OUT LOUD: The Realities of Depression and Suicide
In honor of Gail, The RiverGuidess (1956–2015)
When the Academy Award for best Documentary Short went to CRISIS HOTLINE: VETERAN’S PRESS, its producer, Dana Perry, stood out like a napalmed thumb among Hollywood’s glitziest. She dedicated her Oscar to the 15-year-old son she lost to suicide, declaring, “We should talk about suicide out loud.”
Perry later told reporters: “We need to talk about suicide to work against the stigma … because the best prevention for suicide is awareness and discussion, not trying to sweep it under the rug.”
I took her statements to heart.
So I’m talkin’.
I’ve been reluctant to weigh in on the weighty topic of depression in a public forum for very personal reasons. However, I recently became keenly aware that to stay silent and put on my fall-back facade is to turn away from my truth and become a doormat to shame.
Over the past decade, three of my treasured women friends— beautiful, brilliant, extraordinary women — made a conscious decision to leave this world.
Each woman’s life was ravaged by depression.
Each had felt suicidal off and on throughout her life.
Each made her departure alone. And each left us private little hints that we recognized, in retrospect, as tender, thoughtful good-byes.
Choosing to die by your own hand is a very personal decision, perhaps the single most personal decision an individual can make. It was certainly the most difficult choice ever pondered by Gail, Bernadette, and Janna.
I know. From experience. Having pondered. And pondered. And planned, and cried, and raged, and fell to my knees begging for mercy, then pondered some more.
For those of you who don’t know me and haven’t been exposed to my underbelly, let me bare it now.
For a year and a half in 2012–2013, I lived with a compelling urge to go off the rails, throw myself under the bus, and make the ultimate choice. Thinking about ending it all was not a foreign experience. I’ve long since made peace with the voice in my head that yells, “I’m done. Get me outta here!” and see it as my psyche’s pressure-relief valve. But this time was different. Much different.
Initially, I attributed the thoughts to chronic sleep-deprivation, compounded by a love affair that capsized, a crushing business failure, the need to re-invent myself (yet again), a heart-wrenching rift with a branch of my family, and the loss of beloved Bernadette, whose suicide coincided with my decent into hell. Stressors like these can bring even the most resilient among us down.
When a person is down or mildly depressed for more than two weeks, it becomes ever more difficult to turn it around. Negative thought-streams like self-pity and self-condemnation have an irresistible pull. Once the downward-rushing thoughts take hold, even the “normal” stuff of life becomes oppressive as you go deeper into the darkness.
That’s what happened to me as I watched longtime friends send their kids off to college and started believing that my very conscious choice to opt out of having children was an idiotic mistake. My dis-regulated mind convinced me I had cheated myself out of one of the most rewarding parts of life, adding to my already heavy emotional burden. Pile on the stress of leaving the man and the home I’d loved for seven years, my Lexus (and girl cave) getting totaled, and a stubborn ankle injury that made it nearly impossible to exercise, and anyone who isn’t blessed with super-powers would be down in the dumps.
This was not a midlife crisis, a dark night of the soul, a descent into the underworld, and it certainly wasn’t garden-variety depression. I had a textbook case of severe clinical depression with all but one of the diagnostic criteria for Major Depressive Episode and a number of the criteria for anxiety disorder. It felt like a rat was gnawing away in my stomach 70% of the time. My speech was muddled, my eyes cast down, my gait reduced to a shuffle. My brain actually shrunk, as evidenced by the fact that I could adjust the cranial plates of my skull. I could not write or think clearly. The self I had known was nowhere to be found. Clinical depression had stolen everything. This went on for 18 months.
There. I said it.
Take that, shame.
Clinical depression is a measurable syndrome that renders its victims unable to take pleasure in activities that once brought them joy. In shrink-rap we call this anhedonia, i.e.: the polar opposite of hedonism, the total absence of pleasurable sensations, emotions, states of mind and body. Nada. Zip. Zilch. Zero. You’re in a dead zone. Moreover, the afflicted individual loses all interest, all ability to pursue enjoyable activities. Your libido goes belly-up (and I’m not talking missionary position), and your appetite becomes a live-wire flying around everywhere looking for comfort — to no avail.
You know that you are truly ready to fly over the cuckoo’s nest when your formerly rich inner-life is hijacked by a jet stream of negative thoughts that tell you God is insane and there is only one way out of this hell.
Everything you’ve known yourself to be — intelligent, sexy, creative, athletic, friendly, articulate, energetic, confident— it’s all gone. For months, even years, on end. And your depression convinces you it will never come back.
Imagine.
You can’t.
You either know the territory or you don’t.
If you’ve never been there, don’t pretend to understand. It doesn’t help.
Don’t say, “Everyone is having a hard time lately; the world is in transition.”
Or, “I was depressed until I chose to be happy and began to create my reality.” Or, “Just go out and dance it through,” (see definition of anhedonia, above).
And if someone says “I’m done. I want out!” please, please, please don’t say, “You’ll just have to come back and do it again,” or “You’ll get stuck in the Bardo,” or, “You’ll end up in purgatory for all of eternity.” (Notably, the Catholic Church has softened their position on this a bit.)
Please don’t use hackneyed phrases like, “It’s a permanent solution to a temporary problem,” (not true for those who’ve had episodes of clinical depression throughout their adult lives). And definitely eschew trite, ethereal phrases like, “You’re in your second Saturn return.”
Oh, and do quash your urge to flatter with, “But Goddess, you are so beautiful!” or to cheer your friend up with a bit humor: “Sounds like your cheese has slid off the cracker.”
Better to say, “I don’t really understand what you’re going through, but I can see that you’re in pain. I wish I knew how to help. Is there anything I can do?” And then do whatever you can, respecting your means and personal limits.
One of my favorite teachers once explained it this way: “Depression is a different dimension altogether. It’s like a rip tide. You can’t get out on your own. If you fight it, you just get dragged down faster and harder. You have to relax and surrender, allow a power stronger than the tides to pull you out.”
For me, that stronger power was not faith or hope, not meditation or yoga, not the higher love I’d felt when a near-death experience gave me a glimpse of God. The stronger power that saved my life was my family and community. If it weren’t for the handful of people who stepped up and pulled for me, I probably wouldn’t be here. Thank you to my infinitely patient, albeit boondoggled, high-functioning mother. Thank you to my big brother who brought his level head to the table. Thank you to his wife who stayed on the phone with me and held solid ground while I big-wave surfed countless panic attacks until I remembered how to breathe. Thank you to Bobby Love, who did all he could to keep me from drowning while keeping his scuba diving business afloat. Thank you to my four precious friends (you know who you are) who had the requisite empathy and compassion to say: “I don’t want to see you in so much pain. If you decide to go, I’ll honor your decision.” And thank you to my saviors: Susan, Tim & Taylor Bratton who adopted me into their family and cared for me for 10 months.
Okay. Deep breath.
At the risk of over-sharing, I am compelled to tell you a little more of my story. My shame is screaming: “Don’t you dare say that OUT LOUD!” But my All Knowing Self will not allow me to keep this card cemented to my chest in the wake of Gail’s death and in light of her reluctance to follow in my spiritually-incorrect footsteps.
In the depths of suicidal depression and anxiety that was so debilitating, I rarely went out of the house for an entire summer, Susan Bratton led the search until we found Dr. William Prey.
Prey did not slap me with a diagnosis and write me a prescription like the other psychiatrists (five of them) I consulted in an effort to save my own life. I spent two thousand dollars looking for someone I could trust. I could not, would not allow a doctor to shrink me into a diagnostic frame and straightjacket me with drugs. Prey listened carefully and identified a variety of causes for my condition: an overwhelming number of life-stressors, two untreated head injuries, too much glutamine and not enough gaba in my brain (likely since adolescence), a mis-managed thyroid condition, the loss of my precious estrogen due to menopause, and debilitating insomnia (at one point, I went 14 days without sleep).
Prey didn’t pull out his prescription pad and write a med order for Seroquel (a super-strong sedative), or Depakote (a highly toxic anti-depressant), or Geodon (a sedative-hypnotic with nightmarish side effects), or Abilify (the add-on medication that increases the “efficacy” of all the above). Prey did not scare the bejeezus out of me with a blank-eyed look like the other five doctors. (One of the shrinks actually prescribed Restoril, a benzodiazepine — think Valium or Xanax — knowing full well that I’d had an extreme reaction to benzos in the past. I told him to get his head out of his ass and refused to pay his final bill.)
Over the course of 15 months, Dr. Prey and I worked together to drill down an effective combination of thyroid medication, a mild non-toxic pharmaceutical that modulates glutamine in the brain, essential fatty acids, vitamins, and a specific amino acid profile (no tryptophan or 5HTP for me).
Prey is both a psychiatrist and a sleep doc by training, so he was also able to address my chronic insomnia. He counseled me to make lifestyle changes that would help re-establish my circadian rhythms: eating breakfast within half an hour of waking (still hard, but I’m getting there), cutting out coffee (duh), taking a short walk first thing in the morning, staying away from bright overhead lights in the evening, getting back into regular exercise, establishing a daily meditation practice — none of which is easy when you’re in unremitting mental anguish and physical pain.
On a couple of occasions when I was in need of extreme measures, Prey prescribed intravenous ketamine, a treatment that has been clinically proven to break the descending spiral of depression. The treatment allowed me to see the light and remember who I am for a week, sometimes two. These brief glimpses of sunshine in the midst of an 18-month long Category 5 shit-storm were a literal a life-saver.
Recovering from depression takes time and patience. But treatment can work and recovery is possible. As bizarre as it sounds, some of us are actually blessed by the experience and learn firsthand the true meaning of the meme “What doesn’t kill you makes you stronger.” Thanks to Dr. Prey, not only did my brain heal, it got sharper and quicker than before. I tried to impress this upon Gail and, in the last weeks of her life, insisted she give medication a fair trial.
During the final weeks of her life, I got together with Gail on three occasions. We went for one of our long, heart-to-heart walks; she told me that she was done, done, done and wanted out. (I’d heard this from her many times before.) Another night, we went to a movie, and another for a bite to eat at Boca Pizzeria. She talked and laughed about her various exit strategies. I played along, thinking she just needed to say the words out loud to blow off the silent steam of shame people feel when they have suicidal thoughts. So I listened, knowing full well what it’s like to fall down that black hole where you feel utterly bereft and completely alone.
The last text I would ever receive from Gail came just a few days later. I had bailed out on our plan to go to a Super Bowl party, so she went without me. Her text the next morning said: “It was fun!”
A week later, she was gone.
If I could turn back the clock and do anything different, I wouldn’t have left it up to Gail to get herself to the clinic and talk to someone about anti-depressants. I would have taken her by the hand and marched her down there myself.
But Gail’s patience, her endurance, her inner resources were tapped out. She’d suffered enough. It wasn’t a matter of being, as one of her musician friends said, “unable to let love in.” Gail knew she was loved. She also knew that she could no longer stand to be buried alive by the pain that swallowed her up again and again.
Some people see suicide as an act of defying God. Others see it as an act of self-hatred. Still others, call it the coward’s way out. In some cases those characterizations are valid. Not with Gail. Nor Bernadette, nor Janna. Each of these women left the visible world with humility and grace in an act of free will that took a certain kind of courage that no one who hasn’t walked in their shoes can possibly understand.
Geralyn Gendreau, LMFT, is an author, editor, ghostwriter, and writing coach who has been helping authors finish their books for 20 years. She loves to show writers how to build emotional momentum and become one of those authors who says: “My book practically wrote itself!” Connect with Geralyn and she’ll send you her 3 Pro Tips to FINALLY FINISH YOUR BOOK!
