July 12, 2011

I once had a patient who said, "When I'm depressed, I feel like I'm in a glass box. I can see the world, and they can see me, but neither of us can reach the other. I feel so alone. I feel so empty. Lately it's just getting worse. Everything keeps happening to make it worse. It used to feel like I could at least breathe in the box. Now it feels like the windows and all the holes are closed. And it's beginning to fill up with water."

I'll never forget this patient. He described his emotions so eloquently. And his pain was so palpable in the room. He had struggled with depression for many years, off and on. He had been in and out of therapy, and he had had several different antidepressant trials. His slides back into despair and darkness were sometimes precipitated by the struggles of his life, such as relationship, work, and financial problems. Other times, they just seemed to come for no reason — "I have no reason to be depressed," he would say. "I just can't stop crying. I want this to end."

When someone is depressed, they may feel very isolated. It is also possible for that isolation to be created through social withdrawal. One of the symptoms of depression is the feeling of hopelessness, seeing no way out — that the box is filling with water.

Depression remains poorly understood in our society. For one, the English language uses the same word to describe being bummed about the outcome of a basketball game as it does for being debilitated, unable to function, and profoundly hopeless for weeks at a time.

While all of us have times of sadness in our lives, clinical depression should never be considered "normal." And it is treatable. Up to 10 percent of people with untreated depression will commit suicide. It is, therefore, a life-threatening illness. Consider someone with an infected wound on their leg; it would be extraordinarily rare not see a doctor for it. If they knew (or were told) that the infection had a 10 percent mortality without treatment and that taking an antibiotic tablet each day could resolve the infection, we would question the wisdom of the person who didn't take the antibiotic.

With psychotherapy and a medication adjustment, my patient recovered. The water rescinded from the box. Not only did the holes and windows reopen, but a door was found and he was able to escape his "glass box." He returned to work and has become very successfull and well respected in his profession. He has established and maintained a long-term loving relationship and has a closeness with his family now that he never previously knew. And he feels joy again. And hope.

If you are struggling with depression, don't stay stuck in your own glass box. Pound on the walls until you are seen and heard. If the water begins to enter your box, seek help urgently. Tell your partner, your friend, your family, your doctor — let someone know you are struggling, so you can seek treatment and find hope too.
