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Depression: An Illness, Not a Choice

I am not proud of it.

A few weeks ago and for the first time in many decades, I unpredictably dipped into a depression that, to put it mildly, kicked my ass. Haha, I’m joking.

Actually I’m not.

For the most part, throughout my life, my mental health issues have stemmed from severe anxiety and agoraphobia, with moderate depression rearing its ugly head only every now and then. But not this time. This one was more than ugly, it was hideous. Blue days, black nights — the whole shebang.

According to the Mayo Clinic, depression is a “mood disorder that causes a persistent feeling of sadness and loss of interest … You may have trouble doing normal day-to-day activities and sometimes you may feel like life isn’t worth living …More than just a bout of the blues, depression isn’t a weakness and you can’t simply ‘snap out of it’ … Some people may feel generally miserable or unhappy with and without really knowing why.”

When I was younger, I was intolerant of my unusually sad thoughts. And as the definition describes above, I often felt unhappy but I had no clue why. I believed that depressed people, including myself, used feeling down-in-the dumps as an excuse to give up and not be accountable in life. Or worse, that they simply wanted attention. In other words, I believed being depressed was a choice.

Last week I watched the 1957 film Gunfight at the OK Corral with Kirk Douglas and Burt Lancaster. Douglas plays Doc Holliday; an ex-dentist turned rogue gunslinger and avid gambler. He is wanted by bounty hunters and lawmen everywhere. Doc Holliday is also dying from tuberculosis. His character is coughing incessantly, gasping for breath and needing periods of bed rest. Despite his illness, he is feared by everyone and does his share of killing bad guys throughout the film.

There is a memorable scene when Holliday is playing poker at a saloon. The poker table he is sitting at is right in front of a window. At the same time a gang of rough riders are shooting up the town. Gunshots and people screaming and yelling can be heard outside. Bullets fly past Holliday shattering lamps, liquor bottles and boring holes in the walls of the saloon. The frightened card dealer is trembling for his life as he ducks from the screaming assault of bullets. He begs Holliday to end the game and take cover. But Holliday does not flinch, blink or move a muscle despite the blizzard of lead whizzing by his head. Holliday says stoically, “Just keep dealing. I’m not breaking this run. Hit me!”

The doomed Doc Holliday does not care if he takes a bullet. He knows his illness will eventually kill him, so he chooses not to move. His fate is already sealed.

Depression can be similar. When it’s acute you don’t give a hoot. You don’t care what happens to you. The problem is most don’t get to choose like Doc Holliday.

When we are depressed, we don’t choose our thoughts — depression chooses for us. That is chilling. It’s as close to the bottom as you can get.

Another character who is desperate and suffering from an incurable disease is Walter White in the highly successful TV series Breaking Bad. White bravely and honorably chooses to make sure his family is taken care of financially before he expires from cancer. Granted he chooses a life of crime, which I am not condoning, but he is oblivious to the consequences of the law, as Doc Holliday is oblivious to the bullets.

The difference again is that both characters choose — same desperation, different cognitive process. Plus, Doc Holliday and Walter White are really dying. When you’re depressed it only feels like you are dying.

I realize now why I have always related to characters that have nothing to lose. It’s because I feel less alone when I put myself in their shoes. I know the feeling. Their resigned perspectives comfort me.

One of my teachers in middle school told me that depression was an attitude. It was a spineless way of surrendering to the fight. It was an option. I believed him just as I believed everything adults told me when I was a child. Unbeknownst to my teacher, hearing that cemented much of the shame I carried about my emotions for years.

The truth is until you experience it yourself, until you know what it’s like to not care if you get hit by a bullet or stricken with a fatal illness, the deep reality of depression is too profound for the untried mind to grasp.

So, I treated my depression with every tool that I had. The most vital one was reaching out to others because I knew I couldn’t do it alone. However, twenty years ago and beyond I would have simply invalidated my hopelessness as a faulty weakness and would not have taken steps to get well. I would even have chastised myself for “letting this happen to me.”

Although I am not Doc Holliday or Walter White thankfully, or anyone with nothing to lose, I can still commiserate with the utter desperation. When I say desperation I don’t mean being afraid. I mean the existential malaise of having temporarily lost your purpose in life and not knowing how to get it back. In other words, the lack of desire to thrive.

German philosopher Arthur Schopenhauer once defined his own antidote for the existential malaise of depression: “A happy life is impossible; the best that a man can attain is a heroic life”

Thank you, Doc Holliday and Walter White.

Depression: An Illness, Not a Choice

John Tsilimparis, MFT

JOHN TSILIMPARIS, MFT is a psychotherapist in Los Angeles that has become a go-to expert for the media on many areas of psychological issues. He has appeared on KCBS-TV, KABC-TV, KCAL-TV, KTLA-TV and other news programs to comment on subjects such as, marriage and divorce, holiday stress, empty nest syndrome, seasonal affective disorder, celebrity addictions, lottery fever, etc. John's radio appearances include Air-Talk with Larry Mantle on KPCC-FM and recently on KPFK-AM radio.

John has also been featured as a regular on the TV documentary series, Obsessed, on the A&E Television Network. He also appeared on the reality show Collection Intervention and The View.

John teaches classes for students as well as lay people about anxiety disorders, depression, and addiction. He has presented workshops at UCLA Extension. John teaches at Pepperdine University and Antioch University.

He is also a regular blogger on the Huffington Post and has published articles on many of the subjects mentioned above. Please visit his Huffington Post page.

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APA Reference
Tsilimparis, J. (2018). Depression: An Illness, Not a Choice. Psych Central. Retrieved on November 24, 2020, from
Scientifically Reviewed
Last updated: 8 Jul 2018 (Originally: 15 Jan 2018)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
Published on Psych All rights reserved.