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

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 even considered doing a pre-frontal lobotomy.  

It’s a narrative that became a 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:

”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 new-onset depression after my heart attack – 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-cardiac 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 for him, 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.”

♥

NOTE FROM CAROLYN:  I wrote more about new-onset depression following a cardiac diagnosis in my book  “A Woman’s Guide to Living with Heart Disease“.  You can ask for it at bookstores (please support your local independent bookseller!) or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

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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:

When are cardiologists going to start talking about depression?

10 non-drug ways to treat depression in heart patients

Is it post-heart attack depression – or just feeling sad?

When grief morphs into depression: five tips for coping with heart disease

Depressed? Who, me? Myths and facts about depression after a heart attack

“I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack

Depressing news about depression and women’s heart disease

Deep thoughts about death and heart disease (excerpt from Dr. Sherwin Nuland’s book How We Die)

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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?