depression


I wrote recently about my recent hospitalization for complications following prostate surgery. I mentioned the other patient in my room, but I didn’t say anything about our interactions. I think that’s a story worth telling.

I’ll call my roommate Dwayne. He is a 55-year-old who was transferred in for treatment of pneumonia in the wee hours of Sunday morning, a few hours after I was admitted. His wife stayed with him for several hours, but then left, and no one came to visit him during the next couple days that we shared the room. The room was “semi-private,” meaning  that there was very little privacy in evidence, so I learned a fair amount about him. At every shift change, the departing nurse came in with the arriving nurse to give the next shift an update on each patient–their diagnoses, reason for admission, and treatment plan. Usually the report is given in the patient’s room, so he overheard my report again and again, and I overheard his.

Dwayne’s pneumonia may have been his immediate problem, but it was by no means his only medical condition. He had diabetes, liver disease, and kidney disease. Wow! My problems were minor in comparison. I heard the diagnosis “end stage renal disease” repeated over and over. I had had a scare when first admitted regarding my kidneys, but by Monday morning I had been assured they were fine. He would never receive that assurance.

I felt sorry for Dwayne, but was also rather annoyed by him. He watched TV constantly, and I had little appreciation for his tastes–Wrestlemania, shoot-em-up action shows, lots of drooling over customized cars and trucks. The first night he talked on the phone at midnight, while I was trying to sleep, then watched TV for another couple hours, not bothering to keep the sound down. His phone then started ringing at 6 the next morning. There was a curtain separating us, but he certainly knew I was there and presumably could infer I would appreciate some quiet.

I probably should have asked him to turn down the sound, but I was in quite a bit of pain initially and thought that it, not he, was the main factor keeping me awake. Lying in bed that night, I started wondering about him, and my thoughts weren’t very charitable. What had been his role in causing all his medical problems? Lifestyle choices do affect our health, after all. He didn’t seem to be trying to get up and walk around despite the nurse’s statement that it would help with his pneumonia. Was that behavior typical for him; had he been neglecting his health for years?

I was prepared to ask him to turn his TV down the next night, but didn’t need to. I had a medical procedure late that night, and wasn’t ready to go to bed myself until near 2 the next morning. He had spent the previous afternoon at kidney dialysis. I started thinking about what his life must be like. How did it affect someone to have their blood cleaned by a machine every few days? I had overheard that he wasn’t able to work. Did he miss that? Where was he spiritually? Did he turn to God when things got difficult?

Tuesday morning, my doctor’s PA mentioned that she would come by that afternoon to discuss discharging me. I had only spoken briefly to Dwayne in the previous couple days. I had been too preoccupied with my own troubles to want to converse with him. Still, while waiting that afternoon for the PA’s visit, I started wondering whether I had been too uncommunicative. Jesus told his followers to let their light shine. Here was someone whose life seemed full of darkness, and I couldn’t think of anything I had said or did that he could have interpreted as light.

Finally, late in the afternoon, I realized that I would regret it if I didn’t at least try to have more of a conversation with him. His TV show was just ending, so I made a comment about it, then asked him about the dialysis. He was like a damned up river suddenly released, gushing forth the story of his last few years. A doctor had prescribed too much medication for his diabetes, and he had felt worse and worse. After about a year like this, he was admitted to the hospital; doctors were shocked with the meds he was on. His diabetes could have been managed with minimal medication, but the extra medication had irreparably damaged his kidneys. He had talked to a lawyer, but a malpractice case probably wouldn’t prevail in court. He wasn’t able to work because of dialysis three days a week. He tried to find part time work the other two days, but no one would hire him when they learned of his condition. His wife had to work so they could keep medical insurance. He had “lots of toys” at home, but didn’t get much satisfaction anymore from going out riding his motorcycle, ATV, and the like. His doctors said he was a poor candidate for a kidney transplant because of his other medical problems. He got down at times and thought of giving up. He wouldn’t do anything to himself but knew that he could stop dialysis and soon be dead. He had a granddaughter, and thinking of her helped him keep going

I asked whether he had a church family; he didn’t, but sometimes went to his daughter’s church. I asked if I could pray with him, and he readily agreed. After we prayed, I gave him my phone number and encouraged him to call me if he needed to talk.

About then, the PA came in, saying she would have been in earlier to discharge me but she had a rough afternoon. I didn’t give her my explanation for why she was delayed. God had been prompting me to lift the bushel of self-preoccupation off my head and shine into the darkness of that hospital room. Knowing how slow I am to realize that the Spirit is urging me to do something, He made sure He gave me plenty time to hear and respond. I don’t know if Dwayne will ever call, or if he has thought since then about our talk. At the time, though, we seemed to connect well. Hopefully, I won’t be so slow to reach out to the next Dwayne that crosses my path.

 

 

 

 

 

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This isn’t a review, but a reflection. The movies that intrigue me do so because they explore questions like how we should live our lives, what makes for good (and bad) relationships, and how we come to be made whole or broken, saved or lost. I write about those movies to engage these and similar issues

Eisenberg and Segel. Image by Jakob Ihre/AP

Eisenberg and Segel. Image by Jakob Ihre/AP

I recently saw “The End of the Tour,”  the movie about Rolling Stone journalist David Lipsky (played by Jesse Eisenberg) interviewing writer David Foster Wallace (Jason Segal) shortly after Wallace’s landmark novel Infinite Jest was published in 1996. Lipsky travels to Wallace’s modest rented home in Bloomington, Illinois, then accompanies him on a trip to Minneapolis for the last stop of the book tour. The movie is a long conversation between two intelligent men in their 30s, one probing, the other alternately spilling out his thoughts and lamenting the artificiality of their interaction. These seem to be two men struggling with despair, only one of whom realizes the struggle is occurring.

In alluding to despair, I’m thinking of the way that Danish philosopher Soren Kierkegaard used the term. In his Sickness Unto Death, he describes despair as a condition of the self. Here’s how I recently summarized the ways Kierkegaard thought we despair:

“We can despair in two ways, according to Kierkegaard. First, a person can wish to be rid of  him- or herself, that is, can be unwilling to be oneself, a condition that Kierkegaard calls “the despair of weakness.” Second, the person can despair to be a self, that is, can despair because one desires to be a self that one cannot be, a condition referred to as ‘the despair of defiance.’”

It doesn’t take much effort to see that David Foster Wallace (the Wallace of the film, that is, who might not have resembled the real man) was well acquainted with despair. He tells Lipsky that he is addicted to junk television (we see one TV-watching binge during the movie). Any addiction, TV included, can be considered either an attempt to escape from oneself or an attempt to be a self other than who one is (or both). Of the two possibilities, Wallace seems mainly to have been trying to get away from himself.

Wallace seems quite aware of his propensity towards despair. In 1988, eight years before Lipsky’s interview, he was hospitalized and put on suicide watch. He says to Lipsky (all quotes are my best attempts to transcribe the dialogue from the movie, but I can’t vouchsafe their accuracy), “I was a 28 year old who had exhausted a couple ways of living.” After describing the experience in the hospital, he added, “and when that happens you become unprecedentedly willing to explore some other avenues of how to live.” I haven’t read Infinite Jest, but I understand that it can be considered just such an exploration of ways to live. Wallace isn’t so sure his search has unearthed a workable solution. Looking back to the time he fell apart, He tells Lipsky, “I don’t think we change. I think I still have the same parts of me. I’m trying hard to find a way to just let them live.” He was well aware that despair still lurked within.

Wallace sees contemporary culture as making it particularly difficult for him (or anyone else, for that matter) to be a self capable of wholeness. That culture produced the endless flood of TV shows constantly available to soothe his angst. He foresees a time in which the internet and virtual reality become even more insiduous pathogens capable of infecting and  destroying the self. He says at one point that his writing is about “how easy it is to be seduced off your path because of the way the culture is.” He then mentions what he fears: “What if I become a parody of that?”

Wallace seems to have thought that a genuine connection with another human being would aid him in his struggles. He opens up to Lipsky with that end in mind. That effort proves fruitless, since Lipsky has no intention of being genuine. He would rather present a counterfit self in order to charm Wallace and thereby obtain material for his Rolling Stone article. Wallace at one point says that literary success has made him feel like a whore, but Lipsky is the real whore here, prostituting his humanity in an attempt to gain success.

Lipsky wishes to be a self he can’t be–he wishes to be an acclaimed author like Wallace–but, as portrayed by Eisenberg, anyway, doesn’t have the insight to realize that this striving is a form of despair. As Lipsky prepares to drive away after the interview is completed, Wallace leans into his car window and says, “I’m not so sure you want to be me.” Good words of warning for those times when we start thinking that we will be at peace if only we manage to be someone other than who we are.

silver-linings-playbookI recently saw Silver Linings Playbook, the romantic comedy starring Bradley Cooper and Jennifer Laurence as potential mates whose combined psychiatric maladies evince a fair portion of the Diagnostic and Statistical Manual for Mental Disorders.  Pat Solitano Jr. (Cooper) has just completed an eight-month court-ordered stint in a psychiatric hospital.  The staff thinks he should stay longer (one doctor protests that he’s just getting used to the place), but his mother Delores (Jackie Weaver) signs him out against medical advice.  Pat claims he’s fine, though the evidence suggests otherwise.  He insists that he has a strong marriage with his estranged wife Nikki, but we learn he was hospitalized after he found her having sex with a fellow teacher and proceeded to beat her lover senseless.  He becomes wild-eyed and agitated whenever he hears “Ma Cherie Amour,” their wedding song.   He throws Hemmingway’s A Farewell to Arms through his bedroom window because he doesn’t like the ending, then wakes up his parents at 4 a.m. to harangue them about the book.  He seems oblivious to the obstacles that  Nikki’s restraining order against him might present to his plans for reconciliation.  He’s been diagnosed with bipolar disorder; more noticeably, he is an emotionally damaged person using denial and hostility in a futile effort to cope.  He is initially indifferent to the doleful Tiffany (Laurence), a recent widow whose response to her loss included sleeping with everyone in her office, resulting in her dismissal.  Neither of them is at all ready for a significant relationship.  This being a romance, though, things happen.

The movie minimizes the misery that mental illness causes—an understandable weakness, given that it’s a comedy.  Screenplay writer (and director) David O. Russell seems to suggest that there isn’t much difference between people bearing psychiatric diagnoses and the rest of us.  If those around Pat were compasses, all of them would be pointing somewhere well away from true north.  His father, Pat Sr. (Robert DiNiro), a bookie obsessed with Eagles football, tries to get everyone to perform inane rituals in order to give the Eagles “good juju.”  His mother is caterer to everyone else’s craziness.  His friend Ronnie (John Ortiz) is a henpecked husband whose mild-mannered veneer periodically cracks to reveal rage.   Even his doctor (Anupum Kher), who is reasonably therapeutic in the clinic, seems a little unbalanced when Pat runs into him at an Eagles game.  The primary difference between those labeled as ill and everyone else seems to be the label itself.  It would be nice if psychiatric disorders could be fixed by rubbing off the label, but this approach hasn’t proved all that successful in clinical practice.

Exploring the nature of mental disorders isn’t the focus of the movie, though.  Its concerns are romance and recovery.  The romance is sweet if not entirely believable.  What’s more interesting is what the movie has to say about recovery from emotional disturbance.  At first, Pat espouses optimism and hard work as salubrious for what ails him.  He learned in the hospital to avoid negativity and to focus on achieving his goals.  If you’re positive, he tells his doctor, there’s a chance for a silver lining.  The problem, of course, is that what he’s believing in and working for—patching up the relationship with Nikki—is extremely unlikely to happen.  Besides, his preoccupation with Nikki blinds him to the attractions of Tiffany, the person who is interested in him and available for a relationship.  The film discourages unrealistic yearning in preference for the sentiments expressed by Crosby, Stills, and Nash:  “If you can’t be with the one you love, love the one you’re with.”

So recovery comes through entering real relationships, not chasing impossible ones.  Such relationships have to be based on acceptance, not on critical judgment or a condescending attitude.  A key event in Pat and Tiffany’s relationship occurs on their first date (which Pat maintains isn’t a date because he will soon be reunited with Nikki).  As they sit in a diner eating raisin bran (chosen because you don’t eat raisin bran on a date), Tiffany reveals the details of her sexual exploits.   Pat is spellbound, but is concerned that if they spend time together Nikki may see them as equally disturbed.  “It’s just not right lumping you and I together,” he proclaims.  Tiffany explodes, “You think I’m crazier than you.”  She knocks the raisin bran off the table and runs outside.  Pat follows, futilely trying to explain away what he just said.  He learns his lesson—he never again makes invidious comparisons—and that not only helps their relationship but fosters Pat’s own gradually dawning self-awareness.

Another point: relationships that facilitate recovery are equitable, not exploitive.   Pat wants to skirt the restraining order by having Tiffany deliver a letter to Nikki.  She agrees, but later backs out, saying that she has always done things for others that aren’t good for her but won’t do that anymore.  Pat agrees to a reciprocal favor, namely be her partner in a dance contest.  Both see this as a fair exchange, and, for each, it represents progress in their ability to balance their interests with those of others.  Relationships conducive to recovery also entail looking out for each other’s well-being.  For example, Pat chases away a man who wishes to take advantage of Tiffany’s sexual availability, telling him that she’s wounded and needs protection.  Such shelter not only draws the two of them closer; it also provides affirmation of Tiffany’s worth.

Unfortunately, the plot includes duplicity on Tiffany’s part.  This adds something to the dramatic tension and, in the film, doesn’t detract from either protagonist’s recovery or from the progression of their relationship.  In real life, dishonesty is a poison both intrapsychically and interpersonally.  Apart from this false note, the film works not only as a romantic comedy but as a story of how relationships foster wholeness.  In the end, Pat and Tiffany are not only better because they have each other, but better because they’ve grown.  Fortunately, healthy relationships help us change for the better not only in romantic comedies but in real life.

I’ve written previously about self-presentation on social media sites.  Thus I was interested in a recent ABC News article describing a study linking Facebook use to depression.  Heavier Facebook users were found to be more likely to report being unhappy.  They were also more likely to think others are happier and have better lives than they do.  Why might there be a connection?  The article suggests that it’s because the photos posted by other Facebook users are much more likely to be smiling and cheerful rather than frowning and glum.  Thus, frequent Facebook visitors are presented with an endless parade of grinning faces, and conclude that everyone else is having a better time than they are.

I don’t have access to the original article, and thus don’t have many details about the methodology employed, but I wonder whether the above explanation is warranted.  Isn’t it equally plausible that depression causes rather than is caused by excessive Facebook use?  Couldn’t it be that people who start off by suspecting that everyone else has a better life than they do are drawn to Facebook as a way to confirm those suspicions?

Whether Facebook use is cause or effect, the study does suggest that there are plenty of unhappy souls staring at computer screens, looking at pictures of smiling people.  Maybe we need to give such viewers a lift by posting more pictures of ourselves frowning or scowling.  Why, though, are so many of us posting smiling pictures of ourselves?  It isn’t because we’re actually smiling all the time.  There’s quite a bit of impression-management that takes place on the typical Facebook wall, so that what is seen by others is a carefully calculated fiction.    In his book The Church of Facebook, Jesse Rice describes what is happening as follows: “Fear is very much part of the climate of Facebook.  When we are afraid of what people think of us, we work hard to craft just the right image composed of just the right pictures, personal information, and status updates.  We position and reposition the spotlights on our Facebook portraits to reflect our most interesting side.  The emphasis is on being clever, not on being genuine.”  (as quoted in Christian Reflection: Virtual Lives, p. 38) We want to make a favorable impression, and are hiding our real selves behind well-burnished personae.  Others don’t know us, and we don’t know ourselves.

Are online self-presentations inevitably inflated and fraudulent?  Couldn’t we instead strive to be authentic?  A recent post by Cathleen Falsani on the God’s Politics blog describes authentic relationships occurring via social media.  She had used Facebook only for entertainment and casual social interaction until a day in April, 2008, when she read a status update reporting the death of Mark, a friend.  She and dozens of others who knew Mark shared stories and pictures about him.  A thread was started, one that still continues.  Falsani writes:

“If you had told me a few years ago that I would find community — real, authentic, deeply connected, deeply faithful community — online, I would have scoffed. I’m not, by nature, a joiner.  And yet, here we are, almost four years of daily interaction later, with a communion of 20 souls around the world. Since we formed this unlikely community online, we’ve walked with each other through sickness and pregnancies, the death of parents and siblings, job losses and career changes, one-and-a-half presidential elections, recession and war, adoptions, divorces and even a marriage between two friends who met through the thread.”

The bonds she developed as a result of daily online communication were so strong that, a few years in, she and her family moved from Chicago to Laguna Beach, California so they could regularly interact in person with several other members of the group.  Facebook need not be an avenue for concealment and dissimulation; Falsani found genuine fellowship there, and her experience suggests that the rest of us can do the same.

I got most of the way through this day before running across a report that today is ostensibly the most depressing day of the year.  Apparently, a few years ago British psychologist Cliff Arnall identified the third Monday in January as such, based not on any empirical evidence showing that we are all in the pits that day, but on a rationalistic analysis having to do with time elapsed since Christmas, failed New Year’s resolutions, bleak weather, and the like.  Yes, it’s junk science, but where would my discipline of psychology be without occasional meaningless calculations like this?

 I was actually feeling pretty good today.  I’m off work, the weather is beautiful, and I’m looking forward to the year to come.  Learning that this day is supposed to be the most depressing actually lifts my mood more.  If this is a bad day, the good days to come are bound to be really great!  I can’t wait until June 18, which Dr. Arnall predicts will be the happiest day this year!

The magazine Business Week recently tried to determine the most unhappy cities (among the 50 largest) in America.   To make their estimates, they combined several measures that they judged would indicate misery among the populace.  The factors weighted most heavily were depression level, suicide rate, crime rate, and economic factors.  The first three of these certainly make sense; though income level is a fairly weak predictor of unhappiness, the economic indicators that were chosen–unemployment and job loss–may be a better predictor.  Attention was also given to divorce, the amount of green space, and number of cloudy days.  So, what rust belt city came out on top . . . er, on bottom?  None of them did!  Number one in misery was instead awarded to:

 portland

That’s Portland, Oregon, with Mt. Hood in the background.  Portland residents have achieved their lofty rating by having the highest depression rate of any of the 50 cities.  They also divorce a lot (ranking fourth in that category) and have plenty of cloudy days (220 a year).  Second prize goes to St. Louis largely by virtue of having the highest crime rate of any of the cities studied; third was New Orleans and fourth was Detroit.  More dreary Midwestern cities made the top ten, but so did sunbelt havens Las Vegas and Jacksonville, Florida.  The entire report can be found here. 

I wonder about the methodology of the study.  Though some of the measures at least have good face validity, others are more arguable.  How sure can we be that the clouds over Portland actually make its residents more unhappy?  Green space is nice to have, but does it really contribute substantially to happiness?  Depression estimates were based on doctor/hospital reports and insurance claims.  Maybe Portland’s high depression rating is an artifact of more people in Portland than elsewhere discussing their mood with their physician.  Or it could be that Portland doctors are more prone to use the mental health codes from the diagnostic manual when billing insurance providers.

Regardless of how accurate the specific rankings are, it does make sense to think that some cities have more unhappiness than others.  Though factors such as those examined by the Business Week writers may start the unhappiness ball rolling, it probably acquires a momentum of its own.  I blogged earlier about the contagion of happiness–happiness, like the flu, seems to pass from one individual to the next.  It makes sense to think that unhappiness works the same way.  So, Portlanders, watch out for those depressed neighbors!  Washing your hands often and sucking up zinc capsules may ward off colds, but they won’t keep you from catching this form of dis-ease!

In my General Psychology class on Friday, we discussed a paradox of American happiness.  International surveys have found a moderate positive correlation between income and happiness, and American income levels have increased dramatically over the past 50 years, but America hasn’t displayed a corresponding increase in happiness.  I mentioned one explanation given for this finding: social support and social capital have decreased steadily during the same period, negatively impacting our happiness levels.  I didn’t mention that the decrease in our social ties is a generational phenomenon, in that each generation shows less social involvement than the previous one. 

I was reminded of this generational issue by a blog entry by Scott McNight, who just finished a series of posts on a book by Jean Twenge, a psychology professor at San Diego State University.  The title of her book gives indication that she is interested in a
particular aspect of the paradox I referred to in class.  It’s called Generation Me: Why Today’s Young Americans Are More Confident, Assertive, Entitled–and More Miserable Than Ever Before.   Twenge’s subject is iGens, or Americans born after 1970.  I gather that she portrays them as self-confident and high in self esteem, but also as having little respect for authority and few social tiegeneration-mes.   This combination of characteristics inclines them to increased depression and anxiety.   According to McNight, Twenge sees the excessive focus on the self as resulting in a belief that one has to stand alone rather than function as part of a community, a way of thinking that can produce considerable anxiety.   Social relationships are mediated through cell phones, instant messages, and emails rather than being live, person-to-person encounters.  Comparing such ways of relating  to their nutritional equivalent, Twenge says that such distal forms of connecting with others are equivalent to being malnourished from eating junk food.  

McNight concludes, “The USA has more but feels worse. Part of the problem is the decline of community.”  As Robert Putnam showed us in Bowling Alone, the decline of community began well before the iGens were born.  In the absence of a restoration of community, even the manna of economic recovery will probably do little to satisfy us.