Perpetual Sorrow:
From conception onward
Entropic armies destroy
Delicate structures, aging, mutating
Disease, death, decay
Infants doomed to expire
Mothers abandoned to grief

Eternal Joy:
Renewal a living rejoinder
Creative mystery manufactures
Intricate forms, adapting, evolving
Fertilization, gestation, emergence
In birth a yearning to love
In pregnancy the genius of hope

Life Balanced Between

Sadness. Regret. Grief.

In the old days, I’d have called this state of mind depression. But that word refers to a mental illness, and this doesn’t feel pathological. Rather, it seems utterly normal to feel down after everything that’s happened.

As March draws to a close, I look back on a six month run of painful events that started with my sister’s death from alcoholism on October first. The last three months of 2011 were shadowed by that loss. My first holiday season with no one else alive from my family of origin felt especially mournful. As the days shortened and darkened around my bereavement, I continued to face one disappointment after another on the acupuncture front. And just as my hopes of once again earning an income began to flicker out, the company that pays me disability insurance threatened to cut me off on false pretenses.

With all that stress, perhaps it’s no surprise that in mid-January I suffered my ruptured aneurysm and two hospitalizations. This bodily malfunction caused pain of greater severity for longer periods than I’d ever endured before, not to mention tsunamis of nausea and a twelve hour stint of nearly non-stop vomiting. Because of intestinal obstruction, I was fed intravenously for several weeks after seven days of flat-out starvation. Today, despite six weeks of normal eating and living, I still feel sorely depleted.

Not long after the internal hemorrhage, a friendship that has been important to me for years ended in a big, angry blowup that appears final. Also, during the past few months my spinal problems worsened, and now my left arm is afflicted by nerve root compression that causes stabbing pain. As a result, I can’t use that hand to carry anything much heavier than a glass of water. And the abdominal discomfort that’s plagued me for a year (and that we now know was caused by the same vascular insufficiency that created the aneurysm) is bothering me more than ever.

And of course there’s the letdown after the major manic episode that swelled, crested, and broke as my world seemed to be falling to pieces. Inevitably, it seems, energetic and euphoric states are followed by their opposites.

At the tail end of all this chaos, my cousin came to town and we held an informal ceremony for my sister at the western edge of San Francisco, where the city meets the Pacific Ocean. My wife and I owned a beautiful vintage house near that beach until December 1999. My sister visited us often there, and she loved to walk along the shore and collect sand dollars.

The memorial at Ocean Beach felt painful. First and foremost, of course, there was my grief about my sister’s passing, which I’ve had trouble facing before now: the pain has seemed too overwhelming.

But that neighborhood often makes me uneasy just by itself, because it brings to mind difficult memories. For instance, very near the spot where we spread a few teaspoonfuls of Janice’s cremains, in 1996 my wife and I watched in horror as an enormous Akita grabbed our beloved three-pound Pomeranian, biting hard and killing her almost instantly. The resulting emotional devastation ruined our weekly walks along the beach and probably fed into my hastiness in abandoning the area a few years later (see below).

Going to that beachside neighborhood feels especially poignant because before Mickey’s death I was enjoying some of the most satisfying years of my life. We lived in a wonderful city just a few blocks from the surf. I was a respected surgeon who drove to work every day along one of the most beautiful routes in California. My avocation as a figurative sculptor kept me occupied during my free time. I felt happy and proud of myself.

So much has changed since then. My neck disease ended both my surgical career and my sculpting. My mental health collapsed. We left San Francisco after I sold our beach house with little forethought during the rising phase of an extremely intense manic episode. As years passed, I tried many new careers but wasn’t able to sustain any of them. Our financial situation gradually deteriorated. And now I’m faced with many new losses that seem to echo all that escaped my grasp twelve years ago. My sister’s memorial on the sand wove my unraveled dreams into a tapestry of regret.

But change and eventual decay are what life promises, yes? Earlier tonight I was looking at a book we bought long ago, back when we lived in that unique house near the beach. It shows photos of the neighborhood and coastline dating from the mid 1800′s through the 1950′s. In one 1936 aerial photo of the amusement park that used to line the shore you can even see the house we once owned; it would have been eleven years old at that time.

What struck me in looking at those photos was how the people looked so ordinary in their happiness. Gazing out from those images were romantic couples strolling along the esplanade, boisterous families gawking at the amusements, and robust men racing out of the surf. One photograph showed a group of young women wearing swimsuits that looked like today’s scuba diving outfits; the hand-pencilled caption read: Bathing Beauties. Most of these young people were posing self-consciously for the cameras, but they all looked excited to be spending a day at the beach. We can only imagine what happened as they grew older. What joys, adventures, and successes did they find in life? What disappointments, illnesses, and tragedies did they eventually suffer? Could they have guessed that their innocent pleasure would be captured in a souvenir book and viewed a century later, long after their death? Did they ever think they would be reduced to anonymous images, historically interesting but otherwise nearly forgotten?

This is the nature of life. It buds, blossoms, fruits, and falls. As I survey the wreckage of the past six months it seems like nothing more than ordinary human history. I don’t feel sorry for myself. It would be isolating and self-pitying to call my natural sadness a mental illness. Loss and grief connect me with the global family of humankind. They pull me into the passion play that repeats itself generation after generation. The actors and scenery change, but hope, fear, joy, and grief cycle forever through their seasons, as humanity lives and loves.

My last several posts 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 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. It then captures both thought dysfunction (impaired thinking and concentration) and the ‘vegetative signs’ of depression (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 this source 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? In my opinion, our culture has fed us a huge depressing lie: that the purpose of life is enjoyment. More likely, the purpose (if there is one) is to experience what life brings, whether good or bad. Enjoyment is nice but not central to a meaningful life.

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.

However, it was not a happy childhood. For those interested, here is an incomplete list of the traumas I experienced:

• Intense 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 second wife (his former mistress during the marriage) abused me with breathtaking sadism.
• My father was narcissistic, suffered from alcoholism, and disliked children.
• My sister a psychotic break (precipitated by heavy LSD use) when I was ten.
• My stepmother inflicted sexual humiliation on me between the ages of eleven and fourteen.
• I became involved in drugs and alcohol at age twelve (daily use by age fourteen).

So I suffered a traumatic, unhappy childhood in pleasant and prosperous surroundings. 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. The neighborhood was not far from 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; 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 gorgeous spouse from a well-to-do and intact family, spawn a couple of genius kids, develop a fascinating and lucrative career, 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, perhaps, but not out of the question. In the American ghettoes, however, to fantasize like that would appear psychotic to your companions.

Maybe we ought to look again at what modern 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, posing 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 finding 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 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 work against depression until my last breath, if necessary. 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 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 is nothing but a band-aid that covers rather than heals. After all, we could 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. They would insist that psychiatric pharmaceuticals have long half lives, produce sustained benefit, and don’t lead to life-destroying behavior. And in truth there is a quantitative difference in side effects and social problems. But there is no 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. As a child, I saw relatives with happy families, and I envied them. As an adult, I resented that my colleagues continued in their careers, while mine ended because of a badly damaged neck. 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 life is supposed to look like a TV commercial, while grief, defeat, illness, and pain 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.

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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.

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(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.)

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