But Doctor, I am Pagliacci

Following Robin Williams’ death and my brief comments about depression in my entry about it, I’ve had some people ask me for some more detailed thoughts on the subject, and whether I myself have ever experienced depression. I wrote about the subject in 2010, as part of a Reader Request Week, so if you’re interested, here’s the link to that. The short version is that while I have had events in my life where I was almost certainly depressed (as most of us have, I suspect), I’m not someone who suffers from depression as a disease.

But again, I know a lot of people who do. I suspect that some of this is because I know a lot of creative people and the correlation between depression and creativity is well known and well documented. But I also suspect this is also because I know people, and I suspect that depression, as a chronic and persistent ailment, happens to a lot of people regardless of their creativity. One of the silver lining positive things about knowing many people with depression is that it’s gone a very long way to hammer against that bias against mental illnesses that I have as part of the background radiation of life — the bias that tells you that someone with a mental illness isn’t merely sick but is wrong in some ineffable way. I know that’s incorrect and actively unhelpful now; I hope it makes me a better human and a better friend for my friends who have depression.

On the tangentially-related topic of humor and depression, the world seems to be largely divided into two camps — the camp who is apparently oblivious to the idea that funny people, especially professionally funny people, might have a darker side to their life (“He was funny and seemed so happy! Who knew that other side was there?”) and the ones who are all too familiar with that aspect of the life of a “funny” person — they’re the ones who, after hearing of Williams’ passing, tweeted something along the lines of the quote I’m using as the headline (context, for those of you who don’t know).

With the former camp, it’s easy to be exasperated, especially if you write humor yourself. Where do these folks think the capacity for humor comes out of? If you don’t have an understanding of the whole wide range of the human condition, your attempts at humor are going to come across as insipid at best and cruel at worst; there’s a reason I note that the failure state of “clever” is “asshole.” People who are really funny — the sort of funny more complex than a banana peel on a slippery floor — are funny because they know people. They’re smart. They’re observant. And, very often, their own life experience, with all its ups and downs, is the reason why know which keys turn the lock on the funny.

It’s easy to become exasperated with people who don’t seem to know this, but it’s also at least slightly unfair, because it’s process — it’s backstage matter. Most people don’t live with a professional comedian or humorist, they’re merely entertained by them, and they’re entertained by the output, not by the process. We laugh at the joke, not that the work that goes into it. Likewise, humor feels easy and light; we laugh at it, and laughing seems like the simplest thing in the world to do. If people don’t know about the darker parts of the minds that create humor, it’s at least in part because it often ruins the humor to dwell on it.

On the flip side of this I personally get exasperated by the “but doctor, I am Pagliacci” response as well, because I think in many ways it trivializes depression. Humor needs knowledge of humans and empathy; it doesn’t need depression. From everything that I know about it from friends who have it, depression doesn’t heighten your access to the human condition, it deadens it — takes you out of the place where you can create and where you can say anything about life, funny or otherwise.

I get that tossing about the Pagliacci quote can be an attempt to be understanding — or at least be an attempt to explain — but I think it just ends up being the equivalent of a mental shrug. Of course that funny person was doomed. That’s just what happens to funny people. That’s no more correct or helpful than being surprised a funny person wasn’t happy all the time.

I’m not saying a comedian or humorist can’t take their depression and make it funny. Of course they can — it’s in the heart of humor to make you understand something by making you laugh about it. But the depression isn’t why they’re funny. Depression isn’t helping them be funny. Depression is a thing they have to route around. Sometimes they can’t. That fact deserves an acknowledgment more than a shrug and a quote about a sad clown.

I don’t have any answers about depression, in no small part because my own direct experience of it in my own head is (thankfully) limited. What I do know is that for my own part I want to be done with people being hesitant or ashamed about a disease that happens to them, despite the fact it takes place in the part of the body where who they are lives. Treating it differently than other ailments of the body doesn’t do anyone any good and does active harm if it keeps people from getting help.

I also want to be done with thinking that depression is anyone’s fault. This piece in Slate, addressing the people who wondered why Robin Williams didn’t know that people loved him, speaks to that. This piece, by Erica Moen, speaks to that. Countless pieces out there by people who deal with depression speak to it. They know what they’re talking about, because they live it.

For my part, I’m listening. I think we should all be doing that.

64 thoughts on “But Doctor, I am Pagliacci

  1. I’ve fought major depression and anxiety disorders for 15 years. This year was particularly, dangerously bad. I went immediately to the Pagliacci quote when I heard about Williams, because it spoke to me. I can see how it might come off as too glib. But to me it has always conveyed the feelings of alienation and loneliness and hopelessness that come with depression.

    Tastes differ, and different people deal with the disease in different ways. I’ve always gone for black humor about it. That makes some people who love me uncomfortable, and some people with depression don’t like that. I get it.

    Thanks for writing thoughtfully about the subject.

  2. Like you, I have been depressed at times but don’t suffer from depression but I have some really gifted friends that do. Thank you for the insight.

  3. I have also found, that having BEEN THERE has made it so much easier to understand and empathize with this problem. Having dealt with it at some point in our past has made it so much easier to understand people who are there now or not dealing or commit suicide. We know how hard it was or is.

    But to me it has always conveyed the feelings of alienation and loneliness and hopelessness that come with depression.
    Exactly this. I always hear the Pagliacci joke as someone who really gets it, from having been there. Not as a shrug.

  4. I suspect a lot of people tweeting the Pagliacci quote are referencing his rendition of it, as well as his acknowledgement of his struggles (for example, excerpts from interviews that were played during yesterday’s All Things Considered).

  5. The Pagliacci joke makes me think of all the bios of cleaned up rock stars I’ve read. Invariably, once they clean up, there’s the moment where they have to make music sober for the first time in years, and it’s only then they realize that the substances didn’t enable access to their genius, but blocked it.

    I wonder if the idea doesn’t become a self-fulfilling prophecy for comedians, too–if you’re funny, you have a dark side, and that’s what enables you to be funny, so you have to indulge your depression rather than try to cure it.

  6. So, at what point, if ever, do we bear the responsibility that the things/opinions we have or do negatively impact someone who is depressed?
    If we mock a lgbt or a religious person who is depressed are we in some way responsible if they commit suicide?

  7. I never would have thought of it as a shrug or a dismissal; rather, as a statement of how fundamental the problem is. The people I know who’ve been posting it, or reposting it, are pretty much all people with significant experience of severe depression; either personally hospitalized for it or have friends who have been. It doesn’t sound at all dismissive to me.

    It’s a problem statement, not a dismissal.

  8. John writes:

    I suspect that some of this is because I know a lot of creative people and the correlation between depression and creativity is well known and well documented.

    Doesn’t this statement suggest that to some degree depression is why they are funny?

    This correlation is well known, but is it real?

    I can’t help but think that we are so accustomed to stories where it turns out that creative people suffer from depression, or addiction, that we come to expect it. After all, there are no news stories documenting the absence of depression in creative people.

  9. I think the quote about Pagliacci can be useful as a response to the “But they seemed so happy and funny!” line because it does illustrate that “seeming happy and making people laugh” != “can’t possibly suffer from depression.”

    The problem is when it starts being used as short-hand and instead of understanding how “seeming happy and funny” is one way some people learn to navigate through having depression (and not always with success), so you can’t automatically assume funny people don’t suffer from depression, it becomes a pat and over-simplified explanation for depression and who deals with it.

    Instead of “Yes, this person seemed happy and was funny, but they were also depressed – depression can affect anyone,” it becomes “Of course that funny person was depressed,” which ends up harmfully equating “is funny” with “must be depressed.”

    Depression is complex and people who deal with it do so in different ways – generalizing about it, even in an attempt to understand it better, helps no one.

  10. I wonder if those with a talent for humour and depression use their talent to hide from the depression. I think if you hide from depression rather than facing it and getting treatment early (for those who can) it becomes harder later on. Add in the stigma that mental health problems have attached to them and the idea that if you have what other people envy you have no reason to be depressed and it would be even harder to get the help needed.

    That Robin Williams was more open and able to talk about his addiction problems than his mental health issues tells us a lot about how society treats metal health issues (nobody should feel obligated to share any personal information with the wider public).

    Treatment needs to be easier to access, affordable at all levels and tailored to the individual rather than attempting a one size fits all approach. It also needs to be stigma free so people not only have access to the help they need but wont face consequences for seeking help.

    I also wonder if all the people asking what he had to feel depressed about realise that it is comments like that which stop people seeking help by invalidating what they are going through.

  11. I was going to link to the Cracked article before DC Spartan beat me to it. It hits pretty hard on why people who are funny usually are depressed as well.

  12. Both those pieces were good. Pohlig’s reminded me of how much I see life from the wrong end of the telescope when I am in depression, so the love others have for me seems incredibly remote and far away. And the image at the end of Moen’s piece -the glass wall – was spot on. Thanks for this sympathetic and intelligent post.

  13. @Mike my understanding of it is that laughing at the stuff you go through is one of the healthier ways of coping with it. See Chris Titus’s work, for example. A lot of people who have had really shitty lives resort to comedy as a coping mechanism, even if they never take to the stage (I’d love to, but then my mom would eventually find out, and then the news reports would read “Researcher {name} was found in several pieces scattered across the state of {home state}…..”). We laugh because it channels the self-destructive impulses outwards instead of inwards. Chris Titus has a lot of really interesting things to say about it, and paradoxically, making jokes about the abuse I’ve suffered has actually made it easier to handle. It’s reducing its power over you because you’re laughing in its face. It’s certainly a healthier coping mechanism than alcohol or drugs or denial or Jesus (the effects of all of which I’ve seen in my family and want no part of). Antidepressant medications don’t work well enough on me to justify the side effects, but comedy and a good therapist have really helped me with my depression. I’m still going to have days where I want to “press the button”, to paraphrase Erika Moen’s piece, but they’re not as often as they used to be, and I’m getting better at dealing with them.

  14. I also was going to link to the article that DC Spartan posted above.

    I am (among other things) a comedic performer and I also was diagnosed with depression in 1994. Many people use comedy as a coping strategy when they are sad, and that can be just as true of people with depression. Sometimes, we find we are good at it. We chase that spotlight because it’s better than standing in the darkness.

    I shared the Pagliacci quote because it hit home. Sometimes I am Pagliacci too. It’s horrible that someone who inspired so many people to laugh, to weep, to think, and to understand died feeling so worthless and in such pain that death seemed like the only escape. But that is what depression does to you. I have stood on a stage at a renfaire to laughter and applause and then gone back to my motel room to pace half the night because I cannot sleep for fear I will start crying and never ever stop. With the help of cognitive behavioral therapy and medication, I have been mostly stable, but I know that black hole is always there. All the therapy and meds can do is remind you that things will get better, that this will end, and all you need to do is to use your tools and your support system and hang on as best you can.

    I also chose to tweet a photo of myself standing on my desk, a la Dead Poets Society, because doing something so seemingly silly on the surface that is in reality expresses a deep and profound truth – that to me embodies the spirit of Robin Williams, and that is how I chose to honor him.

    But I too am Pagliacci.

  15. “I’m not someone who suffers from depression as a disease.”

    is it possible that the level of depression one experiences is so mild that it doesn’t register as an ongoing condition versus an occasional sad day?

  16. Like others above, I have struggled with depression and the Pagliacci quote rings true to me. I don’t see it as trivializing at all – I think it reflects deep truth.

  17. Icarus – the general description is that if continued feelings of sadness, etc last for longer than 2 weeks you should seek advice from a doctor. If it is not the result of something specific – what is often termed “situational depression”, like after a death in the family, job loss, etc – then it warrants further investigation.

    Often the first thing to do is a complete physical exam, to see if there are underlying conditions such as thyroid issues or medication side effects that could be causing the issue.

  18. @Mike:

    “Doesn’t this statement suggest that to some degree depression is why they are funny?
    This correlation is well known, but is it real?”

    At risk of wandering off-topic, I’ll just throw in the well-known statistical maxim that “Correlation does not imply causation.” (xkcd does probably my favorite interpretation of said maxim.) Essentially, it seems probable that there is some link between the two, at least in a number of cases, but that doesn’t mean that one causes the other. Or, to put it another way, it’s statistically just as valid to say that being funny causes depression.

  19. The Cracked piece is probably the most successful of all the pieces that have tried to discuss creativity and depression. The Pagliacci quote I think resonates with all of those who have tried to escape depression through performance or creativity, only to have to face it again once the performance is over.

    I first became aware of my own depression when I was 14, though I did not admit to myself that I needed help until I was almost 40 (I am 52). It was several years after that until I actually sought help. I am lucky that my depression did not take me to places where I could have hurt myself.

    Right now, the hardest thing about depression for me is realizing that it will never go away, even though I am doing everything “right.” I am on medication. I am in therapy. I am trying to eat better. I exercise (the most effective thing for me). Although I am not in a relationship, nor do I want to be, I come from a big family, all of whom I would hang out with, in-laws included, even if we were not related. I have a large circle of good friends. I can call any of these people at any time and have someone who will listen sympathetically and not just tell me to “Get over it.”

    Even with all that, the depression comes back again and again. I can’t even imagine having to fight depression and addiction. My heart just aches when I think of Robin Williams falling back into substance abuse after 20+ years of sobriety, and getting to a point where he thought the only way he could stop the pain was through suicide.

    As for the link to creativity, I have always believed performance and creative expression can be used as masks or escapes from the self. This is not an original thought, and several others have said the same thing. Many depressed people, and I am one of them, can remember every awkward or stupid thing they have ever done when faced with a social situation: “This person must hate me because I was mean to Suzy in the fifth grade.” Creativity and performance can allow someone to believe that metaphoric Suzy accepts her, at least for awhile. That depression comes back exponentially after the escape is over is not surprising to me. I can have a really good day, and then be miserable for days afterwards. It was a fluke. You will never be that happy/successful/accepted again. It is not logical, but it happens.

    Like several others on this thread, I would urge anyone who has depression, even if it is not chronic, to seek help. There is still a part of me that thinks I should be able to defeat this on my own. I can’t. You can’t. Brave people like Robin Williams have shared their personal pain in the hope of de-stigmatizing mental illness. That he lost his battle with it does not mean others should give up. Get help. You deserve it.

  20. I always assumed that the Pagliacci ‘joke’ was more of a tragic statement. Pagicliacci makes everyone laugh, but who makes HIM laugh? Also, that was a SHIT doctor.

    Interestingly, I saw the same joke presented from Groucho Marx, but mentioning someone named Gronkot?

  21. The difference between occasionally being down or sad and actual clinical depression as a disease is that depression isn’t just more sadness, but it’s incorrect responses by one’s brain. Aside from chronic depression (which lasts weeks, months, or even years), depression is typically triggered as a stress response, not a sadness reponse.

    It isn’t just “when something sad happens, I can’t stop myself from being far more sad than is appropriate”. That is part of it and manifests as a downward spiral of one thing bringing you down triggers thoughts of everything real and imaginary wrong in your life with no middle ground. However, an even more common source, and clearer sign that depression is a real physical malfunction in one of your organs (namely your brain), is that clinical depression isn’t just triggered by sad events but by stress. A person with depression’s brain responds to many stressful situations by triggering the depression to distance oneself from the stress and power down rather than letting stress do the work evolution intended. Not to go too far off tangent here, but all of our physiological stress responses can be traced back to pretty obvious fight or flight responses. Depression doesn’t so that. Depression is the stress response being broken in some way.

    So it’s a common misunderstanding that depression is just caused by (or at least triggered by) sad situations and excessive responses to those. In reality, it is usually caused by the stress response being broken. So someone can be quite happy and have things going great, but a stressful situation can trigger an episode of depression even with no relation whatsoever to anything sad or “down.” For example, there are some movies that I can’t take my wife to because they are just too intense and will trigger her depression.

    So depression isn’t the difference between someone being an appropriate level of kind of sad versus someone dropping into deep melancholy with some sort of continuum between them. No, depression is very clear organ malfunction. Unfortunately, it’s in the organ we know the least about.

  22. One part of the link between depression and creativity is that many of these people have bipolar I or II, in which they alternate periods of depression with either mania or hypomania. It’s amazing how productive and creative you can be in the “up” phases (though in full-blown manic phases things get completely out of control – see Jonathan Winters for a sad example).

  23. Wizardru – Just Grock (Charles Adrien Wettach). He was thought to be the greatest clown of his time.

  24. I think the shortest description of depression is that it strips away what generates meaning for life in its victim. People generate the meaning in their lives, it doesn’t come from outside. The fact that people love you doesn’t matter if depression has taken love’s meaning and importance from you. the fact that you’re successful in your job doesn’t matter if depression has robbed you of finding meaning in your own personal success. And when disease takes away the capacity to find meaning for living, you have the disease called depression.

    The Pagliacci joke, by itself, captures this conundrum well. Pagliacci has lost his own personal meaning for living. The doctor has not. The doctor assumes Pagliacci simply needs to be reminded of the things worth living for. But the thing that gives the doctor meaning (humor) gives Pagliacci nothing. It spotlights the camp of people who are oblivious to depression as a real thing, which is something worth spotlighting.

    It’s not that Robin Williams needed reminding that people loved him. It’s that Robin Williams lost the internal mechanism that makes being loved a worthwhile, meaningful thing.

    The problem I have with the Pagliacci joke is the context in which it is told. Go click on that link and read the Watchmen comic in which the joke is told. The first frame on that page is Rorschach explaining the Comedian. And Rorschach’s first words about it are “Blake understood… He saw the cracks in society.

    The joke about Pagliacci is told by Rorschach as a way of explaining the Comedian, yes, but the problem is Rorschach thinks the Comedian’s existential crisis, his inability to find meaning in his own life, is the correct response. Rorschach presents the Comedian as truly understanding life and that the Comedian’s emotional disconnect from life was the best and most appropriate response.

    Which is to say, in the context of The Watchmen, the Comedian and Rorschach are both people having problems connecting with the meaning in their lives, and so Rorschach sort of the flip-side of the oblivious doctor. The doctor is oblivious to the idea that depression is a real thing and doesn’t get that humor won’t help Paglicci. Rorschach is oblivious that other people find real meaning in their lives and doesn’t get that the Comedian didn’t “understand” life in some truly profound way, rather Rorschach was oblivious to the fact that he and the Comedian had disassociative personalities, that it was hard for them to connect to the things that made other people happy and connected with their lives.

  25. Been there….was on a fairly heavy dose of anti-depressants for about 10 years. Fortunately, my doctors have determined that my brain chemistry has been sufficiently altered so that I no longer have the symptoms of depression. Please note, I had been ON the medications for 10 years, but I had suffered severe depression for about 38 years prior to being placed on those medications. There weren’t the mechanisms in place to adequately diagnose, treat, and assist the sufferers when I first started exhibiting the symptoms. Plus, there’s that stigma of having some kind of “mental problem” when you suffer depression. I recall seeing a billboard in Lima, OH, that read, “You wouldn’t tell a friend, ‘It’s just cancer, get over it.’, would you?” The Air Force has started recognizing that depression isn’t just a condition, it’s chronic in some people, and I was one of those who had it pretty bad. When you throw a few curves like a very nasty divorce into the mix, that doesn’t help the situation any, either. Being sad once in a while isn’t the same as being depressed. You don’t want to do anything, some days, you just don’t want to get out of bed because you know the horrors that await you throughout the day. I’ve had days like that, and days when it seemed like the best thing to do would be to end it all. The only thing that prevented me was what it would have done to my family, and that maybe, just maybe, there was the hope of something I could do that would ease the pain, make it better, or just completely get over it….

  26. Just as a side, being a very depressed person all my life, I can say that I am also considered pretty darn funny. Many depressed people don’t feel deadened, they feel alienated. and have difficulty connecting. Making people laugh is a connection, and it is a way to make people love you if only for a minute. The older I get, the more I understand how depression hurt my relationships. The biggest problem is that no medication actually helps my depression, it just deadens me to the blackness. For depressed people, and bipolar people, medications are a real problem, and make living seem so much more flat, dead and dull.

  27. I actually encountered the Pagliacci reference for the first time due to this – wasn’t he a sad clown – and it rang hollow. It doesn’t matter to me whether Robin Williams’ depression was integral to his humour, some automatic biological counterpoint. I’m just really sad that he is gone, like that, alone and without comfort. I never met the man, but my affection for him is real nonetheless. He deserved better. Sometimes life is really shitty.

    I have lived with depression for 15 years, and it never made me feel particularly creative. If anything, it makes me feel like my words are trapped inside me and I’m just making time, pretending to be normal.

    I am grateful for the commentary addressing depression that has come out of this. It is very difficult for me to articulate the reality of living with depression, even to my close family – who just do not get it (“Isn’t it all just in your head? You’re being irrational.”). Having it be up for general discussion, as something to be taken seriously, has made me feel less isolated and more able to tell the truth to the people around me.

  28. @Ken Marable
    It’s true that depression can be kicked off by stress, but, in at least my case I don’t think it’s just that the fight or flight response was *broken* so much as there was nothing useful for the fight or flight response to *do.*
    My stress was cancer treatment and the financial terrors that go with. There wasn’t anything that I could usefully hit and running was counterproductive. What I ended up with was an ability(not the right word, since I can’t adjust a thing) to tune down the fear and not look directly at the thing that I just had to bear….but, that is only useful in limited circumstances and otherwise very problematic. It took my joy, too, and a good portion of my ability to function. I want those back. I suppose you could call it broken, but, it’s a little like a set or work goggles that you need for a task, but, really want to be able to take off because you can’t see or do other things with them on. My therapist is working on helping me find the latch.
    Whether my brain weasels are related to anyone else’s or not, I really feel for anyone dealing with depression or other things that mess up our perception of the world and our ability to function.

  29. One of the problems that people with life-long depression have is that they think that it’s normal, or at least normal for them. Depression already tells you you will feel this way forever (see Ten Lies Depression Tells You .) You kind of assume everyone feels this way, they’re just better at coping with it. (Because you know you’re really The Worst.)

    I’ve lived with depression all my life. At least, I think I have; maybe it’s just my normal. But if I have, I have no idea what it would be like to not be depressed, to not have moments practically every day where you wonder if being dead would be an improvement, to not to have to make an effort all the time to push it out of your mind and focus on what needs doing and keep so busy you don’t have time to think of it.

    (And, yes, I’ve used — and am still using — antidepressants. I’ve tried a bunch of different ones. They don’t make the pain go away, they just make me not care about it so much, so I can go out and do what needs to be done. Sort of like Powdermilk Biscuits.)

  30. Yesterday was wonderful. I laughed, I enjoyed my coffee while listening to the wren sing. The world was green and beautiful. This morning I woke up. I went outside to have my coffee but something was wrong. The world was gray. A switch had been flipped. I could barely mumble to my husband that I was having a bad day. He, concerned look on his face, asked “why?” I looked at the stranger next to me and said “I don’t know.”

  31. John, I was one of those people who posted the Pagliacci thing. And while it is (admittedly) facile, what I was trying to get at is purely the tragedy of the situation. Bringing joy to other people does not mean you have joy yourself, which I see as truly tragic.

    I definitely don’t view that anecdote as suggesting that in order to be funny you need a tormented dark side, but just that Pagliacci’s only suggested relief is an avenue that’s open to everyone else, but not to him. It also speaks to the inequality of our relationship with the great clown — he brings the pleasure to us, but we have no power to help him in return.

    Regardless of how people choose to express their feelings, I will say this: His death has spurred a lot of people to talk about depression, and that’s helped de-stigmatize mental illness, and that’s progress for our society. Small solace after such a terrible event.

  32. Is there really such thing as a creative personality type? And does it really correlate with depression? I mean, I read lists of traits that creatives are supposed to have (curious, motivated, able to focus, ambitious, associative, difficulty with interpersonal relationships) and can without too much bending, fit those traits into the conventional portrait of a typical engineer. I’m an engineer and having known and worked with many other engineers in my career, I’ll affirm that engineers encompass the whole wide panoply of human personality characteristics. I’m quite skeptical of the notion that there’s an engineer ‘type’ or, for that matter a creative ‘type’. Most people I know seem to have creative impulses, whether it’s their vocational focus or not.

    There was a study a few years ago that showed a link between people who are in specific creative professions and certain types of mental illness (e.g. dancers are more likely to be bi-polar), but that people working in creative professions as a whole were no more susceptible than the general population to mental illness. It’s hard to know whether it might be the particular rigors of particular creative professions that either draws people with existing mental maladies and/or perhaps intensifies latent ones. But there’s seems to be no evidence that it’s personality in particular that correlates.

    My mother has struggled with depression for decades. Her profession: nursing, which tells you nothing about her depression. And that’s the point. Pagliacci, to me, is a banal statement that depression knows no boundaries. (And Watchmen is so bleak anyway that the ‘joke’ becomes even more banal in context.) Depression isn’t confined to a ‘type’. And you often can’t tell a sufferer from the face they show the world. (I wouldn’t know that my own mother suffers from depression except that she’s told me.) Humans are humans, and compassion and empathy flow from understanding that our individual uniqueness is a universal trait.

  33. @Ken Marable Yes absolutely. I was once triggered into a months long spiral because I broke a glass container that held the end of a week long reaction that took a lot of work and I knew I’d have to redo it all (and at that was a point when I was off my anti-depressants. When I’m on them my response to stress like that is similar but severely shortened. A day or two instead of months).

    My depression also tends to express itself in anger and apathy far more than in sadness which confuses people. Anne Wheaton’s post on Wil Wheaton’s depression resonated with me strongly because her observations in him mirrored closely observations in myself.

  34. @Matt W A comment I saw on twitter today brought home to me why I’ve been feeling a bit uneasy with a lot of the depression articles over the last two days even while being glad it’s being discussed.

    “also, ordinary people can also be depressed, or addicts. I’m uneasy with the kind of…creative mystique thing.”

    The very well written ones don’t fall into this trap but I’ve been seeing a bit of a…romanticism almost of “creative types” channeling depression and using their work as an escape from it. All people are susceptible to depression since we all have brains and some of them refuse to work right but some of what I’ve been seeing is it’s almost…acceptable? justified? if someone has a creative outlet.

  35. For me the Pagliacci quote was the exact opposite of a mental shrug. It was the succinct packaging of a complex, intense set of emotions and it certainly did not lead me to brushing over these issues but to think of them more.

  36. It’s effing bollocks, pardon my French, that’s what it is. I am reminded of the old saying, that a poor person is a nutter but a wealthy person is eccentric.

    If you want to honour the life of someone creative, then it’s fine to do so if their art meant something to you. Anyone who has any decent understanding of clinical depression will know that it can mean that just getting up and getting dressed and eating a meal is sometimes more than you can manage; creative people are creative despite mental health difficulties, and plenty of ordinary people suffer from mental health difficulties and are treated like outright pariahs because of it.

    Stop it with the effing romanticism already.

  37. For anyone who is dealing with depression and wondering whether to try medication, please don’t be discouraged by the posters who said that meds for depression and bipolar deaden everyone – sadly, they do have that effect for some people, but by no means all (I’m one of the lucky ones). That said, you often have to try more than one before finding a med that works well for for you, and it’s true that there are some people who are not helped by medication.

    Another non-medication treatment modality that has been clinically validated is Cognitive Behavioral Therapy (CBT). Clinical trials have shown it to be effective, and the combination of CBT and meds is more effective than either alone. You have to be careful to get a therapist who is trained and experienced in CBT – some will say they use it when they just use parts of it in a hodge podge of mixed modalities.

  38. @mgwa CBT has worked wonders for me. I don’t react well to antidepressants, but CBT has helped a lot. It’s also really good if you have depression + something (in my case, depression + PTSD + anxiety). I’ve made a lot of progress from it.

  39. My mother-in-law has battled this her whole life — and I’m not really versed in it enough to know all the nuance — bipolar, particularly. There was even a suicide attempt some years ago, mercifully unsuccessful. But the weird thing was that for ten years, her doctors pretty much begged her to start on Lithium, but her brain had decided that lithium was tantamount to surrender. She’d been on just about every other combination you can imagine… but lithium was a no-go.

    Well, about 2 years ago she decided that it would be a great and novel idea to take lithium and now she’s an utterly different and better off. She’s not easy, but after the suicide attempt I told my wife that it would be great if we could get her to be merely “back to awful” as she had been before the attempt — she’s well past that, now.

    The stuff can work. I hope folks seek out help.

  40. Here’s the thing about the Pagliacci line. I know the context it’s being referenced in…

    But to me, it means the opera “I Pagliacci,” in which a troop of clowns comes to a rural village to put on a play about a cheating wife–played by a woman who is planning to elope on her possessive and jealous husband(Pagliacco). She refuses to reveal the name of her lover, and the play quickly becomes real life as he kills her.

    Perhaps the analogy that everyone has been making (without knowing it) is appropriate. It *is* a tragedy, masked as a comedy, with the audience clapping along, unaware until the last minute that real things are at stake. And it hurts–it effing hurts, as someone who has had depression and been suicidal–to think that we didn’t know.

    http://en.wikipedia.org/wiki/Pagliacci

  41. @Robotech_Master – thank you so much for both links. “I’m just handing out sticks, you’re the one surviving” is wonderful! OTOH, I’m horrified to read the misogynist, hateful attacks the developer of Depression Quest has endured.

  42. @mgwa I did not mean to say that meds don’t work at all since they don’t work for me. Not that solipsistic! I did not make the point very well, but most anti-depressants only work for 25 to 33% of treated populations. I have seen no research to se if these populations overlap or not. There is no medication I have tried that works for me, adn the incessant cycle of bloating, brain fog, deadened affect, etc make trying yet another one not worth the while.

    That being said, I have tried stuff for decades. I think that a person with depression should make the effort to try meds to start off with. since they may be one of the 1/3 of the population they help and trying is a step forward.

    I like CBT, except having steps to follow to assist you in your depression only work if you follow them, hard to do if you are depressed! I think that initially a depressed person should meet several times a week with a therapist to help overcome this apathetic helplessness.

    Reading all these comments has been most interesting

  43. As someone who is slowly coming out of a depressive episode and just starting CBT, this was a great post and great comments.
    Not much to add except to really underscore John’s comment to Listen. Even though I have depression and anxiety, it’s still different from other’s and listening to what they need is the best way to help.

  44. @carolannie1949 – I didn’t think you meant that. Someone else wrote that meds make everyone feel flat. I’m so sorry they don’t work for you.

    And the proportion of people for whom there is some med that helps is higher than the proportion who respond well to any given med – that’s why it’s so important to have multiple meds on the market, even multiple ones in the same class. Some people can respond badly to 3 SSRIs and do great on the 4th, some do badly on SSRIs but do well on Welbutrin, some only do well on a combination of meds (whether two antidepressants, or an antidepressant and an anxiolytic, or some other combo). Psychopharmacology is as much an art as a science.

  45. I have only tasted the fringes… But for a while, I was tasting those fringes about every month. Wanting to cry for no reason? Feeling like I sucked and everything was nearly hopeless? Emotional swings with little reason? Yeah, PMS, it can happen. Mine wasn’t severe. I eventually identified the timing and could apply lessons learned from Hambly’s The Silicon Mage (…yeah, that duology has helped me hugely…).

    In my case, if I take an extra B-complex vitamin most days, it reduces that PMS “shadow of depression” to irritation and some mental dragginess. It’s a vitamin imbalance, apparently. (I also take my thyroid meds — at different times of day! — because hypothyroidism will also do a number on me.)

    I can’t speak to the deeper, constant depression. It’s only the shallows I’ve known… But, yeah, sometimes something helps. Vitamins if there’s a deficiency. Thyroid meds (TSH should be between .4 and 4 and ideally no higher than around 2-ish!), if needed. Therapy. Etc. Which is a lousy kind of attempt at inspiration, and probably doesn’t adequately convey my feelings that no one should have to live with that day-after-day (or even just for a few days each month…) if there’s any way to help. But it’s all I’ve got the words for tonight.

    *wishes for many good days for everyone*

  46. I sometimes like to think that I am three things: my body and my mind (My mind being two things, my emotions and my intellect).
    When I am feeling very bad it is very difficult to force my intellect to override my emotions.

    Emotionally I _know_ that it doesn’t matter whether I do or do not: Emotionally, they don’t like me and are just after my money.
    Intellectually: ‘Hey, emotions you’re a fucktard because they _definitely_ ain’t after your twelve bucks, and consider how they try to make you feel better.’
    Emotions: ‘Doesn’t matter. Nothing matters. Sometimes I welcome the migraine curls of flashing lights because they are colorful. And, intellect? You don’t matter, only emotions do.’

    Just to prevent wellness checks I have never considered offing myself but have thought about it in the context of “Wow, I’ve heard that people kill themselves to get away from migraine pain. I’m so glad that mine were only about an eighth of a toothache*”

    *Toothache, baseball to the groin and childbirth pain scale (one to ten): Toothache 13
    Baseball to just the left one 3
    Giving birth 10

  47. Quoting myself from a post over at Shakesville:

    I think about Robin Williams and I think, “Oh shit, that’s me.” I mean, it sounds like I’ve got it very mild in comparison, and my sense of humor isn’t nearly what his was, but still …

    I see people saying that he “hid” his depression behind the laughs, but no, it’s not that simple. Yes, my sense of humor is a defense mechanism and a coping mechanism, but it is so, *so* much more than that. It’s a source of joy — *shared joy* — and a weapon against the darkness.

  48. When my depression goes from mild to severe there is a stage when I’m fairly brilliant. My brain works perfectly, my insight is heightened. In that stage, I’m witty by default, and if I make jokes it’s a riot. After that comes a stage when I just can’t stop making jokes, but it’s not as funny anymore. Especially not to me. I listen to my own strained jokes and feel that my brain is a broken useless idea machine, and I wish it would just stop. So… yeah.

  49. I think depression is a mental state brought on very often by your experience not being validated/allowed by the people around you. In the UK in 1980s, there were around 80,000 women locked up for ‘mental’ conditions that were normal human responses to having your actual experience of sexist violence denied, leaving the subject feeling that they were going mad. My father had severe depression which he received ECT for. He was a Jew during the Second World War who frequently said Hitler had the right idea, using self loathing as a way of keeping himself safe in a very unsafe world. Likewise, he was an extreme male chauvinist who had the unfortunate luck to be married to a woman more intelligent and capable than him. Rather than acknowledging his world theory was shit, he hit her to make her fit his theory. She left him. He found himself a wife finally that would look after him like a baby whilst being the subject of his scorn and derision because of her gender. He was not a happy man ever but it was more due to his ideology rather than a disease as such.

  50. I’ve been trying to dodge most of the discussion about Robin Williams death mostly because I don’t trust most of the internet to do it right. So I stick to the digital rivers and lakes that I’m used to – intelligent, compassionate, and well-moderated.

    Thank you, John, for pointing out that piece by Erica Moen. I’m already a fan of hers, but this goes beyond that. I’ve been struggling with chronic clinical depression for almost twenty years now – self-medicated, medicated, currently unmedicated due to finances – and the very clear point she made about the slim difference between not wanting to kill herself, but not wanting to exist hit me hard. Really hard.

    It was the first time I have heard anyone else say besides me.

    Depression lies. It isolates you in your own head. No one else feels quite the way you do, no one is as bad and dirty and worthless and weak as you are. No one else daydreams of just not waking up, or disappearing from time so that not only do you not exist, but you never have, so everyone you love will be free of the baggage that is you. Everyone else is just happy, stable, better than you – ur doin it wrong.

    I hate, hate, hate that it takes something like this – the death of Williams – to once again remind everyone not tangentially touched by depression that it’s a thing. A big thing. A thing that comes from dark corners and steals joy and spoons and aspirations and connections with other people. A thing that kills. How many more brilliant, creative, famous people – the list is too long, too painful to share – will it take to really turn the tide in convincing society that mental health really is a health issue?

  51. ..And then I read the Slate article you linked. I didn’t before, unsure that I could handle the one-two punch after Moen’s piece. I’m glad I did. It says so much of what I’ve been thinking the past few days, and a lot of the things I almost wrote here.

  52. As an aside: The “Pagliacci” joke from Watchmen can be traced back at least to the late 19th/early 20th century. There is a poem, “Reir llorando” (“To Laugh, Crying”) by mexican poet Juan de Dios Peza (1852-1910) that features a depressed nobleman that goes to the doctor to cure his depression; the doctor sends him to see the comedian Garrick (a reference to English actor David Garrick (1717-1779) ). The dejected patient replies “I will not be healed that way: I am Garrick!”. I do not know if Peza was inspired by comething himself, or if this is original with him.

    Poem in Spanish: http://www.poemas-del-alma.com/juan-de-dios-peza-reir-llorando.htm

  53. I have been going thru the worst year of my life with anxiety and depression. a year of medications and several diagnoses and waves of improvement followed by a return of the symptoms. I fear losing my wife over it.

    When I see the Pagliacci story, all I see is the hopelessness for him because he has tried to heal himself, went to the doctor and was told that he’s already done the best thing for help and it didn’t work.

    (Aside, not suicidal, but it is so often the only question I get when I ask for help, I’m occasionally tempted to say yes so I could get some targeted help.)

  54. As someone who’s been to that precipice more times than I want to recount, my first reaction to the news was to wonder why I wasn’t lured over it while someone who’s brought joy, entertainment and even wisdom to hundreds of millions of people was.

    I did not step back from the precipice purely of my own accord, and I don’t think very many people do. It’s entirely true that clinical depression lies to you. It doesn’t so much tell you you’re unloved as it makes it hard to feel that love. You may know intellectually that you’re loved, but that’s never the same thing. Without the feeling you forget how much it will devastate the people close to you if you go over the precipice. You simply can’t believe you matter that much. You think how much easier it is to end it and that, though it may hurt them, you tell yourself that it’s the best thing for everyone in the long run. If you get away from the precipice, you eventually see what a hateful pack of lies that part of you was telling the rest of you.

    But none of that means the people who love you are powerless to help and, most of all, to help encourage you to get the medical help that can help you get better. I think maybe the isolating effect that fame can have on people, especially as they outlive the people that loved them before they were famous, can be an impediment to that help.

    This news makes me sad. First it made me sad to hear that a fellow warrior fell to a common foe. Second it made me sad because Robin Williams was a joy to me as a child and a teenager, and I admired his wit and art as an adult. I wondered if I was being selfish. I didn’t know him personally. All I knew was his public work and persona. What right do I have to mourn him? But his work was an integral part of who he was, and I’ve decided that it’s legitimate to mourn that part of him, as long as I remember that there were people close to him that knew the whole human being, and far more than just a renowned artist has been lost.

  55. Personally, I agree with those who are saying “I am Pagliacci”. It isn’t about shrugging off someone’s death. It is about admitting that we each have burdens to bear and some of us may need a little extra help in shouldering ours.

    As other, better people have said “I am Pagliacci“.

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