Ambushed

Dana Jennings, who blogs in the New York Times about his struggle with prostate cancer, writes today that he is "recovering well from an aggressive case of prostate cancer" and that all "physical signposts of health are pointing in the right direction."

Which would be fine, except that he is depressed. And feels ambushed.

This isn’t about sadness or melancholy [Jennings writes]. It’s more profound than that. Broadly, I have a keen sense of being oppressed, as if I were trapped, wrapped up in some thick fog coming in off the North Atlantic.

To be more specific, I’m exhausted, unfocused and tap my left foot a lot in agitation. I don’t much want to go anywhere — especially anyplace that’s crowded — and some days I can’t even bear the thought of picking up the phone or changing a light bulb. All of this is often topped off by an aspirin-proof headache.

The fatigue frustrates me most. When I envision myself it’s as a body in motion, walking or running, not foundering in bed. On one recent day, I slept till 10 in the morning — getting 11 hours of sleep — then took a nap from noon to 2. And I was still tired.

I’ve had occasional depression over the years, but nothing as dogged as this. When I first learned that I had prostate cancer, I wondered about depression. But after the shock of the diagnosis wore off, I was sharp and clear-headed. I wasn’t depressed as I went through treatment — surgery, radiation and hormone therapy. I was buoyed by a kind of illness-induced adrenaline.

Jennings' description resonates with me in two respects. First, it resembles my own experience of depression. With me the dominant symptoms are usually hypersomnia and fatigue. And he's not kidding when he says there are days when changing a light bulb seems impossibly hard; with me that's standard.

Sure, there's also a general sense that my life is awful and will never get better, but most of the time I'm able to dismiss that as the distorted thinking typical of depression. In and of itself it isn't bad. What sucks is the loss of productivity, so that even when I'm back to normal I feel -- accurately -- that I'm badly behind in my work. And if only two or three weeks elapse before the next depression, the biochemically induced sense of hopelessness is reinforced by an existential sense of despair. I feel like I'm in a ditch so deep I will never be able to claw my way out.

Second, it confirms something my therapist has told me for years: People who have experienced both cancer and depression often maintain that of the two, depression is worse. Of course, as Jennings' case indicates, it isn't an either/or proposition. For at least one cancer patient in four, it's a both/and.

Toward the end of his post, Jennings declares, "It’s harder to write about the weight of depression than it is to write about prostate cancer and its physical indignities. Cancer is clear biological bad luck. But depression, no matter how much we know about it, makes part of me feel as if it’s somehow my fault, that I’m guilty of something that I can’t quite articulate."

Of course, that kind of guilt has nothing to do with depression. It's an artifact of our culture. Physical illness okay (with some exceptions), mental illness not okay (with no exceptions at all).