Yesterday my post took too much time to tell a story too far off-topic; the main subject is meant to be behavioral health. Even though life-history, spirituality, and psychology overlap, I plan to keep mental health the central stream. Yesterday’s final paragraph said what the entire memory/story had been driving toward: remember how excited we were as youths? Wouldn’t it be nice to regain some of that passion? Even if it also meant making some silly mistakes? Or taking some risks?

Not long ago I concluded that to a large extent, for me, fulfilment depends on passion. Life begins to look dull and pointless when everything feels lukewarm. There needs to be an occasional volcano, or some lightning storms, or comets racing across the sky. Maybe feeling a lava flow’s heat scorch my face, or listening to the roar of a tornado from across an abandoned field would do me good. Over the past decade, my mental health clinicians inculcated me with a sense of fragility. Last year at this time friends were going on a trip to experience three-day ‘vision quests’ alone in the high desert. My therapist and psychiatrist convinced me that doing so might make me depressed. Wouldn’t want that.

But what if I had taken the challenge, and then became depressed? Couldn’t I have learned from that, just like my ‘manic-psychosis’ in 2000 brought me ecstatic spiritual enlightenment? The time has come to quit handling my psyche like a wounded dove, and let it step forth as a muscular mountain lion (we have those around here), alert and voracious.

Today’s post extends the theme a little further. It is not as short as I’d hoped, but it completes the diptych. Having made the point that hazards are the price we pay for feeling the thrill of life, I now walk myself back to when I stood in the currents of danger, and gazed at death’s face. Yesterday’s post laid the groundwork for this closing anecdote. Here is the stage setting:

Now for the story: After we reached this area above the falls, I noticed many people were camped on one side of the river, and none on the other. It seemed sensible to me to cross the flow, and set up our site away from the masses. I looked for a place to traverse, and settled on a spot where the stream widened to forty or fifty feet (12-15 m), but was only about four to six inches (10-15 cm) deep. At this location the water was sliding down the face of a hillside of solid granite. The expanse of ash-colored rock looked as big as a hockey rink, and formed a steep grade as it leaned against the mountain. Its surface dipped slightly in the middle, forming a shallow depression where the river spread out to became a flat, flowing sheet. Broad and smooth, the channel introduced no frothing or white water. All I saw was a layer of perfectly transparent water, moving quite fast, but only as deep as a full sauce pan. It looked like wading across would be no problem; the spot seemed like the perfect ford.

I led Paul to the place I’d found, and started to step in. Without explaining why, my hiking companion hung back and just watched. With no hesitation, I waded with confidence toward the other side. Not paying much attention, I made it ten feet (3 m) or so into the flow before realizing the hazards of my action. First, the granite surface felt almost as smooth and slippery as ice. My feet seemed ready to slide right out from beneath me. Second, the water carried far more force than I expected. Although the stream was only inches deep, my standing in the middle of the flow created an obstacle that brought forth the water’s hidden power. By blocking the current, my body caught the river like a sail catching gale-forced wind. A wave of boiling turbulence climbed my leg to mid-thigh, and I had to lean hard into this wall of water to keep it from knocking me over. It felt like a linebacker was slamming into my lower body. Finally, I looked downstream, and saw that this broad sluice ended at a jumble of angular boulders the size of compact cars. Huge flags of water sailed into the air where the river smashed into the rocks, and the roar sounded just like the waterfalls we’d passed coming up the trail. After crashing over the granite blocks, the water gushed into what looked like a small, deep lake. The surface of this icy body of water bubbled in whirlpools and eddies that spread away from the inlet. That I had not noticed the chaos and danger where the granite channel poured into the pool below shows how little I had thought through my plan.

With a sudden flash of clarity, I realized the danger of my situation. For the first time in my life, death stared at me with its frozen eyes. Almost like watching a movie, I could imagine my feet slipping out from under me, and could almost feel my hands claw at the glassy granite surface as I slid down its face at shocking speed. I felt the shove of the water driving me toward the boulders, and imagined my bones cracking hard against them. My head jerks against my neck like a doberman on a chain, my legs snap like dry sticks, and I fly into the water as if I were a bumblebee in the jet of a garden hose. I land face down, then writhe against my clothing and the icy water, trying to turn over. I am sinking and freezing at the same time. My arms don’t work right, and my jeans feel like lead blankets wrapped around my legs. I put every ounce of my waning strength into holding my breath, but my lungs are already screaming. After just a few more clock-ticks, I can’t hold it one more second, and against all my willpower my chest bursts, forcing me to blow out air, and suck in water. Ice-cold liquid floods my mouth then slams against my throat. My larynx clamps tight in a gagging spasm, and my chest heaves, both choking against the liquid, and wrenching in gasps for oxygen. Every muscle in my body cramps like twisted rope as my lungs fill with a column of cold, cold water. Then a kind of peace descends. In an oddly calm way I think, “So this is what it’s like to drown.” The screen fades, and then turns black.

As this imaginary scene flickered in my mind, I kept my body motionless, as if paralyzed. By leaning into the massive wave breaking against my lower body, and not shifting my feet by even an fraction of an inch, I was holding my footing. But how could I possibly get back to dry rock? I was no more than a quarter of the way across the river, so heading forward was not an option. I turned cautiously, looking to see if Paul had suggestions. He sat an a flat rock far away from me, looking in my direction but talking to a pair of young women who had their backs to me. I noticed some strangers watching my predicament, and moving toward me as they recognized my danger. But no one could help. Even if they’d had suggestions, I could not have heard them over the thunder of water blasting against rocks.

I had no choice but to back up. With barely perceptible shuffles, I crept my feet backward bit by bit. Time seemed to stop. My body ached with the tension of resisting the pitiless column of water shoving against me, at the same time as moving my feet and legs with surgical precision. I could not make the slightest misstep, or my hiking boots would lose their tenuous connection to the slick granite, and I would die. I knew this one fact with absolute certainty. At no time in my life have I been more aware of every muscle in my body. At the precipice of extinction, my mind had more connection to physical reality than ever before. Daydreams, distractions, future plans, regrets, and every other extraneous mental action left me. All was focused on moving just the right way to survive. For someone who has contemplated suicide with clock-like regularity, at that moment I was fighting for my life with every cell and particle of my being.

Have you guessed that I inched my way out of that situation without catastrophe? Maybe my predicament was not as dire as I thought. I have not been back to that area since, so perhaps the granite was not as steep as I picture it, the water not as fast, the boulders not as big. It does not matter. On that day I saw my death with the same clarity as I see the computer screen right now. At age sixteen, this was when I first met mortality. As should be clear from the story I told yesterday about chasing the bear, which happened that very night after my aborted river crossing, the need for caution did not sink in right away. In fact, I continued to make wild and risky decisions for a few more years. But the way was now prepared for me to some day ‘settle down’.

I am quite settled. Domestic and cautious, I try to make careful decisions, and not wreck things by acting rashly. I made poor choices in the run-up to my breakdowns ten years ago, and that further cemented my anxiousness to avoid mistakes. Not that I don’t do stupid things. I can’t help it. But I do not take risks that I can forsee.

So the binary story of today and yesterday is now complete, and they arrive at more or less the same conclusion: I have learned to play it safe at the expense of simple play. I don’t let loose and just see what happens. I don’t ‘throw caution to the winds’, as exciting as that phrase always sounds to me. Dulling the knife-edge of passionate impulse may be necessary, but it is also sad.

Of course, there are those who refuse to get in line. They hang-glide at 15,000 feet. Or scuba dive deep into labyrinthine underwater caves. Or fly over rough dirt on motorcycles, hurling off jumps without looking first to see where they might land. Thrill-seeking probably brings that exact sense of death’s nearness that I experienced back at age sixteen, in the middle of a freezing river. That so many pursue such adventure shows the value of it. For my part, I am so cautious that violent accidental death is unlikely. More probably I’ll succumb to boredom. If I don’t change.

I don’t plan to take up rock climbing. The most dangerous thing I’m likely to do is hike around our house in the mountains near (is it really a coincidence?) Yosemite. Doesn’t sound too scary, except for the mountain lions. The cats have many deer to eat in this region, and being well-fed are not likely to attack adult humans. Still, I have to admit, it feels just a little thrilling to take the miniscule chance of getting eaten by a carnivorous wild animal. Perhaps that would be better than dying in a nursing home in thirty years. As I intimated in the story of the river, my first brush with death was also, in a strange way, my first contact with life. Just as you can’t see a white object unless you have a dark background, you cannot feel truly alive until you shake the hand of the reaper.

Death and life. Yang and Yin. They depend on each other, define one another. Death would have no meaning if nothing were alive. And life feels less significant when we lose touch with what makes this moment in history special. This instant, this second is ours, and there are only a finite number. If we lose sight of our ultimate fate, we risk devaluing our brief afternoon on this planet. How sad to spend a short life wanting to die, for instance. Death is not far, and obsessing about suicide makes no sense to me anymore. At age fifty, I finally ‘get it’ that my time is limited; until recently I had forgotten what those seething, frozen waters taught me at age sixteen. Suicide is a way of escaping life, but in a way, so is excessive caution. Right now, for me, risking more is a way of dying less.

This turned out longer than I planned. I also fear it sounds trite and obvious. I lay no claim to clairvoyance or unparalleled insight. All I know is that recovering my youthful zest for life seems vital to me right now. After ten years of fearfulness, introspection and self-pity, I want to recover bravery, a forward view, and self-confidence. The time has come to crack open the chrysalis, and emerge into the next stage of my adulthood. That requires stepping out of my protective shell, and into the heated embrace of fate.

(I modified this post on 2009 August 9, c. 06:40 PDT.)

My last several posts, in addition to some communications with other bloggers, talked about depression. Actually, they mainly discussed anti depression, but that prompted the rationale for today’s installment: you can’t consider how to cure an illness (if it is one, vide infra) without knowing a little about it. So, ‘what is depression, anyway?’

The word gets tossed about much more often than it gets defined. Here is the MedLinePlus medical dictionary definition:

(1) : a state of feeling sad (2) : a psychoneurotic or psychotic disorder marked especially by sadness, inactivity, difficulty with thinking and concentration, a significant increase or decrease in appetite and time spent sleeping, feelings of dejection and hopelessness, and sometimes suicidal thoughts or an attempt to commit suicide

Definition (1) is straightforward: feeling sad. Number (2) starts with feelings: sadness, plus dejection and hopelessness. In addition, it then captures both thought dysfunction and the ‘vegetative signs’ of depression. The former includes impaired thinking and concentration; the latter encompasses inactivity, appetite changes, and disordered sleep. The final component is suicidality, either in thought or action.

So to simplify we have: sad feelings, impaired thinking, changes in bodily functions, and suicide. Does that sound like depression to you?

Everything listed can be true for me to varying degrees at different times. What it fails to mention, though other dictionaries probably would, is ‘anhedonia’ or loss of ability to experience pleasure. Inability to enjoy anything often constitutes the crux of depression for me. If I could experience pleasure, life would not look so hopeless. Maybe I would then be motivated to eat, sleep, and think properly. Life is meant to be enjoyed, after all.

Or is it? That is the huge depressing lie that our culture has bought into: that the purpose of life is enjoyment. I disagree. I think the purpose (if there is one) is to experience what life brings, whether good or bad. If we also enjoy it, or if we learn from it, so much the better.

I grew up in a well-to-do household with many financial advantages. I attended good schools, went to a fancy summer camp, and lived in a house with a panoramic ocean view. The neighborhood had lovely landscaping, access to mountain trails, and a kid could bicycle to the beach in twenty minutes. Now, I am not at all suggesting it was a happy childhood. For those interested, here is an incomplete list of the traumas I experienced:

• Constant parental discord starting with my earliest memories.
• Prolonged and isolated hospitalization at age three.
• Parental divorce at age four.
• Annual moves for the next six years.
• My mother suffered from clinical depression, with numerous hospitalizations and shock treatments.
• She killed herself when I was six.
• My father’s new wife (his former mistress during the marriage) abused me with breathtaking sadism.
• My father tended to be narcissistic, suffered from alcoholism, and disliked children.
• My sister became entrapped in the drug culture, and suffered LSD-induced psychosis when I was ten.
• My stepmother started inflicting sexual humiliation and abuse when I was eleven, continuing about four years.
• I became involved in drugs and alcohol at age twelve (daily use by age fourteen).

But although my my childhood left a lot to be desired, the surroundings were pleasant and prosperous. My high school had its share of celebrity children, and the prevalent attitude was that life ‘should‘ be happy and fun. Money worries ‘should not’ exist. Everyone ‘should’ be gorgeous and sexy. This all was going on pretty close to Hollywood, and many of the kids I went to school with grew up to continue the tradition of exporting these standards to the entire world.

How realistic are these expectations? Not long ago I attended a support group where one African-American attender came from a different environment. Crack sales on the corner, imprisoned or dead fathers, drive-by shootings, endemic destitution, and pervasive squalor. He had trouble understanding the concept of depression. When he first received the diagnosis, apparently, he told his psychiatrist that his feelings of despondency and hopelessness were normal. That would be the natural conclusion for someone growing up in such a habitat, wouldn’t it? How many of his classmates expected to some day meet a stunning spouse from a well-to-do and intact family, have a couple of genius kids, work a fascinating and lucrative job, and live to an advanced age surrounded by loving children and grandchildren? White middle to upper-middle class people do not think such dreams to be wildly unrealistic. Improbable, of course, but not out of the question. In the American ghettoes, however, to fantasize like that would practically seem psychotic to your companions.

Maybe we ought to look again at what life typically brings. A huge proportion of marriages end in divorce. Financial security is a fading dream. Death is inevitable and illness almost so. The chemical byproducts of industrialization degrade the planet, spawning a very real threat of ecological collapse. People move all the time, making stable communities a historical memory. War never ends. We’re no longer surprised by genocide and terrorism. And meeting people who grew up in truly loving and healthy families happens almost as rarely as discovering four-leafed clovers.

Does this sound like a world where we might expect to be happy? You could even ask, of course, if human existence has ever been conducive to widespread joy and contentment. So maybe sad feelings, dejection, and hopelessness are not pathological. I realize this is a ‘depressing’ viewpoint. But before we start drugging ourselves because we feel ‘sad’, we might ask if it is really a sickness, or maybe just a normal human reaction. Especially for sensitive people with concern for others, like most of us who get diagnosed with depression.

I am not suggesting we just live in misery. I will continue to fight my depression until my last breath. But it helps to know the true enemy. Is it really my brain, the way the mental health system teaches? Do I need to conclude I am a ‘sick’ person because the combination of a horrible upbringing and living in a discouraging world has left me susceptible to ‘sad’ feelings? Maybe those of us who feel the pain of this life are actually the sane ones. Could it be that happy people are just in denial?

OK, that last statement probably takes the point too far. Still, I do believe that sadness must be considered a pretty natural reaction. Any discussion of depression treatment would do well to start from that realization. Then we can proceed to identify endless despair and lack of pleasure as on over-reaction, but perhaps not an entirely pathological one. So when we look at what we should do, we will know that what we are fighting is, in part, the state of the world. Then the problem becomes, how can we find tranquility in the face of all the problems?

Starting from that position, using a psychiatric ‘medication’ looks like a band-aid. We can suck cocaine into our noses and feel better. But is that the best way to deal with life on this planet? Psychiatrists and drug companies, if they bothered to read this, would go bananas at the comparison. Psychiatric pharmaceuticals have long half lives. Their benefit is sustained. They don’t lead to life-destroying behavior. They don’t cost a ridiculous amount of money ( lol ). So I’ll grant, there is a quantitative difference in the side effects and problem profile. But there is not really a qualitative difference in philosophy. Whether you buy the drug in a pharmacy or on the sidewalk out front, you are still treating life’s pain with chemicals.

Personally, I think that is not the best approach. Better to learn tools to cope with the tragedy and hardship than to drug yourself until you no longer care about it. And it is possible to retrain yourself to find peace and satisfaction in life in the face of its heartache and struggle. However, you will probably still feel sad. Part of the reason I became so miserable was my belief that things ‘should’ be better. I saw relatives with truly happy families, and I thought that ‘should’ have been me. I saw classmates with gorgeous dates, and felt I deserved the same. I resented that my colleagues continued in their careers, while mine ended with me in chronic pain, saddled with a badly damaged neck and a threatened spinal cord. My resistance to making peace with my fate, not the misfortune itself, made me miserable. Now that I can accept my hardships as not being all that unusual, and certainly not ‘unfair’, I can just be sad, without abandoning all hope for joy. It is OK to be sad. It is natural, maybe even healthy. My goal is to learn to experience the sadness, but also allow myself to bask in contentment from time to time.

I believe that ‘sadness’ is not the problem, despite how the definition of depression emphasizes it. Anhedonia is the real enemy. The inability to enjoy anything because of sorrow is a confusion about how feelings work. You can be sad a lot, but still find things to enjoy. But to get to this point I have had to abandon the unrealistic expectations fed to me by our modern culture. What a lie to believe one ‘should’ get through life without being seared to the bone by tragedy and suffering! The fact is, every human frame will sometimes feel the flames of hell. But in our hearts we can look around, see the autumn trees outside the hospice window, and smile despite the pain.

Not long ago I posted a ‘Tweet’: The surest path to satisfaction is to lower your standards. What surprises me is that I now actually accept that to be true.

In closing, I would like to point people toward Acceptance and Commitment Therapy. It is not a therapy so much as a philosophy of recognizing the truth, and even the beauty, of pain. You don’t need a therapist to ‘get it’ (try this book–and I’m not getting a kickback from Amazon). ACT is not all that different from Buddhism, actually. But it is a good path for westerners who need to escape our society’s crazy message that only the beautiful, sexy, and rich are living life properly. Or that life is supposed to look like a TV commercial, while grief and defeat and illness and hurt are for losers. In the end, every one of us loses everything we love. What could be sadder? The trick has been to allow sorrow to rain on my parade, and just keep marching and pounding that drum.

Note: the author of Health and Life directs me to this article which expands on the topic of antidepressant (in)efficacy. It also cites the STAR*D study, which made a mammoth attempt to assess and compare treatments. The short form of their result is that drugs, and even accepted therapies, don’t work all that well. But such a short wrap-up does the project a disservice, since it studied issues that always get ignored by drug companies. Some day I may devote an essay to it.

(I modified this post in several places on 2009 August 4, c. 13:45 PDT. I did not introduce any substantive changes in the message or opinion.)