Plato's Cave and Depression

One of my current work responsibilities is to act as Americans with Disabilities Act (ADA) coordinator for a large organization. As such, I have worked with employees who suffer from depression to establish reasonable accommodations. During the ADA process I have also listened to managers who do not want to or cannot understand the condition. They (the managers) usually present to me a long list of rationalizations of how the employee is just lazy and is trying to get out of work. When I tell people about my current situation I usually get one of the following responses:

1) How can you be depressed you have such a great attitude?
2) I am surprise you have not lost it sooner.
3) You are just looking for excuses.
4) You just want attention.
5) Pull up your big boy pants and deal with it.

What is interesting about these statements is the duality of them. They are false and true, positive and negative at the same time. They also represent a lack of knowledge of what depression is. To precede each of these perceptions will be addressed separately to help you understand their impact.

1) "How can you be depressed you have such a great attitude?" When I get this comment, people are usually referring to my 12 year relationship with cancer. Recently I was asked by a dermatologist, who was removing yet another section of my skin for testing, what was my secret to living as long as I have with cancer. I have a great attitude towards my cancer, it is one of the reasons that I have survived as long as I have. I do not look at my life with the disease as a battle; my cancer is a part of me that cannot be denied. Yet it is a relationship that I did not voluntarily enter into. Fighting a battle implies that there is a winner and a loser. To win the fight is to be called cancer free and live. However we all die, not to sound depressing but it is the truth, I just have a better idea of what I might eventually die from. Also, even to be called cancer free, the legacy of the disease will still have an impact on my life. The trick is, and what I am still working on, is how I live. I lost sight of that this year; I began focusing on the battle, not the life, which is a contributing factor for my current state of being.

Just because I have come to accept the reality of cancer, that does not mean I like having the disease. I do get tired of the pain, the emotional roller coaster, and the changing of treatment programs. All these things take a toll on the body and spirit. In addition, all the medication I have taken has had a negative impact on my body which directly impacts my mental being. Also focusing in on only one issue (in my case cancer), has taken my attention away from other areas of my life.

Sometimes the public display of joy is often just a false front; it is pretending to be fine so others do not worry. There are days that I feel like I am part of the lyrics out of an old Smokey Robinson and Miracles song:

Now there's some sad things known to man
But ain't too much sadder than the tears of a clown
When there's no one around (Cosby)

I can present a good attitude and front about certain aspects of my life, yet feel completely inadequate in others. I have to remember that it is the whole, not just part of my life that needs to be taken care of.
2) "I am surprise you have not lost it sooner." It is true my life has had its share of challenges, however I have to keep in mind there are people who would like my problems, even the cancer. Meaning that no matter how bad I feel, there are others who are in a worse place. That does not mean the issues are not painful or serious, but there are others, for example, whose situation in life does not allow them access to the medical treatment or support system I have. An example of this phenomenon was presented to me in 2007, during a hospitalization that was caused by a bad reaction to a treatment program. At the injection site I had a skin temperature around 106 and a core temperature around 104. I was lying in bed over 100 miles away from my family, hurt, in pain, with a high fever, and feeling very alone. Then I got my roommate.

He was an older gentleman who was in the advanced stages of cancer. In the three days we shared a room together my family came every day, he had but one visitor. While I was taking pain medicine, he was on a morphine pump. In my mind I can still hear the click every time he pushed the button trying to get some relief. His condition did not take away my situation. I was still in trouble, with a high fever and infection. But, I was thankful that I was not alone in my pain. With time it has become easy to lose sight of this lesson. Understanding that there are others who are in worse shape does not mean that I am wishing bad things to happen to them. But, it helps to put my situation into perspective.

3) "You are just looking for excuses." This statement is claiming that I am looking for a way out of being fully engaged in my life. Depression prevents me from appreciating every aspect of my life. I am not looking for excuses for my past behavior and I know that all the medications in the world will not stop life from happening. But if I do not take the time and put in the work to understand my disease I am doomed to repeat the behavior over and over again. Thus preventing me from ever being fully engaged. For me depression is not a justification for past behavior, the clouded thinking may have been a contributing factor, but I have to take the responsibility. I have to realize that depression not only impacts me, it affects my family and friends.

4) "You just want attention." Yes I do, the acting out was a way for asking for help. I could sense there was something not right within me; I was not processing information rationally. When I first hit the bottom, there was nothing in my toolkit that would allow me to ask for help in an appropriate manner. According to the Center for Disease Control (CDC) that 1 in 10 adults suffer from depression and many never seek help. Instead of dealing with the situation they engage in self destructive behavior. People will often turn to alcohol, drugs, and other addictive behaviors or in worst case scenario suicide.

5) "Pull up your big boy pants and deal with it." I partially agree with this statement, yes I have to do work to make my situation better. When people are saying this, it is not to offer support it is a denial that the condition exists. People are often confused about the symptoms of depression, because they have experienced similar things for short periods of time. For example most people feel sad when they lose a loved one, but they were able to work through that emotion in a relatively short period of time. With major depression the person is not able to move beyond that feeling and it starts to impact their total perception of the world. This stance is related to one of the dumbest statements I have ever heard associated with depression, "It is all in your mind." Of course it is that is why they call it a mental illness. Part of the reason I was in trouble was due to my inability to ask for help.
For me the first step in dealing with depression was to reach a level of personal acceptance about my condition. Part of what pissed me off, and contributed to the denial, was I thought many of the issues coming to light had been dealt with in my past. I could not accept I was in trouble until I hit the bottom of the cave, where I no longer had a choice, either I got better or die. Once I recognized where I was then the question became, how do I move from the shadows back into the sunlight? What I have come to learn is there are many paths out of the darkness.

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