Saturday, February 11, 2006

On Being "Surprisingly Depressed"

Three weeks ago I underwent a spinal fusion that was recommended to me as a remedy for my unyielding back pain. I can track the beginnings of my back pain to a sports injury that I experienced when I was 10. While running the hurdles relay for my CYO track team, I caught the back end of the hurdle with my front leg and landed face first on the track, dislocating my shoulder and clavicle. The back pain that resulted from the injury has come and gone since then. I’ve seen orthopedic physicians, chiropractors, physical therapists, I’ve taken oxycontin, had massages and acupuncture, and had 2 surgeries prior to this one. Nothing works.

I’ve been toying with the idea of having this surgery for a few years, always putting it off because I was in school, not wanting to spend my summer vacation recovering, or because I was starting a new job. But I was recently told by quite a few of the country’s leading orthopedic surgeons that I had no other option, either I consented to the surgery, or stopped scheduling office visits because there was nothing more that they could do.

I was reluctant to have this particular surgery as I’ve heard that the recovery is excruciating, and it has been. I spent 2 weeks in the hospital, and although I’ve tried here and there to take on limited responsibilities at work, I’m not physically able to walk or even sit upright for more than 2 hours at a time. But the most difficult part of attempting to recover from this surgery hasn’t been the physical pain, but rather the psychic pain, the depression, that reared its ugly head a few days following the surgery.

I had a conversation with my surgeon while I was still in the ICU. After speaking for a few minutes about my pain level, and the specifics of the recovery, he verbally noted that I appeared “surprisingly depressed” with the addendum that he recommended adding Paxil to my daily prescription cocktail.

I contemplated the specifics of his words—what does he mean by “surprisingly depressed”? Is having major surgery, the inability to walk, eat, or perform basic human functions not grounds for slipping into a depressive state? Fuck, it’s taken a lot less than that for me to fall into the slippery slope of depression in the past. Is there ever a time when we view experiencing a major depressive episode as “normal”? Or is it always “surprising”?

When I inquired as to why my surgeon thought a prescription antidepressant was necessary, he went into a whole song and dance about how depression is about a chemical imbalance in the brain. I had to laugh. How can depression which supersedes a painful or traumatic event be viewed as being due to a chemical imbalance? I think that the good majority of people who experience a major depressive episode following a horrific medical diagnosis, the death of a loved one, or the loss of a job, are not suffering from a chemical imbalance so much as they're suffering from pain that is so immense in magnitude that it spills over into every aspect of their lives to the point that it impedes daily maintenance or basic functioning. How can we medicate for that?

It’s a tricky seesaw on which the depressed have to sit, on the one hand is your desire to express your inner most turmoil outwardly, on the other is the desire to hide it, mask the utter despair with a smile. The problem with the former is that others can only tolerate so much talk of sorrow and anguish before they stop listening, the problem with the latter is that even the best actors break character every now and then, they drop lines and miss entrances, their masks become translucent when confronted with the right light.

Depression for me is hitting the “reject call” button on my cell phone after recognizing the number on the caller ID, out of complete ambivalence as to whether I talk to whoever’s on the other end of the phone. It is refusing to eat, even when threatened with the insertion of a feeding tube; not out of vanity, or out of a compulsion to lose weight, but out of a strong desire to withhold food from myself. It is pretending to be asleep when friends, family, or even medical staff enter my room; it is detesting the thought of even basic conversation or socialization with anyone. It is hitting the snooze button on the alarm over and over in a desperate attempt to spend the day sleeping, for in sleep we can escape our own realities. It is not wanting to “snap out of it,” because that would require admitting the potential capability of experiencing joy on some level.

In the days and weeks to come I know that I’ll “snap out of it.” I’ll get back to work, I’ll start to eat again, I’ll return all of the phone calls from friends and go out for martinis with them on Fridays. But there’s still the lingering thought that my depression isn’t cured so much as it’s in hibernation. Paxil isn't a remedy. It will simply make my bad days more bearable while reducing my great days to the same intensity.... bearable.

I had surgery to remedy my back pain after exhausting all other options; I’m currently looking for a solution to remedy my chronic depression. Yet, the difference between dealing with physical and psychic pain is vast. When dealing with physical pain there always seems to be another doctor, another procedure, another reason to hope that the pain will subside. But with psychic pain, the realization is that there is no remedy. In the brilliant words of William Styron: “In depression… the pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come—not in a day, an hour, a month, or a minute. It is hopelessness even more than pain that crushes the soul.”