September 1, 2017 at 8:02 pm #843hvaParticipant
There is no debate over the idea that alcohol is used by an overwhelming number of people suffering from depression as an escape mechanism. To medicate the problem… or to, temporarily at least, get away from the problem.
And there is not much debate over the fact that alcohol is a depressant, and typically makes everything worse.
The first time I became clinically depressed I was in graduate school and it happened overnight. I had been drinking for several days. I went to bed on a crisp fall Saturday night, intoxicated but feeling otherwise normal. Upon waking Sunday morning, I sat up, swung my feet to the floor, and knew immediately that something was terribly wrong. This was not just a hangover. The room spun around me and I was clutched by a feeling of dread unlike anything I had ever before experienced.
Panicking, I grabbed Saturday’s newspaper. The words pulsated into an indecipherable muddle of ink. I stood up in my small room and needed to clutch the edge of the mahogany bureau to support my trembling legs. My heart beat rapidly, as though it were trying to pound its way out of my chest. I sat back down on the bed for several minutes, hoping these awful sensations, especially the dread, would subside. When they didn’t, I again lurched to my feet and out the door to the corridor, where I spent the next several hours pacing back and forth. At times the anxiety reached a crescendo of terror. After spending half a day pacing the halls, I used the pay phone on the ground floor of the dorm to call my fiancé. I tried to describe how I felt. She didn’t understand what could be wrong with me. I didn’t either, and it would take me some time to find out.
During the coming weeks and months my condition remained unchanged. I desperately managed through the final exams of this last semester of my Master’s program, got married shortly thereafter, and embarked on a surreal skiing honeymoon in New Hampshire. I drank heavily to blunt my extreme psychic pain. I was so loaded up with Smirnoff vodka on the day of my wedding that I swayed from side to side as I proceeded down the aisle of the church. Drinking only masked my symptoms. Later in the day, or the next day, I felt worse. I wanted to die, but lacked the initiative and mental acuity to form a plan.
One day in February the symptoms abated, and within two more days had vanished. I had emerged, inexplicably but wondrously, from what Winston Churchill called “the black dog.” Not at that time having a name with which to christen my malady, I thought it was “one of those things,” like a rare, malign intestinal ailment. Within a couple days of my return to normality I celebrated my liberation with a couple pints of vodka. My rejoicing was premature.
Three years into my first regular job out of school the second episode hit. I did not yet know that a single bout of depression makes it likely that another will follow. This is partly because the now famous “neural pathways” in the brain become vulnerable to the brain chemical instability that is a hallmark of the severe, clinical depression.
This time I went to a local counselor and was formally diagnosed. My therapist emphasized the clinical nature of my condition in order to distinguish it from its less agonizing variant, situational depression. I needed major help, he announced portentously. More of it than he could give me, it turned out.
When three months of his ministrations were unavailing, he sent me across town to a psychiatrist. This inaugurated my adventures with antidepressants. Prompt relief, I was assured by the doctor, who was kind but terse, lay just around the corner. After several frustrating months of trial and error the depression subsided, vanquished, apparently, by the newest drug just come onto the market. The psychiatrist assured me that with my condition stabilized I could gradually wean off the drug. Weaning off did not work and neither did weaning back on. Instead, I would spend the next 30 years experimenting with more than a dozen prescription drugs, sometimes singly, and then in shifting combinations.
During these three decades I have had about 12 attacks of severe depression. The majority have lasted several months, arriving without warning or an identifiable precipitating cause. Most recently, I was severely depressed for nearly a year, ending in March of 2015. Every bout has been agonizing and a few disabling. Several apparently responded to new medications or novel “cocktails,” while others abated according to their own inner timetable.
As I gradually educated myself about the disease I learned three fundamental facts. First, the more depressions you have, the more you are likely to have. Second, among the vulnerable, depressions can come and go without discernable cause. Third, and most important for me, depression and alcohol are intertwined, genetic fellow travelers. The precise nature of this diabolical relationship has not been scientifically pinpointed, but many drunks are depressives and vice-versa. Both ailments are heritable and thus run in families. They likely share similar genetic and brain vulnerabilities
Learning about the dangerous relationship between depression and alcohol during my second episode did not throw me off drinking. After my initial bout, I stopped imbibing when I was depressed. Once recovered, I celebrated with vodka and continued on my merry way. And so it went. This behavior makes no sense to me today, but with each remission, I considered myself cured forever and as invincible as ever. So, for eight more years I continued drinking, with increasingly dire consequences, not stopping until life crashed down around me. By the time I stopped for good 20 years ago, it was too late to stabilize my confused and discombobulated neurotransmitters and depression continued to plague me.
Brains vulnerable to alcoholism often carry the same susceptibility to depression. But neither science nor pharmacology knows as much about the causes of depression as they often claim. In the 21stcentury both alcoholism and depression are labeled diseases of the brain. How much the disease model accurately characterizes alcoholism is for another article, but it is certainly true of depression. Depression is characterized by brain chemicals run amuck. The problem is that this does not tell us as much as we may think.
The loudest voices in the discussion, the pharmaceutical industry, and most psychiatrists, tell us about brain chemical imbalances and about neurotransmitters like serotonin and norepinephrine in short supply within the afflicted brain. It may not be coincidental that both Big Pharma and psychiatrists make billions of dollars from the production and sale of medications said to increase the abundance of these slacking chemicals. But the chemical imbalance explanation of depression has not been proved and it demonstrates correlation rather than causation.
What causes neurotransmitters to get out of whack to begin with? Does a cog in the brain mysteriously malfunction? Does emotional stress throw our brain chemistry out of balance? Does the fault lie elsewhere, such as in our gut, as recent theories suggest? Billions of dollars in profits hang in the balance, depending on the answers to these and other questions. But the answer lies in the mysterious realm of multi-causality. Depression, like alcoholism, has a host of causes, the exact mix for any one person depending on a host of factors.
We do know that what is called clinical depression has a strong biological component. Hence, anti-depressants work sometimes for some people. How many? Perhaps 30 or 40 percent, depending on who is doing the counting. Researchers outside the pill manufacturing and dispensing industries point out that pharmaceutical companies have the luxury of selecting the clinical trials they submit to the FDA. Failed trials, and there are many of them, are buried in-house. And even when antidepressants do work, they are accompanied by often intolerable side effects and are eventually subject to the “poop-out” factor, meaning they stop working.
In both depression and alcoholism, the complexities of brain chemistry likely precede and accompany the experienced affliction. Actual causation is more complex and in both cases the biological disease explanation has limitations. Empirical evidence tells us that for both ailments psychological and environmental factors combine with inborn vulnerabilities that parse out differently for each person.
In the fields of both alcoholism and depression, the multi-causal explanatory model leads to the question of psychiatric and psychological comorbidity. In my case, psychological vulnerabilities likely came into play.
My visit to the counselor during my second depressive episode commenced many years of therapy, much of it useless. I doubt these hundreds of talking sessions, many of which took place in sobriety and some of which were illuminating, did much to alleviate either my alcoholism or my depression. I already knew that I grew up in a stable family environment. My parents were kind, educated, well-intended, and responsible. In school I was athletic, mostly well-liked, and, eventually, a good student.
I did recall in the course of therapy that when I was seven years old and my younger brother entered the picture, I did not welcome him into the household. Instead, I was fiercely jealous. His first night home was nearly his last, as I tried to smother him in his bassinet, coming to my senses just in time to lift the pillow from his head and creep back into my own room. In response to my hostile reaction to my brother’s arrival my parents decided to divide their attention in what seemed like a logical manner.
My mother focused on my brother and my Dad on me. Thus, my mother disappeared from my life, which only exacerbated my anger, and I was stuck with my father, who at that time loomed as an intimidatingly austere and demanding figure. Perhaps this at least partially explains why I evolved into a boisterously defiant teenager who as an adult learned that in order to excel I needed to hide my anger, and along with it all my other feelings.
As an adult, therapists suggested to me, I had learned to sublimate and repress my anger and other feelings. In an ironic reflection of my professor father, I learned to get along and get ahead in life at the helm of my analytical mind. This was fine up to a point, that point being my relationships with other people. These relationships were congenial, to be sure, but superficial. I thought of myself as kind and compassionate. But these were mostly operating principles I had adopted rather than genuine impulses in the direction of healthy and contented living. Beneath these superficial principles swirled a cauldron of sublimated and projected angst and hostility. I was once diagnosed by a workplace psychiatrist as “defiant.” I indignantly informed the psychiatrist that he was flat out wrong, not seeing the irony in this reaction until years later. By then I had gained a modicum of self-awareness, but therapy never helped me to leverage this glimmering awakening into substantive change. For me, psychic and emotional repair was long in coming.
Was the anger that I gradually directed even at myself the cause of my twin ailments? If not the cause, then they certainly formed the root out of which they grew. And observing my brothers and sisters in recovery two things are clear. First, in looking back most of us can identify pre-morbid psychological conditions and environmental factors such as childhood abuse that predated and fed our alcoholic tendencies. Second, upon embarking on sobriety we discovered that these issues had not vanished. To the contrary, drinking and drugging hard-wired them into our psyches and our lives.
Mere abstinence is no magic elixir enveloping us in an idyllic life the day after our last drink. We need to recover. This takes much longer than we think it should and want it to, partly because our psychological wounds and vulnerabilities become more rather than less obvious and intrusive. Their tenacity can befuddle and demoralize us, which is one reason why the embracing and curative fellowship of recovery is so essential to our unfolding well-being. With this support, we can bravely face our emotional wounds and psychological challenges and evolve into new beings and toward hopeful futures.
Each of my relapses occasioned further psychological evaluation and self-examination. I was cautioned by more than one psychologist to watch my tendency to isolate myself from others. The most astute among them noted my proclivity to intellectualize and tried unsuccessfully to ferret out emotions I didn’t feel. I responded by thinking yet harder about my intellectualizing proclivities. While fiddling with my medications, psychiatrists confirmed that although sobriety did not halt my depression, a resumption of drinking could prove catastrophic. With this knowledge firmly implanted, I was never seriously tempted to drown my pain in further vodkaholic indulgences.
Meanwhile, some medications–or combinations of medications–were effective, but never for long. In the last five years, before the recent depression I referred to earlier, I had three relapses that first interrupted and then rendered impossible a return to graduate school in preparation for a career change. Over the years I have been hospitalized twice for complicated medication overhauls and once to protect me from suicidal ideations and impulses.
Speaking of suicide, no serious attempt is a cry for help. It is a desperate effort by a person to remove him or herself from severe and unremitting pain. Clinically depressed people are uniformly frustrated by the impossibility of describing what the condition feels like to those who have never similarly besieged. The state of major depression has no analogs in ordinary reality. It is not like being sad, but very sad. It is not like being down, or having the blues, but more so. Depression cannot be seen by the naked eye or measured by the armamentarium of modern medicine.
This makes its agony all the more isolating and suffocating. It throws its black cape over the whole of external reality, eviscerates the brain’s capacity for thought and the ordering of experience, and it swallows the soul, leaving its victim without a shred of initiative or voice. The best description of depression is probably novelist William Styron’s slim, autobiographical volume, Darkness Visible, in which he characterizes “depression” as a wimp of a term for so ferocious a condition, one that is more akin to “a storm in the brain.” It is a storm soothed by nothing except, for me, slightly, by the withdrawal into pure aloneness, inaction, and physical blackness. During my last, lengthy bout I could find a small measure of solace by lying inert in bed, my eyes closed, heavy covers enfolded over and around my head, mutely mulling over methods of killing myself. Every day I would eventually decide, “I won’t do it today,” while reserving the possibility for tomorrow.
Being around people hurt. The more people, the more movement, the more physical stimuli, the more pain. It felt like a relentless and unyielding kaleidoscope of torment, fear, and runaway anxiety. I was raised in a Christian household in which I was taught that suffering was redeeming, that it had meaning. I never sensed meaning in any of my depressions, nor did any revelatory light dawn in its aftermath. Depressions were a predatory blight on the self, blotting out any semblance of normal consciousness, and leaving me barren of insight. I never thought of God, or felt a drop of spiritual solace.
Seven months into my most recent depression and at the urging of my psychiatrist, I tried electroconvulsive therapy. ECT helps some people who are beyond the reach of therapy and medications. We don’t know how it works, but the guess is that the electrical current coursing through the brain rearranges its misbehaving brain chemicals in an ameliorative manner. I had 15 treatments, nine as an inpatient and the remainder as a commuter, though I was driven to and from the hospital by a compassionate and loyal friend in recovery. A “behavioral health” unit is not a suitable or reassuring environment for the mentally afflicted. ECT is scary and disheartening. The operating rooms in which the procedure is administered are white and sterile to the point of appearing sinister. The medical personnel rarely cheer things up. Aside from the random kindly nurse, the patient is processed efficiently to clear space for the next sufferer. The anesthesiologist may crack an unintelligible or macabre joke. After coming to in the recovery room, it takes a number of unnerving minutes to realize where one is and what has just happened.
The cheering and optimistic advertising featuring the grinning cured notwithstanding, ECT doesn’t work for many people, and it didn’t work for me. It did leave me, as it does others, with short- and long-term memory deficits from which I doubt I will fully recovery.
Emerging from ECT none the better magnified my despair. My psychiatrist, a caring woman, threw up her hands. After research, I switched to a physician with 30 more years of experience, a thirst for staying current with the latest research, and a welcomed compassion for her patients. She tried several new, finely-tuned concoctions and the third one worked. I have been largely well since and return to her for minor adjustments and periodic check-ins.
There have been occasional flickers of the “demon,” as Andrew Solomon calls it in his magisterial volume on depression, The Noonday Demon. But these flickers have been relatively brief and mild and I can usually track down and address a precipitating trigger. I now learn and even grow from these stumbles. And the prolonged blackness of this last episode has invigorated me to undertake a comprehensive revamping of my “lifestyle,” which now includes running most days of the week, a healthy and green diet, meditation, a dedication to spiritual principles, and an even increased involvement in Alcoholics Anonymous.
The wondrous part of this story is that over these months my life has changed. Feelings, real and vibrant feelings, have flooded in. The full collection, including happiness, sadness, palpable anger, and joy. Relationships are being transformed, opening into new vistas that I had only glimpsed before. I have discovered within myself reserves of (dare I say it) humility and an eagerness for self-awareness, nurtured by my incomprehensibly loving and acutely perceptive wife.
Today I ask myself, “What has happened here?” And, “Being 63 years of age, in AA for 25 years, sober for 20, and of at least average intelligence, what took so long?” And finally, “What, exactly, has brought this about?”
I don’t have answers to these questions. My questing analytical mind tells me I better damn well come up with some. My recovery fellowship tells me to quiet my mind and tame my need for certitudes, to relax into and to luxuriate, for the time granted to me, in the new life I have been given from a source that defies comprehension and description.
Shortly before I finished this article I sat in a meeting with 40 or so of my fellow alcoholics and addicts. We were discussing the broad topic of how we have recovered from a lethal disease. We said and heard many of the usual things. Yet, half way through the meeting tears came to my eyes and stayed there for the remainder of the hour. It came to me that I felt love for each person in the room, including those who sometimes annoy me, and that many of them love me. I also realized that this love is woven into the hope given me by my recovering community, the hope that sustained me through the worst of my depressions, and which I know will hold me in its arms through whatever comes.
About the Author, Galen T.
Galen spent most of his career in the ministry, and in mental health and career counseling. He has published numerous articles as a career consultant. He is now an independent writer focusing on the application of personal narrative to addiction recovery and life generally. He has been sober since 1995 and is active in several of his local AA groups.
The audio story was narrated and recorded by Len R. from Jasper, Georgia. Len is interested in starting a secular AA meeting in his area. If you would like to join him, you may reach him by email at lenr[email protected]
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