{there is no cure for sadness} Jonathan Bitz

{there is no cure for sadness}

jonathan bitz

There is no cure for sadness.

There never has been.

2,500 years ago they called it the "black bile", or melancholia. A widely known condition even back in antiquity, scholars such as Hippocrates wrote about it. Attributed to sadness, gloom, and grief, the "black bile" was an umbrella term that encompassed an array of symptoms such as ulcers, dysentery, diseases of the lungs and even hemorrhoids. In an understanding that is a little more closely related to our contemporary notion of melancholy and depression, the black bile was also seen to have the ability to manifest itself on the body in the form of epileptic seizures. When affecting the mind, it was said to materialize in the form of gloom.

It appears that the black bile has always been epidemic: multitudes of people have been said to have been under its influence, commoners and historical figures alike. Some notable Grecian examples have been said to be Heracles, Ajax, Socrates and even Plato.

The Greeks believed that, in excess, the bile possesses a potential to create madness. In moderation however, it was said to have the ability to create beings that are superior to their counterparts.

Throughout the ages, academics have written lengthy dissertations on the topic. Some of the notable canon on the subject is: Aristotle and his follower's, Problemata Physica; Albrect Durer's, Melancolia I; Robert Burton's, Anatomy of Melancholy; Klibanksy, Panofsky and Saxl's research entitled, Saturn and Melancholy; Kay Redfield Jamison's, Touched with Fire; and William Styron's classic, Darkness Visible.

Theories have been developed in dogmatic fashion: Melancholia is this. It feels like that. It looks like this monster. It manifests itself like that.

As the ages have moved along, we have attempted to neaten our encapsulations: At the beginning half of the 20th century a new catch-all word was created, to describe the multitude of symptoms. Of fear. Of pain. Of grief. Of sadness. Of the black bile. Of melancholia. Of that particular sensation that is so strong it is capable of paralytic dehabilitation and the loss of care for ever wanting to hit the floor, and get out of bed again.

What is this new, inappropriately named pig-in-a-blanket? Depression.

In Darkness Visible, William Stryon stated his disdain for the new descriptor. "Melancholia would still appear to be a far more apt and evocative word for the blacker forms of the disorder," he wrote, "but it was usurped by a noun with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground?"

Stryon furthers his scorn in his criticism of Adolf Meyer, the scientist who created the identifier. Stryon wrote that Meyer obviously, "has a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering 'depression' as a descriptive noun for such a dreadful and raging disease."

Medical professionals, such as Dr. Meyer, are not unlike the rest of western culture in that they like to state their opinions in dogmatic form, often appealing to "science" (from the Latin, scientia, meaning "knowledge") to ground their perspective, and opinions. And, sometimes, when something is stated with enough conviction and wit and simplicity, it latches-on to the social psyche: What once had its own implicit meaning and subsequent life, partially on account of its dreadful name: the black bile ? now seems to have a more P.C. ring to it: It?s as though we believe that if we can call the condition by a name that sounds less threatening and vile ? then we can conquer it. Here again, our rationalism and arrogance seem to be working in unison. We say: here, all you need is a little pocket shovel, to dig your way out of this depression. Billboards and commercials around the country read, ?You Won?t Ever Have to Get Stuck in a Depression Again??

Take your meds. Fish oil. Protein shakes. And call me next week?

We know what this is, we say.

You will feel better, we promise.

I can name this condition in three syllables, we boast.

The fact of the matter however, is that we have no real, clear idea as to what ?depression? is. Is it a disease? A condition? A state? Is it just plain, old sadness? We do not know ? but researchers have argued the entire gamut ? mostly coming to the conclusion that yes, depression is a disease. Yes, depression is pathological. It is brain damage.

And yes, there are elements of sadness. Typically.

But, even if we get the semantics of classification correct, how does this assist our crusade to more accurately diagnose and rehabilitate?

Answer? We do not know, apart from creating and relying on new drugs and making the pharmaceutical companies richer.

And yes: mental health professionals around the world have the leverage of research, colleagues, and a wealth of materials on which to draw from. And yes, all of the mental health professionals do possess the quality of having a slightly more ?objective?, or outside, point of view ? but, this is no different than the spouse, friend, or family member that stands entrenched in the dilemma, as a witness to a depressive?s story and manifest symptoms. The professional uncertainty, wrapped in dogmatism, is as strong as the layman?s often uniformed uncertainty for this condition which does not hold up to quantitative analysis, like cancer, or glaucoma.

Depression is not a spot on the skin. It is not a wrinkle on the tongue.

In the process of clinical diagnosis, there are a multitude of problems, primarily predicated on the paradigm that is employed in analysis: Check this box. Don?t check this one. Sure, I have problems sleeping ? so I check that box ? but what kinds of problems sleeping? Do I sleep too much, too little, or do I have flights of fancy when going into, or out of, sleep? Here, we need to get more specific. And here, Depression does not lend itself to quantitative analysis. A narrative, or qualitative analysis, is much more appropriate. Because depression is uncertain, changing, and ambiguous. It does not fit into neat, little checkboxes. It is about a life story. An amalgam of mood, emotion, perspective and experience.

A testament to the struggles of this ambiguity of pigeon-holing depression can be seen in the work that Grazyna Rajkowska published in May of 1999 in the reputable journal, Biological Psychiatry.

In her study, Rajkowska examined brain tissue from a dozen deceased depressives ? whose deaths ranged from suicide, homicide, to heart attacks and car accidents. Working within the current paradigm of depression ? a paradigm that stresses the accepted notion of serotonin and norepinephrine deficiencies in the brain as causes for common depression ? Rajkowska utilized a broad sample: one of the subjects had been depressed for only a couple of months, another for nearly fifty years. The ages ranged from thirty to eighty-six.

Rajkowska was seen as an expert on the prefrontal cortex ? the region of the brain that sits right behind the eyes and has long been suspected to be responsible for coordinating interior, cognitive thoughts with actions. Complex cognitive behaviors such as making appropriate social behavior, gauging moral sensibility, and acting on accurate planning are believed to be functions which are controlled by this region of the brain. In depressives, this region of the brain has been seen to be of utmost interest on account of its dearth of energy utilization ? especially during acute depressive episodes. Even non-depressives have been seen in studies to have decreased blood flow to this region of the brain when they have sad thoughts.

What Rajkowska?s studies and her subsequent computer-aided mapping illustrated was that, in parts of the prefrontal cortex, cells were damaged. It appeared that there was, in fact, anatomical pathology; a.k.a., brain damage. Rajkowska?s findings were the first evidence in the field of depression that spoke to the notion that there are, in fact, abnormalities at the cellular level. Here, Rajkowska?s study illuminates a striking notion: that the longer a patient is ?depressed? ? the more damage that is done to the prefrontal cortex.

The most interesting notion that came out of this study, however, was the progressive hypotheses about glial cells; and more particularly, their absence in a depressive?s brain. ?The Permissive Theory?, which states that low amounts of serotonin in the brain enables a higher possibility of injury ? is also analogous to glial cells. In this capacity, both serotonin and glial cells can be seen as protectors.

Even more interesting is the idea that the analogy can be extended to the entire depressive: Depression, in this sense, looks like a state of vulnerability ? wherein, unprotected nerve cells (deficient with glial cell and serotonin pathway protectors), when attacked by stressors, are unable to defend themselves, or begin the repair process and rebound from the damage caused by cognitive stressors. Here, the depressive is seen as being deficient in mechanisms, in the brain and in daily life, which guard from injury.

The practical implications of this permissive theory include: a certain vulnerability and fragility when facing adversity on the part of the depressive. As well, the depressive is seen as having difficulty in appropriately ranking priorities; making socially-acceptable decisions; and as this author can testify to ? a depressive can often turn typical turmoil into catastrophic tragedies. With these glasses on, everything looks like the end of the world.

Often, when triggers are pulled ? heads come rolling off backwards. The world spins in retrograde. And the slippery slope becomes icy and fraught with the wrenches of existence. Coping mechanisms and resources are depleted; and at this point language can no longer account for the actions of a person with these lead weights around their eyes and, subsequently, their perspective.

In ancient Greece, followers of the Stoics, Cynics, Skeptics, Epicureans and Aristotelians sought to find remedies for coping with extreme sadness, loss and grief. Their prescription was called ataraxia, otherwise translated as ?serene detachment?. In this mode, the depressive, griever, or sad person ? attempts to avoid acute emotions by playing in the world cautiously; and deliberately. Ataraxia was said to be a state of contentment, and moreover, a plausible solution for the great pains of existence.

From our millions of miles in time away from these schools of Greek moral philosophers ? their panacea feels much more organic, possible and often, real, when standing in comparison to today?s methods of rehabilitation and treatment. Ataraxia was seen to be simply, a coping mechanism for the basic human emotions of existence: of sadness and grief and fear, due to loss. It was, and still is, not a colored pill.

What we begin to gain a picture of here is the notion that the melancholic, on account of his/her emotional state, has a different aptitude, or filter ? for viewing the world, relative to the depressive?s contemporaries. At this point, yet another passage is helpful in eloquently articulating this vein. In his book, Against Depression, Peter Kramer writes that the notion of ataraxia (which is by no means an antiquated method of dealing with extreme sadness) ?involves a sober mistrust of intimate commitment and a constant awareness of life?s pains. To be braced against misfortune is to be aware of the injustices, misunderstandings, and impossibilities that corrupt our relationships to one another, to nature, and to the self.?

Articulating the depressive?s unique outlook slightly differently, it was once written that the black bile ?is a corrosive substance that strips off the veil of human pretension and allows the sufferer to see the world as it truly is.?

Even great western thinkers like Pascal, Descartes, Kant and Hegel all shared the notion that melancholy is a mark of insight; and a virtue, in that, the melancholic is more acutely aware of his surroundings than someone without the corrosive lenses. For these philosophers, melancholy is what people should feel in this cacophonous, and at times incomprehensible, universe.

Again, Kramer writes, ?Melancholy is awareness, of our distance from God, meaning, and purpose? Melancholy is, moreover, an intellectual gift, a spur to writing and imagining.?

Passages like this, accompanied with the famous depressives throughout history ? Goethe, Keats, Blake, Wordsworth, Coleridge, Byron, Shelley, Tennyson, Mozart, Napoleon, Van Gogh, T.S. Eliot, Victor Hugo, Emily Dickinson, E.A. Poe, Ezra Pound, Virginia Woolf, Anne Sexton, Robert Lowell, Sylvia Plath, Jack London, Hemingway (to name a select few, and all writers at that) ? mark it as no surprise that melancholia has been elevated to heroic status.

And if nothing else, the heroic brand of melancholy has gained a foothold in our psyche. We have been told that there are, indeed, correlations between great artists, musicians and writers, and the black bile. From the ever-growing list of notable names throughout history, coupled with the traits that depressives exhibit, socially ? the acceptance of depression is convoluted, but still at times, heralded.

It has been said that depressives can exhibit charming, alluring and admirable social traits on the surface. Depressives often appear as self-absorbed, self-critical and typically they can be seen as selfish ? and while these are not standard social charms, they do lend themselves heartily to the romantic notion of the Socratic hero who is centered and concentrating on the realm of pure forms. This type of hero has left the bulk of his secular existence in favor of pushing toward a more reflective and, as Socrates said, examined life. And yes, the stereotype fits ? depressives can appear to be greatly complex: cognitively, emotionally, and spiritually. Aloofness not being the least cultivated of their traits.

But, should we glorify the depressive?s condition? With this heroic tradition of melancholy ? part of the world has. But, if you look at the continuum of elements, we begin to find that the semantic melee is quite interesting, and while it is convoluted to say the least ? it is also much more dangerous than is often esteemed.

Have you ever had the luxury of walking through a dreary psych ward and sitting on one of the polyester torn couches between the monotone pales of the halls ? with patients shuffling their feet down the corridor; with faces frozen in solid terror and longing and sadness and guilt and ignorance?

To be sure, depression is not a grandiose condition. In its depths, it is the death of everything close and important to the sufferer. It is the tragic demise of a mother, a father and every sibling. It is the tearing-away of that innocent, childish life that we all were once in possession of ? in one fowl rip.

One way we can examine the dangerous nature of depression is to illustrate the spectrum of closely related cognitive conditions: Mood disorders, dysthymic (chronic) depression, anxiety, acute depression, hypomania, mania, bi-polar, schizophrenia, epilepsy, stroke. All of these conditions share a myriad of symptoms, some of them so close, that they begin to overlap and often, strain the limits of language and classification ? furthering the notions that A.) Depression is not necessarily heroic ? it is terrifying and, B.) Depression is not as easy to classify as we have been lead to believe.

To begin, look closer at one of the components on the continuum: hypomania. Here, we can start to understand the difficulty in diagnosis. Some researchers have concluded that manifest symptoms of hypomaniacs are those exact traits which enable a person to get along well in society. Successful business people tend to exhibit some hypomaniacal traits: Grandiose vision and imagination, high intelligence, impulsivity, and neurotic/obsessive behaviors. Like some of the other forms of depression, hypomaniacs can be almost sociopathic in their public dealings ? they are well-spoken and smooth in their verbal dealings; they?re often funny, smart and can appear to be passionate (otherwise construed as frenzied, self-absorbed and tempestuous).

But, take one step away from hypomania and you have all the symptoms of torturous mania, and manic depression: neurosis, rapid fluctuations in mood, problems with memory, pain, acute bouts of fear, confusion, desperation, morbidity and flights of fancy, to name a few.

The resemblance of a number of the conditions on the above-stated spectrum is at once, complicated and tenuous. For example, epileptics can exhibit traits that are found at other places on the continuum: an ability to fall into fervor over a particular belief, and rapid fluctuations in mood and temper. Most importantly, in most of the conditions on the continuum, epilepsy and stroke victims included ? the prefrontal cortex appears to be notably affected.

Other similarities include the medications for the conditions. Anticonvulsants are a drug class used to treat epilepsy, but they are also used for depression and anxiety. The E.C.T. process, often employed in treating patients in an acute state of most of the conditions on the continuum, works by inducing a short seizure in the brain. Likewise, another drug class, the Atypical Antipsychotics, are used to treat schizophrenia, but at lower doses it is also used to treat the whole range of depressive symptoms. And an interesting side note: people with a subtype of epilepsy have been seen to be afflicted with hypergraphia, where one writes compulsively for lengthy periods of time ? a neurosis that manic depressives also can share.

On a similar note, many researchers have pointed to the notion that depression is polymorphic, meaning that each acute episode in a person?s lifetime can take on a completely different look and feel. Where a depressive took an SSRI (Selective Serotonin Reuptake Inhibitor ? i.e., Prozac) for one episode, and that seemed to serve as the panacea ? the same depressive can have a subsequent attack, wherein an SSRI will not work its same magic.

In the end, there is no neat and simple cure for depression, melancholia, or the black bile. And there certainly is no permanent cure for sadness. This despite what all the drug companies will say and do. There is not always a medicated cure for the symptoms of depression, as evidenced by the multitudes of relapsing minds that inhabit the nuthouses of this world.

And more notably, most depressives that have been in and out of the system for decades seem to have the same story: Tried every medication. None seemed to work. The depression has subsequently progressed, and morphed from the everyday chronic, mild depression, to bi-polar, or even manic depression. This evidence coupled with our relative ignorance about the long-term effects of the cognitive medications that are employed for the array of mental disorders ? melds a sight of fright into this author?s point of view. Could it be that the medications can actually make the depressive symptoms worse?

Possibly. Consider this: Prozac and other drugs such as Seroquel, while they are supposed to inhibit anxiety ? can also lubricate a depressive?s mental state, leading them directly into yet another anxiety, or manic attack. Also, researchers have pointed-out that patients taking this combination of Prozac and Seroquel have 3 times the possibility of committing suicide. All this while the drugs are supposed to be protecting the depressive from these impulses.

Melancholy is not simple. It is not neat. It is not a disease. Sure, there is an incredible amount of dis-ease ? but depression is not cancer. And while it may be something that is ?contracted?, it is not necessarily terminal. And it is not necessarily a bad thing. It is a blessing and a curse. Its upside is, in this author?s humble opinion, an opening of the senses ? an awareness of the world that would otherwise be inhibited.

In this author?s opinion, depression is something that everyone has the capacity for ? and becoming aware of it is the first step in crossing the threshold between those with depression, and those without?

What this author believes is the most helpful paradigm to work from, is that we simply do not know ? but will continue to learn about, this dreadful state. Through narrative analysis and not solely quantitative diagnosis.

Because how can you quantify depression when it appears to be yet another form of perspective, an ethereal lens - which enables its bearer to see the world how it truly is?

And while this may be the upside of the depressive ? it does not mean that the process can?t be terribly troubling, sinister and filled with the dark desire of wanting to step off this secular ride ? no less, at the crest of one those gargantuan peaks on the coaster ride ? to heighten the fall. To be sure, there is a particular strength that is needed to endure these treacherous nights of fear and dread. Often, the human will is too soft to sustain the tremendous weight warranted for this strength of endurance.

And too often, in the middle of a particularly terrible episode ? depressives do take a step off this secular ride and commit suicide.

The great German philosopher, Martin Heidegger proposed an interesting, and helpful, corollary to the notion of depression. In his monster book, Being and Time, Heidegger concocted a charming theory that centered itself upon a phrase he also created, ?the totality of beings?. The totality of beings, for Heidegger, was the sum total of everything in the universe: suns, planets, stars, the void, the earth, its buildings, the land, the sea, you and me. Everything.

Heidegger believed that our human cognitive construct was not virile and capable enough to come to know the totality of beings. But, he proposed, we do get glimpses of it. Through our emotions. Mostly non-directed, irrational emotions. Like anxiety. Like depression.

You feel it in your sternum. Like G-Forces. Like fear. Like violent joy. Like stormy life. Like wild love.

The black bile is not a plague. It is a great gift. But it is also tempestuous, and tenuous. It will sear your insides if you stand in its fiery melt for lengthy periods of time. It will disrupt your daily living and, at times, make it nearly impossible for you to get along as the people around seem to be doing, from work to home to work to home.

But this is exactly where the blessing is: in that space where pure terror meets exalted joy. In here, there is fortune. For in this author?s eyes, there is a significant difference between the depressives of the world and those who glide along, undisturbed and unflinching to the current of life. Unaware. Unconscious.

I am not here to glorify this condition. Apart from stating the fact that depression is incredibly difficult to classify and diagnose, and we should own up to that ? I am here to say that there is a variety of learning that can take place when we examine depression. Through the misunderstandings that surround depression we are given a chance to explore something that is maybe even of greater consequence to the whole of humanity: the downfall of dogmatism and pedantic assessments and assumptions.

A tale of sadness, life, love and all the four letter words, A Biography of Fear is the freshman effort from Denver native Jonathan Bitz.