1 00:00:04,049 --> 00:00:07,946 "I felt a funeral in my brain, 2 00:00:07,946 --> 00:00:10,410 and mourners to and fro 3 00:00:10,410 --> 00:00:13,041 kept treading, treading til I felt 4 00:00:13,041 --> 00:00:15,929 that sense was breaking through. 5 00:00:15,929 --> 00:00:17,713 And when they were all were seated, 6 00:00:17,713 --> 00:00:19,757 a service, like a drum, 7 00:00:19,757 --> 00:00:22,315 kept beating, beating, 8 00:00:22,315 --> 00:00:25,955 til I felt my mind was going numb. 9 00:00:25,955 --> 00:00:27,907 And then I heard them lift a box 10 00:00:27,907 --> 00:00:30,148 and creak across my soul 11 00:00:30,148 --> 00:00:33,100 with those same boots of lead again, 12 00:00:33,100 --> 00:00:36,178 then space began to toll, 13 00:00:36,178 --> 00:00:38,396 as if the heavens were a bell 14 00:00:38,396 --> 00:00:40,340 and being were an ear, 15 00:00:40,340 --> 00:00:44,193 and I, and silence, some strange race wrecked 16 00:00:44,193 --> 00:00:46,570 solitary here. 17 00:00:46,570 --> 00:00:49,809 Just then, a plank in reason broke, 18 00:00:49,809 --> 00:00:53,015 and I fell down and down 19 00:00:53,015 --> 00:00:55,825 and hit a world at every plunge, 20 00:00:55,825 --> 00:01:00,429 and finished knowing then." 21 00:01:00,429 --> 00:01:03,773 We know depression through metaphors. 22 00:01:03,773 --> 00:01:07,482 Emily Dickinson was able to convey it in language, 23 00:01:07,482 --> 00:01:10,269 Goya in an image. 24 00:01:10,269 --> 00:01:12,221 Half the purpose of art 25 00:01:12,221 --> 00:01:16,026 is to describe such iconic states. 26 00:01:16,026 --> 00:01:19,957 As for me, I had always thought myself tough, 27 00:01:19,957 --> 00:01:21,491 one of the people who could survive 28 00:01:21,491 --> 00:01:24,691 if I'd been sent to a concentration camp. 29 00:01:24,691 --> 00:01:27,651 In 1991, I had a series of losses. 30 00:01:27,651 --> 00:01:29,291 My mother died, 31 00:01:29,291 --> 00:01:31,509 a relationship I'd been in ended, 32 00:01:31,509 --> 00:01:33,229 I moved back to the United States 33 00:01:33,229 --> 00:01:35,407 from some years abroad, 34 00:01:35,407 --> 00:01:38,695 and I got through all of those experiences intact. 35 00:01:38,695 --> 00:01:41,693 But in 1994, three years later, 36 00:01:41,693 --> 00:01:46,102 I found myself losing interest in almost everything. 37 00:01:46,102 --> 00:01:47,888 I didn't want to do any of the things 38 00:01:47,888 --> 00:01:50,076 I had previously wanted to do, 39 00:01:50,076 --> 00:01:52,037 and I didn't know why. 40 00:01:52,037 --> 00:01:53,821 The opposite of depression 41 00:01:53,821 --> 00:01:57,211 is not happiness, but vitality, 42 00:01:57,211 --> 00:01:58,691 and it was vitality 43 00:01:58,691 --> 00:02:02,221 that seemed to seep away from me in that moment. 44 00:02:02,221 --> 00:02:04,314 Everything there was to do 45 00:02:04,314 --> 00:02:06,581 seemed like too much work. 46 00:02:06,581 --> 00:02:08,197 I would come home 47 00:02:08,197 --> 00:02:11,564 and I would see the red light flashing on my answering machine, 48 00:02:11,564 --> 00:02:13,632 and instead of being thrilled to hear from my friends, 49 00:02:13,632 --> 00:02:15,241 I would think, 50 00:02:15,241 --> 00:02:18,445 "What a lot of people that is to have to call back." 51 00:02:18,445 --> 00:02:20,879 Or I would decide I should have lunch, 52 00:02:20,879 --> 00:02:23,425 and then I would think that I'd have to get the food out 53 00:02:23,425 --> 00:02:25,433 and put it on a plate 54 00:02:25,433 --> 00:02:29,636 and cut it up and chew it and swallow it, 55 00:02:29,636 --> 00:02:33,367 and it felt to me like the Stations of the Cross. 56 00:02:33,367 --> 00:02:35,695 And one of the things that often gets lost 57 00:02:35,695 --> 00:02:37,582 in discussions of depression 58 00:02:37,582 --> 00:02:39,894 is that you know it's ridiculous. 59 00:02:39,894 --> 00:02:42,614 You know it's ridiculous while you're experiencing it. 60 00:02:42,614 --> 00:02:44,620 You know that most people manage 61 00:02:44,620 --> 00:02:47,103 to listen to their messages and eat lunch 62 00:02:47,103 --> 00:02:48,969 and organize themselves to take a shower 63 00:02:48,969 --> 00:02:50,599 and go out the front door 64 00:02:50,599 --> 00:02:51,969 and that it's not a big deal, 65 00:02:51,969 --> 00:02:55,014 and yet you are nonetheless in its grip 66 00:02:55,014 --> 00:02:59,043 and you are unable to figure out any way around it. 67 00:02:59,043 --> 00:03:03,236 And so I began to feel myself doing less 68 00:03:03,236 --> 00:03:05,126 and thinking less 69 00:03:05,126 --> 00:03:07,802 and feeling less. 70 00:03:07,802 --> 00:03:10,142 It was a kind of nullity. 71 00:03:10,142 --> 00:03:12,647 And then the anxiety set in. 72 00:03:12,647 --> 00:03:14,694 If you told me that I'd have to be 73 00:03:14,694 --> 00:03:16,454 depressed for the next month, 74 00:03:16,454 --> 00:03:19,692 I would say, "As long I know it'll be over in November, I can do it." 75 00:03:19,692 --> 00:03:21,044 But if you said to me, 76 00:03:21,044 --> 00:03:24,094 "You have to have acute anxiety for the next month," 77 00:03:24,094 --> 00:03:26,450 I would rather slit my wrist than go through it. 78 00:03:26,450 --> 00:03:28,263 It was the feeling all the time 79 00:03:28,263 --> 00:03:30,399 like that feeling you have if you're walking 80 00:03:30,399 --> 00:03:31,956 and you slip or trip 81 00:03:31,956 --> 00:03:33,855 and the ground is rushing up at you, 82 00:03:33,855 --> 00:03:36,512 but instead of lasting half a second, the way that does, 83 00:03:36,512 --> 00:03:38,542 it lasted for six months. 84 00:03:38,542 --> 00:03:41,328 It's a sensation of being afraid all the time 85 00:03:41,328 --> 00:03:45,242 but not even knowing what it is that you're afraid of. 86 00:03:45,242 --> 00:03:47,539 And it was at that point that I began to think 87 00:03:47,539 --> 00:03:51,707 that it was just too painful to be alive, 88 00:03:51,707 --> 00:03:54,168 and that the only reason not to kill oneself 89 00:03:54,168 --> 00:03:57,531 was so as not to hurt other people. 90 00:03:57,531 --> 00:04:00,004 And finally one day, I woke up 91 00:04:00,004 --> 00:04:02,347 and I thought perhaps I'd had a stroke, 92 00:04:02,347 --> 00:04:04,986 because I lay in bed completely frozen, 93 00:04:04,986 --> 00:04:07,043 looking at the telephone, thinking, 94 00:04:07,043 --> 00:04:10,559 "Something is wrong and I should call for help," 95 00:04:10,559 --> 00:04:12,340 and I couldn't reach out my arm 96 00:04:12,340 --> 00:04:14,772 and pick up the phone and dial. 97 00:04:14,772 --> 00:04:18,911 And finally, after four full hours of my lying and staring at it, 98 00:04:18,911 --> 00:04:20,395 the phone rang, 99 00:04:20,395 --> 00:04:22,351 and somehow I managed to pick it up, 100 00:04:22,351 --> 00:04:24,136 and it was my father, 101 00:04:24,136 --> 00:04:27,055 and I said, "I'm in serious trouble. 102 00:04:27,055 --> 00:04:29,652 We need to do something." 103 00:04:29,652 --> 00:04:32,903 The next day I started with the medications 104 00:04:32,903 --> 00:04:35,578 and the therapy. 105 00:04:35,578 --> 00:04:37,855 And I also started reckoning 106 00:04:37,855 --> 00:04:39,657 with this terrible question: 107 00:04:39,657 --> 00:04:41,730 if I'm not the tough person 108 00:04:41,730 --> 00:04:44,116 who could have made it through a concentration camp, 109 00:04:44,116 --> 00:04:45,879 then who am I? 110 00:04:45,879 --> 00:04:47,736 And I have to take medication, 111 00:04:47,736 --> 00:04:51,151 is that medication making me more fully myself, 112 00:04:51,151 --> 00:04:53,831 or is it making me someone else? 113 00:04:53,831 --> 00:04:55,558 And how do I feel about it 114 00:04:55,558 --> 00:04:58,189 if it's making me someone else? 115 00:04:58,189 --> 00:05:01,470 I had two advantages as I went in to the fight. 116 00:05:01,470 --> 00:05:04,357 The first is that I knew that objectively speaking, 117 00:05:04,357 --> 00:05:06,081 I had a nice life, 118 00:05:06,081 --> 00:05:07,988 and that if I could only get well, 119 00:05:07,988 --> 00:05:09,503 there was something at the other end 120 00:05:09,503 --> 00:05:11,180 that was worth living for. 121 00:05:11,180 --> 00:05:14,222 And the other was that I had access to good treatment. 122 00:05:14,222 --> 00:05:17,986 But I nonetheless emerged and relapsed, 123 00:05:17,986 --> 00:05:20,311 and emerged and relapsed, 124 00:05:20,311 --> 00:05:23,386 and emerged and relapsed, 125 00:05:23,386 --> 00:05:25,231 and finally understood 126 00:05:25,231 --> 00:05:27,552 I would have to be on medication 127 00:05:27,552 --> 00:05:29,832 and in therapy forever. 128 00:05:29,832 --> 00:05:32,160 And I thought, "But is it a chemical problem 129 00:05:32,160 --> 00:05:33,970 or a psychological problem? 130 00:05:33,970 --> 00:05:37,559 And does it need a chemical cure or a philosophical cure?" 131 00:05:37,559 --> 00:05:39,741 And I couldn't figure out which it was. 132 00:05:39,741 --> 00:05:41,895 And then I understood that actually, 133 00:05:41,895 --> 00:05:44,246 we aren't advanced enough in either area 134 00:05:44,246 --> 00:05:46,152 for it to explain things fully. 135 00:05:46,152 --> 00:05:49,492 The chemical cure and the psychological cure 136 00:05:49,492 --> 00:05:51,216 both have a role to play, 137 00:05:51,216 --> 00:05:54,606 and I also figured out that depression was something 138 00:05:54,606 --> 00:05:57,416 that was braided so deep into us 139 00:05:57,416 --> 00:05:59,143 that there was no separating it 140 00:05:59,143 --> 00:06:01,583 from our character and personality. 141 00:06:01,583 --> 00:06:03,569 I want to say that the treatments we have 142 00:06:03,569 --> 00:06:06,175 for depression are appalling. 143 00:06:06,175 --> 00:06:07,927 They're not very effective. 144 00:06:07,927 --> 00:06:09,850 They're extremely costly. 145 00:06:09,850 --> 00:06:12,361 They come with innumerable side effects. 146 00:06:12,361 --> 00:06:14,089 They're a disaster. 147 00:06:14,089 --> 00:06:17,066 But I am so grateful that I live now 148 00:06:17,066 --> 00:06:18,823 and not 50 years ago, 149 00:06:18,823 --> 00:06:20,303 when there would have been almost nothing 150 00:06:20,303 --> 00:06:21,982 to be done. 151 00:06:21,982 --> 00:06:24,087 I hope that 50 years hence, 152 00:06:24,087 --> 00:06:26,025 people will hear about my treatments 153 00:06:26,025 --> 00:06:28,168 and be appalled that anyone endured 154 00:06:28,168 --> 00:06:30,826 such primitive science. 155 00:06:30,826 --> 00:06:35,473 Depression is the flaw in love. 156 00:06:35,473 --> 00:06:38,768 If you were married to someone and thought, 157 00:06:38,768 --> 00:06:42,485 "Well, if my wife dies, I'll find another one," 158 00:06:42,485 --> 00:06:45,347 it wouldn't be love as we know it. 159 00:06:45,347 --> 00:06:47,375 There's no such thing as love 160 00:06:47,375 --> 00:06:50,051 without the anticipation of loss, 161 00:06:50,051 --> 00:06:52,632 and that specter of despair 162 00:06:52,632 --> 00:06:56,423 can be the engine of intimacy. 163 00:06:56,423 --> 00:06:58,983 There are three things people tend to confuse: 164 00:06:58,983 --> 00:07:02,952 depression, grief, and sadness. 165 00:07:02,952 --> 00:07:06,285 Grief is explicitly reactive. 166 00:07:06,285 --> 00:07:09,320 If you have a loss and you feel incredibly unhappy, 167 00:07:09,320 --> 00:07:11,040 and then, six months later, 168 00:07:11,040 --> 00:07:14,076 you are still deeply sad, but you're functioning a little better, 169 00:07:14,076 --> 00:07:15,903 it's probably grief, 170 00:07:15,903 --> 00:07:18,210 and it will probably ultimately resolve itself 171 00:07:18,210 --> 00:07:19,736 in some measure. 172 00:07:19,736 --> 00:07:22,381 If you experience a catastrophic loss, 173 00:07:22,381 --> 00:07:23,748 and you feel terrible, 174 00:07:23,748 --> 00:07:26,560 and six months later, you can barely function at all, 175 00:07:26,560 --> 00:07:29,009 then it's probably a depression that was triggered 176 00:07:29,009 --> 00:07:31,696 by the catastrophic circumstances. 177 00:07:31,696 --> 00:07:35,343 The trajectory tells us a great deal. 178 00:07:35,343 --> 00:07:38,624 People think of depression as being just sadness. 179 00:07:38,624 --> 00:07:40,899 It's much, much too much sadness, 180 00:07:40,899 --> 00:07:42,563 much too much grief 181 00:07:42,563 --> 00:07:45,568 at far too slight a cause. 182 00:07:45,568 --> 00:07:48,346 As I set out to understand depression, 183 00:07:48,346 --> 00:07:51,092 and to interview people who had experienced it, 184 00:07:51,092 --> 00:07:53,397 I found that there were people who seemed 185 00:07:53,397 --> 00:07:55,565 on the surface to have what sounded like 186 00:07:55,565 --> 00:07:57,749 relatively mild depression 187 00:07:57,749 --> 00:08:01,150 who were nonetheless utterly disabled by it. 188 00:08:01,150 --> 00:08:03,087 And there were other people who had what sounded 189 00:08:03,087 --> 00:08:04,643 as they described it 190 00:08:04,643 --> 00:08:06,786 like terribly severe depression 191 00:08:06,786 --> 00:08:09,678 who nonetheless had good lives in the intercesses 192 00:08:09,678 --> 00:08:11,879 between their depressive episodes. 193 00:08:11,879 --> 00:08:14,426 And I set out to find out what it is 194 00:08:14,426 --> 00:08:15,982 that causes some people 195 00:08:15,982 --> 00:08:18,343 to be more resilient than other people. 196 00:08:18,343 --> 00:08:19,810 What are the mechanisms 197 00:08:19,810 --> 00:08:21,654 that allow people to survive? 198 00:08:21,654 --> 00:08:25,027 And I went out and interviewed person after person 199 00:08:25,027 --> 00:08:27,105 who was suffering with depression. 200 00:08:27,105 --> 00:08:28,949 One of the first people I interviewed 201 00:08:28,949 --> 00:08:30,646 described depression 202 00:08:30,646 --> 00:08:34,086 as a slower way of being dead, 203 00:08:34,086 --> 00:08:36,338 and that was a good thing for me to hear early on 204 00:08:36,338 --> 00:08:37,766 because it reminded me 205 00:08:37,766 --> 00:08:39,642 that that slow way of being dead 206 00:08:39,642 --> 00:08:41,646 can lead to actual deadness, 207 00:08:41,646 --> 00:08:43,695 that this is a serious business. 208 00:08:43,695 --> 00:08:46,051 It's the leading disability worldwide, 209 00:08:46,051 --> 00:08:49,354 and people die of it every day. 210 00:08:49,354 --> 00:08:51,339 One of the people I talked to 211 00:08:51,339 --> 00:08:53,062 when I was trying to understand this 212 00:08:53,062 --> 00:08:54,826 was a beloved friend 213 00:08:54,826 --> 00:08:56,798 who I had known for many years, 214 00:08:56,798 --> 00:08:59,248 and who had had a psychotic episode 215 00:08:59,248 --> 00:09:01,213 in her freshman year of college, 216 00:09:01,213 --> 00:09:04,030 and then plummeted into a horrific depression. 217 00:09:04,030 --> 00:09:05,818 She had bipolar illness, 218 00:09:05,818 --> 00:09:08,094 or manic depression, as it was then known. 219 00:09:08,094 --> 00:09:10,382 And then she did very well 220 00:09:10,382 --> 00:09:12,083 for many years on lithium, 221 00:09:12,083 --> 00:09:13,574 and then eventually, 222 00:09:13,574 --> 00:09:15,349 she was taken off her lithium 223 00:09:15,349 --> 00:09:17,230 to see how she would do without it, 224 00:09:17,230 --> 00:09:19,062 and she had another psychosis, 225 00:09:19,062 --> 00:09:21,496 and then plunged into the worst depression 226 00:09:21,496 --> 00:09:23,430 that I had ever seen 227 00:09:23,430 --> 00:09:26,020 in which she sat in her parents' apartment, 228 00:09:26,020 --> 00:09:29,630 more or less catatonic, essentially without moving, 229 00:09:29,630 --> 00:09:32,042 day after day after day. 230 00:09:32,042 --> 00:09:35,452 And when I interviewed her about that experience some years later 231 00:09:35,452 --> 00:09:38,430 — she's a poet and psychotherapist named Maggie Robbins — 232 00:09:38,430 --> 00:09:41,247 when I interviewed her, she said, 233 00:09:41,247 --> 00:09:45,060 "I was singing 'Where Have All The Flowers Gone' 234 00:09:45,060 --> 00:09:48,487 over and over to occupy my mind. 235 00:09:48,487 --> 00:09:51,638 I was singing to blot out the things my mind was saying, 236 00:09:51,638 --> 00:09:56,143 which were, 'You are nothing. You are nobody. 237 00:09:56,143 --> 00:09:58,569 You don't even deserve to live.' 238 00:09:58,569 --> 00:10:00,978 And that was when I really started thinking 239 00:10:00,978 --> 00:10:03,313 about killing myself." 240 00:10:03,313 --> 00:10:05,252 You don't think in depression 241 00:10:05,252 --> 00:10:07,127 that you've put on a grey veil 242 00:10:07,127 --> 00:10:09,231 and are seeing the world through the haze 243 00:10:09,231 --> 00:10:11,109 of a bad mood. 244 00:10:11,109 --> 00:10:13,983 You think that the veil has been taken away, 245 00:10:13,983 --> 00:10:15,828 the veil of happiness, 246 00:10:15,828 --> 00:10:18,360 and that now you're seeing truly. 247 00:10:18,360 --> 00:10:21,155 It's easier to help schizophrenics who perceive 248 00:10:21,155 --> 00:10:23,212 that there's something foreign inside of them 249 00:10:23,212 --> 00:10:25,080 that needs to be exorcised, 250 00:10:25,080 --> 00:10:27,081 but it's difficult with depressives, 251 00:10:27,081 --> 00:10:31,287 because we believe we are seeing the truth. 252 00:10:31,287 --> 00:10:34,005 But the truth lies. 253 00:10:34,005 --> 00:10:36,094 I became obsessed with that sentence. 254 00:10:36,094 --> 00:10:38,531 "But the truth lies." 255 00:10:38,531 --> 00:10:40,814 And I discovered, as I talked to depressive people, 256 00:10:40,814 --> 00:10:43,665 that they have many delusional perceptions. 257 00:10:43,665 --> 00:10:45,393 People will say, "No one loves me." 258 00:10:45,393 --> 00:10:47,023 And you say, "I love you, 259 00:10:47,023 --> 00:10:49,475 your wife loves you, your mother loves you." 260 00:10:49,475 --> 00:10:51,520 You can answer that one pretty readily, 261 00:10:51,520 --> 00:10:53,247 at least for most people. 262 00:10:53,247 --> 00:10:55,253 But people who are depressed will also say, 263 00:10:55,253 --> 00:10:57,048 "No matter what we do, 264 00:10:57,048 --> 00:10:59,230 we're all just going to die in the end." 265 00:10:59,230 --> 00:11:01,541 Or they'll say, "There can be no true communion 266 00:11:01,541 --> 00:11:03,224 between two human beings. 267 00:11:03,224 --> 00:11:05,893 Each of us is trapped in his own body." 268 00:11:05,893 --> 00:11:07,573 To which you have to say, 269 00:11:07,573 --> 00:11:09,047 "That's true, 270 00:11:09,047 --> 00:11:10,881 but I think we should focus right now 271 00:11:10,881 --> 00:11:12,777 on what to have for breakfast." 272 00:11:12,777 --> 00:11:14,746 (Laughter) 273 00:11:14,746 --> 00:11:16,538 A lot of the time, 274 00:11:16,538 --> 00:11:19,250 what they are expressing is not illness, but insight, 275 00:11:19,250 --> 00:11:21,877 and one comes to think what's really extraordinary 276 00:11:21,877 --> 00:11:24,949 is that most of us know about those existential questions 277 00:11:24,949 --> 00:11:27,347 and they don't distract us very much. 278 00:11:27,347 --> 00:11:29,521 There was a study I particularly liked 279 00:11:29,521 --> 00:11:31,170 in which a group of depressed 280 00:11:31,170 --> 00:11:32,995 and a group of non-depressed people 281 00:11:32,995 --> 00:11:35,755 were asked to play a video game for an hour, 282 00:11:35,755 --> 00:11:37,584 and at the end of the hour, 283 00:11:37,584 --> 00:11:39,189 they were asked how many little monsters 284 00:11:39,189 --> 00:11:40,960 they thought they had killed. 285 00:11:40,960 --> 00:11:43,218 The depressive group was usually accurate 286 00:11:43,218 --> 00:11:45,169 to within about 10 percent, 287 00:11:45,169 --> 00:11:46,548 and the non-depressed people 288 00:11:46,548 --> 00:11:49,878 guessed between 15 and 20 times as many 289 00:11:49,878 --> 00:11:51,988 little monsters — (Laughter) — 290 00:11:51,988 --> 00:11:55,993 as they had actually killed. 291 00:11:55,993 --> 00:11:59,015 A lot of people said, when I chose to write about my depression, 292 00:11:59,015 --> 00:12:00,919 that it must be very difficult 293 00:12:00,919 --> 00:12:04,052 to be out of that closet, to have people know. 294 00:12:04,052 --> 00:12:06,089 They said, "Do people talk to you differently?" 295 00:12:06,089 --> 00:12:08,300 And I said, "Yes, people talk to me differently. 296 00:12:08,300 --> 00:12:10,183 They talk to me differently insofar 297 00:12:10,183 --> 00:12:13,204 as they start telling me about their experience, 298 00:12:13,204 --> 00:12:14,900 or their sister's experience, 299 00:12:14,900 --> 00:12:16,736 or their friend's experience. 300 00:12:16,736 --> 00:12:18,981 Things are different because now I know 301 00:12:18,981 --> 00:12:21,463 that depression is the family secret 302 00:12:21,463 --> 00:12:23,816 that everyone has. 303 00:12:23,816 --> 00:12:26,906 I went a few years ago to a conference, 304 00:12:26,906 --> 00:12:30,076 and on Friday of the three day conference, 305 00:12:30,076 --> 00:12:32,558 one of the participants took me aside, and she said, 306 00:12:32,558 --> 00:12:35,886 "I suffer from depression and 307 00:12:35,886 --> 00:12:39,101 I'm a little embarrassed about it, 308 00:12:39,101 --> 00:12:41,142 but I've been taking this medication, 309 00:12:41,142 --> 00:12:44,338 and I just wanted to ask you what you think?" 310 00:12:44,338 --> 00:12:46,895 And so I did my best to give her such advice as I could. 311 00:12:46,895 --> 00:12:48,722 And then she said, "You know, 312 00:12:48,722 --> 00:12:51,528 my husband would never understand this. 313 00:12:51,528 --> 00:12:54,078 He's really the kind of guy to whom this wouldn't make any sense, 314 00:12:54,078 --> 00:12:57,063 so I just, you know, it's just between us." 315 00:12:57,063 --> 00:12:58,846 And I said, "Yes, that's fine." 316 00:12:58,846 --> 00:13:00,663 On Sunday of the same conference, 317 00:13:00,663 --> 00:13:03,861 her husband took me aside, 318 00:13:03,861 --> 00:13:05,586 and he said, "My wife wouldn't think 319 00:13:05,586 --> 00:13:07,943 that I was really much of a guy if she knew this, 320 00:13:07,943 --> 00:13:10,164 but I've been dealing with this depression 321 00:13:10,164 --> 00:13:11,871 and I'm taking some medication, 322 00:13:11,871 --> 00:13:14,376 and I wondered what you think?" 323 00:13:14,376 --> 00:13:15,722 They were hiding 324 00:13:15,722 --> 00:13:18,060 the same medication in two different places 325 00:13:18,060 --> 00:13:21,167 in the same bedroom. 326 00:13:21,167 --> 00:13:22,711 And I said that I thought 327 00:13:22,711 --> 00:13:24,302 communication within the marriage 328 00:13:24,302 --> 00:13:26,240 might be triggering some of their problems. 329 00:13:26,240 --> 00:13:30,646 (Laughter) 330 00:13:30,646 --> 00:13:32,363 But I was also struck 331 00:13:32,363 --> 00:13:34,040 by the burdensome nature 332 00:13:34,040 --> 00:13:36,065 of such mutual secrecy. 333 00:13:36,065 --> 00:13:37,981 Depression is so exhausting. 334 00:13:37,981 --> 00:13:40,841 It takes up so much of your time and energy, 335 00:13:40,841 --> 00:13:42,560 and silence about it, 336 00:13:42,560 --> 00:13:45,153 it really does make the depression worse. 337 00:13:45,153 --> 00:13:46,870 And then I began thinking about all the ways 338 00:13:46,870 --> 00:13:48,944 people make themselves better. 339 00:13:48,944 --> 00:13:51,367 I'd started off as a medical conservative. 340 00:13:51,367 --> 00:13:53,693 I thought there were a few kinds of therapy that worked, 341 00:13:53,693 --> 00:13:55,442 it was clear what they were, 342 00:13:55,442 --> 00:13:57,224 there was medication, 343 00:13:57,224 --> 00:13:58,807 there were certain psychotherapies, 344 00:13:58,807 --> 00:14:00,976 there was possibly electro-convulsive treatment, 345 00:14:00,976 --> 00:14:03,820 and that everything else was nonsense. 346 00:14:03,820 --> 00:14:05,682 But then I discovered something. 347 00:14:05,682 --> 00:14:07,326 If you have brain cancer, 348 00:14:07,326 --> 00:14:08,798 and you say that standing on your head 349 00:14:08,798 --> 00:14:11,655 for 20 minutes every morning makes you feel better, 350 00:14:11,655 --> 00:14:13,323 it may make you feel better, 351 00:14:13,323 --> 00:14:14,926 but you still have brain cancer, 352 00:14:14,926 --> 00:14:17,169 and you'll still probably die from it. 353 00:14:17,169 --> 00:14:19,543 But if you say that you have depression, 354 00:14:19,543 --> 00:14:21,802 and standing on your head for 20 minutes every day 355 00:14:21,802 --> 00:14:24,147 makes you feel better, then it's worked, 356 00:14:24,147 --> 00:14:26,707 because depression is an illness of how you feel, 357 00:14:26,707 --> 00:14:28,316 and if you feel better, 358 00:14:28,316 --> 00:14:31,100 then you are effectively not depressed anymore. 359 00:14:31,100 --> 00:14:32,994 So I became much more tolerant 360 00:14:32,994 --> 00:14:35,766 of the vast world of alternative treatments. 361 00:14:35,766 --> 00:14:38,351 And I get letters, I get hundreds of letters 362 00:14:38,351 --> 00:14:40,789 from people writing to tell me about what's worked for them. 363 00:14:40,789 --> 00:14:43,056 Someone was asking me backstage today 364 00:14:43,056 --> 00:14:44,652 about meditation. 365 00:14:44,652 --> 00:14:46,964 My favorite of the letters that I got 366 00:14:46,964 --> 00:14:48,531 was the one that came from a woman 367 00:14:48,531 --> 00:14:50,559 who wrote and said that she had tried therapy, 368 00:14:50,559 --> 00:14:51,955 she had tried medication, 369 00:14:51,955 --> 00:14:53,340 she had tried pretty much everything, 370 00:14:53,340 --> 00:14:56,007 and she had found a solution and hoped I would tell the world, 371 00:14:56,007 --> 00:14:59,804 and that was making little things from yarn. 372 00:14:59,804 --> 00:15:02,911 (Laughter) 373 00:15:02,911 --> 00:15:05,913 She sent me some of them. (Laughter) 374 00:15:05,913 --> 00:15:10,155 And I'm not wearing them right now. 375 00:15:10,155 --> 00:15:12,100 I suggested to her that she also should look up 376 00:15:12,100 --> 00:15:17,101 obsessive compulsive disorder in the DSM. 377 00:15:17,101 --> 00:15:19,752 And yet, when I went to look at alternative treatments, 378 00:15:19,752 --> 00:15:22,598 I also gained perspective on other treatments. 379 00:15:22,598 --> 00:15:25,748 I went through a tribal exorcism in Senegal 380 00:15:25,748 --> 00:15:27,422 that involved a great deal of ram's blood 381 00:15:27,422 --> 00:15:29,422 and that I'm not going to detail right now, 382 00:15:29,422 --> 00:15:31,422 but a few years afterward I was in Rwanda 383 00:15:31,422 --> 00:15:33,304 working on a different project, 384 00:15:33,304 --> 00:15:36,058 and I happened to describe my experience to someone, 385 00:15:36,058 --> 00:15:37,523 and he said, "Well, you know, 386 00:15:37,523 --> 00:15:39,633 that's West Africa, and we're in East Africa, 387 00:15:39,633 --> 00:15:41,652 and our rituals are in some ways very different, 388 00:15:41,652 --> 00:15:43,542 but we do have some rituals that have something 389 00:15:43,542 --> 00:15:45,544 in common with what you're describing." 390 00:15:45,544 --> 00:15:47,301 And I said, "Oh." And he said, "Yes," he said, 391 00:15:47,301 --> 00:15:49,895 "but we've had a lot of trouble with Western mental health workers, 392 00:15:49,895 --> 00:15:52,484 especially the ones who came right after the genocide." 393 00:15:52,484 --> 00:15:54,795 And I said, "What kind of trouble did you have?" 394 00:15:54,795 --> 00:15:56,587 And he said, "Well," he said, 395 00:15:56,587 --> 00:15:59,113 "They would do this bizarre thing." 396 00:15:59,113 --> 00:16:00,982 He said, "They didn't take people out in the sunshine 397 00:16:00,982 --> 00:16:02,698 where you begin to feel better. 398 00:16:02,698 --> 00:16:04,315 They didn't include drumming or music 399 00:16:04,315 --> 00:16:05,810 to get people's blood going. 400 00:16:05,810 --> 00:16:07,680 They didn't involve the whole community. 401 00:16:07,680 --> 00:16:09,409 They didn't externalize the depression 402 00:16:09,409 --> 00:16:11,012 as an invasive spirit. 403 00:16:11,012 --> 00:16:13,150 Instead what they did was they took people 404 00:16:13,150 --> 00:16:15,966 one at a time into dingy little rooms 405 00:16:15,966 --> 00:16:17,552 and had them talk for an hour 406 00:16:17,552 --> 00:16:19,550 about bad things that had happened to them." 407 00:16:19,550 --> 00:16:25,041 (Laughter) (Applause) 408 00:16:25,041 --> 00:16:27,358 He said, "We had to ask them to leave the country." 409 00:16:27,358 --> 00:16:30,477 (Laughter) 410 00:16:30,477 --> 00:16:32,982 Now at the other end of alternative treatments, 411 00:16:32,982 --> 00:16:35,155 let me tell you about Frank Roussekoff. 412 00:16:35,155 --> 00:16:37,978 Frank Roussekoff had the worst depression 413 00:16:37,978 --> 00:16:41,006 perhaps that I've ever seen in a man. 414 00:16:41,006 --> 00:16:43,027 He was constantly depressed. 415 00:16:43,027 --> 00:16:44,842 He was, when I met him, at a point at which 416 00:16:44,842 --> 00:16:48,322 every month he would have electroshock treatment. 417 00:16:48,322 --> 00:16:50,913 Then he would feel sort of disoriented for a week. 418 00:16:50,913 --> 00:16:52,700 Then he would feel okay for a week. 419 00:16:52,700 --> 00:16:54,677 Then he would have a week of going downhill. 420 00:16:54,677 --> 00:16:57,061 And then he would have another electroshock treatment. 421 00:16:57,061 --> 00:16:58,700 And he said to me when I met him, 422 00:16:58,700 --> 00:17:01,160 "It's unbearable to go through my weeks this way. 423 00:17:01,160 --> 00:17:02,729 I can't go on this way, 424 00:17:02,729 --> 00:17:04,963 and I've figured out how I'm going to end it 425 00:17:04,963 --> 00:17:06,550 if I don't get better. 426 00:17:06,550 --> 00:17:08,782 But," he said to me, "I heard about a protocol 427 00:17:08,782 --> 00:17:11,220 at Mass General for a procedure called 428 00:17:11,220 --> 00:17:13,430 a cingulotomy, which is a brain surgery, 429 00:17:13,430 --> 00:17:16,034 and I think I'm going to give that a try." 430 00:17:16,034 --> 00:17:17,955 And I remember being amazed at that point 431 00:17:17,955 --> 00:17:19,302 to think that someone 432 00:17:19,302 --> 00:17:22,429 who clearly had so many bad experiences 433 00:17:22,429 --> 00:17:24,350 with so many different treatments 434 00:17:24,350 --> 00:17:27,395 still had buried in him somewhere enough optimism 435 00:17:27,395 --> 00:17:29,945 to reach out for one more. 436 00:17:29,945 --> 00:17:32,011 And he had the a cingulotomy, 437 00:17:32,011 --> 00:17:34,151 and it was incredibly successful. 438 00:17:34,151 --> 00:17:35,767 He's now a friend of mine. 439 00:17:35,767 --> 00:17:38,721 He has a lovely wife and two beautiful children. 440 00:17:38,721 --> 00:17:42,010 He wrote me a letter the Christmas after the surgery, 441 00:17:42,010 --> 00:17:43,304 and he said, 442 00:17:43,304 --> 00:17:45,758 "My father sent me two presents this year, 443 00:17:45,758 --> 00:17:48,114 First, a motorized CD rack from The Sharper Image 444 00:17:48,114 --> 00:17:49,750 that I didn't really need, 445 00:17:49,750 --> 00:17:51,555 but I knew he was giving it to me to celebrate 446 00:17:51,555 --> 00:17:53,498 the fact that I'm living on my own 447 00:17:53,498 --> 00:17:55,684 and have a job I seem to love. 448 00:17:55,684 --> 00:17:57,046 And the other present 449 00:17:57,046 --> 00:17:58,851 was a photo of my grandmother, 450 00:17:58,851 --> 00:18:00,781 who committed suicide. 451 00:18:00,781 --> 00:18:03,839 As I unwrapped it, I began to cry, 452 00:18:03,839 --> 00:18:05,795 and my mother came over and said, 453 00:18:05,795 --> 00:18:08,680 'Are you crying because of the relatives you never knew?' 454 00:18:08,680 --> 00:18:13,260 And I said, 'She had the same disease I have.' 455 00:18:13,260 --> 00:18:15,948 I'm crying now as I write to you. 456 00:18:15,948 --> 00:18:19,099 It's not that I'm so sad, but I get overwhelmed, 457 00:18:19,099 --> 00:18:21,364 I think, because I could have killed myself, 458 00:18:21,364 --> 00:18:23,344 but my parents kept me going, 459 00:18:23,344 --> 00:18:25,074 and so did the doctors, 460 00:18:25,074 --> 00:18:26,916 and I had the surgery. 461 00:18:26,916 --> 00:18:29,024 I'm alive and grateful. 462 00:18:29,024 --> 00:18:31,362 We live in the right time, 463 00:18:31,362 --> 00:18:35,917 even if it doesn't always feel like it." 464 00:18:35,917 --> 00:18:37,752 I was struck by the fact that depression 465 00:18:37,752 --> 00:18:39,446 is broadly perceived to be 466 00:18:39,446 --> 00:18:43,083 a modern, Western, middle class thing, 467 00:18:43,083 --> 00:18:45,289 and I went to look at how it operated 468 00:18:45,289 --> 00:18:47,200 in a variety of other contexts, 469 00:18:47,200 --> 00:18:49,072 and one of the things I was most interested in 470 00:18:49,072 --> 00:18:51,170 was depression among the indigent. 471 00:18:51,170 --> 00:18:53,029 And so I went out to try to look at what was 472 00:18:53,029 --> 00:18:55,501 being done for poor people with depression. 473 00:18:55,501 --> 00:18:57,566 And what I discovered is that poor people 474 00:18:57,566 --> 00:19:00,002 are mostly not being treated for depression. 475 00:19:00,002 --> 00:19:03,012 Depression is the result of a genetic vulnerability, 476 00:19:03,012 --> 00:19:06,246 which is presumably evenly distributed in the population, 477 00:19:06,246 --> 00:19:08,153 and triggering circumstances, 478 00:19:08,153 --> 00:19:10,078 which are likely to be more severe 479 00:19:10,078 --> 00:19:11,931 for people who are impoverished. 480 00:19:11,931 --> 00:19:14,174 And yet it turns out that if you have 481 00:19:14,174 --> 00:19:16,576 a really lovely life but feel miserable all the time, 482 00:19:16,576 --> 00:19:18,576 you think, "Why do I feel like this? 483 00:19:18,576 --> 00:19:20,260 I must have depression." 484 00:19:20,260 --> 00:19:22,213 And you set out to find treatment for it. 485 00:19:22,213 --> 00:19:24,276 But if you have a perfectly awful life, 486 00:19:24,276 --> 00:19:26,079 and you feel miserable all the time, 487 00:19:26,079 --> 00:19:28,955 the way you feel is commensurate with your life, 488 00:19:28,955 --> 00:19:30,677 and it doesn't occur to you to think, 489 00:19:30,677 --> 00:19:32,384 "Maybe this is treatable." 490 00:19:32,384 --> 00:19:35,504 And so we have an epidemic in this country 491 00:19:35,504 --> 00:19:38,372 of depression among impoverished people 492 00:19:38,372 --> 00:19:41,114 that's not being picked up and that's not being treated 493 00:19:41,114 --> 00:19:42,832 and that's not being addressed, 494 00:19:42,832 --> 00:19:45,248 and it's a tragedy of a grand order. 495 00:19:45,248 --> 00:19:46,858 And so I found an academic 496 00:19:46,858 --> 00:19:48,522 who was doing a research project 497 00:19:48,522 --> 00:19:50,449 in slums outside of D.C., 498 00:19:50,449 --> 00:19:53,259 where she picked up women who had come in for other health problems 499 00:19:53,259 --> 00:19:55,130 and diagnosed them with depression, 500 00:19:55,130 --> 00:19:58,274 and then provided six months of experimental protocol. 501 00:19:58,274 --> 00:20:00,480 One of them, Lolly, came in, 502 00:20:00,480 --> 00:20:03,007 and this is what she said the day she came in. 503 00:20:03,007 --> 00:20:05,525 She said, and she was a woman, by the way, 504 00:20:05,525 --> 00:20:08,156 who had seven children. She said, 505 00:20:08,156 --> 00:20:10,745 "I used to have a job but I had to give it up because 506 00:20:10,745 --> 00:20:12,913 I couldn't go out of the house. 507 00:20:12,913 --> 00:20:15,203 I have nothing to say to my children. 508 00:20:15,203 --> 00:20:18,004 In the morning, I can't wait for them to leave, 509 00:20:18,004 --> 00:20:21,205 and then I climb in bed and pull the covers over my head, 510 00:20:21,205 --> 00:20:22,836 and three o'clock when they come home, 511 00:20:22,836 --> 00:20:24,606 it just comes so fast." 512 00:20:24,606 --> 00:20:26,692 She said, "I've been taking a lot of Tylenol, 513 00:20:26,692 --> 00:20:29,574 anything I can take so that I can sleep more. 514 00:20:29,574 --> 00:20:33,452 My husband has been telling me I'm stupid, I'm ugly. 515 00:20:33,452 --> 00:20:36,864 I wish I could stop the pain." 516 00:20:36,864 --> 00:20:39,474 Well, she was brought into this experimental protocol, 517 00:20:39,474 --> 00:20:41,720 and when I interviewed her six months later, 518 00:20:41,720 --> 00:20:46,252 she had taken a job working in child care 519 00:20:46,252 --> 00:20:50,117 for the U.S. Navy, she had left the abusive husband, 520 00:20:50,117 --> 00:20:51,939 and she said to me, 521 00:20:51,939 --> 00:20:54,461 "My kids are so much happier now." 522 00:20:54,461 --> 00:20:56,377 She said, "There's one room in my new place 523 00:20:56,377 --> 00:20:59,006 for the boys and one room for the girls, 524 00:20:59,006 --> 00:21:01,002 but at night, they're just all up on my bed, 525 00:21:01,002 --> 00:21:03,812 and we're doing homework all together and everything. 526 00:21:03,812 --> 00:21:05,717 One of them wants to be a preacher, 527 00:21:05,717 --> 00:21:07,723 one of them wants to be a firefighter, 528 00:21:07,723 --> 00:21:10,550 and one of the girls says she's going to be a lawyer. 529 00:21:10,550 --> 00:21:12,510 They don't cry like they used to, 530 00:21:12,510 --> 00:21:14,837 and they don't fight like they did. 531 00:21:14,837 --> 00:21:18,863 That's all I need now is my kids. 532 00:21:18,863 --> 00:21:20,852 Things keep on changing, 533 00:21:20,852 --> 00:21:26,046 the way I dress, the way I feel, the way I act. 534 00:21:26,046 --> 00:21:29,885 I can go outside not being afraid anymore, 535 00:21:29,885 --> 00:21:33,125 and I don't think those bad feelings are coming back, 536 00:21:33,125 --> 00:21:36,114 and if it weren't for Dr. Miranda and that, 537 00:21:36,114 --> 00:21:39,471 I would still be at home with the covers pulled over my head, 538 00:21:39,471 --> 00:21:42,157 if I were still alive at all. 539 00:21:42,157 --> 00:21:45,766 I asked the Lord to send me an angel, 540 00:21:45,766 --> 00:21:49,281 and he heard my prayers." 541 00:21:50,467 --> 00:21:53,605 I was really moved by these experiences, 542 00:21:53,605 --> 00:21:56,056 and I decided that I wanted to write about them 543 00:21:56,056 --> 00:21:57,555 not only in a book I was working on, 544 00:21:57,555 --> 00:21:58,957 but also in an article, 545 00:21:58,957 --> 00:22:01,085 and so I got a commission from "The New York Times Magazine" 546 00:22:01,085 --> 00:22:03,264 to write about depression among the indigent. 547 00:22:03,264 --> 00:22:04,848 And I turned in my story, 548 00:22:04,848 --> 00:22:06,444 and my editor called me and said, 549 00:22:06,444 --> 00:22:08,387 "We really can't publish this." 550 00:22:08,387 --> 00:22:09,783 And I said, "Why not?" 551 00:22:09,783 --> 00:22:12,241 And she said, "It just is too far-fetched. 552 00:22:12,241 --> 00:22:15,818 These people who are sort of at the very bottom rung of society 553 00:22:15,818 --> 00:22:17,784 and then they get a few months of treatment 554 00:22:17,784 --> 00:22:20,277 and they're virtually ready to run Morgan Stanley? 555 00:22:20,277 --> 00:22:22,209 It's just too implausible." 556 00:22:22,209 --> 00:22:24,290 She said, I've never even heard of anything like it." 557 00:22:24,290 --> 00:22:26,793 And I said, "The fact that you've never heard of it 558 00:22:26,793 --> 00:22:29,809 is an indication that it is news." 559 00:22:29,809 --> 00:22:35,696 (Laughter) (Applause) 560 00:22:37,165 --> 00:22:40,150 "And you are a news magazine." 561 00:22:40,150 --> 00:22:42,027 So after a certain amount of negotiation, 562 00:22:42,027 --> 00:22:43,512 they agreed to it. 563 00:22:43,512 --> 00:22:44,973 But I think a lot of what they said 564 00:22:44,973 --> 00:22:47,144 was connected in some strange way 565 00:22:47,144 --> 00:22:49,302 to this distaste that people still have 566 00:22:49,302 --> 00:22:50,811 for the idea of treatment, 567 00:22:50,811 --> 00:22:52,616 the notion that somehow if we went out 568 00:22:52,616 --> 00:22:55,312 and treated a lot of people in indigent communities, 569 00:22:55,312 --> 00:22:57,272 that would be an exploitative thing to do, 570 00:22:57,272 --> 00:22:58,960 because we would be changing them. 571 00:22:58,960 --> 00:23:01,047 There is this false moral imperative 572 00:23:01,047 --> 00:23:02,813 that seems to be all around us 573 00:23:02,813 --> 00:23:05,026 that treatment of depression, 574 00:23:05,026 --> 00:23:07,435 the medications and so on, are an artifice, 575 00:23:07,435 --> 00:23:09,777 and that it's not natural. 576 00:23:09,777 --> 00:23:12,610 And I think that's very misguided. 577 00:23:12,610 --> 00:23:15,895 It would be natural for people's teeth to fall out, 578 00:23:15,895 --> 00:23:18,795 but there is nobody militating against toothpaste, 579 00:23:18,795 --> 00:23:21,709 at least not in my circles. 580 00:23:21,709 --> 00:23:23,887 And people then say, "Well, but isn't depression 581 00:23:23,887 --> 00:23:25,994 part of what people are supposed to experience? 582 00:23:25,994 --> 00:23:27,874 Didn't we evolve to have depression? 583 00:23:27,874 --> 00:23:29,858 Isn't it part of your personality?" 584 00:23:29,858 --> 00:23:32,388 To which I would say, mood is adaptive. 585 00:23:32,388 --> 00:23:35,702 Being able to have sadness and fear 586 00:23:35,702 --> 00:23:37,590 and joy and pleasure 587 00:23:37,590 --> 00:23:39,532 and all of the other moods that we have, 588 00:23:39,532 --> 00:23:41,442 that's incredibly valuable. 589 00:23:41,442 --> 00:23:44,550 And major depression is something that happens 590 00:23:44,550 --> 00:23:46,685 when that system gets broken. 591 00:23:46,685 --> 00:23:48,387 It's maladaptive. 592 00:23:48,387 --> 00:23:49,944 People will come to me and say, 593 00:23:49,944 --> 00:23:52,388 "I think, though, if I just stick it out for another year, 594 00:23:52,388 --> 00:23:54,726 I think I can just get through this." 595 00:23:54,726 --> 00:23:56,998 And I always say to them, "You may get through it, 596 00:23:56,998 --> 00:23:59,646 but you'll never be 37 again. 597 00:23:59,646 --> 00:24:02,165 Life is short, and that's a whole year 598 00:24:02,165 --> 00:24:04,182 you're talking about giving up. 599 00:24:04,182 --> 00:24:05,936 Think it through." 600 00:24:05,936 --> 00:24:08,751 It's a strange poverty of the English language, 601 00:24:08,751 --> 00:24:10,598 and indeed of many other languages, 602 00:24:10,598 --> 00:24:12,862 that we use this same word, "depression," 603 00:24:12,862 --> 00:24:14,698 to describe how a kid feels 604 00:24:14,698 --> 00:24:16,548 when it rains on his birthday, 605 00:24:16,548 --> 00:24:18,861 and to describe how somebody feels 606 00:24:18,861 --> 00:24:21,391 the minute before they commit suicide. 607 00:24:21,391 --> 00:24:24,775 People say to me, "Well, is it continuous with normal sadness?" 608 00:24:24,775 --> 00:24:27,579 And I say, in a way it's continuous with normal sadness. 609 00:24:27,579 --> 00:24:29,749 There is a certain amount of continuity, 610 00:24:29,749 --> 00:24:31,736 but it's the same way there's continuity 611 00:24:31,736 --> 00:24:33,738 between having an iron fence outside your house 612 00:24:33,738 --> 00:24:35,538 that gets a little rust spot 613 00:24:35,538 --> 00:24:38,192 that you have to sort of sand off and do a little repainting, 614 00:24:38,192 --> 00:24:40,854 and what happens if you leave the house for a hundred years 615 00:24:40,854 --> 00:24:43,368 and it rusts through until it's only a pile 616 00:24:43,368 --> 00:24:45,186 of orange dust. 617 00:24:45,186 --> 00:24:47,190 And it's that orange dust spot, 618 00:24:47,190 --> 00:24:48,979 that orange dust problem, 619 00:24:48,979 --> 00:24:52,231 that's the one we're setting out to address. 620 00:24:52,231 --> 00:24:54,331 So now people say, 621 00:24:54,331 --> 00:24:57,124 "You take these happy pills, and do you feel happy?" 622 00:24:57,124 --> 00:24:58,779 And I don't. 623 00:24:58,779 --> 00:25:01,386 But I don't feel sad about having to eat lunch, 624 00:25:01,386 --> 00:25:04,177 and I don't feel sad about my answering machine, 625 00:25:04,177 --> 00:25:07,251 and I don't feel sad about taking a shower. 626 00:25:07,251 --> 00:25:10,106 I feel more, in fact, I think, 627 00:25:10,106 --> 00:25:12,660 because I can feel sadness without nullity. 628 00:25:12,660 --> 00:25:16,928 I feel sad about professional disappointments, 629 00:25:16,928 --> 00:25:19,383 about damaged relationships, 630 00:25:19,383 --> 00:25:21,224 about global warming. 631 00:25:21,224 --> 00:25:24,024 Those are the things that I feel sad about now. 632 00:25:24,024 --> 00:25:26,805 And I said to myself, well, what is the conclusion? 633 00:25:26,805 --> 00:25:29,366 How did those people who have better lives 634 00:25:29,366 --> 00:25:31,889 even with bigger depression manage to get through? 635 00:25:31,889 --> 00:25:34,425 What is the mechanism of resilience? 636 00:25:34,425 --> 00:25:36,662 And what I came up with over time 637 00:25:36,662 --> 00:25:39,255 was that the people who deny their experience, 638 00:25:39,255 --> 00:25:41,333 the ones who say, "I was depressed a long time ago 639 00:25:41,333 --> 00:25:43,256 and I never want to think about it again 640 00:25:43,256 --> 00:25:44,898 and I'm not going to look at it 641 00:25:44,898 --> 00:25:46,772 and I'm just going to get on with my life," 642 00:25:46,772 --> 00:25:48,653 ironically, those are the people 643 00:25:48,653 --> 00:25:51,259 who are most enslaved by what they have. 644 00:25:51,259 --> 00:25:53,761 Shutting out the depression strengthens it. 645 00:25:53,761 --> 00:25:57,318 While you hide from it, it grows. 646 00:25:57,318 --> 00:25:59,655 And the people who do better 647 00:25:59,655 --> 00:26:02,178 at the ones who are able to tolerate the fact 648 00:26:02,178 --> 00:26:04,261 that they have this condition. 649 00:26:04,261 --> 00:26:06,531 Those who can tolerate their depression 650 00:26:06,531 --> 00:26:08,544 are the ones who achieve resilience. 651 00:26:08,544 --> 00:26:10,281 So Frank Roussekoff said to me, 652 00:26:10,281 --> 00:26:11,967 "If I had it again to do over, 653 00:26:11,967 --> 00:26:13,949 I suppose I wouldn't do it this way, 654 00:26:13,949 --> 00:26:16,005 but in a strange way, I'm grateful 655 00:26:16,005 --> 00:26:17,585 for what I've experienced. 656 00:26:17,585 --> 00:26:20,941 I'm glad to have been in the hospital 40 times. 657 00:26:20,941 --> 00:26:23,744 It taught me so much about love, 658 00:26:23,744 --> 00:26:26,661 and my relationship with my parents and my doctors 659 00:26:26,661 --> 00:26:30,958 has been so precious to me, and will be always." 660 00:26:30,958 --> 00:26:32,960 And Maggie Robbins said, 661 00:26:32,960 --> 00:26:35,841 "I used to volunteer in an AIDS clinic, 662 00:26:35,841 --> 00:26:38,640 and I would just talk and talk and talk, 663 00:26:38,640 --> 00:26:40,622 and the people I was dealing with 664 00:26:40,622 --> 00:26:42,661 weren't very responsive, and I thought, 665 00:26:42,661 --> 00:26:46,635 'That's not very friendly or helpful of them.' 666 00:26:46,635 --> 00:26:48,492 And then I realized, 667 00:26:48,492 --> 00:26:50,514 I realized that they weren't going to do more 668 00:26:50,514 --> 00:26:52,992 than make those first few minutes of small talk. 669 00:26:52,992 --> 00:26:54,864 It was simply going to be an occasion 670 00:26:54,864 --> 00:26:57,680 where I didn't have AIDS and I wasn't dying, 671 00:26:57,680 --> 00:27:00,685 but could tolerate the fact that they did 672 00:27:00,685 --> 00:27:02,610 and they were. 673 00:27:02,610 --> 00:27:06,166 Our needs are our greatest assets. 674 00:27:06,166 --> 00:27:08,198 It turns out I've learned to give 675 00:27:08,198 --> 00:27:12,100 all the things I need." 676 00:27:12,100 --> 00:27:14,093 Valuing one's depression 677 00:27:14,093 --> 00:27:16,278 does not prevent a relapse, 678 00:27:16,278 --> 00:27:18,861 but it may make the prospect of relapse 679 00:27:18,861 --> 00:27:22,694 and even relapse itself easier to tolerate. 680 00:27:22,694 --> 00:27:25,262 The question is not so much 681 00:27:25,262 --> 00:27:27,437 of finding great meaning and deciding 682 00:27:27,437 --> 00:27:29,371 your depression has been very meaningful. 683 00:27:29,371 --> 00:27:31,512 It's of seeking that meaning 684 00:27:31,512 --> 00:27:33,255 and thinking, when it comes again, 685 00:27:33,255 --> 00:27:35,088 "This will be hellish, 686 00:27:35,088 --> 00:27:37,657 but I will learn something from it." 687 00:27:37,657 --> 00:27:39,752 I have learned in my own depression 688 00:27:39,752 --> 00:27:41,903 how big an emotion can be, 689 00:27:41,903 --> 00:27:44,385 how it can be more real than facts, 690 00:27:44,385 --> 00:27:47,704 and I have found that that experience 691 00:27:47,704 --> 00:27:50,688 has allowed me to experience positive emotion 692 00:27:50,688 --> 00:27:54,208 in a more intense and more focused way. 693 00:27:54,208 --> 00:27:57,526 The opposite of depression is not happiness, 694 00:27:57,526 --> 00:27:59,304 but vitality, 695 00:27:59,304 --> 00:28:02,104 and these days, my life is vital, 696 00:28:02,104 --> 00:28:04,803 even on the days when I'm sad. 697 00:28:04,803 --> 00:28:07,963 I felt that funeral in my brain, 698 00:28:07,963 --> 00:28:10,048 and I sat next to the colossus 699 00:28:10,048 --> 00:28:11,896 at the edge of the world, 700 00:28:11,896 --> 00:28:14,384 and I have discovered 701 00:28:14,384 --> 00:28:16,328 something inside of myself 702 00:28:16,328 --> 00:28:18,537 that I would have to call a soul 703 00:28:18,537 --> 00:28:22,074 that I had never formulated until that day 20 years ago 704 00:28:22,074 --> 00:28:26,904 when hell came to pay me a surprise visit. 705 00:28:26,904 --> 00:28:30,848 I think that while I hated being depressed 706 00:28:30,848 --> 00:28:33,136 and would hate to be depressed again, 707 00:28:33,136 --> 00:28:35,496 I've found a way to love my depression. 708 00:28:35,496 --> 00:28:37,921 I love it because it has forced me 709 00:28:37,921 --> 00:28:40,704 to find and cling to joy. 710 00:28:40,704 --> 00:28:44,269 I love it because each day I decide, 711 00:28:44,269 --> 00:28:45,932 sometimes gamely, 712 00:28:45,932 --> 00:28:48,002 and sometimes against the moment's reason, 713 00:28:48,002 --> 00:28:51,024 to cleave to the reasons for living. 714 00:28:51,024 --> 00:28:55,064 And that, I think, is a highly privileged rapture. 715 00:28:55,064 --> 00:28:58,096 Thank you. 716 00:28:58,096 --> 00:29:02,096 (Applause)