Depression: Fear and Loathing in My Prefrontal Cortex

July 24, 2017

BY SAMUEL HILLESTAD

I broke the one rule of relationships. I helped my girlfriend build an Ikea bookshelf.

Crouched on the floor, surrounded by mountains of Styrofoam and a bundle of bubble wrap, I searched for hole F on board C where I was supposed to secure a cam lock nut with two size J screws.

"Uh oh," I said.

"What’d you do?" my girlfriend asked.

"Don’t worry about it."

If you’ve never used a cam lock nut before – beware. If you put it in screw-side-down, you’re never gonna get that sucker out. Thankfully, my girlfriend was focused on board B and her hammer.

Tap tap tap tap tap

I started to pry at the cam luck nut, but it wouldn’t budge. I immediately feared the worst – that I’d ruined the bookshelf. For one beautiful moment, my only concern was that my girlfriend would notice my pit stains. But I had bigger concerns, like the drilling sensation in my temple.

Breathe, I told myself as my nail started to peel off from my finger.

Bang

I tried using the screwdriver as leverage.

Bang

I shook the board wildly.

Bang

"What’s going on?" she asked.

"It’s stuck."

She pried at the cam lock nut with her fingernail. She tried to use a screwdriver as leverage. She shook the board wildly.

"Well fuck, Sam. What are we going to do now?"

"I don’t know. I don’t know!" The drilling sensation drove deeper into my skull.

"They better let you replace it," she said and went back to hammering.

"They will." I hoped.

She sighed and turned away.

That’s when the drill hit grey matter, and a synapse in my prefrontal cortex misfired.

Bang

If I’d have been hooked up to a skullcap of electrodes at the time, the doctors in the white lab coats would have furrowed their brows, muttering in astonishment as they saw a bundle of neurons light up on the screen like bootleg fireworks on the Fourth of July.

"Verrrrrrrry interesting," the assistant said.

A jolt of electricity shot through my posterior lobe.

"See that?" the surgeon said, not without a certain amount of excitement. "Watch close or you’ll miss it. What you’re seeing now is an Acute Neurological Electromagnetic Event."

"A what?"

"Watch!"

The screen flashed and my brain turned molten red.

"I don’t understand. I thought it took some sort of trauma for the brain to overheat? Was it the girlfriend?"

I stumbled into the bathroom and locked the door.

"Of course not. Sometimes these things just happen."

I collapsed and grabbed my knees, shaking violently as my head rattled against the cold tile floor.

"Patient now appears to be scratching his shoulders. Epidermal tissue broken," the surgeon said.

"Shouldn’t we do something?"

"Just wait. He’s about to get a surge of serotonin. It’s the Nagasaki Effect."

"How do you know all this?"

"Me? I’m just making it up. Doctors don’t know shit about depression."

I looked in the mirror. My shoulders and arms were covered in long, pink scars. Disappointing. I’d hoped for some real blood.

But my face – it was the face of a pale, sunken creature.

Bang

Staring in the bloodshot eyes of this vaguely familiar beast, I vowed to do whatever it took to beat this disease. Never again, I promised myself.

Though I hesitate to make bold, sweeping claims about humanity, if there’s one thing that we all have in common, it’s that feeling. That ancestral urge to fight back. To overcome. To conquer.

You see, for the longest time I pictured depression as an epic battle between the Olympic forces of Good and Evil. As I plunged further into my depression, the Evil forces marched across my head, burning and raping and pillaging every last Good thought they could get their hands on. But no matter how bad it got, even when the Good was reduced to a smoldering ember deep down in some forgotten corner of my brain, the Good kept fighting.

How romantic.

Six months later, I clawed myself again. This time I drew blood – real blood. I fought depression, and I lost. Again and again and again.

That’s what makes depression such a pernicious, unfathomable disease. Depression tricks you into believing it’s a battle, and that with the right blend of willpower and strategy, you can emerge victorious. But if there’s one thing I’ve learned through this whole ordeal, it’s that depression is fundamentally unconquerable.

That, and the simple, undeniable truth that Ikea instructions were written by the devil himself.

"I got it out," she said.

"What?"

"The cam lock nut."

"Oh," I said and picked up a hammer.

"Here?" I asked.

"Yep."

Bang

So if you can’t battle depression head on, what can you do? First things first – you need help. It’s too easy to convince yourself, like I did, that you can beat this disease on your own. You can’t. You need to talk to a therapist, your friends, your parents, and if you’re lucky enough to have a dog, spill your heart out to her. Trust me, she’ll listen.

Asking for help is not weakness. It took me four years to tell somebody I was depressed, and it took another year before I picked up the phone and called a professional. Asking for help is terrifying, courageous, and absolutely essential.

I won’t bore you with the details about my experience with therapy and anti-depressants, but I will say this – it works. It’s no cure-all. It’s not even really a cure. It doesn’t miraculously make you happy again, and it doesn’t magically fix your problems. What it does is help you breathe again.

Now that I had breathing room, I was finally clear-headed enough to draft a battle plan. My strategy was to replace dark thoughts with goals. Through achievements, I thought, I could beat depression once and for all. I still have the list in my journal. It reads as follows:

I will go to the gym five times a week and gain 15 pounds
a. In one month
I will write a novel
I will wake up at 5am every day
I will learn Spanish
a. And piano
I will get a promotion at work

Easy, right?

I failed and I failed bad. Failure one day turned into failed weeks and months, and ultimately, I kept coming back to the same undeniable truth. My 24 years on this planet added up to a failed life.

Luckily, it turns out that some doctors do know shit about depression. It was my psychiatrist who gave me the best advice I’ve ever gotten.

"Start small," she said. "Ridiculously laughable small."

We decided on a single goal:

Eat three meals a day.

At one point, I lost 25 pounds in a matter of weeks. My arms turned to sticks, and my rib cage showed in the mirror. I’d gag at the mere thought of food. Some days, all I could choke down was a few spoonfuls of plain oatmeal, and other days, I couldn’t even keep that down.

So yes, eating three meals a day may sound simple, but for me, it took every last atom of willpower I had left.

That’s exactly the point though. I stopped focusing on depression and I started focusing on food. At its core, it was the same struggle. But instead of fighting some ephemeral, unbeatable entity in my head, I had a simple, concrete goal. Eating a bowl of plain Greek yogurt was infinitely easier than quieting the demons in my head telling me to step in front of BART every morning on the way to work. I pick Greek yogurt every time.

Eventually, I strung together a few weeks of eating three meals a day, so I moved onto a new goal. I started with crunches. I moved on to pushups and planks, and after a few weeks, I even dared to show my face at the gym.

There are an infinite number of ways to handle depression, but to this day, I’m convinced that Greek yogurt and crunches saved my life.

Fighting depression with unflinching persistence may sound heroic – like the raging against the dying of light – but I speak from experience when I say that the more you focus on the darkness, the more it consumes you.

There are no battles with depression. There is no war. It’s a random, horrifying cocktail of toxic chemicals feeding on the fear and loathing in your prefrontal cortex. Notice the chemicals. Accept them. Know that at least for a little while, they’re here to stay. That’s when the healing begins.

Ask for help. Start small. Find hope.

"But how did he beat it?" the assistant asked.

"I don’t think he did. He still seems to be struggling," the surgeon answered.

"I don’t understand."

"I’m afraid I don’t either. But do you see that? See how the red spots are starting to shrink? They’re still there. They’ll always be there. But there’s hope."

Samuel Hillestad graduated from Brown University in 2015, went on to briefly work for a non-profit before selling out to one of those faceless San Francisco tech startups. They maintain their sanity by writing.