I have a mysterious kind of depression

None of the experts I have consulted have any idea why I feel the way I do or what to do about it

Published February 24, 2011 1:30AM (EST)

Dear Cary,

I can't believe I'm writing to you, but you seem to have such insightful answers to non-straightforward issues, that I think that maybe you could help me.

I'm 32, married, educated and employed. I work at a stable job in a wonderful city. On the surface, everything looks great. But I'm depressed. I have been for years. Neither I nor my various counselors/psychiatrists can make sense of it. There isn't any one thing that we can point to and say, "Aha! This is why you're depressed." And really, I'm OK with that. I'm OK feeling like there might be a thousand tiny reasons that all combine to make me depressed. My problem is the grindingness of it all. Is there light at the end of the tunnel? Will I ever be not depressed? I'm beginning to lose hope, and while I'm not suicidal, I do feel drained and directionless. I go through the motions of each day without any real emotional variation, and I am getting to the point where I need to feel like I won't be depressed forever, even if I don't know when it will end. But, of course, I can't know that. So how do I keep going? Do you have any words of wisdom for me?


Depressed in Durango

Dear Depressed in Durango,

I like your statement about the grindingness of it. I like that word, "grindingness." It says a lot. You say you feel "drained and directionless. I go through the motions of each day without any real emotional variation." That also says a lot.

One thing it says is anhedonia.

Did any of the people you talked to mention anhedonia? You might go back to them and say the word "anhedonia" and see if they do anything. Sometimes when people write to me they uncover clues that may not have emerged in conversations with doctors and therapists. So then you can go back to these experts with a more focused request: Maybe I have anhedonia? Please help me investigate this possibility. Or maybe there is a medical cause. What are the possible medical causes of depression? Please give me all the tests.

I think it is a little early to conclude that you have a mysterious illness that no one can diagnose. I suggest you start from scratch and be systematic. You might begin with this useful survey of depression treatments.

See how broad a field it is?

What I have learned by having chordoma, which is a very rare form of cancer, is that just because something is rare doesn't mean you can't have it. Think about the black swan. Examine all rare medical conditions that can cause depression.

Likewise, be thorough in your investigation of possible treatments. For instance, if you haven't had cognitive behavioral therapy then you don't know whether it can work for you. You can't rule it out. If you haven't tried eating three meals a day, exercising and getting enough sleep then you don't know that that can't work for you. If haven't tried all the possible treatments for a sufficient length of time, then you don't know what will help. Rigorously investigating treatments means trying things out for long enough to see if they have any effect. It means accurately observing and measuring whether specific changes bring noticeable improvement.

Keep in mind that the people who run the Helpguide Web site, which I link to up above, lost their daughter to suicide. She was depressed. "She stuck with a single therapeutic mode and her prescribed medications," they write, "even though the combination seemed to just make her worse. Finally in desperation, she attempted suicide twice; the second time she succeeded."

The fact that you are not having suicidal thoughts now does not mean you won't have them in the future. This is not something to take lightly.

So that is my concrete advice. Take action in the world. Insist that your doctors help you rule out all possible causes and aid you in trying all possible treatments.

There. I've said it.

Now, as you know, I also have wide-ranging opinions and speculations about how one should live and what is wrong with our society and what is wrong with the messages we are given by our society about what will make us happy.

OK. Here are a couple of my thoughts. When you say, "I'm 32, married, educated and employed," I do not think to myself, wow, that person sounds happy. I think, wow, that sounds dull. There is no joy in the sentence. It sounds, frankly, like depression. It sounds like the airless, pleasureless realm of anhedonia.

I hear sadness. I hear a silenced self. I wonder who that silenced person is. It may be an athlete. It may be an artist. Perhaps there is some striving, messy, error-prone genius in you that is not being heard. Perhaps this genius is angry at you because she's not being heard.

I would ask this: Why did you choose to create this great-looking surface? What important part of yourself have you betrayed in creating it? What have you sacrificed? What have you allowed to die?

You say, "On the surface, everything looks great."

A lovely surface is a tragedy. If there is no ugliness on the surface, the the ugliness must be underneath, eating away at us. There is always ugliness. It's got to be somewhere.

Here's the other thing. You say that you're OK feeling like there might be a thousand tiny reasons that all combine to make you depressed. Likewise, a person who is relatively happy may have a thousand tiny sources of happiness. Throughout the day, a person has moments of pleasure. You learn to have these things that get you through. Maybe it is a raisin bran muffin bought from the sliding window of Specialties at Montgomery and Market streets in San Francisco. It tastes good, doesn't it? Maybe it is the heat on your chilly hands of a medium-size paper cup of drip coffee bought with the muffin and carried into the street. Maybe it is seeing the security guard behind the desk in the lobby of your building, the clack of your heels on the stone floor, shifting your bag with the muffin in it to your left hand and pressing the round button for the 27th floor and seeing it light up.

Maybe it is a song on the radio as you are driving to work. Maybe it is something you have on. 

There have got to be moments in your life that give you pleasure and you have got to pay attention to them.

I think you have made a great beginning by writing this letter. You have begun a journey of self-discovery that will be years unfolding.

And so it begins. Good luck. Don't take hazy, noncommittal half-truths for answers. This is your life. You deserve to know. That's the only way you will come alive again.

January 2011 Creative Getaway

What? You want more advice?


By Cary Tennis

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