Until recently I would rather have died than admit what I am about to say, but here it is: I suffer from depression and acute anxiety. The truth is, Robin Williams’s death this week struck me as sad at first, but soon took up more and more of my thoughts over the past few days until it became a clarion call. I needed to speak up, for the first time in my life. If it helps just one person to feel less alone, the uncomfortable exposure is worth it. So, I’m speaking out about this condition, which is woven into the fabric of who I am.

Before anything, though, I must fervently state that suicide is no answer at all. If I had ever acted on any impulses or thoughts I had to kill myself in my darkest days, I would have missed out on so much in the years ahead. I never would have experienced the joy, happiness, love, friendships, and thrilling, enriching experiences, not to mention my own personal achievements, which no one and nothing can take away from me now. I have even come to see my depression as a kind of gift, which helps me to experience life more deeply and on more levels.

My earliest experience with feeling hopelessly sad was when I was about nine or ten years old and I had been in the hospital with pneumonia. I had severe asthma as a child, so it was a scary and life-threatening ordeal. For weeks afterward, I was on a lot of medication, including corticosteroids. That was when I first remembered feeling out-of-step with the world. For me, that feeling of alienation is the most pervasive and debilitating aspects of depression. From that time on, I looked at my peers and felt a chasm between us. I couldn’t often relate to them and I didn’t really know why. I’m not sure that feeling has ever left me.

During my teenage years, I suffered from what is called “major depression.” I was hospitalized for seven months. I was in such anguish, I flatly refused to go to school. I didn’t want to leave the house. I just wanted to curl up and read books from my early childhood, as if I could reverse the aging process and become a care-free little girl again if I read The Wind in the Willows for the tenth time.

Much of what I felt was what normal teenagers experience and feel, but depression is, in part, the grotesque magnification of typical emotions and moods. I felt like a hideous freak and that I needed to hide myself from the world. When my parents suggested I needed to be hospitalized, I embraced it. I thought I was somehow winning or getting away with something… I didn’t have to go to school! I could hide myself away and maybe never go back!

I came of age in the hospital. I learned that I loved The Cure. I pierced my own ears several times and they got infected. I shaved the side of my head. I also learned that art was my passion and salve. It has been so ever since. In the hospital, I made many friends who remain close to my heart, though I don’t remember their last names or have any idea how to find them now. They were the only people who stood on my side of the warped glass, looking in at the world from afar.

I had not completed my descent into depression when I entered the hospital. I learned that sadness presaged despair and unending tears, which gave way to numbness. Finally, I would arrive at a state of complete emptiness. This was rock bottom and it was a relief. The only drawback is that, to feel better, you have to climb back through all of those stages again: the hollowness, the numbness, the grief, and then sadness before there can be any happiness. The staff at the hospital actually told me the crying and agitation I felt meant the meds were working. Because I was feeling something again. I have made that descent and climb more than once. 

The ordeal of trying to find the right medication is discouraging and often fruitless. It is darkly funny that patients with a condition marked by interminable pessimism would be so difficult to treat pharmacologically. As for me, prozac made me crazy and agitated. Lithium made me listless and sleepy. Zoloft did nothing. Paxil worked a little and so that’s what I continued to take until I was in college. I never seriously thought about killing myself, although I experienced a desire to self-harm and thoughts of “suicidal ideation.” The bad thing about putting a bunch of sick teenagers together is that there is a lot of copycat behavior and thinking.

When I left the hospital and rejoined the “real” world, I felt a permanent displacement. The effort of getting through my days, turning in homework, and pretending to be a “normal” teenager was about all I could muster. Every day felt like so much work and so much effort. I often didn’t know how I could get through it. I would have liked to disappear from my family and never see anyone ever again. I suppose that might qualify as suicidal ideation, just wanting to disappear. It would have been a relief to be locked away in a little dark cell forever, with no demands and no face to put on. Ironically, that would have felt like freedom.

It wasn’t until I was in college that my depression finally lifted. I became excited about school and living on my own. I saw my future as a ladder of goals I would work diligently to reach. Sometimes I would wake up and feel that empty chasm opening up inside of me, but I would tell myself in a clipped Mary Poppins-esque voice to just keep going, “spit spot.”

And that seemed to be the solution for a long time. To not stop. To just keep going and throw myself into work and life. I thought I had kicked it or that I knew how to manage my depression and often patted myself on the back for learning how to do it on my own. However, I think I may have been ignoring rising signs for a long time.

Early this year, I finally had to admit that I needed to seek help again. It came after a day in which I lay in my bed all morning unable to do anything but listen to my pounding heart and racing , panicked thoughts. For about a year, I had been feeling a constant feeling of impending doom. My thoughts would often run in circles and I couldn’t get off certain subjects that caused me the most stress and made me feel most powerless. I was consumed with thinking about every possible catastrophe that might befall me. I would game out possible chains of events, looking for the worst-case scenario so that I could prepare myself. When I couldn’t think of anything else to worry about, I worried I was overlooking something that needed worrying.

This is what is known as Generalized Anxiety Disorder and, at least for me, it is the other side of depression. It is closely linked to all the negative thinking that causes depression. In a way, it felt much worse and more terrifying than depression because, rather than sapping my energy, it expended what little energy stores I had. It was frenetic and exhausting and brutal. Depression might call to you with a steady stream of voices saying things  like “you are worthless, ” “what’s the point?” and “nobody cares.” Anxiety, on the other hand, shouts at you: “You’re an idiot,” “what the hell are you thinking?” ” you will fuck this up,” and “no one gives a shit.”

I have sought treatment and new medication and I do think it has helped a lot. The most effective therapy I’ve found is cognitive behavioral therapy, which is the practice of identifying distorted thinking and challenging it. It became a little easier to get moving in the morning and to accomplish things after awhile. Yoga and meditation have also become life-savers for me. In learning to sit with the sadness and emptiness, I’ve found peace.

After several months though, I have to conclude that Andrew Solomon is quite right when he says “the truth lies.” Depressed people can carry persistent delusions, but often the thoughts that torment them are undeniable insights. Things like: “We are all essentially alone.” “The planet is fragile and we are overwhelming it.” “I may grow old and have no money and no one to take care of me in the end.” None of these thoughts may be denied or disproven. Dwelling on them is what makes a depressed person depressed.

Why are some people more prone to depression than others? I know in my case, it runs in the family. Partly due to the grief of losing a child, my grandmother suffered from depression in the decades before adequate treatment was available. She was hospitalized herself at one point. My father, too, has been dogged by depression and anxiety. Like me, they have both found relief from modern antidepressants.

Just as depression runs in families, so does suicide. No one in my family has ever committed suicide, as far as I know. It’s a mystery why one person may come through depression stronger while others never make it back. Some people come back again and again and then finally succumb, worn out by the battle. I wonder if one day, researchers will begin to study families like ours, full of resilient depressives and look for some contrasting factor  – possibly genetic – that separates us from families where suicide touches every generation.

I have often heard people say, “well, everyone feels anxious or depressed sometimes.” That is true. I believe every human being has the capacity to feel depressed and many will experience some measure of it in their lifetime. Depression comes from loss, either experienced or feared.

Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we have, and depression is the mechanism of that despair… In depression, the meaninglessness of every enterprise and every emotion, the meaninglessness of life itself, becomes self-evident. The only feeling left in this loveless state is insignificance. – Andrew Solomon, The Noonday Demon

The more fiercely I love, the brighter and more beautiful the world can appear. However, each time I feel that pure joy and connectedness, the more I fear and mourn its loss even while I still have it.

How could someone like Robin Williams, who understood joy and laughter so well, feel such devastation? Perhaps at every moment, he experienced keenly the ephemeral nature of comedy. He knew better than anyone that the laughter always stops and is replaced by an empty pause until the next laugh comes. He lived in that silence, in the interstices, as much as in the laughter. Perhaps in the end, he made his home there.