(This article was originally published in the print and online editions of BusinessMirror on 03 November 2010. We are re-posting it hoping to help any reader experiencing depression or their concerned family and friends. There are many resources like this book that can either help you, or help you help them.)
Having just spent some time in the hospital for a heart ailment, reading a book about depression would probably be the last thing on my mind. But the invitation to review Down to 1 – Depression Stories had with it a built-in attraction: it was written by Dr. Margie Holmes.
Now why would Holmes, the Philippines’ own sex doc, write a book about depression, I wondered.
I have a copy of Homes’ first book, “Life, Love and Lust” and am somewhat of a fan. I’m old enough to have followed her TV show No Nonsense with Dr. Holmes, which I remember to have aroused some controversy at the time of its airing, especially from the censors and the Catholic hierarchy. Sex was not yet as pervasive in popular culture then, and frank and open talk about sex on TV was considered revolutionary by some and immoral behaviour by others.
I know that as a psychologist, Dr. Holmes probably deals with various mental disorders, but I just didn’t figure depression to be her thing. Even her column here in BusinessMirror, BodyMind, which comes out every Sunday, covers mostly topics about sex and relationships. (Holmes majored in International Family Planning with special studies in Sex Therapy and Marriage).
But after Reading Down to 1, I would find out that depression actually affects sex and relationships more than we know or ever care to acknowledge.
The more startling revelation though, Holmes makes right off the bat: that the sunshiney and always bubbly sex doc I see on TV is writing the book not only from the perspective of a professor and psychologist, but also from that of a patient and fellow sufferer.
“I have finally written the book I would have loved to read when I was depressed, in a deep dark well full of stinky, skanky, fetid water, where no one could hear me and I hadn’t the energy to get out by myself,” she writes in the book’s preface.
In a later chapter (on medication), she writes, “Let me tell you that at the depths of my depressions, when death would’ve been welcome as long as I didn’t have to do it myself, I would have taken anything to get better. If my doctor so much as wondered whether camel’s pee would help me, I would have drunk it by the gallon.”
This is not an easy thing for a UP professor and preeminent psychologist to admit, even if, as Holmes herself says in her book, depression “is so common among us that psychiatrists have called it the common cold of mental illness.” Oh no, not in the Philippines, where any mention of mental illness is still taboo.
But Holmes does not give herself credit for coming out with it. Instead, she applauds the 10 formerly or currently depressed people she interviewed for the book, whom she calls simply her FCD 10—Kay Añonuevo, Roman Azanza, her husband Jeremy Baer, Peque Gallaga, Alya Honasan, Elizabeth Lolarga, Niña Poblador, Lore Reyes, Mike Santos and Patis Tesoro.
If these names are familiar to you, they should be. They are accomplished people in their own fields, and the fact that they are known makes their public confessions of their depression stories all the more courageous, Holmes notes.
Talking about one’s own mental disorder is a big deal. Holmes reminds us of the last presidential campaign and the big furor over P-Noy’s alleged clinical depression, the vehement denials and accusations surrounding it.
Indeed, this is what I like most about the book: that it is written from the perspective of people who have successfully fought or are still fighting their battle with various depressions. If they (the FCD 10 and Holmes herself) are the happy and productive people we know them to be today then their experiences with depression offer hope to those going through similar ordeals.
It makes for a very positive read, not depressing at all.
The second best thing about Down to 1, is that it is only 92 pages long with just three chapters, by no means biblical. The writing is good for a layman even as it deals with the subject of depression with depth.
I like it that the book is not culturally neutral. Holmes has no qualms using Filipino words, idioms and phrases, when their meanings are more apt for use. She just gives those not familiar with the language a glossary at the end of each chapter so they won’t get lost. There are also lists of recommended readings and notes after each section for those who wish to do further research.
Holmes’ insights are a unique blend of the medical and scholarly with the personal, and she gives valuable inventories in the book.
At the beginning, she gives a clear definition of what clinical depression is and isn’t. How does one know if one is indeed clinically depressed? What exactly is clinical depression? How do people know if they are truly depressed or merely sad?
These questions are answered right away from a scientific standpoint through a self-administered test developed by Duke University’s Dr. William W.K. Zung, which is intended to assess the level of depression in a person. The Zung SDS or the Zung Self-Rating Depression Scale, is quite easy to do. It took me about 10 minutes following the detailed instructions in chapter 1.
One just needs to answer 20 questions with corresponding points for each answer and tally them in the end. The scores range from 20 through 80, with 70 and over indicating the presence of severe to extreme depression. A score of 50 and below is within normal range. I scored a 33. Holmes recommends the test-taker to return at a later time to compare changes in one’s responses.
Then there’s the DSM definition of depression. DSM stands for The Diagnostic and Statistical manual of Mental Disorders, the criteria used by the American Psychiatrists Association. Page 22 of the book lists the important elements that must be present before the DSM says you can be considered clinically depressed.
But it is when Holmes shares the stories of the FCD 10 and some of her letter-writers that the book really strikes sparks. Whether it is the teacher who can’t bear to face another class or the guy who can’t find the courage to tell his fiancée about his history of mental illness, these first person chronicles make for very involving prose.
The subjects share the coping strategies they’ve found most helpful in dealing with their depressions and they don’t gloss over or water down anything. All the human flaws and follies are exposed for our education. For instance, Baer talks about how he dealt with his depression by having sex with prostitutes.
Sometimes I find some recollections swinging between serious and (forgive me, I’m not being churlish or mean here) funny, like when Director Peque Gallaga writes about how he lost his libido after taking Prozac, but called it a welcome break—“relieved of being a slave to my sexual urges.”
Gallaga also recalls how he and his partner and colleague (I assume its fellow filmmaker Lore Reyes) who were both on Prozac at the same time were unusually feisty when they found themselves stuck in traffic. “…we would jump out of the car and fight with bus drivers, taxicab drivers and the other Jason Ivlers of the world.”
The honesty in these anecdotes is quite refreshing. It makes the book very character-centered. There’s an appealing emotional undertow when the FCD 10 and the letter-writers share information, observations and feelings, down to all the incidental details. We feel for these people and we genuinely wish for them to get better, and when they do, we gratifyingly share a sense of emotional resolution, like when Honasan writes about discovering yoga and how it “dramatically and unequivocally” changed her life and helped her “land easily” from her last round with Prozac.
Honasan also writes about the healing power of pets, and how her two dogs helped her come to grips with her depression.
Holmes does not dodge and skirt the tough issues on medication, particularly the adverse effects of psychotropic drugs like Prozac, which somewhat got a ringing endorsement from some of the FCD 10, and the possibility that some anti-depressants cause suicidal tendencies.
She even shared a scathing letter from a fellow psychologist who calls herself “Doctor with a Ph.D.”, who scolded Holmes for supposedly encouraging people to use medication as their first line of defence rather than trying psychotherapy first.
In fairness, Holmes does provide a whole chapter on medication and its side effects and cautions. She points out that studies have shown that anti-depressants work for people with severe depression but there are many other treatments, be they traditional, psychological (psychoanalysis, cognitive behavioral therapy) or alternative (yoga, aromatherapy, massage, herbal supplements).
But she acknowledges that medication “will make your depression shorter and ease suffering while it lasts.”
“Always, always ask yourself if the ‘cure’ is worse than the illness. My depressions were sometimes so crippling, I would take about anything to make them go away. The sooner, the better, even if it made me as fat as the circus lady. And saying I already am won’t make me even more depressed,” Holmes shares.
The last part of her book is about suicide, and Holmes tackles all the thorny issues about it on every level the chapter might as well be a standalone primer on the subject. I wondered how things could have been different for families of suicide victims if they had known what Holmes shares here.
Perhaps this, indeed, is the book Holmes was destined to write. Down to 1 is more than a useful guidebook for anyone going through depression, or for their love ones who are just as affected.
We all need someone to lean on when trouble surrounds us and we falter. This book gives us a small circle of friends who are going through a similar journey. And here, they are telling us we can tap the better parts of our nature to lick a disease that brings out our worst. ###