Lemme explain one way that the disease of depression can work.

[xiphias]

I'm going to assume that all of the people reading this have never committed suicide. I mean, for all I know, there is really good broadband in the afterlife, and so I could be wrong. But, probably, many of you don't know what it's like. So let me tell you a story. This isn't the ONLY story, but it's one that can happen. It's based a little on what I know of the clinical work on depression, a little on what I learned working at the suicide hotline, and a lot on what it can be like for me. I'm not telling Robin Williams's story here, but I'd like to comment a bit about what I assume he was going through. Again, this might not be anything like the true story, but it's a possible story.

All depression can kill, but bipolar, which is what Robin Williams had, is the most virulent form. When I heard that Williams killed himself, I was in total shock and disbelief for about ten seconds, at which point I went, "Oh -- right. That totally makes sense." We totally knew about his manic phases; his comedy was largely based on his mania. So, he was reliant on it, but it goes away. Real fast.

I have an analogy for what the beginning of my depressive phase feels like. I have no idea if it makes any sense to anybody outside my head, but I'm going to try.

There's this sink, and it's full of water. That water is your capacity to feel happiness. It isn't actually "happiness" -- it's just your ability to feel happy if something happy happens. Anyway, suddenly someone pulls the plug on the sink. No, it doesn't feel like someone pulls the plug -- it feels like the bowl just cracks, and the water goes out through the crack. Except it doesn't go out just like it's dripping out, or even flowing out -- it feels like it's being PULLED out. Like someone stuck a wet-dry vac on the crack, and turned it on high, and pulled out an entire sinkful of water through the crack in four seconds.

And that was your capacity to feel happiness. Not your happiness: your ability to ever HAVE happiness.

Again, that's just me. That's just what it feels like to me when it starts.

Going back to Williams -- if that happened to him, if he suddenly swung to the lowest, he'd probably have used something to try to bring him back up, like the cocaine he used. I imagine that, when he hit the bottom, he used cocaine to attempt to bring him back up to normal range, and, when he hit the top, he used quaaludes to try to bring him back down to the normal range, because mania is exhausting and dangerous even if it's what you're known for and what you need professionally. That's what I imagine -- that he tried to use cocaine and 'ludes to keep himself stable.

It doesn't work very well, but in the 1970s, it was genuinely as good a mechanism as anything else available. Your other choices were electroshock therapy -- back then it was genuinely electroshock and not electroconvulsive -- and lobotomy. In 1974, they started using lithium, but it took a LONG time for them to figure out how to use that safely -- I remember my father having very scary reactions to it in the mid-Eighties. So Williams's drug abuse was honestly as good as it got.

That's all a digression. It's just something I want to throw out there -- that Robin Williams's "bad" life choices were actually the best life choices available to him. Massive drug abuse IS a bad life choice -- but it was truly the least-worst bad life choice he could have made.

Anyway.

Let's get back to having the capacity for happiness being sucked away. And it's not just happiness in the present. You can remember happy occasions in the past. You can remember your wedding, or when you first had sex (assuming that that is a pleasant and not-overly-embarrassing memory), or when you got your first kitten. And you are vaguely aware that you probably DID feel pleasure at that time, but there's no pleasure associated with the memory. Your capacity to feel happiness in the past has been retroactively removed. Your capacity to feel pleasure in the present is nonexistent. And you have every reason to expect that your capacity to feel pleasure in the future is gone, too. You can have pleasant experiences without feeling any pleasure.

The next thing that goes is any sort of energy. Remember that "spoons" metaphor for limited capacity because of chronic illness? Yeah. Not only do you not have any spoons, you can't quite remember what a "spoon" is.

As it turns out, "motivation" is driven by the expectation of benefit. Taking any sort of action not only requires the energy to take an action, but also a REASON to take an action. If I am to clean the fridge, it's because I WANT to have a clean fridge (and I want to have a clean fridge more than I DON'T want to bother to clean the fridge). The motivation to clean the fridge requires two things: a desire for a clean fridge, and enough energy that the action isn't painful. "Effort" is, in itself, a very mild form of pain. So, to clean the fridge, the expectation of pleasure deriving from benefit has to be greater than the slight -- trivial, even -- pain caused by the effort of doing so.

Two things, though. First, the amount of pain that a particular amount of effort causes is proportional to the percentage of total "spoons" that it takes. If a action takes only a very small amount of my spoons, it causes almost no pain. If a single action takes ALL my spoons, it causes a great deal of pain. (That isn't always obvious, because the experience of being ABLE to exert that much effort also causes "pride", which may even, in itself, outweigh the pain.)

To act: expected pleasure in action > pain caused by taking action.

With "spoons" near zero, 1/spoons, which is "pain", approaches infinity. And with "capacity to feel pleasure" at or near zero, "expected pleasure from action" is at or near zero.

So "motivation" = ~0/~infinity. Which is right around zero.

So one has no capacity to act. Taking a shower, for instance, has near zero expected benefit, and a very large expected. If one is in actual physical discomfort, then there is a motivation to take some sort of action. If one gets hungry enough, one might eat. Or might not. If one starts developing bed sores, one might get out of bed and shower. Or might not.

There is an exception, though. Remember that you still have the capacity to feel NEGATIVE emotions (even if that's often blunted, too). Such as "shame". You may be embarrassed to be unshowered and undressed in front of your friends. So perhaps you'll go through that much effort, to avoid the extra shame of looking bad in front of the people you care about.

But there's only so much you can do about that. You MIGHT be able to scrape together enough motivation for very basic physical care, and to attempt interaction with your friends, but not more than that.

"Shame" is the opposite of "pride". "Pride", or "self-respect", is the result of acting in accordance with your own self-image. This requires achievement. If you don't have any sort of achievement, you can't have self-respect, which means that you have shame. Your inability to act, because of your inability to have motivation, because of your inability to feel pleasure, must necessarily result in shame.

The state of constant, ongoing shame is worthlessness.

Now, let's talk about your friends and family. They worry about you. You KNOW that. You know that your depression causes them pain. They try to help you, and they can't. Nothing they're doing is helping.

This means that your inability to get better causes frustration in your friends and family. "Frustration" is the state of wanting a thing and being denied that thing. The people that love you want you to be happy, and you are denying them that. That means that you are hurting the people who love you, the people who you love.

Which is, of course, ANOTHER shameful action -- there is NOTHING more shameful than hurting the people you love. Which confirms "worthlessness".

So. Here is where you are. You do not feel pleasure. You have no capacity to feel pleasure. You are incapable of achieving anything worthwhile, and, in doing so, you are harming the people you love.

Why are you still alive? Because motivation ~= 0. Killing yourself takes energy.

Now here's the evil bit:

You still have no capacity to feel happiness, but "being in less pain" is the same direction. I mean, sure, the numbers are still negative, but -5 > -10. You can move in a positive direction, by moving to "still painful but less painful." If you can cause LESS frustration to your friends, then that might be worthwhile. Since energy is still zero, though, motivation is still zero, and so you're unable to stop causing your friends pain, which is, again, more shameful, which leads to more pain...

All because energy stays at or near zero.

Guess what the first thing to begin to come back when you begin to come out of depression is?

Did you guess? Energy. Not much, but just a tiny bit.

So you begin to have just a tiny bit of energy. And, while you still have no capacity to feel pleasure, you COULD stop causing your friends pain, which would be in the right direction. Removing a source of pain from your friends is a good thing. It's the only good action you can take to benefit them. It is the only action available that can lessen your shame.

Oh, they'll probably think they're sad for a period of time. But they're not getting anything from your friendship anyway. They're good people, so they're denying this fact to themselves: that a friendship is only worthwhile if it's mutually beneficial. It won't take a long time for them to realize that they've just been freed from a burden, and they'll be, on the whole, happier.

The only ethical action you can take is to act for the benefit of your friends and family, by removing a source of ongoing pain. As soon as you can get enough energy to get enough motivation, you can take that action.

Comments

[xiphias.livejournal.com]

Further thing I want to observe. People have been saying that it's important to express your love and care to your friends who are depressed. And that's absolutely true in many forms of depression. In many forms of depression, knowing you are loved will make things more tolerable.

In THIS form, however, having your friends and family express their love to you? Makes it worse. Because that just increases the pain that you're currently causing them.

How do you know the difference? Well, you don't. Whatever you do might make things better, or might make things worse. It depends on how the depression is currently attacking. In some cases, I've kept people from committing suicide by saying that I would never forgive them if they did so -- that them killing themselves would hurt me forever, and that the amount of pain caused by helping them was less than the pain I'd feel if I failed.

Of course, in other cases, that would just make the person withdraw and want to escape by killing themselves.

You don't know. Depression kills, no matter WHAT you do. You can try, and you'll often succeed, and you'll sometimes fail, and you have no fucking way to know. And the most dangerous time for suicide is once the person is getting BETTER. People kill themselves when they're healing. BECAUSE they're healing.

My point is this: if you have a friend or family member who kills themselves, it's not your fault. There's a pretty damn good chance that there was nothing you could have done differently that would have made one damn bit of difference. So you can mourn, but you oughtn't feel guilty for doing something wrong. EVERYTHING you can do is wrong, sometimes.

I hate depression more than I hate any other disease. Mainly because it's the one that attacks me personally. But partially because it is so fucking insidious. It's not the most deadly disease out there, it's not the most virulent, it's not the most painful. But it's the one that pisses me off the most strongly.

[sethg]

I am reminded of the Oliver Sacks essay about the artist who got a stroke in the part of his brain responsible for color vision and not only lost the ability to see in color, but lost the memory of what it was like to see colors.

[kiya]

Yes. Like that.

[browngirl.livejournal.com]

Well this rings true to me, but for twenty years you've been one of the people whom I've known understands depression.

*takes notes for explaining if necessary*

[xiphias.livejournal.com]

I understand one kind of depression. My knowledge in one area may or may not transfer over to other areas.

[undauntra.livejournal.com]

I don't know about bipolar, but I can give a comparison between what you wrote and my experience of atypical depression. (No, really, that's the name of a specific type of depression.)

Capacity for happiness: Not actually sucked away.
Capacity to remember happiness: Gone.
Energy: Gone.
Motivation: Limited to avoidance of negatives, as you describe. But sense of duty and obligation still work.

The comparison goes off the rails when you get to talking about shame, worthlessness, and feelings of being a drain on friends and family. I suspect that a large part of this difference is because I can generally hold down a job even when depressed. Also, I have a lot less empathy than you do.

[xiphias.livejournal.com]

Well, that story wasn't ENTIRELY about me. I've managed to keep going on duty and obligation for a while, but I find it absolutely exhausting -- there's not a specific limit to how much I can do that way, but the difficulty of keeping on doing so increases over time. Over the years and decades, I've largely worked through much of the shame and worthlessness stuff.

You also have the advantage of external validation of your worth through remarkable academic achievement. A brass rat is a physical reminder of measurable worth; I imagine that such a thing might be helpful to some people, in some circumstances, in some forms of depression.

[rosefox]

I strongly suggest cut-tagging this and putting a big warning on it. Descriptions of depressed and suicidal thought patterns can be very very triggering, especially for people who are already inclined in that direction and perhaps have recently been triggered by news coverage of a famous person's suicide.

[xiphias.livejournal.com]

Thank you for pointing that out.

[thnidu.livejournal.com]

1. Memory-tagging and saving.
2. This clarifies so much to me about the depressive behavior of a close relative, though one who has never attempted suicide (AFAIK).
3. Second rosefox's urging about cut-tagging.

[vvalkyri.livejournal.com]

Yeah. There is also self worth or thoughts of being able to do things. Mom when not depressed was very social and a great hostess and could get an amazing amount of sh*t done. After a ton of time depressed she believed none of that, and fooled me into believing her when she said she couldn't make friends easily. I'm sure she believed it herself, too.

[snippy]

One of the things that has stopped me every time I try to plan it is that I will inevitably leave a mess for somebody else to clean up. I can't come up with a way that doesn't do more injury to other people.

[xiphias.livejournal.com]

Good. Continue to fail to come up with such a way.

This

[sistercoyote.livejournal.com]

I said that one of the surprising things Robin's death brought up for me is that I don't currently have an "exit plan", which I haven't been able to say since I was in my late teens.

I still have reasons not to take an exit plan, should one come up for me, and they're all about either not inconveniencing other people or not ending up dependent for the rest of my life (what my personal variant of low self-regard does: I even figure I'll screw suicide up).

So, yes. Keep coming up with those reasons, and so will I, OK?

Re: This

[snippy]

It's a deal.

[firecat]

"Robin Williams's "bad" life choices were actually the best life choices available to him. Massive drug abuse IS a bad life choice -- but it was truly the least-worst bad life choice he could have made."

THANK YOU.

Also thank you for the rest of the post, which is the best of MANY I have seen about suicidal depression over the past several days. May I link to it on other social media?

[xiphias.livejournal.com]

Please. As always, if it's not friends-locked, it's public and you can do what you want, if you keep my name and/or handle attached to it.

Well...

[ysabetwordsmith.livejournal.com]

>> I'm going to assume that all of the people reading this have never committed suicide. I mean, for all I know, there is really good broadband in the afterlife, and so I could be wrong. <<

For folks who have farmemory, what tends to stick are the highs, the lows, and the areas of greatest repetition. Marriages, losses, handicrafts, etc.

You can see how suicide, and the things that drive one to it, are extremely memorable from one life to another. Ending unbearable pain is a really popular reason for amputating one's body. But it tends to create this little pause when, say, one injures something and people say, "On a scale of no pain to worst pain ever ..." and one's scale includes, say, that time one was burned alive and that time one drowned oneself to escape being racked again.

One learns that the most crucial freedom is that of life and death, to choose whether or not to continue participating. One learns not to criticize the choices of others, for it is a thing that each may only decide for themselves, what makes a life worth living or how much pain is unbearable. One learns that forcing someone to stay in an untenable position is torture.

The memory of pain and death tend to teach compassion.

It's been interesting reading various posts about depression and suicide. Some people come right out and say it's stuff they've faced in this life. Others, the hints are there how it's probably farmemory. But they're mostly in the same group of folks who won't diss someone else's choices.

Re: Well...

[xiphias.livejournal.com]

I'd imagine that remembering other lives, and therefore expecting that suicide wasn't the end of the self would change the equation, too -- although I'm not sure in what way.

If you believe that what you are doing is mulligan-ing your hand for a better draw (in the Magic: the Gathering definition of "mulligan") it might seem that the cost of suicide is less. You're just swapping out for a different choice.

On the other hand, if you're feeling that existence itself is unbearable, then suicide won't actually solve the problem.

Re: Well...

[ysabetwordsmith.livejournal.com]

>> I'd imagine that remembering other lives, and therefore expecting that suicide wasn't the end of the self would change the equation, too -- although I'm not sure in what way. <<

Yes, it changes a great deal. For example:

* If your current body is hurting you, say for instance you have a terrible disease, then suicide will solve that problem by separating you from that body. However, if that situation was a key lesson on your life list, you're just going to have to redo it, or pick a different lesson.

* If the circumstances of your current life are hurting you, say for instance you are a slave and cannot realistically escape, then suicide will solve that problem by removing you from that life.

However, if the situation was a key lesson on your life list, you're just going to have to redo it, or pick a different lesson.

>> If you believe that what you are doing is mulligan-ing your hand for a better draw (in the Magic: the Gathering definition of "mulligan") it might seem that the cost of suicide is less. You're just swapping out for a different choice. <<

This applies in situations where you realize early enough that the deck is stacked against you so you're not losing a lot of vested interest. Suicide always costs you whatever you've invested in establishing yourself in that life; you have to start over from scratch. In this regard, farmemory is tremendously helpful for considering all situations in which death is a possibility, such as whether to tackle a friend who is being shot at or how far to go with extreme treatment of a disease.

Dying tends to be very unpleasant. But death is okay, and it's not the end. You get relief from your burdens, you get to see souls you've been missing, you get emotional support from spirits whose job that is. That helps a lot. If you did a lousy job with your last life, though, you're probably not going to feel very proud of yourself.

>> On the other hand, if you're feeling that existence itself is unbearable, then suicide won't actually solve the problem. <<

That is true. And there are a whole lot of closely related problems that add up to, "Wherever you go, there you are." You can't run away from your own company. If you don't like the person you are, then you are just going to have to grow out of that some way. Plenty of things look circumstantial that aren't -- relationships, for example, tend to follow consistent patterns based on how you interact with people. It's vitally important to identify what the real issue is and what solutions might really fix that. This is more work than many people are willing or able to do, especially when they're already so strung out as to contemplate suicide.

Re: Well...

[ysabetwordsmith.livejournal.com]

But a person will farmemory tends to recognize the situation sooner just from sheer experience. It's information. It allows you to make more rational, more effective decisions. Most problems are soluble. Some are not soluble with resources currently available. Some are not soluble at all. You learn to tell the difference.

A majority of suicides come from things that could be fixed, if resources are available. It's easier to see those from the rearview mirror, a fact reported by many people who tried and failed to commit suicide. But if you've got that memory, you can use it in advance. It's like dueling Medusa while looking in a mirror: scary, exhausting, and might still get you killed but at least you know what to try in a situation that gets most people turned to stone. In this instance, farmemory helps you by motivating you to fight for your current life.

Some suicides come from problems that are insoluble either in theory or in practice. Here farmemory helps by making it easier to stay rational in a scary situation and figure out what will minimize suffering. For instance, one person might find a decade of increasing dementia acceptable and another would find being tortured acceptable, but not vise versa. Furthermore, farmemory helps you feel confident of your plan, carry it out effectively, and prevent avoidable pain to innocent bystanders. A person with farmemory is better able to choose an efficient method and to utilize it in a private place. They are unlikely to swallow random handfuls of pills in the family home.

In rare cases, one may enjoy family support. Few people are ever willing to agree that someone else has a right to end their own life, but it does happen, and farmemory again raises this chance and helps minimize suffering for everyone. Revisit the dementia case; that's a leading motivator for these rare cases. Then one may think through a desired death which is peaceful and surrounded by family, while one is still sapient.

A person with farmemory can also share this experience with others. It's not as convincing as personal experience, but it is really useful for identifying the root cause of suicidal thoughts, because you know which questions to ask and those are not dependent on remembering other deaths but at evaluating current life. Are you in physical pain? Are you in emotional pain? Do you feel like nobody cares whether you live or die? Are circumstantial factors hurting you? What are all the possible ways to solve your problem? Which of those have you already tried? Which might still be feasible to try? And so on.

Just by being there and talking through those questions, you can ameliorate one leading motive for suicide, feeling that nobody cares. Humans are troop animals; isolate them and they tend to go insane and die on you. Reconnecting makes a surprising number of problems seem a lot more bearable and soluble. It's not always enough, but it is worth a try.

[nellorat.livejournal.com]

When I was severely depressed, my capacity to experience happiness wasn't the issue as much as the will to make myself do the kinds of things that would bring more happiness. I'm sure that's one reason I didn't stop eating but ate more and more: it was a form of happiness that took little input of will in part because I also had motivation from a natural drive.

I was also angry much of the time; I think that did have much to do with forcing myself to do anything when I had almost no spoons. Any added demand or obstacle was TOO MUCH.

Regarding motivation, I find it fascinating that very high blood sugar has a very similar effect on me now. "Will" seems like such an outmoded 19th-century concept, but I have no better term. That automatic connection between thinking of doing something and doing it--that has been severed.

I think this characteristic also happens to most of us when we have a virus; I notice it mainly when the direct symptoms are mild, because otherwise I'm sleeping most of the day anyway.

I feel very lucky for what Effexor does for me.