It's Tuesday night and I just finished a lecture at about 7:40 and headed home. That involves about a 45 minute drive down Minnesota Highway 8. The last two days in Minnesota have been bitterly cold. That first bitter cold that feels like it is 35 below, but it is really only there to steel you against 35 below. It was actually 19 above. The only consolation to driving down one of the most dangerous roads in Minnesota in the dark and bitter cold is that I get to listen to Terry Gross on NPR. To make things even more interesting she was interviewing a depressed blogger with huge appeal on the internet. She writes the popular blog Hyperbole and A Half.
Terry Gross started out with a lot of questions about the quirky cartoon character that blogger Allie Brosh uses to represent herself on the blog. The interview proceeds through some introductory excerpts but comes to the author's depression at about the 13:38 mark and goes for about 20 minutes. As I am listening to her talk about depression, I am thinking of the hundreds of people I have talked with about their depressions. I am always trying to find out if I missed anything or if there is a different way to view all of these unique presentations of depression.
Ms. Brosh's description of depression and its personal and interpersonal toll is unique among descriptions of depression I have seen in the media. She talks about the transition from an emotional depression with excessive emotion and self loathing to a state that is totally devoid of emotion. The "emotional deadening" in some ways is a relief and she later says that it has lead to reduced anxiety. She has thought of herself as too emotional and thought it was interesting that she no longer had that weakness. She blogs about it as Adventures in Depression and Depression Part Two and we have already learned that these were very popular posts on her blog.
In one example, she describes an interaction with a friend telling her that her cat has died and she states she is not able to generate enough "organic emotion" that she needs to be concerned about showing an appropriate facial expression to her friend. Her concern is that she is doomed to live an emotionless state and that rapidly equates to meaninglessness and eventual suicidal thinking. She talks about needing to manage this information to protect people and also protect herself from their emotional reaction. She is eventually able to tell her husband and mother, but even during this interview she discloses that her husband may have heard details of her plan that he had never heard before. This disclosure is clearly painful and she pauses - overcome with emotion.
The emotion in the interview is familiar to me. It is how people really describe severe depressions. They don't recite symptoms in a diagnostic manual, they talk about what the depression means to them and how it affects them and their relationships. They talk about how it affects their inner life. They talk about what seems to help and what strategies are useful and not useful. In the moment, it can be painful to be around a person with depression. Any empathic person resonates with the emotion in this interview. At one point Terry Gross apologizes for putting her through it. Things are tense.
Ms. Brosh talks about the type of interpersonal interaction that was most useful. She cautions against advice giving like "try yoga" or be thankful for everything that you have and you will come out of your depression. What was helpful was somebody taking her seriously and listening to her experience especially her thoughts about suicide. As you listen to the interview she is clearly changed by the depression and has adapted to it. Her main deterrent to suicide was the impact it would have on the people she loved, but we also hear how tenuous that connection can be during severe depression. We learn that one of the thoughts that would keep her going if she got depressed again would be the idea that she knows she will come out the other side. Terry Gross asks her about treatment and whether "any kind of therapy or medication that alleviates some of it?" She clarifies that she is about 60% recovered. Despite some initial concerns about medication she found that it (bupropion) was "very helpful".
I found this to be a powerful piece about depression. It describes the feeling and thinking state of the depressed person and the associated problems with relatedness. At one point Terry Gross comments on the artistic aspects of creativity that flows from the depression and Ms. Brosh appreciates than comment. With all of the abstract discussion of depression in the popular press and the assembly line treatment approach in health care systems, this interview is a more genuine discussion and rich source of information about what it is really like for the person and the struggle to recover. I highly recommend listening to the audio file and reading the blog.
George Dawson, MD, DFAPA