In this, the last year of the 20th century, we can glance back across
triumphs that rise like mountains on the landscape of these 100 years.
Scientific ingenuity and technical acumen have allowed us to split the
atom, walk across the moon, see the barren terrain of Mars, and map
nearly the whole human genome. Does any terra incognito remain
inaccessible to our inquiry?
But these achievements have not muted what the French novelist and philosopher Albert Camus called the essential question of philosophy: is life worth living? Our age may be brilliant, but it is also tragic. Steven Serpas, publications manager at the National Depressive and Manic-Depressive Association, estimates that 20 million Americans, or roughly 8% of us, are clinically depressed. Of these, 15% commit suicide every year if their depression remains untreated. No wonder Surgeon General David Satcher is laboring to infuse this disease into the public discourse. His is not a lone voice crying out in the wilderness. We all intuit that no one can live by bread alone. Our task, especially for those of us who battle depression, is to create lives of meaning. This truth is deeply personal, for I am writing these words from my bed in the psychiatric ward of a hospital in Ohio. Just as one never expects to get cancer, I never thought depression could afflict me, forcing me to fight an enemy as insidious and remorseless as cancer is as it radiates throughout me. Depression is no state of mind; it is a disease that obliterates the dichotomy between mind and body and instead demands that I confront myself as a precarious unity, a person whose every cell is saturated with disease.
But in writing these words I legitimize depression as part of the public domain, as something larger than me, for depression does not distinguish between rich and poor, black and white, female and male. This psychiatric ward, which serves a city of perhaps 100,000 people, has treated judges, corporate executives, other doctors, Ph.D.s, even a Catholic bishop, as well as the indigent: those who live on the ragged fringe of American prosperity and will never share its bounty.
Perhaps paradoxically, depression is the public disease that has retreated to the silence of our collective psyche. There it remains in limbo as a taboo. Depression drips with a stigma that frightens me more than any atrocity could. I fear the people who inhabit this ward with me: the gaunt, gray-haired man who has neither shaved nor bathed in weeks, the man who sleeps in the bed beside mine at night but whose eyes I avert during the day, the woman who spends much of her time squatting on the floor before a window that looks out across the weathered tombstones lining a cemetery in mournful rows. I tell myself that I am not like them, but I am wrong.
We all belong to the same fraternity and share the same frail genetic architecture. Everyone has his nights of Gethsemane, but ours are longer, darker, more desolate. We do not know where to turn for comfort when we grieve, for support when we falter, for wisdom when we have lost our sense of self, and for love when we have forgotten what the word means. Here, in the absence of love, is the essence of depression, which festers in me and in all its casualties because we cannot face ourselves or anyone else. And so we pass one another as though we are ghosts. We have no identity and nothing to say. No wonder Dr. Satcher has had to grab America by its collective shirt collar; otherwise most of us would never give depression a thought.
According to an old Russian folktale that Fyodor Dostoyevsky retold in THE BROTHERS KARAMAZOV, hell is a fiery lake into which God casts wicked souls. There they struggle in agony to stay afloat, though those who exhaust their will and stamina sink to the bottom, where God forgets them. We are the forgotten.
I understand our shadowy existence in the netherworld of human consciousness. A man who breaks a femur needs a cast; a girl who cuts her lip needs a few stitches. We can unleash our modern arsenal of antibiotics and vaccines to thwart microbes. CAT scans and X-rays can pinpoint a brain tumor or pneumonia. But depression is the Stealth Bomber of afflictions. The incremental deterioration of a person is difficult to observe and harder to treat. Every day the tree of pharmacology sprouts a new branch of psychiatric drugs. But they come from no ordinary orchard. Each drug affects a person in a unique way depending on its dosage and combination with other drugs, and it may not reach full potency for weeks. All is in flux, the Greek philosopher Heraclitus might have said about psychiatry, and the psychiatrist must have a deft touch in recalibrating and recombining drugs much as a coach shifts athletes on and off the court during a basketball game. Meanwhile the patient remains enmeshed in malaise.
Psychiatry remains a fledgling science whose imprecision frustrates both physician and patient. As Americans we expect unambiguity as our birthright. "Just do it" rings the slogan, and "it" stands for myriad concrete actions: running, bicycling, mountain climbing, rollerblading, swimming. Shakespeare hit upon the perfect metaphor when he described the world as a stage, for we understand whatever we can reduce to a verb, to an action. Herein lies the secret of our love affair with computers. With the click of a mouse we are always on the go, though never fast enough. We are forever demanding higher connection speeds and faster modems. We are no longer in the throes of an arms race but rather one of fiber optics. Velocity is its own virtuosity.
Herein lies the crux of the matter: depression's victims have lost their verve. They are objects locked in the inertia of rest and surrounded by a world in frenetic motion. The din of fax machines and the staccato of computer keyboards drown out our silent melancholy, a melancholy that the healthy cannot hear but might intuit if they were a little more reflective and compassionate toward us.
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