The emotional pain experienced by a depressed person can easily rival the physical pain suffered by a cancer victim. The suffering of a depressed person is difficult for his healthy colleague to appreciate. Sometimes the complaints of the depressed seem absurd and childish. You may wonder whether the patient is behaving much like the "Princess and the Pea"--overreacting to subjective feelings which could not possibly be so terrible as the patient describes them.

I doubt that depressed patients are playing games with their friends and physicians.(1)

The following comparisons may make depression more vivid and understandable to the non-depressive. In 1972 I had a major surgical operation, a spinal fusion, serious enough to keep me on my back almost constantly for two months. The day of the operation was worse for me than most of my depressed days, made so by the fear that the operation might be disastrously botched and leave me permanently disabled. But though I was full of pain and discomfort, the first day after each operation (when I already knew that there had been no disaster) was easier to get through than were the run-of-the-mill days of my first couple of years of black depression, and was about the same as the average days in my later depression years.

Another example: A day in which a wisdom tooth was pulled had about the same pain content for me as a day in my later "gray depression" years. The nice side of an operation or of a tooth- pulling is that when you are already safe, though in pain and confined to bed or crutches for months, you know the pain will end. But my depression went on for month after month and year after year, and I became convinced that it would not ever end. That was the worst of all.

Here is another comparison: If I were presented with the choice, I'd choose to spend three to five years of that period in prison rather than live the thirteen years in the depressed state I passed them in. I've not been a prisoner, so I can't know what it is like, but I do know the years of depression and I believe that I'd make such a deal.

I refused to let myself do the pleasurable things that my wife wisely suggested I do -- go to the movies, take a walk on a sunny day, and so on -- because I thought that I ought to suffer. I was superstitiously operating on the nutty presumption that if I punished myself enough, no one else would punish me for my misdeed. And later on I refused to do these casual pleasurable things because I thought that I would be kidding myself by doing them, covering up the symptoms of my depression and therefore preventing a real cure--more bad depressive-type thinking.

During my first year of depression there was one good day. My wife and I went to visit overnight at a country shack with friends. In the morning when we woke in sleeping bags I heard a bird and saw the trees against the sky, and I felt exquisite joy of relief--the relief that one feels at the finish of a long exhausting ordeal of physical or mental work when you can at last rest, lightened of your burden. I thought, maybe it is over. But after a matter of hours I was again full of fear and dread and hopelessness and self-loathing. And even an hour of such relief did not return for perhaps another full year. (The next good moment was the night our first child was born, about three years after the depression began. Incidentally, I will seldom mention my good wife because it is not possible to do justice to one's spouse in an account such as this one.)

Though the pain grew less acute with time, and my outlook came to seem only a constant gray rather than totally black, after six to eight years of it I became more and more convinced that I would never escape. Such prolonged depression is medically unusual, and physicians can honestly reassure patients that they may expect relief within weeks or months, or a year or so at most, though the depression may return. But that was not the case with me.

For awhile I dreamed about entering a monastery, perhaps a silent monastery, where there would be no burdens or expectations. But I knew that I could not run away until the children would be grown. The prospect of hanging on for that long period of future depression depressed me more.

Upon awakening every single morning for all those years my first thought was, "All those hours! How am I going to get through them?" That was the worst moment of the day, before I could get my fear and sadness under conscious control. The best moments of the day were crawling into bed finally to go to sleep, at night or for a nap in the late afternoon.

You may doubt that I was really depressed for so long or that my depression was deep. How could anyone be continually depressed for thirteen years? In fact, there were hours when I was not depressed. Those were the hours when I was deep enough in my work and in creative thinking that I forgot about my depression. These hours happened almost every morning, once I had gotten myself started on the day, provided that the work I was doing was reasonably creative rather than just such routine work as editing or proofreading--and providing, also, that I was not overly pessimistic about the probable reception of that particular piece of work. This meant that for probably half the days during the year I had a couple of hours in the morning, and perhaps an hour late in the evening after I had a drink, when I was not consciously sad.

Only work helped. For a long time my wife thought that she could distract me with movies and other entertainment, but it never worked. In the midst of the movie I'd be thinking how worthless a person I am, and about the failures of all my efforts. But in the midst of work--and especially when I would have a beautiful hard problem to think through, or a new idea would come to me -- my depression would ease. Thank goodness for the work.