Finding the root of depression starts with empathy!

The recent event involving Robin Williams has spawned a lot of comments and discussion on the subject of depression and suicide, a topic that has also had a lot of attention in the emergency services world recently. We know that depression is an illness and we should treat it as such; however, we have to recognize that there is so much we don't know, understand, nor are able to appreciate about it. Henry Thoreau once wrote “There are a thousand hacking at the branches of evil to one who is striking at the root." Some people work in a positive force toward helping those afflicted with depression; unfortunately, there are many that provide no positive recourse toward healing, intentionally or not, by belittling and criticizing the actions of severely afflicted individuals without scientific or clinical backing. They judge with no credibility!

Giant, Goya (Francisco de Goya y Lucientes)

Take a second and imagine having no vitality. In a recent article I read, the author asked “What if you are unable to see the worth in anything, or the beauty, or the reason, or the point, or the hope. Could you imagine the complete, total, absolute rejection of life?” This reminded me of a quote in which Laurell K. Hamilton so eloquently describe the pain of depression. She said, “There are wounds that never show on the body that are deeper and more hurtful than anything that bleeds.”

As an example, take the life of David Foster Wallace, an American novelist, short story writer, and professor. He lived an extraordinary life filled with success and external happiness. He published novels, received the only award you get in the nation for being a genius, wrote some of the most feel good essays in the contemporary world, was married, and hanged himself at the age of 46.

Now, listen to these words by Mr. Wallace, and just for a minute, put aside your preconceived notions:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror beyond falling.” 

Did this change your understanding? Can we consider approaching the problem differently?

Clinical depression is an unimaginable suffering. A pain that many people choose to battle, often times for years and decades. They hold on and burn until the heat becomes too much, which should be applauded - the strength and endurance of people that hold on. This is the time they give us to help. When someone ultimately commits suicide, it is the failure of all mankind. It is our failure for hacking at the branches of the problem and not working toward finding the root.

A good friend and colleague told me that when we see depression as a true medical condition instead of a weakness or crutch, then the way we talk, interact, and ultimately treat our patients will change.  We have to change our perspective, not only personally, but clinically and scientifically. This will take more research, more money, and more time; however, right now, we need to provide, to our best ability, every ounce of empathy that we can muster. If not for the sake of our patients, please start for the sake of our brothers and sisters in uniform.

FTM-PTB-DTRT-KTF-EGH … EGH