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Five Stages Of Depression

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On the onset of a major depressive episode, sufferers will most likely ponder a series of questions: How could this happen? Where did it come from? Why does mental illness have to be so stigmatizing? It’s a mix of denial and anger, similar to the first two stages of Elisabeth Kübler-Ross’s famous model on death and dying. Although her model outlines the coping process for the terminally ill, I believe the same logic applies equally well for sufferers of depression.

Formed after interviewing thousands of terminally ill patients in the late 1960s, Kübler-Ross’s hypothesis became a breakthrough in the field of near-death studies. Over the years, people have found solace knowing that acceptance, the fifth and final stage, is possible. Although depression is not a fatal diagnosis, for those suffering, thoughts of death will loom heavy. Some may feel death has already arrived, floating through a worldly existence they no longer recognize. Less fortunate victims will see death as a way out, cutting their life short as a means to an end. During my own experience, I faced death everyday, secretly wishing it would come and take me away from such paralyzing sadness. Very few days go by that I don’t appreciate how lucky I was to have pushed through such dark impulses.

The start of November means it has been approximately three years since I experienced the first stages of depression. The questions mentioned above — the initial how, where, and why — developed during this time, and would become the first of many questions in the months that followed. Looking back, each line of questioning was part of something larger, a property of five stages parallel to Kübler-Ross’s seminal theory from nearly half a century ago.

Sometimes I am not sure whether — if given the chance — I would take back what happened to me three years ago this month, as I am now stronger and more empathetic for having gone through it. My only regret is that I was not more prepared. Perhaps, by adapting Kübler-Ross’s five stages through the lens of depression, sufferers could benefit in ways I couldn’t, understanding the process as they fight through each stage.

Below is an outline of the five stages as seen through the eyes of my own depression. I have not sugarcoated or overstated the truth in any way. What you are about to read is an honest portrayal and timeline of actual events. I hope it can serve as a source of interpretation — to sufferers as well as the friends and family who care for them — in the way Kübler-Ross’s model did for those affected by terminal illness. Fortunately for depression sufferers, the outcome is not fatal; in fact, it is the opposite: a second chance at life.

Denial and Anger

The first stage, denial, will most likely be a brief and sporadic affair, as depression leaves sufferers little doubt of its existence. Anger will ultimately prevail, but like most of life’s injustices, staying mad becomes counterproductive. You soon realize fisticuffs will not work on such a complicated foe: a twisted version of your mental self — for lack of a better phrase, an inner demon.

As the illness worsens, more rhetorical questions will enter the fray. These are generally why questions, mostly in the form of “Why me?” Of course, there is no answer to this. Biology and external stresses will serve as causes, but you will never find the reason why you, of all people, were chosen for such a maddening affliction.
Sometimes I would flip this “why me” conundrum, asking why it couldn’t have been Denise, my verbally-abusive supervisor — one of the many external stresses prior to my depression. At this point, however, people like Denise are no longer a part of your life, as you will find yourself too mentally paralyzed to function in a job or school setting. You will most likely find yourself confined to a couch in your parents basement, listening to Elliot Smith and chain smoking cigarettes — a new habit you will have picked up once you reach the what’s-it-matter, who-gives-a-shit point of your depression.

Bargaining

Once the denial and anger subside, a new line of questioning will form: a series of ifs that serve as internal bargaining chips between you and your depressive episode, which has now personified itself into human form. My incarnation wore a thin, nefarious-looking mustache and sat in a lawn chair, roasting marshmallows and reminding me of past regrets.

During stage three, this unwelcome visitor badgered me constantly, devaluing my worth with snarky barbs and autobiographical ghost stories filled with tales of failed relationships and bad decisions. Tired of being angry, I tried confronting him diplomatically, with small bets and bargains in exchange for his departure. Weeks of negotiation would follow, pleas of irrational ultimatums and lofty promises. Eventually I gave up trying to reason with him and entered the next stage of the depression, a lost-in-the-wilderness phase: a cruel world of suicidal thoughts egged on by the man who’d set up camp inside my head.

Depression

The next stage of the Kübler-Ross model is depression. Seeing as this entire model is for depression, this may seem like a hole in my theory; however, because the sadness will worsen after the bargaining process, I believe it is actually an apt title for stage four.

This desperate stage will be your longest and most brutal; it will test the patience of your friends and family and most likely result in weeks of not showering. You will wander around the house in the same food-stained t-shirt and pungent-smelling pajama bottoms for days on end; a pitiful state where just putting on pants may be the most challenging part of your day. My memory of this time is splotchy, a hazy blur of fluorescent-lit waiting rooms and drab psychiatrist furniture. I remember the monologue I would give to each new doctor, detailing the sadness, explaining it wouldn’t be so bad if it weren’t for the racing thoughts.

These racing thoughts — constant, obsessive, and debilitating — will be your undoing. They will cycle through your brain in rapid circles until your head begins to pound. At this point, the depression has manifested itself physically, leaving you achey, tired and weak. You will grow even more frail once you lose your appetite, as food now tastes bland and the urge to eat diminishes. Your tastebuds, like the rest of your body, have fallen victim to depression’s trap, and not even your favorite foods can convince the tongue otherwise.

Doctors will prescribe you cocktails of high dosage medications with hard to pronounce names like buprenophine and tryptophan and monoamine oxidase inhibitor. They will numb and nauseate; make you dizzy and tired, dazed and confused; dry your mouth and turn your face puffy. Worst of all, few of these drugs are fast acting (nearly all anti-depressants take at least four to six weeks to kick in), making the search for the right treatment a slow, trial-by-error process. However, you must stay patient, as one of these combinations will eventually bring you back to life.
On a positive note, your chemistry skills will greatly improve during this time. Terms I had not heard since high school science were thrown out regularly — various chemical combinations with suffixes ending in -ides and -odes and -ines. Additionally, you will never be in short supply of cigarettes (your new, awesome habit) now that you are at CVS every week with a new prescription of pills to test out. It will be important to find a friendly pharmacist at this time, for they will be substituting as your barista these next few months.

A small percentage of you will not take to medication. If you find yourself in this boat, drastic measures may be suggested. What you decide to do is your decision, but it is imperative that you listen to professionals and learn the reality of these recommendations. Whether it is a powerful mood-stabilizing drug like lithium or something as extreme as electro-convulsive therapy (ECT), I implore you to listen to the doctor when weighing your options — you’re paying two hundred dollars an hour for their opinion, so you might as well heed their advice. Most importantly, do not buy into what you read about these treatments on the internet, as most of these posts have been written by bloggers with no degree, people who have nothing better to do than play doctor on mental health blogs.

I was part of the small percentage who did not take to medication, so my psychiatrist recommended I undergo ECT. After weeks of deliberation, I nervously agreed. I won’t expand too much on ECT, but I will say this: Homeland has not given it an accurate portrayal. ECT is generally outpatient, and while there will certainly be some memory loss, there’s no way you would forget something as significant as linking Congressman Brody to Abu Nasir. The memory loss is tolerable; it improves over time. Personally, I find not remembering this time in my life to be a gift — it’s not exactly a fond memory you want saved. Not to mention, I found all side effects to be worth the result. After my thirteenth ECT treatment, the depression began to recede, and a return to life finally seemed possible.

Acceptance

Embracing acceptance was difficult. In the weeks following ECT, I found myself in a limbo between stages. I was apprehensive to enter the coveted stage five acceptance phase, unsure if I was resting on a recovery table or the upswing of an emotional seesaw. A relapse seemed all too possible.

In the months that followed, I worked through these fears — the potential of another depression, a life of medications and above-average visits to doctor’s offices — and came to terms with my depression, admitting to myself that I was a victim of that horrendous-sounding term mental illness. Embracing this term would be one of the hardest steps of acceptance, as it is a term I wish society would deem unPC, like midget or hunchback. I say this because, to me, the connotation associated with “mental illness” is troublesome, whose origins date back to a time when they called it mental illness and treated it like animal science. For the sake of acceptance, however, you quickly realize the name of your illness is inconsequential, that chemical imbalances are prevalent throughout the world, evident in many of the world’s greatest leaders and creative geniuses.

Acceptance, too, will come with query: a two-part question that seeks to sum up the entire episode. There are no more hows or whys or maybe ifs, only what — the first being What the fuck… as in “What the fuck just happened to me?” Which is soon followed by a very important What now? as in, “What now can I do to learn and grow and find value from this bullshit experience?” And just like that you finally have an answer, a set of tenants to live by: to learn to cope and cherish joy, to accept the fragility of life and find pleasure in the world around you. Or, in the words of the great Warren Zevon, as told to David Letterman just weeks before succumbing to a fatal cancer diagnosis: make every sandwich count. Because when it comes down to it, life is about appreciating the mundane of the day-to-day; finding a way to savor each bite of your lunch break — even if all you’ve packed is a boring old peanut butter and jelly on wheat. Because I can assure you, once you your appetite is back, you will find it tastes more delicious than ever before.

To all those currently suffering, I wish you more than luck. TC Mark

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