Am I Really Guilty? Am I Indecisive?


Depression, the illness, runs in our family, There! I've said it, and it wasn't easy. Of the three generations now living, five members have had it and three of the youngest are now under treatment. We think it occurred, undiagnosed, two generations back beyond us, making five, in all.

Thankfully, we believe that with the national free screening to be held tomorrow, thousands of others suffering from this ailment, which can cause despair, will be discovered and helped. As noted in Parade magazine, last year 24,000 were screened; this year as many as 50,000 are expected.

In our cases, diagnosis has sometimes been made difficult because of the sufferer's unwillingness to admit the possibility of having a "mental illness," a misnomer for what doctors now call a "mood disorder." As William Styron says in his eloquent memoir, "Darkness Visible," "the mind announces . . . that it is the body with its perhaps correctable defects -- not the precious and irreplaceable mind -- that is going haywire."

Of the depression victims in our family, all but one have college degrees. We have professions, talents in poetry, drama, the arts. We live mostly in the "irreplaceable mind." And in that we have much in common with many famous sufferers from depression: Lincoln, Hemingway, Van Gogh, Camus, Plath, Sexton, Styron. . . .

Prestigious company, you would say. Yet the weight of social bias, a bias born of ignorance, has prevented some of us from admitting this fellowship. Light being shed by publicity surrounding the national screening may begin to dispel the shadowy aura of the term "depression."

This screening at hospitals and other sites is of utmost importance for other reasons. One, it will bring help to thousands of people who are miserable but do not know why. Two, it will reveal that numerous physical symptoms which are running up the national health bill in futile physician-patient searches for the cause are actually brought on by brain chemistry gone awry. Now there are chemical, that is to say medical, remedies for the condition.

Among my own family, we have made visits to emergency rooms, neurologists, gastroenterologists and other specialists, including acupuncturists, in a search for help -- or at least an explanation of why we feel tired and unwell so much of the time. Of course, it was necessary to have tests and examinations in order to eliminate physical causes. But once family members are diagnosed with depression, we learn of a wide array of therapies and medications from which the doctor can choose. At present, three members of our family have been prescribed three different medications, one has gone off medication and one is in therapy.

We each know that from time to time we may need more help. In order to get help we have to recognize the symptoms, and we realize that self-education about the ailment is necessary.

Fortunately, numerous illuminating articles and books are published. One of the best books is "Depression: the Mood Disease," written by Francis M. Mondimore for the lay person, recently published in its second edition by Johns Hopkins University Press. It is a hopeful book, including the latest ideas about diagnosis and treatment.

Diagnosis, of course, is the first step. But omitted from the various self-tests published as a preliminary to the national screening are two questions Dr. Mondimore -- and we -- think should be primary. One is, "Do you feel guilty?" Furthermore, "Do you dwell obsessively on your supposed guilt?" And, "Are you REALLY guilty?"

If Vincent Foster had analyzed his feelings this way, he might have realized he had an officeful of subordinates in the White House whose bungling was more responsible for some of the unfortunate decisions than he was. Of course, he would have needed help to see this -- obsessive thinking is not easily diverted.

Another question we'd suggest -- and it is also on Dr. Mondimore's list: "Are you indecisive?" Of course, most people have had times when it was hard to decide something. But, "Are you tortured by indecision?" To escape, "Do you often make a wrong decision?" This can be fairly minor -- one of us sometimes buys and charges a number of items that she later must return as inappropriate, too expensive or just plain not needed. But one of our male members suffers this torment in a worse way.

Often the indecision concerns matters most people would not give more than a moment's thought to: Shall I read a book or watch TV? Should I do the laundry or vacuum the house? Shall I take the kids to the zoo or play ball with them in the back yard? We call that "dithering," swinging back and forth when we should be able to tell easily which we want or need to do. The more we dither, the more likely we are to flop down and do nothing, the more futile we feel and the more the depression deepens.

Anyone may have a laundry list to check symptoms by, but these two are unlike the published fatigue, insomnia and weight loss or gain, which can have purely physical causes. Asking yourself if you feel guilty much of the time, and if it is often very difficult to make a decision even in minor matters, can clarify whether you may be suffering from depression and whether you should take advantage of the free screening program tomorrow.

Depression is a serious illness, sometimes leading to complete breakdown -- we've had three of those -- followed by hospitalization, and even sometimes leading to suicide, which we've been brushed by but have escaped. This free national screening can save many people from having a serious, untreated illness and undoubtedly will save many lives. Could one be yours?

Eileen Tarcay is a Baltimore writer.

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