Defending My Disease

While I was reading The Washington Post Book Review one Saturday afternoon in 2000, my hands started to tingle.. “Hm . . . weird" I thought, "isn’t that a symptom of a heart attack?” My inner judge piped up: “Only you, Jan, would think you were having a heart attack because you feel a little tingling . . . you're only forty-two."
*****
I had just completed my first of year of teaching after a hiatus of staying home with my kids through their pre-school years. At a graduation party that afternoon, I had eaten rich stuff -- buttery hors d’oeuvres and chocolate cake. Maybe I had overdone it.
When I heard the EMT folks at the door, I decided I had to get down the stairs by myself. I got out to the hallway and, feeling weak, started to crawl to the landing. At the landing, I sat down and descended the staircase by sitting, pulling myself forward, and sitting again.
“I’ll be all right,” I said to my children and managed a smile as I was wheeled out on the stretcher.
Lying in the back of the ambulance, I tried to figure out the driver’s route by counting the lights and paying attention to the swerves the vehicle made, and I thought to myself, “This is so stupid. I’m probably having a panic attack . .”
At the hospital, outfitted with a nitrogen patch, I started to feel better. Someone brought me a heated blanket. “This is like a spa,” I thought and fell asleep. The next morning I learned that I had had a heart attack, or what would have been a heart attack if I hadn’t gotten oxygen so quickly
In the hospital bed that afternoon I told myself, "You don't have to get up at any time tomorrow. You don't have to think about anything. All you're supposed to do is rest." I was tired, but I was happy. When I’d been this tired before, I knew that I would be expected to get up the next day and grade papers, drive my kids to lessons, fix supper, fold laundry. In the hospital, all anyone expected me to do was rest, eat, and submit to thermometers, needles, and tests.
The concern of family and friends, and even people we hardly knew, began to come in waves of kindness. People brought meals and sent flowers; they scooped up our children for whole afternoons; they did our grocery shopping, brought magazines, walked our dog . . .
Months later, as I recuperated, sometimes I thought, “Wow, in those years when the kids were so little and I was struggling with depression, I really could have used the lasagnas and casseroles, the cards and flowers and phone calls, the offers to baby sit.”
*****
Until recently, a depressive outlook seemed natural and normal to me. I don’t remember a time when I wasn’t depressed to some degree. Guilt motivated me. I thought self-effacement was attractive. Expecting the worst was my world view. I had interests -- reading, swimming, and singing -- but pleasing people and winning others’ affection was what really mattered.
I had been in therapy before I got married, and I started seeing a therapist again when I was pregnant with my second child. She began to train me to examine my negative and sweeping assumptions (“He never listens to me,” “Everyone thinks I’m too sensitive”). She gently suggested that I consider trying an antidepressant. I resisted, but I finally followed her advice. I had gotten to the point where I was thinking, all the time, of leaving my husband and children. I owed it to them to at least try the medication before I took such drastic action.
The difference pre- and post-medication was dramatic. Willpower or insightful talks with a therapist could not have effected this healing. I had been in therapy with three different people for five years before I tried medication, and the results had been unsatisfying. My vision was impaired by negativity and self-loathing. The sky might be blue, but I saw gray. A stranger might smile, and I assumed she was mocking me. “You look tired” might be an expression of concern, yet I heard it as a disparagement of my appearance. The medication enabled me to exchange the pair of old, dark eyeglasses for a new pair, through which I saw life with more clarity. I could see that good, as well as bad, was a part of reality. Kindness could be as real as cruelty. Joy could be as real and true as sorrow. During the time I was considering trying the medication, I asked a spiritual mentor for advice. She told me that she herself was taking anti-depressants, and then she said, “The crucifixion is only half the story. There was a resurrection, too, you know."
Because of the stigma of depression, I haven’t let people know that I suffer from it or that I’m on medication. I’ve heard too many people talk glibly about prozac as if it were a happy pill or the flavor of the month. A man I admired once said something like “Now we use chemicals as another form of dulling the pain, another form of denial.” So, I was the kind of person who didn't want to face reality? The problem was that I was too willing to face negative realities, and I was in denial about the reality of good things in my life. Before I used anti-depressants, I exaggerated dangers and slights. I was in denial about the reality that life isn’t just about pain.
The condition of depression isn’t recognized as warranting the same kind of help that a heart condition does. For a long time, I hardly believed myself that depression was a life-threatening disease. It took me years to justify seeking out therapy and then five more years to justify taking anti-depressants. On some level I thought it was my fault that I was depressed, or at least, it was my fault that I couldn’t pull myself out of the hole.
Not for a minute have I thought that I don’t need my beta blockers, ace inhibitors or cholesterol pills. No one expects me to just push through the heart weakness. The medications are there, and they make me better, less at risk for another heart attack. The anti-depressants make me better, but I have wondered if using them is a weakness in character.
Everyone knew about my hospitalization for a heart condition and, once they found out about it, they responded. Far fewer people knew I was depressed, but they, like me, didn’t treat it as a disease. It was, at best, a personality trait, at worst, a character flaw or failure of will.
When I had my heart attack, I didn’t feel the need to justify. No one judged me. Everyone accepted my fatigue. All the support and affection I could have wanted was provided. What’s more, I felt entitled to it. The heart condition was rewarded. The depression was hidden, and I felt judged whenever someone minimized the reality or effect of depression. Going back to work after my heart crisis was viewed as heroic, but the real heroism had been getting up every day when I was in the throes of self-disgust and pessimism.
The fear of judgment made me hide my depression and kept me from getting the help that I needed. After the close call with my heart, I saw how supportive people want to be. But people don’t always understand depression, and it can make them uncomfortable. They don’t know what to do to help, so they tend to say or do nothing. The silence reinforces the shame.
Many people have outed themselves as sufferers of depression or mental illness since I had that heart attack: Alma Powell, Jane Pauley, and William Styron were pioneers. There is still, though, some deep rooted belief that depression isn't quite a legitimate illness. Many years ago, I offered to talk about my experience with depression at an assembly at the school where I worked.
But I backed out.