My Top Books for Understanding Depression and Recovery – 1

Every list of top books on depression is highly personal, and mine may be more so than most. I’ve left out several of the standards you’ll find in other lists and added others that cover far more than this one condition because they’ve helped me make progress in recovery. They’ve deepened my understanding of healing and the sources of resilience that everyone possesses, however hidden from awareness they may be.

There are too many to cover in one post. These are the first five:

1. Healing and the Mind
2. Against Depression
3. Speaking of Sadness
4. Why Zebras Don’t Get Ulcers
5. Man’s Search for Meaning

There will be several posts in this series, and at least one will include the books you mention in your comments, along with your words about their personal significance.

1. Healing and the Mind by Bill Moyers

   This companion book to a PBS series of the 1990s is an excellent introduction to numerous forms of healing. Bill Moyer’s interviewing style lets 15 practitioners from many fields speak for themselves about the importance of community support, meditation, lifestyle changes, neuroscience, doctor-patient relationships and many others approaches. The one that was most helpful to me was the whole person healing practice of Rachel Naomi Remen.

   A physician who has lived most of her life with a debilitating disease, Remen believes that healing has to draw on the strengths of a person at all levels – physical, emotional, intellectual, spiritual, social. It requires an inner exploration and self-discovery that taps into the resilience needed to restore health. To achieve that empowerment, the fear that drains inner strength has to be ended.

   As she says, her form of practice doesn’t take the disease away. “It takes the fear away. And when the fear is taken away, people are empowered to deal with whatever they need to deal with and to seek and find meaning in the events of their lives.”

   Remen tells the story of a man who refused treatment because he felt that by accepting the need for it, he’d be surrendering authority over himself to the illness. He thought of the disease as a great black hole, and his fear of being pulled into it made him fight with all his strength. However, she says, “when he imagined himself letting go and being drawn into this hole, in its darkness he found a profound healing.”

   Too often I hear people talking about “letting go” as a simple decision, like releasing a balloon to float away. This story brings out the great sense of risk involved and the courage to accept the loss of control. Ultimately, I think everyone has to take that chance on the unknown in order to heal.

2. Against Depression by Peter Kramer

   I’ve gained a lot of insight about depression from Peter Kramer’s books, especially this one. He brings out two ways of thinking about the illness. First, he helps make sense of the many directions research has taken to find an explanation of depression. Rather than championing one or another, he puts them together to describe an initial pathway to understanding, one that is incomplete but promising in its outlines.

   He summarizes research in genetics, the role of trauma and life experience, the theories about neurotransmitters, research on stress, revelations about the effects of depression on the immune system and its relationship to many other diseases, effects on the size and shape of brain structures, neuroplasticity and psychotherapy.

   His ability to present all this objectively and to bring out the contribution of each avenue of research has helped me get my bearings among so many approaches to explaining depression.

   A second important dimension consists of the insights from Kramer’s vivid portrayals of his own patients. One chapter describes the sudden and dramatic change for the better some depressed people undergo, what he calls the “return.” He tells the story of a woman whose personality after recovery turned out to be completely different from the depressed one he had come to know in treatment.

   At the moment he was expecting some praise or thanks for his therapeutic skills, the restored patient rebuked him instead. She was angry that he had taken that ill self too seriously, humoring it, dealing with it as if it were the real her.

   “With Margaret, in employing the most basic elements of therapy – empathy, tentative interpretation, the search for meaning – I had in effect sided with the illness and against the person Margaret was in health. The feelings I had underscored for Margaret were foreign to her. She experienced them, she reported them, but there is a sense in which they were not hers.”

   The illness had projected a false personality that had hidden the real Margaret from her own awareness. This story and several of similar depth helped me understand the power of depression to shape my beliefs about the kind of person I was. This has been a basic insight of my own healing.

3. Speaking of Sadness by David Karp

   Based on interviews with 50 people living with depression, Karp found a pattern of four broad stages that each person went through in dealing with the illness that led to a new identity.

   1. First comes a period of inchoate feelings when you notice a number of problems long before you have any idea about depression, or even the words to describe it.

   2. Next comes a recognition that these are serious problems. You start to think that “something must really be wrong with me.”

   3. Then a crisis happens. You’re in more pain and chaos than you’ve ever known. Things seem so out of control that you know you need some sort of help and seek it out.

   4. The fourth stage is coming to grips with long-term depression. Something changes as you go through recurring episodes and perhaps find that treatment isn’t getting the job done. You start to think of depression as part of who you are.

   It’s in this fourth stage that you may develop a depression identity, as Karp calls it. Then you need to find a way of living with the illness indefinitely.You may accept depression as your dominant condition that is occasionally interrupted by periods of partial recovery. Or you may believe the opposite, that you are basically healthy but sometimes get depressed.

   It’s common to find a higher purpose in the pain of depression, that it leads to insight and a level of spirituality that otherwise would not have been possible. However you may think about your life with recurrent depression, your beliefs are likely to change. You may go through critical times when new crises or information force you to redefine yourself and reinterpret your previous experience.

4. Why Zebras Don’t Get Ulcers by Robert Sapolsky

   Robert Sapolsky is one of the most important researchers on the role of stress throughout the course of life, as well as one of the most gifted interpreters of neuroscience for the lay public. This is the book that introduced me to the role of stress and the chemical changes it sets in motion in reinforcing the damage depression causes to the human body.

   The interesting thing about people is that they can experience extreme stress from purely psychological events. In people psychological and emotional stressors may be sustained through daily life, thus setting the stage for prolonged damage on numerous body systems caused by the altered chemistry of the stress response.

   The research Sapolsky reviews is finding more and more links between the prolonged exposure to excessive levels of glucocorticoids (the chemicals released by the stress response) and numerous impacts related to depression, including damage to neurotransmitter systems, loss of memory, slowing down of physical reactions and psychomotor function, diminishing effectiveness of the immune system and many others.

   The damage caused by excessive exposure to the chemistry of stress contributes to changes in brain chemistry and structure. Long-term reduction in the size of certain parts of the brain as well as chronic neurochemical imbalances help explain the self-perpetuating nature of the illness. Over time, depression recurs without reference to external events. The link with triggering experience is broken.

5. Man’s Search for Meaning by Viktor Frankl

   Viktor Frankl’s classic is one of those books that brings you back to the values and meaning that sustain your life. It’s been a constant reminder for me that healing requires a refocusing on the fundamental purpose that drives you to stay alive. Frankl based his practice as a psychiatrist on the centering and healing effect of finding meaning in the events and illnesses you struggle with.

   As the first half of this book dramatizes so powerfully, it was Frankl’s experience in a Nazi concentration camp that convinced him of the centrality of a sense of purpose to survival.

   Without a sense of purpose, no one could live for long in those camps. He saw the truth of this starkly in the fate of fellow inmates. Those who could believe in a positive future, or even a single event like liberation from the camp, lived. Those who lacked that inner sense of purpose and meaning died. Learning the bare skills of survival was not enough; there had to be a vision of what came next that transcended all the suffering.

   Frankl believed – and I share that belief – that all of us need a sense of meaning and purpose not just for bare survival but for fulfillment as human beings. When I reached a low point in my life, facing both cancer and depression, I found resilience and energy to heal in the most basic purpose of all, the drive to stay alive by fighting off these illnesses.

   I knew that both cancer and depression could kill me if I did nothing to stop them. Rachel Remen talks about resistance to healing and the need to take away the fear that can turn you away from it. The way that fear can be removed is by finding the sort of purpose that Frankl describes.

Let us know which books have helped you understand depression and find your own path to recovery.