Finding meaning in the pain: the role of existential depression in our nation's opioid crisis

This is the text of my Sept. 23, 2017 acceptance speech given before the Washington Psychiatric Society for their Journalist of the Year award. In it, I ask psychiatrists to be unafraid to name existential crises for what they are and to step up their efforts to help people find meaning and mattering in their pain.

As a journalist, I have a lot in common with you as the clinical researchers I interview and whose work I cover. Our jobs are fundamentally the same: gather facts, put them together to tell a story, and then test whether or not the story is true. Why is this true? And how do we know? The why and the how. The basic scientific method. And as a journalist, I have always sought to take these hows and whys, and put them into a larger context so show the fuller meaning of a thing.

In my life, I have had a series of mental health crises, ultimately, all of them existential in nature, all of them serious and frightening. My truth ultimately was that I did not matter. I applied the scientific method; but my how and the why went something like this: How did I get so unlucky? Why me? My other truth was that psychiatry could not help me. I had concluded this in part because the clinicians I could afford seemed more interested in medicating my pain, not helping me assign it meaning, which was important to me.

One day, during what had been months of a deep depression, I came face to face with the fallacy of my truth. I had sent my son off to school on the bus. I went back inside and sat on the stair case beneath the skylight, and stared blankly at the wall. The how and the why I tended to fixate on were how could I end my life with the least amount of trouble? Why would I want to live such a meaningless existence? Some days, so deep in this suicidal, probably catatonic depression, I would not even notice I had not walked the dog, and so she would just mess on the floor.

But that day, I sat on a different step than usual, who knows why? A shaft of sunlight moved slowly across my head. I could feel the warmth tickle my scalp. And it felt so good. And in that moment, I connected with my life. The real questions were, Why won’t I let myself matter? And how could it be okay for me to steal my son’s mother?

That was more than a decade ago. I have not had a depressive episode since. It was not easy. I would never pretend it was. But I leaned on a new truth: that I mattered to my son, and that was enough. Eventually, as my mood improved, the evidence increased that this was a truth that withstood all testing.

This helped me keep testing other truths, including that psychiatry had nothing to offer me. I applied my scientific skills directly to it as an editor and journalist, and here I am tonight, accepting an award that proves how wrong I was.

In the process, I have been privileged to witness some of the most dramatic and important episodes of this field testing its own truths: the battle over the DSM’s relevance and inherent worth, the debate over whether grief should be considered a clinical condition, the questions over the whether the BRAIN Initiative will turn out to have been worth the astronomical investment, and how to apply the Goldwater Rule.

But please, as a field, don’t let it end there. Keep testing your truths. We are a nation in pain right now. We need your medicine. Whether it’s over our divided views on how to define a malignant leader, or why we have the opioid epidemic. There is a deeper current beneath these how and why questions: what does it all mean?

This is where you can shine.

As it is, your star is in the ascendant now. As you are increasingly looked upon to help shape policies around addiction, mental health care delivery in non-psychiatric clinical settings, and within the framework of value-based reimbursement, remember that among the specialties, yours is also the one most expert in how to find meaning and metaphor from pain. You are uniquely qualified to help us tell new stories that express new truths based on data derived from the how and the why, but also from all of our need to matter.

When people talk of our lack of shared values, what they are really saying, I believe, is our lack of a shared story that gives our common pain and struggle meaning. We have heard that we all have the right to our own opinions, but not our own facts. I would challenge you to find the nuance in this.

All pain is personal. Is there room for this in our debates? Help show this country how to identify and test its truths, to sit on a different step and experience how our respective lives feel from a different angle. Help us ask the right questions—and in the way you know now to do better than the rest, demonstrate that the power to heal and alleviate pain is in the process of testing our truths, not in the truth itself.

Truth will change, our need to apply it in a meaningful way will not. This country lacks the skill, and maybe the resolve for that right now. But you don’t. As your star is in the ascendant, remember to shine with your particular brilliance: test your truth.

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