Descent into Delirium

In coming alongside the depressed, we might recognize that some depressed folks are depressed because the world is too much with them.   Like those who are hypersensitive to the ‘buzzing, booming, confusion‘ of life and who withdraw or become agitated in its presence, some folks are depressed because they cannot NOT see the world as a house of horrors.

When I have suggested such to people I get a similar response, “Well, yes..there is a lot  of bad stuff in the world but there is a lot of good too.”     Sigh.   Yes, I know.  There is a lot of good stuff too.   Those of us who live in safe, affluent environments and are sheltered from the bad stuff in the world find it easy to say that sort of thing.  Those of us who have never been traumatized by some horror do too.

I am saying that there are some among us who see only the horrors of life.  Perhaps at some level, they see the flowers and birds and lamb-like clouds that float gently on the breath of God but even that is a horror to them because they feel so awful. 

The very audacity of Spring!

As T.S. Eliot wrote in the opening line of The Waste Land:

“April is the cruelest month…”   

Whatever that may have meant to Eliot, many have understood it to mean that the person who is depressed or despairing experiences the flower-bursting beauty of April as a mockery. 

Are they wrong to experience such beauty in that way?  No.  Given that they see most clearly the horrors of life,  April appears a contrast to their own experience. They are driven more deeply into the winter-darkness of the soul…and often prefer it. 

The idea that some people are depressed because they clearly see horror in the foreground of experience has a long history.   I have thought about it for a long time myself.  I have come alongside the depressed many times and sometimes, after hearing them speak of such things, I found myself thinking, “Well, you do have a point!”     But, often it was a point heard only in the abstract.  “Every schoolchild knows there is suffering in the world. 

However, it was not until I experienced deep delirium after my heart transplant in April 2019, that the idea took on flesh for me.

I am not going to go into detail here (I’m working on a book about it) but will tell you why it so transformed my thinking. 

The experience of delirium, which occurs in 70% of ICU patients, varies from person to person.  For some, it manifests in confusion, for others hallucinations, and for others something all but unnameable.  It can be temporary and it can last for a while.  It can even cause some degree of permanent damage to cognition and memory.

I experienced all three and, loosely speaking, in that order.   The first week of my stay, while I was on kidney dialysis and being pumped full of drugs, I became confused about where I was, why I was there, who other people were and what was happening to me.

Some time afterward, I began to experience hallucinations within my room.  Things floating in air.  I saw people who were not there and didn’t see people who were.  I watched the paint peel from the walls.  And, I figured out how to turn the hands of a clock back with my mind. 

That was all pre-transplant.  However, for two weeks following transplant, I utterly broke with reality and went somewhere completely other than where I was.  I don’t know if I was there 10 minutes or 10 days.  It felt like an eternity. 

It was not a dream.  And, it was not a hallucination.  It was something that approached a vision, though I hesitate to say that lest people think I’ve become more inflated than I am.   (I would call it a ‘visionoid, as something that resembles the real thing,‘ but that sounds like a medical condition.  I could call it vision-esque,  but that might be taken as a performance involving baggy pants and seltzer water  and that would minimize it. )  All I can tell you is that it was far more real than everyday reality: the colors were far more vivid, the sounds far more acute, and the emotions completely beyond the pale.  

Terror comes to mind.

I want to say ‘vision‘ not because I think I’m Ezekiel, or Jesus, or Paul, or the blessed John on the Isle of Patmos. I want to say vision because I was led somewhere and shown things that are the Reality within reality or as Tim Mackie put it in one of his lectures:  an experience in which you are taken into the deep heart of human experience. (c.f. his lecture on the temptation of Jesus in the wilderness in his Podcast “Exploring My Strange Bible.)

I was taken to a place that was filled with the most violent, disordered, disfigured people on earth.   And, I witnessed and was engaged with the most fearful things, things I couldn’t begin to describe.  Death.  Violence.  The continual threat of violence.  Hannibal Lectors lined the hallways.  Piles of bodies- men, women, and children stacked in coal cars that extended into the dark of a tunnel. Assassins.  Terrorists.  Beings half-human, half-animal.  People who seemed to be made from scrap metal.  All dangerous.  All vicious.  All on the edge.

There were people who were charged with caring for those people.  They were themselves corrupted and corruptible.

I was there for days or so it seemed.  When I tried to sleep I heard scratching on the walls, tapping at the windows, tiny feet running through the ceiling, racing across the roof.  I was told it was the sound of Trouble…Trouble scratching its way through the walls.

The threat of a terrorist attack loomed large. Some people hated the very existence of the place and had vowed to destroy it.  They had tried once before with well=placed bombs. 

Finally, I was beaten to the point of death by a gang of residents and as I lay dying the building caved in upon us.  (The sound of that is the sound you hear when you are defibrillated and are half-conscious.   Roar and clang.)

When I emerged out of it, I found myself tied to a bed.  Dark.  A woman sat with me and I was completely out of control   Somehow the terror of the place where I had been returned with me.  I flailed.  I screamed.  I swore.  Soon four nurses surrounded me and that only served to amp me up even more.  (They were wise to restrain me but I was so weak from the transplant I’m not sure what I could have done.)

My actions were perfectly reasonable within the bounds of that horrific experience.  I thought the building we were in was about to explode and I didn’t know where my family was so I could warn them. 

Now, I get that there are good medical explanations for what I experienced.  I get that the brain is a pattern maker and that we are all sense-makers and storytellers.  I understand that we are in the realm of subjective experience.  I agree that it’s an iffy proposition interpreting one’s own dreams and visions.   I know…I know…I know.

But, I don’t care. I know what I endured and it was more real than everyday reality.
And not one day passes that I do not think about it.  And because I am not one to ‘waste my miseries,’  I have tried to make sense of it.  Sometimes the horror of it is too much to dwell on though. 

I won’t say anything here about how I’ve explored it, but I will tell you this:  It was as if all of the suffering and pain and horror, all of the disfigurement, disorder, and destruction, all of the violence and evil of this world was compressed into one building and all at once.  And I was there to see it, suffer with it, and suffer because of it.  And, the experience was compounded by the fact that I was cut off from the world I know and from the supports that constitute my everyday life. 

Thankfully, I emerged from it relatively intact.  Traumatized, yes.  But only with small-letter ptsd.

As a pastor, I have lived my adult life coming alongside suffering people but I had no clue, no clue whatsoever, as to what suffering was until that experience.

Before this experience, I knew there was suffering in the world.  Heart failure had, at times, given me a  taste.  But, those hard moments were few and far between and usually managed by medicine. 

And, I have been right there with everyone else as we read online about some distant ethnic cleansing, some war, some mass shooting, some famine, some virulence stalking some country, some kidnapping, some rape, some child molested and left to die in some distant wood, another shooting, another theft.  

I know about the diseases that haunt us down.   The shortness of time.  Loneliness.  

And somehow I have managed along with everyone else to live with it, to shake my head at the tragedy of it, and then move on, maybe a little wounded by it, maybe a little scarred, but it’s all in a day. 

There is a lot of good stuff in the world, you know.

But I’m not sure that’s true for everyone.  Some people really have to strain to see the good stuff.   I am convinced there are those who know what I’m talking about and who cannot get past the horror that surrounds us, who cannot get beyond the trauma they experience (or have experienced) because of it and are left  wounded and often alone. 

I believe it is a calling to come alongside them and listen.

They may have something to say that we desperately need to hear.  

And, maybe there is something we have to add to the conversation too. 

For Good Reason

Not long ago, a student asked me what I recommend he could do for a friend of his who was depressed.  Since I’ve been talking about ‘coming alongside’ since I began to get my feet on the ground post-transplant, his was a question that naturally followed.  I think my answer surprised him:

“Well, first, you have to ask yourself whether your friend is depressed for good reason.”   He cocked his head like a dog who was trying to make sense of his master’s belch. “You don’t want to fault him for being a realist, do you?” 

His head twisted so far, I thought he was going to roll over.

My question to him was not as weird as it sounds.  We assume that depression has its causes.  Chemical imbalances in the brain.  ‘Stupid thinking by not-stupid people,” to quote the ever-rational therapist, Albert Ellis. A response to loss fueled by errors in how one thinks, to paraphrase CBT’s Aaron Beck.    Genetics.  Family history.  And, those may all be good causes, especially when considered together.

But, I didn’t say good causes.  I said good reason. I meant to suggest to him that perhaps his friend’s depression was a moral good.  Is my student’s friend depressed for good reason?   Does the friend’s struggle serve a positive end, a positive purpose worth serving?  That’s how we know something is good.  Does X serve the purpose for which it exists? 

My house key is a good little house key because it unlocks the front door, the purpose for which it was created.   If it never unlocked the front door, it would be a bad house key and, like non-salty salt,  fit only to be ‘cast out and trod under the foot of men.”

Q:  For what purpose might at least some forms of depression exist?  

A:   The truth.  Some who suffer in that way may have a clearer vision of the truth of this world.

If prophets exist not so much to foretell the future but to speak the Truth, then maybe some people who suffer depression are contemporary prophets, eager to tell us how things are.  And maybe some of them are depressed or find that experience compounded because we don’t listen.  So, maybe rather than rushing to fix them, drug them, shock them, reason with them, we ought to sit down and listen to them.

At least some depressed folks may be the ones gifted to see, feel, and know the deep reality in which we all live and maybe what they see is horrible to behold.

What if we listened to them on the off chance that they have something to tell us?


To do that we need to think about the language we use in describing the experience we call depression.   Our language about it suggests that we think of it as something people ‘have.‘  The word ‘depression’ is a noun.  Depression is this thing that some people carry like a 400-pound brick.  

Or we think of it as a character trait.  He has a depressive personality.   In other words, he’s sort of bent that way, oriented that way.  Genetics and practice, you know.  “A man who has carried a 400-pound brick his whole life, at the end of his life, looks like a man who has carried a 400-pound brick his whole life.”

I’d like to suggest that what we call depression is a dynamic, an energy, a power.   (I’d  also suggest that turning the verb ‘depress‘ into a noun by adding that magic ‘ion‘ gives us a feeling of control.  Whew!  At least we know what it is now.  When we ‘thing‘ a dynamic, we feel as if we are in a better position to manage it.) 

I have come to think that the experience of the  ‘D-word,” at least for some,  is more like having a living lion in the house than a statue of a lion in the house.

But, if this thing we call ‘depression’ is a dynamic then what?  What is the sufferer supposed to say, “I am depressing myself?”  I’ve heard some therapists say that.  It is intended to give the sufferer a sense of agency.  “If I can depress myself, I can un-depress myself!”  

Or, maybe the sufferer should say, “My children are depressing me!  My husband- who started out as my knight in shining armor but has become a recliner that belches- is depressing me.”   But then do wall-bouncing children and belching, scratching knights have that kind of power?

Maybe the suffering should say, “I am under the influence of a depressing spirit.”  Or, maybe it’s none of that that, “it’s merely this chemical imbalance I have.”

Maybe the whole experience of that heaviness is a dance with several partners.

Maybe some people who suffer from it do so because they have a clearer vision of reality than the rest of us.  Maybe those of us who do the happy-clappy dance through life are self-deceived about the nature of the world around us and the depressed are those granted the gift of dancing with deep reality. 

Maybe some of them pay such a high cost because the rest of us refuse to see for ourselves?

Life is difficult.  So wrote Scott Peck in his book The Road Less Travelled.  Those first- three words of the book are worth the price of the book.  

“Well, yeah…it is…BUT…” we say.

Maybe that’s the difference between those of us who tap-dance in the rain and those of us drag themselves across an unvarnished floor of despair.   

We tap-dancers have big BUTS and the depressed have no buts a’tall.

The preamble to the wisdom teachings of Jesus includes these words and I paraphrase:  “How utterly and profoundly blessed are those who mourn because they see themselves and the world for what it is.” ( King Jimmy Version)  Why?  Because they will be comforted, oh yes!  But also because they GET IT.

The most painful parts of my heart transplant were not the hours of gasping for air as my old heart began its fast descent.  It was not the roasting darkness of night time, surrounded by bewildered doctors, nurses, and loved ones as I agonized for air.  It was not the massive toothache that became my body when the lining of my old heart became infected.  It was not the endless puking, the starvation, the eternal nights of wild-eyed wakefulness. It was not having my chest cut, my rib cage split, the lifting out of my old broken heart or the replacement of it with the healthy heart of another.  It was not post-transplant pain.  I managed that with Tylenol.

It was not even that I was sliding toward dying.  

By far, the most painful aspect of that whole experience was the deep delirium I suffered post-transplant.  It was an awful, awe-filled descent into a grace-filled hell.

What I learned in the throes of that merciless, merciful madness has utterly transformed my life because, whatever its cause, it seemed to be a deep dive into the world as world, a deep dive into a non-real Reality.

It pertains to the topic at hand and I will write about it next.