Back in April of 2009, I posted the following blog entry about depression, titled "Understanding Suicide," on Salon's blog site. It eliclited a number of responses, mostly positive and compassionate, but there were some that still felt suicide was a "selfish" act, a stance that while understandable, I still find deeply troubling and incredibly frustrating. In the wake of Robin Williams' tragic suicide, I'll once again post this essay, only here on my own site, in the hopes of spreading the word that suicide is the fatal outcome of a disease called depression, not a morally corrupt choice.
During the past few weeks or so, I've noticed that on some mornings, I've been waking in a state of depression, which is a bit alarming as I know all too well just how devastating a full-blown clinical depression can be.
Obviously, I'm struggling deeply with the wear of chronic physical pain, and my brain chemistry is starting to give way, just like it did five years ago when an infection, which I thought had been cured two years earlier after 18 months of agony, took up residency in my jaw and face again (and has been there ever since).
As any hope for a cure seemed so hopeless back then, I slowly began to sink into a hole so black, so absolute, that all roads seemed to point to just one solution if I was ever going to get out of pain, and that solution was suicide. This led to a stint in the local hospital's psych ward, and then a few weeks later, admission to a psychiatric hospital.
With all of the physical complications I've endured as a result of this blood disorder, frequently spending weeks in the hospital at a time, I can say with absolute certainty that nothing--nothing--is as painful as a major clinical depression. And nothing, it seems, is as misunderstood by so many, particularly when it's accompanied by suicidal ideation.
For most people, suicide is unthinkable, so when a loved one takes his or her own life, we can get lost in a state of confusion and anger. I recall reading a book by a psychiatrist a few years ago who'd lost both of his sons in a 13-month period--one was a six-year-old who'd died of cancer and the other was a teenage boy who'd killed himself.
What was shocking, aside from the obvious tragedy of losing two children in such a short amount of time, was that the doctor talked little about his teenager, saying only that suicide was the ultimate "selfish" act, and he chose instead to write about his six-year-old, as the younger boy's ordeal was most likely easier to understand. The boy was, in a sense, an innocent victim of his disease, unlike his "selfish" brother who took his own life.
I remember feeling such shock that this esteemed psychiatrist, of all people, didn't understand the fatal power of depression.
A few years ago, I was hired as a freelance medical editor for a few months, and I was lucky enough to edit tons of the latest materials about depression and suicide. Perhaps what's most misunderstood about clinical depression is that it's not just a state of malaise or of feeling blue; it's a medical disease that if left untreated will only worsen throughout one's lifetime.
In the same way that Type II diabetics cannot absorb their own insulin, when clinical depression occurs, receptors in the brain close, and a person can no longer absorb their own serotonin, along with some other key chemicals.
Why this shutdown happens is still a mystery. Take, for example, a set of twins, both raised by the same parents in the same circumstances. In response to a tragedy, one twin will go through a normal grief period while the other will go into a major depression, and no one knows why. All that's known is that a person simply cannot function without these crucial brain chemicals, and the act of suicide is simply a way to get out of excruciating psychic pain.
In my own case, before I got depressed, I was going through one of the happiest periods of my life. For years I'd worked to get myself to a place where I'd perfectly balanced my work life (freelance writing and editing) and my creative life (songwriting and painting), and felt more inspired and joyous than I had in years.
This is what made the sudden return of chronic pain so devastating, and what ultimately made my receptors close to the very chemicals so necessary to live.
It's hard to describe suicidal depression, but essentially, it's a loss of control over our own emotional state. Ordinarily, when one is down or feeling blue, there are things that can lift the spirit, like inspirational readings, listening to music, and talking with others. But when one is clinically depressed, absolutely nothing works to lift the darkness, and slowly the will to live can begin to erode.
In the same way one in chronic pain can lose hope that anything will ever change, the depressed patient also loses hope for a cure, and a battle surfaces between our primal will to survive and an aching desire to no longer feel this hell on earth.
In that sense, the act of suicide is the fatal outcome of a deadly disease, not a moral choice by the patient. Far from being selfish or cowardly, when a depressed patient reaches the decision to end his or her own life, nothing is more harrowing or frightening, because there's the realization that pain has overrode the fundamental desire to live. It's hard to imagine that anything in life could be that painful, but unfortunately, these states exist, and the last thing we should do is judge someone in this unthinkable quandary.
In my own case, I knew that I'd reached the limits of my endurance five years ago when I awoke one morning and felt no love whatsoever for anyone in my life anymore (even my mom), as every emotion had become eclipsed by pain. I was shocked at this revelation, because I knew the things that had been keeping me alive--namely the desire to not hurt anyone in my family--were no longer operating. I intuitively knew that I had about 24 hours left to live, and so I called a suicide hotline, which in turn called an ambulance for me, even though my local hospital is just two blocks away.
That's how bad I was; I couldn't even walk this short distance, as every ounce of energy was going into just staying alive and not swallowing the bottle of pills that offered permanent relief.
In time (four agonizing weeks or so), the antidepressants began to work, but not everyone is so lucky, particularly those who've struggled with depression repeatedly in their lives. Studies have shown that clinical depression actually damages the brain, and if left untreated, the illness only gets worse throughout one's lifetime. As the years roll by, the depressions become more frequent, more severe, and require less stimulus to set them off. That's why intervention with medication as soon as possible is so paramount to healing.
Studies have also shown that antidepressants can actually have a curative effect, meaning that if the first depression is treated with medication and therapy, the likelihood of it happening again decreases sharply.
Of course, there are those patients who use a suicide attempt as a cry for help, or as a means to get attention, and some of them do end up dying. But for the patient who is suffering from severe and extended clinical depression, suicide is nothing more than a way out of a type of pain that can never really be put into words.
I've heard it said that suicide is "a permanent solution to a temporary problem," but this isn't quite accurate, at least in terms of a major clinical depression. For some, the problem is debilitating and lifelong, and for these patients, suicide is the means to finally rest, even at the cost of life itself.