On cancer, medication, side effects, depression, and risk.
By Barbara White. Reblogged from iamnotmakingup.com.
The wound and the eye are one and the same. From the psyche’s viewpoint, pathology and insight are not opposites—as if we hurt because we have no insight and when we gain insight we shall no longer hurt.
—James Hillman, Re-Visioning Psychology, 1975.
First, a recollection:
About seven years ago, I began taking an anti-cancer medication, Tamoxifen, after months of fretting about whether or not to do so. I had learned that in a very small percentage of patients, it could kindle or worsen depression. Although it was very rare for that to happen,—my surgeon had never seen a single case, my oncologist maybe one or two—I was indeed one of the “small percentage” to be felled. It took me some time to identify what was happening, but it really hit me that January when I caught a bad cold and had to stop my vigorous daily exercise routine. That habit was likely what had been keeping me afloat, and the sudden need to forgo it was devastating. After a period of perilous despair, during which I felt increasingly disinterested in the next week, day, and hour, I realized that the medication I was taking in the hope of staving off a life-threatening illness was itself life-threatening. For me. (Those last two words are crucial.) Fortunately, my doctors understood this and supported my choice to discontinue the medication. Any doubts I had ever had about the chemical aspect of mood were dispelled that January. There are so many debates and opinions in the offing about whether medication is necessary, helpful, virtuous, and so on. Having had such a severe depressive episode instigated by medication—the inverse of the usual—proved once and for all to my bodymind that chemistry can drive mood. I was not as in charge as I would have liked to think. I could not just repair my mental state with talk, toughness, or the right course of action. Sometimes there is no best course of action available. Sometimes one engages in revivifying exercise and finds it helps. And sometimes one gets a cold and realizes that the bank of endorphins has been used up for the time being. Sometimes Whole Foods runs out of fish oil.
Next, a reflection:
It’s easy to think we know what depression is and to think we have wisdom about what is best for another who has experienced despair and anguish. But we know little. As many point out, the casual of the use of the d-word,—“Maleficent isn’t playing any more?! I am so depressed!”—hinders understanding. The mysterious and “yin” nature of the disease does too. Its darkness is powerful and seductive. It’s resistant to illumination. Even those who spend their lives experiencing mood challenges, and treating them, acknowledge the limits of their understanding. Some say that those who die of suicide are selfish, or that they failed to ask for help. Some say that pharmaceutical companies are agents of the State, that their medications are designed to break down the body’s natural chemicals, and that they will inevitably lead to a cure worse than the disease. (Tell that to someone who’s planning to take her life this week. A decline down the road might not be a bad alternative.) That one may eschew the word “suffering” and choose spiritual practice over medication, as long as one meditates in the “right way.” These are all things I have read this week, and I have been especially disheartened to hear some who identify themselves as spiritual practitioners reveal such self-satisfaction, such a lack of humility and compassion. I remember when I was diagnosed with and treated for cancer, dealing with (some) others’ responses was infinitely more difficult than accepting my own morbidity and eventual mortality. I’ve felt similarly pained by much of what I have read this week.
I cannot help but think that the persistent misunderstanding of depression and other mental health conditions relates closely to the fear of decline and death that is so evident in US culture. There are so many claims about superfoods and antioxidants and kale. (Oh, right, kale has been dethroned; is that right? Oops!) However, such apparently “positive” possibilities to engineer über-health inevitably reveal a dark side: all too often, such a desire to be well conspires with a similarly American rush to judge others and to express opinions that arise less from knowledge than from unconsidered attitudes—and, I suspect, from fears. Why else would one police another’s kale consumption? I see this in the discussion about cancer as well: the notion that one can outrun it in one way or another, that it can be cured. I have yet to hear anyone besides me ask in response, “And then what? No death? A better one? Worse?”
I find it hard to imagine that such a “police state of mind” is good for anyone’s mental or physical health. Yet there continues to be a cultural emphasis on the transaction: do this, and you’ll get this. Thing is, there is not always a thing to do, and if there is, it is sometimes comes with a heavy tax. Risk more cancer? Or risk suicide with a drug designed to fend it off? Fortunately, I had a reasonable alternative available. But not everyone does.
Considering how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to light . . . it becomes strange indeed that illness has not taken its place with love, battle, and jealousy among the prime themes of literature.
—Virginia Woolf, On Being Ill (1926)
For those who have not had the “opportunity” to experience depression personally, or to look into its eyes in some other way, might you consider acknowledging your unknown knowns? Might you be able to tolerate the not knowing, as in Keats’s notion of negative capability? Might you emulate my doctors, who understood that their vast experience did not grant them omniscience, and who were able to accept that, even though it was statistically improbable, a life-saving medication could cause life-threatening side effects? Had they not, I might not be here to be wondering about this.
Here is the invitation, should you choose to accept it: For every opinion you express about depression, or other mental-health issue, read one article or essay about it. Or better yet, talk to someone who has lived with mental-health challenges, and instead of nursing your own opinion about how they should handle it, ask them about their experience, choices, and outcomes. It might be good for your own mental health too.
There’s No Map, But—
Below are some links that regarding mental health, depression, and well-being. They do not all agree with one another or with what I write above. I don’t always agree with myself either.
These two posts from The Belle Jar are especially informative:
When Getting Better Is No Longer An Option
Life as a Mountain Hike (Guest Post)
HuffPo Canada Living has had some good articles this week:
Arti Patel, Robin Williams’ Death Reminds Us Of The Impact Of Words Like ‘Sadness’ And ‘Depressed'”
Shannon Fisher, “Suicide Isn’t A Product Of Not Trying”
Spiritual Practitioners Discuss Depression
Lodro Rinzler, Meditation Isn’t Enough: A Buddhist Perspective on Suicide
Krista Tippett discusses her experience of depression (among many other things) on The One You Feed” (podcast)
“If you know someone who’s depressed, please resolve never to ask them why. Depression isn’t a straightforward response to a bad situation; depression just is, like the weather.
Try to understand the blackness, lethargy, hopelessness, and loneliness they’re going through. Be there for them when they come through the other side. It’s hard to be a friend to someone who’s depressed, but it is one of the kindest, noblest, and best things you will ever do.”
― Stephen Fry