Plato's Cave and My Experience of Depression

Figure 1

Introduction

One of the things I love about philosophy is how the basic lessons of the vocation creep into your life at unexpected points in time. The word itself means "loving wisdom" (Ayto, page 392). People who think that this academic pursuit is dry and boring have a hard time believing in its usefulness. The problem is that historically, philosophers have had a love affair with the use of language, making philosophical text difficult to read. In 1905 the American philosopher and psychologist George Stuart Fullerton highlighted this issue in the opening pages of An Introduction to Philosophy. "They are often repelled by philosophy, and I cannot but think that this is in part due to the dry and abstract form in which philosophers have too often seen fit to express their thoughts. The same thoughts can be set forth in plain language, and their significance illustrated by a constant reference to experiences we all have -- experiences which must serve as a foundation to every theory of the mind and the world worthy of serious consideration" (Fullerton). I find that by using common language, even the works of the most abstract philosopher becomes accessible and relevant. In addition, there has to be a practical application of the wisdom, or it just becomes a mental exercise.

I recently became reacquainted with how the lessons of philosophical text are applicable to the everyday events of my life. This revelation came about at the start of my journey with depression. The process involved an attempt to understand the source of and how to move beyond my current state of thinking. During a side conversation with a peer, I was reminded of something I had read in my junior year of college many, many years ago. The exchange transported me back to Book VII of Plato's Republic, where Socrates was locked into a discussion about knowledge. During the exchange he introduces the allegory of the cave. His description of the residents of the cavern perfectly illustrated what was going on in my life.

Figure 2

"Imagine human beings living in an underground, cave like dwelling, with an entrance a long way up, which is both open to the light and as wide as the cave itself. They've been there since childhood, fixed in the same place, with their necks and legs fettered, able to see in front of them, because their bonds prevent them from turning their heads. Light is provided by a fire burning far above and behind them. also behind them, but on higher ground, there is a path stretching between them and the fire. Imagine that along this path a low wall has been built, like the screen in front of puppeteers above which they show their puppets." (Plato, page 187: 514 a-b)

The puppeteers are moving figurines of humans, animals, plants, and other objects in front of the fire so the shadows of these cutouts project images onto a wall that is in front of the residents (Socrates refers to them as prisoners). The performers are talking and making other noises as they put on their show. Since the dwellers of the cave have known nothing but the shadows and the sounds of the cave, they come to represent what is real. Then Socrates describes what would happen if some of them were suddenly freed from their bindings.

At first they would be reluctant to move their heads, because what is front of them is familiar and everything else is unknown. When they begin to view the rest of the cave, the figure of their fellow residents comes into their field of perception. The images would seem alien to them since they are not the same as the shadows. Due to the darkness even when an individual looks directly at his/her neighbor they cannot be clearly seen. Once the courage has been summoned to wander up the path towards the entrance, the light becomes brighter and the images that come into view are closer to reality. After their eyes adjust to the light, they can see the fire and the puppeteers working their craft. Imagine if you will, how scared some of the inhabitants of the cave must be, all they have ever known as real has just been torn away. For some the temptation to return to their original state must have been overwhelming and they retreat back to the perceived safety of the darkness. Others become comfortable and choose to stay near the fire making it their new reality. It is warm and they can see clearer than at the bottom of the cave.

The remaining few press on to the mouth of the cave. Once these souls reached the entrance they have to make a choice of either proceeding into to the sunlight or retreat back into the darkness. For those who move forward, the outside world is bright and at first painful. When their eyes adjust, the environment comes into focus. They realize that what they knew to be plants and animals in the cave were just cut outs and shadows cast by the puppeteers. A realization sets in that what they were exposed to in the darkness were merely poor copies of the real objects.

Figure 3

Application of the Cave to Real Life

Let's put Socrates' analogy in a modern context. The cave is created from many contributing sources, including the self. We come into this world with limited information and throughout our lives we go through a process of learning what is real and what are just representations. The projections of the images are produced by a multitude of designers. Media (TV, movies, music, Internet, books, news outlets), religion, government, educational systems, family, and society are just some of the influences involved. The American anthropologist Margaret Mead notes how children learn about the norms of a society. "As infants in the home, and later within the educational system of the wider society, child-rearing methods expose them thoroughly to the culture of their society, so that they perforce assimilate the values of that society" (Mead, page ix). The process that Mead is talking about teaches what is acceptable, not necessarily what is real.

In creating the list of producers of shadows, there is a fine line being walked. The very items being named are also the tools that are employed to help see reality. The overlap of information about the world is one of the reasons that it is hard to know if you are looking at real or outlines of the object. To see the difference there has to be a conscious effort by the individual to seek out reality. With depression there is a sense of withdrawal and the ability to closely observe and questioning the images is lost. You get to a state where you do not care if the images are real or not, you become disengaged from your own life.

There is a mythology surrounding the public understanding of depression that clouds the issue and interferes with treatment. So before proceeding any further I like to make sure the reader is working off the same definition as I am. According to U.S. National Library of Medicine, "Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods" (U.S. National Library of Medicine). This does not sound so bad; everyone goes through short period where they feel this way. However if it transitions to Clinical Depression then the consequences become serious. "Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time" (U.S. National Library of Medicine).

Many of the warning signs that are associated with depression go unrecognized. It is not unusual for people to go through shorts periods of time with these traits. The more common symptoms of depression include:

• Low or irritable mood most of the time
• A loss of pleasure in usual activities
• Trouble sleeping or sleeping too much
• A big change in appetite, often with weight gain or loss
• Tiredness and lack of energy
• Feelings of worthlessness, self-hate, and guilt
• Difficulty concentrating
• Slow or fast movements
• Lack of activity and avoiding usual activities
• Feeling hopeless or helpless
• Repeated thoughts of death or suicide
• Low self-esteem is common with depression. It is also common to have sudden bursts of anger and a lack of pleasure from activities that normally make you happy, including sex. (U.S. National Library of Medicine)

If left untreated the items on this list can have a debilitating impact on a person's life. In some cases they will cause an individual to take their own life. There two types of clinical depression, major and minor, "to be diagnosed with major depression, you must have five or more of the symptoms listed above for at least 2 weeks. Major depression tends to continue for at least 6 months if not treated. You are said to have minor depression if you have less than five depression symptoms for at least 2 weeks. Minor depression is similar to major depression except it only has two to four symptoms (U.S. National Library of Medicine).

For me, depression is like being at the bottom of the cave. Only this time instead being born here, life events have returned me back in the dark abyss. Throughout my life I have worked to see beyond the shadows to understand what is real. Now, I find myself metaphorically sitting in the darkness looking at the fussy images being projected on the wall, unable to turn my head to see the world around me. Since my eyes have experienced the sunlight I am at first blinded by the darkness. Over time as my eyes adjust, it become easy to sit in the darkness not having to think. I start to accept the darkness around me as a tolerable alternative, because the gloom allows for only limited information to penetrate. In the murkiness of the cave, strapped in the chair unable to turn your head creates a feeling of isolation in a sea of people.

This relationship of depression and darkness is supported in an article by Dr. Jeffrey Kiehl, Vice-President of the C.G. Jung Institute of Colorado. "Darkness descends without call. Unlike the predictable occurrence of night, this darkness comes whenever it wants, and does not leave at a foreseen time. This unpredictable and chaotic nature of the dark mood enhances its depth of being. With darkness comes loneliness, and isolation that seems unbearable. Looking out into the world, but feeling separated from the experience of this world" (Kiehl). Depressions keeps you from seeing the world in the sunlight, therefore you cannot see your life for what it is. The darkness focuses on the shadows created by the cutouts which are highlighting the negative images of the object. Hence people can only see the bad in their life; the joy of the light is ignored.

Returning to the light represents change and at first the change is painful. Having made the climb up the cave path before, I can remember the discomfort of transitioning to each level of understanding. The discomfort was caused by the new information challenging something that is familiar and safe. Socrates describes the dilemma each individual faces when they start the journey. "When one of them was freed and suddenly compelled to stand up, turn his head, walk, and look up toward the light, he'd be pained and dazzled and unable to see the things whose shadows he'd seen before" (Plato, page 187: 515 d).

Unregulated life events have caused me to return to the darkness of the cave. At first the descent was slow and unnoticeable over a period of years. Until I came closer to the floor, the path suddenly became steep. Then I spent the remainder of the fall down tripping and stumbling out of control. Once there, I was unable to get completely comfortable and became agitated. At first there was a feeling of an internal betrayal because I know that there was more to see besides the shadows, but I had become too afraid to look. The longer I remained in the darkness the harder it became to get out of the chair. In one sense the darkness appears to be safe, there are only a limited number of images to be perceived and the complexity of the world becomes masked. Once my eyes have become adjusted to the darkness looking at the fire and the sunlight behind me becomes painful. Over time I allow the chains to hold me fast to the chair, but the internal agitation remained and grew causing a conflict within my soul.

Depression is a lived experience.

— Dr. Jeffrey Kiehl

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Figure 4

Staying in the Cave

Some of the links in the chains that keep me in place and the reason why so many do not seek help with depression are forged by the social stigma that accompanies mental health illnesses. (Yes, depression is a form of mental health illness.) Mental health is a very broad term covering a multitude of conditions, often what happens when the label has is placed on a person, and people with little understanding of the condition apply a worse case stigma to it. Frequently mental health issues are portrayed as a personal weakness or character defect. Once identified as having a mental illness, questions arise about a person's ability to function within society. An August 2012, article on the website Everyday Health highlights the stigma associated with depression.

"Our culture has a fairly rigid definition of what constitutes appropriate behavior, and there is definitely a social stigma associated with depression,” says Joseph Hullett, MD, senior medical director of clinical strategy for OptumHealth Behavioral Solutions in Golden Valley, Minn. “A social stigma, in general, is like the mark of Cain, a label used to identify groups in a society in terms of behavioral traits.”

• According to Dr. Hullett, social stigmas about depression often translate to inaccurate stereotypes, such as:
• People with depression lack willpower.
• Depressed people’s emotions are out of control.
• Depressed people are a danger to others.
• People with depression are “defective,” like broken machines.
• Depressed people are just whiney and make excuses.
• People with depression are antisocial.

“Stigma surrounding depression is particularly prevalent in families of over-achievers and in companies where there is a high level of success,” says Gabriela Cora, MD, MBA, a psychiatrist in Miami. “Men tend to struggle more with depression-related stigma because they’re afraid others will see depression as a sign of weakness. They may try to fight depression on their own instead of seeking help.” (Bowers)

Table 1: Serious psychological distress in the past 30 days among adults age 18 and over

One of my current work responsibilities is to act as Americans with Disabilities Act (ADA) coordinator for a large organization. As such, I have worked with employees who suffer from depression to establish reasonable accommodations. During the ADA process I have also listened to managers who do not want to or cannot understand the condition. They (the managers) usually present to me a long list of rationalizations of how the employee is just lazy and is trying to get out of work. When I tell people about my current situation I usually get one of the following responses:

1) How can you be depressed you have such a great attitude?
2) I am surprise you have not lost it sooner.
3) You are just looking for excuses.
4) You just want attention.
5) Pull up your big boy pants and deal with it.

What is interesting about these statements is the duality of them. They are false and true, positive and negative at the same time. They also represent a lack of knowledge of what depression is. To precede each of these perceptions will be addressed separately to help you understand their impact.

1) "How can you be depressed you have such a great attitude?" When I get this comment, people are usually referring to my 12 year relationship with cancer. Recently I was asked by a dermatologist, who was removing yet another section of my skin for testing, what was my secret to living as long as I have with cancer. I have a great attitude towards my cancer, it is one of the reasons that I have survived as long as I have. I do not look at my life with the disease as a battle; my cancer is a part of me that cannot be denied. Yet it is a relationship that I did not voluntarily enter into. Fighting a battle implies that there is a winner and a loser. To win the fight is to be called cancer free and live. However we all die, not to sound depressing but it is the truth, I just have a better idea of what I might eventually die from. Also, even to be called cancer free, the legacy of the disease will still have an impact on my life. The trick is, and what I am still working on, is how I live. I lost sight of that this year; I began focusing on the battle, not the life, which is a contributing factor for my current state of being.

Just because I have come to accept the reality of cancer, that does not mean I like having the disease. I do get tired of the pain, the emotional roller coaster, and the changing of treatment programs. All these things take a toll on the body and spirit. In addition, all the medication I have taken has had a negative impact on my body which directly impacts my mental being. Also focusing in on only one issue (in my case cancer), has taken my attention away from other areas of my life.

Sometimes the public display of joy is often just a false front; it is pretending to be fine so others do not worry. There are days that I feel like I am part of the lyrics out of an old Smokey Robinson and Miracles song:

Now there's some sad things known to man
But ain't too much sadder than the tears of a clown
When there's no one around (Cosby)

I can present a good attitude and front about certain aspects of my life, yet feel completely inadequate in others. I have to remember that it is the whole, not just part of my life that needs to be taken care of.

2) "I am surprise you have not lost it sooner." It is true my life has had its share of challenges, however I have to keep in mind there are people who would like my problems, even the cancer. Meaning that no matter how bad I feel, there are others who are in a worse place. That does not mean the issues are not painful or serious, but there are others, for example, whose situation in life does not allow them access to the medical treatment or support system I have. An example of this phenomenon was presented to me in 2007, during a hospitalization that was caused by a bad reaction to a treatment program. At the injection site I had a skin temperature around 106 and a core temperature around 104. I was lying in bed over 100 miles away from my family, hurt, in pain, with a high fever, and feeling very alone. Then I got my roommate.

He was an older gentleman who was in the advanced stages of cancer. In the three days we shared a room together my family came every day, he had but one visitor. While I was taking pain medicine, he was on a morphine pump. In my mind I can still hear the click every time he pushed the button trying to get some relief. His condition did not take away my situation. I was still in trouble, with a high fever and infection. But, I was thankful that I was not alone in my pain. With time it has become easy to lose sight of this lesson. Understanding that there are others who are in worse shape does not mean that I am wishing bad things to happen to them. But, it helps to put my situation into perspective.

3) "You are just looking for excuses." This statement is claiming that I am looking for a way out of being fully engaged in my life. Depression prevents me from appreciating every aspect of my life. I am not looking for excuses for my past behavior and I know that all the medications in the world will not stop life from happening. But if I do not take the time and put in the work to understand my disease I am doomed to repeat the behavior over and over again. Thus preventing me from ever being fully engaged. For me depression is not a justification for past behavior, the clouded thinking may have been a contributing factor, but I have to take the responsibility. I have to realize that depression not only impacts me, it affects my family and friends.

4) "You just want attention." Yes I do, the acting out was a way for asking for help. I could sense there was something not right within me; I was not processing information rationally. When I first hit the bottom, there was nothing in my toolkit that would allow me to ask for help in an appropriate manner. According to the Center for Disease Control (CDC) that 1 in 10 adults suffer from depression and many never seek help. Instead of dealing with the situation they engage in self destructive behavior. People will often turn to alcohol, drugs, and other addictive behaviors or in worst case scenario suicide.

5) "Pull up your big boy pants and deal with it." I partially agree with this statement, yes I have to do work to make my situation better. When people are saying this, it is not to offer support it is a denial that the condition exists. People are often confused about the symptoms of depression, because they have experienced similar things for short periods of time. For example most people feel sad when they lose a loved one, but they were able to work through that emotion in a relatively short period of time. With major depression the person is not able to move beyond that feeling and it starts to impact their total perception of the world. This stance is related to one of the dumbest statements I have ever heard associated with depression, "It is all in your mind." Of course it is that is why they call it a mental illness. Part of the reason I was in trouble was due to my inability to ask for help.

For me the first step in dealing with depression was to reach a level of personal acceptance about my condition. Part of what pissed me off, and contributed to the denial, was I thought many of the issues coming to light had been dealt with in my past. I could not accept I was in trouble until I hit the bottom of the cave, where I no longer had a choice, either I got better or die. Once I recognized where I was then the question became, how do I move from the shadows back into the sunlight? What I have come to learn is there are many paths out of the darkness.

Table 2: Percent of population with at least one prescription drug in drug class in past 30 days

Two Parts to Being Human

There are those who believe that depression is caused solely by a chemical imbalance in the body. The homepage of the Stanford School of Medicine website supports this position. "Major depression is caused by imbalance of certain neurotransmitters (chemical messengers) in the brain, such as serotonin, norepinephrine, and dopamine. Antidepressants work either by changing the sensitivity of the receptors or by increasing the availability of neurotransmitters in the brain" (Stanford). This sounds too easy; if I pop two pills a day then I will feel great for the rest of my life.

I have a hard time placing unquestioning faith in a medical system, especially since I have spent a great deal of my life questioning everything else. Experience has taught me that there is fluidity with the pharmaceutical industry. For instance, the drugs I am currently using for my melanoma were not available when I started this journey in 2001. What is a medically sound practice this year, may be proven ineffective or detrimental the next year. If you look hard enough you can always find "scientific" studies that will attempt to nullify other scientific studies. The following 2006 article about the effectiveness of antidepressants was published in the Wall Street Journal.

"In March, a review of decades of research concluded that something other than "changes in chemical balance might underlie depression." And as Jeffrey Lacasse and Jonathan Leo write in PLoS Medicine, although ads for SSRIs say they correct a chemical imbalance, "there is no such thing as a scientifically correct 'balance' of serotonin." (Begley)

Figure 5

I am not suggesting that people go about ignoring what their medical professional is telling them, but it is incumbent upon the patient to advocate for their own health plan with educated questions and discussions. Just because a TV commercial (a fine example of a shadow on the wall) tells you that a little blue pill will fix all your problems does not mean it is true. Understand that medications do not act the same with everybody. What works for your neighbor may be hazardous to you. That is why when you receive a prescription of antidepressants there will be a page and a half of very small print listing all of the possible side effects of the drug, to include causing suicidal thoughts.

To help me understand the complexity of my condition I turned to the work of another philosopher, Rene Descartes and his discussion on the dualism in each human. Descartes believed humans consist of two parts the body and mind. His famous statement, "I think therefore I am" (Descartes, Discourse) helped him establish in a later work, Meditation, that only through the mind could he prove that the body existed. A part of Descartes' motivation was to prove the existence of a soul that could transcend the body at death.

"one hand, I have a clear and distinct idea of myself, in as far as I am only a thinking and not a unextended being, and since on the other hand I have a distinct idea of body in so far as it is only an extended being which does not think, it is certain that I, [that is to say my soul, by virtue of which I am what I am], is entirely [and truly] distinct from my body, and that it can [or be] exist without it." (Descartes, Meditation, page 74)

Descartes was trying to say the mind could exist without the body, hence the ability to transcend into heaven. In this plain of reality the two work together to form a person. If the mind is not well, the physical being will be impacted. Just like diseases that ravage the body may also have a profound impact on the mind. You cannot treat one without addressing the other. Hard sciences have a difficult time accepting the metaphysical idea of a soul (mind), which is separate from physical or empirical body. In his book Descartes' Error, neuroscientist, Antonio R. Damasio is trying to debunk Descartes’ understanding of the mind.

"(1) The Human brain and the rest of the body constitute an in dissociable organism, integrated by means of mutually interactive biochemical and neural regulatory circuits (including endocrine, immune, and autonomic neural components); (2) The organism interacts with the environment as an ensemble; the interaction is neither of the body alone nor of the brain alone; (3) The physiological operations that we call the mind are derived from the structural and functional rather than from the brain alone: mental phenomena can be fully understood only in the context of an organism's interacting in an environment." (Damasio, page xvi)

Damasio's claim is that since the brain and the body cannot exist without the other, then it is kind of silly to have this argument. While Descartes wanted a solid division between the mind and body, scientists such as Damasio wanted to definitively say that no such dualism exists. Even if you do not believe in a "soul," Descartes' idea of the mind/body debate cannot be easily dismissed as not relevant or important. The American philosopher John Searle describes this age old debate.

"On the one hand, there are mental things, such as our thoughts and feelings; we think of them as subjective, conscious, and immaterial. On the other has, there are physical things; we think of them as having mass, as extended in space, and as causally interacting with other physical things. Most attempted solutions to the mind-body problem wind up by denying the existence, or in some way downgrading the status of, one or the other of these types of things." (Searle, page 14)

The body and mind need different things to address the disease of depression. While medicines may address the physical aspects of the disorder, there is a second part (that Descartes, Damasio, Searle all agree) which is an understanding where you are at in your cave. All the pills in the world will not help you with becoming fully engaged with the world. The mind (not just the physical brain) has to address the issues that life presents.

There is something more to being human than just mechanical processes, there is an awareness of self. Searle highlights this point, "The most important of these features is consciousness. I, at the moment of writing this, and you, at the moment of reading it, are both conscious" (Searle, page 15). To realize consciousness is a metaphysical, not an empirical operation. The medication will not take you out of the darkness, addressing the chemical imbalance will only start to illuminate your cave. But the individual suffering from depression has to have the courage to move out. Not unlike when we were children starting to engage the world, there is a learning process that each person goes through. As we grow older each person has the fortitude to challenge the images in front of them, but they have to be open to taking that step. Socrates thought the ability to learn is universal trait within all humans. "But our present discussion, on the other hand, shows that the power to learn is everyone's soul" (Plato, page 190). With the right tools, environment and willingness everyone has the power to learn through their depression.

What I am searching for is access back to my identity, as Descartes would say, “I know that I exist and I am seeking to discover what I am, that "I" that I know to be" (Descartes, Meditations, page 26) Too often the "I" is not clear and being in the darkness of the cave there is no chance of seeing myself in the light. As I move up the pathway, the pain of stepping into the light (addressing the issues) at first it feels as if it is infinite even though it is finite. There is a level of comfort staying with the known, even if the present reality is not fulfilling. It takes a measure of courage to begin the journey that for me will last the rest of my life.

There are treatment protocols that support the idea of looking internally for the causes of depression and have shown to be effective in helping patients by itself or in conjunction with medication. Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), was developed by Dr. Allen Beck in the 1960s. It is a process in which client, with their therapist, work together to find the root cause of the depression. For some, depression creates a perception that everything in the world as bad. CBT is designed to help the patient gradually illuminate the darkness by changing the messages that they tell themselves. In an interview with Judith S. Beck, PhD., director of the Beck Institute explains the process:

"Beck says automatic thoughts "may have a grain of truth. But," she adds, "the depressed person distorts or exaggerates the reality of the situation." This negative distortion helps fuel the depression.

With cognitive therapy, a person learns to recognize and correct negative automatic thoughts. Over time, the depressed person will be able to discover and correct deeply held but false beliefs that contribute to the depression.

"It's not the power of positive thinking," Beck says. "It's the power of realistic thinking. People find that when they think more realistically, they usually feel better."

Cognitive Therapy for Depression: How It Works

Cognitive therapy posits that most problems have several parts. Those parts include:

• the problem as the person sees it
• the person's thoughts about the problem
• the person's emotions surrounding the problem
• the person's physical feelings at the time
• the person's actions before, during, and after the problem occurs

The way cognitive therapy works is a patient learns to "disassemble" problems into these various parts. Once a person does that, problems that seemed overwhelming become manageable." (Hoffman)

CBT helps the patient break down the problems into manageable pieces. There is an old saying, "How do you eat an Elephant?" The answer is one bite at a time. The idea is to reduce the size of the issue to be addressed by creating small steps. That way the individual can establish a consistent pace which will begin to bring light back into their life. To get to the "I", I have to take a journey into my own soul, but I cannot take that trip if I believe that the obstacles in front of me are impassable. To end this discussion I would like to introduce the story about a young Ojibway boy (Mishi-Waub-Kaikaik) on a vision quest.

"Instead, the fear had come from within himself, from within his spirit. And Mishi-Waub-Kaikaik ranged within his own soul in quest of his fears. He discovered things that he had not known because of his preoccupation with the activities of man and the immediate and concrete world around him. He discovered things that would be hidden to others unless he revealed them. When he began to understand these things, Mishi-Waub-Kaikaik felt better." (Johnston, page 47)

Part of the purpose of the vision quest is to gain spiritual guidance which will lead the quester to find the meaning and purpose of their life. Mishi-Waub-Kaikaik had to look within his self to find the answers and source of his fear; it was through this process he came to know himself as a human. Even though the vision quest ends with a solo event, the preparation for it involves several people. The parents, tribal elders, peers and Shamans all help young Mishi-Waub-Kaikaik prepare for his journey. This same group is there to help the quester understand what they have experienced. Just like any therapy program there are several people who are there to support you. In the end the quest is your own.

Figure 6

A Life-Long Commitment

Understand this is not a one and done experience, mental well being is a lifelong process. For me this is still an ongoing adventure, I am exploring the depths of my fear that holds me prisoner. Just like my cancer, I have to be aware of my depression so it does not rule my life. Therapies such as CBT have been shown to be effective in managing and preventing relapses of depression. But, is incumbent on me each day to have the courage to face the world. I know that there will still be bad days, but if I look for one thing that is good in my life, I can build the rest of the day upon that. The morning I was seriously contemplating taking my own life, I had trouble finding that one thing.

Many times in this piece I have used the term "courage" to begin the journey back into the light. That does not mean that some are weak or a coward for not moving. They are not at a place that will allow them to proceed. It could be that the physical part of their condition is so out of balance that prevents them from working on the soul. Even if help is asked for, there is no guarantee any will be there that works for you. A recent article written by former Marine, describes his frustration when he was seeking help for depression and Post Traumatic Stress Disease. He was reluctance to reach out for assistance, because he blamed his pending discharge from the military on asking for aid. "The way my leaders had treated me tore me up on the inside, and their words haunted me. They had convinced me that I was not a Marine in pain, but someone looking for free benefits from the Department of Veterans Affairs. At work, at home, in bed, all I could think about was how my career in the corps had ended in such a terrible, tasteless fashion, with my peers and leaders turning their backs on me because I had enrolled in treatment" (Brennan). Two days before his retirement, the loss of identity and the lack of support drove him to attempt suicide. After a forced three day stay at a psychiatric facility he concluded, "I had wasted three days – three days that convinced me I would never ask for help from someone never again" (Brennan). Too often the first time or several times a person seeks out help, none is given and the darkness grows deeper around them. The story of this Marine has been told by many other veterans, but the phenomenon is not just limited to former or current service members. It is a tale that I have heard from many people seeking help and I have felt the same way on numerous occasions. There is a feeling that the mental health system in this country has failed them. The problem is that we live in a cookie cutter world; our society likes answers to fit neatly into a box. Combating mental health issues does not have a predetermined solution. The trick is finding the resources that work for you and being open to receive it.

I cannot give you a step by step road map out of your cave. Depression, like my cancer, is a personal and individualized disease. That does not mean you are alone, but the path out has to be your own. The only steps that I can offer are:

1) Recognize you are in a cave.
2) Understand your condition.
3) Seek help.
4) Work at getting back into the light.

If these four things are not done then all the medication and counseling in the world will not help you escape from the darkness. Item 1 has to be first, no one else can tell you where you are at, and if you do not recognize the darkness then you will block yourself from the light. Items 2, 3, and 4 can happen in any order. To begin my journey out of the cave. After I acknowledged where I was, I gave myself permission to be human. Before I could work my way up the path, I had to learn how to walk again by taking small steps. So each day I look for that one thing that makes it all worthwhile. Once found it then I can build my day around it. If it cannot be found I know I am in trouble and to seek assistance. While I am not completely out of the cave yet, I know that I am in there. This was the start of working my way out. While writing about my depression, I am not looking for your sympathy or pity. I am going through this exercise, because it is through writing that I come to understand the world and myself, so it is a part of my therapy.

Figure 7

Final Thought

As an end note, maybe quoting philosophers to gain an understand depression is not such a good idea. Of the four philosophers cited in this work, three had major personality issues. Socrates was an anti-social SOB with suicidal tendencies; he basically forced the state to euthanize him. Descartes was constantly on the move, not telling family or friends where he was. In the end he created a self-imposed exile. As biographer Desmond M. Clarke observed, "He had become [by 1638] a reclusive, cantankerous, and oversensitive loner, who worried incessantly about his place in history and the priority he claimed for various discoveries" (Clark, page 180). Finally the noted philosopher and psychologist George Stuart Fullerton committed suicide at the age of 66 after a disease left him an invalid. (John Searle is still alive so no one has dug up any dirt on him yet.) I bring up this last point for a couple of reasons. First of all, I love the irony of it. But more importantly, it highlights the reality that anyone is susceptible to depression, and if left unattended can have a devastating impact on a person's life. Finally who is better suited to talk about depression than the person who has lived it?

References

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Bowers, Elizabeth Shimer. Medically reviewed by Farroks Sohrabi, MD. Countering the Social Stigma of Depression. Everyday Health. http://www.everydayhealth.com/health-report/major-depression/facing-social-stigma-of-depression.aspx. August 15, 2012. (accessed September 22, 2013)

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