My Depression Diagnosis
“I wish I could show you when you are lonely or in darkness the astonishing light of your own being.”
“Your depression is in remission,” my doctor announced as he poked his head around the COW (Computer on Wheels).
I was at my annual physical, or possibly a medication follow up appointment, I don’t recall exactly, and we were reviewing my medication list. It was pretty unexciting, as might be expected for a healthy 30-something year old, with the exception of Lexapro and Lunesta, an antidepressant and sleep aid, respectively. I had shared that life was going fairly well; I was looking forward to my future, had plans with friends, and was thinking kindly towards my family.
“My depression is in remission?!” I retorted. “When you say it like that it sounds like the condition is terminal.” I did not like this framing. Stubborn by nature, I challenged him. “Do you think depression is my true nature and I happen to be experiencing temporary relief?” He wallowed, backtracked a little bit, seemingly caught off guard by my opposition. The conversation got deep quickly, as it does when discussing matters of mental health. Was depression faulty brain chemistry, and therefore a cause, materially and biologically rooted, needing a fix, as a mechanic would fix a car, as his remark implied? Or was it a symptom, a loving message, sent by a loving universe, whispering, “You are not on the path I set for you.” My heart raced, his voice quickened, only a few sentences and we had opened pandoras box, one of the trickiest health issues of our time.
This is not the first such conversation I have had with a doctor. It is one example of several; a theme, a pattern. I had a therapist (an incredibly sweet lady who helped me in many ways) tell me that unless I began taking medication, she could no longer see me, due to my lack of “progress”. I had heard the term “treatment-resistant depression.” Did I have treatment-resistant depression? The thought alone was terrifying. But something in me didn’t buy it. It didn’t pass the sniff test. There was a whisper, an inner guide, softly saying, “You are okay as you are, Tyler. You are not broken. I love you.”
I could sense my doctor’s helplessness, and the resultant futility of my questioning, and I felt a lot of compassion for him. Don’t hate the player, hate the game, 🤷♂️. This man, like each and every healer I have seen, was simply doing his job, to the best of his ability, wishing me nothing but the best, limited to the tools and teachings of the only system at his disposal, western medicine, and science. At the same time, for whatever reason, unexplainable really, deep down I believed the whisper, the inner seed buried under a concrete medical system, and I felt a lot of compassion for myself as well.
The conversation fizzled.
I left the appointment, another strained relationship with another well-meaning doctor, questioning if I was fundamentally broken or if that whisper was worth something. “Treatment-resistance depression” they say. I am not so sure about that. But if that’s not it, then what? “Unsuccessful treatment.” That is fair, hard to argue the treatment had been up until that point unsuccessful, or that me as the patient had been largely unresponsive to it, at least when measured by conventional results (more to say about “results”). What about “ineffective treatment?” That is a novel idea, with big implications. That perspective flips the model on its head. It turns the tables 180 degrees. It shifts the focus from the patient to the treatment. It is no longer about what the treatment can tell the patient but about what the patient can tell the treatment. The patient is no longer the student, the patient is the teacher. Instead of labeling a patient as “depressive” or “anxious” or “bipolar”, it investigates what’s behind the symptoms. What is your depression saying, what can we learn from your anxiety, how might our modern world be causing bipolar disorder?
Did you know that for a long time our ancestors thought the Sun revolved around the Earth. It must have seemed so obvious. How could anything but Earth be the center of the universe? It wasn’t until people like Copernicus, Galileo, and Kepler came along and started questioning the foundational principle. Many people were killed, on account of heresy, for that.
I was speaking with a friend of mine recently who is a therapist and we were discussing the topic of diagnosis in mental health. She told me that grief had recently been introduced as a billable diagnosis code. I think that is amazing. Let’s diagnose everybody with grief, and then work to understand it. Better yet, lets simply hold space for it, and patiently love it back to health.
Diagnosis is helpful for the psychotherapist (categorization of symptoms) but harmful for the patient (identification with diagnosis).
To borrow a sentiment from the great Swiss psychologist and thinker, C.G. Jung, the attitude of the healer is infinitely more important for the patient than technique or method.
Is depression more a disease of the soul, or of brain chemistry? This is an nontrivial question. If we don’t understand the nature of the dis-ease, then we don’t understand how to treat it.
The best treatment for depression is expressed by 14th century Persian poet, Hafiz …
“I wish I could show you when you are lonely or in darkness the astonishing light of your own being.”
P.S. For good measure, my doctor included a diagnosis of “irritability” in my chart, in light of our conversations.
P.P.S. What if it is the most caring, most sensitive, most wise among us presenting with “mental health” symptoms? Our culture doesn’t like sensitivity or wisdom. These qualities don’t advertise relentlessly, they don’t produce for production sake, they don’t consume mindlessly, they don’t look away from suffering. Perhaps the tumult we are all experiencing is a sign of our lack of balance as a species, a lack of reciprocal relationship with our home, Earth, and it is Mother Nature’s way of self-correcting. “Mental health” symptoms might be the healthiest symptoms we have.
Galway Kinnell communicates my message more beautifully, and in not so many words.
“Saint Francis and the Sow”
The bud
stands for all things,
even for those things that don’t flower,
for everything flowers, from within, of self-blessing;
though sometimes it is necessary
to reteach a thing its loveliness,
to put a hand on its brow
of the flower
and retell it in words and in touch
it is lovely
until it flowers again from within, of self-blessing;
as Saint Francis
put his hand on the creased forehead
of the sow, and told her in words and in touch
blessings of earth on the sow, and the sow
began remembering all down her thick length,
from the earthen snout all the way
through the fodder and slops to the spiritual curl of the tail,
from the hard spininess spiked out from the spine
down through the great broken heart
to the sheer blue milken dreaminess spurting and shuddering
from the fourteen teats into the fourteen mouths sucking and blowing beneath them:
the long, perfect loveliness of sow.
Thank you for reading. I’d love to hear your thoughts.
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What you’re pushing back on is the idea that a diagnosis quietly becomes an identity. “Remission” implies the problem is the person rather than the framework being used to understand them. The way you describe listening to that inner whisper reads less like denial and more like orientation. Symptoms don’t always mean something is broken; sometimes they’re pointing to a mismatch between a person and the world they’re living in.
There was a whisper, an inner guide, softly saying, “You are okay as you are, Tyler. You are not broken. I love you."
Does this voice have a name? I'd call it The Healer. I'd call it The Truth. I'd call it The Way. It's exciting to wonder about this being, and how it is central to many belief systems.
Today in church it was mentioned: That still, small voice-- and we were invited to quiet our busy minds and listen for direction. The direction comes!
Beautiful writing, Tyler. Thank you for sharing.