0:00:03.627,0:00:07.838
"I felt a funeral in my brain,

0:00:07.838,0:00:10.240
and mourners to and fro

0:00:10.240,0:00:12.900
kept treading, treading til I felt

0:00:12.900,0:00:15.836
that sense was breaking through.

0:00:15.836,0:00:17.605
And when they were all were seated,

0:00:17.605,0:00:19.603
a service, like a drum,

0:00:19.603,0:00:22.315
kept beating, beating,

0:00:22.315,0:00:25.831
til I felt my mind was going numb.

0:00:25.831,0:00:27.707
And then I heard them lift a box

0:00:27.707,0:00:29.994
and creak across my soul

0:00:29.994,0:00:33.053
with those same boots of lead again,

0:00:33.053,0:00:36.070
then space began to toll,

0:00:36.070,0:00:38.210
as if the heavens were a bell

0:00:38.210,0:00:40.201
and being were an ear,

0:00:40.201,0:00:44.069
and I, and silence, some strange race wrecked

0:00:44.069,0:00:46.493
solitary here.

0:00:46.493,0:00:49.670
Just then, a plank in reason broke,

0:00:49.670,0:00:53.011
and I fell down and down

0:00:53.011,0:00:55.686
and hit a world at every plunge,

0:00:55.686,0:01:00.198
and finished knowing then."

0:01:00.198,0:01:03.680
We know depression through metaphors.

0:01:03.680,0:01:07.389
Emily Dickinson was able to convey it in language,

0:01:07.389,0:01:10.130
Goya in an image.

0:01:10.130,0:01:12.113
Half the purpose of art

0:01:12.113,0:01:15.997
is to describe such iconic states.

0:01:15.997,0:01:19.757
As for me, I had always thought myself tough,

0:01:19.757,0:01:21.460
one of the people who could survive

0:01:21.460,0:01:24.614
if I'd been sent to a concentration camp.

0:01:24.614,0:01:27.497
In 1991, I had a series of losses.

0:01:27.497,0:01:29.198
My mother died,

0:01:29.198,0:01:31.324
a relationship I'd been in ended,

0:01:31.324,0:01:33.167
I moved back to the United States

0:01:33.167,0:01:35.268
from some years abroad,

0:01:35.268,0:01:38.556
and I got through all of those experiences intact.

0:01:38.556,0:01:41.539
But in 1994, three years later,

0:01:41.539,0:01:45.932
I found myself losing interest in almost everything.

0:01:45.932,0:01:47.577
I didn't want to do any of the things

0:01:47.577,0:01:49.959
I had previously wanted to do,

0:01:49.959,0:01:51.877
and I didn't know why.

0:01:51.877,0:01:53.697
The opposite of depression

0:01:53.697,0:01:56.934
is not happiness, but vitality,

0:01:56.934,0:01:58.429
and it was vitality

0:01:58.429,0:02:02.082
that seemed to seep away from me in that moment.

0:02:02.082,0:02:04.237
Everything there was to do

0:02:04.237,0:02:06.411
seemed like too much work.

0:02:06.411,0:02:08.058
I would come home

0:02:08.058,0:02:11.440
and I would see the red light[br]flashing on my answering machine,

0:02:11.440,0:02:13.585
and instead of being thrilled to hear from my friends,

0:02:13.585,0:02:15.133
I would think,

0:02:15.133,0:02:18.368
"What a lot of people that is to have to call back."

0:02:18.368,0:02:20.755
Or I would decide I should have lunch,

0:02:20.755,0:02:23.301
and then I would think that[br]I'd have to get the food out

0:02:23.301,0:02:25.340
and put it on a plate

0:02:25.340,0:02:29.389
and cut it up and chew it and swallow it,

0:02:29.389,0:02:33.090
and it felt to me like the Stations of the Cross.

0:02:33.090,0:02:35.541
And one of the things that often gets lost

0:02:35.541,0:02:37.443
in discussions of depression

0:02:37.443,0:02:39.801
is that you know it's ridiculous.

0:02:39.801,0:02:42.537
You know it's ridiculous while you're experiencing it.

0:02:42.537,0:02:44.681
You know that most people manage

0:02:44.681,0:02:46.995
to listen to their messages and eat lunch

0:02:46.995,0:02:48.907
and organize themselves to take a shower

0:02:48.907,0:02:50.167
and go out the front door

0:02:50.167,0:02:51.644
and that it's not a big deal,

0:02:51.644,0:02:55.001
and yet you are nonetheless in its grip

0:02:55.001,0:02:59.276
and you are unable to figure out any way around it.

0:02:59.276,0:03:03.236
And so I began to feel myself doing less

0:03:03.236,0:03:05.126
and thinking less

0:03:05.126,0:03:07.802
and feeling less.

0:03:07.802,0:03:10.142
It was a kind of nullity.

0:03:10.142,0:03:12.647
And then the anxiety set in.

0:03:12.647,0:03:14.694
If you told me that I'd have to be

0:03:14.694,0:03:16.454
depressed for the next month,

0:03:16.454,0:03:19.692
I would say, "As long I know it'll be[br]over in November, I can do it."

0:03:19.692,0:03:21.440
But if you said to me,

0:03:21.440,0:03:24.940
"You have to have acute anxiety for the next month,"

0:03:24.940,0:03:26.450
I would rather slit my wrist than go through it.

0:03:26.450,0:03:28.263
It was the feeling all the time

0:03:28.263,0:03:30.399
like that feeling you have if you're walking

0:03:30.399,0:03:31.956
and you slip or trip

0:03:31.956,0:03:33.855
and the ground is rushing up at you,

0:03:33.855,0:03:36.512
but instead of lasting half a[br]second, the way that does,

0:03:36.512,0:03:38.542
it lasted for six months.

0:03:38.542,0:03:41.328
It's a sensation of being afraid all the time

0:03:41.328,0:03:45.242
but not even knowing what it is that you're afraid of.

0:03:45.242,0:03:47.539
And it was at that point that I began to think

0:03:47.539,0:03:51.707
that it was just too painful to be alive,

0:03:51.707,0:03:54.168
and that the only reason not to kill oneself

0:03:54.168,0:03:57.531
was so as not to hurt other people.

0:03:57.531,0:04:00.400
And finally one day, I woke up

0:04:00.400,0:04:02.347
and I thought perhaps I'd had a stroke,

0:04:02.347,0:04:04.986
because I lay in bed completely frozen,

0:04:04.986,0:04:07.430
looking at the telephone, thinking,

0:04:07.430,0:04:10.559
"Something is wrong and I should call for help,"

0:04:10.559,0:04:12.340
and I couldn't reach out my arm

0:04:12.340,0:04:14.772
and pick up the phone and dial.

0:04:14.772,0:04:18.911
And finally, after four full hours[br]of my lying and staring at it,

0:04:18.911,0:04:20.395
the phone rang,

0:04:20.395,0:04:22.351
and somehow I managed to pick it up,

0:04:22.351,0:04:24.136
and it was my father,

0:04:24.136,0:04:27.550
and I said, "I'm in serious trouble.

0:04:27.550,0:04:29.652
We need to do something."

0:04:29.652,0:04:32.903
The next day I started with the medications

0:04:32.903,0:04:35.578
and the therapy.

0:04:35.578,0:04:37.855
And I also started reckoning

0:04:37.855,0:04:39.657
with this terrible question:

0:04:39.657,0:04:41.730
if I'm not the tough person

0:04:41.730,0:04:44.116
who could have made it[br]through a concentration camp,

0:04:44.116,0:04:45.879
then who am I?

0:04:45.879,0:04:47.736
And I have to take medication,

0:04:47.736,0:04:51.151
is that medication making me more fully myself,

0:04:51.151,0:04:53.831
or is it making me someone else?

0:04:53.831,0:04:55.558
And how do I feel about it

0:04:55.558,0:04:58.189
if it's making me someone else?

0:04:58.189,0:05:01.470
I had two advantages as I went in to the fight.

0:05:01.470,0:05:04.357
The first is that I knew that objectively speaking,

0:05:04.357,0:05:06.810
I had a nice life,

0:05:06.810,0:05:07.988
and that if I could only get well,

0:05:07.988,0:05:09.503
there was something at the other end

0:05:09.503,0:05:11.180
that was worth living for.

0:05:11.180,0:05:14.222
And the other was that I had[br]access to good treatment.

0:05:14.222,0:05:17.986
But I nonetheless emerged and relapsed,

0:05:17.986,0:05:20.311
and emerged and relapsed,

0:05:20.311,0:05:23.386
and emerged and relapsed,

0:05:23.386,0:05:25.231
and finally understood

0:05:25.231,0:05:27.552
I would have to be on medication

0:05:27.552,0:05:29.832
and in therapy forever.

0:05:29.832,0:05:32.160
And I thought, "But is it a chemical problem

0:05:32.160,0:05:33.970
or a psychological problem?

0:05:33.970,0:05:37.559
And does it need a chemical cure[br]or a philosophical cure?"

0:05:37.559,0:05:39.741
And I couldn't figure out which it was.

0:05:39.741,0:05:41.895
And then I understood that actually,

0:05:41.895,0:05:44.246
we aren't advanced enough in either area

0:05:44.246,0:05:46.152
for it to explain things fully.

0:05:46.152,0:05:49.492
The chemical cure and the psychological cure

0:05:49.492,0:05:51.216
both have a role to play,

0:05:51.216,0:05:54.606
and I also figured out that depression was something

0:05:54.606,0:05:57.416
that was braided so deep into us

0:05:57.416,0:05:59.143
that there was no separating it

0:05:59.143,0:06:01.583
from our character and personality.

0:06:01.583,0:06:03.569
I want to say that the treatments we have

0:06:03.569,0:06:06.175
for depression are appalling.

0:06:06.175,0:06:07.927
They're not very effective.

0:06:07.927,0:06:09.850
They're extremely costly.

0:06:09.850,0:06:12.361
They come with innumerable side effects.

0:06:12.361,0:06:14.890
They're a disaster.

0:06:14.890,0:06:17.660
But I am so grateful that I live now

0:06:17.660,0:06:18.823
and not 50 years ago,

0:06:18.823,0:06:20.303
when there would have been almost nothing

0:06:20.303,0:06:21.982
to be done.

0:06:21.982,0:06:24.870
I hope that 50 years hence,

0:06:24.870,0:06:26.250
people will hear about my treatments

0:06:26.250,0:06:28.168
and be appalled that anyone endured

0:06:28.168,0:06:30.826
such primitive science.

0:06:30.826,0:06:35.473
Depression is the flaw in love.

0:06:35.473,0:06:38.768
If you were married to someone and thought,

0:06:38.768,0:06:42.485
"Well, if my wife dies, I'll find another one,"

0:06:42.485,0:06:45.347
it wouldn't be love as we know it.

0:06:45.347,0:06:47.375
There's no such thing as love

0:06:47.375,0:06:50.510
without the anticipation of loss,

0:06:50.510,0:06:52.632
and that specter of despair

0:06:52.632,0:06:56.423
can be the engine of intimacy.

0:06:56.423,0:06:58.983
There are three things people tend to confuse:

0:06:58.983,0:07:02.952
depression, grief, and sadness.

0:07:02.952,0:07:06.285
Grief is explicitly reactive.

0:07:06.285,0:07:09.320
If you have a loss and you feel incredibly unhappy,

0:07:09.320,0:07:11.400
and then, six months later,

0:07:11.400,0:07:14.760
you are still deeply sad, but[br]you're functioning a little better,

0:07:14.760,0:07:15.903
it's probably grief,

0:07:15.903,0:07:18.210
and it will probably ultimately resolve itself

0:07:18.210,0:07:19.736
in some measure.

0:07:19.736,0:07:22.381
If you experience a catastrophic loss,

0:07:22.381,0:07:23.748
and you feel terrible,

0:07:23.748,0:07:26.560
and six months later, you can barely function at all,

0:07:26.560,0:07:29.900
then it's probably a depression that was triggered

0:07:29.900,0:07:31.696
by the catastrophic circumstances.

0:07:31.696,0:07:35.343
The trajectory tells us a great deal.

0:07:35.343,0:07:38.624
People think of depression as being just sadness.

0:07:38.624,0:07:40.899
It's much, much too much sadness,

0:07:40.899,0:07:42.563
much too much grief

0:07:42.563,0:07:45.568
at far too slight a cause.

0:07:45.568,0:07:48.346
As I set out to understand depression,

0:07:48.346,0:07:51.920
and to interview people who had experienced it,

0:07:51.920,0:07:53.397
I found that there were people who seemed

0:07:53.397,0:07:55.565
on the surface to have what sounded like

0:07:55.565,0:07:57.749
relatively mild depression

0:07:57.749,0:08:01.150
who were nonetheless utterly disabled by it.

0:08:01.150,0:08:03.870
And there were other people who had what sounded

0:08:03.870,0:08:04.643
as they described it

0:08:04.643,0:08:06.786
like terribly severe depression

0:08:06.786,0:08:09.678
who nonetheless had good lives in the intercesses

0:08:09.678,0:08:11.879
between their depressive episodes.

0:08:11.879,0:08:14.426
And I set out to find out what it is

0:08:14.426,0:08:15.982
that causes some people

0:08:15.982,0:08:18.343
to be more resilient than other people.

0:08:18.343,0:08:19.810
What are the mechanisms

0:08:19.810,0:08:21.654
that allow people to survive?

0:08:21.654,0:08:25.270
And I went out and interviewed person after person

0:08:25.270,0:08:27.105
who was suffering with depression.

0:08:27.105,0:08:28.949
One of the first people I interviewed

0:08:28.949,0:08:30.646
described depression

0:08:30.646,0:08:34.860
as a slower way of being dead,

0:08:34.860,0:08:36.338
and that was a good thing for me to hear early on

0:08:36.338,0:08:37.766
because it reminded me

0:08:37.766,0:08:39.642
that that slow way of being dead

0:08:39.642,0:08:41.646
can lead to actual deadness,

0:08:41.646,0:08:43.695
that this is a serious business.

0:08:43.695,0:08:46.510
It's the leading disability worldwide,

0:08:46.510,0:08:49.354
and people die of it every day.

0:08:49.354,0:08:51.339
One of the people I talked to

0:08:51.339,0:08:53.620
when I was trying to understand this

0:08:53.620,0:08:54.826
was a beloved friend

0:08:54.826,0:08:56.798
who I had known for many years,

0:08:56.798,0:08:59.248
and who had had a psychotic episode

0:08:59.248,0:09:01.213
in her freshman year of college,

0:09:01.213,0:09:04.300
and then plummeted into a horrific depression.

0:09:04.300,0:09:05.818
She had bipolar illness,

0:09:05.818,0:09:08.940
or manic depression, as it was then known.

0:09:08.940,0:09:10.382
And then she did very well

0:09:10.382,0:09:12.830
for many years on lithium,

0:09:12.830,0:09:13.574
and then eventually,

0:09:13.574,0:09:15.349
she was taken off her lithium

0:09:15.349,0:09:17.230
to see how she would do without it,

0:09:17.230,0:09:19.620
and she had another psychosis,

0:09:19.620,0:09:21.496
and then plunged into the worst depression

0:09:21.496,0:09:23.430
that I had ever seen

0:09:23.430,0:09:26.200
in which she sat in her parents' apartment,

0:09:26.200,0:09:29.630
more or less catatonic, essentially without moving,

0:09:29.630,0:09:32.420
day after day after day.

0:09:32.420,0:09:35.452
And when I interviewed her about[br]that experience some years later

0:09:35.452,0:09:38.430
— she's a poet and psychotherapist[br]named Maggie Robbins —

0:09:38.430,0:09:41.247
when I interviewed her, she said,

0:09:41.247,0:09:45.600
"I was singing 'Where Have All The Flowers Gone'

0:09:45.600,0:09:48.487
over and over to occupy my mind.

0:09:48.487,0:09:51.638
I was singing to blot out the[br]things my mind was saying,

0:09:51.638,0:09:56.143
which were, 'You are nothing. You are nobody.

0:09:56.143,0:09:58.569
You don't even deserve to live.'

0:09:58.569,0:10:00.978
And that was when I really started thinking

0:10:00.978,0:10:03.313
about killing myself."

0:10:03.313,0:10:05.252
You don't think in depression

0:10:05.252,0:10:07.127
that you've put on a grey veil

0:10:07.127,0:10:09.231
and are seeing the world through the haze

0:10:09.231,0:10:11.109
of a bad mood.

0:10:11.109,0:10:13.983
You think that the veil has been taken away,

0:10:13.983,0:10:15.828
the veil of happiness,

0:10:15.828,0:10:18.360
and that now you're seeing truly.

0:10:18.360,0:10:21.155
It's easier to help schizophrenics who perceive

0:10:21.155,0:10:23.212
that there's something foreign inside of them

0:10:23.212,0:10:25.800
that needs to be exorcised,

0:10:25.800,0:10:27.810
but it's difficult with depressives,

0:10:27.810,0:10:31.287
because we believe we are seeing the truth.

0:10:31.287,0:10:34.005
But the truth lies.

0:10:34.005,0:10:36.940
I became obsessed with that sentence.

0:10:36.940,0:10:38.531
"But the truth lies."

0:10:38.531,0:10:40.814
And I discovered, as I talked to depressive people,

0:10:40.814,0:10:43.665
that they have many delusional perceptions.

0:10:43.665,0:10:45.393
People will say, "No one loves me."

0:10:45.393,0:10:47.230
And you say, "I love you,

0:10:47.230,0:10:49.475
your wife loves you, your mother loves you."

0:10:49.475,0:10:51.520
You can answer that one pretty readily,

0:10:51.520,0:10:53.247
at least for most people.

0:10:53.247,0:10:55.253
But people who are depressed will also say,

0:10:55.253,0:10:57.480
"No matter what we do,

0:10:57.480,0:10:59.230
we're all just going to die in the end."

0:10:59.230,0:11:01.541
Or they'll say, "There can be no true communion

0:11:01.541,0:11:03.224
between two human beings.

0:11:03.224,0:11:05.893
Each of us is trapped in his own body."

0:11:05.893,0:11:07.573
To which you have to say,

0:11:07.573,0:11:09.047
"That's true,

0:11:09.047,0:11:10.881
but I think we should focus right now

0:11:10.881,0:11:12.777
on what to have for breakfast."

0:11:12.777,0:11:14.746
(Laughter)

0:11:14.746,0:11:16.538
A lot of the time,

0:11:16.538,0:11:19.250
what they are expressing is not illness, but insight,

0:11:19.250,0:11:21.877
and one comes to think what's really extraordinary

0:11:21.877,0:11:24.949
is that most of us know about[br]those existential questions

0:11:24.949,0:11:27.347
and they don't distract us very much.

0:11:27.347,0:11:29.521
There was a study I particularly liked

0:11:29.521,0:11:31.170
in which a group of depressed

0:11:31.170,0:11:32.995
and a group of non-depressed people

0:11:32.995,0:11:35.755
were asked to play a video game for an hour,

0:11:35.755,0:11:37.584
and at the end of the hour,

0:11:37.584,0:11:39.189
they were asked how many little monsters

0:11:39.189,0:11:40.960
they thought they had killed.

0:11:40.960,0:11:43.218
The depressive group was usually accurate

0:11:43.218,0:11:45.169
to within about 10 percent,

0:11:45.169,0:11:46.548
and the non-depressed people

0:11:46.548,0:11:49.878
guessed between 15 and 20 times as many

0:11:49.878,0:11:51.988
little monsters — (Laughter) —

0:11:51.988,0:11:55.993
as they had actually killed.

0:11:55.993,0:11:59.150
A lot of people said, when I chose[br]to write about my depression,

0:11:59.150,0:12:00.919
that it must be very difficult

0:12:00.919,0:12:04.520
to be out of that closet, to have people know.

0:12:04.520,0:12:06.890
They said, "Do people talk to you differently?"

0:12:06.890,0:12:08.300
And I said, "Yes, people talk to me differently.

0:12:08.300,0:12:10.183
They talk to me differently insofar

0:12:10.183,0:12:13.204
as they start telling me about their experience,

0:12:13.204,0:12:14.900
or their sister's experience,

0:12:14.900,0:12:16.736
or their friend's experience.

0:12:16.736,0:12:18.981
Things are different because now I know

0:12:18.981,0:12:21.463
that depression is the family secret

0:12:21.463,0:12:23.816
that everyone has.

0:12:23.816,0:12:26.906
I went a few years ago to a conference,

0:12:26.906,0:12:30.760
and on Friday of the three day conference,

0:12:30.760,0:12:32.558
one of the participants took me aside, and she said,

0:12:32.558,0:12:35.886
"I suffer from depression and

0:12:35.886,0:12:39.101
I'm a little embarrassed about it,

0:12:39.101,0:12:41.142
but I've been taking this medication,

0:12:41.142,0:12:44.338
and I just wanted to ask you what you think?"

0:12:44.338,0:12:46.895
And so I did my best to give[br]her such advice as I could.

0:12:46.895,0:12:48.722
And then she said, "You know,

0:12:48.722,0:12:51.528
my husband would never understand this.

0:12:51.528,0:12:54.780
He's really the kind of guy to whom[br]this wouldn't make any sense,

0:12:54.780,0:12:57.630
so I just, you know, it's just between us."

0:12:57.630,0:12:58.846
And I said, "Yes, that's fine."

0:12:58.846,0:13:00.663
On Sunday of the same conference,

0:13:00.663,0:13:03.861
her husband took me aside,

0:13:03.861,0:13:05.586
and he said, "My wife wouldn't think

0:13:05.586,0:13:07.943
that I was really much of a guy if she knew this,

0:13:07.943,0:13:10.164
but I've been dealing with this depression

0:13:10.164,0:13:11.871
and I'm taking some medication,

0:13:11.871,0:13:14.376
and I wondered what you think?"

0:13:14.376,0:13:15.722
They were hiding

0:13:15.722,0:13:18.600
the same medication in two different places

0:13:18.600,0:13:21.167
in the same bedroom.

0:13:21.167,0:13:22.711
And I said that I thought

0:13:22.711,0:13:24.302
communication within the marriage

0:13:24.302,0:13:26.240
might be triggering some of their problems.

0:13:26.240,0:13:30.646
(Laughter)

0:13:30.646,0:13:32.363
But I was also struck

0:13:32.363,0:13:34.400
by the burdensome nature

0:13:34.400,0:13:36.650
of such mutual secrecy.

0:13:36.650,0:13:37.981
Depression is so exhausting.

0:13:37.981,0:13:40.841
It takes up so much of your time and energy,

0:13:40.841,0:13:42.560
and silence about it,

0:13:42.560,0:13:45.153
it really does make the depression worse.

0:13:45.153,0:13:46.870
And then I began thinking about all the ways

0:13:46.870,0:13:48.944
people make themselves better.

0:13:48.944,0:13:51.367
I'd started off as a medical conservative.

0:13:51.367,0:13:53.693
I thought there were a few[br]kinds of therapy that worked,

0:13:53.693,0:13:55.442
it was clear what they were,

0:13:55.442,0:13:57.224
there was medication,

0:13:57.224,0:13:58.807
there were certain psychotherapies,

0:13:58.807,0:14:00.976
there was possibly electro-convulsive treatment,

0:14:00.976,0:14:03.820
and that everything else was nonsense.

0:14:03.820,0:14:05.682
But then I discovered something.

0:14:05.682,0:14:07.326
If you have brain cancer,

0:14:07.326,0:14:08.798
and you say that standing on your head

0:14:08.798,0:14:11.655
for 20 minutes every morning makes you feel better,

0:14:11.655,0:14:13.323
it may make you feel better,

0:14:13.323,0:14:14.926
but you still have brain cancer,

0:14:14.926,0:14:17.169
and you'll still probably die from it.

0:14:17.169,0:14:19.543
But if you say that you have depression,

0:14:19.543,0:14:21.802
and standing on your head for 20 minutes every day

0:14:21.802,0:14:24.147
makes you feel better, then it's worked,

0:14:24.147,0:14:26.707
because depression is an illness of how you feel,

0:14:26.707,0:14:28.316
and if you feel better,

0:14:28.316,0:14:31.100
then you are effectively not depressed anymore.

0:14:31.100,0:14:32.994
So I became much more tolerant

0:14:32.994,0:14:35.766
of the vast world of alternative treatments.

0:14:35.766,0:14:38.351
And I get letters, I get hundreds of letters

0:14:38.351,0:14:40.789
from people writing to tell me[br]about what's worked for them.

0:14:40.789,0:14:43.560
Someone was asking me backstage today

0:14:43.560,0:14:44.652
about meditation.

0:14:44.652,0:14:46.964
My favorite of the letters that I got

0:14:46.964,0:14:48.531
was the one that came from a woman

0:14:48.531,0:14:50.559
who wrote and said that she had tried therapy,

0:14:50.559,0:14:51.955
she had tried medication,

0:14:51.955,0:14:53.340
she had tried pretty much everything,

0:14:53.340,0:14:56.700
and she had found a solution[br]and hoped I would tell the world,

0:14:56.700,0:14:59.804
and that was making little things from yarn.

0:14:59.804,0:15:02.911
(Laughter)

0:15:02.911,0:15:05.913
She sent me some of them. (Laughter)

0:15:05.913,0:15:10.155
And I'm not wearing them right now.

0:15:10.155,0:15:12.100
I suggested to her that she also should look up

0:15:12.100,0:15:17.101
obsessive compulsive disorder in the DSM.

0:15:17.101,0:15:19.752
And yet, when I went to look[br]at alternative treatments,

0:15:19.752,0:15:22.598
I also gained perspective on other treatments.

0:15:22.598,0:15:25.748
I went through a tribal exorcism in Senegal

0:15:25.748,0:15:27.422
that involved a great deal of ram's blood

0:15:27.422,0:15:29.422
and that I'm not going to detail right now,

0:15:29.422,0:15:31.422
but a few years afterward I was in Rwanda

0:15:31.422,0:15:33.304
working on a different project,

0:15:33.304,0:15:36.580
and I happened to describe[br]my experience to someone,

0:15:36.580,0:15:37.523
and he said, "Well, you know,

0:15:37.523,0:15:39.633
that's West Africa, and we're in East Africa,

0:15:39.633,0:15:41.652
and our rituals are in some ways very different,

0:15:41.652,0:15:43.542
but we do have some rituals that have something

0:15:43.542,0:15:45.544
in common with what you're describing."

0:15:45.544,0:15:47.301
And I said, "Oh." And he said, "Yes," he said,

0:15:47.301,0:15:49.895
"but we've had a lot of trouble with[br]Western mental health workers,

0:15:49.895,0:15:52.484
especially the ones who came[br]right after the genocide."

0:15:52.484,0:15:54.795
And I said, "What kind of trouble did you have?"

0:15:54.795,0:15:56.587
And he said, "Well," he said,

0:15:56.587,0:15:59.113
"They would do this bizarre thing."

0:15:59.113,0:16:00.982
He said, "They didn't take people out in the sunshine

0:16:00.982,0:16:02.698
where you begin to feel better.

0:16:02.698,0:16:04.315
They didn't include drumming or music

0:16:04.315,0:16:05.810
to get people's blood going.

0:16:05.810,0:16:07.680
They didn't involve the whole community.

0:16:07.680,0:16:09.409
They didn't externalize the depression

0:16:09.409,0:16:11.120
as an invasive spirit.

0:16:11.120,0:16:13.150
Instead what they did was they took people

0:16:13.150,0:16:15.966
one at a time into dingy little rooms

0:16:15.966,0:16:17.552
and had them talk for an hour

0:16:17.552,0:16:19.550
about bad things that had happened to them."

0:16:19.550,0:16:25.410
(Laughter) (Applause)

0:16:25.410,0:16:27.358
He said, "We had to ask them to leave the country."

0:16:27.358,0:16:30.477
(Laughter)

0:16:30.477,0:16:32.982
Now at the other end of alternative treatments,

0:16:32.982,0:16:35.155
let me tell you about Frank Roussekoff.

0:16:35.155,0:16:37.978
Frank Roussekoff had the worst depression

0:16:37.978,0:16:41.600
perhaps that I've ever seen in a man.

0:16:41.600,0:16:43.270
He was constantly depressed.

0:16:43.270,0:16:44.842
He was, when I met him, at a point at which

0:16:44.842,0:16:48.322
every month he would have electroshock treatment.

0:16:48.322,0:16:50.913
Then he would feel sort of disoriented for a week.

0:16:50.913,0:16:52.700
Then he would feel okay for a week.

0:16:52.700,0:16:54.677
Then he would have a week of going downhill.

0:16:54.677,0:16:57.610
And then he would have another[br]electroshock treatment.

0:16:57.610,0:16:58.700
And he said to me when I met him,

0:16:58.700,0:17:01.160
"It's unbearable to go through my weeks this way.

0:17:01.160,0:17:02.729
I can't go on this way,

0:17:02.729,0:17:04.963
and I've figured out how I'm going to end it

0:17:04.963,0:17:06.550
if I don't get better.

0:17:06.550,0:17:08.782
But," he said to me, "I heard about a protocol

0:17:08.782,0:17:11.220
at Mass General for a procedure called

0:17:11.220,0:17:13.430
a cingulotomy, which is a brain surgery,

0:17:13.430,0:17:16.340
and I think I'm going to give that a try."

0:17:16.340,0:17:17.955
And I remember being amazed at that point

0:17:17.955,0:17:19.302
to think that someone

0:17:19.302,0:17:22.429
who clearly had so many bad experiences

0:17:22.429,0:17:24.350
with so many different treatments

0:17:24.350,0:17:27.395
still had buried in him somewhere enough optimism

0:17:27.395,0:17:29.945
to reach out for one more.

0:17:29.945,0:17:32.110
And he had the a cingulotomy,

0:17:32.110,0:17:34.151
and it was incredibly successful.

0:17:34.151,0:17:35.767
He's now a friend of mine.

0:17:35.767,0:17:38.721
He has a lovely wife and two beautiful children.

0:17:38.721,0:17:42.100
He wrote me a letter the Christmas after the surgery,

0:17:42.100,0:17:43.304
and he said,

0:17:43.304,0:17:45.758
"My father sent me two presents this year,

0:17:45.758,0:17:48.114
First, a motorized CD rack from The Sharper Image

0:17:48.114,0:17:49.750
that I didn't really need,

0:17:49.750,0:17:51.555
but I knew he was giving it to me to celebrate

0:17:51.555,0:17:53.498
the fact that I'm living on my own

0:17:53.498,0:17:55.684
and have a job I seem to love.

0:17:55.684,0:17:57.460
And the other present

0:17:57.460,0:17:58.851
was a photo of my grandmother,

0:17:58.851,0:18:00.781
who committed suicide.

0:18:00.781,0:18:03.839
As I unwrapped it, I began to cry,

0:18:03.839,0:18:05.795
and my mother came over and said,

0:18:05.795,0:18:08.680
'Are you crying because of the[br]relatives you never knew?'

0:18:08.680,0:18:13.260
And I said, 'She had the same disease I have.'

0:18:13.260,0:18:15.948
I'm crying now as I write to you.

0:18:15.948,0:18:19.990
It's not that I'm so sad, but I get overwhelmed,

0:18:19.990,0:18:21.364
I think, because I could have killed myself,

0:18:21.364,0:18:23.344
but my parents kept me going,

0:18:23.344,0:18:25.740
and so did the doctors,

0:18:25.740,0:18:26.916
and I had the surgery.

0:18:26.916,0:18:29.240
I'm alive and grateful.

0:18:29.240,0:18:31.362
We live in the right time,

0:18:31.362,0:18:35.917
even if it doesn't always feel like it."

0:18:35.917,0:18:37.752
I was struck by the fact that depression

0:18:37.752,0:18:39.446
is broadly perceived to be

0:18:39.446,0:18:43.830
a modern, Western, middle class thing,

0:18:43.830,0:18:45.289
and I went to look at how it operated

0:18:45.289,0:18:47.200
in a variety of other contexts,

0:18:47.200,0:18:49.720
and one of the things I was most interested in

0:18:49.720,0:18:51.170
was depression among the indigent.

0:18:51.170,0:18:53.290
And so I went out to try to look at what was

0:18:53.290,0:18:55.501
being done for poor people with depression.

0:18:55.501,0:18:57.566
And what I discovered is that poor people

0:18:57.566,0:19:00.200
are mostly not being treated for depression.

0:19:00.200,0:19:03.120
Depression is the result of a genetic vulnerability,

0:19:03.120,0:19:06.246
which is presumably evenly[br]distributed in the population,

0:19:06.246,0:19:08.153
and triggering circumstances,

0:19:08.153,0:19:10.780
which are likely to be more severe

0:19:10.780,0:19:11.931
for people who are impoverished.

0:19:11.931,0:19:14.174
And yet it turns out that if you have

0:19:14.174,0:19:16.576
a really lovely life but feel miserable all the time,

0:19:16.576,0:19:18.576
you think, "Why do I feel like this?

0:19:18.576,0:19:20.260
I must have depression."

0:19:20.260,0:19:22.213
And you set out to find treatment for it.

0:19:22.213,0:19:24.276
But if you have a perfectly awful life,

0:19:24.276,0:19:26.790
and you feel miserable all the time,

0:19:26.790,0:19:28.955
the way you feel is commensurate with your life,

0:19:28.955,0:19:30.677
and it doesn't occur to you to think,

0:19:30.677,0:19:32.384
"Maybe this is treatable."

0:19:32.384,0:19:35.504
And so we have an epidemic in this country

0:19:35.504,0:19:38.372
of depression among impoverished people

0:19:38.372,0:19:41.114
that's not being picked up[br]and that's not being treated

0:19:41.114,0:19:42.832
and that's not being addressed,

0:19:42.832,0:19:45.248
and it's a tragedy of a grand order.

0:19:45.248,0:19:46.858
And so I found an academic

0:19:46.858,0:19:48.522
who was doing a research project

0:19:48.522,0:19:50.449
in slums outside of D.C.,

0:19:50.449,0:19:53.259
where she picked up women who had[br]come in for other health problems

0:19:53.259,0:19:55.130
and diagnosed them with depression,

0:19:55.130,0:19:58.274
and then provided six months[br]of experimental protocol.

0:19:58.274,0:20:00.480
One of them, Lolly, came in,

0:20:00.480,0:20:03.700
and this is what she said the day she came in.

0:20:03.700,0:20:05.525
She said, and she was a woman, by the way,

0:20:05.525,0:20:08.156
who had seven children. She said,

0:20:08.156,0:20:10.745
"I used to have a job but I had to give it up because

0:20:10.745,0:20:12.913
I couldn't go out of the house.

0:20:12.913,0:20:15.203
I have nothing to say to my children.

0:20:15.203,0:20:18.400
In the morning, I can't wait for them to leave,

0:20:18.400,0:20:21.205
and then I climb in bed and[br]pull the covers over my head,

0:20:21.205,0:20:22.836
and three o'clock when they come home,

0:20:22.836,0:20:24.606
it just comes so fast."

0:20:24.606,0:20:26.692
She said, "I've been taking a lot of Tylenol,

0:20:26.692,0:20:29.574
anything I can take so that I can sleep more.

0:20:29.574,0:20:33.452
My husband has been telling me I'm stupid, I'm ugly.

0:20:33.452,0:20:36.864
I wish I could stop the pain."

0:20:36.864,0:20:39.474
Well, she was brought into[br]this experimental protocol,

0:20:39.474,0:20:41.720
and when I interviewed her six months later,

0:20:41.720,0:20:46.252
she had taken a job working in child care

0:20:46.252,0:20:50.117
for the U.S. Navy, she had left the abusive husband,

0:20:50.117,0:20:51.939
and she said to me,

0:20:51.939,0:20:54.461
"My kids are so much happier now."

0:20:54.461,0:20:56.377
She said, "There's one room in my new place

0:20:56.377,0:20:59.600
for the boys and one room for the girls,

0:20:59.600,0:21:01.200
but at night, they're just all up on my bed,

0:21:01.200,0:21:03.812
and we're doing homework[br]all together and everything.

0:21:03.812,0:21:05.717
One of them wants to be a preacher,

0:21:05.717,0:21:07.723
one of them wants to be a firefighter,

0:21:07.723,0:21:10.550
and one of the girls says she's going to be a lawyer.

0:21:10.550,0:21:12.510
They don't cry like they used to,

0:21:12.510,0:21:14.837
and they don't fight like they did.

0:21:14.837,0:21:18.863
That's all I need now is my kids.

0:21:18.863,0:21:20.852
Things keep on changing,

0:21:20.852,0:21:26.460
the way I dress, the way I feel, the way I act.

0:21:26.460,0:21:29.885
I can go outside not being afraid anymore,

0:21:29.885,0:21:33.125
and I don't think those bad feelings are coming back,

0:21:33.125,0:21:36.114
and if it weren't for Dr. Miranda and that,

0:21:36.114,0:21:39.471
I would still be at home with[br]the covers pulled over my head,

0:21:39.471,0:21:42.157
if I were still alive at all.

0:21:42.157,0:21:45.766
I asked the Lord to send me an angel,

0:21:45.766,0:21:49.281
and he heard my prayers."

0:21:50.467,0:21:53.605
I was really moved by these experiences,

0:21:53.605,0:21:56.560
and I decided that I wanted to write about them

0:21:56.560,0:21:57.555
not only in a book I was working on,

0:21:57.555,0:21:58.957
but also in an article,

0:21:58.957,0:22:01.850
and so I got a commission from[br]"The New York Times Magazine"

0:22:01.850,0:22:03.264
to write about depression among the indigent.

0:22:03.264,0:22:04.848
And I turned in my story,

0:22:04.848,0:22:06.444
and my editor called me and said,

0:22:06.444,0:22:08.387
"We really can't publish this."

0:22:08.387,0:22:09.783
And I said, "Why not?"

0:22:09.783,0:22:12.241
And she said, "It just is too far-fetched.

0:22:12.241,0:22:15.818
These people who are sort of at[br]the very bottom rung of society

0:22:15.818,0:22:17.784
and then they get a few months of treatment

0:22:17.784,0:22:20.277
and they're virtually ready to run Morgan Stanley?

0:22:20.277,0:22:22.209
It's just too implausible."

0:22:22.209,0:22:24.290
She said, I've never even heard of anything like it."

0:22:24.290,0:22:26.793
And I said, "The fact that you've never heard of it

0:22:26.793,0:22:29.809
is an indication that it is news."

0:22:29.809,0:22:35.696
(Laughter) (Applause)

0:22:37.165,0:22:40.150
"And you are a news magazine."

0:22:40.150,0:22:42.270
So after a certain amount of negotiation,

0:22:42.270,0:22:43.512
they agreed to it.

0:22:43.512,0:22:44.973
But I think a lot of what they said

0:22:44.973,0:22:47.144
was connected in some strange way

0:22:47.144,0:22:49.302
to this distaste that people still have

0:22:49.302,0:22:50.811
for the idea of treatment,

0:22:50.811,0:22:52.616
the notion that somehow if we went out

0:22:52.616,0:22:55.312
and treated a lot of people in indigent communities,

0:22:55.312,0:22:57.272
that would be an exploitative thing to do,

0:22:57.272,0:22:58.960
because we would be changing them.

0:22:58.960,0:23:01.470
There is this false moral imperative

0:23:01.470,0:23:02.813
that seems to be all around us

0:23:02.813,0:23:05.260
that treatment of depression,

0:23:05.260,0:23:07.435
the medications and so on, are an artifice,

0:23:07.435,0:23:09.777
and that it's not natural.

0:23:09.777,0:23:12.610
And I think that's very misguided.

0:23:12.610,0:23:15.895
It would be natural for people's teeth to fall out,

0:23:15.895,0:23:18.795
but there is nobody militating against toothpaste,

0:23:18.795,0:23:21.709
at least not in my circles.

0:23:21.709,0:23:23.887
And people then say, "Well, but isn't depression

0:23:23.887,0:23:25.994
part of what people are supposed to experience?

0:23:25.994,0:23:27.874
Didn't we evolve to have depression?

0:23:27.874,0:23:29.858
Isn't it part of your personality?"

0:23:29.858,0:23:32.388
To which I would say, mood is adaptive.

0:23:32.388,0:23:35.702
Being able to have sadness and fear

0:23:35.702,0:23:37.590
and joy and pleasure

0:23:37.590,0:23:39.532
and all of the other moods that we have,

0:23:39.532,0:23:41.442
that's incredibly valuable.

0:23:41.442,0:23:44.550
And major depression is something that happens

0:23:44.550,0:23:46.685
when that system gets broken.

0:23:46.685,0:23:48.387
It's maladaptive.

0:23:48.387,0:23:49.944
People will come to me and say,

0:23:49.944,0:23:52.388
"I think, though, if I just stick it out for another year,

0:23:52.388,0:23:54.726
I think I can just get through this."

0:23:54.726,0:23:56.998
And I always say to them, "You may get through it,

0:23:56.998,0:23:59.646
but you'll never be 37 again.

0:23:59.646,0:24:02.165
Life is short, and that's a whole year

0:24:02.165,0:24:04.182
you're talking about giving up.

0:24:04.182,0:24:05.936
Think it through."

0:24:05.936,0:24:08.751
It's a strange poverty of the English language,

0:24:08.751,0:24:10.598
and indeed of many other languages,

0:24:10.598,0:24:12.862
that we use this same word, "depression,"

0:24:12.862,0:24:14.698
to describe how a kid feels

0:24:14.698,0:24:16.548
when it rains on his birthday,

0:24:16.548,0:24:18.861
and to describe how somebody feels

0:24:18.861,0:24:21.391
the minute before they commit suicide.

0:24:21.391,0:24:24.775
People say to me, "Well, is it[br]continuous with normal sadness?"

0:24:24.775,0:24:27.579
And I say, in a way it's continuous[br]with normal sadness.

0:24:27.579,0:24:29.749
There is a certain amount of continuity,

0:24:29.749,0:24:31.736
but it's the same way there's continuity

0:24:31.736,0:24:33.738
between having an iron fence outside your house

0:24:33.738,0:24:35.538
that gets a little rust spot

0:24:35.538,0:24:38.192
that you have to sort of sand[br]off and do a little repainting,

0:24:38.192,0:24:40.854
and what happens if you leave[br]the house for a hundred years

0:24:40.854,0:24:43.368
and it rusts through until it's only a pile

0:24:43.368,0:24:45.186
of orange dust.

0:24:45.186,0:24:47.190
And it's that orange dust spot,

0:24:47.190,0:24:48.979
that orange dust problem,

0:24:48.979,0:24:52.231
that's the one we're setting out to address.

0:24:52.231,0:24:54.331
So now people say,

0:24:54.331,0:24:57.124
"You take these happy pills, and do you feel happy?"

0:24:57.124,0:24:58.779
And I don't.

0:24:58.779,0:25:01.386
But I don't feel sad about having to eat lunch,

0:25:01.386,0:25:04.177
and I don't feel sad about my answering machine,

0:25:04.177,0:25:07.251
and I don't feel sad about taking a shower.

0:25:07.251,0:25:10.106
I feel more, in fact, I think,

0:25:10.106,0:25:12.660
because I can feel sadness without nullity.

0:25:12.660,0:25:16.928
I feel sad about professional disappointments,

0:25:16.928,0:25:19.383
about damaged relationships,

0:25:19.383,0:25:21.224
about global warming.

0:25:21.224,0:25:24.240
Those are the things that I feel sad about now.

0:25:24.240,0:25:26.805
And I said to myself, well, what is the conclusion?

0:25:26.805,0:25:29.366
How did those people who have better lives

0:25:29.366,0:25:31.889
even with bigger depression manage to get through?

0:25:31.889,0:25:34.425
What is the mechanism of resilience?

0:25:34.425,0:25:36.662
And what I came up with over time

0:25:36.662,0:25:39.255
was that the people who deny their experience,

0:25:39.255,0:25:41.333
the ones who say, "I was depressed a long time ago

0:25:41.333,0:25:43.256
and I never want to think about it again

0:25:43.256,0:25:44.898
and I'm not going to look at it

0:25:44.898,0:25:46.772
and I'm just going to get on with my life,"

0:25:46.772,0:25:48.653
ironically, those are the people

0:25:48.653,0:25:51.259
who are most enslaved by what they have.

0:25:51.259,0:25:53.761
Shutting out the depression strengthens it.

0:25:53.761,0:25:57.318
While you hide from it, it grows.

0:25:57.318,0:25:59.655
And the people who do better

0:25:59.655,0:26:02.178
at the ones who are able to tolerate the fact

0:26:02.178,0:26:04.261
that they have this condition.

0:26:04.261,0:26:06.531
Those who can tolerate their depression

0:26:06.531,0:26:08.544
are the ones who achieve resilience.

0:26:08.544,0:26:10.281
So Frank Roussekoff said to me,

0:26:10.281,0:26:11.967
"If I had it again to do over,

0:26:11.967,0:26:13.949
I suppose I wouldn't do it this way,

0:26:13.949,0:26:16.500
but in a strange way, I'm grateful

0:26:16.500,0:26:17.585
for what I've experienced.

0:26:17.585,0:26:20.941
I'm glad to have been in the hospital 40 times.

0:26:20.941,0:26:23.744
It taught me so much about love,

0:26:23.744,0:26:26.661
and my relationship with my parents and my doctors

0:26:26.661,0:26:30.958
has been so precious to me, and will be always."

0:26:30.958,0:26:32.960
And Maggie Robbins said,

0:26:32.960,0:26:35.841
"I used to volunteer in an AIDS clinic,

0:26:35.841,0:26:38.640
and I would just talk and talk and talk,

0:26:38.640,0:26:40.622
and the people I was dealing with

0:26:40.622,0:26:42.661
weren't very responsive, and I thought,

0:26:42.661,0:26:46.635
'That's not very friendly or helpful of them.'

0:26:46.635,0:26:48.492
And then I realized,

0:26:48.492,0:26:50.514
I realized that they weren't going to do more

0:26:50.514,0:26:52.992
than make those first few minutes of small talk.

0:26:52.992,0:26:54.864
It was simply going to be an occasion

0:26:54.864,0:26:57.680
where I didn't have AIDS and I wasn't dying,

0:26:57.680,0:27:00.685
but could tolerate the fact that they did

0:27:00.685,0:27:02.610
and they were.

0:27:02.610,0:27:06.166
Our needs are our greatest assets.

0:27:06.166,0:27:08.198
It turns out I've learned to give

0:27:08.198,0:27:12.100
all the things I need."

0:27:12.100,0:27:14.930
Valuing one's depression

0:27:14.930,0:27:16.278
does not prevent a relapse,

0:27:16.278,0:27:18.861
but it may make the prospect of relapse

0:27:18.861,0:27:22.694
and even relapse itself easier to tolerate.

0:27:22.694,0:27:25.262
The question is not so much

0:27:25.262,0:27:27.437
of finding great meaning and deciding

0:27:27.437,0:27:29.371
your depression has been very meaningful.

0:27:29.371,0:27:31.512
It's of seeking that meaning

0:27:31.512,0:27:33.255
and thinking, when it comes again,

0:27:33.255,0:27:35.880
"This will be hellish,

0:27:35.880,0:27:37.657
but I will learn something from it."

0:27:37.657,0:27:39.752
I have learned in my own depression

0:27:39.752,0:27:41.903
how big an emotion can be,

0:27:41.903,0:27:44.385
how it can be more real than facts,

0:27:44.385,0:27:47.704
and I have found that that experience

0:27:47.704,0:27:50.688
has allowed me to experience positive emotion

0:27:50.688,0:27:54.208
in a more intense and more focused way.

0:27:54.208,0:27:57.526
The opposite of depression is not happiness,

0:27:57.526,0:27:59.304
but vitality,

0:27:59.304,0:28:02.104
and these days, my life is vital,

0:28:02.104,0:28:04.803
even on the days when I'm sad.

0:28:04.803,0:28:07.963
I felt that funeral in my brain,

0:28:07.963,0:28:10.480
and I sat next to the colossus

0:28:10.480,0:28:11.896
at the edge of the world,

0:28:11.896,0:28:14.384
and I have discovered

0:28:14.384,0:28:16.328
something inside of myself

0:28:16.328,0:28:18.537
that I would have to call a soul

0:28:18.537,0:28:22.740
that I had never formulated[br]until that day 20 years ago

0:28:22.740,0:28:26.904
when hell came to pay me a surprise visit.

0:28:26.904,0:28:30.848
I think that while I hated being depressed

0:28:30.848,0:28:33.136
and would hate to be depressed again,

0:28:33.136,0:28:35.496
I've found a way to love my depression.

0:28:35.496,0:28:37.921
I love it because it has forced me

0:28:37.921,0:28:40.704
to find and cling to joy.

0:28:40.704,0:28:44.269
I love it because each day I decide,

0:28:44.269,0:28:45.932
sometimes gamely,

0:28:45.932,0:28:48.200
and sometimes against the moment's reason,

0:28:48.200,0:28:51.240
to cleave to the reasons for living.

0:28:51.240,0:28:55.640
And that, I think, is a highly privileged rapture.

0:28:55.640,0:28:58.960
Thank you.

0:28:58.960,0:29:02.096
(Applause)