What Depression Does to Our Minds When It Attacks

After two of my acquaintances died on the same day in the same way—by shooting themselves—I heard various comments:

     “But he was such a strong Christian! How could he do this?”

      “Well, I always thought only losers had depression, like people living on the street, or alcoholics and drug addicts – nobody but losers!”

None of the people who said these things understood depression at all or what it can do to anybody.  

I’ve been a journalist, a college teacher in Hong Kong, and—for 22 years—a pediatrician. I was chief of staff and a trustee at a 700-plus bed medical center with 2 campuses and 400 doctors. I am a dedicated Christian, a Presbyterian elder, and a veteran of medical mission trips to the Amazon. I speak fluent Spanish, some Portuguese, a little German, and a bit of Cantonese. When I am thinking rationally, I can see that I am intelligent, witty, well-liked and respected.

I also have battled depression for more than 40 years, and when I am depressed, I do think I am a complete loser.  

I have been so depressed that I have considered killing myself many times. I decided 30 years ago that I could never safely own a firearm because I knew what I would do with it someday. Even so, I have come close to buying a gun. A few years ago, I had extremely severe, treatment-resistant depression—an epoch more than an episode—that lasted several years and steadily worsened despite multiple medicines and weekly visits to my psychiatrist. Eventually, I did go shopping for a pistol. With great difficulty, I chose not to buy it and committed myself to the hospital instead.

I had extreme depression— much more severe than that endured by the great majority of people who become depressed. Most need only counseling and perhaps medicine to become happy once more. They don’t lose their jobs or have to be admitted to hospitals, and they do not come close to killing themselves. Unfortunately, most who are depressed do not seek any help—often because they fear what others will think. This is a mistake, because effective help is available.

I too was afraid of the stigma and of being labeled a loser. Until I entered the hospital for intense treatment, I hid my depression as long as possible. I was afraid others would think me weak instead of strong, think there was something “wrong” with me, that I was broken and could not be “fixed.” I feared they would believe I could not be an effective physician if they knew I had depression.

I also have a stubborn independent streak. I believed that I could “handle it”—a trait common among physicians. We see a problem and we fix it. Before I ended up in the hospital, I (eventually) let only my partners, my pastor, and a few close friends know that I was seeing a psychiatrist and taking medicine. No one in my own family knew. I was too ashamed to tell anyone I had a mental illness.

That severe bout of depression had begun 4 years earlier, while I watched my husband battle renal failure and then cancer. I cared for him until he died, and then I nearly died, too. During the last year of my husband’s life, I never missed a scheduled day of work until 2 days before his death. A week after he died, I went back to work. I never missed another day until I went shopping for that gun 2 years later.

I was determined not to let my illness stop me from doing my job. I decided that no one would say I was weak instead of strong and tough. I continued to work during a depression that was totally debilitating. I couldn’t pay my bills on time. I couldn’t clean my house. I lost 60 pounds in a year without trying because I couldn’t eat. I quit opening my mail and answering my phone. I completely isolated myself, and I often sat at home weeping. (Again, this was an extreme in the spectrum of depression.)

Even so, I made sure to put on a good face whenever I was with other people. I still smiled at my patients, partners, and friends. I went to church every week, and I cracked jokes that made everyone laugh. I was still respected. I hid my problems at all cost.

The time finally came, though, when my illness did affect my performance. I arrived late for office hours. I could not complete my charts. I could not concentrate. I hid in my office crying at times. Sometimes I wrapped my stethoscope tightly around my neck, finding that sadly comforting. Some of my partners even began to wonder whether I was using drugs. Finally, they told me, “You’re going to take two weeks off now and go do whatever you need to do to fix whatever is wrong with you; if you don’t fix it, your job will be in jeopardy.”