Carrol Cox cbcox at
Mon Aug 28 11:25:10 PDT 2000

kelley wrote:

> <snip stuff that would illustration talcott parson's discussion of the
> 'sick role' nicely>
> > You know nothing that every
> >depressed patient has not been told by psychiatrists, therapists, books,
> >articles, friends, him/herself a thousand times.
> well i never heard that lots of activity and exercise helped before, so there!

O.K. Now you know. It is remarkable how exercise helps *some* who suffer from depressive illness. It is equally remarkable how it utterly fails to help others. "Activity" is a rather vague term. At almost any meeting of a support group there will be at least mention of two things. It does help (mostly in the sense of providing distraction) to get active, and secondly, one of the major symptoms of depression is the serious inability to get active. So if you meet up with a sufferer from depressive illness hiding at home, probably the inactivity is a symptom or result rather than cause of the depression. One of Jan's close friends recently discovered that she suffers from depression; she began taking paxil, and it helped a lot. But then she started taking it only when she felt bad, which is worse than useless, since if Paxil works it works by preventing depression not by 'curing' it. I think this friend has been running into trouble this summer (she teaches school and is on vacation) in simple things, like brushing her teeth, showering, besides severe insomnia and a terrible reluctance to leave her apartment. Activity (forced activity) will probably help her some when the school year begins, but it is uncertain.

> >You are an ingnorant shit.

> such a charmer you are.

Well, Reese is. I've never called you names, though you piss me off quite often.

> i have a question, how do "they" know the difference between depression
> and Depression?

Good question. Often "they" don't. Often the sufferer doesn't. If you start failing to take a shower or start stuffing yourself with chocalate or start fearing to answer the phone or open your mail, in addition to feeling like shit, you may be suffering from depression. I probably suffered from depression from the age of 12 or so on -- I started getting treatment at around 55.

> having lived for three and half years with someone who
> seemed fine and then who, gradually, started singking deeper and deeper
> into a depression, i started doing some research to see if this was
> something more than a severe reaction to several rather traumatic
> events: father committed suicide, no job, band broke up/falling out with
> friends/, and mother and older siblings moved out of state.

There is strong evidence that in bipolar ("manic depression") there is a genetic element -- which does not mean that it is inherited. There is only conflicting evidence on whether there is a genetic element in depression or not. My father suffered from depression and migraine. His father was a binge drinker once or twice a year (perhaps meant nothing, perhaps meant something). His older sister set herself on fire (she was in her late fifties) and killed herself. Two aunts and my grandmother suffered from severe migraine. My father's older brother probably suffered from depression late in life -- but he also had malaria from service in New Gunea, so it's a tossup. My younger daughter suffers from both migraine and depression. I know a number of families with that sort of cluster, but unlike in the case of bipolar, in which systematic studies have shown a genetic factor with some certainty, the evidence in the case of unipolar is still mostly anecdotal and not wholly persuasive. The point of this is that it's interesting that your friend's father committed suicide. It's estimated that over 90% of all sucides involve depression.

We/they/everyone do *not* know (except for a few tentative guesses) how depression comes into existence. What knowledge "we" do have is tentative and superficial. A high proportion of patients have suffered from childhood abuse (physical, emotional, sexual) but not all by any means. As I said in an earlier post, extreme grief is not itself depression, but it can (apparently, but "how" is not exactly known) cause the person to develop depression.

> iseemed to me, at the time, that there was no way to tell the difference
> between depression and Depression. but i read you and some folks at the
> pulp culture list and there is an insistence that there is absolutely a
> difference. so how do they tell?

Not easy. It is only in retrospect that I can recognize past instances of depression. At the time I either ascribed them to this or that external cause or to some foul-up on my own part. There can be a bewildering intermixture of cause and effect. A bit of gallows humor. Back when I was in the Air Force (and still had a naive trust in psychiatry) I remember telling my wife that I suffered from pathological procrastination and that probably I ought to seek psychiatric counselling on it some day. She said, don't be crazy. But she was wrong, I was crazy. The first line in Pound's *Cantos* that really gripped me was "and the mortal fatigue of action postponed." It seemed to describe my life -- and for decades I explained my own experience as the result of such postponement of action, never suspecting that such postponement was *itself* a symptom of illness.

One way (sort of) to tell is to try out anti-depressants for awhile. If they work, then you probably suffer from depression. If they don't work, then perhaps you don't suffer from depression -- or you are among the 30% that ADs don't help, or you haven't tried the right AD for you, or ... One symptom of depression, incidentally, is worrying that maybe you aren't depressed but merely a lazy bum. If you find that sitting on the floor against the wall with your head between your legs seems a good thing to do, perhaps you are suffering from depression.

There may or may not be a separate condition named "Anxiety," or thay may be only a symptom of depression -- or . . . . Therapy helped there. I was talking to my therapist about the lead ball in one's chest -- and she informed me that it was a build-up of carbon dioxide in the lower lungs. It develops with incredible rapidity -- but it is caused by shallow breathing that doesn't get to the lower lung. Deep breaths make it go away. There really is a lot not known about depression (or the brain in general). I just get pissed off at those who seize on this real ignorance as a basis for total (and quite destructive) skepticism concerning what really is known.

To end on a positive about ADs. A student in one of my advanced classes some years ago told me that she was taking Prozac but that her mother refused to admit that a daugher of hers could be "crazy," so she lied to her mother and said that she needed Prozac as a migraine treatment. (Most ADs do help migraine.) And then she added, referring to those that were afraid that taking ADs would "change" them somehow. Prozac, she said, didn't change her. It simply helped her to actually be what she was.


> kelley

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