In the fifth of a series of lectures sponsored by the Block Island Mental Health Task Force, on October 25 island resident Michael Brownstein addressed an audience of about 20 on depression and bi-polar disorder. Drawing on biblical and literary references, Brownstein entitled his talk, “Depression: ‘Thou hast laid me in the lowest pit, in darkness, in the deeps.’”

Brownstein is a physician and scientist emeritus of the National Institute of Health and a former director of the genetics laboratory the National Institute of Mental Health. He is currently engaged in pharmaceutical research directed specifically at the development of drugs for cancer and depression.

Drawing the subtitle of his talk from Psalm 88 of David, Brownstein pointed out that the passage illustrated the very depths to which depression brings its sufferers, depths which most of us cannot understand. Though most Psalms conclude in a fairly optimistic way, he said, “Psalm 88 ends in the pits; it doesn’t get any better. It is a very depressing psalm.”

Distinguishing clinical depression from the more familiar type known to most of us when we’re grieving a loss, such as that of a loved one, Brownstein pointed out that normal grieving has a time limit. People empathize with those who mourn, he suggested, while depression is more difficult to understand.

Referring to Walt Whitman, who documented his days nursing wounded veterans of the Civil War and “the toll of the war on young soldiers,” Brownstein noted the great American poet was fundamentally an optimist. He quoted Whitman’s words for those on the brink: “Whoever is not in his coffin and dark grave, let him know he has enough.”

But for Emily, a young woman whose YouTube video Brownstein shared with the audience, being alive is not enough. She speaks directly to a camera, which captures her depression. She is a beautiful woman, with long blond hair whose soulfully sad eyes are on the verge of spilling over in tears.

She depicts a depression that’s come upon her and assaulted her unabated for three weeks and that fills her with self-hatred and dread. “I don’t know why, but I hate everything about me, my body, myself. I don’t care about my life.”

‘I don’t want to keep living like this’

She indicates she’s been on Paxil, but without noticing any changes, and says she was recently switched to Effexor and Klonopin (the latter is used to treat anxiety). However, what is clear is her uncertainty about the effectiveness or non-effectiveness of her meds, and she doesn’t know what to do. She says, “I don’t want to put this out on the Internet. I don’t want to keep living like this. It sucks!”

With all motivation gone, she can’t raise herself to care for anything — “not the food piece or the psych piece.” She goes on to describe that that very day she “hit rock bottom,” wanting to kill herself. She says, “I shoplifted a few things from Nordstrom’s and then when I was caught, I had a complete panic attack and ended up on the floor.” She says she’s spent the last hour cutting herself and taking diuretics.

Emily appeals directly to her audience not to disdain her, not to “do the rude thing and blow me off or be unkind. I need support right now.” Rather she says, “If you’ve gone through something like this and made it out... tell me. Tell me. I want to die. Tell me what to do.” She adds, “It seems to me that everywhere there is light and air and I ought to be happy.” But she could not be.

In discussing Emily’s plight, Brownstein says she embodies most of the symptoms of depression: ongoing sadness and crying; loss of interest in anything; weight loss, insomnia, agitation, feelings of worthlessness; difficulty thinking and recurring thoughts of death and suicide.

Loss of purpose and friendships

Referring to Emily’s point that her friends are tired of her and have drifted away, Brownstein again turns to Psalm 88, which reads, “Lover and friend hast thou put far from me.” In situations of loss, he says, “We gather with each other; we know we’ll get through.” For those going through depression, however, there is often an erosion of everything purposeful in life: loss of jobs and of friendships.

As to Emily’s cutting herself, Brownstein said, “Cutters say that it gives them some relief.” For a while they are able to feel pain, he says, when most of the time they cannot feel anything at all. Their despair is echoed, Brownstein says, in the lyrics “Hello, darkness, my old friend,” the opening line of Simon and Garfunkel’s iconic “The Sound of Silence.”

Another writer Brownstein refers to is William Styron, who chronicles his own struggles with depression in a book entitled “Darkness Visible: a Memoir of Madness,” first published in 1989. For Styron, the first signs of depression were a relentless insomnia and “a troubling sense of malaise.”

Grim statistics

Statistics on depression are grim, as Brownstein explained: “Ninety-five percent or 18.8 million American adults suffer from depression and only one-third achieve remission. Fewer than 25 percent ever receive treatment.” Acknowledging the difficulty in finding the right medication for treating depression, Brownstein said a few new diagnostic tools have become available to physicians and even to individuals undergoing the symptoms themselves.

One is called M3 — or My Mood Monitor — and studies have indicated is “good for identifying bi-polar disorder, depression and post traumatic stress disorder (PTSD).” Another such assessment tool is called the Patient Health Questionnaire, with nine questions. Though individuals may take these tests themselves, along with their assessments, they are also advised to see their physician, usually their primary care practitioner, in order to begin the process of finding appropriate treatment.

One of the advantages of taking the test is that it may help an individual understand feelings and symptoms that otherwise may seem mysterious and frightening.

Things that steal the mind

Brownstein distinguished between what is called uni-polar depression, and depression that is part of bi-polar disorder. Uni-polar depression is another term for major depressive disorder. Along with schizophrenia, these disorders are what Brownstein called, “Things that steal the mind.”

Going on to highlight the effects of bi-polar disorder, Brownstein showed another YouTube video, this time about Emanuel, who manifests a heightened manic stage — his speech comes so rapidly that he cannot utter words without stuttering.

Analyzing his own symptoms, Emanuel says, “I have no control. This should not be happening. I should be on medication. I want to go out and drive as fast as I can, want to dance. It’s hard to understand that this is actually happening to me. I want to go out and do something stupid. I have this energy. The more I do things, the more energy I have. This is not typically me.”

Throughout Emanuel’s tirade, he is self-aware. However, while hypo-mania might be acceptable to some extent — that is, with an individual “who is simply more talkative and more energetic than is considered usual” — Brownstein said the mania exhibited by Emanuel was more extreme. “And the persistence of mania,” he added, “can be very destructive.”

For bi-polar disorder, clinicians work, he noted, “to reduce the frequency of episodes.” In addition, researchers are trying to develop “more effective drugs freer of side effects,” he said, “and we need better diagnostic tools. We also need to listen to what people say and what they do.” He said that people needed advice about which drugs and therapies “have been shown repeatedly to work.”

Reached after the meeting, Brownstein advocates continuing genetic research because it “may reveal biochemical pathways that are abnormal in depression. This information, along with new functional imaging methods, may contribute to the development of new drugs.”

Noting “it takes courage for anyone with mental health problems to admit them,” Brownstein is hopeful that recent efforts by the Mental Health Task Force to establish a telemedicine link to physicians at Butler Hospital will be successful. He says people who seek such support will “now be able to interact with physicians on the mainland face-to-face and in private. I hope that folks who can benefit from care of this sort will avail themselves of it.”