Depression is a Killer, and it Almost Killed Me Last Year [ post from November 14, 2019 ]
Gosh, I can’t believe it’s been more than two years since my last post here. Hello readers, sorry to keep you waiting so long. If you pop back in occasionally to see if I’ve posted anything new, or if you subscribe to my posts and are happy to see a new one, I’m truly flattered. Let me update you about some of the things that have been happening in my life.
I guess since the title of this post is dramatic I should get to that right away. A big part of the reason why I haven’t posted in so long is because I struggled with severe depression in 2017 and 2018. In fact, I’ve struggled with chronic depression since I was a teenager. Last year the depression was especially bad and it was extremely difficult not to kill myself.
[I’m torn here as I write between an impulse to go on and on and the desire not to let this become another 10,000 word ‘draft’ like a few others on different subjects that sit neglected in my WordPress archive already.]
Suicide is one of the leading causes of death in the United States, is strongly linked with depression, and has been increasing for twenty years. It has been a theme in my writing, because I have felt a strong, often constant, suicidal impulse throughout my adult life. Not killing myself is, by a wide margin, the most difficult thing I have ever done. Though it is no accomplishment.
Don’t be alarmed, this post has a “the rest of the story” and is not a cry for help.
I find it difficult to talk directly about depression and suicide because I have no particular answers or solutions to offer to other people who suffer. I also find it difficult to not talk about these subjects because they have been such a huge part of my life. There are several other reasons to not talk about them.
But when your life is so heavily impacted, it is difficult to have relationships with other people if you don’t talk about what ails you. Depression makes it difficult anyway, but not being able to tell people about your dysfunction makes you incongruent.
In 2018, I had a kind of a dream job but was chronically unable to complete my assignments in time. Not only was the job great, I badly needed the money to support my family — I was 110% motivated, but still failing.
[that’s where I ran out of energy when I started writing this post in July]
Well, let me see if I can make this a short-ish version and finish it up before I run out of energy again. I was seeing a psychiatrist and a therapist and tried several different medications, none of which helped me very much or for very long. Eventually it became apparent to my wife and I that, in addition to the depression, my physical health was failing in some way. I could hardly get out of bed, even when I didn’t feel depressed at all. I’ve actually had some chronic diseases since childhood and my health has always been fragile, but it had gotten worse to the point that I was almost completely debilitated. Unable to complete any of my assignments, I was forced to finally resign at work.
After many tests and visits to specialists, I was diagnosed with Addison’s disease in early 2019. Treatment since then has given me a bit of my life back, though I continue to struggle with energy issues that leave me somewhat disabled. Getting through the minimum necessities of each day is a struggle and I can rarely summon up the energy to write. My depression, however, has improved dramatically.
Depression and other mood effects are a common symptom of Addison’s disease. As soon as I started treatment with hydrocortisone the “bad depression” that I had struggled so much with went away. Life is difficult and I still get depressed sometimes, but it feels like natural emotion tied to my life and circumstances, not like a monster inside of me. The overwhelming impulse that ‘something is really really wrong and I need to kill myself’, which was a constant part of my internal life, has been gone for the past eleven months. And what’s wild is that if I forget to take my Addison’s medication that feeling starts to come back right away.
One theory of clinical depression, perhaps the main theory of the disease, is that it is caused by undiagnosed physical or bio-chemical pathology. When experiencing grief, for example, it is natural to be ‘down’ or ‘depressed’, but that natural emotion turns into clinical depression when some part of the bio-chemical process in the brain gets out of order. People can’t “snap out of it” anymore than they can “snap out” of heart disease or cancer. Depression also isn’t any one particular thing, each depressed person doesn’t have the same particular dysfunction, rather it is a pattern of symptoms with a huge number of known causes and contributing factors (and doubtless many that are unknown). There is some hope in that, because medical technology will continue to improve and the specific physical or biochemical problems causing or contributing to a particular individual’s depression might some day be identified and treated. I mean, that’s basically what happened to me, and it could also happen to you. In the mean time, treatment therapies are targeted at the general symptoms of depression and still offer significant relief for millions of people.
I wish I had some great advice to give or solutions to offer to people who are reading this and struggling with depression themselves. Addison’s disease is somewhat rare and unlikely to be the answer for the next person down the row. Anti-depressants didn’t help me much, but they help some people a lot and are certainly worth a try. Keep hanging in there, keep trying to find things that help.
Something that did help me, before I was diagnosed with Addison’s, was coming to grips with the fact that whatever was happening to me I couldn’t help, I couldn’t control, and wasn’t my fault — that my frequent inability to push forward and get things done wasn’t from lack of trying hard but rather was in spite of all my earnest efforts. When I finally admitted that often I just needed to sit down and rest or lay down and rest, that it wasn’t a choice and that fighting it didn’t accomplish anything, and forgave myself for that weakness, the intensity of my emotions became easier to bear. As my psychiatrist pointed out, “If you keep continuously banging your head against a brick wall it doesn’t feel good!”
There are other things that are almost certain to help with depression, and all of them have helped my depression a little bit when I could manage them: getting regular exercise, maintaining a healthy diet, getting out of the house regularly, keeping to a daily schedule, socializing regularly. These are things that are actually important for anyone’s mental health.
One thing that my psychiatrist talked about with me is that it is important to seek help before the point when you are about to kill yourself. This is hard. By the time you are in a state of active crisis, like if you are riding the elevator up to the top of a building to jump off, you are often in too deteriorated of a mental state to reach out for help. So you should call a crisis line, or go in for crisis counseling, or talk to your doctor about your depression, when things start to get bad — try not to wait until things have already gone completely bad. One thing that we did, when my depression was getting especially bad, was remove some of the items in our home that would facilitate suicide.
Life continues to be a struggle for me, but it is a lot less miserable of a struggle today. I hope to be able to post more here in the coming year and get more writing done. The sequel to BLAZING THE SUN has been mostly finished for two years already and I want to finally get it out the door.
What else has happened… Did you hear I have a son? He’s two years old now and just the sweetest, brightest little boy you could hope to meet. Check out my Instagram for a few pics. We have another baby on the way now too, a little brother or sister due in May. Life marches forward in spite of everything.
the short story section what used to be the short story section [below] with a piece of personal narrative that I wrote years ago, describing some of the struggles I have had with my health and with depression in the past. Erica thinks it might be the best thing I have ever written, though I’m not too sure. It’s at least half good, and no one else has ever really read it before, so maybe I should share it.
TRIGGER WARNING: The following story is a piece of emotionally raw personal narrative that involves physical and emotional pain and touches on the subject of suicide.
Please note that this was written more than ten years ago and describes my life as it once was, not as it is today.
A Somewhat Normal Life
The counselor says that he keeps thinking maybe you should write something about your skin. As if it were interesting, something people would want to hear about. And who knows, maybe it would be. Or maybe you have a way of talking about it that’s interesting. He is a good counselor, he listens, he doesn’t try to tell you how to solve your problems, as if he could. You talk to him because you’ve been depressed, because sometimes you think about killing yourself. You don’t tell him that you think about killing yourself every day, that it’s always lurking at the edges of your conscious thoughts, when it’s not at the center of them, that it’s been that way for years and that some days it seems like the hardest thing in the world not to kill yourself and you lay in your bed all day with fists clenched and try to fall asleep again hoping that when you wake up it will have passed. You don’t tell him about the times you needed to take a knife and cut yourself without understanding why, or that sometimes you feel this powerful compulsion to cut up your own face. You don’t want him to worry about you, or implement whatever steps a counselor might be supposed to implement if their patient is in a ‘real’ crisis. Your problems aren’t so horrible and overwhelming, they just seem horrible and overwhelming to you, as everyone’s problems probably do. Your regrets are things that cannot ever be changed, and you think that you can’t live with them, but everyone’s regrets are things that cannot ever be changed. The counselor is a nice man, or at least he can pretend to be one convincingly enough; his professional demeanor is fully developed, so you wouldn’t venture to guess what kind of person he is on the inside, although you would tend to believe good things about him. He thinks that you should write something about your skin, he thinks you’ve basically got it together and just need to keep putting one foot in front of the other, he’s mentioned the idea that you should write something about your skin more than once. It seems such an uninteresting thing to write about, it seems like a stupid idea, although you wouldn’t give any hint to him that you think so, and you don’t hold any conviction by the thought that it is a stupid idea, that’s just the way it strikes you when you hear it, and you think that it is very possible that you are wrong. Years go by after he says that and one day you wonder if he was right and that it is something you need to write about. Although, it is still hard to understand why anyone would care. But the things that you write are always that way, they are the things that need to be written, and you don’t ever know why they need to be written, you don’t know if it is for yourself or for your readers, your imaginary readers, but you write the things that you have to, in the way that you have to, because you have to. That is the nature of what you do.
You can’t tell anyone about your skin. That’s one of the things about it, one of the rules. You can’t tell them, because they wouldn’t understand. You look good, you look healthy enough. Even most doctors cannot see past that, and you have to avoid those ones or risk the disasterous consequences. When it gets bad you don’t look good or healthy anymore, but you try not to be seen by anyone at those times, and you are good at keeping up appearances. Then the doctors might say you have open wounds and that you shouldn’t have let it get so bad, as if it was something you had any control over, as if it wasn’t something you were fighting with every fiber of your being against, and if you’re lucky they put you on prednisone for a month, or if you’re unlucky they do, because that can be a blessing or a curse, but at least the doctor that says you have open wounds will realize that just because you look good or look healthy enough doesn’t mean that you are. You go to a lot of trouble to look good and to look healthy and to not have people realize there is something wrong with your skin.
“I just have really dry skin.”
If it ever comes up, that’s what you say and it is basically true. When you say it to someone you can’t help saying ‘just’, like a nervous tic. It probably signals them sub-consciously that there is more to it than that, but they don’t really care even if there is. Which is good.
When you scratch, it feels good. It is hard to explain this to people, because everyone thinks that scratching feels good. They think you are just exaggerating the pleasure that comes from relief. But you have had normal itches, like most people have had, and the itches that come from your skin disease, and the difference is profound. A dermatologist who did understand, although most don’t, once termed the phenomenon ‘itch orgasm’. It is a feeling of physical ecstasy that is very much like an orgasm, although not sexual. When you experience ‘itch orgasm’ it is very difficult to notice or concentrate on anything else. Time seems to stop. Your fingernails dig into your skin as if of their own accord, and your whole body clenches as the dermal matter falls from your legs, or arms, or face, and forms a layer of white around you. Your body clenches so tightly with pleasure and conflict — the gross, physical pleasure of the scratching and the psychological horror that arises from feeling such pleasure at tearing your own body away. It feels so good and you have been hurting so bad.
If you try to tell people about that, they can’t understand it. You don’t like to admit it to yourself, but sometimes you scratch when you aren’t even itching. You wonder why it feels so good, if it is a psychological remnant from your infancy and childhood of scratching and scratching and hurting. If it was psychological, why does the prednisone make it stop? The prednisone makes it stop so fast.
It takes a little bit of prednisone. 50 or 60 milligrams, really. A little bit of prednisone can be the most wonderful thing. You will never scratch again if they just give you 50 or 60 milligrams of prednisone. It’s amazing how you feel then. So much energy. Your skin is clear, your lungs are clear, you can breathe. Such a sense of physical well being, like you are a superhuman. Is that how healthy people feel? Could it be possible? You can breathe so easily, your skin doesn’t hurt, there is no tension in you from trying to block the itch out of your mind. So relaxed. You could accomplish anything if you could live like this.
The doctors don’t like you to be on prednisone for very long. They say that the side effects are worse than the disease, which is not entirely convincing. It’s like when they tell you that the drugs they give you might cause cancer, and they can’t understand why you are unconcerned. You would rather die than go on living like this, and that should be normal, but you don’t tell them that because you don’t want to sound dramatic. It is important to keep the doctors on your side. The problem with prednisone is that when you stop taking it the disease often comes back worse than before. They call this a ‘rebound reaction’. Some of the doctors you have seen were too stupid to realize that it would happen. They didn’t do you any favors when they gave you your first course of prednisone at 18 months old. Your parents thought it was a miracle until you came off of it, but they said anyway that it was the first time in your life when you were happy for a while and slept soundly. Now, as an adult, you know that even as you get down below 40 or 30 milligrams the itching and scratching will start to come back, your lungs will start closing up, and your nose will always run. When you get below 10 milligrams it will get bad again, and you hope by the time you stop completely it will not all have come back worse than it was before, but sometimes it does.
Constant itching causes a constant tension in your body and face. You hold your hands carefully against your chest to try to prevent them from unconsciously scratching and to keep from accidentally touching things that could irritate your skin, and to keep from accidentally touching things that could infect your skin where it has been scratched open, or where it has cracked open on its own. It is hard to concentrate or focus on anything for very long. You twitch from the tension of the itching and the overcoming it. When you do overcome it. When you don’t overcome it you feel only mild embarassment in your parents’ house as you pull up your pants legs or pull off your shoes and socks or shove one arm under your shirt and tear at your skin while breathing, short and fast, and brushing absently at the white powder and chunks that the scratching creates, grateful that the carpet is light and it blends in. You really are like a drug addict, the ones who are so far gone that they hardly receive any pleasure from their fix anymore. It feels good, of course, but no matter how sunk your body is into the ecstacy of that feeling you are always aware on some level that you are destroying yourself, and you are always on some level trying to stop, like trying to stop having an orgasm in the middle of having one, and your whole body is clenched tautly in an unpleasant mixture of pleasure, horror, and pain.
When it stops itching it hurts. The wounds hurt. They get infected, of course, because they’re always there. So when you aren’t itching constantly you are in constant pain, and the itching can then become a blessed relief from the pain of the wounds, but tends to result in the wounds becoming worse. They don’t start out as wounds, they start out as very mild abrasions, or else tiny bumps, or cracks in your skin, bloody red crevices that appear out of nowhere and somehow itch more than they hurt.
When you step into the shower you have to ease your way in. Slowly. The pain brings tears to your eyes, although you have such a high tolerance for pain from your lifetime of endless cuts and cracks, abrasions and minor wounds, and bacterial infections. The stinging of the water makes your brain want to jump out of your skull. You can’t take a bath, it’s too hard on your skin. Too drying. A bath doesn’t hurt as much, but does more damage.
After you finish bathing you have to coat your skin with vaseline. This is the best treatment, and about the only good one. You coat yourself with vaseline from head to toe, and try not to let too much of it get into your hair. The problem with coating yourself with vaseline, of course, is that then you are covered with grease, so whatever clothes you put on are going to be ruined, but you have a drawer full of old pajamas that you wear after coating your skin with vaseline, and you keep them separate from other clothes and wash them on a hot water cycle. The grease on your skin gradually seeps into your other clothes anyway, but as long as you keep the pajamas separate and don’t wear anything else until most of the vaseline has seeped in or rubbed off then the grease on your regular clothes is not heavy enough for most people to notice. Once your skin is coated with vaseline, you have to sit with it like that for several hours, that is the point, that’s why it works. So you usually take a shower before bed and coat your skin with vaseline and go to sleep, then most of it will have rubbed off on the pajamas or bedsheets by the time you wake up in the morning and you can put on regular clothes and go out of the house. You only take a shower every other night, because it is too hard on your skin to bathe more often than that, but you coat your skin with vaseline at least once every 24 hours. On the first day, after a shower the night before, you still look quite clean and fresh, but by the second day a lot of residual vaseline will have built up in your hair. Grease has to go somewhere, one’s skin doesn’t digest it after all. People react to you differently then, on those second days, when your hair is greasy and you look unbathed. This is a source of great frustration for you, because you are a naturally clean and meticulous person. Body odor, at least, is never a problem, because one aspect of your skin disease is that you hardly sweat.
If you take a shower and don’t coat your skin with vaseline afterwards, it becomes as dry as paper, scaly like a lizard’s skin, and cracks open in great cracks. When your skin is doing well you can sometimes skip the vaseline and coat your skin in olive oil instead, which is much less greasy and seems somehow more socially acceptable, as if it is more normal to be covered from head to toe in olive oil than in vaseline.
You would never tell anyone that you coat your skin in vaseline, not even your closest friends. The reason why you wouldn’t tell them is less out of embarassment, although that is part of it, than it is out of a desire to be physically healthy and normal, at least to appear to be so. You are a kind of leper, but you don’t want other people to know that you are. This is how you think.
To keep your skin from getting worse you have to be excruciatingly conscious of everything that touches you. Not only the fabric you wear, which can only be 100% cotton or silk, but the things you sit on, the things that brush your legs, especially anything you touch with your hands. Almost everything is an irritant. It takes a lot of mental energy to always be conscious of everything your body touches. It is a difficult habit to build, harder than it sounds. Of course when there are pollens in the air they will get on your skin anyway and you have to stay inside as much as possible. None of this solves anything, it is a question of limiting the damage. If you touch much of anything you have to wash your hands, but if you wash your hands much it is too hard on your skin and becomes an exacerbation of its own, even if you only wash them with water, so this is always a problem. Allergens build up on your skin from the air and washing them off helps, but if you shower more than every other day the drying effect of the water becomes more of a problem than the allergens were. And when you run your hands over your skin to wash it that triggers the itching as much as anything and it is so destructive to scratch your skin when it is soft and wet in the shower. You can step out of the shower having turned to hamburger, sopping up the weepy, watery, superficial wounds nervously with your towel, much worse than before you got in. In the short term it will feel much better for a day or two if you rub hard against the top layer of skin while you are in the shower and rub all the dead and scabberous skin away until only fresh, new, pink skin is left underneath, and you look better then, especially if it is on your face which it often is, but in the long term this is a path that leads to greater destruction. It’s so difficult to resist the short term.
Things like sitting in the grass are obviously out. When you were in college and your good natured professors would say, “It’s a nice day, why don’t we go sit in the grass and have class outside,” you would just go home. Outside of college, in the grown-up world, it is easy to avoid those situations, although that has negative impacts on your social life. You are, of course, allergic to many foods, which is part of the problem, and makes it almost impossible to eat socially with other people, so you are isolated in any case, although you try to build a social life in spite of that and not be limited. It makes other people uncomfortable for you to have dinner with them and not eat, although it doesn’t bother you. If you try to explain why you can’t eat their food with them they either don’t believe you or simply don’t understand. You get better at navigating these situations as you get older.
And what about love? Sex. You wish you knew, and are afraid to know. You are good looking, so women find you superficially attractive. But not anymore after one or two dates. You wonder if this is because they get close enough to notice something is wrong with your skin. Or if the tension in your face puts them off, if they were thinking that when the two of you were alone together you would finally relax and you didn’t. It is your secret terror that when you do go to make love with a woman she will reach a certain threshold of skin to skin contact and experience revulsion and say, “Gross.” When you were a teenager the disease remitted for a few years and its return in college was extraordinarily bitter because you had finally gotten over the insecurities of your childhood and begun to have a little bit of success at dating women. For a year or two your body had been beautiful, but no woman would ever see or enjoy that. They seem to even cringe a little at the touch of your dry hands. If you were making love with them and instead of the sweaty, soft skin they were expecting they felt your dry and papery skin against them, they would think, “Gross.” Or from the texture of the very thin layer of vaseline that covers your body. This is how you thought, or perhaps still think.
When you were a child your school papers would often have blood on them. Hunched over at your desk with both hands crammed into your socks, trying to claw quietly, trying not to breath too heavily, with big chunks of dead and not so dead skin sprinkling out of your socks onto the floor. It was amazing that the other children liked you. Children can be much more tolerant than adults. Every time you ever met a new child growing up the first thing they said to you was, “What’s wrong with your skin?” But they didn’t really care, they just wanted to know. Once you told them, it was fine, and they treated you like anybody else. Usually, they liked you better than most.
As an adult you have developed enough self-consciousness and self-control to not scratch very much in public places, in social situations. Of course you rub at or scratch an itch on your face much more than other people, or an itch on your arm, but not so much as to be conspicuous. Someone would have to know you for a while before they would realize that it was a pattern. And they wouldn’t say anything. Only occasionally when you have gotten brave and made the mistake to go out hiking or in some wilderness with other people has the itch become so bad that you could not resist it for some moment or two and had to embarassedly try to explain to your friends why you were bleeding. Sometimes, of course, when it gets bad, you have to avoid social situations altogether for this reason. But when it is bad like that you are sick anyway.
What’s the point? That’s the question, isn’t it. You sometimes lay and wonder that and wish that you would die. In another age, in another era, you would have never lived through childhood. The infections would have killed you when you were just a young child. The asthma would have killed you. So many times machines opened your lungs back up when you couldn’t breathe at all. But you’ve had a somewhat normal life and there are certainly people who have had it worse, which doesn’t make it feel better really, and it’s not that you feel sorry for yourself, but sometimes you look up at the sky and you wonder ‘what’s the point?’ Everyone asks the same question, but maybe it is not such a dagger in the heart for them. You’ve never understood why people cling so desperately to life. Is their life so much better than yours, that they are so attached to it and you are not? Life is pain, isn’t that what some character said in a movie who was healthy and strong and lived life the way he wanted. It’s one thing to conflict with people, but another to conflict with the universe itself. You can’t help the way you were born, it cuts you just the same as it cuts anyone else, in one way or another, and if it’s better or worse for them that doesn’t make it any easier for you. And yet, they cling to life, and yet you don’t understand why — and you wonder if it’s because of that. You wonder if it’s you. This tortured body will forgive you.