What is Depression? (In three paragraphs)

I make the joke about the three paragraphs because many millions of pages have been written, and similar numbers of "subjects" studied on this still topic. And, while much meaningful information has been discovered, and much solace is to be found in the art created by those suffering, depression for me remains elusive.

As a medical psychotherapist with over two decades of experience in intensive mental health care, I try to walk the line every day with my patients. I use "proven" therapies such as cognitive behavioural therapy and mindfulness-based practices; we explore a trauma-based perspectives; we work through writing and other art forms for healing; and, we work on self-care. I also prescribe medication for some, and more often that not, while medication is never the "answer," it often lifts the veil of depression enough for psychotherapeutic endeavours to be more successful.

Patients ask me, "What is it, depression?" I answer ever in a blur of explanations involving physiology, neuroscience, family history, trauma, triggers, and so on. The truth, I admit every time, is that we really don't know. We just don't know. We know enough to often be able to be of some help, but we don't really know.

I do know this: that the ebb and flow of depression in my own life at times feels intolerable. That it is easy to blame ourselves, harder to be still and to keep trying to heal. That I may need to let go of the possibility that I will ever "kick it" completely. That while there are complex neurological underpinnings to depression, what rings most true for me is that it is an oppression of the soul. That truth is often excruciating in the paradox that when one is depressed it is hard to muster self-compassion, and yet that in the end this is the only "magic bullet." And still, that bullet is not one solid form, it is an ever deepening process of vulnerability and terror which often doesn't feel so great, until sometimes it does. Nothing permanent or certain. Not a very impressive "treatment," is it? Well, it's the main thing I'm working on these days. Fumbling through, really. 

Tragically Hip

I stood mesmerized for two and a half hours at the Tragically Hip show last night. Just one of over 20,000 people, leaning over the edge of my front row balcony seat, swaying.

Like many Canadians, I have been somewhat obsessed with Gord Downie's tragic diagnosis of terminal brain cancer, and his radiant light through this tour. It's as if he exposes us to the core of being alive, and while we can't touch it, we reach...so close, so far...ever closer in the yearning.

In the epic "Ahead By A Century," Gord Downie
sings about "illusions of one day casting a golden light." Last night he cast that light, and we were held in it. The power of the twinkling in the stadium was all the more immense against closeness of the dark.

When one is struggling with depression, the veil can lift in moments like this. We can come alive in the places we felt dead. We can twinkle. But we must hold ourselves gently, because these moments are not in fact antidotes to our darkness. They are treasured, powerful moments for potential awakening, but they must be supported by a fuller, more persistent process of healing too. We must be patient. We must be present.

At the end of the concert, singing Grace Too, Gord Downie screamed, "Now!" again and again. "Now! Now! NOW!"

Not "No," but "Now."

That scream is still reverberating inside me.
I am grateful.

*Photo courtesy of Ari Kaplan