LETTER TO A DEPRESSED PERSON

Victor Bloom MD

Dear Jonathan,

Your therapist shared some of your writings with me over the years and I have read them with some interest. I am afraid that if I disagree with anything you say, you would claim that I didn't study them well enough, I should go back and re-read until I understand and agree.

One cannot help but agree with your contention that there is much injustice in the world. It has been so since the beginning of recorded time. I suppose the wildebeast, if they thought about it, would object that it is not fair that lions and other jungle cats have been hunting them for millions of years.

People say we have injustice because of the Law of the Jungle; it's a dog-eat-dog world out there; might makes right; civilization is just a thin veneer. You are heard to say that you don't want to live in a world populated by evil people. Not every guy is Joe Sixpack and not every gal is a bimbo. Most adolescents are not juvenile delinquents. You have met more than a few really decent and admirable people.

If you will see or read Thornton Wilder's "Our Town", you will conclude that the average, ordinary person is mostly good; Anne Frank was not wrong when she said that "in spite of everything, I still think that people are good at heart." Obviously, she was referring to her extended family. Eventually, the family was betrayed and all but her father, Otto, ended up in the death camps. But there was a Dutch lady who hid them and kept the diary, and so we have the story, which has been made into a book, a play, a movie, and has become a legacy and a movement for peace and justice. Except for a few skinheads, the young people of Germany are no longer Nazis.

As you well know, there are many people who are working for peace and justice, for a sanity that will preserve civilization into and through the 21st century. In spite of terrible wars, the movement for peace and justice has grown. Political-correctness is a fact of life, despite its occasional irrational excesses. It means that more and more people have equal opportunities to succeed and live a life of relative security and dignity.

How is it that many people can live in this world and others find it unbearable, insufferable, the cause of exquisite psychic pain, which leads to alienation and finally to suicide? My clinical experience of five decades tells me that some people who are afflicted with a temperamental disorder which is caused by neurochemical imbalance, cannot tolerate this life. They are sensitive, excruciatingly sensitive, to the slings and arrows of outrageous fortune, to the world as it is. To them, Reality is intolerable. Why is this so?

The average person, as part of his neurochemical balance, has a moderating influence that modulates the experience of mental pain. When things go wrong he does not feel anguish; he feels mildly or moderately irritated or angry. He usually has coping mechanisms to deal with everyday problems. He adapts with behavior which restores a feeling of mastery, whether it be to walk the dog, eat a snack, take a nap or create something, whether it be a cabinet or a bookcase, a garden or a painting, a poem or an essay, or a letter to the editor. He has the ability to soothe himself.

When ordinary coping mechanisms fail or are insufficient, the person is in need of professional help. Sometimes that help comes in the form of psychotherapy. Sometimes the therapy dwells on the here and now of rational thinking and coping mechanisms, called 'counseling', which includes the giving of advice and the unlearning of maladaptive thinking. Sometimes the therapy is deeper and analytic, referring to forgotten past experiences which are now causing trouble.

Sometimes medications are just what the doctor ordered. In other words, it is a plain fact that some of the newer medications for emotional disorders produce miracle cures or dramatic alleviation of symptoms. To the best of our knowledge, the medication restores the balance of brain chemistry which has been causing the unhappy dwelling upon the negative. Once the cloud is lifted, the sun can shine again and illuminate the world in a new and positive light.

Think of a Christmas tree with multicolored lights, red, green, blue and amber. It is beautiful and a wonder to behold. Now think of this same tree with only the blue lights lit. It is now somber and dark. That is the brain in depression. The newer antidepressive medications enable the other lights to shine in context. The blue lights are still there, but they are not the only lights. Just as the tree is beautiful, the world can be beautiful and liveable again. We don't know how or why some people develop depression. It is most certainly a complex of hereditary and environment factors. But the fact is, that the vast majority of depressed persons are helped with a combination of psychotherapy and medication.

Some people have a concept of 'rational suicide'; that is, they want to kill themselves and rationalize that it makes no sense to live in an imperfect world, a world which apparently causes them unbearable pain. The ultimate self-defense is the idea that the world is imperfect, not I. The world is as it is, and will remain imperfect. Civilization depends upon good people doing their best to make it better. Suicide hurts the cause of improving the world. In the battle raging for the forces of good to overcome the forces of evil, a soldier is missing.

The world is populated in the main by decent, hardworking people. Those who find the world intolerable need our help, not our criticism or indifference. And they are not helped by a societal stigma against psychiatric treatment and the taking of appropriate medication.

Sincerely,

Victor Bloom, M.D.

Clinical Associate Professor

Department of Psychiatry

Wayne State University

School of Medicine