Ep. 352/ Andrew Soloman on depression.

Welcome back to Beyond Well. I'm Sheila Hamilton and this is a program for people who want to learn more about our interior lives. This show was originally released in 2020 and we hope you enjoy this show again. I'm Sheila Hamilton and I am completely delighted today to have as our guest Andrew Solomon. Andrew is a writer and lecturer on psychology, politics and the arts. He's the professor of clinical psychology at Columbia University and a frequent contributor to the New Yorker NPR and the New York Times. His books have won over 50 awards including the National Book Award, but the book that drew me to Solomon's work was his memoir, The Noon Day Demon, an elegantly written and meticulously researched memoir of depression. I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity and then the anxiety set in. It's a sensation of being afraid all the time but not even knowing what it is that you're afraid of. And it was at that point that I began to think that it was just too painful to be alive and that the only reason not to kill oneself was so as not to hurt other people. Andrew's TED Talk has been viewed nearly 10.5 million times translated in 33 languages to say the work that you've done, Andrew, in terms of allowing people to understand the language of depression, the reality of how serious it is as a potentially fatal illness. I can't even speak to the number of friends that I have given that talk to in your book to who said thank you I now understand my loved ones illness. So I appreciate you being with us. Thank you very much. It's an honor and a pleasure to be here. I have been wanting to ask you this question because as I was trying to pin you down for this interview, you were talking about the realities of COVID and quarantine, how it is completely difficult to get any sense of structure or rhyme or reason. Why do you think that is? What is happening with our psychology that is making quarantine so difficult? I think human beings are essentially social animals and that we all drive on our interactions with others and that to some extent we understand ourselves through the way that we're seeing in the eyes of other people. So we need not only the actual mirror in which we may come our hair in the morning, but also the kind of larger mirror that's provided by the gains of other people. And most of us have a number of people we love and care about and the quarantine has brought about two kind of complicated problems, one of which is that isolation and the sense of being cut off from the people in whose eyes make sense. And the other which is almost equally difficult is that many people are in quarantine with members of their family or with a very small group of people. There is a sense that that small group of people, you know, becomes over time stressful to interact with when there's no respite and there's no getting away. So Sarcra famously said that hell is other people and I think hell is also the absence of other people and I think we're dealing with both of those problems at once right now. That is not the small group and a way from everyone else. But it's one of the most brilliant descriptions I have ever heard. I've never heard it summed up more aptly. Where are you quarantining? We're quarantining in Rhineback, New York about two hours north of the city where we have what was previously weekend place, but where we've been in residence since March. And so you're with your husband and your son, I imagine, right? And with my husband, my son and my husband's best friend who lives with us who started my son, Sarcra brand father, he's older than my husband and is filled in that role. So Andrew, I'm very curious about the next steps of this quarantine, whether or not you believe that in order for us to maintain some semblance of our mental health, we're going to have to start gradually expanding our quarantine bubbles to include other trusted members of ours. And so we're going to have a lot of our community groups, our friends relatives. The concern is that we've placed a great deal of emphasis on our physical health, which is without doubt that if we remain remote from other people and stay in strict isolation. And so we're going to have a lot of mental health, which I think requires a certain amount of interaction with other people. And while I would never want to compromise any of the recommendations that exist in terms of our physical health, because they're obviously absolutely essential. And also requires a certain amount of care and sustenance. And there are people who feel adequately connected by the process of having zoom conversations like the one we're having right now. And there are people for whom that's insufficient. I had a letter a couple of weeks ago now from someone who wrote to me with the story of her best friend who would kept saying, I'm old by myself and I'm funny. If it built nine struggling and I'm feeling depressed and so on and who finally killed herself. And so I think there are people for whom the isolation can be very toxic. There are people who will die of COVID without even having it because they're dealing with so much isolation. And I think it has to be taken on a case by case basis. And so we'll need a small expansion. Some people need a larger expansion. I think some of the passion and fury that we've seen just lately in the protest that have taken place since the brutal murder of George Floyd. I've had to do not only with people's deep feelings about racism in prejudice in this country, but also with a feeling of being praised by isolation and having a cause that is involved gathering in large groups of people as a mental crucial and essential in a way that might not have been more working. Yeah, I was going to ask you about that because you know, your city in New York is like ours Portland, Oregon. Just with so much tension, so much rage, so much bubbling underneath the surface. And I wondered how much of that was the impact on people's mental health during quarantine. Have you actually seen any kind of really good research that's been done in terms of the number of people who are out there protesting like what their true causes were. So many of them have already lost their jobs. So many of the people in Portland were already living in poverty. So many were already dealing with anxiety and depression. And it was almost like this was the perfect catalyst for them to also talk about the inequities in their lives. I think that's absolutely right. And no, I haven't seen anything reliable, but the protests have been going on for at this point when it really is a week or 10 days. And it's difficult to do research. Also, I think it will be difficult to do research. Because I don't think people always know exactly where all of their passion and feeling are coming from. They certainly don't know in the immediate moment when they're feeling it so they may know in retrospect. I think that the issue of police violence and racism has been an important and urgent issue in the United States for a long time. And I don't want to trivialize the authenticity of people's fighting against it or even the ability of people's fighting against it on the basis that it's all really just a manifestation of how about a hard time they have to kill them. But I think that the film that has been part of the fuel that has driven people out into the streets. And I think that process of being in a large group of people with the United good purpose and working together has taken on an aura of fervor, which has been at the very least informed by the isolation that we see. Yeah, I've been worried about my friends who had underlying conditions, including diabetes, including, you know, heart disease, including depression, including anxiety. So the messages that we're getting from the government never really attend to people's mental health. They don't talk about the potential worsening of people's depression or anxiety as if it's an illness they need to be concerned about. And yet others are saying this will be the long tail of the pandemic. The mental health crisis will be the long tail. How do we begin to get people to understand that mental health implications will be just as costly if not more in the long run. Well, in the first place, that's been very specific to our government and to, I think, the generally incompetence with which it's approached this crisis. And there's a perception that somehow the mental health problems affect those who are weak and in some sense, worthless and that the physical health problems may be affecting people who are strong and vital. There's a lot of prejudice built into it. When the COVID crisis began in Wuhan, the Chinese government moved thousands and thousands of the mental health workers came to Wuhan to help people deal with what they knew would be the mental health piece of the problem. Nothing like that has been underdekened by our federal government, though some state governors have made gestures in that direction. Presumably, and I don't have a crystal ball, but presumably at some point this virus we brought under control at some point we're going to be able to treat it or we're going to be able to vaccinate against it. But I think it's going to take a much longer time to deal with the residual mental health complications. And I see them everywhere. I mean, I see from my father who is nearly 93, the presumption that the lights that he knew in New York, he'll probably never get back to in the way that he knew it. And he's sad about that they're not depressed. I see in my son who's 11 years old, the stress and the difficulty. of not having direct interaction with his friends when his friends have been so defining, so brutal he hasn't, and they've really seen another child in two and a half months. And I see it in myself and in my contemporaries. I think there is altogether a sense that people are freeing around the edges. That when I talk to people, there's a lot of talk about how difficult things are. The mother of one of my son's friends wrote to the other day and said, "I can't get my son to get dressed," he responds to where his pajamas all day. I don't know what I should do. I think these children are going to grow up with a sort of strong influence from the crisis as for people who are escalating into really serious illness. I mean, those are all examples of people who are in what I recall the worry well. But as for people who are escalating into serious mental illness, serious mental illness tends to be cyclical. And once you have broken into it, once you have had whatever your genetic vulnerability is, figured by external circumstances that are so difficult and traumatic, it can take a lifetime of management. It can be a recurring problem at the very least it undermines our sense of your own resilience. And that will have an effect for the rest of your life. And so I think even when we get COVID under control that the sense of acromatized population, traumatized by the loss of income, traumatized by the last company, traumatized by the loss of the secure sense that our basic way of life is invulnerable, I think that traumatized population is going to be dealing with a sense of fragility for a terribly long time. You have been so open about your own decision to go ahead and use medication. And one of the things that you said that I thought was just brilliant is that there's this false moral imperative, the treatment of medication is not natural. It's so misguided, it'd be natural for people's teeth to fall out, but nobody is meditating against toothpaste. I really want that as a bumper sticker on my car. But I'm wondering because I have noticed that many of my friends who take medication regularly and do very well on it are not doing well under COVID circumstances. And so what's your advice for people in terms of how to maintain a semblance of your wellness during this time if the medications are not doing what they should have done before? Would you say that this is a time to be talking to your doctor about increasing, adding on, how are you managing it? Well, I would say, first of all, that people have the idea that taking medication is an out of sign of weakness. And as I said a moment ago, that's been the position, I think, of our government. Actually, it takes a lot of courage and a lot of determination to figure out what your vulnerabilities are and to figure out the best way to address them. So people who are taking medication should not feel bad about taking medication. They should not feel bad about increasing or supplementing the medications that they're on. And people who don't take medication should bear in mind that getting through this crisis in a state of adequate mental health will leave them better prepared for life on the other side. And that this supposedly courageous thing of not taking medication may leave them very vulnerable on the other side. I don't think medication is right for everyone. Some people have terrible side effects, some people don't get good effects, some people have other ways, they think when to address the problem, but I don't think anyone should feel afraid of medication. For people who are on medication and not doing well, those are people who are vulnerable to depression. That's why they're on medication in the first place. And depression always represents the the meeting of your vulnerability, genetic or otherwise, and figuring external circumstances. And the figuring external circumstances are pretty enormous right now in a whole variety of ways. And people should be in touch with their therapist. They should do telemedicine if they can for talk therapy. And they should be talking to who has prescribed their medication and saying, "Well, I developed these symptoms I had before. I started medication should we go up. I've developed these symptoms which seem to me to be very bizarre and which I've never had before. Is there a medication that will help me address them? And just do whatever you need to do to get through this crisis. If you want to undo it when the crisis is over, you can undo it when the crisis is over. But in the meanwhile, don't let yourself go to pieces. It doesn't help you. It doesn't help anyone else." You also gave some really beautiful advice about people who say they just want to muscle through these crisis for a person who said, "Look, I'm just going to try and see if I can get through the year." And you talked about, you'll never get 37 back. I want you to talk about why this pretty much American belief that we should muscle through these illnesses exist and what we can do to counter that belief. Well, we still live in a society with mental health and physical health are treated very differently. They're treated very differently in ordinary conversation. They're treated very differently by the insurance industry, despite laws that were supposed to change that. They've been passed some time ago and it proved largely ineffective for at least somebody ineffective. But there are all types of situations in which the stigma and attachment to mental health remains there. And there is a sense that the great American is kind of Daniel Boone and is out exploring and is facing every danger and is coming through everything and smelling like a rose. I didn't know if Daniel Boone smelled like a rose. But in any event, you wrote the difference. And I think we want people to be strong. And I think that people who are having a difficult time are threatened by the evidence of other people's weakness that it often attaches to weakness within those people. But I also think that there is a kind of misapprehension that getting treatment for depression or anxiety or any of these other problems is somehow a bridge that you cross and then you can never come back that you've gone over the Rubicon and there will be no return. And people think that you become this different kind of person. You become a person who is reliant on therapy. You become a person who is reliant on medication and you'll never get your integrity back. And I always say to people when they're in that mode of saying I'm going to tough it out. Try taking medication or try doing therapy or try whatever it is that you might want to try. And if it helps, great. And if it doesn't help, you can always go back. And if it helps, but you somehow decide you don't like the way it makes you feel, you know, give it a few months and see what your overall sense of yourself is like. And then you can change your mind. It's not this permanent, unsolvable, never again, will you be your true self? People somehow think that medication actually changes your personality. And there's a wonderful question. Some years ago in the New York court in which there's a woman in a psychiatrist double saying, "Doc, but the medication isn't working. I still have feelings." And you would have feelings. And we do have feelings and we have a lot of feelings when we're on medication. And if not like the medication makes you lose all of the feeling you have. But I sometimes said to people, you know, when I was really depressed, I felt incredibly sad about having to take a shower. And I felt incredibly overwhelmed by using the telephone. And I felt incredibly stressed by having to deal with a friend who stopped by. And now I feel incredibly sad about environmental catastrophe. And I feel incredibly frustrated by the persistence of racism in the United States of America. And I feel traumatized by climate change. And I feel like those are things that are, it's a better locust for ones anxiety and despair and hard feelings and grief. And having your grief available to address the problems of the world or to address, you know, the loss of somebody you love or the people who die or even the loss of your job being available to deal with those things. Instead of being utterly overwhelmed by pulling yourself out of bed and changing out of your performance, that's actually the nature of vitality and vitality is what we're at. Oh my god. Just wanted that to sit there and let people like be able to process that because he said so much that's so important. I have wondered if the recent polls by the Kaiser Family Foundation that show 50% of Americans now saying they're suffering from some mental health disorder to be a positive thing in some way that perhaps people are waking up to the essential nature of our interior and how we should be minding it. Do you think there's anything positive about this, Andrea? Well, I mean, it's obviously not positive that so many people are having such a hard time. Yeah. My heart goes out to the people who are struggling and suffering. And if we could make their depression remit, it would be fantastic. Yeah. But if people are willing to acknowledge their depression or their anxiety or any other form of mental illness or distress that they're experiencing, that really represents significant progress. And I think that it's difficult for the stigma to remain so acute about a condition that's affecting half the people in the country. It's a point that, which if you're looking for TV, if you're watching online, if you're paying attention, you know that this is happening to almost everyone. And there's a point to what you have to say, okay, so what is everyone doing about it? And it makes it easier to address, to get in some form of treatment or some form of attention. That's the upside, but I hope that the mental illness won't persist indefinitely. I hope people will begin to feel better as they return to normal life. Some people will. And for some people, the city of instability that this is introduced into their understanding of the world. is going to be there for a long time. I've often wondered because you've been so brilliant on the topic of resilience, developing resilience, how you did it in your own, pulling yourself out of your deep, deep depression. Whether there were some things that you learned during that that you haven't already spoken about, that you haven't really shared, is there something that would be applicable to people's lives today that might help them? Well, I would say that the first thing is to understand that depression does exist very widely. I think it's important to understand that it exists on a spectrum. I think it's important to understand that the opposite of depression is not happiness but by charity, and that a lot of what you experience in depression is not feeling sad, though you may feel sad as well, but feeling overwhelmed and unable to deal with the basic business of your ordinary life. And so if people can be awake to that, then they can say, oh, the fact that I have all this time, but I can't manage to get my kid a bath, that's actually a loss of vitality. And even if I'm not sitting in my room crying, it's a sign of depression that I should address. If people are able to say, oh, the fact that I feel this level of concern about what's going to happen to my job on the far side of what happened has now escalated beyond reasonable concern. I guess which people could be awake to those transitions and understand that most of us are experiencing more sadness and more sense of being uncertain about the future. Because we're in a sad situation, and our future is in fact very uncertain. So there is a kind of rational response. But when that rational response affects your ability to do what you need to do to address the concerns that that response pertains to, then you've developed an illness or a situation that requires some address. But if you just feel generally sad about the state of the world, that's fine. If you feel like you're so sad about the state of the world, that it's impeding your ability to include the state of the world into far as you can in your own particular and perhaps miniature way, then that's the point at which you really have to question. I want to talk about-- because it's a gay pride month, and this is a wonderful generally time for celebration and parties and parades. And obviously that's not going to happen. So how can people still be supportive of one another, still celebrate the gains that have been made, and also to provide some hope for activists that are out there still working? Well, it is gay pride. And it's been kind of heartbreaking getting all of the messages that I get from all the gay organizations that I'm involved with saying, instead of having a parade, we're going to have a Zoom call on Wednesday for 20 minutes. And it just feels to me like that's not much of a fiesta. I think that it's a difficult time for gay people. More gay people are single. People who are in the LGBTQ community are more likely to be impoverished. There's a lot in the media about middle class white men like me, who manage to get married and live pleasantly and comfortably. But and also a lot of the community, particularly are LGBTQ people of color who are living in situations in which there's very little tolerance for them. I think a lot of people are turning in this moment for comfort to religious institutions and a prejudice against gay people in religious institutions remains very ingrained. And that gay people who are experiencing that kind of prejudice may feel cut off from the reassurances that might come in the belief that there is a God who has a purpose in all of what's going on. There are many ways, and we think it's difficult for gay people. But I have been impressed in this month also at how much evidence I've seen of gay people reaching out to one another, of people who are LGBTQ, who are in one way or another trying to come together in groups and to bring about support. And while it is depressing to have pride months during the quarantine, it is on the other hand, encouraging that during this quarantine, at least we have pride month. And it gives us a patient to be judged one another and to celebrate our ways of life and not to feel as lonely and cut off as many people, especially outside of major urban centers, often do. Andrew, I could talk to you forever, but I promised to keep this at half an hour. And I promise I will circle back with you from time to time, because honestly, I think in terms of a voice that really, really speaks to people from deep, deep lived experience, but also just your exhausting research that you do on these topics, it makes you almost the perfect person as a spokesperson for those of us who would like to see more attention paid to mental health. Thank you again so much for being with us and continued safe quarantine for you and your family. Thank you, Sheila. This has been a lovely conversation. [MUSIC PLAYING]