We know depression through metaphors. Emily Dickinson was able to convey it in language, Goya in an image. Half the purpose of art is to describe such iconic states. As for me, I had always thought myself tough, one of the people who could survive if I’d been sent to a concentration camp.

In 1991, I had a series of losses. My mother died, a relationship I’d been in ended, I moved back to the United States from some years abroad, and I got through all of those experiences intact.

But in 1994, three years later, I found myself losing interest in almost everything. I didn’t want to do any of the things I had previously wanted to do, and I didn’t know why. The opposite of depression is not happiness, but vitality. And it was vitality that seemed to seep away from me in that moment. Everything there was to do seemed like too much work. I would come home and I would see the red light flashing on my answering machine, and instead of being thrilled to hear from my friends, I would think, what a lot of people that is to have to call back. Or I would decide I should have lunch, and then I would think, but I’d have to get the food out and put it on a plate and cut it up and chew it and swallow it, and it felt to me like the Stations of the Cross.

One of the things that often gets lost in discussions about depression is that you know it’s ridiculous. You know it’s ridiculous while you’re experiencing it. You know that most people manage to listen to their messages and eat lunch and organise themselves to take a shower and go out the front door and that it’s not a big deal. And yet you are nonetheless in its grip and you are unable to figure out any way around it. And so I began to feel myself doing less and thinking less and feeling less. It was a kind of nullity.

And then the anxiety set in. If you told me that I’d have to be depressed for the next month, I would say: “As long I know it’ll be over in November, I can do it.” But if you said to me: “You have to have acute anxiety for the next month,” I would rather kill myself than go through it. It was the feeling all the time like that feeling you have if you’re walking and you slip or trip and the ground is rushing up at you, but instead of lasting half a second, the way that does, it lasted for six months. It’s a sensation of being afraid all the time but not even knowing what it is that you’re afraid of. And it was at that point that I began to think that it was just too painful to be alive, and that the only reason not to kill oneself was so as not to hurt other people.

And finally one day, I woke up and I thought perhaps I’d had a stroke, because I lay in bed completely frozen, looking at the telephone, thinking: “Something is wrong and I should call for help,” but I couldn’t reach out my arm and pick up the phone and dial. Finally, after four full hours of my lying and staring at it, the phone rang, and somehow I managed to pick it up, and it was my father. I said: “I’m in serious trouble. We need to do something.”

The next day I started with the medications and the therapy. And I also started reckoning with this terrible question: “If I’m not the tough person who could have made it through a concentration camp, then who am I? And if I have to take medication, is that medication making me more fully myself, or is it making me someone else? And how do I feel about it if it’s making me someone else?”

I had two advantages as I went into the fight. The first is that I knew that, objectively speaking, I had a nice life, and that if I could only get well, there was something at the other end that was worth living for. And the other was that I had access to good treatment.

But nonetheless I emerged and relapsed, and emerged and relapsed, and emerged and relapsed, and finally understood I would have to be on medication and in therapy forever. And I thought: “But is it a chemical problem or a psychological problem? And does it need a chemical cure or a philosophical cure?”

One of the people I talked to when I was trying to understand depression was a beloved friend who I had known for many years, and who had had a psychotic episode in her freshman year of college, and then plummeted into a horrific depression. She had bipolar illness, or manic depression, as it was then known. Then she did very well for many years on lithium, and then eventually, she was taken off her lithium to see how she would do without it. She had another psychosis, and then plunged into the worst depression that I had ever seen, in which she sat in her parents’ apartment, more or less catatonic, essentially without moving, day after day after day. When I interviewed her about that experience some years later, she said: “I was singing ‘Where Have All The Flowers Gone,’ over and over, to occupy my mind. I was singing to blot out the things my mind was saying, which were: ‘You are nothing. You are nobody. You don’t even deserve to live.’ And that was when I really started thinking about killing myself.”

In depression you don’t think that you’ve put on a gray veil and are seeing the world through the haze of a bad mood. You think that the veil has been taken away, the veil of happiness, and that now you’re seeing truly. It’s easier to help schizophrenics who perceive that there’s something foreign inside of them that needs to be exorcised, but it’s difficult with depressives, because we believe we are seeing the truth.

But the truth lies. I became obsessed with that sentence: “But the truth lies.” And I discovered, as I talked to depressive people, that they have many delusional perceptions. People will say: “No one loves me.” And you say: “I love you, your wife loves you, your mother loves you.” You can answer that one pretty readily, at least for most people. But people who are depressed will also say: “No matter what we do, we’re all just going to die in the end.” Or they’ll say: “There can be no true communion between two human beings. Each of us is trapped in his own body.” To which you have to say: “That’s true, but I think we should focus right now on what to have for breakfast!”

A lot of people said, when I chose to write about my depression, that it must be very difficult to be out of that closet, to have people know. They said: “Do people talk to you differently?” I said: “Yes, people talk to me differently. They talk to me differently insofar as they start telling me about their own experience, or their sister’s experience, or their friend’s experience!”

Now let me tell you about Frank Russakoff. Frank Russakoff had the worst depression perhaps that I’ve ever seen in a man. He was constantly depressed. He was, when I met him, at a point at which every month, he would have electroshock treatment. Then he would feel sort of disoriented for a week. Then he would feel okay for a week. Then he would have a week of going downhill. And then he would have another electroshock treatment. And he said to me when I met him: “It’s unbearable to go through my weeks this way. I can’t go on this way, and I’ve figured out how I’m going to end it if I don’t get better.” “But,” he said to me, “I heard about a protocol at Mass General for a procedure called a cingulotomy, which is a brain surgery, and I think I’m going to give that a try.” And I remember being amazed at that point to think that someone who clearly had so many bad experiences with so many different treatments still had buried in him, somewhere, enough optimism to reach out for one more. And he had the cingulotomy, and it was incredibly successful.

He’s now a friend of mine. He has a lovely wife and two beautiful children. He wrote me a letter the Christmas after the surgery, and he said: “My father gave me two presents this year, first, a motorised CD rack from The Sharper Image that I didn’t really need, but I knew he was giving it to me to celebrate the fact that I have a job I seem to love. And the other present was a framed photo of my grandmother, who committed suicide. As I unwrapped it, I began to cry, and my mother came over and said, ‘Are you crying because of the relatives you never knew?’ And I said: ‘She had the same disease I have.’ I’m crying now as I write to you. It’s not that I’m so sad, but I get overwhelmed, I think, because I could have killed myself, but my parents kept me going, and so did the doctors, and I had the surgery. I’m alive and grateful. We live in the right time, even if it doesn’t always feel like.

It’s a strange poverty of the English language, and indeed of many other languages, that we use this same word, depression, to describe how a kid feels when it rains on his birthday, and to describe how somebody feels the minute before they commit suicide. People say to me: “Well, is depression continuous with normal sadness?” And I say, in a way it’s continuous with normal sadness. There is a certain amount of continuity, but it’s the same way there’s continuity between having an iron fence outside your house that gets a little rust spot that you have to sand off and do a little repainting, and what happens if you leave the house for 100 years and it rusts through until it’s only a pile of orange dust. And it’s that orange dust spot, that orange dust problem, that’s the one we’re setting out to address.

So now people say: “You take these happy pills, and do you feel happy?” And I don’t. But I don’t feel sad about having to eat lunch, and I don’t feel sad about my answering machine, and I don’t feel sad about taking a shower. I feel more, in fact, I think, because I can feel sadness without nullity. I feel sad about professional disappointments, about damaged relationships, about global warming. Those are the things that I feel sad about now. And I said to myself, well, what is the conclusion? How did those people who have better lives even with bigger depression manage to get through? What is the mechanism of resilience?

And what I came up with over time was that the people who deny their experience, and say: “I was depressed a long time ago, I never want to think about it again, I’m not going to look at it and I’m just going to get on with my life,” ironically, those are the people who are most enslaved by what they have. Shutting out the depression strengthens it. While you hide from it, it grows. And the people who do better are the ones who are able to tolerate the fact that they have this condition. Those who can tolerate their depression are the ones who achieve resilience.

Frank Russakoff said to me: “If I had a do-over, I suppose I wouldn’t do it this way, but in a strange way, I’m grateful for what I’ve experienced. I’m glad to have been in the hospital 40 times. It taught me so much about love, and my relationship with my parents and my doctors has been so precious to me, and will always be”.

Valuing one’s depression does not prevent a relapse, but it may make the prospect of relapse and even relapse itself easier to tolerate. The question is not so much of finding great meaning and deciding your depression has been very meaningful, it’s of seeking that meaning and thinking, when it comes again: “This will be hellish, but I will learn something from it.” I have learned from my own depression how big an emotion can be, how it can be more real than facts, and I have found that that experience has allowed me to experience positive emotion in a more intense and more focused way. The opposite of depression is not happiness, but vitality, and these days, my life is vital, even on the days when I’m sad.

I think that while I hated being depressed and would hate to be depressed again, I’ve found a way to love my depression. I love it because it has forced me to find and cling to joy. I love it because each day I decide, sometimes gamely, and sometimes against the moment’s reason, to cleave to the reasons for living. And that, I think, is a highly privileged rapture.