What it is that Grips Us: A Series on Depression and RA

When melancholy sets in, a kind of invisible but thick and heavy fog invades the heart, envelops the body, constricting its very core. All we feel is this constriction, this haze around us. We don't even understand at first what it is that grips us. — Aleksandra Solzhenitsyn, The Cancer Ward

Plastic medical tubing hung in spider webs, crisscrossing the gap between the hospital bed where my father lay, eyes closed and nearly lifeless, and the whirring dialysis machine purging the toxicity from his blood. In the middle of the night, red eyed and lost in the labyrinth of a mental encasement, the agony I felt at the sight of my father finally pierced the surface of my near catatonic stupor. Unsure if he could hear or understand me, I lowered my head and whispered close to his ear, "I have always loved you, though for years we hardly talked. Please don't go like this. Not like this." The phone call from my mother earlier that evening was brief and to the point: "Your father is in the hospital. He swallowed all of his medications. They don't know if he will make it."

My grandfather spent the majority of his adult life institutionalized, eventually released near the age of retirement to live out his final years tucked away in his home and distant from all who hardly knew him. My great grandfather is even more remote and haunting. I was told that he hung himself from the rafters in his basement. Beyond these sparse and harrowing details, I know nothing of these men whose name I carry. A pervasive darkness seems to have risen from the depths of time to lodge itself permanently in our family tree, blotting out the stories of lives lived that otherwise would have passed through the generations.

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My foray into knowing more about mental health

I came to the study of mental health in the same way many people stumble upon their academic interests; I observed my surroundings and was dissatisfied with what I understood. Tempestuous and gloomy emotions seemed to infect my family. The suffering extended beyond our home. Two of my close friends left this life by their own hands. When I think of mental health, I see both the system of knowledge, and a torrent of haunting images.

In clinical psychology, the subjective, the cultural, the historical, the biological, and the genetic come to bear on a single subject. Something like depression is in many ways abstract. Boundaries can be drawn around it, circumscribing it in clinical terms and formulating ways of talking and communicating about it, but there remains the difficulty of it being a subjective personal experience embedded in many different contexts and layers. Nevertheless, we must do our best to encapsulate it in an objective and rigorous manner. Despite the increased understanding of the neuroanatomical, neuroendocrinological, and neurophysiological correlates of major depressive disorder, there is no laboratory test for it. Diagnosis requires a blend of self-report, observable behavior, and clinician interpretation, with consideration for family history, cultural factors, severity, duration, functional consequences, and individual case history.

Emotional pain and suffering in various forms are inherent to human experience. "To be melancholic or depressed is not necessarily to be mentally ill or in a pathological state," writes anthropologist Francis Zimmerman from the School of Advanced Studies in the Social Sciences, Paris. "On choosing to focus on melancholy as a clinical condition, we are faced with the issue of whether it is a disease or some other sort of assemblage of signs and symptoms."¹ We must also ask, what is pathological mental suffering and what is normal? There is a difference between swimming in the tides of life, occasionally tossed by storms of grief, melancholy, loss, and sadness, and drowning in unseen currents that pull one into the depths of misery for seemingly endless periods of time. It is far more difficult to navigate this ocean of mental life than one might at first expect. There are no easy answers. There are guidelines, however, as we will see in section four of this series.

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I completed a bachelor degree of anthropology in 2013, focusing most of my studies on the culture of mental health and systems of care for psychopathology. Thereafter, I entered a master's program in mental health counseling but soon found myself more at home in research and theory than in one-on-one therapy. I chose to graduate with a Master of Science in Applied Psychology in 2016 and to switch fields to Health Behavior and Health Education. In the fall of 2017, I begin PhD training in the School of Public Health at the University of Michigan and have a joint appointment in the Populations Studies Center at the Institute of Social Research.

"Ensuring quality of life" a father to a child with irritable bowel syndrome once told me, "is the most important aspect of care." Living with rheumatoid arthritis, I wholeheartedly agree. Yet, It is hard to have quality of life when pain and disease ravage the body, therefore medical and biological science are of the utmost importance in the treatment of illness. It is likewise hard to have quality of life if the social and psychological aspects of a disease keep one submerged in the throes of isolation, sadness, anxiety, fear, hopelessness, and grief. Researching the efficacy of methods and interventions to improve quality of life for those with chronic illness is my main drive in the public health field.

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Chronic illness and depression

"I just don't get it" a man recently confided in me while discussing his recent engagement to a woman living with an autoimmune disease, "With chronic illness, you get double stigma. They call you weak for being sick, and weak for being depressed about it. It's a shame people are so out of touch. We need more awareness." His offhand but piercing comment spurned this series that is a mix of personal experience and the academic literature of psychology and mental health.

The series is a collection of essays. It addresses a range of topics on depression and living with rheumatoid arthritis. If the reader has any specific questions or topics of curiosity related to the subject they would like to see covered, please comment below or on the site's Facebook posts. Likewise, if you wish to follow this series, please join our Facebook page and/or become a member of our site www.rheumatoidarthritis.net.

Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or the National Hopeline Network at 1-800-SUICIDE (1-800-784-2433). These toll-free crisis hotlines offer 24-hour suicide prevention and support. Your call is free and confidential. To find a suicide helpline outside of the US, visit IASP or Suicide.org.