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 till 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 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, till I felt 0:00:22.315,0:00:25.831 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, 0:00:40.201,0:00:43.284 and I, and silence, some strange race 0:00:43.284,0:00:46.493 wrecked, 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. 0:01:15.997,0:01:19.587 As for me, I had always thought myself tough, 0:01:19.587,0:01:21.460 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, 0:01:35.268,0:01:38.432 and I got through all of those experiences intact. 0:01:38.432,0:01:41.539 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, but[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, 0:02:51.644,0:02:54.985 and yet you are nonetheless in its grip 0:02:54.985,0:02:58.737 and you are unable to figure out any way around it. 0:02:58.737,0:03:03.236 And so I began to feel myself doing less 0:03:03.236,0:03:05.326 and thinking less 0:03:05.326,0:03:07.694 and feeling less. 0:03:07.694,0:03:10.049 It was a kind of nullity. 0:03:10.049,0:03:12.415 And then the anxiety set in. 0:03:12.415,0:03:14.694 If you told me that I'd have to be 0:03:14.694,0:03:16.283 depressed for the next month, 0:03:16.283,0:03:19.507 I would say, "As long I know it'll be[br]over in November, I can do it." 0:03:19.507,0:03:20.623 But if you said to me, 0:03:20.623,0:03:23.923 "You have to have acute anxiety for the next month," 0:03:23.923,0:03:26.296 I would rather slit my wrist than go through it. 0:03:26.296,0:03:28.078 It was the feeling all the time 0:03:28.078,0:03:30.306 like that feeling you have if you're walking 0:03:30.306,0:03:31.708 and you slip or trip 0:03:31.708,0:03:33.593 and the ground is rushing up at you, 0:03:33.593,0:03:36.311 but instead of lasting half a[br]second, the way that does, 0:03:36.311,0:03:38.249 it lasted for six months. 0:03:38.249,0:03:41.281 It's a sensation of being afraid all the time 0:03:41.281,0:03:45.057 but not even knowing what it is that you're afraid of. 0:03:45.057,0:03:47.477 And it was at that point that I began to think 0:03:47.477,0:03:51.476 that it was just too painful to be alive, 0:03:51.476,0:03:54.060 and that the only reason not to kill oneself 0:03:54.060,0:03:57.191 was so as not to hurt other people. 0:03:57.191,0:04:00.184 And finally one day, I woke up 0:04:00.200,0:04:02.208 and I thought perhaps I'd had a stroke, 0:04:02.208,0:04:04.939 because I lay in bed completely frozen, 0:04:04.939,0:04:06.888 looking at the telephone, thinking, 0:04:06.888,0:04:10.451 "Something is wrong and I should call for help," 0:04:10.451,0:04:12.186 and I couldn't reach out my arm 0:04:12.186,0:04:14.648 and pick up the phone and dial. 0:04:14.648,0:04:18.802 And finally, after four full hours[br]of my lying and staring at it, 0:04:18.802,0:04:20.164 the phone rang, 0:04:20.164,0:04:22.412 and somehow I managed to pick it up, 0:04:22.412,0:04:24.212 and it was my father, 0:04:24.212,0:04:27.365 and I said, "I'm in serious trouble. 0:04:27.365,0:04:29.528 We need to do something." 0:04:29.528,0:04:32.856 The next day I started with the medications 0:04:32.856,0:04:35.224 and the therapy. 0:04:35.224,0:04:37.531 And I also started reckoning 0:04:37.531,0:04:39.410 with this terrible question: 0:04:39.410,0:04:41.483 If I'm not the tough person 0:04:41.483,0:04:44.039 who could have made it[br]through a concentration camp, 0:04:44.039,0:04:45.679 then who am I? 0:04:45.679,0:04:47.628 And if I have to take medication, 0:04:47.628,0:04:51.335 is that medication making me more fully myself, 0:04:51.335,0:04:53.754 or is it making me someone else? 0:04:53.754,0:04:55.450 And how do I feel about it 0:04:55.450,0:04:57.989 if it's making me someone else? 0:04:57.989,0:05:01.300 I had two advantages as I went in to the fight. 0:05:01.300,0:05:04.280 The first is that I knew that, objectively speaking, 0:05:04.280,0:05:05.901 I had a nice life, 0:05:05.901,0:05:07.786 and that if I could only get well, 0:05:07.786,0:05:09.224 there was something at the other end 0:05:09.224,0:05:11.010 that was worth living for. 0:05:11.010,0:05:14.052 And the other was that I had[br]access to good treatment. 0:05:14.052,0:05:17.816 But I nonetheless emerged and relapsed, 0:05:17.816,0:05:20.095 and emerged and relapsed, 0:05:20.095,0:05:23.139 and emerged and relapsed, 0:05:23.139,0:05:25.092 and finally understood 0:05:25.092,0:05:27.336 I would have to be on medication 0:05:27.336,0:05:29.632 and in therapy forever. 0:05:29.632,0:05:32.006 And I thought, "But is it a chemical problem 0:05:32.006,0:05:33.770 or a psychological problem? 0:05:33.770,0:05:37.466 And does it need a chemical cure[br]or a philosophical cure?" 0:05:37.466,0:05:39.525 And I couldn't figure out which it was. 0:05:39.525,0:05:42.002 And then I understood that actually, 0:05:42.002,0:05:44.076 we aren't advanced enough in either area 0:05:44.076,0:05:46.013 for it to explain things fully. 0:05:46.013,0:05:49.260 The chemical cure and the psychological cure 0:05:49.260,0:05:51.062 both have a role to play, 0:05:51.062,0:05:54.805 and I also figured out that depression was something 0:05:54.805,0:05:57.308 that was braided so deep into us 0:05:57.308,0:05:58.927 that there was no separating it 0:05:58.927,0:06:01.413 from our character and personality. 0:06:01.413,0:06:03.445 I want to say that the treatments we have 0:06:03.445,0:06:05.990 for depression are appalling. 0:06:05.990,0:06:07.817 They're not very effective. 0:06:07.817,0:06:09.650 They're extremely costly. 0:06:09.650,0:06:12.099 They come with innumerable side effects. 0:06:12.099,0:06:13.888 They're a disaster. 0:06:13.888,0:06:16.766 But I am so grateful that I live now 0:06:16.766,0:06:18.576 and not 50 years ago, 0:06:18.576,0:06:20.087 when there would have been almost nothing 0:06:20.087,0:06:21.488 to be done. 0:06:21.488,0:06:24.069 I hope that 50 years hence, 0:06:24.069,0:06:25.926 people will hear about my treatments 0:06:25.926,0:06:28.059 and be appalled that anyone endured 0:06:28.059,0:06:30.885 such primitive science. 0:06:30.885,0:06:35.441 Depression is the flaw in love. 0:06:35.441,0:06:38.582 If you were married to someone and thought, 0:06:38.582,0:06:42.177 "Well, if my wife dies, I'll find another one," 0:06:42.177,0:06:45.223 it wouldn't be love as we know it. 0:06:45.223,0:06:47.173 There's no such thing as love 0:06:47.173,0:06:49.817 without the anticipation of loss, 0:06:49.817,0:06:52.401 and that specter of despair 0:06:52.401,0:06:56.130 can be the engine of intimacy. 0:06:56.130,0:06:59.059 There are three things people tend to confuse: 0:06:59.059,0:07:02.859 depression, grief and sadness. 0:07:02.859,0:07:06.145 Grief is explicitly reactive. 0:07:06.145,0:07:09.104 If you have a loss and you feel incredibly unhappy, 0:07:09.104,0:07:10.737 and then, six months later, 0:07:10.737,0:07:13.959 you are still deeply sad, but[br]you're functioning a little better, 0:07:13.959,0:07:15.687 it's probably grief, 0:07:15.687,0:07:17.979 and it will probably ultimately resolve itself 0:07:17.979,0:07:19.428 in some measure. 0:07:19.428,0:07:22.179 If you experience a catastrophic loss, 0:07:22.179,0:07:23.393 and you feel terrible, 0:07:23.393,0:07:26.390 and six months later you can barely function at all, 0:07:26.390,0:07:28.975 then it's probably a depression that was triggered 0:07:28.975,0:07:31.449 by the catastrophic circumstances. 0:07:31.449,0:07:35.081 The trajectory tells us a great deal. 0:07:35.081,0:07:38.439 People think of depression as being just sadness. 0:07:38.439,0:07:40.775 It's much, much too much sadness, 0:07:40.775,0:07:42.439 much too much grief 0:07:42.439,0:07:45.368 at far too slight a cause. 0:07:45.368,0:07:48.115 As I set out to understand depression, 0:07:48.115,0:07:50.950 and to interview people who had experienced it, 0:07:50.950,0:07:53.981 I found that there were people who seemed 0:07:53.981,0:07:55.686 on the surface to have what sounded like 0:07:55.686,0:07:57.748 relatively mild depression 0:07:57.748,0:08:01.195 who were nonetheless utterly disabled by it. 0:08:01.195,0:08:03.053 And there were other people who had what sounded 0:08:03.053,0:08:04.365 as they described it 0:08:04.365,0:08:06.616 like terribly severe depression 0:08:06.616,0:08:09.431 who nonetheless had good lives in the interstices 0:08:09.431,0:08:11.586 between their depressive episodes. 0:08:11.586,0:08:14.271 And I set out to find out what it is 0:08:14.271,0:08:15.874 that causes some people 0:08:15.874,0:08:18.127 to be more resilient than other people. 0:08:18.127,0:08:19.686 What are the mechanisms 0:08:19.686,0:08:21.530 that allow people to survive? 0:08:21.530,0:08:24.699 And I went out and I interviewed person after person 0:08:24.699,0:08:26.874 who was suffering with depression. 0:08:26.874,0:08:28.825 One of the first people I interviewed 0:08:28.825,0:08:30.706 described depression 0:08:30.706,0:08:33.967 as a slower way of being dead, 0:08:33.967,0:08:36.091 and that was a good thing for me to hear early on 0:08:36.091,0:08:37.457 because it reminded me 0:08:37.457,0:08:39.456 that that slow way of being dead 0:08:39.456,0:08:41.491 can lead to actual deadness, 0:08:41.491,0:08:43.495 that this is a serious business. 0:08:43.495,0:08:46.154 It's the leading disability worldwide, 0:08:46.154,0:08:49.184 and people die of it every day. 0:08:49.184,0:08:50.953 One of the people I talked to 0:08:50.953,0:08:52.927 when I was trying to understand this 0:08:52.927,0:08:54.595 was a beloved friend 0:08:54.595,0:08:56.613 who I had known for many years, 0:08:56.613,0:08:59.155 and who had had a psychotic episode 0:08:59.155,0:09:01.059 in her freshman year of college, 0:09:01.059,0:09:04.115 and then plummeted into a horrific depression. 0:09:04.115,0:09:05.541 She had bipolar illness, 0:09:05.541,0:09:08.184 or manic depression, as it was then known. 0:09:08.184,0:09:10.228 And then she did very well 0:09:10.228,0:09:11.936 for many years on lithium, 0:09:11.936,0:09:13.311 and then eventually, 0:09:13.311,0:09:15.271 she was taken off her lithium 0:09:15.271,0:09:17.106 to see how she would do without it, 0:09:17.106,0:09:19.081 and she had another psychosis, 0:09:19.081,0:09:21.419 and then plunged into the worst depression 0:09:21.419,0:09:23.291 that I had ever seen 0:09:23.291,0:09:26.306 in which she sat in her parents' apartment, 0:09:26.306,0:09:29.383 more or less catatonic, essentially without moving, 0:09:29.383,0:09:31.865 day after day after day. 0:09:31.865,0:09:35.082 And when I interviewed her about[br]that experience some years later -- 0:09:35.082,0:09:38.413 she's a poet and psychotherapist[br]named Maggie Robbins — 0:09:38.413,0:09:41.646 when I interviewed her, she said, 0:09:41.646,0:09:45.030 "I was singing 'Where Have All The Flowers Gone' 0:09:45.030,0:09:48.240 over and over to occupy my mind. 0:09:48.240,0:09:51.375 I was singing to blot out the[br]things my mind was saying, 0:09:51.375,0:09:55.865 which were, 'You are nothing. You are nobody. 0:09:55.865,0:09:58.691 You don't even deserve to live.' 0:09:58.691,0:10:00.869 And that was when I really started thinking 0:10:00.869,0:10:03.082 about killing myself." 0:10:03.082,0:10:04.990 You don't think in depression 0:10:04.990,0:10:07.127 that you've put on a gray veil 0:10:07.127,0:10:09.107 and are seeing the world through the haze 0:10:09.107,0:10:11.001 of a bad mood. 0:10:11.001,0:10:13.721 You think that the veil has been taken away, 0:10:13.721,0:10:15.643 the veil of happiness, 0:10:15.643,0:10:18.067 and that now you're seeing truly. 0:10:18.067,0:10:21.031 It's easier to help schizophrenics who perceive 0:10:21.031,0:10:22.842 that there's something foreign inside of them 0:10:22.842,0:10:25.029 that needs to be exorcised, 0:10:25.029,0:10:27.193 but it's difficult with depressives, 0:10:27.193,0:10:31.040 because we believe we are seeing the truth. 0:10:31.040,0:10:33.987 But the truth lies. 0:10:33.987,0:10:35.985 I became obsessed with that sentence: 0:10:35.985,0:10:38.360 "But the truth lies." 0:10:38.360,0:10:40.813 And I discovered, as I talked to depressive people, 0:10:40.813,0:10:43.495 that they have many delusional perceptions. 0:10:43.495,0:10:45.162 People will say, "No one loves me." 0:10:45.162,0:10:46.813 And you say, "I love you, 0:10:46.813,0:10:49.335 your wife loves you, your mother loves you." 0:10:49.335,0:10:51.258 You can answer that one pretty readily, 0:10:51.258,0:10:52.923 at least for most people. 0:10:52.923,0:10:55.190 But people who are depressed will also say, 0:10:55.190,0:10:56.895 "No matter what we do, 0:10:56.895,0:10:59.168 we're all just going to die in the end." 0:10:59.168,0:11:01.371 Or they'll say, "There can be no true communion 0:11:01.371,0:11:03.024 between two human beings. 0:11:03.024,0:11:05.600 Each of us is trapped in his own body." 0:11:05.600,0:11:07.449 To which you have to say, 0:11:07.449,0:11:08.770 "That's true, 0:11:08.770,0:11:10.588 but I think we should focus right now 0:11:10.588,0:11:12.484 on what to have for breakfast." 0:11:12.484,0:11:14.669 (Laughter) 0:11:14.669,0:11:16.338 A lot of the time, 0:11:16.338,0:11:19.234 what they are expressing is not illness, but insight, 0:11:19.234,0:11:21.891 and one comes to think what's really extraordinary 0:11:21.891,0:11:24.825 is that most of us know about[br]those existential questions 0:11:24.825,0:11:27.115 and they don't distract us very much. 0:11:27.115,0:11:29.274 There was a study I particularly liked 0:11:29.274,0:11:30.954 in which a group of depressed 0:11:30.954,0:11:32.855 and a group of non-depressed people 0:11:32.855,0:11:35.478 were asked to play a video game for an hour, 0:11:35.478,0:11:37.291 and at the end of the hour, 0:11:37.291,0:11:38.942 they were asked how many little monsters 0:11:38.942,0:11:40.806 they thought they had killed. 0:11:40.806,0:11:43.018 The depressive group was usually accurate 0:11:43.018,0:11:45.076 to within about 10 percent, 0:11:45.076,0:11:46.547 and the non-depressed people 0:11:46.547,0:11:50.092 guessed between 15 and 20 times as many 0:11:50.092,0:11:51.834 little monsters — (Laughter) — 0:11:51.834,0:11:55.945 as they had actually killed. 0:11:55.945,0:11:59.011 A lot of people said, when I chose[br]to write about my depression, 0:11:59.011,0:12:00.780 that it must be very difficult 0:12:00.780,0:12:03.904 to be out of that closet, to have people know. 0:12:03.904,0:12:06.104 They said, "Do people talk to you differently?" 0:12:06.104,0:12:08.176 And I said, "Yes, people talk to me differently. 0:12:08.176,0:12:10.090 They talk to me differently insofar 0:12:10.090,0:12:12.880 as they start telling me about their experience, 0:12:12.880,0:12:14.715 or their sister's experience, 0:12:14.715,0:12:16.489 or their friend's experience. 0:12:16.489,0:12:18.781 Things are different because now I know 0:12:18.781,0:12:21.462 that depression is the family secret 0:12:21.462,0:12:23.539 that everyone has. 0:12:23.539,0:12:27.167 I went a few years ago to a conference, 0:12:27.167,0:12:29.820 and on Friday of the three-day conference, 0:12:29.820,0:12:32.711 one of the participants took me aside, and she said, 0:12:32.711,0:12:36.116 "I suffer from depression and 0:12:36.116,0:12:38.885 I'm a little embarrassed about it, 0:12:38.885,0:12:40.988 but I've been taking this medication, 0:12:40.988,0:12:43.936 and I just wanted to ask you what you think?" 0:12:43.936,0:12:46.770 And so I did my best to give[br]her such advice as I could. 0:12:46.770,0:12:48.490 And then she said, "You know, 0:12:48.490,0:12:51.281 my husband would never understand this. 0:12:51.281,0:12:53.854 He's really the kind of guy to whom[br]this wouldn't make any sense, 0:12:53.854,0:12:56.721 so I just, you know, it's just between us." 0:12:56.721,0:12:58.507 And I said, "Yes, that's fine." 0:12:58.507,0:13:00.616 On Sunday of the same conference, 0:13:00.616,0:13:03.660 her husband took me aside, 0:13:03.660,0:13:05.354 and he said, "My wife wouldn't think 0:13:05.354,0:13:07.789 that I was really much of a guy if she knew this, 0:13:07.789,0:13:10.255 but I've been dealing with this depression 0:13:10.255,0:13:11.609 and I'm taking some medication, 0:13:11.609,0:13:14.114 and I wondered what you think?" 0:13:14.114,0:13:15.537 They were hiding 0:13:15.537,0:13:17.752 the same medication in two different places 0:13:17.752,0:13:20.397 in the same bedroom. 0:13:20.397,0:13:22.418 And I said that I thought 0:13:22.418,0:13:24.102 communication within the marriage 0:13:24.102,0:13:26.116 might be triggering some of their problems. 0:13:26.116,0:13:30.307 (Laughter) 0:13:30.307,0:13:31.962 But I was also struck 0:13:31.962,0:13:33.768 by the burdensome nature 0:13:33.768,0:13:36.141 of such mutual secrecy. 0:13:36.141,0:13:38.026 Depression is so exhausting. 0:13:38.026,0:13:40.794 It takes up so much of your time and energy, 0:13:40.794,0:13:42.298 and silence about it, 0:13:42.298,0:13:45.029 it really does make the depression worse. 0:13:45.029,0:13:46.762 And then I began thinking about all the ways 0:13:46.762,0:13:48.728 people make themselves better. 0:13:48.728,0:13:51.167 I'd started off as a medical conservative. 0:13:51.167,0:13:53.539 I thought there were a few[br]kinds of therapy that worked, 0:13:53.539,0:13:55.348 it was clear what they were -- 0:13:55.348,0:13:56.992 there was medication, 0:13:56.992,0:13:58.468 there were certain psychotherapies, 0:13:58.468,0:14:00.913 there was possibly electroconvulsive treatment, 0:14:00.913,0:14:03.588 and that everything else was nonsense. 0:14:03.588,0:14:05.420 But then I discovered something. 0:14:05.420,0:14:07.172 If you have brain cancer, 0:14:07.172,0:14:08.644 and you say that standing on your head 0:14:08.644,0:14:11.639 for 20 minutes every morning makes you feel better, 0:14:11.639,0:14:13.153 it may make you feel better, 0:14:13.153,0:14:14.741 but you still have brain cancer, 0:14:14.741,0:14:17.030 and you'll still probably die from it. 0:14:17.030,0:14:19.542 But if you say that you have depression, 0:14:19.542,0:14:21.647 and standing on your head for 20 minutes every day 0:14:21.647,0:14:24.131 makes you feel better, then it's worked, 0:14:24.131,0:14:26.491 because depression is an illness of how you feel, 0:14:26.491,0:14:28.100 and if you feel better, 0:14:28.100,0:14:30.930 then you are effectively not depressed anymore. 0:14:30.930,0:14:32.963 So I became much more tolerant 0:14:32.963,0:14:35.888 of the vast world of alternative treatments. 0:14:35.888,0:14:38.272 And I get letters, I get hundreds of letters 0:14:38.272,0:14:40.788 from people writing to tell me[br]about what's worked for them. 0:14:40.788,0:14:42.989 Someone was asking me backstage today 0:14:42.989,0:14:44.452 about meditation. 0:14:44.452,0:14:46.917 My favorite of the letters that I got 0:14:46.917,0:14:48.391 was the one that came from a woman 0:14:48.391,0:14:50.598 who wrote and said that she had tried therapy, 0:14:50.598,0:14:52.985 she had tried medication,[br]she had tried pretty much everything, 0:14:52.985,0:14:55.822 and she had found a solution[br]and hoped I would tell the world, 0:14:55.822,0:14:59.634 and that was making little things from yarn. 0:14:59.634,0:15:02.633 (Laughter) 0:15:02.633,0:15:06.157 She sent me some of them. (Laughter) 0:15:06.157,0:15:09.845 And I'm not wearing them right now. 0:15:09.845,0:15:12.360 I suggested to her that she also should look up 0:15:12.360,0:15:16.408 obsessive compulsive disorder in the DSM. 0:15:16.408,0:15:19.536 And yet, when I went to look[br]at alternative treatments, 0:15:19.536,0:15:22.444 I also gained perspective on other treatments. 0:15:22.444,0:15:25.347 I went through a tribal exorcism in Senegal 0:15:25.347,0:15:27.360 that involved a great deal of ram's blood 0:15:27.360,0:15:29.422 and that I'm not going to detail right now, 0:15:29.422,0:15:31.422 but a few years afterwards I was in Rwanda 0:15:31.422,0:15:33.180 working on a different project, 0:15:33.180,0:15:35.976 and I happened to describe[br]my experience to someone, 0:15:35.976,0:15:37.736 and he said, "Well, you know, 0:15:37.736,0:15:39.556 that's West Africa, and we're in East Africa, 0:15:39.556,0:15:41.390 and our rituals are in some ways very different, 0:15:41.390,0:15:43.403 but we do have some rituals that have something 0:15:43.403,0:15:45.390 in common with what you're describing." 0:15:45.390,0:15:47.053 And I said, "Oh." And he said, "Yes," he said, 0:15:47.053,0:15:49.695 "but we've had a lot of trouble with[br]Western mental health workers, 0:15:49.695,0:15:52.452 especially the ones who came[br]right after the genocide." 0:15:52.452,0:15:54.779 And I said, "What kind of trouble did you have?" 0:15:54.779,0:15:56.325 And he said, "Well, 0:15:56.325,0:15:58.989 they would do this bizarre thing. 0:15:58.989,0:16:00.874 They didn't take people out in the sunshine 0:16:00.874,0:16:02.574 where you begin to feel better. 0:16:02.574,0:16:05.668 They didn't include drumming or music[br]to get people's blood going. 0:16:05.668,0:16:07.510 They didn't involve the whole community. 0:16:07.510,0:16:09.285 They didn't externalize the depression 0:16:09.285,0:16:10.718 as an invasive spirit. 0:16:10.718,0:16:13.349 Instead what they did was they took people 0:16:13.349,0:16:15.977 one at a time into dingy little rooms 0:16:15.977,0:16:17.320 and had them talk for an hour 0:16:17.320,0:16:19.550 about bad things that had happened to them." 0:16:19.550,0:16:25.010 (Laughter) (Applause) 0:16:25.010,0:16:27.372 He said, "We had to ask them to leave the country." 0:16:27.372,0:16:30.429 (Laughter) 0:16:30.429,0:16:32.873 Now at the other end of alternative treatments, 0:16:32.873,0:16:34.908 let me tell you about Frank Russakoff. 0:16:34.908,0:16:37.961 Frank Russakoff had the worst depression 0:16:37.961,0:16:40.876 perhaps that I've ever seen in a man. 0:16:40.876,0:16:42.869 He was constantly depressed. 0:16:42.869,0:16:45.010 He was, when I met him, at a point at which 0:16:45.010,0:16:48.168 every month he would have electroshock treatment. 0:16:48.168,0:16:50.743 Then he would feel sort of disoriented for a week. 0:16:50.743,0:16:52.546 Then he would feel okay for a week. 0:16:52.546,0:16:54.246 Then he would have a week of going downhill. 0:16:54.246,0:16:56.931 And then he would have another[br]electroshock treatment. 0:16:56.931,0:16:58.346 And he said to me when I met him, 0:16:58.346,0:17:00.898 "It's unbearable to go through my weeks this way. 0:17:00.898,0:17:02.405 I can't go on this way, 0:17:02.405,0:17:04.669 and I've figured out how I'm going to end it 0:17:04.669,0:17:06.226 if I don't get better. 0:17:06.226,0:17:08.934 But," he said to me, "I heard about a protocol 0:17:08.934,0:17:11.157 at Mass General for a procedure called 0:17:11.157,0:17:13.183 a cingulotomy, which is a brain surgery, 0:17:13.183,0:17:15.754 and I think I'm going to give that a try." 0:17:15.754,0:17:17.708 And I remember being amazed at that point 0:17:17.708,0:17:19.008 to think that someone 0:17:19.008,0:17:22.229 who clearly had so many bad experiences 0:17:22.229,0:17:24.088 with so many different treatments 0:17:24.088,0:17:27.210 still had buried in him somewhere enough optimism 0:17:27.210,0:17:29.760 to reach out for one more. 0:17:29.760,0:17:31.940 And he had the cingulotomy, 0:17:31.940,0:17:33.981 and it was incredibly successful. 0:17:33.981,0:17:35.474 He's now a friend of mine. 0:17:35.474,0:17:38.966 He has a lovely wife and two beautiful children. 0:17:38.966,0:17:41.915 He wrote me a letter the Christmas after the surgery, 0:17:41.915,0:17:43.104 and he said, 0:17:43.104,0:17:45.511 "My father sent me two presents this year, 0:17:45.511,0:17:48.113 First, a motorized C.D. rack from The Sharper Image 0:17:48.113,0:17:49.534 that I didn't really need, 0:17:49.534,0:17:51.631 but I knew he was giving it to me to celebrate 0:17:51.631,0:17:53.359 the fact that I'm living on my own 0:17:53.359,0:17:55.406 and have a job I seem to love. 0:17:55.406,0:17:56.967 And the other present 0:17:56.967,0:17:58.543 was a photo of my grandmother, 0:17:58.543,0:18:00.795 who committed suicide. 0:18:00.795,0:18:03.730 As I unwrapped it, I began to cry, 0:18:03.730,0:18:05.610 and my mother came over and said, 0:18:05.610,0:18:08.925 'Are you crying because of the[br]relatives you never knew?' 0:18:08.925,0:18:13.013 And I said, 'She had the same disease I have.' 0:18:13.013,0:18:15.594 I'm crying now as I write to you. 0:18:15.594,0:18:19.189 It's not that I'm so sad, but I get overwhelmed, 0:18:19.189,0:18:21.410 I think, because I could have killed myself, 0:18:21.410,0:18:23.113 but my parents kept me going, 0:18:23.113,0:18:24.862 and so did the doctors, 0:18:24.862,0:18:26.716 and I had the surgery. 0:18:26.716,0:18:29.531 I'm alive and grateful. 0:18:29.531,0:18:31.791 We live in the right time, 0:18:31.791,0:18:35.670 even if it doesn't always feel like it." 0:18:35.670,0:18:37.567 I was struck by the fact that depression 0:18:37.567,0:18:39.292 is broadly perceived to be 0:18:39.292,0:18:42.829 a modern, Western, middle-class thing, 0:18:42.829,0:18:44.981 and I went to look at how it operated 0:18:44.981,0:18:46.984 in a variety of other contexts, 0:18:46.984,0:18:49.103 and one of the things I was most interested in 0:18:49.103,0:18:50.893 was depression among the indigent. 0:18:50.893,0:18:52.674 And so I went out to try to look at 0:18:52.674,0:18:55.254 what was being done for [br]poor people with depression. 0:18:55.254,0:18:57.412 And what I discovered is that poor people 0:18:57.412,0:18:59.969 are mostly not being treated for depression. 0:18:59.969,0:19:02.888 Depression is the result of a genetic vulnerability, 0:19:02.888,0:19:06.046 which is presumably evenly[br]distributed in the population, 0:19:06.046,0:19:07.999 and triggering circumstances, 0:19:07.999,0:19:09.902 which are likely to be more severe 0:19:09.902,0:19:11.777 for people who are impoverished. 0:19:11.777,0:19:14.204 And yet it turns out that if you have 0:19:14.204,0:19:16.344 a really lovely life but feel miserable all the time, 0:19:16.344,0:19:18.344 you think, "Why do I feel like this? 0:19:18.344,0:19:20.013 I must have depression." 0:19:20.013,0:19:21.936 And you set out to find treatment for it. 0:19:21.936,0:19:24.029 But if you have a perfectly awful life, 0:19:24.029,0:19:25.896 and you feel miserable all the time, 0:19:25.896,0:19:28.722 the way you feel is commensurate with your life, 0:19:28.722,0:19:30.446 and it doesn't occur to you to think, 0:19:30.446,0:19:32.229 "Maybe this is treatable." 0:19:32.229,0:19:35.365 And so we have an epidemic in this country 0:19:35.365,0:19:38.278 of depression among impoverished people 0:19:38.278,0:19:40.790 that's not being picked up[br]and that's not being treated 0:19:40.790,0:19:42.846 and that's not being addressed, 0:19:42.846,0:19:45.046 and it's a tragedy of a grand order. 0:19:45.046,0:19:46.534 And so I found an academic 0:19:46.534,0:19:48.351 who was doing a research project 0:19:48.351,0:19:50.092 in slums outside of D.C., 0:19:50.092,0:19:53.089 where she picked up women who had[br]come in for other health problems 0:19:53.089,0:19:54.868 and diagnosed them with depression, 0:19:54.868,0:19:58.134 and then provided six months[br]of the experimental protocol. 0:19:58.134,0:20:00.463 One of them, Lolly, came in, 0:20:00.463,0:20:02.760 and this is what she said the day she came in. 0:20:02.760,0:20:06.155 She said, and she was a woman, by the way, 0:20:06.155,0:20:08.247 who had seven children. She said, 0:20:08.247,0:20:10.898 "I used to have a job but I had to give it up because 0:20:10.898,0:20:12.958 I couldn't go out of the house. 0:20:12.958,0:20:15.186 I have nothing to say to my children. 0:20:15.186,0:20:17.953 In the morning, I can't wait for them to leave, 0:20:17.953,0:20:20.943 and then I climb in bed and[br]pull the covers over my head, 0:20:20.943,0:20:22.589 and three o'clock when they come home, 0:20:22.589,0:20:24.390 it just comes so fast." 0:20:24.390,0:20:26.630 She said, "I've been taking a lot of Tylenol, 0:20:26.630,0:20:29.389 anything I can take so that I can sleep more. 0:20:29.389,0:20:33.159 My husband has been telling me I'm stupid, I'm ugly. 0:20:33.159,0:20:36.664 I wish I could stop the pain." 0:20:36.664,0:20:39.304 Well, she was brought into[br]this experimental protocol, 0:20:39.304,0:20:41.612 and when I interviewed her six months later, 0:20:41.612,0:20:46.019 she had taken a job working in childcare 0:20:46.019,0:20:49.824 for the U.S. Navy, she had left the abusive husband, 0:20:49.824,0:20:51.906 and she said to me, 0:20:51.906,0:20:54.275 "My kids are so much happier now." 0:20:54.275,0:20:56.252 She said, "There's one room in my new place 0:20:56.252,0:20:58.860 for the boys and one room for the girls, 0:20:58.860,0:21:01.399 but at night, they're just all up on my bed, 0:21:01.399,0:21:04.011 and we're doing homework[br]all together and everything. 0:21:04.011,0:21:05.684 One of them wants to be a preacher, 0:21:05.684,0:21:07.384 one of them wants to be a firefighter, 0:21:07.384,0:21:10.350 and one of the girls says she's going to be a lawyer. 0:21:10.350,0:21:12.355 They don't cry like they used to, 0:21:12.355,0:21:14.913 and they don't fight like they did. 0:21:14.913,0:21:18.693 That's all I need now is my kids. 0:21:18.693,0:21:20.605 Things keep on changing, 0:21:20.605,0:21:25.798 the way I dress, the way I feel, the way I act. 0:21:25.798,0:21:29.485 I can go outside not being afraid anymore, 0:21:29.485,0:21:32.894 and I don't think those bad feelings are coming back, 0:21:32.894,0:21:35.929 and if it weren't for Dr. Miranda and that, 0:21:35.929,0:21:39.546 I would still be at home with[br]the covers pulled over my head, 0:21:39.546,0:21:41.895 if I were still alive at all. 0:21:41.895,0:21:45.627 I asked the Lord to send me an angel, 0:21:45.627,0:21:49.957 and he heard my prayers." 0:21:49.959,0:21:53.312 I was really moved by these experiences, 0:21:53.312,0:21:55.851 and I decided that I wanted to write about them 0:21:55.851,0:21:57.230 not only in a book I was working on, 0:21:57.230,0:21:58.541 but also in an article, 0:21:58.541,0:22:00.862 and so I got a commission from[br]The New York Times Magazine 0:22:00.862,0:22:02.878 to write about depression among the indigent. 0:22:02.878,0:22:04.494 And I turned in my story, 0:22:04.494,0:22:06.090 and my editor called me and said, 0:22:06.090,0:22:07.800 "We really can't publish this." 0:22:07.800,0:22:09.550 And I said, "Why not?" 0:22:09.550,0:22:11.855 And she said, "It just is too far-fetched. 0:22:11.855,0:22:15.633 These people who are sort of at[br]the very bottom rung of society 0:22:15.633,0:22:17.337 and then they get a few months of treatment 0:22:17.337,0:22:19.969 and they're virtually ready to run Morgan Stanley? 0:22:19.969,0:22:21.823 It's just too implausible." 0:22:21.823,0:22:24.028 She said, I've never even heard of anything like it." 0:22:24.028,0:22:26.562 And I said, "The fact that you've never heard of it 0:22:26.562,0:22:29.562 is an indication that it is news." 0:22:29.562,0:22:35.696 (Laughter) (Applause) 0:22:37.317,0:22:39.811 "And you are a news magazine." 0:22:39.811,0:22:41.793 So after a certain amount of negotiation, 0:22:41.793,0:22:43.034 they agreed to it. 0:22:43.034,0:22:44.649 But I think a lot of what they said 0:22:44.649,0:22:46.944 was connected in some strange way 0:22:46.944,0:22:49.086 to this distaste that people still have 0:22:49.086,0:22:50.549 for the idea of treatment, 0:22:50.549,0:22:52.431 the notion that somehow if we went out 0:22:52.431,0:22:55.127 and treated a lot of people in indigent communities, 0:22:55.127,0:22:57.025 that would be an exploitative thing to do, 0:22:57.025,0:22:58.667 because we would be changing them. 0:22:58.667,0:23:00.700 There is this false moral imperative 0:23:00.700,0:23:02.489 that seems to be all around us 0:23:02.489,0:23:04.843 that treatment of depression, 0:23:04.843,0:23:07.142 the medications and so on, are an artifice, 0:23:07.142,0:23:09.314 and that it's not natural. 0:23:09.314,0:23:12.163 And I think that's very misguided. 0:23:12.163,0:23:15.695 It would be natural for people's teeth to fall out, 0:23:15.695,0:23:19.025 but there is nobody militating against toothpaste, 0:23:19.025,0:23:21.153 at least not in my circles. 0:23:21.153,0:23:23.655 And people then say, "Well, but isn't depression 0:23:23.655,0:23:25.840 part of what people are supposed to experience? 0:23:25.840,0:23:27.581 Didn't we evolve to have depression? 0:23:27.581,0:23:29.488 Isn't it part of your personality?" 0:23:29.488,0:23:32.234 To which I would say, mood is adaptive. 0:23:32.234,0:23:35.563 Being able to have sadness and fear 0:23:35.563,0:23:37.405 and joy and pleasure 0:23:37.405,0:23:39.208 and all of the other moods that we have, 0:23:39.208,0:23:41.272 that's incredibly valuable. 0:23:41.272,0:23:44.319 And major depression is something that happens 0:23:44.319,0:23:46.331 when that system gets broken. 0:23:46.331,0:23:48.048 It's maladaptive. 0:23:48.048,0:23:49.620 People will come to me and say, 0:23:49.620,0:23:52.388 "I think, though, if I just stick it out for another year, 0:23:52.388,0:23:54.464 I think I can just get through this." 0:23:54.464,0:23:56.767 And I always say to them, "You may get through it, 0:23:56.767,0:23:59.476 but you'll never be 37 again. 0:23:59.476,0:24:02.026 Life is short, and that's a whole year 0:24:02.026,0:24:03.982 you're talking about giving up. 0:24:03.982,0:24:05.520 Think it through." 0:24:05.520,0:24:08.366 It's a strange poverty of the English language, 0:24:08.366,0:24:10.474 and indeed of many other languages, 0:24:10.474,0:24:12.692 that we use this same word, depression, 0:24:12.692,0:24:14.497 to describe how a kid feels 0:24:14.497,0:24:16.209 when it rains on his birthday, 0:24:16.209,0:24:18.737 and to describe how somebody feels 0:24:18.737,0:24:21.191 the minute before they commit suicide. 0:24:21.191,0:24:24.296 People say to me, "Well, is it[br]continuous with normal sadness?" 0:24:24.296,0:24:27.440 And I say, in a way it's continuous[br]with normal sadness. 0:24:27.440,0:24:29.640 There is a certain amount of continuity, 0:24:29.640,0:24:31.597 but it's the same way there's continuity 0:24:31.597,0:24:33.584 between having an iron fence outside your house 0:24:33.584,0:24:35.261 that gets a little rust spot 0:24:35.261,0:24:38.007 that you have to sand off and do a little repainting, 0:24:38.007,0:24:40.654 and what happens if you leave[br]the house for 100 years 0:24:40.654,0:24:43.552 and it rusts through until it's only a pile 0:24:43.552,0:24:44.786 of orange dust. 0:24:44.786,0:24:46.959 And it's that orange dust spot, 0:24:46.959,0:24:48.748 that orange dust problem, 0:24:48.748,0:24:51.737 that's the one we're setting out to address. 0:24:51.737,0:24:53.977 So now people say, 0:24:53.977,0:24:56.708 "You take these happy pills, and do you feel happy?" 0:24:56.708,0:24:58.594 And I don't. 0:24:58.594,0:25:01.416 But I don't feel sad about having to eat lunch, 0:25:01.416,0:25:04.252 and I don't feel sad about my answering machine, 0:25:04.252,0:25:07.097 and I don't feel sad about taking a shower. 0:25:07.097,0:25:09.951 I feel more, in fact, I think, 0:25:09.951,0:25:12.381 because I can feel sadness without nullity. 0:25:12.381,0:25:16.728 I feel sad about professional disappointments, 0:25:16.728,0:25:19.075 about damaged relationships, 0:25:19.075,0:25:21.114 about global warming. 0:25:21.114,0:25:23.839 Those are the things that I feel sad about now. 0:25:23.839,0:25:26.573 And I said to myself, well, what is the conclusion? 0:25:26.573,0:25:29.134 How did those people who have better lives 0:25:29.134,0:25:31.688 even with bigger depression manage to get through? 0:25:31.688,0:25:34.485 What is the mechanism of resilience? 0:25:34.485,0:25:36.569 And what I came up with over time 0:25:36.569,0:25:39.485 was that the people who deny their experience, 0:25:39.485,0:25:41.517 the ones who say, "I was depressed a long time ago 0:25:41.517,0:25:43.254 and I never want to think about it again 0:25:43.254,0:25:44.496 and I'm not going to look at it 0:25:44.496,0:25:46.386 and I'm just going to get on with my life," 0:25:46.386,0:25:48.345 ironically, those are the people 0:25:48.345,0:25:51.043 who are most enslaved by what they have. 0:25:51.043,0:25:53.607 Shutting out the depression strengthens it. 0:25:53.607,0:25:56.887 While you hide from it, it grows. 0:25:56.887,0:25:59.747 And the people who do better 0:25:59.747,0:26:02.346 are the ones who are able to tolerate the fact 0:26:02.346,0:26:03.968 that they have this condition. 0:26:03.968,0:26:06.438 Those who can tolerate their depression 0:26:06.438,0:26:08.220 are the ones who achieve resilience. 0:26:08.220,0:26:10.003 So Frank Russakoff said to me, 0:26:10.003,0:26:11.519 "If I had it again to do over, 0:26:11.519,0:26:13.656 I suppose I wouldn't do it this way, 0:26:13.656,0:26:15.620 but in a strange way, I'm grateful 0:26:15.620,0:26:17.123 for what I've experienced. 0:26:17.123,0:26:20.940 I'm glad to have been in the hospital 40 times. 0:26:20.940,0:26:23.543 It taught me so much about love, 0:26:23.543,0:26:26.383 and my relationship with my parents and my doctors 0:26:26.383,0:26:30.772 has been so precious to me, and will be always." 0:26:30.772,0:26:32.698 And Maggie Robbins said, 0:26:32.698,0:26:35.687 "I used to volunteer in an AIDS clinic, 0:26:35.687,0:26:38.701 and I would just talk and talk and talk, 0:26:38.701,0:26:40.514 and the people I was dealing with 0:26:40.514,0:26:42.581 weren't very responsive, and I thought, 0:26:42.581,0:26:46.542 'That's not very friendly or helpful of them.' 0:26:46.542,0:26:48.184 And then I realized, 0:26:48.184,0:26:50.311 I realized that they weren't going to do more 0:26:50.311,0:26:52.698 than make those first few minutes of small talk. 0:26:52.698,0:26:54.755 It was simply going to be an occasion 0:26:54.755,0:26:57.633 where I didn't have AIDS and I wasn't dying, 0:26:57.633,0:27:00.606 but could tolerate the fact that they did 0:27:00.606,0:27:02.393 and they were. 0:27:02.393,0:27:05.996 Our needs are our greatest assets. 0:27:05.996,0:27:08.135 It turns out I've learned to give 0:27:08.135,0:27:12.160 all the things I need." 0:27:12.160,0:27:13.851 Valuing one's depression 0:27:13.851,0:27:16.045 does not prevent a relapse, 0:27:16.045,0:27:18.706 but it may make the prospect of relapse 0:27:18.706,0:27:22.924 and even relapse itself easier to tolerate. 0:27:22.924,0:27:24.969 The question is not so much 0:27:24.969,0:27:27.144 of finding great meaning and deciding 0:27:27.144,0:27:29.171 your depression has been very meaningful. 0:27:29.171,0:27:31.342 It's of seeking that meaning 0:27:31.342,0:27:33.146 and thinking, when it comes again, 0:27:33.146,0:27:34.786 "This will be hellish, 0:27:34.786,0:27:37.487 but I will learn something from it." 0:27:37.487,0:27:39.751 I have learned in my own depression 0:27:39.751,0:27:41.764 how big an emotion can be, 0:27:41.764,0:27:44.861 how it can be more real than facts, 0:27:44.861,0:27:47.810 and I have found that that experience 0:27:47.810,0:27:50.702 has allowed me to experience positive emotion 0:27:50.702,0:27:54.222 in a more intense and more focused way. 0:27:54.222,0:27:57.709 The opposite of depression is not happiness, 0:27:57.709,0:27:59.163 but vitality, 0:27:59.163,0:28:01.904 and these days, my life is vital, 0:28:01.904,0:28:04.649 even on the days when I'm sad. 0:28:04.649,0:28:07.962 I felt that funeral in my brain, 0:28:07.962,0:28:09.986 and I sat next to the colossus 0:28:09.986,0:28:12.233 at the edge of the world, 0:28:12.233,0:28:14.322 and I have discovered 0:28:14.322,0:28:16.173 something inside of myself 0:28:16.173,0:28:18.306 that I would have to call a soul 0:28:18.306,0:28:22.062 that I had never formulated[br]until that day 20 years ago 0:28:22.062,0:28:26.580 when hell came to pay me a surprise visit. 0:28:26.580,0:28:30.678 I think that while I hated being depressed 0:28:30.678,0:28:33.012 and would hate to be depressed again, 0:28:33.012,0:28:35.756 I've found a way to love my depression. 0:28:35.756,0:28:37.781 I love it because it has forced me 0:28:37.781,0:28:40.550 to find and cling to joy. 0:28:40.550,0:28:44.038 I love it because each day I decide, 0:28:44.038,0:28:45.578 sometimes gamely, 0:28:45.578,0:28:48.276 and sometimes against the moment's reason, 0:28:48.276,0:28:50.854 to cleave to the reasons for living. 0:28:50.854,0:28:54.977 And that, I think, is a highly privileged rapture. 0:28:54.977,0:28:58.960 Thank you. 0:28:58.960,0:29:02.096 (Applause)