Sunday, July 20, 2014

Shades of Depression: Anhedonia, Anxiety, Anger, and Alienation

            Depression has been described in many ways. Through my experiences and my reading and discussions with others, I think that while there are some common experiences, the details of each person’s experience with depression are unique, and vary even among multiple experiences of depression for the same individual. I’ve felt terrible sadness, apathy, hopelessness, helplessness, and these things I thought were all normal. Yet I’ve also had other experiences less well-associated with depression, and I’m not alone.

Anhedonia

            “Anhedonia is defined as a loss of capacity to experience pleasure. This inability to enjoy pleasurable things is associated with a number of mental health problems including depression. The word anhedonia comes from ancient Greek and means without delight. The individual who is experiencing this condition will find that their life is emotionally empty.

            “…A world without pleasure is a grey place indeed. Without this emotion, life become monotonous, and there doesn’t seem to be much point in doing anything. Day to day living becomes an endurance race, and there is no motivation to try to improve things. The inability to experience pleasure means that life can feel pointless, and that is not a satisfying form of existence. It is a particularly dangerous way to feel if people are trying to recover from an addiction.
            “…Pleasure is a vital component of the internal reward system – it helps people grow and learn. If the individual is unable to experience rewards they will fail to make any progress.” —‘Anhedonia in Recovery’

            Anhedonia sucks. It sucks away your motivation to recovery, to do anything at all. “What’s the point?” you may think.



            “I know nothing. I can do nothing. I understand nothing. I know nothing. Nothing. And all this misery does not even make me particularly unhappy.” —Gerhard Richter

            I go through the motions, but get no pleasure, and soon may not have the energy or motivation to go through the motions. I wander through a twilight fog where everything has lost its color.
            In this state, anytime I feel a glimmer of feeling for anything, I grab it, fiercely, and hold on as long as I can, until that fleeting joy is gone. I feel as though I am hopping from melting ice floe to melting ice floe over a killing-cold lake, and I wonder if they will sink, or get too far apart, or run out before I reach the other side I’m hoping is there.

            “I tend to find the ecstasy hidden in ordinary joys, because I did not expect those joys to be ordinary to me.” —Andrew Solomon

Anxiety

            “If you told me that I’d have to be depressed for the next month, I would say, “As long as I know it’ll be over in November, I can do it.” But if you said to me, you have to have acute anxiety for the next month,” I would rather slit my wrist than go through it. It was the feeling all the time like that feeling you have if you’re walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months.” —Andrew Solomon, ‘Depression, the secret we share’ TED Talk

            Living in terror or panic for a prolonged time affects your body. Your adrenal glands wear out. You’re hypervigilant. You can’t sleep, and your body doesn’t recharge. The cortisol soup your whole system is swimming in takes its toll. Your brain rewires. Your sense of the future becomes foreshortened. Anything can trigger you to fight, flight, or freeze. It can become too much to leave the house, into a world of unknown variables and overwhelming stimulation. It can feel like having no skin.
            You develop learned helplessness when nothing you can do stops the source of fear and panic. It wears you out when you feel you have to keep this vulnerability hidden, which if you are living with someone or something that is threatening to you and more powerful than you, is highly likely. You feel small, disempowered. You are liable to lash out at the smallest trigger. It is as though the gain has been turned up on everything—a whisper is a shout, a simple word is a hammer blow.
            It is hard for me to tell, having lived with terror all my life, what is a genuine assessment of a threat, what is a childhood flashback, what is either causing or a result of depression. What I do know is, regardless of cause and effect, terror is the most debilitating of all. With anhedonia, even at its worst, I still can connect to the idea that I haven’t experienced absolutely everything, and perhaps there is something out there in which I can take pleasure. Anger, even frustrated and helpless anger, urges me to action against that which is intolerable and unjust.
            Fear chases me into a corner, binds my chest with invisible iron bands so I cannot even dare breathe or make a noise, lest someone notice I am here and take more from me when I have nothing to give, or beat down someone so beaten down by life I feel paralyzed.

            “Suicide is really more of an anxiety response than a depression solution: it is not the action of a null mind but of a tortured one. The physical symptoms of anxiety are so acute that they seem to demand a physical response: not simply the mental suicide of silence and sleep, but the physical one of self-slaughter.” —Andrew Solomon, ‘The Noonday Demon’

Anger

            “First, you are faced with an experience that seems wrong or unfair. Second, you don’t feel able to calmly correct it. And yet, in order for you to feel okay, the situation must be successfully resolved because leaving it as it is does not feel like an acceptable option (the third factor). You feel a strong desire to right a situation that seems wrong, yet you also believe that, at least for now, you are unable to do so. When this set of circumstances occurs, your normal, built-in, human response is anger.”
—Marcia Cannon, ‘The Gift of Anger’
            “A lot of painful things happened to me, and I just wanted to forget. I would wake up in the mornings and just be angry that I woke up. I felt like there wasn’t any help for me, ’cause I was just on this earth wasting space. I lived to use drugs and used drugs to live, and since drugs made me even more depressed, I just wanted to be dead.” —Sheila Hernandez

             “It’s like a hurt. It’s just like they raking your heart out your body, and it won’t stop, it’s just like somebody’s taking a knife and keep stabbing you all the time.” — Danquille Stetson

            It’s been said that depression is anger turned inward. I think depression can have in it anger both turned inward and outward. In depression what I have felt is helpless anger.
            I’ve been angry at hurt I could not prevent or defend against, angry both at the source of the hurt and at myself for my impotence or weakness.
            All this anger is exhausting and demoralizing, and without effective ways to express all this anger non-abusively and feel heard, it becomes a hopeless, angry despair. Loneliness is not just the absence of people but the absence of compassionate understanding.

            “I meet people and I know that they don’t have the level of experience that I have.” —Bill Stein

            Despite a lifetime of painful interpersonal traumas, I have come to believe there are some out there who aren’t habitually, mindlessly hurtful. Yet the absence of a flaw doesn’t indicate the presence of a virtue.
            We humans are rarely comfortable with the expression of emotions like anger and fear and shame, even when we are only bystanders. It takes awareness, effort, investment, and a willingness to learn from inevitable failures to practice empathy, compassion, validation, and humility in the face of these things; with emotional boundaries that don’t trend to self-protective insensitivity. Too often we rely on comparison and pity in the face of others’ pain; or unwanted and inappropriate judgment, advice, and humor. Intellectual understanding blocks empathy.

            “Generosity and love demand great expenditure of energy and effort and will.” —Andrew Solomon, ‘The Noonday Demon’

            Prolonged anger can also have physical health consequences—heart attacks, hardening of the arteries, strokes, hypertension, high blood pressure, heart rate and metabolism changes, muscle and respiratory problems (Dr. Herbert Benson, The Relaxation Response, 1975).

Alienation and the Struggle to Overcome it

            Depression is an alienating experience. Anhedonia, acute anxiety, and anger are alienating experiences.

            “You can’t measure in objective terms how sick people are or what their symptoms are. You can only listen to what people say and accept that that’s how it feels to them.” —Deborah Christie
 

            “There is an interaction between illness and personality; some people can tolerate symptoms that would destroy others; some people can tolerate hardly anything. Some people seem to give in to their depression; others seem to battle it. Since depression is highly demotivating, it takes a certain survivor impulse to keep going through the depression, not to cave in to it.” —Andrew Solomon, ‘The Noonday Demon’

            Compassionate understanding isn’t something we’re automatically good at, nor empathy, nor non-judgment, listening skills. Capacities for these are there, unless you’re a sociopath, but it takes mindful work and perseverance, and humility, to build and practice these skills. It’s not easy, it’s not always fun, and it requires uncomfortable self-examination and self-honesty and a willingness to fail and try again.
            Becoming a brain surgeon is hard work and you would (I hope) not presume to try brain surgery without that work. Yet many people try to offer support who have underdeveloped humility, awareness, and trustworthiness necessary to be effective. We do this because we don’t know what we don’t know. We also do this because shame shuts down genuine human connection and vulnerability (see Brené Brown’s work for more on overcoming these issues).
            I’ve been there. I’ve not only bought the t-shirt but run the t-shirt stand. But having had the experiences I’ve had, I can never return to not-knowing. Sooner or later I think most everyone is touched by tragedy or trauma, and ignorance is no longer an option. The choice is, what do you do then?

            “You cannot draw a depressed person out of his misery with love (though you can sometimes distract a depressed person). You can, sometimes, manage to join someone in the place where he resides. It is not pleasant to sit still in the darkness of another person’s mind, though it is almost worse to watch the decay of the mind from the outside. You can fret from a distance or you can come close and closer and closest. Sometimes the way to be close is to be silent, or even distant. It is not up to you, from the outside, to decide; it is up to you to discern. Depression is lonely above all else, but it can breed the opposite of loneliness. …So many people have asked me what to do for depressed friends and relatives, and my answer is actually simple: blunt their isolation. Do it with cups of tea or with long talks or by sitting in a room nearby and staying silent or in whatever way suits the circumstances, but do that. And do it willingly.” —Andrew Solomon, ‘The Noonday Demon’

            “Our needs are our greatest assets. I am able to just be there with people because of the stuff I’ve needed from people. I guess I’ve learned to give all the things I need.” —Maggie Robbins

Sources and further reading:
            ‘Anhedonia in Recovery’ article
            Hyperbole and a Half: Adventures in Depression by Allie Brosh
            Hyperbole and a Half: Depression Part Two by Allie Brosh
            Depression, the secret we share’ TED Talk by Andrew Solomon
            The Noonday Demon’ by Andrew Solomon
            The Gift of Anger’ by Marcia Cannon
            Honor Your Anger’ by Beverly Engel
            Healing Through the Dark Emotions:The Wisdom of Grief, Fear, and Despair’ by Marcia Greenspan
            The power of vulnerability’ TED Talk by Brené Brown
            Listening to shame’ TED Talk by Brené Brown
            Suicide: Read This First’ on metanoia.org
            What can I do to help someone who may be suicidal?’ on metanoia.org
            Emotional Intelligence information on EQI.org

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