You are constantly told in depression that your judgment is compromised, but a part of depression is that it touches cognition. That you are having a breakdown does not mean that your life isn't a mess. If there are issues you have successfully skirted or avoided for years, they come cropping back up and stare you full in the face, and one aspect of depression is a deep knowledge that the comforting doctors who assure you that your judgment is bad are wrong. You are in touch with the real terribleness of your life. You can accept rationally that later, after the medication sets in, you will be better able to deal with the terribleness, but you will not be free of it. When you are depressed, the past and future are absorbed entirely by the present moment, as in the world of a three-year-old. You cannot remember a time when you felt better, at least not clearly; and you certainly cannot imagine a future time when you will feel better.

There is so much pain in the world, and most of these people keep theirs secret, rolling through agonizing lives in invisible wheelchairs, dressed in invisible bodycasts.

Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication.
“Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication.
“So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm.
“But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh.
“So maybe you’ll stay on a really low maintenance dose?” They ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication.
“Well, I sure hope you get off it sometime soon,” they say.

The opposite of depression is not happiness, but vitality and my life, as I write this, is vital even when sad. I may wake up sometime next year without my mind again; it is not likely to stick around all the time. Meanwhile, however, I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, when hell came to pay me a surprise visit. It's a precious discovery. Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping. For a petrifying instant here and there, a lightning-quick flash, I want a car to run me over...I hate these feelings but, but I know that they have driven me to look deeper at life, to find and cling to reasons for living, I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely, and sometimes against the moment's reason, to be alive. Is that not a rare joy?

People with family histories of alcoholism tend to have lower levels of endorphins- the endogenous morphine that is responsible for many of our pleasure responses- than do people genetically disinclined to alcoholism. Alcohol will slightly raise the endorphin level of people without the genetic basis for alcoholism; it will dramatically raise the endorphin level of people with that genetic basis. Specialists spend a lot of time formulating exotic hypotheses to account for substance abuse. Most experts point out, strong motivations for avoiding drugs; but there are also strong motivations for taking them. People who claim not to understand why anyone would get addicted to drugs are usually people who haven't tried them or who are genetically fairly invulnerable to them.

Antonin Artaud wrote on one of his drawings, "Never real and always true," and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true.