Tales from the Dark Wood In the middle of the journey of life, I was plunged into a dark wood, for I had lost the right path. — Dante, The Inferno Part II: "Far from the Garden" by Douglas S Johnson "suddenly I awoke in my bed and heard my mother as she was speaking with someone in the garden far down below my window; and I wondered that anyone could move about and live in the world with such ease." - Franz Kafka There is often made manifest in persons suffering from depression an almost ineffable displacement, an unwilled detachment, as though there had been a diaspora of their souls, which thereafter wander far from their bodies, lost in an unlighted and lonesome land, neither damned nor saved, caged in the dark depths of Sheol. Frequently, there comes with this feeling a crushing sense of anxiety, a fear of being left alone, an intense, almost metaphysical hypochondria. Everything seems to be unspeakably out of joint or irreparably broken, and one does begin to marvel at the fact that others are unaffected, that they, in fact, move about with apparent ease, and even with relative happiness. If watching other people continue to live gracefully is difficult for the depressed person, remembering how simple life seemed before the manifest crisis is a veritable torture. In fact, curiously enough, anything external that is of a positive nature, and even pleasant memories, can serve as nothing better than a vivid reminder of the vile predicament to which the sufferer has so unwittingly fallen victim. Spring sunshine, easy laughter, and the playful talk of friends can begin to be perceived with a sense of blind horror and aversion, for they are but a token of how solitary one has become, just as the lovely panorama viewed from a jail cell window can do naught but inform the prisoner of the bars that confine him. It is at this point that the isolated sufferer most often begins to think of self-destruction. It is almost cliché for the family and friends of the suicide victim to torment themselves with "what else, what one thing could I have done, said, etc. so that this wouldn't have happened?" The sad answer, often enough, is "nothing." Beyond offering whatever consolation, comfort, and encouragement they can and helping the sufferer to seek professional help, those close to the depressed person can do little to bridge the great chasm that has opened up between their loved one and the living, vital world. This is not to say that aid should not be offered; of course it should, for it does have a very important place in recovery. It is merely to say that the restoration of the fallen soul to the garden of former peace and stability is not something that is finally accomplished from the outside, but rather from within: whether by biological realignment, by psychological insight, by self-determination, or by God — or by an unexplainable combination of these. With this in mind, we may address, speaking rather broadly, three types of suicidal behavior and discover to what degree we may help in each case. *** The Cry for Help: The first type of behavior is commonly termed the "cry for help" or the "cry for attention." These designations are somewhat misleading, as they sound infantile in nature and are often equated with "crying wolf" or "throwing a tantrum." Nothing could be farther from the truth. Any attempt at suicide, or even talk of suicide, is to be taken very seriously. Paradoxically enough, this first type of suicidal behavior, when it is recognized or suspected by family or friends, is the most often discounted, ignored, or "swept under the rug," when, in fact, the person who has displayed it is the most likely to respond to correct attentions. "Correct attentions," it must be said, are not gifts and coddlings and meaningless sympathies. Babying and the giving of material excuses for affection are insults, even to the relatively young victim. Besides, these are not what the suicidal person wants anyway, even if she is confused enough to think this is the case. What is needed is a direct, personal intervention: an assurance that the world is more stable than it seems from the depressed person's vantage point; a sincere and ongoing assertion of love and of a willingness to listen and understand; a gentle but persistent guiding toward the establishment or re-establishment of physical, mental and spiritual order in her life (the creation of which she will have to participate in herself); and, very importantly, the introduction of professional help. How does one know when a suicide attempt is a "cry for help" (not to be read "just a cry for help")? Since most people who are really intent on dying usually succeed in doing so, a survived attempt may be viewed with some little hope (though never with insouciance or with the idea that the person "wasn't really serious"). The person will probably also show some receptivity to help, though this may not be the case at first, and patience and enduring care must be employed. The Desire for Control: One of the most salient properties of clinical depression is the feeling of having lost control over one's life. All of us experience this in varying degrees at different times, and especially in this hectic age. For the depressed person, however, it goes far beyond the frustration and angst of constantly running late or having too much to do. The sensation experienced in this case is akin to whirling downward at alarming speed into a black maelstrom of anxiety, hopelessness and despair, over which the sufferer has no apparent control; in fact, there is a progression of devastating inner phenomena which steadily rob him of volition. In the midst of this kind of personal madness, it can seem that there is but one thing left in the depressive's control: the element of life and death, "to be or not to be." This realization often gives rise to suicidal thoughts. Curiously, sometimes this realization of power will be enough to help get one through the worst times of depression. "I could kill myself" becomes a curious comfort, and many even find temporary relief and refuge in setting dates or making elaborate plans for their own deaths. Though this is admittedly macabre and still a sign of grave emotional illness, it is for some a way to cope in a provisional manner. (Again, an onlooker should never be comforted by such notions and should take every evidence of suicidal tendencies as though it were deadly serious, for it is.) At other times, though, the deed is carried out; the sufferer decides to invoke what little control he feels he has left, and so decides "not to be." If the person survives the attempt, there is some hope here as well, for this type of behavior is somewhat tied to the "Cry For Help," and thus the sufferer may respond to the intervention techniques mentioned above, especially emotional reassurance and comforting and the reordering of his environment. (Once more, the need for procuring qualified, licensed professional help for the depressed or suicidal person, along with ministering to him via intervention, cannot be stressed enough.) The "Successful" Attempt, or The Outcome of a Terminal Illness: Clinical depression is an illness. It is not a personal weakness, a sign of spinelessness, a symptom of spiritual fragility or a moral failing. It is an emotional and physical disease that requires therapy and medication just like any other infirmity, and, in some cases, it requires more attention than heart disease or cancer. Unfortunately, like all other diseases, clinical depression is sometimes fatal. This is a grim prospect and not something most like to think about, neither sufferer nor her family and friends, but it is nonetheless true. Sometimes depression has a terminal outcome. What facing this truth does is relieve us of certain misconceptions about the depressed person who has "successfully" committed suicide. Armed with this knowledge, we no longer have to torment ourselves with false beliefs like 1) suicide is shameful and should never be spoken of; 2) the depressed person who ends her life has committed an unforgivable sin and is going to hell; 3) survivors must pretend that the suicidal death was really an accident, in order to save face; 4) the person who killed herself could have "just chosen" to live if she'd really wanted to; 5) survivors must hold themselves perpetually to blame, since they could have done or said that one mysterious thing that could have saved the loved one from death. There is very little that can be done to save the person who, due to the ravages of clinical depression, feels deeply compelled to die. It is amazing that in this modern society in which we have made so many progressions and in which we have the freedom to express almost any sentiment or opinion concerning formerly taboo topics, we are still loath to say, "My son/daughter/husband/wife/lover died of depression." Somehow, it doesn't ring true for us; even the phrase itself seems false. We still want to make apologies and insistences that begin, "but maybe we could have…If I had just… If I hadn't said that…" Such self-flagellations are useless and are but the remnant of medieval views of mental illness, the looming shadows of Freud and Bedlam. It is sad to say, but, in reality, there is very little that can be done to save the person who, due to the ravages of clinical depression, feels deeply compelled to die. Still, the family and friends of the depressed person should never despair and give up, no matter how bad things seem. As the saying goes, "where there is still life, there is still hope," and it should be kept ever in mind that people have recovered from the most abject extremes of depressive illness and have gone on to live quite productive lives afterward, just as thousands of people every year miraculously recover from "terminal" malignancies. Nonetheless, if the end of depression is fatal, the victim should be treated with as much dignity and respect and honesty as one who has struggled nobly against cancer, diabetes, or infection. Many times, the depressed person, even the one who does not survive, has fought more nobly than anyone. Finally, it needs to be said that nothing in human nature is simple, nor can any function be divided into three final types of behavior. Furthermore, suicidal depression is certainly not a topic to be summed up one column. What I hope we have, then, is an inroad, a way to begin thinking about depression and suicide. We have presented here no statistics: they are meaningless when it is one's own loved one who has been struck down. We have given no snap cures or foolproof preventions: there are none. We have not explored every form of suicidal behavior: one need but taste the water to know it is bad; it is not necessary to drink the whole pool. What I hope we have done is to begin to understand a thing that is often hard to comprehend: why someone would seem outwardly, physically well and would still want to die. If we can accomplish this, this beginning to understand, and if we can learn how to apply this understanding and make it grow, perhaps here we will find something, if not entirely curative, then at least salutary, for our suffering loved ones and for ourselves. This is the second in an eight-part series on depression written by Douglas S Johnson exclusively for The New Times. 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