My Skin’s On Too Tight

I hit rock bottom when I wept watching Xena: Warrior Princess. It was June 18, 2001. (I know because I just looked it up on IMDb.) I’d been a fan of the television series for years, in no small part because of lead Kiwi actress Lucy Lawless clad in leather. Now it was coming to an end. In the series finale, Xena is dead, and despite heroic but fruitless efforts to resurrect her, the warrior princess’s implied lover, Gabrielle, is left alone. The scene that got to me is the final one, with a long shot from the sky showing the latter standing solo on the bow of a ship sailing into some new unknown life. Alone. All alone.

My reaction was disproportionate to the cheesy made-for-syndicated-TV moment. But I could feel in my soul the heartbreak, loneliness, and loss that Xena’s best friend experienced. I cried at the thought of the two lovers separated — one dead and the other left to live on without her. I knew it was silly to weep at a fantasy TV show, but something deeper was going on inside me. Even though I was surrounded by people — my wife, my three daughters, my mother and brother, my friends, my coworkers — inside I felt so alone.

A few months later, after 9/11 and the additional sadness it brought, I finally went to a psychiatrist. He diagnosed me with major depression — the clinical kind — the one that goes way beyond just having the blues for a while.

I also had, and still do have, chronic pain syndrome, thanks to a rare genetic disease called multiple epiphyseal dysplasia (M-E-D) that causes my joints to deform, resulting in a constant grind when I move my body. I’ve been in pain all of my life, but as I’ve aged, it has worsened. Now, at 65, I hurt from head to toe. It wears me down.

Chronic pain and depression go hand in hand. According to a literature study published by the Journal of the American Medical Association (JAMA), patients in pain are more likely to be depressed than patients not in pain. At the same time, depressed people report more pain than people who are not depressed. In addition, it was reported that individuals with long-term chronic pain are three times more likely to be depressed than those without pain. The paper compared rates of depression in various settings and found, for example, that an average of 56 percent of patients at orthopedic or rheumatology clinics were depressed.

How do I describe what it is to be clinically depressed?

Let’s go to an expert first: According to the Mayo Clinic, “Depression ranges in seriousness from mild, temporary episodes of sadness to severe, persistent depression. Clinical depression is the more severe form of depression, also known as major depression or major depressive disorder. It isn’t the same as depression caused by a loss, such as the death of a loved one, or a medical condition, such as a thyroid disorder.”

That definition doesn’t capture the reality of depression as I felt it.

In November 1992, I happened to read an article in The New York Times Magazine about Frank Aller, a long-time friend of Bill Clinton’s, predating his presidency. Aller and Clinton were Rhodes scholars together at Oxford University in England in the ’60s. A few years later, in 1971, Aller shot himself in the head with a .22 caliber pistol in his hometown of Spokane, Washington. The article linked his suicide to his decision to avoid the Vietnam draft and talked about how it bedeviled him. But that angle didn’t capture the deeper reality of Aller’s life as a brilliant super-achiever who “took it all too seriously,” according to a friend. Though some in his circle speculated that he couldn’t live with being called a draft dodger, the women in his life presented a subtler picture that led me to think he had clinical depression.

In the article, there was a quote from Aller's friend Jan Brenning, who confessed she couldn’t figure out why Aller killed himself, but observed, “he was caught in skin that had gotten too tight.”

The idea of “skin too tight” has stayed with me through the decades since then. To me, it sums up what I felt at the worst of my depression, a terrible sense of being suffocated in my own body.

I make a distinction between psychological depression and physical depression. I am not a doctor or medical professional and am simply speaking from my own experience. I believe I am dealing primarily with physical depression, some malfunction in the brain that causes feelings of hopelessness and despair. Something about my body chemistry is off-kilter, perhaps due to my MED, and it caused such symptoms as an all-encompassing feeling of being trapped, unable to experience much joy, with persistent thoughts that all is not right with the world.

This is not to dismiss those who feel depression (a multifaceted word for sure) for any of a thousand other reasons, physical and psychological. Depression is so personal that it manifests itself in wholly different ways for different people.

Depression can be dealt with through medication, therapy, exercise, acupuncture, and other methods. I was lucky. After some trial and, mostly, error, my psychiatrist got me on an effective antidepressant. He warned me that these types of drugs work slowly, so I mustn’t be an impatient patient. That wasn’t the case for me. From the first day I took this new drug I felt better. It wasn’t euphoria. Rather, it was an absence of the crushing feeling of my skin being too tight that I’d experienced for so long. I also got relief by talking with counselors and by exercising as much as my chronic pain allows. (Remember: I am not a doctor and am not advising you to take any drug or supplement to deal with pain or depression. Always consult a physician about any treatment you are considering.)

Now, two decades later, most of my clinical depression is under control thanks to medication, but often my intractable chronic pain can make me feel hopeless, weary, and threatened.

My Skin’s On Too Tight

The notion of "skin too tight" sums up what I felt at the worst of my depression, a terrible sense of being suffocated in my own body.

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