Economic and political leaders of the world gather in Davos, Switzerland, each January to review the past year’s events and chart a course for the coming year. On the last day of the meeting, the entire ensemble ascends to the Schatzalp, or “Snow Beach,” on the slopes overlooking the village. Picnic tables line the cutout flat near the hotel, and the buffet is arranged neatly on carved snow tables. Well-dressed and chic, the crowd networks, creating a buzz audible over the Big Band-era tunes played by the group on stage. The bright noon sun warms the setting and reflects off the white snow of surrounding mountains.
Dean Ornish, author of several bestsellers—Love and Survival and Reversing Heart Disease—and I walk past the sweets table and play with the fruit. In this magical environment, we both lament that everyone we know could not enjoy the moment we were experiencing. The occasion seemed ideal to ask Dean to expand on a comment he made at a seminar earlier that week as he poetically described his personal battle with depression.
“When you are depressed, for the first time in your life you think you have seen the world with absolute clarity,” said Ornish. “And the reality is painfully depressing. No good can come of this existence, and your personal contribution is worthless. Until then all the times you thought you were happy, you were just deluding yourself.”
Our session highlighted the growing knowledge of the connection of depression with disease. At a first cut, approximately 18 percent of the lost workdays are attributed to depression. But what about more organic ailments that most of us think occur without any involvement from the brain? For example after a heart attack, the second most important predictor of death is depression. Patients who are depressed are more likely to have complications after heart surgery, including infection—perhaps a result of the reduced immunologic function associated with depression. They also get readmitted to the hospital more often and die more frequently after heart surgery.
The converse is also true. Patients who have someone or thing that they love at home survive major illness better than those who do not. This is true even if the loved entity is a pet. They also do better if they belong to an organization that can provide them social support, which is perhaps why churchgoers often seem to survive more often than expected.
Dean reached his lowest point of depression while in college in Texas. All the precipitating factors appeared stacked against him—a lonely dorm room with a brilliant roommate who made him feel inadequate, as well as a high-pressure, pre-med existence in an unfriendly environment far from home. He contemplated suicide by several means and had worked out the details meticulously.
Mental illness afflicts 20 percent of adults and is the largest cause of work loss in the country. As a society we have historically ignored the problem and felt the disease to be a weakness of those suffering. Yet depression is caused by biochemical changes in the mind that are related to genetic as well as environmental factors. And they are responsive to aggressive pharmacologic and environmental treatments.
Numerous herbal remedies have been shown to help patients with mild to moderate depression. More conventional approaches with cognitive-behavioral therapy and selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, may also be useful. Dean’s dedicated parents saved his life by rescuing him at school and supporting him through recovery. For Ornish, life changed.
“Depression, like any form of suffering, can be a doorway for transforming our lives for the better,” Ornish says. “I was profoundly depressed in college years ago. Having survived it, I became interested in understanding what caused me to feel that way, and found that the different parts of what became my lifestyle program were enormously helpful in my life. Unfortunately, most physicians are not trained to help people use the experience of suffering as a doorway for change.”
The social stigmata associated with this organic ailment should not stop others from seeking and gaining a full recovery.