Andrew Solomon "Inspired by Melancholy: The Creative Mind and Its Pain"

if you could find your seats quickly we'll be able to start please also take a moment to turn off your cell phones please and I'd like to call your attention the fact that there will be a reception afterwards so you can spend time with our speaker and there also I his books available and if you want to get a signed copy that's one of your options we are not always happy sometimes the state of mind can become tyrannical and ragingly powerful other times oppressive and debilitating our special guest this evening Andrew Solomon is an author who has spent a fair amount of time in less comfortable cognitive landscapes and the harrowing narratives of his experience have helped millions of readers feel new heights of empathy and have deepened our understanding of what it is to be human tonight he will be discussing the creative mind melancholy and pain professor richard gordon will introduce our special guest in a moment I'm here to say a bit about creativity and mind at bard and to acknowledge and thank the many individuals who are responsible for bringing our guest to Bard especially the family of Jaime Bernard the James Kirk Barnard foundation was established to support scientific research on depression and autism it is through their support that we're able to consider together why creativity and self-expression are sometimes impelled by our less comfortable emotions bard distinguishes itself as an intellectually rigorous liberal arts environment that attracts and inspires students who are fascinated by the literary and creative arts and who share a sense of connectedness through social action challenging all aspects of the human condition from multiple perspectives there are many examples such of these opportunities at bard from the language and thinking program citizen science the bard high school early college programs the hannah arendt center the trustee leaders Scholars Program and student groups such as Active Minds whose mission it is to improve understanding and acceptance of individuals who's experienced a vivid range of emotions including depression in bard classrooms we learn the role of mirror neurons in empathy we learn about the genetic factors that influence autism we learn about neurotransmitters that suffuse the brain in moments of elation and insight and we learn the intrinsic rewards of creation resolution and closure the full range of life at bard complements a science approach so that we can appreciate the implications of these findings examine how we make decisions how we view and respond to each other and the type of communities that we decide to build our students ask not only what do I know and how do I know it but more importantly our students have the desire and the encouragement at bard to pursue the more important question what am I going to do about it programs like the mind brain and behavior concentration provide an interdisciplinary haven for students who want to learn more about the neuroscience of cognition imagination and creativity and you want to combine what they learn in the sciences with their passion for the arts and language to develop a deeper understanding of what it is to be human Andrew Solomon like Jamie Bernard is a gift to all who have the bittersweet experience of reading his accounts his narrative experience inspires empathy compassion and respect were able to share his presentation tonight thanks to the support of the Wellness Committee the Bard Dean of Students office and Active Minds most importantly we extend our thanks to the James Kirk Barnard Foundation for their ongoing support of Active Minds and for bringing Andrew Solomon to campus to help us all continue to celebrate a life of immense creativity here to introduce our speaker this evening is Professor Richard Gordon for your patients with two introductions one of the remarkable historical trends in the field of psychiatry and its cognate helping professions in the late 20th century century in the early part of the 21st is the recognition of the crucial importance of depression in terms of its widespread but often hidden prevalence it's cruel consequences for psychic life and physical well-being indeed the World Health Organization and a massive study conducted in the 1990s concluded that depression would be the number one cause of disability in the world of the year 2020 a year that does not seem so far away this moment one wonders that this widespread awareness of the importance of depression is an illness one one things about the preoccupations of late 19th century psychiatry with phenomena such as hysteria and the relatively minor attention given to depression one phenomenon we know was very important in our growing awareness of depression was the discovery of antidepressant medications in the late 1950s although their importance was hardly noticed at first however this was a crucial discovery depression was now an illness that could be treated at a medical level perhaps it was not yet noticed because the pathology of depression was still not recognized for what it is it was not until the less toxic antidepressant such as prozac entered the scene in the late 1980s that this could occur but I remember even my own clinical internship in the early 1970s in New York City the depression was beginning to be taken seriously and it was suddenly registering with psychiatric observers that depression was the central problem for many patients whose diagnoses were currently being misconstrued Andrew Solomon's book represents a kind of apogee of the awareness about two that has occurred it's both a reflection of a historical trend but also a marvelous wide-ranging guide to the many dimensions personal scientific therapeutic social and political of this insidious and devastating illness while Andrew Solomon begins his treatise with a deep exploration of the sources and subtleties of his agonizingly painful journey he then explores in depth and develops an elaboration of such problems as the relationship of depression to addiction the understandable and yet sometimes desperate search for alternative treatments the roots of depression and evolutions larger social dimensions of depression and the psychic devastation that poverty wreaks on the human soul Solomon's voice remains alive throughout the book and he often reflects on the relationship between either his own interviewees or other authors experienced on his own struggles this transforms what might otherwise be viewed as a textbook at least an outline into something quite different we welcome Andrew Solomon's amplification and reflections on the subject of melancholy and creativity lightest Fenster honored his work on a buried and still taboo source of human misery Andrew Solomon were grateful that you're speaking us tonight at Bard College well good evening and thanks to all of you for having me here and to the many organizations that have apparently helped to make it possible for me to come I'm delighted to be here and I said recently I gave a talk at my own alma mater and was talking about how when I was an undergraduate I had always dreamed when I walked through the place where we had to then go to get our books that one day I would be the kind of author who people were required to read in college little expecting it would be a memoir and that it would be read in the abnormal psych class um but I I nonetheless made it through I'm very interested in this question of depression the creative mind I'm interested in larger questions of depression as well there are kind of two false assumptions out there I think one of which is that only creative people actually know these terrible demons and that's not the case I've met many people who are very depressed and who are not remotely creative but I think the I think that's a misapprehension but on the other hand there's also I think a misapprehension that somehow one doesn't have a right to depression if one isn't experiencing a kind of isolated and devastated life and if one has no internal capacities at all I think that's also a fiction and just to give you a little bit of background I've been working for the last 11 years on the book which will be out in November which is about how families respond to various kinds of challenging and unusual offspring families of death people families of autistic people families of people with schizophrenia families with musical prodigies were also quite overwhelmed and so on and so forth and as I've done that work and it's been very much immersed in the world of all of these families various people had said to me but you did that depression book turn 20 do more on depression I said no I think I've covered depression but I was wrong I hadn't I hadn't covered it it comes up over and over and over again it comes up in conjunction with those other conditions it comes up in conjunction with the process of trying to make sense of the world that lies at the root I think of all Creative Writing and I was very struck by a conversation that I had fairly recently with a well-known author who preferred that I not use her name and to protect the privacy of her brother but she's been an enormous ly successful author and her brother has schizophrenia and we were talking about the experience and about what it meant for her and what it meant for her family and about all of the things that they'd grappled with and toward the end of our conversation she said to me you know my brother has the same mind that I have and I said what do you mean and she said well she said I also make up whole worlds and try to describe them in ways that are convincing and try to live in them as if they were reality she said but I know they aren't real and I write them down so I've won a lot of literary prizes and he can't make that distinction and to his from the rest of his life in mental hospitals and I think the finest of that line is incredibly vital I also think that there is a sense in which almost all mental illnesses are useful in small quantities so to have a little bit of the kind of slightly crazy imagination that the person I've just described had has been very useful for her and have a lot of it has destroyed her brother to be a little bit obsessive is a necessity if you write books with lots of footnotes to be too obsessive can actually destroy you and I think it's true with depression too and I think it's part of what makes it so difficult to reconcile depression and creativity and to figure out how to balance them that there's actually great meaning in sadness and the sense of disaffection can be a motive for reaching out across that disaffection connecting with others or it can be the basis for looking deep into yourself and finding what's new and original in your own experience that you can express and so I think this sense the depression it can be at the center of great creativity or can be the obstruction that prevents someone from achieving creativity has to do with how much depression there is how well it's regulated what the personality if the person is and we don't have a sort of depression amador in which we can say you know if you have four degrees of depression it's very useful and if you have eight degrees we're real trouble we have this very variable set of symptoms that manifest in randomly complicated ways a lot of our medical culture is binary because decisions about whom to medicate and how to treat people are binary decisions you have insurance coverage for therapy or you don't you need the medication or you don't we're going to the hospital or you're not but the reality is that the human experience consists almost entirely of nuance and shades of gray and so often that that binary model which has become prevalent for pragmatic reasons causes people either to think well I don't really have depression and therefore enough to deal with the complexities of their moods or to think I have depression therefore I'm someone who's terribly ill and I have to sort of just cave into it because there's nothing that I can do about it they're they're both dangerous models the book that I wrote about depression and was a book that I spent some considerable time working on I had been depressed myself very severely depressed and then as I began to emerge from that depression through a mix of treatment and medication and therapy and time and some changes in life circumstances as I began to emerge from it I tried to write down some of what I had been experiencing because that was a means of processing it much of what I wrote down by way of processing it would not be very interesting for anyone to read but there were moments in it that I thought might be and then I wanted to read everything I could on the topic and what I found was that there were extraordinary personal memoirs in which people courageously talked about their struggles and there were medical textbooks which explained a lot of what we understand which is still quite primitive about the neurology behind the the condition and there were sort of sociological texts that tried to talk about what was happening and there were economic treatises that talked about what the consequences of depression were World Health Organization as mentioned in the introduction was very involved in figuring out what the economics were of depression as a persistent illness and all of these books were very interesting and they all use different vocabulary and there seemed to be anything that brought them all together and that reconciled them and so part of what I wanted to do in writing a book was to write something in which I attempted to address the idea that actually people talk about the biochemical explanation of depression and the psychosocial explanation of depression and those are two different vocabularies for a single set of phenomena and when our capacity at brain imaging is much more advanced will doubtless be able to see all kinds of subtleties and complexities that we can't now see and it will always be the case that those subtleties and complexities will affect our behavior and our experience and this business of saying well I have a depression but it's really biological or I have a depression but you know it's really it came out of these experiences it all is related to one's experiences one's experiences are inextricable from one's biology and so I felt like there was a need somehow to pull that together and to say that in the same way that a word can exist as a sound or as a set of shapes on a page and both things are describing some other phenomenon so these are different ways of describing a single experience and of course as soon as you say that you realize that depression also refers to a set of experiences which are different for everyone who grapples with them but I also got very frustrated as I worked on this material by the idea of depression as a modern Western middle class illness which is a very pervasive idea out there and I really wanted to write something in which I indicated that it is in fact something that is existed across history and was described 2,500 years ago in much the terms we use today that it's something that exists across cultures I went off to look at depression among the Greenlandic Inuit and depression among survivors of the Khmer Rouge in Cambodia and it tribal rituals for the treatment of depression in Senegal and also then to look at the idea that it exists across a wide spectrum of the of financial situations and social situations that in some ways the people who are more privileged are more likely to seek treatment but the complaint itself does not select only for for those who are privileged and does not in fact even man most frequently in an in people because of some self-indulgent navel-gazing that is apparently the affliction of of people who are more educated and who have more prerogatives in life so having looked at those three problems I then began to filter them through the experiences of other people and there are lots of people in the book that I wrote and I'm going to describe just a few of them to you who are all people who are in fact extremely creative and to talk about their experiences of depression as well as my own so mine my first really serious depression began in 1994 and my mother had died in 1991 I had been very very traumatized by it I wrote a book a previous book which was partly about those experiences and as long as I was writing it I somehow remained in those experiences but I wouldn't say that the depression was really in any simple equivalence a result of my mother's dying it was more that my mother's dying opened up more widely assitive abyss of despair that I think had always been there and in retrospect I was talking hism people earlier today about the counseling services here at bard when I was an undergraduate I think treatment for mental illness was still very stigmatized and I know it's still somewhat stigmatized even on liberal campuses you know I had a lot of precursor depressive episodes and I managed to keep functioning through them and I I wish that I had recognized them for what they were and that I had gotten the treatment a long time ago but in any event in 1994 I really began to go to pieces and there was in treatment then with someone whom I fondly refer to as the incompetent psychoanalyst and who kept telling me that she thought it was very courageous of me to keep fighting this depression without medication and so I kept fighting it and I kept getting worse and worse and worse and finally there was a day when I woke up was the day I think before my 31st birthday and I was lying in bed and I had been feeling I had been so anxious I had been finding everything so overwhelming and I had been doing less and less as a result of that I would come home and I would hear the messages that people had left for me instead of thinking how great all those people called everything how will I ever call them back and I would get up and I would think I really should take a shower but the idea of going in it and turning the water on and having to stand underneath it and then take the towel off the towel rack and then it just all sounded like the Stations of the Cross more and more and so I found myself withdrawing from life and I finally reached the point on this day before my 31st birthday when I woke up and I felt so paralyzed that I almost wondered like I did wonder whether I might have had a stroke because I was lying in bed there was a telephone on the bedside table and I kept thinking I feel so bad I have to call someone for help and I lay there for four hours staring at the telephone and not able to bring myself to reach out and pick up the telephone and I think that there's often confusion about what the essence of depression is depression is often accompanied by sadness and it's a very sad stage and there's a lot of sadness that's part of it but I think depression most of all is the loss of vitality and it's the loss of the energy to be engaged in your own life and that's a sorrowful condition and it may be triggered by tragic events in one's actual life but the feeling that one has in depression is not so much of sadness but of nullity it's a kind of feeling of disappearing and on that day I lay in bed for four hours and finally the phone rang and it was my father and I said to him I I don't know what's happened to me but I can't move and he's oh wait right there and I'll be down and a relationship I'd been in a little while before that had ended I was feeling alone in the world even though I had friends and so on around me and it was humiliating to move back into my father's apartment and to be so overwhelmed that I couldn't even manage to cut up my food and he would joke and say I'll be an old man someday and you'll cut up my food and I said I would and he is old now but he's still cutting up his quite admirably but in any event it was it was just a terribly difficult time and one of the things which is actually one of the symptoms of the illness is that when you're in it you tend to see medical professionals who brightly say to you we're going to do this we're going to do that we're going to treat it you're going to get better really it's something to last very long but the feeling you have is that it will last forever and I know there's been an issue of suicide on the campus here and I'll return to that a little later in the talk but I think that the reason or part of the reason people tend toward suicide is that there is that sense that no matter what everyone else is saying it won't get better and what you're experiencing is somehow the the new reality which will be the reality forever and it's intolerable it's intolerably painful I'm going to read you just a little bit from what a couple of the people I interviewed had to say about their experience of depression this is from a writer named Laura Anderson who wrote to me after I'd written something journalistic about depression and we then got into a long correspondence became quite central to this to this book and she remains a great friend and she wrote to me in September of 1998 which was fairly early in our knowing each other and she said I am not yet in a full-blown depression but I'm slowing down a little I mean that I have to focus on each thing I do on more in more levels I'm not completely depressed at this point but I have entered a recession and then she said a week later I only take baths now because the water beating down on me from the shower is too much to deal with in the morning and seems these days like such a violent way to begin the day driving seems like such an effort so does visiting the ATM shopping you name it and a week later the whole day thus far has been an exercise in forcing myself to do the tiniest things and trying to evaluate how serious my situation is am i really depressed am I just lazy is this anxiety from too much coffee or from too much antidepressant the self-assessment process itself made me to weep I looked at old photos today and they seem like they are snapshots of someone else's life and finally she said she described going to the Botanical Garden her boyfriend dragged her out it was the first time she'd gone out in quite some time and she said by the description of one tree it said all parts deadly poisonous I thought maybe I could find the tree she want to leave her too and curl up under a rock ledge and drift off I miss the Lora who would have loved to put on her bathing suit and lie in the Sun today and look at the blue blue sky she has been plucked out of me depression takes away whatever I like about myself which is not so much in the first place feeling hopeless and full of despair is just a slower way of being dead I try to work through these large blocks of horror in the meantime I can see why they call it mean and this is from someone else who is a very old friend who I've known since high school we were in college together and she's an immensely brilliant and creative woman who's now published a book of poetry and is working as a psychoanalyst but when we were in college she developed bipolar disorder and she had a terrible depression it was the first time that I ever saw such a thing up close and I remember at the time people now say to me oh I deal with these people all the time and they just don't understand and I think I didn't understand either I kept thinking okay I'm sorry you feel so bad but you know let's do something why don't we just here open the window come on and there was always that kind of cheering her on thing which I now really regret I think it was incredibly counterproductive and and rather annoying I'm sure but she then really did very well for a long time and then she was seeing a psychiatrist who said we've done so well for a while why don't we see whether if you go off your medication you'll be fine this is usually not a good idea and it's particularly not a good idea for bipolar illness which is particularly uh noumena below resolving over time and she went into a psychotic manic sowed which was then followed by the worst depression I'd ever seen in which he basically sat catatonic and didn't speak for I would say two months at least and when we talked about it afterwards this is part of what she said about it says Maggie Robbins is the name of this woman I would lie in bed singing where have all the flowers gone over and over to occupy my mind I realize now that I could have had some other drugs or that I could have asked someone to come and sleep in my room but I was just too sick to think of that I couldn't say what scared me so much but I thought I would explode from the anxiety I just went down and down and down and down we kept changing medications and I just kept going further down I believe my doctors anyways accepted that I would eventually come back to normal but I couldn't wait I couldn't even do the next minute I was singing to blot out the things my mind said which were you are you don't even deserve to live you are worthless you are never going to be anything you're nobody and that was when I really started thinking about killing myself you don't think in depression that you've put on a grey veil and are seeing the world through the haze of a gray mood you think that the veil has been taken away the veil of happiness and that now you're seeing truly you try to pin the truth down and take it apart and you think the truth is a fixed thing but the truth is alive and it runs around you can exorcise the demons of schizophrenic who perceive that there's something foreign inside of them but it's much harder with depressed people because we believe we are seeing the truth but the truth lies and I'm going to think for a second about that idea of a truth that lies because I think it's a very potent idea and quite a wonderful description of part of what happens in depression in point of fact a lot of what she said is true and a lot of the time you know you deal with people who are depressed and they have two categories of statement that they make some things they say are untrue people say no one loves me and you can say so people love you your wife loves you your grandmother loves you whoever it is who happens to love the person most people are loved by someone but people also say things like I just feel like whatever any of us do we're all just going to die in the end or they say you know each of us is in our own body there's no real communion in which two people genuinely know each other and what you have to say to that is that's true but we should maybe focus now on what we'll have for lunch today and not on that and what's curious in a way is the ability of most of us to tolerate so many of the painful truths of life and to go on with our lives without being profoundly undermined by em by those truths and by the kind of strangeness --is that are embedded in them and there was a fascinating study that was done awhile ago in which a group of depressed and non-depressed people were given a video game to play it was a very old video game but at the end of the thing they asked all of the people how many little monsters they thought they'd killed I think people played for an hour and the people who were depressed were mostly accurate to within five percent and the people who are not depressed guests between 10 and 15 times as many little monsters as they had actually killed and one of the things that you have to struggle with in talking to people about depression is that frequently there is a lot of insight in depression and that again comes back to this notion of depression in the creative mind the reason that depression and creativity may be linked is in part because there is a lot of insight contained in depression but some of that insight no matter how profoundly true it is can be deadly and the protective coating of unentitled s that keeps most of us alive most of the time is actually a very valuable thing and if one loses it one is in and when it's in serious trouble so I'm going to talk a little bit about treatments and about the various kinds of treatments that people pursue often I found in conversation that people will say when they talk about their depression they say in a very kind of brave way well I've just decided I'm not going to take medication and I'm going to fight this through one I own and there are two there are two problems embedded in that point of view which for some people may be the correct one it may work well one of them is that though it does not appear that most of the medications currently used and certainly not the talk therapies that are certainly used they don't appear to cause permanent damage to your brain who really knows but they don't appear to it is fairly clear that continued repeated depressive episodes do you in fact carve paths into one's neural circuitry that depression is a cyclical illness some people have a single episode occasioned by a particular event but for most people who have recurrent depression it will continue to recur they will continue to have it it will continue on an ongoing basis and the other thing though is that people sort of say well you know I was depressed for a while but I pulled out and I might get depressed again and I'll just make my way through it and I always say to people like that that life is actually very short and one doesn't get the time back if you spent the year that you were 27 being very depressed and didn't do any of the other things you might have done while you were 27 you'll never be 27 again and that's it and so a lot of the time that position which seems stalwart and courageous and which I think is intuitive and which was the position I had in the days of the aforementioned psychoanalyst it can be a very dangerous condition that being said I also think that there is a lot of evidence that you know that everyone has different things that work well for them and what works for one person what works for another person are different and there are some people whose ego strength requires that they achieve resilience on their own and there are some people who get terrible side effects from medications it's a it's a blur and there isn't some universal thing I'm frequently asked in public settings I've been really depressed what medications are you on by people who assume that since I seem to be managing okay that if they take the exact same things they will and it's the again the sort of sadness that it's also it's so difficult to figure out I'm on a mix of five medications it took years to figure them out they seem to work really well it was a complicated process the exact same combination will not work for most other people and psychopharmacology and psychotherapy are both very subtle arts which often gets lost that being said when I started working on this topic I thought there are basically two things that are acceptable in that work and one of them is psychotherapy and the other is medication and the rest of this stuff is gobbledygook of some kind and then over time I really shifted that point of view because I came to think that you know if you have lung cancer and you say but I stand on my head every morning for 15 minutes and I feel great it's terrific and it's wonderful that you are feeling better but you nonetheless have lung cancer and it will probably advanced and with no other treatment it's likely to kill you but if you have depression and you say I feel so much better if I stand on my head for 15 minutes every morning then actually you found an effective therapy because depression is an illness of how you feel and if you feel much better after you do that you're not depressed anymore and it's worked so I found people as I was working on this book who had practiced all kinds of things that some of which seemed zeny to me but that had worked for them and I became very agnostic about it I should have thought if you find something and it seems to work for you Who am I to question that belief some of them were a little bit extreme there was one one woman who wrote to me and said that she had tried medication she had tried even electroconvulsive therapy which is also very effective for depression and it's not the most pleasant treatment to have but it is actually the most effective treatment that there is for depression we don't really understand very much about the way it works but in any event this woman had tried all of these things when she said the things she had found that made her feel better that she hoped I would tell more people about was making little things from yarn and some of which she sent to me and which I'm not wearing tonight but in any event she seemed to have a little element of obsessive-compulsive disorder as part of her complaint but I'm now going to talk to you for a second about psycho surgery and I'll talk about someone who's in my book and I'll talk also briefly about someone who isn't in my book the person who isn't in the book is someone called Helen Mae Berg who is a professor now at Emory and who has really pioneered the use of deep brain stimulation for the treatment of depression and deep brain stimulation is a procedure in which an electrode it's been around for a long time in the use of working for working with Parkinson's disease an electrode is implanted in the brain it is used to stimulate a particular area of the brain and so regularizes the metabolism of that area and helen was doing scanning work she's really trained as a scanner and she noticed that an area which had never really had any particular function assigned to it called area 25 seemed to be dysregulated in a lot of the depressed patients whose brain she was scanning and so she came up with this procedure in which she actually implanted an electrode in this area which had not previously been treated that way it was a similar device to the one used for Parkinson's but in a very different location and she's achieved especially in the last five years and the most astonishing results with what she's done it was one of her patients who I talked to who described and she described the moment when the device was implanted she doesn't tell the patient the patient has to be conscious through the procedure because you need to know if somehow something is going in the wrong place and they suddenly have a spasmodic response to try to indicate a problem but anyway the patient is conscious and they get the device positioned and they turn it on but she never tells the person that she's turning it on and there was one of the patients who said and the only people who do this are people who have failed medication psychotherapy electroconvulsive therapy all other known and available treatments and on permanent disability so people who are really very severely disabled with their depression and she said you turn on she turned on the device in this one patient and the patient said what did you just do and she said why and he said all my life I've been in a room with a thousand screaming children and they just left the building most of us are not going to pursue invasive brain surgery I mean she gets huge numbers of letters from people who say you know but my anteater has been really tired so I thought maybe I'd get deep brain stimulation instead she said you really don't want people cutting your brain up unless you really really have to and drink more coffee but but the idea anyway of that intense physicality of depression and that sense that we're in a state of constantly of discovering a new approach a new address you know my hope would be and I think hers too but perhaps there are other less invasive ways of targeting that area perhaps there are medications that can reach there perhaps there are even talk therapies that somehow will appear to change the way that metabolism goes forward in that area 25 I'm gonna describe to someone who when I met him was unspeakably depressed he was a guy who had gone to went to Northwestern he was on the soccer team he was a kind of all-around well-adjusted nice guy and then one day he was driving home from a movie theater and he suddenly felt such a strong compulsion to kill himself that he almost couldn't make it home and he turned the car around and he just drove to a hospital and said I don't know what's happened to me over the years that followed he had reached the point at which he was having electro convulsive therapy on a monthly basis because it was the only thing to which he was responsive he would have the therapy at the beginning of the month the aftermath of having ECT treatments is that you're usually quite zonked and out of it for a week or so he would have a week of feeling okay a week of going downhill and then he would get to the point at which he was in such catastrophic condition that he had to go back for another round of treatment and he said to me he said I have a plan I have a plan for how to end it all he said because I can't keep going like this and he had heard about a procedure which was a precursor to the work that Helen made Berg has been doing which was a cingulotomy that was practiced at a hospital in Boston at Mass General and he wrote and asked whether he could enter the cingulotomy protocol and I met him shortly before he went in to have the surgery and one of the things that I remember being struck by and this comes back to the idea I started with it the nuance of psychic experience I thought it's a lot of optimism after you failed all these treatments and after you've had at that point seven years of being basically completely disabled by this even if you're saying that you have a plan for how to enter it still the fact that you're going to go and try one more thing represents a certain underlying resilience and it's one of the things that's been fascinating to me in working with people who are depressed is that sometimes depression takes away all of that resilience and sometimes it's there under the most puzzling and surprising of circumstances I want to read you from a letter he wrote me a year after the surgery he said my dad gave me two presents this year first a motorized CD rack from the sharper image it's totally unnecessary and extravagant but my dad knew I'd get a kick out of it I opened this huge box and saw something I didn't need it all and knew my dad was celebrating the fact that I'm living on my own have a job I seemed to love and can pay my own bills the other present was a photo of my grandmother who committed suicide as I opened the present I began to cry she was beautiful she's in profile looking downward my mom came over to the chair and asked if I was crying because of all the relatives I never knew and I said she had the same disease I have I'm crying now as I write to you it's not that I'm so sad I just get overwhelmed maybe it's that I could have killed myself but didn't because those around me convinced me to keep going and I had the surgery I'm alive and grateful to my parents and the doctors we live in the right time even if it doesn't always seem like it I found that very profound and very stirring and as someone who is doing reasonably well on intense medication regimen I also have that sense that well there's a great deal about our times that I don't care for that we're incredibly lucky in this regard I hope that when in 25 years people will say how could you deal with those primitive medications and those awful treatments and so on you know that there'll be this huge leap forward but in looking at that experience of the different ways that people address this and the different qualities of resilience that people find I became as I mentioned at the beginning very interested in cultural models of treating depression and I traveled to Senegal because I wanted to look at a treatment which I had heard of but about which not an enormous amount had been written called the unde op which was used for depression and I happen to have a good friend who was living in Senegal and who had a Senegalese girlfriend and I said to David do you think Ellen could possibly help if I wanted to research this and he said oh yes she definitely could so I went to Senegal and we went to see someone who Ellen actually knew who was the cousin of a friend of the mother of someone she went to there's some long complicated line of connections but it was sewn who actually performed the endur and so we went off and we went and I interviewed Madame DF and she told me all about the procedure and at the end I said to her you know I really would love to see and UNDOF I said do you think that would be possible and she said I've never had a foreigner - bob was the word in the local language witness one before she said but if you wanted to then then yes you've come with Ln we have this connection you would be welcome to and I said that's fantastic I said when are you next we need to do one and she said well definitely sometime in the next six months and I said that's a long time for me to be here waiting for for the end up to come along and she's I said is there any way to expedite this process she said no and so I said well thank you very much and I said I was going to go and just as I was leaving she said I hope you don't mind my saying this and I said what is it and she said you don't look that great herself she said are you depressed and I said well I am still somewhat depressed and she said well I've certainly never done this for a on a rapport she said but if you would like I could do and up for you and I said oh um yes I said that's a really that's a great yes absolute that would be great and we left and a Len turned to me and she said are you completely crazy do you have any idea what you're getting ourselves into I won't take you through the whole complicated tale of what it was all like but I will tell you that the high point of the induct a m-- when I was put in a makeshift wedding bed in the central square of this town and all of the residents of the town who had taken the day off to come and participate in this were dancing around me in concentric rings I was in the makeshift wedding bed with a ram and I was told that it would be very very bad luck if the RAM got away so I was holding on to the RAM who was not very happy about the arrangement and at some key moment there are throwing pieces of cloth over us they suddenly yanked all the cloth up I was pulled on to my feet the loin cloth which was all I was wearing at that point was pulled off the Rams throat was slit and I was covered in the blood of the freshly slaughtered Ram and I thought this is this is a change I thought but I had a very interesting experience a few years later while I was working on my current book which was actually quite sobering chiz that I was in Rwanda working on other research entirely and I was talking to someone when I was there and I described this experience that I had had in Senegal and he said I was very interesting to hear about that it's really very different from anything that would happen here that's West Africa this is East Africa it's a different and we were talking about the whole structure of things and he said you know he said we we had a lot of problems here after 1994 with Western aid workers who came to Rwanda he said you know and we're trying to use techniques that were just they were just wrong for us and I said really what did they do and he said okay he said unlike the thing you've just described they did not take people outside where the sunshine helps you to feel better they did not get the whole village to join in acknowledging the problem they did not describe it as something that was invasive as a spirit and could therefore be taken out of you he said they did not have the music to kind of get your blood up and when he said instead they took people one at a time into these dingy little rooms and asked him to talk for 45 minutes about bad things that had happened to them he said made everyone completely miserable we had to put a stop to it so that was that was that experience but back again to my point of the subtlety and complexity of depression I'm going to skip relatively quickly forward but I wanted to just touch on the two other areas that I alluded to before I returned to a couple of the people you've heard from already about their depression Hippocrates describing em depression said in 2500 BC so sorry in 500 BC 2500 years ago said that it was an illness associated with autumn seasonal lecture series associated with autumn and that it's symptoms included sadness anxiety moral dejection tendency to suicide aversion to food despondency sleeplessness irritability and restlessness accompanied by prolonged fear so that's really a description that seems to me to be every bit as good as the one that's in the current Diagnostic and Statistical Manual of the American Psychiatric Association and further not only did he have that idea but he also said that it was an organic dysfunction that should be treated with oral remedies and he argued a lot with Socrates who had said that it was a philosophical problem that was resolved by conversation so that split between the medical people and the therapy but that goes back a lot longer than you think they didn't however have the oral remedies only the idea that where one needed were oral remedies but I really want to talk a little bit about the issue of depression among the very poor if we understand that depression is in large measure a dysfunction of the brain and that it's likely to be triggered at least some of the time by traumatic circumstances it doesn't really make much sense to think that people who are living incredibly bleak difficult lives would be less vulnerable to it than others and yet that idea is unbelievably persistent in the cultural discourse in this country and in many others and what I realized as I worked on this is that if you have an absolutely fantastic life but you feel really awful all that obvious that there's something wrong with you and people will say that's so crazy you've got such a great life why do you feel like that you should see someone if you have a terrible life and you feel terrible all the time the likelihood is that the reason that you will think you feel terrible is because your life is so awful and nobody will say that's so strange did you feel that way but a lot of the time people who are leading unbelievably difficult lives and feel very depressed are not depressed because of how hard their lives are or at least not so much as they are having very difficult lives because when you're depressed it's very difficult to fix any of what's wrong in your life no matter what level of privilege or lack of privilege you may be at and so the question of depression among disadvantaged populations in this country is an enormous problem and it's a problem which has received shockingly little attention and to which there's very little address there is a professor who I got to know was doing research in this area in the Washington DC area she had set up a protocol in which she screamed all of the people who came through a clinic looking for treatment for it was a family planning clinic and there were people were coming in for treatment and she just did random screenings and then she decided which of those people appeared to meet criteria for depression and she offered them treatment and some of the women were game and a lot of the women actually had to kind of be talked into it and so I met some of these women both before and after treatment and I'm just gonna describe one of them to you with someone who said to me I had a job but I had to quit because I just couldn't do it I don't want to get out of bed I just feel like there's no reason to do anything I'm already small and I keep losing more and more weight I don't get have to eat or anything I just don't care sometimes I sit and just cry cry cry over nothing just cry I just want to be by myself I had nothing to say to my own kids after they left the house I would get in bed with the door locked I feared when they came home three o'clock and it just came so fast my husband was telling me every stupid I was dumb I was ugly I'm tired I'm just so tired I've been taking painkillers gonna be Tylenol or anything for pain a lot of it though anything I can get to put me to sleep and this one was brought in to a protocol in which she received six months of treatment she was in group therapy and to receive some medication when I saw her six months later she had left the abusive husband she had gotten a job she was transformed to a degree that seemed almost inconceivable and I should have mentioned before I began that she had seven children which would be overwhelming I think for almost anyone but she was suddenly dealing with them in a completely different way and this is what she had to say to me then she said my kids are so much happier they want to do things all the time now we talk hours every day and they are my best friends as soon as I come in the door I put my jacket down purse and we just get out books and Reid doing homework all together in everything we joke around we all talk about careers and before they didn't even think careers my eldest wants to go to the Air Force one wants to be a firefighter what a preacher and one of the girls is going to be a lawyer I talked to them about drugs and they keep clean now they don't cry like they used to and they don't fight like they did I love to know they can talk to me about anything I don't care what it is there's one room in the new place for the boys and one for the girls and one for me but they all just like to get up on my bed with me and we're all sitting around there at night that's all I need now is my kids I never thought I would get this far it feels good to be happy I don't know how long it's going to last but I sure hope it's forever and things keep on changing the way I dress the way I look the way I act the way I feel I'm not afraid anymore I can walk out the door not being afraid I don't think those bad feelings are coming back and if it weren't for dr. Miranda and that I'd still be at home in bed if I were still alive at all I asked the Lord to send me an angel and he heard my prayers after I talked to a lot of the women who had been in this protocol those to whom were not as eloquent as this but many of whom had achieved really astonishing transformations I decided to write an article about it for for The Times and I proposed the topic and they seemed interested and I turned in the article and my editor called me and said you understand we really can't publish this and I said no I said why well he said well he thought it's just you know it's a little bit ridiculous this thing about all of these people in their lives were so awful and then they became virtually sort of vice presidents in Morgan Stanley afterwards he said it's just I've never heard of such a thing it just doesn't seem real and I said I know you've not heard of it and I really hadn't heard of it either but I went out and I reported it and the reason you haven't heard about it is that there aren't many of these treatment programs I said but that's actually what makes it news and you are a news magazine and then I went down after I eventually got a sort of watered down version of the article done and I met with people in Congress to talk about this situation and I met particularly with pete Domenici republican of new mexico and the late paul wellstone democrat of minnesota who were the two people who had worked the most on mental health legislation in Congress and I said you know treatment program for these people would be the humane thing to do the changes in these lives are extraordinary I said but even if you're not very focused on those questions of what's humane I said this is someone who was receiving social assistance with children who were most likely headed toward the juvenile justice system whose children are now planning meaningful careers and who herself has a job and is a functioning member of the society I said it is in the economic interests of the country to provide adequate treatment for people who are disadvantaged for mental health disorders and it's extraordinary that there are so few programs and that there is so little access available and demand she gave me a sort of long complicated explanation said well he said you're talking about would be a health care directive and this is a congress that's resistant to directives especially in the area of health care he said there are all kinds of problems with that he said we have a line-item budget and even if over time this makes economic sense we can't take the money this year out of justice programs to pay for setting up programs have active outreach into these communities they sort of went on and on and on and I met with Paul Wellstone afterwards and he said to me we live in a representative democracy and in a representative democracy all of the voters have representation on Capitol Hill but the people you're describing are invaders he said on election day they're not in the polling places they're mostly at home with the covers pulled up over their heads he said and it would take a lot of political capital to bring about this kind of change and it's not something anyone can afford to do unless they know about the situation understand it and develop a will to bring about some degree of change in it so that's why I have a little feeling of mission about that that piece of the story and some of those some people in the circumstances of the women I spend time with then we'll have better access to care under the reformed health legislation some of them still won't I'm going to close by reading to you the last things that were said to me or not the last things were said to me but things that I put last in the book that were said to me by the three people I started with Laura Maggie and Frank who had the brain surgery I'll start with Frank if I had it to do over I wouldn't do it this way but I think I've gained a lot and grown a lot because of it I became closer to my parents to my brother to friends I have this experience with my doctor that's been very good there really are upsides to depression it's just hard to see them when you're in it I said I would do it differently if I had it to do over again and I guess I would but now that I feel like the worst is over I'm grateful for having been where I've been I do believe I am better off having been to the hospital 30 times and having had brain surgery I've met so many good people along the way and I would just say that he's now married that his kids are friendly with my kids he's gone on and and built a life but I was very interested that that element of resilience that I feel had kept him going in such dire circumstances also helped him to see some value in the depression and that issue of value seems to me to be at the center of this question of depression and the creative mind this is from Maggie who was the person who I knew for so long and who talked about the veil of happiness being taken away she said I used to get nervous a lot and I would just talk and talk and then I started volunteering it in aides residence they had teas there and I supposed to help get the tea and cake and juice for the patients and to sit with them and chat because many of them didn't have people to visit them and were lonely I remember one day early on I sat down with some people and tried to kick off the conversation by asking them what they'd done for the fourth of July they told me but they just weren't keeping up their end of the conversation at all and I thought this is not very friendly or helpful of them and then it hit me these guys are looking to make small talk in fact after those first brief answers they weren't going to talk at all but they didn't want me to believe to leave so I decided I'm here with them and I'm going to be with them it's simply going to be an occasion where on a person who doesn't have AIDS and doesn't look really sick and isn't dying but who can tolerate the fact that they do and they are and so I just stayed within that afternoon without talking the loving is that you are there simply paying attention unconditionally if suffering is what the person is doing right then that's what they're doing your being with that not trying like crazy to do something about it I've learned how to do that our needs are our greatest assets I am able to just be there with people because of the stuff I've needed from people I guess I've learned to give all the things I need and this is from Laura who wanted to chew on a leaf in the botanical garden depression has given me kindness and forgiveness where other people don't know enough to extend it I am drawn toward people who might put off others with a wrong move or a misplaced barb I had an argument about the death penalty tonight with someone and I was trying to explain without being too self referential then one can understand horrifying actions understand the terrible links between mood and job and relationships and the rest of everything I would never want depression to be a public or political excuse but I think that once you have gone through it you've got a greater and more immediate understanding of the temporary absence of judgment that makes people behaved so badly you learn even perhaps how to tolerate the evil in the world others close by saying that those were stories that were very transformative for me transformative in my creative process but transformative also in in my life and that I agree with them I don't want to be depressed again and I don't have the option of living my life another way so there's nothing much to be accomplished in pondering whether I would preferred to have life go a different way but I think there's a great deal that one can draw from the experience I think creativity is one of the ways manifesting whatever it is that one can draw from it a few years after I published this book my college roommate committed suicide and as a couple of students have here and it was shocking at the time he was someone who had always seemed joyful he lived very far away and I didn't see him very often but I knew the people who were depressed Maggie was depressed Terry was full of exuberance and full of energy and full of happiness and I had to suddenly think Here I am supposedly a great expert on this I had no idea I didn't see it coming and I think that one of the ironies maybe the central irony that I found in working on all of this and of course I then understood Terry's exuberance as I kind of mask over what I was able to reinterpret as evidence of great despair but I think there are many people who feel depressed or experienced depression and what they want to do is to push it away and ignore it and if they can pull themselves out of it enough to function never to talk about it or think about it again to make themselves safe from it and there are other people who go through these experiences and plunge into them and keep thinking about them and even though that sounds in many ways like the harder route my experience with all of these people in with many others is that it's actually the better route it's the the attempt to keep it at bay that makes one most vulnerable to it and the attempt to live more deeply in it and to integrate it into a coherent narrative of a life that's the thing that makes it tolerable and that allows one to say as I do that every day that I wake up and don't feel like that seems like a blessing in a way that I don't know that I would have been able to imagine if I hadn't had those rather grim experiences so thank you very much thank you thank you thank you thank you thank you I'll be glad to take some questions if anyone has them yes I think there's a microphone in front or I can just repeat questions if you want to ask them yes this is a prepared question actually came with it you know how when you learn a new word very often you'll see it again the next day and maybe several times the first word I began to study courses of the prodrome zuv various diseases and I saw a link in your studies has did it occur to you or did you come across any revelatory evidence that depression is caused by viruses I'm thinking of there are several cytomegalovirus Epstein bars that have certain kind of programs they have a cyclical nature nature which depression also does and during a prodrome there are there there are no symptoms it's the onset and yet the they seem to be precursors of these kinds of viruses I noticed that have you did you stumble on anything like that well it's actually it's an interesting it's a slightly technical question but it's a very interesting one there's been some really interesting research that's come out of Hungary just in the last 18 months or so which has linked the onset of schizophrenia to early exposure to attacks toxoplasmosis which is carried by cats particularly it does not mean that everyone who has a cat will have children who end up developing schizophrenia but there is an idea that actually the presence of those viruses can have an effect on especially on early neurological development there's also evidence that there's a possible viral basis if the mother has certain viruses there was an actually rather bad article in The Times a couple of weeks ago about the idea that viruses cause autism and it was unbelievably reductive and simplistic and there was a lot that was wrong in the scientific arguments that put forward but in point of fact the early exposure to uterine viruses has been associated with a variety of later life problems and seems to be connected to I mean schizophrenia is for various reasons easier to measure because it's less frequent and the diagnosis is usually clearer so there's no question that early exposure to viruses actually affects neurology and if it can affect neurology in those dramatic ways it could doubtless lead into into depression in addition there's the question that I think you were asking if I understood it correctly which is that the onset of some of these illnesses is associated with depressive type symptoms and the one in which that's most obvious i think is epstein-barr or chronic fatigue where people just lose all of their energy and vitality and because they don't at that point appear to have a lot of other symptoms it seems to be a psychiatric diagnosis I think that viruses can exacerbate all of these things and I think we have very little understanding of exactly how it works I do think sometimes people get treated for depression when what they actually have is a virus that would respond better to an antiviral agent 100 other and I think that sometimes people go through a lot of treatment for somatic illnesses that they don't actually have because what they really what they really have is just depression and if you were able properly to treat the depression all of the constellation of symptoms around it might remit but I think the diagnosis the diagnostic process is is not so great and and there is a lot of overlap yes thank you thank you thank you thank you other questions someone in the back what kind of psychotherapy so my real feeling about psychotherapy in general is that while the modality is important the competence of the person practicing it is what's most important and I happen to have ended up with someone who has psychoanalytic training and who's been unbelievably helpful to me the psychoanalytic training has very much informed the therapy that we've done over many years but I don't know that I would therefore say everyone should go psychoanalytic I think it was a good match there was a study done quite a long time ago now in which they took a group of people who had mental health diagnoses relatively mild ones and they assigned them randomly some of them to incredibly well-known psychotherapists and some of the people who were sort of just English teachers not that there's anything just about being an English teacher anyway to people who didn't really have all those qualifications and they asked them after the third session do you think this person can help you and the people didn't know what the qualifications were three people they were seeing those who thought the person would help them were better a year later and those who didn't weren't no matter whether the person were well trained or not having said all of that you know I think cognitive behavioral therapy has been an important breakthrough I think that it's got a lot of press and I think that interpersonal therapy and dialectical behavioral therapy are both also very effective for large groups of people I still think that if one has the leeway for it that the more probing methods that have come out of psychoanalysis can be very vital though I think classic psychoanalysis itself is not effective in the treatment of depression that wasn't a very clear and precise this is the one answer but I think that's sort of the spectrum that's out there yes if I found the oh yes um absolutely you know what I did actually find it and that I found it very exhilarating I mean partly because I thought I'm going to be telling this story but um but actually it was it was a very moving ceremony it was a very moving ceremony had many pieces to it and I gave you a very very quick and sort of jokey description of it had many pieces to it that were very compelling the sense that the entire village were not paid for doing and it was just a thing that they did that I had this problem they were all taking the day off they were all gonna spend the whole day doing all of these things to try to help me feel better was very powerful it was a real I felt enormous ly supported by it and I don't happen to believe in the city of underlying idea of what exactly it was there was being exorcised from me so it didn't have an effect at that level but but it was moving and I think that the the piece of it and one night it was a very exhilarating thing and I met a lot of people both in that town and elsewhere because I spent some time in Senna Galan to traveled around and talked to people about it who were doing way much better after they had had an induct and I saw that it had worked for many people and I will tell you that I had also the interesting experience when I was in the car I went to what was supposed to be one of the better mental hospitals in Dakar and when I went there they were explaining their admissions procedure and part of the admissions procedure in that hospital and indeed in all of the hospitals that were functioning in that region was that if someone came in a member of his family came in with him they lived together in the hospital the other person who came and lived in the hospital with that person also attended whatever the city of therapeutic interventions were there was a medical facility not some place that was doing something it was ritual and learned a lot about them and when the person went home that other person went home with him and helped to sustain that ethos and I thought to myself gee here you know your relative goes in there shut away you have an hour a day maybe when you can come and visit them by and large unless it's a small child and there are special arrangements and then the person's released back out into the world and has to suddenly deal with the whole world and nobody knows quite how to support them I thought there was actually a lot to be learned from this situation there so it's a fun story but actually it was quite a profound and revelatory experience for me and yes it's another extremely interesting question whether ADHD is in any way a form of depression I'll answer the question a little bit indirectly there's been a huge amount of work recently on the genetics of both autism and schizophrenia which have been being researched as two separate areas and Mike wiggler working at Cold Spring Harbor lab demonstrated that there are many locations on the genome which are sensitive to repetitions where you get multiple copies of genes or two deletions where you get an insufficient number of copies of those genes and that it appears that in many instances multiple copies of a given gene result in autism and deletions of the same gene may result in schizophrenia the reason that I bring it up is simply that autism and schizophrenia used to be thought of as versions of one another autism was originally described excuse-me as childhood schizophrenia and then we had this revelation that actually they were very different and their symptoms were very different as indeed they are and that they were structurally very different and that the the phenotype the way that the genes were expressed mean leads to something altogether different but if they actually deal with repetitions and deletions in the same spot then they're very closely tied together and while the downstream mechanisms may be different the originating problem may be quite similar in those two illnesses and I was interviewing John Chrystal who's the head of the Department of Psychiatry at Yale and he said I said well do you think that the distinctions between all of these illnesses are going to break down and he said he would not surprise me if in 20 years we think it's all on a spectrum so do I think ADHD is the same as depression biologically I haven't seen a lot of evidence right now that points to a very specific way of describing that I mean they both clearly entail in some measure or another dysregulation of neurotransmitters but whether they're really the same neurotransmitters whether they're the same receptors that are getting over under stimuli I mean I think it's I think it's a kind of sea of confusion and I think that the serotonin hypothesis of depression the idea that it's an imbalance in row transmitters is very socially useful because a lot of people feel better about taking medication if they say you know you just don't have enough serotonin in your brain I'm not convinced that serotonin is really the causal factor even in depression but the idea that all of these things that are dis regulating and go together seems very valid especially because people who are depressed usually have a lot of trouble focusing so well it's not a dee dee they have a lot of trouble staying focused on something over a period of time in a way that's very similar to a dee dee and a lot of people who have a dee dee because their experience of the world is so disrupted have concomitant depression so the two things are braided I think probably both biologically and socially that would be difficult to you know put it up on a slide and explain it that way clearly I was sure that someone was going to ask me that I believe it's in the anterior cingulate and I'm not quite sure but I have known and I'm bad on that sorry but it's easily found well I mean it's easily found online rather than in your head okay so yes well traditionally the difference between unipolar depression and bipolar depression which is the question is that bipolar depression involves going through periods of mania that is usually marked by psychosis which then give way to these terrible depressions which then lead again into these periods of manic psychosis well unipolar depression does not entail psychosis it entails being depressed and sometimes you feel a little better in the knee feel a little worse but you either stay consistently a little below average or you're kind of doing all right and then you plunge down for a while and then you come back up and you do all right for and then you plunge down again but without the manic piece of it for a long time there was a kind of mythology in the world of Neurology which is that many people had this sort of constant mild depression and yet strangely nobody had constant mild mania nobody had ever come in for treatment of that and so it was assumed that it didn't exist I don't know if any of you have seen Bill Clinton speak but there is such a thing as a consistent low level of mania and and it's a very productive and positive way to be and that's why nobody has sought treatment for it so I think that the I think there's more symmetry than there has appeared to be I think there are many people who have what's now called bipolar 2 in which they have manic periods but they don't have psychotic manic periods they just have periods in which they become over energized don't need so much sleep you know get been a sort of super up and zingy about things and then come back down but I think that the neurology or the the mechanisms of bipolar illness are somewhat better understood than the mechanisms of depression frequently though I think people are misdiagnosed with one or the other and I think that as a general statistical thing not because I'm qualified to say which person has been misdiagnosed but there's a lot of a lot of confusion about it in terms of their response to treatment bipolar disorder is harder to treat has a higher suicide rate suicide rate and is a more devastating diagnosis than most depressions some different you know some people have mild or bipolar some people have worse depression some people have a personality that can deal better or not as well but essentially there's a lot of variety there in the in the response to them the medical course for bipolar disorder is clearer and it responds most to lithium and then to a variety of anti-drugs originally developed as anticonvulsants it's it's less vague and less shadowy but it's a more serious illness and more difficult to get fully under control yes there's a big study on that going on right now at Bellevue actually as well it's an interesting area it will be interesting to see if they discover that some of these treatments are effective the question was about using hallucinogenics for the treatment of depression in people who've got terminal illness will be interesting to see whether a whether the results really hold up as the studies get larger for people with terminal illness and B how we as a society that's incredibly uncomfortable with you know drugs as opposed to medications would respond to the idea of using I mean if there's been so much resistance to using to using marijuana to treat the pain at the terminally ill the idea that suddenly you'll extract things from magic mushrooms and they'll be broadly available you know strains credulity a little bit so I think there are going to be a lot of impediments to having that research lead to real shifts in treatment but there certainly are people who seem to have benefited from it enormously and it's interesting to look at that question of terminal illness or extreme depression even because I think many substances act differently in people depending on what their psychiatric condition is so for example my original depression entailed and unbelievably acute and relentless and constant anxiety and the only way that I was initially able to control it was with xanax and I was at that point taking between 15 and 20 milligrams of xanax a day to deal with this terrible and well now if I take half a milligram of xanax I'm sort of out for 12 hours but I had so much tension and so on and so I needed it to kind of bring it down I think a lot of the time the hallucinogenics that are being used in people who are terminally ill end up affecting their pain and not causing an enormous amount of hallucination and I don't think the mechanisms of that are understood at all but I think it's an interesting area for research and I hope it won't be stymied by a kind of social conservatism around those particular substances and yes sorry you in the air sorry Oh depression can certainly inhibit creativity and a lot of the time I think that what happens is that the depression conduces to creativity after you stop being depressed rather than conducing the creativity while you are depressed so I think that's frequently the direction of it you know I think there are insights that come out of depression which can lead to creativity I think there's a kind of profound reckoning with the nature of life that's part of creativity that can in fact lead to depression but I certainly feel like especially if we're talking about the kind of really serious depression that affected the people whom I was describing to us now the idea that it's you know such a wonderful state and everyone should have one and then we could all be Picasso is misguided and that actually if we have the capacity to address it more effectively and to save a lot of people that suffering that would be tremendous I'm going to take just two more and then I'll stop did you want to start you started and got cut off I would say the question is about what pre depressive episodes I have had I remember just having moments of feeling overwhelmed by everything I can remember being in college and it being a Saturday I remember one particular Saturday night incredibly vividly and I've been invited to a party and I remember going to it and getting to the door and think I just can't go in there I can't go in there I can't deal with all of these people like and they were they were my friends I mean it was not some terribly intimidating event and it was the kind of party that I at other occasions would have liked to go to I can remember stretches like that I can remember stretches when I looked at the things I had to do and got overwhelmed my kind of I don't know entry-level experience with depression is frequently anxiety I can remember suddenly not being able to sleep because I just felt like I could never do my work I could never get it finished and I didn't know what I was going to eat the next day and just getting into a complete you know and I didn't know I don't know what socks to wear I just felt overwhelmed by by those experiences and they happen in number of times and then the thing that was really the serious precursor was I think was the year after the summer after I graduated I had a Eurail pass and I was going around and doing things and I was meeting up with various friends in various places and I just remember getting to Vienna and dr. Freud hello dr. Freud but I got to Vienna and I had become so anxious and I couldn't sleep at all and I didn't sleep for three days and I was and I basically I was staying in a rather unpleasant kind of youth hostel but I never left my little room I didn't eat I didn't sleep I couldn't do anything I eventually just thought I thought this is really bad and I went home I felt like an idiot I thought I really wanted to do this this summer I mean I've done much about that summer but I just from the end I didn't understand that that was was an illness it was treatable the symptoms made sense they were part of a larger experience I just thought I've become crazy something terrible has happened I got home I got through the rest of the summer it was fine but you know now I think to myself oh that was a little preview and you could have taken action then and not had a lot more related things that happened after that so one last one there's someone waving his hands wildly over there yes thank you you know people ask me all the time the question is what one says to a depressed person and it's actually it's a it's a subtle art because what you want in the first place depression is a disease of loneliness and what you want to do is to mitigate the aloneness of someone who is depressed so frequently the depressed person will say I really just want to be by myself and sometimes that means you can be in the room but just don't talk to me and sometimes it means be in the next room and so now it means just come by three times a day but it basically never means just really leave me alone because when you leave people alone they become even more isolated and their depression escalates but the question of what tone to take I interestingly I've been doing work for completely separate reasons on attachment you know on how mothers and babies relate to each other and in doing that work I came across this idea of reflection and containment that what a mother is supposed to do if your baby is unhappy your baby is giggling and burbling you're supposed to giggle and burble right back and if your baby is unhappy you're supposed to kind of an expression of concern in which you are responding in a specific obvious way to the fact that your baby is unhappy but you are not supposed to look like you're as unhappy as the baby because that's a terrifying nobody can help me kind of situation and while that is a principle in attachment it also I think and it took me a long time to think of it but it really seems to me to apply to this you have to try to understand what the other person is going through you have to acknowledge it you have to not trivialize that and not dismiss it and not say it's all going to be fought in some patronizing way but in saying how you need to contain it and to say it's so awful in fact I mean what one says to any individual obviously very any effect is a it's unbelievably awful it's an unimaginable terrible pain it probably will pass over time and I will be here with you to help you get through to the point at which it's okay that's more or less the message in whatever way makes sense in any relationship so on that note I thank you all so much for coming thank you you you

Channel: Fred Cartier

Views: 69,288

Rating: 4.9299779 out of 5

Keywords: Andrew Solomon, Depression, Bard College

Id: A7Avvj2qtnY

Length: 88min 14sec (5294 seconds)

Published: Sun Sep 16 2012