person long accustomed to inaction can find a way to become active again. It is the blotting out of a smudge on my character that had grown too dark for any other set of possibilities to show through.

But this relief comes at a price. Knowing my diagnosis, and knowing the effects that my illness has had on both myself and my friends and family, I am obliged to seek and accept help. This is not just about myself and how I feel; I can't afford to let the world become that small again. It is about every point of intersection, from the present time forward, between myself and the rest of the world. If my physician tells me to seek counselling, then I have to seek counselling. If I fail to do so, with the result that the lives of people around me don't improve, or continue to deteriorate, then I bear the blame for that deterioration. And if my physician tells me to start taking medication, then I have to start taking medication. Never mind my personal distaste for ingesting pills, and never mind the legitimate fear that comes from watching my mother be slowly consumed by a three-decade addiction to prescription drugs. If my brain won't function properly until its dopamine and seratonin cycles are artificially regulated, then artificially regulated they will have to be. And as with counselling, I bear sole responsibility if I choose to ignore informed medical advice.

Maybe I should finish with a story.

One day, a few weeks after beginning my course of treatment, I was sitting in our living room chair. My daughter did something funny--I don't remember what--and I just started to laugh: a helpless belly laugh that carried through the house and brought my wife into the room with a curious expression on her face. After a moment of just looking at me as I slowly calmed down, she crouched by the chair and in a soft voice said, "You're laughing." Realizing that no one had heard the sound of my laughter in months, I nodded to her and let myself smile, feeling a surge of hope that I was starting to get better and that she had cared enough to point this out.

Now, though, I see the scene a little differently. It was not just that she was happy for me: the hope in her voice was aimed in other directions as well. It was directed at our daughter, who for a long time had been stuck with an apparently humorless father at a stage in life when play and laughter ought to be among the most frequent elements. And it was directed at herself, having been stuck with a half-dead husband who had not actively contributed joy to her life in longer than either of us could remember. She had a right--they both have a right--to my laughter. Our states of mind have ethical consequences, and knowledge of our illness makes us responsible for these.

For Openers

I've been thinking about doing this for a while but am not sure how to begin. From the title, it's pretty obvious why I'm here, but it may not be clear what I hope to do. Maybe, it's not even clear to me. But here are some possibilities. Socially, it is important to break the stigma that surrounds mental illness, and as a person with a history of chronic depression stretching back over decades, I might be able to help that process along by sharing my thoughts, feelings, and experiences in an open forum under my real name. It's possible as well that some who read this blog may find a kindred spirit here. Depression is a lonely state--the loneliest I know--and hopefully someone who visits this page will leave it feeling no longer quite so alone. But it would be dishonest to pretend that I did not also have a selfish motive. Forcing myself to shape ideas and feelings into language--whether that language is analytic or poetic--is a way of forcing myself to look at things that might otherwise be easy to sidestep. To the best of my knowledge, there is no cure for the tendency toward depression: it is something many of us have to deal with throughout our lives. The process of thinking through writing is one of the ways I have chosen to deal with mine.

That said, I should probably mention a few things that I do not intend to do. As I have no medical or psychological credentials, I do not intend to offer anything resembling professional treatment or counselling. I do not intent to recommend one single way of coming to grips with mental illness: I can't do that as I am still coming to grips with my own. And I most certainly will not make any recommendations regarding specific medications. This is not an advice page or a resource page. It is just a space to share ideas.

So who am I?

Well, here are the basics. I'm a guy in his 40's, a married father of one, who teaches literature at an undergraduate university in Eastern Canada. I've suffered from depression since at least the age of 10, and am pretty sure that there is a genetic component to my condition, though I am equally sure that inheritance cannot take all the blame. I lived for a very long time in rough awareness that I was depressed while at the same time denying that this was the case, and only early last year made the choice to seek professional help in understanding, and getting out of, the emotional and spiritual black hole that my life seemed to have become. As for any other relevant stuff, I'm pretty sure it will come out as the blog, as yet unplanned, unfolds.

And now comes the hard part. What do I actually say? This is not an autobiography, so starting at the beginning would not make sense. And besides, it would take me too long to get to the point. Maybe something about the idea of depression, itself, and my understanding of the condition ...

Depression is invisible, but its invisibility does not make in non-physical. Causes may vary from case to case, but genetic links have been pretty well established, as have roots in traumatic experience that itself can alter brain structure. And specific dysfunctions of the brain have been identified, for example problems with either the production or re-uptake of hormones such as dopamine and seratonin (as seems to be the case in my own grey matter). In short, our brains don't work as well as other people's, specifically where emotions are concerned. Associated with this problem, we may sometimes experience shortfalls in both intellect and creativity. That is, in the midst of a serious depressive episode, we actually become less intelligent and less creative than otherwise. I need to emphasize that this is a phenomenon of the physical world no less real than a broken leg. Yet when you have a broken leg, no one asks you to get up and walk it off. And no one would ever suggest that if you just got your head out of your ass, you'd be able to walk just fine.

In the case of depression, however, such comments are common. We are visual creatures. Instinctively, we believe what we can see. And because we can't see a living brain under most circumstances, or tell a healthy one from a sick one at a glance, our natural inclination is to not see the connection between brain and mind that is roughly analogous to the connection between legs and walking. Instead, we invoke the disembodied phantoms of our religious and philosophic heritage: the mind as something independent of the body, and the will as something that can operate freely regardless of the condition of the body (including the brain) to which it is attached. These phantoms, deeply embedded in our culture as they are, are not self-evidently true, have no basis in observed reality, and seriously undermine any hope of understanding the nature of mental illness.

Depression is also difficult to explain to someone who has not experienced it. Maybe "impossible" is a better word. "Get over it." "Pull yourself together." "Just knuckle down and do it." I could go on and on with the kind of off-the-cuff advice so often directed at depressed people. And maybe on the surface, the advice looks reasonable. You are confronted with a challenge. You might even understand what is required to overcome the challenge: just get off your ass and do it. What could be simpler? So if you don't do what needs to be done, clearly, there is a deficiency in you:.

You are lazy.
You are melancholic.
You are slothful.
You are weak.

So how do you explain, to a person who has never experienced it, that sometimes the challenge is just getting out of bed? Of course you know what you need to do to get out of bed. You even want to get out of bed, or at least you want to want to get out of bed. But you can't. How do you explain that, between the knowledge of what needs to be done, and the act of doing it, is a chasm, disappearing into nothingness, over which you have as much ability to leap as a person with a broken leg has to execute a running broad jump? How do you explain the lack of emotion so profound that neither the sight of your child nor the prospect of your own annihilation can provoke an eruption of colour into the zero-contrast grey-scale of your inner landscape?

Both this invisibility and this inexplicability combine--along with a fair bit of cultural baggage--to saddle depression, and thus depressives, with a stigma whose results are silent suffering and shame. Even if we recognize or suspect our own condition, many of us are reluctant to admit it. In my case, this reluctance was at least partially linked to a desire not to be like my mother, who suffered from mental illness for most of my life and whose own life came to a very sad and lonely end. It also stemmed from a fear of looking weak in the eyes of others--a fear of being seen as a deficient or inferior person. On the one hand, I did not want to be seen to have let myself become mentally ill, and on the other, I people to think that I was trying to blame all of may many failings and failures on what has often been referred to as basically a trendy pseudo-illness. Also, if I am being brutally honest, I knew that once I admitted my condition, I would be responsible for seeking treatment, and I did not feel either capable or worthy of being helped, whether that help came from others or from myself.

Had the problem been with a broken leg rather than a dysfunctional brain, none of these feelings would have arisen. Having found that I had a bone fracture, I would have sought help through the quickest means possible, without the slightest trace of shame or embarrassment. And having sought help, probably in the form of re-setting and the application of a cast, I would have made no attempt to hide the fact that I was wounded, and in treatment for recovery. In fact, I would probably have encouraged people to sign my cast. the people around me, on the other hand, would not have made moral or character judgments on me, based on my cast and crutches. And my friends and family would certainly have taken the injury and its treatment in stride.

Well, you can consider this blog to be my cast. And I see no shame in wearing it.

p.s. Please feel free to comment on anything I write here. I ask only that any comment you leave, be left in the spirit of the blog itself, namely in a spirit of friendship.