On Being Depressed & the Modern Mental Health Care System
When I was a senior in college, I got depressed. And like many people who find themselves in a depression for the first time, I had no idea what was happening or how to handle it. I had never experienced a state of being so profound that it took hold of me completely; both mentally and physically, and in my conscious hours and even in my dream state, that is, on the rare occasions I was able to sleep. If I had any spiritual inclinations at the time, I would’ve said that even my soul was depressed.
I remember lying in bed one night desperately trying to fall asleep before the sun came up, and as blackness hinted at orange and beige, an early-to-rise bird chirped and inspired a symphony of morning songs that to me were as harsh as nails on a chalkboard. I wanted to curse those bastard birds to hell that morning, to knock them from their native stoops one by one with my own fist, except I hadn’t the confidence to raise my voice, not even at tiny winged creatures perched in the trees outside my window, and I certainly didn’t have the strength to throw a punch. Depression, I was learning, makes a person weak. So instead, I cursed morning under my breath and walked to Shakespeare class in the same sweatpants I slept in.
By this point I was out of it. I had 5 literature courses on my schedule and all of a sudden I couldn’t read. The thoughts in my mind were racing so fast that it was nearly impossible to retain new information. I would forget the beginning of each sentence before I came to the last word. Everything was moving too fast, it seemed, and I wasn’t moving at all.
Looking back, I had my reasons. I was sad about a girl who didn’t want to date me (she might have dated me if I had articulated how I really felt, but I was young and dumb and unsure of myself at the time). I had a few goods friends, but for the most part I had failed to do what every young person should do in college-find like-minded people and start getting involved in things they care about. Instead I socialized with the people closest to me in my dorm, and eventually they became my friends and roommates, though most of us didn’t share much in common except the mutual desire to get fucked up. Oh yeah, and I drank too much. The semester prior to my depression we had a keg party at our house every Thursday, every week, for the entire semester. Still somehow I managed to get straight A’s, but the drinking was certainly taking a toll.
There were other issues too that I now realize were key ingredients to my depression. I lived in a house with 5 guys; dishes crusting over in the sink, dirt-caked floors, a bathroom begging to be cleaned — it was a mini frat house. I had a shitty diet. I ate pizza almost every day that my roommate’s girlfriend brought home from work, and when I wasn’t scarfing down leftover tomato pies I consumed a variety of processed foods. I cooked greasy sausages in our seldom-cleaned George Foreman grill, sandwiched them in a few pieces of white bread, smothered ’em in ketchup and called it a meal. There was one other thing going on too, and as the depression got worse it gave way to paranoia. My roommates and I had started growing marijuana in the cellar (mostly my idea and doing) and now I feared the cops were onto us.
One night I went home to my parents’ house and told my mom that ‘they (my parents) had really fucked me up.’ I was looking for excuses, I suppose, reasons to explain my state of mind and being, and I had pinpointed their less-than-perfect relationship and parenting as a knob to hang my raggedy coat on. That night I lay on the couch and watched TV in what my dad later described as something akin to a fetal position.
After that trip home my mom made me promise to go see the school psychologist. And to my own surprise, I actually did. One day after a pretty girl sitting next to me in class got up and moved a few rows back, presumably because I smelled like shit and my very aura was dark and depressing, I walked to the end of College Avenue to a cluster of buildings bordering the park, signed my name on a clipboard, and sat in a plastic chair until a well-groomed spectacle and sweater wearing gentleman called me into his office. I can’t recall everything we talked about that day, but I do know I spewed out all sorts of nonsense that movies and the few pages of Freud I’d read in school had led me to believe was important.
“My parents always argued when I was growing up.” I said. “They even separated for a while when I was in high school,” I said. “ We didn’t have much money. We still don’t.” I said.
“Most arguments in relationships are about money.” the shrink recited as he scribbled on a pad.
I even uttered a few things that might have mattered, like mentioning the girl, but the majority of the time was spent retelling my past through my own distorted, pseudo-articulate version of it. The one thing I remember most clearly about that session, however, was that when I walked into his office the first thing that came out of my mouth was, “I can’t believe I’m here.”
Interpreting this to mean that I felt like I didn’t belong in his office, the shrink quickly responded on the defensive. “Well Nathaniel, I have plenty of fully functioning people in here every day,” he replied with a hint of annoyance.
But I wasn’t fully functioning. Not even close. And what I really meant was that I could hardly recall how I’d gotten there. By that point I was so deep into the depression that I had so little volition, so little strength both mentally and physically, that it was almost as if I’d floated into his office. I was living in a haze, barely in control of my own movements, much less the things coming out of my mouth.
After our meeting things only got worse. Later that week, or perhaps it was the following week, I was expected to memorize a monologue from Hamlet for class. I had already memorized ‘To be or not to be’ (go figure) earlier in the semester, and now I had to deliver a second monologue. But when you can’t read because your thoughts are racing it becomes very difficult to memorize anything. So I walked into the TA’s office not knowing what I was going to do and said quite simply “I can’t read.”
The look on the TA’s face after I spoke was something like a woman who orders a calzone and is handed a muffaletta-she didn’t know what the fuck I was all about. I was a problem far beyond what her tuition allowance required her to handle. So she brought me to the professor’s office, Dr. Jackson, and to the best of my ability, I told Professor Jackson the deal.
“I can’t read,” I said. “I can’t remember anything.”
He looked at my previous grades in his class. All A’s so far. Very few people in his class were getting A’s. “What’s your GPA?” he asked. He was fitting me as a type-A, an over-achiever, though looking back I think I was getting good grades in college not because I cared so much, but because I had lost the one thing I was good at in high school, basketball, and I was trying to replace it with something. In fact, though it would take years to realize this, no longer playing competitive basketball was indubitably another factor contributing to my state of mind.
“3.8…or something.” I replied.
Then he asked, and this was the first time I’d ever heard this, “Do you think you’re depressed?”
Professor Jackson told me not to worry about his class, or about grades in general. He said to talk to my parents, to rest, and to go see somebody at school who could help. He wanted me to come back in a couple of weeks and tell him how I was doing, but he also said if I merely took the final, no matter what I got on it, he’d give me a C for the semester. He was genuinely concerned and empathetic and I got the sense he’d seen many people like me before, or perhaps he’d been in a similar state himself once upon a time. I think all of the Shakespeare and great works he’d read and taught over the years had actually made him a better man, which unfortunately, isn’t always the case amongst literary folks.
I thanked Professor Jackson, and heeded his advice as best I could, but when things got so bad it became clear I might fail all of my other classes, I reached out to my best friend. One day I called him from a park near my house hardly able to put sentences together and as I sat on a park bench a cop car went by.
“The cops are here” I said to my friend, as if city cops had nothing better to do than harass some skinny sad-eyed college kid. But in my mind at the time, everyone was looking for me. Or looking at me. Some folks were even looking through me. In a depression, the world becomes a dark, threatening place. And during the course of my depression all of that darkness revolved completely and solely around me.
That day my friend picked me up and brought me home, and I never went back to live with my roommates again. My parents were worried and scared, as any good parents would be. For despite all of the bullshit I had told the shrink at our first session in an attempt to sound like I was sitting in a psychologist’s office, they had always been loving and caring, and they were trying the best they could. They had never seen me like this before, and so they did what most Western parents in the 21st century without the money to pay for a private doctor would do. They continued to take me to the school psychologist, and with his recommendation, they took me to see a psychiatrists. They also helped me contact my teachers and arranged for me to finish my coursework in due time.
Not much happened after that with the psychologist that I can recall. We continued to meet and talk, and it was nice having someone to talk to from time to time. But the problem was that he didn’t really know me. He only knew me from those sessions, not who I really was, not who I used to be, not who I was capable of being again. All of the information he was able to gather and jot down and tuck away in his “Nathaniel” folder was derived from a person who was existing in his lowest, saddest, least-articulate, and least confident state. And so little, if any, progress was made.
My first visit to the psychiatrist I remember much more clearly. My dad and I drove up to the university and during the entire car ride my mind was consumed by the idea that we might bump into someone I knew on campus. When we parked the car, I nearly made a break for it, but I had nowhere to go and my dad was able to talk me into giving the psychiatrist a chance. Once inside we were told to take the elevator to the top floor, and on the way up I noticed the floor for the mental health building was unmarked. It occurred to me that this was intentional. It was left blank in order to save people face. People like me. People who were ashamed of where they were going.
We walked to the front desk and after signing in I was told by a secretary to sit down in the lobby and fill out a long questionnaire. The questionnaire contained questions like this, ‘How often do you feel sad or depressed? And, ‘On a scale of 1–10, how sad or depressed do you feel?’ Also, this was an important one, ‘Have you ever thought about harming yourself?’ Interestingly, until that point I had never considered suicide. But after reading the question and then being repeatedly asked the same question by both the psychologist and psychiatrist in the days to come, I began to have all sorts of thoughts and visions about death. One particularly creative and memorable one was the reoccurring image of silver guns floating around my head like some sort of unholy halo. Thankfully, I never really had the will to kill myself, or to try. Although if life or death was as simple as a question (to be or not to be?) I’d have probably told Hamlet to fuck the so-called “slings and arrows of outrageous fortune” and let me take my chances with the “sleep of death.” Fortunately, perhaps for all of us, it isn’t.
After sloppily filling out the form, we were ushered into the psychiatrist’s office where a plump, blonde lady with an exaggerated smile sat behind a desk ornamented with Wellbutrin tissue boxes, Xanex pens, and photos of her family. After introductory remarks, she asked me how I was sleeping. When I said not well, she began by prescribing me 100 mg of Seroquel, an anti-psychotic medication used to combat anxiety, bipolar tendencies (she had her suspicions) and insomnia. She then determined by talking to my dad that depression ran in the family (my uncle had recently attempted suicide) and started me off with 150 milligrams of Wellbutrin, which she said would make me happier. “It’s chemical,” she said, referring to the depression, and my dad, looking desperately for a solution to his son’s inexplicable grief, agreed. She warned us briefly about some of the potential side-effects of the drug; restlessness, shakiness, mood swings, dizziness, constipation and an increased risk for seizures, and then she recommended I do more things I like doing to help fight the depression. Her lone suggestion aside from pills, which I remember very clearly to this day because of how ridiculous it was, was that I treat myself to some ice cream.
That was it. I left with prescriptions and advice to eat ice cream. Not once during our session did she ask me about my diet. Nor did she inquire about my exercise habits, or lack thereof. Was I expending any physical energy during the day that might, aside from make me physically healthier, help me sleep at night? And she certainly didn’t give me any practical techniques such as meditation and breathing exercises that might help me deal with my racing thoughts. Instead, with a smile on her face and a university check in her pocket, she gave me drugs. Drugs for every problem. Drugs that cost money. Drugs that make money. Drugs such as Seroquel, an anti-psychotic medication that was originally designed to treat rare disorders like schizophrenia but since 2000 has been prescribed to millions of people around the world for milder conditions like depression, insomnia and anxiety despite the serious potential side-effects (diabetes, weight gain, heart complications, and even over-dosage and death). While I had fallen into the depression all on my own, drugs were heralded as the only treatment that would lift me out of it by reversing the “chemical imbalance” in my brain. Not once during the three months my depression lasted were any practical, risk-free methods like those I’ve discovered in the ten years since then ever mentioned by either doctor. Free, holistic practices such as those prescribed by Yoga and Eastern philosophies that have been around for thousands of years and have proven to be effective-that is, a strict and nourishing diet, daily exercise, a clean living environment, disciplined habits, and perhaps most importantly, especially when it comes to controlling the mental modifications of the mind and combatting racing thoughts, meditation. Instead, my treatment was to talk, mainly about my past, to take drugs every day and night, and to eat ice cream.
Looking back today as someone who is pro-active in fighting depression before it begins or gets too deep, I am confident that a combination of exercise, proper diet, and meditation would have pulled me out of my slumber far quicker than drugs (which I abandoned after a few months) and the shrink’s talk (which I also abandoned soon after). And so it is mainly to the ancient philosophies of the East, particularly yoga, that I’ve turned to in my late 20’s, not with the desperation of a novice caught in the throws of depression for the first time, but with the confidence of someone who’s been there before and understands at least a little bit about getting out. Understanding that humans have been dealing with depression for ages, and that innumerable free, holistic, and safe techniques exist to fight it has brought me comfort. And unlike the drugs I was prescribed, one doesn’t need to be “sick” to benefit from these techniques. Although I would not suggest based on my limited experience that psychologists and psychiatrists are not valuable to many, personally, I vow to never again resort to the drug prescribing tactics of our modern mental health care system again.
Originally published at http://nathanielkostar.wordpress.com on June 22, 2015.
