by Alfred, Lord Tennyson

Sunset and evening star, 
And one clear call for me! 
And may there be no moaning of the bar, 
When I put out to sea, 

But such a tide as moving seems asleep, 
Too full for sound and foam, 
When that which drew from out the boundless deep 
Turns again home.

Twilight and evening bell, 
And after that the dark! 
And may there be no sadness of farewell, 
When I embark; 

For though from out our bourne of Time and Place 
The flood may bear me far, 
I hope to see my Pilot face to face 
When I have crossed the bar.

‘It matters not what you think,’ Hitchens wrote, ‘but how you think.’ Many assume Hitchens was such a pugnacious debater and polemicist because he was temperamentally inclined toward rhetorical combat. As Amis put it: ‘He likes the battle, the argument, the smell of cordite.’ This is true, but another source of Hitchens’s ferocity in print and on the stage was the fact that his positions were natural extensions of his core principles. It is easier to hold and defend a controversial position when you have internally coherent reasons for doing so.

What you think – or at least what you purport to think – tends to matter more than how you think these days. The best path toward a lucrative career as a political or cultural commentator is the development of a brand that serves a particular set of information consumers. There are plenty of fiery pundits and Twitter warriors out there today, but how many reliably outrage and alienate their own ‘side’? How many are willing to publish an article or a podcast that will result in a loss of followers and prestige within the group?

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“After I recovered in 2006, I was healthy for ten years. I thought I had this depression thing whipped. I went on to have a successful and demanding career. First, I was the chief health lobbyist for AARP during the passage of the Affordable Care Act. Then, after a stint at the Department of Health and Human Services, I became the executive director of the White House Conference on Aging under President Obama. When applying for security clearance for the White House job, the questionnaire asked whether I had been hospitalized for a psychiatric condition in the past seven years. Luckily for me, it had been more than seven years since my hospitalization when I applied, but I have friends with mental health conditions who have been denied security clearance. Even worse, I know people who refuse to be treated for their mental health conditions because they fear it will negatively affect their security clearances and, thus, their ability to qualify for high-level positions.“

“Over my career, I have received recognition for my hard work and dedication to health and long-term care policy. Close friends have told me that they are surprised to learn that I have ever suffered from depression. I’m friendly and approachable—I don’t meet the stereotype associated with people living with depression as sad, angry, and withdrawn.“

“In 2016 I left the White House to join a small nonprofit organization. I loved working in government, but as a political appointee, many friends and colleagues counseled me to leave so that I could return to a government position if Hillary Clinton was elected. Similar to 2005, I was burning the candle on both ends: I was writing countless grant proposals, overseeing a large team, and volunteering for many social causes and campaigns. The 2016 election was much more polarizing than any I’ve experienced. Most people did not expect Donald Trump to win—including me. The election results caused me to crash after months of building anxiety.”

“Once again I spiraled downward. I couldn’t get out of bed. I couldn’t work. I had thoughts of harming myself. This time, my husband urged me to start ECT much sooner in the cycle, and once again, it worked. Within a matter of weeks, I was back at work, pretending nothing had happened. I kept pushing myself harder to show everyone that I was “normal.” I thought I had a pattern: I would function at a high level for many years and then my depression would be triggered by a significant event. I thought I’d be healthy for another ten years.“

“But I started feeling signs of depression again only a year later. From my health services research, I knew that my diagnosis, major depressive disorder, can be triggered by a major event that prompts a person to recall previous traumatic experiences (for instance, my mother’s death when I was very young). During an episode, I am unable to function and have so little energy that even small tasks take extra effort. Many others suffer from persistent depressive disorder, which refers to a low mood that lasts for at least two years. Many people with a persistent depressive disorder are able to function day to day but feel low most of the time. I also learned that depression is highly recurrent, with at least 50 percent of those who recover from a first episode having one or more additional episodes in their lifetime, and 80 percent of those with a history of at least two episodes having another recurrence, according to the literature. So I know that this illness may be with me for a long time.“

Not Alone

“In 2018 two celebrities, Kate Spade and Anthony Bourdain died by suicide in close succession. Several news articles described how selfish they were for taking their own lives. Journalists questioned how someone who was so successful and admired could do this. In reading these articles, I knew that the writers didn’t really understand depression. They didn’t get how it takes over your mind and distorts your thoughts. Depression convinces you that everyone around you would be better off if you were dead. You are a burden, a disappointment, and incapable of functioning. In addition, many people judge those with depression. If they would only exercise more, meditate, see a therapist, take their meds, and so on, they wouldn’t be depressed. But I did everything that was recommended. I exercised nearly every day. I meditated and saw a therapist regularly. I took my antidepressants. Still, I got depressed again. And I’m still struggling to accept the fact that it is not my fault.”

“I’ve observed that many high-achieving people experience bouts of major depression, but we generally hide it from others. Our expectations for ourselves are high, and when we can no longer perform at such intense levels, depression convinces us that we are failures and worthless. So, in the wake of these deaths, I decided to speak out.“

“I share my own experience in the hope that I can help people better understand depression and—more important—give those living with depression hope that they can recover. I also aim to raise awareness of stigma and recovery surrounding mental health issues. As part of my efforts, I work as a network leader with the Stability Network, a growing movement of people living and working with mental health conditions. We share our stories to inspire others and change how people think about mental health. Our message is one of hope and recovery.“

Nora Super is a healthcare practitioner who has decided to share her longtime battle with depression. I applaud her for being open about this mental health problem affecting millions of people worldwide. This is how it began:

“I had my first episode of major depressive disorder in 2005 at the age of forty-one. I had been under a tremendous amount of stress, having just gone through a divorce. I was also going to grad school while simultaneously working full-time and raising two young daughters. I wasn’t sleeping well and had been feeling increasingly anxious and sad. Then Hurricane Katrina hit. Although I had lived in the Washington, D.C., area for more than twenty years, New Orleans is my hometown—I still have relatives who live there and great affection for the city and its unique culture.”

“I was devastated to see people suffering in squalid conditions in the Louisiana Superdome. I could not fathom why we could not get water and food to people in an American city when we could airdrop necessities in war-torn countries across the globe. I felt as if my city had been abandoned. I couldn’t think straight. My thoughts went round and round in a spiral. I had less and less energy and was unable to concentrate on my work. Eventually, I couldn’t get out of bed in the morning, and it took a tremendous amount of energy just to take a shower. My distorted mind convinced me that my family would be better off if I were dead, and I came up with detailed plans for how I would end my life. Over the course of six months, I was hospitalized five times”.

“I tried a variety of antidepressants, gradually increasing the potency of the drugs. I saw a therapist and psychiatrist regularly. I participated in cognitive behavioral group therapy. Still, I sank further into depression. Finally, a physician friend recommended electroconvulsive therapy or ECT. This therapy had gotten a bad rap over the years, especially in One Flew Over the Cuckoo’s Nest, which portrayed it as a punitive, painful treatment. Mental health professionals told me stories about how, in the past, ECT often had been given to patients in psychiatric wards without their consent, without anesthesia, and with severe adverse effects. But others told me that it was now safe and extremely effective.”

“I was reluctant. However, as I had been unable to work for more than six months and knew that my family was deeply worried about me, I decided to give it a try. It ended up saving my life.”

“My ECT was performed as an outpatient procedure, as is generally the case. The actual procedure took about five minutes. I received general anesthesia and muscle relaxers, and electrodes were placed on my scalp. Low-intensity electrical impulses were then emitted to create a brief, controlled seizure that affected the neurons and chemicals in my brain. Treatments are generally given three times a week until the symptoms are in remission, and they may be spaced out over months as maintenance therapy.”

“It was as if my brain was jump-started. It made me feel better almost immediately, and I felt nearly recovered by the fourth treatment.”

“ECT is one of the most effective treatments for severe depression. Yet this is the first time I’ve publicly admitted that I’ve received the treatment because of the stigma associated with it. Mental illness is stigmatized in general, and ECT is so stigmatized that many people are afraid to even mention the treatment that helped them get better. Why are those of us who’ve received it so reluctant to talk about it? No one is ashamed of receiving chemotherapy or immunotherapy. Yet in addition to the negative media impressions about ECT, mental health professionals still portray it as a “last resort” for those with “treatment-resistant” depression. I am left feeling as if it’s my fault that I need it—and ashamed for being suicidal—when I should be shouting to the world about the benefits, for me, of this treatment.”

Nora Super is a healthcare practitioner who has decided to share her longtime battle with depression. I applaud her for being open about this mental health problem affecting millions of people worldwide. This is her story:

“In February 2021 I checked into a psychiatric ward. After I answered yes to the following questions, the emergency department doctor admitted me: Do you have little interest or pleasure in doing things? Do you feel bad about yourself or that you are a failure or have let yourself or your family down? Do you have trouble concentrating on things such as reading the newspaper or watching television? Do you have thoughts that you would be better off dead or hurting yourself? Yes, yes, yes, and yes.

After several weeks of crippling anxiety and depression, I was back in a place I dread more than any other, but I know it’s the safest place for me to be when I feel that low. This wasn’t the first time I’d been there, and unfortunately, it probably wouldn’t be the last. That’s the bad news. The good news is that I recovered and expect to recover again.”

“Think of anxiety as a normal reaction to a situation where people feel pressured and, to some degree, fearful because there’s an unknown factor or a perceived danger,” says Michelle Alejandra Silva, PsyD, assistant professor of psychiatry at Yale School of Medicine and director of the Connecticut Latino Behavioral Health System.

“But it becomes clinically concerning when the feeling persists even when the threat is not there, and when it begins to interfere with day-to-day functioning and relationships.” 

Any single cause or the combined weight of numerous factors can lead to an anxiety disorder. Anxiety triggers can be obvious, like losing a job or house, or more difficult to pin down, such as traumatic events from one’s past.

“Understanding context is key,” Silva says. “I try to do a thorough assessment of patients’ current environment and circumstances to understand their feelings and experiences within their reality. For instance, many of my clients are dealing with poverty or immigration-related stressors.” 

DELIGHTFUL BREAKFAST

DELECTABLE DINNER

YUMMY MEXICAN SALSA IN “MOLCAJETE”

WHEN IT’S COLD AN SCRUMPTIOUS CHICKEN SOUP WITH VEGETABLES IS IN ORDER!

Whoever is doing her work these days is not the best plastic surgeon in the business. Maybe Madonna was never going to age naturally and gracefully, but there is a massive gap between “aging naturally” and whatever this is. As I do find it sad.

I’m not criticizing Madonna for changing her look, because she has that right. For me, it’s more sadness that she’s just taken it way too far, deep into uncanny valley territory. No lie, that picture made me gasp out loud. She looks like Jigsaw.

Sunset and evening star,
And one clear call for me!
And may there be no moaning of the bar,
When I put out to sea,

But such a tide as moving seems asleep,
Too full for sound and foam,
When that which drew from out the boundless deep
Turns again home.

Twilight and evening bell
And after that the dark!
And may there be no sadness of farewell,
When I embark;

For though from out our bourne of Time and Place
The flood may bear me far,
I hope to see my Pilot face to face
When I have crost the bar.

Alfred Lord Tennyson