Depression and Suicide: Diseases or Choices?

The recent death of Robin Williams, an actor and comedian whose performances I enjoyed in a number of films, but particularly in What Dreams May Come, has re-spawned a not so great debate over whether depression is a disease or a choice.  After Matt Walsh took the choice side in that debate, many other argued strongly for the disease side.  While his entry on the subject has more nuance than many people would like to give him credit for, I wasn’t entirely happy with the idea that a depression-fueled suicide is a choice in the way that we usually understand it.  Nor was I happy with the opposing claims that it’s just a disease, that our choice is not involved in depression.

My own experience with depression and suicidal tendencies was that it sapped my ability to make a choice in the fully volitional way I can make choices today.  A choice under the influence of depression was a somewhat different animal; like an animal I felt as if I were stuck in a corner with no escape and no good options.  Fight or die seem to be the two options on the table when you believe that is your situation.

My own experience was that depression was not a choice; it was hundreds, perhaps thousands of small choices.  Every moment that we choose to focus on those things that bother us and fail to balance it with things for which we are grateful, we take a small step toward depression.  Once a habit of keeping a consistent focus on the negative to the exclusion of the positive is established, those little choices become so easy.  That indulgence in our negative event bias becomes our modus operandi and we succumb to the drowning of our psyche in the darkness that is all we have allowed ourselves to see for most of our day.

As we make these choices, our bodies do what they are supposed to do and engage our problem-solving capacities fully.  We turn inward, focusing on the problem of our darkness, increasingly unable to solve that problem as we spend even more time within that darkness, merely exacerbating the problem.  The brain tries to marshal resources to solve the problem, but in so doing it perpetuates the problem to be solved.  Our brain chemistry inadvertently becomes the enemy.

To deal with depression, we have to make a choice.  And then we have to make another choice the very next moment.  Every second becomes a battle for the choice to live and to embrace the joy in life.  Just as the journey into depression is the journey of hundreds or thousands of steps, so to is the journey out of depression.  We improve ourselves one difficult, painful decision at a time.

I’m glad I made that journey back out of depression, and I hope many others make it as well.  Robin Williams didn’t make it back from that journey, but I hope that his choice led him to what dreams may come during our final rest, and I hope that they are the best dreams he has ever had.

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