Thursday, September 16, 2010

Nothing Good On The Menu

Or: How to Manage A Loved One With Major Depression

Depression is ferociously difficult for everyone involved, in that ordinary measures don't even bear consideration. A sensible person sleeps when they are tired, eats when hungry and drinks when thirsty; when sad, might weep or pause for melancholy reflection; might laugh when amused, retort when offended, change the channel when bored, etc. The mildly depressed will dutifully follow their doctor's orders and consume their medicine on schedule and perhaps even receive a modicum of surcease, blessedly returning to such prosaic matters.

The profoundly depressed view such normative responses to stimuli with deep suspicion; their own emotional perceptions having brutally waylaid them their entire lives, people around them quick with platitudes, condescension, disbelief or resentment, they are not conditioned to be 'solutions-oriented'. The deeply depressed withdraw into ever-increasing alienation because with one's back to the wall that's at least one direction that the lacerating winds of psychic agony won't come from. In extending a hand of solace, offering a bridge to fellowship, the healthy person's most sincere gestures appear to the seriously depressed person as threats.

Guilt is a potent self-fulfilling entrenchment for the person with major depression. It's bad enough feeling overwhelming guilt just for breathing and taking up space; the unavoidable inconvenience that one's illness causes others is like salt in the wound. We really don't want to be any trouble, thanks we'll stand, I'll give you $100 if  you let me sleep in your garage - just for one night. And no amount of backpedaling, shit-eating or genuflecting will sooth the sting - there we are, still breathing, much too loud.  And make no mistake, it's an incredible pain in the ass dealing with us, overtime with no pay. Nothing is ever simple, no interaction or transaction free of the most byzantine and unnecessary complications. It's even worse if our illness is constellated with others - borderline PD, schizo-affective, adult ADD, and so on.  We forget the appointment or date or birthday or anniversary, miss the bus, take the wrong bus, lose our bus pass, etc.; then we descend into a slough of despond over it, become almost violently defensive, attempt suicide or cut ourselves with razor blades, overdose, set fire to the garage, etc.

Sure we take the pills. Most of them. Most of the time. But pills just take the edge off - make the madness slightly more manageable - they don't get your shit together for you. If the pills are working, eventually we'll have to get out of bed; if they are not working, we have to actually pick up the phone, call the doctor and tell her they're not working. Either way, we have to actually take them, as prescribed, to find out.  We have to actually take a shower, get dressed, and go to work in order to find out whether or not we can.  And that takes more courage than is quantifiable.

There aren't really any hard-and-fast rules for handling life with a person managing major depression or major depression plus whatever.  Either they were up front with you from the get go - "Before we go any further, I think you should know something about me..." - or they lied about it, or they were lying to themselves about it, or they didn't know, i.e. hadn't yet been diagnosed.  We can go for years thinking it's not us, it's just that life and the universe generally suck so bad it's pretty much unbearable, and we will tend to surround ourselves with people who share this viewpoint.  Being told that we are actually sick and the world is basically neutral is such an intense revelation, it might actually make us sicker (and our behavior more problematic) for a while.  None of the old coping mechanisms for maintaining a good front are effective any more.  It seems to take forever to adjust to all these strange new chemicals fucking up our brains in ways that even the doctors don't understand completely.  We go back and forth between paranoia and trust on every issue, major and minor; we blame everyone else for everything, then blame ourselves for everything, and eventually after a big swim find a middle ground to stand on.

Understand that the person in your life going through this doesn't want your pity, your coddling, your caretaking/codependent behavior, to be rescued, or to not be held to any of the normal standards of relationship one may reasonably expect from anyone without an illness.  What we do want is for you to remember that we're sick.  It's useful information.  That way when we actually accomplish things, you can think to yourself, "Wow, he actually did that."  Not that we want you to hold us to a lower standard than others, as explained above.  When we fail, understand that we don't need to be cut slack any more than anybody else - "What did I expect, after all he IS crazy..." - just remember that, ha ha, yeah, we probably already know we failed and don't need to be reminded.  What we DO need to be reminded is to pick ourselves up, dust ourselves off and get back in the ring.  Don't give us some treacly rah-rah routine - this isn't the Jerry Lewis Telethon - we're not a starving child you're supposed to be horrified for on those TV commercials trying to capitalize on your guilt.  We're just people with a particular set of challenges, JUST LIKE YOU.  So don't take care of us, just remember what we're going through, and maybe that knowledge will help you to be prepared for hard-to-manage behaviors, like spending our last dollar on cupcakes for the kid when we should have saved it for the bus.