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(Neil Young reference)

Depression (Part II)

Depression IS serious, and it is hard to extract any humor from it. In fact, there is some guilt in trying to do so, because even though I can somehow laugh at it, I know that others are afflicted much more severely than I am and
that they can find no laughter in it at all.

A curious phenomenon for me is that caregivers seem to be more deeply impressed by this disease than survivors. That is not hardcore statistics, mind you, but my own experience. And that experience is related mostly to my personal life and to this site, so take it for what it is worth. Still, it is an interesting and contrary observation.

I suspect that the reason is that we who are survivors (or were survivors) learned to deal with that aspect of this whole circus. If we are depressed, there have certainly been times when that has been the least of our concerns. We have been concerned with living and dying, and depression becomes trivial.

I know that when I went through my first go-round with cancer, I came away knowing that I was depressed and that I needed help, and I sought that help, and someday I might tell you about the Rastafarian psychiatrist who attempted to treat me at that time. Don’t get me wrong, I loved the man, but he was funny, really funny, and he would also disappear for weeks at a time
when I needed for him to be around. Again, that is for another day.

In the meantime, as I said, you and I have been concerned about our survival, and about the well-being of those around us, and just carrying
around all of this stuff to worry about, and trying to do it on our own, and we don’t have time for depression. It’s as simple as that.

Beyond that, in some cases, we are not afraid of death. We may even welcome it at some point, at various points. I have said before that the only time I want to die is when I am in severe pain, and some of you know what I am talking about.

In the meantime our loved ones, our supreme caregivers, they are worried about us. If they love us, truly, they are worried about us. They are not thinking of mortgages and car payments and keeping the lawn fertilized and the bedroom clean and the dog from eating the phone box (although they should be, in my case, at least with regard to the latter). They are worrying about us, and all of this other stuff is just stuff they have to deal with while they are worrying about us.

It is really an enormous burden on them. Do not think otherwise.

And when we live, they are so thankful that we get at least a two day reprieve :). But when we die, they are lost. Some of them. Especially the young, but not always the young. Depending on relationship, I am surprised by the number of middle aged people who are devastated by the loss of a parent. I am surprised by the number of elderly folks who say they do not know how they will fill their lives now that the person they have lived with for 40 or 50 years is gone. And that is to say nothing of losing a child. Or of a child losing a parent, which we don’t come across much in this joint, but which happens every day.

All of that said, as survivors, when we learn of our cancer, and as we deal with it, I believe out greatest emotion is fear, if it is not, in fact, acceptance. I believe that for most caregivers, it is grief, and there is a difference to me.

I believe that whatever a survivor feels, fear, acceptance, anger, whatever, it is inherently unselfish. How can it be selfish? It is so real, and so personal, so natural and so instinctive, so of-the-moment.

Grief, mourning, on the other hand, and hate me if you must, these are the provinces of the living, these are selfish emotions (and I mean that not in the typical street usage, but socialogically, psychologically, anthropologically). But it still boils down to selfish. The afflicted is leaving or gone (ostensibly) and you are crying over YOUR loss. I rest my case.

I am not faulting that by any means, or diminishing its importance and its consequences. I am only pointing out that, in my opinion, you have a different issue.

I have managed to stray from the topic again. I wonder why?

Here is what I have to say about depression, and then I am done with it, for at least a week:

I hate it. I think it ruins lives. I know that it is real, and I know that it causes grave damage to people and to families and that for the most part, little is being done to address its causes and its effects. To my mind, a great many of the social maladies in this country and worldwide can be attributed to depression. I am talking about various forms of abuse, about violence, about crime, about poverty, about pregnant teenagers, I mean the gamut. Perhaps
that is too strong, too all-encompassing. I would probably not argue strongly against an opposing view. But it seems that way to me, from time to time.

I think that depression is undervalued in the cancer world as an agent in the lengthening and strengthening of the disease, and that by alleviating this aspect of the disease, we can improve health care immediately. In many cases, this would cost little more than a bit of education about the potential problem and how to deal with it.

And I say that because I also believe that pain management is critical, absolutely vital to succeeding, in one-to-one battles, against cancer. People in pain, including me from time to time, are less inclined to want to live, to
want to fight to live. And depression, while not a physical ailment, is painful indeed. I believe that the medical profession needs to evaluate more carefully the role of depression relief in its pain management program, and
become pro-active in making its resolution a part of its entire pain management program.

I believe that the medical community is now largely aware of the importance of pain management in total care. I do not believe that it understands fully the importance of mental pain management, perhaps largely because medical folks tend to consider psychiatry to be voodoo rather than science. An ‘Art” at best and that in a pejorative sense. That is too bad, if it is the case, and, if it is the case, it is something that needs to change now.

I know a guy that had a rather simple throat problem, a cancer for sure, but something seemingly minor (and seemingly even more minor as my days go by :)) and while we were playing golf one day, he said that if they had to take
out his voice box, he would rather be dead.

At the time, I had not yet had cancer of any form, so I was high and mighty and all righteous about the matter, aided by the fact I had had a dear family friend with the same affliction who happened to be a millionaire real estate broker. So I argued that he should never consider the option of turning down treatment. He was not depressed, by the way, I do not believe. I think he was FEELING depressed. We have discussed that difference.

The point is, had the disease come back, he would have been depressed, and there is a good chance that he would have made a bad choice. I know the man, and I love the man like a surrogate father or an older brother. He is a man of action. He would have chosen to die.

I know because I have been there, have been on the precipice of decision, and have had others push me off of the ledge and back onto sensible ground rather than over the cliff.

It needs to be addressed.

Again, though, I digress.

Depression is not about crying. Perfectly sensible people cry when they are told they have cancer, when they learn that a loved one has cancer.

Depression is not about sadness. Perfectly sensible people have sometimes extended periods of sadness when they learn they have cancer, when they learn that a loved one has cancer.

Depression is not about hate, is not about loss of faith. Perfectly sensible people manage to find an object of hate when they learn that they have cancer, whether it be a doctor, a tobacco company, an asbestos manufacturer, or even God. Perfectly sensible people of faith doubt their
faith at such a troubling time, whether they are the one diagnosed or a loved one wondering why such a wonderful person could be so afflicted.

Clinical depression is about none of the above, although it may consume all of the above, may be instigated by any of the above, and may be manifested most pronouncedly in one or more of the above.

Clinical depression is not temporary depression. In my non-medical but experienced opinion, it is chiefly about not caring. Science cannot quantify not caring, so you are not likely to find it in books about the subject, but I believe that the fatigue, the malaise, the listlessness, the willingness to die, these are about not caring.

I wish I knew why it happens or how it happens, because if I did, I would give away the cure for free. But I do not know. I am fairly certain that like most other items of the mind, it is a combination of genetics, personal environment and society.

This is not a podium for such discussion, so I will leave that at that.

This does not feel like a satisfactory conclusion to this two-parter, probably because in this one instance I have not personalized it, made it my own, made it understandable, as a friend suggested just today.

I am afraid I am not up for that.

I can say this and hope that it helps:

Depression is not the realm of the damned. These days it seems that more people are depressed than not! And even if that is an exaggeration,
acceptance is coming on quick. And that is a good thing.

Therapy is no longer for the rich and famous, hidden away from everyone else. If you need therapy, go get some therapy. As opposed as I was to therapy ( and I think that men are apt to be more opposed than women, although I could be wrong), I did seek therapy and was pleasantly surprised, even if the PhD guy ran from me :). I truly did benefit from that relationship and gained some confidence and some happiness.

We should all recognize that depression either leads to or results from substance abuse in many cases, and that a vicious cycle is likely to be
involved. If you are going to get rid of depression, and if you are drinking or drugging, you are going to have to recognize that the beer and the pot have got to go. Your doctors will give you medications designed to help you wean
yourself of alcohol and other drugs. It is worth it.

In all honesty, if substance abuse is part of your problem, depression can seem like a lot of fun. It can seem pretty darned boring when you lose the alcohol or other drugs, because you are going to have to lose a lot of the friends you had that were associated with that behavior. That sucks. You will be lonely, in fact. Life will be boring, for sure. But what I found in fairly short order was that I found new interests, and that I started doing things
around the house that I didn’t do before.

In my case, I started painting (badly) and took up plants, for want of a better word (well). Still, I will admit even today, life was boring, and even now life is not as exciting as it was, or as it seemed to be. Doctors and others will not like to hear that, but that is true, at least for me, and I am just throwing it out there. You must find other things to fill your time, and you must recognize that the wild times are over. It sucks. I know. I hated it. But it was good for me, and it will be good for you.

Particularly if you are a survivor, you should be aware that cigarettes are not the only carcinogen out there. Why alcohol gets a pass I do not know, but it is a known carcinogen. And when I ask doctors if it is just a problem for your esophagus or stomach or intestine as I might have expected, they ask me, in turn, Do you know how cancer travels? I didn’t know the answer the first time that was asked, but it turns out it travels through your blood stream, or so I have been told repeatedly, which means, of course, that alcohol, if it is a carcinogen, is a carcinogen, potentially, in any part of your body.

Please do not kill the messenger :).

I am not hear to preach. My son has seen the effects of smoking in me, firsthand, and yet, he still walks out to the front porch and lights up a cigarette two or three times a day. I can teach, but I cannot preach. I can be amazed that someone who can manage to smoke ONLY two or three a day does not simply quit, but I cannot preach. I can only teach.

I have better news, I think for survivors and caregivers who think they might be depressed but without the burden of substance abuse. First, as mentioned above, do not hesitate to seek some therapy. It is fairly awesome, the power of simply talking to someone. I am not sure they have as much to do with it as you do. They may be like tour guides, but it is your vacation, if you will, and you are the one who decides where to go. Ultimately, you can find answers in that venue.

And, of course, you can seek help, or just chat or whatever, on various websites, including this one. Some of us say that the chatroom here is the cheapest therapy in town, although it admittedly leaves something to be desired from time to time.

Finally, my best counsel would be to do something. Something of value to yourself. I think that cancer, if you are a survivor, I think cancer, if you are a caregiver, makes you consider mortality. That is bound to be depressing for many of us. We consider our lives and wonder if we have done enough to justify it. That may be foolish, and I will not argue the point one way or the other, but that is what we do, and that is what often mortifies us, depresses us, especially survivors.

Do something to honor your existence! Volunteer. Not necessarily in some cancer-related thing. If you love chess, work with underpriviledged kids with the game or just go to Y and play! If you know soccer ( 🙂 ) then go out and teach kids how to play or just go out and join an age-specific league! If it is cancer you want to work with, there are a myriad avenues to explore. Just go do it!

I say something only slightly modified for you caregivers. If a loved one has passed, do something in his or her honor! Just go do it!

In either case, it is the sitting at home, waiting for something to happen, for better or for worse, that is your worst enemy. Just go do it!

Whoever said an idle mind is the devil’s workshop was right on the mark, my friends. Just go do it!

You see? I have been writing all night. Decadron buzz, I admit, part of the chemo treatment, but this is a part of my way of just doing it :).

Just go do it!