“I’m the least depressed person on earth, except when I’m depressed”

17 Mar

by Carolyn Thomas  @HeartSisters

When I learned that Dr. Sherwin Nuland was going to be doing a guest lecture at the University of Victoria here back in 2012, I was among the first in town to book tickets. I loved his book called How We Die (a finalist for the Pulitzer Prize) ever since I’d featured his chapter on death and heart disease three years earlier here.

His sold-out UVic audience was enthralled by his engaging manner and compelling excerpts read from his newest book called The Art of Aging: A Doctor’s Prescription for Well-Being.

But I was even more intrigued by this famous surgeon/Yale University professor’s personal stories of his own experience living with debilitating depression – a depression so crippling, so impossible to shift, that in his 40s his doctors were considering doing a pre-frontal lobotomy.  

It’s a narrative that has become a famous 2001 TED talk, described as “the first TED talk that made our TED content director cry.”  Here’s how Dr. Nuland described depression – and his later infrequent recurrences of depressed episodes – in that talk:

”When it happens, I can always tell because I feel myself as this totally incompetent human being who stands right next to this perfectly rational sensible man who says: ‘Why are you letting this happen?’ – yet I have no control over it happening.

“I can say, when I’m not depressed, that I’m the least depressed human being on earth.”

Dr. Nuland’s last line is precisely how I would have described myself too. “When I’m not depressed, I’m the least depressed human being on earth.”

That was just before I crumpled into a dark shadow of myself back in 2008 while trying to recuperate from my “widowmaker” heart attack diagnosis and accompanying debilitating cardiac issues, later diagnosed as Inoperable Coronary Microvascular Disease. 

I’ve written quite a bit (here, here and here, for example) about my own bleak depression – a bleakness that, according to Mayo Clinic cardiologists, affects up to 65% of heart patients as they struggle to make sense out of a diagnosis that makes no sense. Although pervasively common, post-heart attack depression is correctly identified in barely 10% of us.

Almost overnight, I went from being, like Dr. Nuland, “the least depressed human being on earth” to somebody who could barely drag myself out of bed, or muster up the energy to have a simple conversation, or care even remotely about how I looked or how I smelled. It took a long time, and a very good therapist, to help me through that period.

When former Globe and Mail reporter Jan Wong wrote about her own journey with debilitating depression in the memoir Out of the Blue, she described the life lessons that depression had taught her:

“The big life lessons are that you can have clinical depression and you can get over it. It’s completely treatable. It has an end.

“Second life lesson: you’ll probably be stronger when you come out of it than you were before.

“The third life lesson is you’ll probably be happier because you leave it behind and you will find a new life.

“The fourth lesson: that family matters. Everything else is extra.”

Dr. Stephen Parker is an Alaska cardiac psychologist (and more importantly, a heart attack survivor himself) who has written about his own experience with post-cardiac depression, too:

“I think the depression and anxiety following a heart attack are a bit different than the depression and anxiety that most therapists encounter, and both are going to be more resistant to treat because there are damned good reasons to feel anxious and depressed.

A heart attack is a deeply wounding event, and it is a wound that takes a long time to recover from, whatever the treatment.”

Dr. Nuland once told The New York Times that he had long ago reconciled himself to how little depression is understood by those who are not depressed.

In the midst of struggling with a bad marriage during the 1970s, he had become progressively depressed trying to save a marriage which was not about to be saved. He realized that his work as a surgeon was suffering, as he explained in his TED talk:  

“I would schedule all my major surgical cases for noon, one o’clock in the afternoon, because I couldn’t get out of bed before about 11 a.m.

“And anybody who’s been depressed knows what that’s like. I couldn’t even pull the covers off myself. Well, you’re in a university medical center, where everybody knows everybody, and it’s perfectly clear to my colleagues, so my referrals began to decrease.”

But his psychiatrist made a bold suggestion back then: instead of the lobotomy that other specialists were discussing as a treatment option, Dr. Nuland would try two 10-session rounds of shock therapy (electroconvulsive therapy, or ECT).  And it worked. Within 3-4 months, the dark bleakness had lifted and he became well enough to be discharged from the mental health facility where he’d been admitted.  He joined a group of surgeons in New Haven and resuscitated his medical career. He went back to work at Yale University, and he began to write books.

Sherwin Nuland recognized that sound mental health could never be taken for granted. For example, he had this warning for young people who do not understand depression because they’ve not (yet) experienced it themselves:

“For people under 30, on the cusp of a magnificent exciting career, anything can happen. Accidents can happen. You can be thrown off the track. It will happen to a small percentage of you.

“But if I, with the bleakness of spirit I had in the 1970s and no possibility of recovery, if I can find my way back from this, then anybody can, too.

“Some of this will seem very familiar. There is recovery. There is redemption. There is resurrection.  There are resurrection themes in every society we study, and it happens a lot.”

Dr. Sherwin Nuland died of prostate cancer at the age of 83 on March 4, 2014 in his Connecticut home. His daughter recalled that he had told her he wasn’t ready for death because he loved life:   “I’m not scared of dying, but I’ve built such a beautiful life, and I’m not ready to leave it.”‘

See also:

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Q:  How does it affect the stigma of mental illness when a well-known person is willing to speak openly about their own experience?

6 Responses to ““I’m the least depressed person on earth, except when I’m depressed””

  1. Suzie March 24, 2014 at 7:54 pm #

    Anyone have good reference re depression and treatment for the elderly? My mom is 83, had heart attack and stroke and is struggling with fatigue and depression. I swear it is the meds as much as the HA. She is on statins too, which I hate.

    I had HA and had similar issues. Terrible depression, no interest in my surroundings, in bed alot….had some behavioral therapy and now take antidepressant (for pain actually)….no one ever asked if I was depressed.

    Feel better mentally, but still upward climb.

    Like

    • Carolyn Thomas March 24, 2014 at 8:20 pm #

      Hello Suzie,
      It is indeed awful to watch a loved one suffering – especially when you’ve been through it yourself. I suspect that what works for the elderly is also what works for younger patients (although the elderly are more likely to have “comorbidities” – other chronic health issues that can make depression feel even worse). For example, if your mother’s taking a beta blocker (as many heart patients are prescribed) it carries a recognized link among the elderly for side effects like depression, confusion, lethargy, and cognitive impairment issues. Your mother might do well to be seen by a gerontologist if possible.

      Also check out this post on non-drug ways to address depression (at any age). It’s important to keep in mind that most studies supporting antidepressant drugs have been funded by the pharmaceutical companies that make the drugs (like this one in the Journal of the American Medical Association that was not only funded by Pfizer – maker of Zoloft, the drug being “studied” – but included a full-time employee of Pfizer listed as one of the study authors).

      Good luck to both you and your mother.

      Like

  2. PalmerPitch March 23, 2014 at 8:18 am #

    Thanks for introducing me to Dr. Nuland’s work. I’ve ordered two of his books since reading this.

    In answer to your question about mental health stigma, I believe it certainly does help the rest of us when we can hear from well-known and successful people who talk openly about their own struggles living with depression – like Dr. Nuland or Olympic athlete Clara Hughes here in Canada and her Big Bike awareness-raising 110-day bicycle journey across the country to 95 communities and more than 80 schools.

    This is such an important issue – thanks for continuing to bring it to our attention.

    Like

    • Carolyn Thomas March 23, 2014 at 1:09 pm #

      Good point about Clara Hughes and her noble campaign to address the pervasive stigma of mental health issues. And hope you enjoy your Nuland books.

      Like

  3. Allison March 17, 2014 at 9:27 am #

    It’s just beyond me why there is any stigma attached to mental illness.

    Our hearts go wonky, our joints need replacing and other structural defects manifest over time. Live long enough and something will go wrong! Why, then, can we not accept it when something bad goes off in our heads? No one tells a person having a heart attack to “snap out of it.”

    I’m grateful for Dr. Nuland for being so upfront about his disease. Better treatment is needed, not more shaming.

    Like

    • Carolyn Thomas March 17, 2014 at 9:40 am #

      Very good points, Allison. Dr. Nuland’s story is inspiring because he not only came back from his debilitating depression, but medical colleagues welcomed him back to his career. That doesn’t always happen…

      Like

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