Mark Starmach

Oct 5, 2020

6 min read

You’d Be Crazy Not To Be Depressed, Says a Psychiatrist

It seems counterintuitive, but a pessimistic outlook may help.

“Well, you have a severe anxious depression,” the psychiatrist said to me. “Severe,” he reiterated. Tension hung. “But that’s great, because we know exactly how to treat that.”

Instantly my temperament lightened. I felt assured on some primal level by the psychiatrist, Dr Ken (name changed for privacy). It was as though he knew exactly how I felt, and just what to say. He was a warm and soulful man, not the cold science-minded sort you’d instinctively associate with the head of the psychiatric unit of a major hospital, close to the end of his career.

He had a mat of grey hair, bifocal glasses, and a single wonky white hair sprouting like a sunflower in the gap between his eyebrows. His office was filled with thank-you letters and heartfelt artwork from his patients over the years — a drawing of a woman clutching a giant yellowy-orange flower like an umbrella caught my eye. Golf trophies too.

The room itself was squirrelled away in the back corner of a labyrinthine administrative building, in the back corner of the hospital grounds, a building seemingly added to haphazardly as demand for the services of the specialists inside had grown. I felt as though I were in a special, brutalist-era sanctum, coiled up in the centre of a snail’s shell — a place inhabited and visited by people who have felt intensely the colour and dark and light of life.

Dr Ken continued.

“Tell me, what percentage of people do you think develop depression at some point in their lives?” he asked.

“It must be high,” I said, “… 30%?”

“It’s actually around 80%.”

I was taken aback. The words that followed from Dr Ken helped me immensely, and I hope they may help you too.

“Think about it,” he said, “First you’re a kid and you have to worry about finding friends, and fitting in while also standing out, and all those teenage hormones and heartaches, as well as the pressure of study and exams…

Then you finish school and go to uni and you have to study even harder and sit even harder exams. Then comes the worry about what you want to do with your life and that can eat away at you, not to mention actually finding your first job which is demeaning and unsatisfying and stressful…

And then somewhere along the way you have to worry about finding your soulmate and marrying them while working your way up the ladder at work and dealing with the existential emptiness of adult life...

And then you have children and that opens up a whole other world of worry…

And then your love fizzles and you get a divorce, and you start growing hairs from your ears and gain a beer belly and lose your youthful vim. So you have a mid-life crisis and buy some sports car but that does nothing. Oh and then your parents die. And then your kids move out and you retire and you’re lonely and lose all sense of purpose in life — and then you start getting sick and developing a whole raft of health issues, then your friends start getting sick too. And then all your friends die and your life is just a series of funerals and doctor’s appointments one after the other, and then finally, finally, you die.”

I’d been laughing from about halfway through Dr Ken’s tirade.

“So, in a way,” he continued, “you’d be crazy not to be depressed at least once in your life. Life is depressing. But it is also beautiful and always changing. And so depression moves on too…”

The Ancient Greeks had a word for Dr Ken’s outlook — stoicism. It is the admission and acceptance that life is very difficult and that there’s very little you can do about it. That things will probably not go your way, and will turn out for the worst. The Stoics saw hope as a dangerous toy, something that lifts you higher only to (inevitably) drop you further when life doesn’t turn out the way you thought it would.

On the surface, this rejection of optimism may sound like a rather bleak worldview, but it comes with an important caveat — that despite all this, all the suffering, all the anxiety, all the turbulence and misfortune, that you will be okay, that you will get through it. Because, in the words of the famous Stoic, Marcus Aurelius, “We are each of us stronger than we think”.

The Stoics took this very seriously. According to a fantastic School Of Life video on the topic, once or twice a year, they would strip themselves of their fancy clothes, wear rags, and sleep on a cold hard floor, consuming only stale bread and rainwater. Why? To remind themselves that existence requires very little, and that even if the very worst happened— you lose your stature and become destitute — you could survive. The modern day equivalent might be going camping, but a simple thought amid our worries might suffice too — “I will lose my job (or have cancer, or never find love, or whatever other scenario happens to be plaguing you), but I will get through it. There will be some semblance of life I can scrounge up on the other side.”

There’s a deeply scientific reason this kind of thinking works. In 2016, researchers ran a test that quantified the effects of (un)certainty on the human mind like never before (you can read it here). They made a computer game in which snakes hid under randomised rocks. It was the participant’s job to lift up all the rocks — and whenever they found a snake, they received an electric shock. What was interesting about this, was that, when the chance of finding a snake was 0% or 100%, participants’ stress and anxiety levels were at their lowest (yes, even when they were certain they would get zapped). However, when it was 50% (ie. it could go either one way or the other), stress and anxiety levels were at their highest. Meaning we love certainty, even if it’s negative, but we’re hardwired to hate uncertainty.

The neurological mechanism behind this is the striatum, a primal part of the brain often dubbed the ‘reward centre’, but perhaps better understood as the ‘action centre’ (as this article by Marc Lewis explains):

“…The striatum is flooded with dopamine and its job description requires it to do something, do anything, to improve those odds. In trying to trigger some corrective action, it activates the sympathetic nervous system — the fight or flight system — which opens your sweat glands, dilates your pupils, and energises the action-oriented muscles throughout your body.”

Put in other words, uncertainty causes stress which, prolonged, causes anxiety and eventually depression. And life is full of uncertainty. But being certain of that, knowing that life will zap you 100% of the time, like the Stoics did, causes stress and anxiety to melt away.

Priming ourselves for tragedy not only reminds us that we will survive it. It quietly assures us when we do survive it. What’s more, it pleasantly surprises us when the gods are kind and things go our way. It tempers us with an acceptance that life will be filled with terrible, hard, difficult things, but also a deeper appreciation for the beautiful things. For our grit and good fortune and love and warm water, and sunlight through sunflowers between eyebrows, and yellowy-orange petals that shield you from the rain…

Dr Ken wrote a prescription and had some final words for me. “Depression always passes,” he said. “Always,” he reiterated. “That’s the nature of it.”

“Thank you.” I left with a new perspective than when I had entered. An understanding that depression is a natural, albeit uncomfortable, part of life’s inevitable suffering. I’d often thought of depression as the feeling as though you have felt everything you are ever going to feel. But depression is but one of the feelings, and being able to feel depressed is a sign that you are capable of feeling life deeply — its lows, but also its momentary highs.

Sooner or later, my depression did pass. Will it come back? If I’m to listen to the Stoics (and Dr Ken), definitely. It already has in smaller, less severe, waves. But knowing this gives me quiet confidence — because as sure as there will be darkness, there will be light again, waiting on the other side of it. Night leads to day leads to night leads to day.

If you are struggling through the dark right now, remember that you have already gotten this far. The fact that you are still here is testament to a strength that mightn’t announce itself to you, but is always there. You aren’t crazy — in fact, you are stronger than you think.