2008 January 23

The genesis of this project was in Autumn, 2007. My medication had stopped working, so I had been to see my family physician about a change. During a follow-up visit, a medical school student preceded the doctor. He began asking about my symptoms. I was, of course, irritated by his questions. Afterward, however, I decided to list all of my symptoms, so that, if faced with another medical school student, I could present him or her with written documentation, instead of trying to remember all of the symptoms. It would save us both a lot of time. The list of symptoms has been through several revisions. Generally, while depressed the language becomes much harsher. When I am feeling better, I try to clean up the language a bit.

The second step in the process came from Chris Matthews’ wonderful book, Life’s A Campaign. He speaks of the importance of a “Rite Of Passage.” Conquering depression, which has dominated my entire life, is to be my Rite Of Passage.

Third, for the past few days I have been considering blogging about the entire experience. I’m not sure if I was thinking about this while I was awake or asleep (because I have been asleep for most of the last two days). But, I finally decided to start this blog.

I will be discussing how Depression has affected my life to this point, and chronicling my efforts from here on out. Please be aware that the language will often be vulgar, and the ideas disturbing. I, myself, am disturbed and repulsed by many of the ideas that originate inside my own head. But, such is the nature of Depression.

So, to begin, here is the List Of Symptoms that I generated for medical school students.

Depression Symptoms

These are the symptoms of depression as I experience them. I have no idea if other peoples’ symptoms are the same, nearly the same, or completely different.

I am writing this while I am in a depressive state, because when I resume full functioning I have a hard time remembering exactly how bad things can get.

You may get the feeling as you read this that it has been written to heighten dramatic effect and to intentionally elicit more sympathy for me from the reader while at the same time diminishing any responsibility that I feel for my own actions. You would be right.

Most of these symptoms are relieved to some extent by Celexa (when it was working for me). A few were only relieved by Cymbalta (when it was working for me). A few were relieved more by Cymbalta than by Celexa. None were relieved more by Celexa than by Cymbalta.

One more thng. Maybe it’s just me, but I keep thinking that “depression” is supposed to be about sadness. But, in writing this paper, I didn’t find that I’m sad about anything. Frustrated and angry, sure. But not sad.

Predictors Of Depression

You might think that a predictor of depression would be classified as a “symptom.” Well, fuck you. This is my list.

Of course, before 2006, I did not know about Predictors of Depression. That’s because I was always, constantly depressed until 2000, and from 2000 to 2006 I was always, constantly not depressed. It was only in 2006 that I realized that depression could come and go. So, here are the two predictors.

  • Procrastination
    When I’m depressed, I procrastinate on everything. The most trivial things I put off. When I am not depressed, I procrastinate nothing. It never even occurs to me to not do something when I should be doing it. And, when I do think about procrastination, it seems like about the silliest thing that a person could do. I am trying to train myself so that when I start procrastinating I know that depression is coming on, and maybe I can do something about it. Maybe.
  • Active vs. Passive
    When I am depressed, my thinking becomes very passive. In other words, I want things to happen to me, without me doing anything. Like, I’ll wish that the earth would just open up and swallow me without a trace; or I’ll win the lottery; or a bridge will fall on me. It doesn’t matter what it is, I just want something to happen where I can be completely passive. When I am not depressed, I want to be active. My thinking focuses on what I can do to influence my future.

Symptoms In Order Of How Much I Hate Them

  • Dread
    Dread is probably the most overwhelming and persistent of all the feelings. When I am depressed, it never leaves. Dread goes from one minute to the next. It covers everything. It’s a feeling that whatever I am about to do will be unpleasant, and that I would prefer to avoid doing it. Sometimes the elements causing the dread can be identified and concrete. For example, if I am about to drive to work, I foresee a flat tire, overheating, blown gasket, failed transmission, engine seizure, brake failure, and on and on. Other times, the causes of dread cannot be identified. For example, if I am about to put on a shirt, I can never figure out exactly what could go wrong, but I still have a feeling that something bad is going to happen while putting on the shirt, and that I would really prefer not to put the shirt on. I have this feeling for absolutely everything, every moment of the day. Except for getting into bed. Going to sleep is the happiest time of the day, because I will be free for a while. When I need to do something that is actually difficult or really unpleasant, I usually can’t talk myself into it.
  • Lethargy
    I’m always tired. I can’t usually move very fast. Sometimes when I’m walking, I get the feeling that if I tripped and fell down that I would not have the energy to get up, but would prefer to lie there until I died. Some of the tiredness, I think, is genuine fatigue. The problem is that I know how I am supposed to act, and I know how I really want to act, so a lot of effort and energy goes into just trying to be socially presentable when I am around other people. The constant stress of keeping my real feelings and inclinations bottled up can really take a toll. So, there is a lot of actual fatigue in addition to the lethargy of depression.
  • Alienation
    I am completely apart from every other human being. No one could possibly understand me, or value me. No one wants to be near me. No one likes me. Even among people that I characterize as “friends,” I always believe that they are merely tolerating me. Given a choice, they would prefer that I not be around, but they will put up with me for some reason (usually because it is financially advantageous for them to do so). This is why I practice so hard being funny. I figure that if I make people laugh they might let me hang around a little bit more. I actually see this as a successful strategy. The funnier I am, the more people tolerate me. So, I always try to be very, very funny. Not that anyone ever likes me for anything other than my ability to make them laugh.
  • Loneliness
    This is tightly related to the Alienation. I’m not sure if there is a difference. I guess there is. Anyway, I am always, constantly, day and night, for ever and ever, lonely. When I was a teen-ager, I thought that having a girlfriend would help break up the loneliness. Even though I didn’t have many girlfriends (three, maybe, if you are loose enough with the term “girlfriend”), none of them ever broke through the loneliness. Later on, I thought that certainly getting married would break through the loneliness. It didn’t.
  • Desire For Connection
    A desperate desire to make some small, tiny, insignificant connection to some other human being haunts me day and night. If I am awake, I am thinking about it. Even when married, it seems that I can never get physically close enough to my wife to overcome this. There is, however, one thing that makes it go away–holding an infant. As long as I actually have an infant (say, under five or six months old–the younger the better) in my arms, I feel this connection to the baby. I could hold babies (especially sleeping ones) forever. Of course, the moment the infant leaves my arms, the search starts for my next “fix.” And, just in case you are curious (I know you are), sex does not help. The pleasant physical sensations and endorphin rush are temporary distractions, but the endorphin rush from watching a funny movie is also a distraction. In neither case is the desire for connection abated past the conclusion of physical sensations.
  • Irritability
    Everything, and I mean everything, gets on my nerves. People get on my nerves; dogs get on my nerves (please know, when you read this, that I absolutely love dogs; some guy once said, “The more I learn about people, the better I like dogs;” he was right; a bad dog has yet to be born); sudden sounds get on my nerves; silence gets on my nerves. I am always right on the edge of erupting. Except when something pushes me over the edge and I blow up. Then I get to feel horrible for blowing up at someone or something that didn’t deserve it. By the way, I’m sure that something that you are doing right now is irritating the hell out of me. Maybe you’ve got a hair sticking up on top of your head, maybe some of your clothes are slightly askew. But, I’m pretty sure that I’m staring at you, because you just irritate me to the point of almost screaming. But don’t look–then I would know that you are scared. Looking to see if I’m staring means that you’re scared. So don’t look. Just know that I’m staring.
  • Loss Of Identity And Personality
    I have spent decades in reflection, introspection, and self-analysis, and many, many years in therapy attempting to form a well integrated and well adjusted identity and personality. When the medications fail, anything that I have discovered about myself goes away. I cannot tap into my identity or personality in order to discern the correct action or reaction in any situation. So, I usually fall back on one of the basic tenets of behavior–when in doubt, be a total jerk. I also cannot find any of the confidence, self-esteem, self-worth, pride, or any other positive attribute that I have built up over the years. What I am left with is to be a worthless shit-pile that acts like a jerk.
  • Inability To Concentrate
    The inability to concentrate is a fairly persistent problem. Also a very frustrating one. There are times that I can concentrate, so I know what it’s like. The problem is that I have no control over concentration. Concentration comes on its own schedule. It cannot be summoned. And, by the way, its schedule is sparse. If I could just rein in the ability to concentrate a little bit, life could be so much better.
  • Inability To Focus
    The inability to focus is kind of like the inability to concentrate, but shorter term. It’s like when you are trying to read a book, and you read the same sentence over and over and still don’t know what the sentence says. Lack of focus is rarer than lack of concentration, but more disturbing when it happens.
  • Distractibility
    The World Wide Web is tailor made for distractibility. I can surf for hours and have no idea what I might have originally been looking for. Distractibility is the enemy of focus and concentration. Distractibility sucks.
  • Fear
    Fear is not always present, but when it comes on it is just about unbearable. It always comes the same way: I am going about my day, and suddenly I get this feeling that something is about to go wrong. And I know that if anything, the slightest little thing, goes wrong at that moment, I will be overwhelmed by it and start crying. And I will never, ever, ever be able to stop crying, and everyone who sees me will realize what a worthless piece of shit that I really am. I spend a lot of time almost crying. I never have cried from fear, but I still get the feeling that I’m about to break down.
  • Nausea and Anxiety
    Like fear, these are not always present. Well, some anxiety is always present, but here I am talking about a particular type. I get this sudden feeling that, unbeknownst to me, I have committed some terrible transgression. At this very moment, some great power (a boss, God, my wife, the entire federal government) is planning my doom as punishment and retribution for a transgression. I know that the plan will inflict great pain and embarrassment on me, but I have no idea when or where it will be applied. I also don’t know what it is that I’ve done to bring about this punishment, or how to correct it. When this feeling comes on me, I always feel that I am about to throw up.
  • Intrusive Thoughts Of Suicide And Self-Harm
    Let me distinguish “Intrusive” from “Non-Intrusive.” “Non-Intrusive” thoughts of suicide are usually entertained when sitting quietly, and wondering if life is really worth living. These are long, carefully considered thoughts. “Intrusive” thoughts, however, are more immediate, and, more to the point, arise from unknown places in the mind. I might be having a not-too-bad day, when I’m waiting to cross the street, and suddenly I’m thinking, “You know, if you step off the curb in front of that bus, it could never stop in time.” Self-harm is much more common. It is rare for me to pick up scissors, a sharp knife, or any other sharp object without wondering how it would feel if I would just plunge it into my abdomen or one of my eyes. Curiously, I never consider mutilating my genitals. I’m guessing that there’s some meaning in that, but I don’t know what it is.
  • Intrusive Thoughts Of Guilt And Shame
    Again, these are thoughts that suddenly spring themselves on me, usually with no apparent association to anything going on at the time. I’ll be having just a regular day when something hugely embarrassing from 40 years ago, which I have not thought of in 20 years, suddenly pops up. Of course, that incident leads to another, and another, and another, until I am consumed in guilt and shame, and whatever kind of good day I might have been having is ruined.
  • Really Scary Intrusive Thoughts
    So, I’ll just be sitting on the couch, watching a football game, when the thought pops into my mind, “Wouldn’t it be cool to write a book that’s a stream-of-consciousness, first-person account of what it’s like to kidnap, torture, and kill someone? But I have no idea what that’s really like. I wonder how hard it would be to kidnap, torture and kill someone…” Note that this is one of the tamer ideas that has suddenly occurred to me. I have no idea why this happens. It doesn’t happen when my medications are working, so I would assume that it doesn’t happen to most people most of the time. When I’m depressed, it happens maybe two or three times a week. Then I’m caught up in trying to figure out how to make the project work. It’s kind of like a reverse concentration problem. I can’t seem to get my mind off of this particular topic. On the plus side, I’m not emotionally and psychologically organized enough to carry out all of the planning that these “projects” would take, and I’m not disorganized enough to go off on one of these projects without some planning. At least, so far. The ideas can be really, really scary sometimes, but when they are happening, I am more fascinated by the details of feasibility than I am aware of the horrendousness of what I am thinking about. (Please don’t lock me up for this.)
  • Flatness Of Emotions
    When I first started on Cymbalta I was surprised by how some (actually, a lot of) emotions became not only stronger but also more variable. For example, imagine that you can grade “happiness” on a scale of 0 to 10. Without Cymbalta I would have only levels 0, 2, 4, and 6.
  • Inability To Feel Some Emotions
    Again, after Cymbalta established itself, I was amazed that I was experiencing nuances of emotions and moods that I had never felt before.
  • Lack Of Empathy
    I think this is related to the two previous symptoms. It used to be that people would say, “Gee, can you imagine how that guy must feel?” And my inner response would be, “Actually, no, not at all.” But, of course, I knew the correct answer and always gave it. With Cymbalta, I think that I actually can imagine how other people feel in a given situation.

If you enjoyed reading this paper, or thought that maybe one of the ideas in it was new to you, or you learned something, or something like that, please give the nice man a hug. I promise that he won’t hurt you, or get wierd on you, and he could really, really use a hug right about now.



One Response to “Introduction”

  1. Rob N. said

    Man, you’ve got it bad. I recognize a good bit of this in me, but not the extreme stuff. And I know how miserable I get. Damn. I don’t know what to say.

    I hope you’ll keep writing. This is the best account of what it’s like that I’ve scene.

    Incidentally, I employ humor as a defense mechanism. People think I’m funny too, and I know I am, but I’m not trying, it’s just that I “see” how screwed up everything really is. I think anybody who’s had hard times tends to be able to make people laugh.

    Thanks for doing this.

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