Mary Brekke spent most of her life being depressed. The problem was, she didn’t know it. So the 73-year-old Chicago resident did what many people do when they’re in pain: She self-medicated. In her case, it was with cigarettes and food.
Twelve years ago, Brekke quit smoking, and eight years ago, at her daughter’s urging, she went to see a psychologist. But by the time she walked into therapist Angelique Sallas’ office, Brekke had been diagnosed as morbidly obese.
“Depression can be a way to avoid feelings,” says Brekke. “Usually, they say, people who are depressed lose weight. I would gain weight because I would sit and keep chewing.”
Sallas diagnosed Brekke as clinically depressed and recommended medication, but Brekke resisted.
“When I was first married, people were using Valium and other kinds of mood elevators. It just seemed to be not right. They [the drugs] were abused, for one thing; they were addictive too,” she says.
Sallas referred Brekke to a psychiatrist who agreed with the diagnosis and prescribed Paxil. Brekke decided to try both counseling and medication.
“Everybody has periods of being down, but a clinical depression is more severe and more difficult to understand because you can’t pull yourself out, you can’t go for a walk in the sunshine and feel better,” says Sallas.
According to the National Depressive and Manic-Depressive Association, women are twice as likely as men to experience depression. In fact, according to the association, one in four women will experience clinical depression in her lifetime. But women also are more likely to seek help, while men often mask their depression with alcohol, drugs or by spending a disproportionate amount of time working, the NDMDA says.
Still, it took her daughter’s persistence to get Brekke to realize she needed help.
How could someone live into her 60s and not know she is depressed?
“It’s like any pain,” explains Sallas. “You don’t realize how severe it is until you don’t have it anymore. You start adjusting your lifestyle to this pain and depressive state. So even if you have a severe depression, you start accommodating, you sort of think that this is somewhat normal.
“The human being is a pretty resilient organism, and so we perform under tremendous states of difficulty.”
Sallas also points to the stigma surrounding mental illness that was prevalent when Brekke was growing up. Even now, with the American notion that we are supposed to do it alone–the buck-up attitude, says Sallas–there remains a barrier to getting help, which is “very devastating.”
Missed the signs
Brekke’s daughter Ann works as an addictions counselor in a Chicago hospital, but even she didn’t recognize her mother’s depression.
“We got accustomed to living life a certain way until we were older,” she says. Her mother was never short of affection or complements, Ann says, “we just all understood she was a pretty unhappy person.”
It was only after Ann’s husband, who also works in the mental health field, asked how long her mother had been depressed that she realized her mother needed help.
The first time she broached the subject, Ann says she was “incredibly inarticulate.” Afraid of hurting her mother’s feelings, she dropped the matter altogether.
A year later, she tried again, but with backup. She researched depression, got brochures and called Sallas, to whom she refers people. Sallas offered to talk with Brekke, and this time Brekke heard what her daughter was trying to say.
Brekke began to see Sallas on a regular basis, once, sometimes twice a week. In addition to Sallas, Brekke also checked in monthly with the psychiatrist and regularly saw her internist, who monitored her physical health. She built a support system for herself.
“The most important thing I learned,” she says, “was to take it seriously. It’s not just taking a pill; you have to do the work that goes with it.”
Asking for help
The other thing she learned, which was new for her, was that she could ask for help.
Brekke has lost 60 pounds and intends to lose more. She watches her nutrition and follows the Weight Watchers program. She teaches a poetry class at a senior citizens center every other week.
She jokes that, with all the resistance she used to have to anti-depressants, she “would fight anybody now who wanted my Paxil.” Her dose has been adjusted several times over the years. She takes 20 mg a day, but without therapy, she says, it wouldn’t have had the kind of life-changing effect that she has experienced.
Being on medication is no guarantee, she says, but now the depression is not so scary and the episodes don’t last as long.
Ann Brekke, 40, agrees that her mother’s emotional well-being is a lot better. “She has peaks and valleys, but we can talk about it. I’m able to say, `You’re feeling pretty depressed right now, aren’t you?’ and that’s a huge step.”
Also, the “lows” now might only last a few weeks, versus the years that Ann remembers when she was growing up.
Brekke remembers those years as well, and recalls a period when her depression was particularly severe. When Ann was a little girl, Brekke says, “she used to tap me on the arm and say, `Mommy, are you in there?’ “
All four of Brekke’s brothers suffered from depression as well, she says, so her depression could have been genetically predetermined. It also could have been prompted by traumatic life events that were left unresolved.
As Brekke says, “everyone has tragedies.” And for her those tragedies started when she was a child.
It happened in the summer of 1939 at a beach in Indiana. Brekke was not yet 10 years old. It was a beautiful August day, she recalls. She was playing in Lake Michigan, along with other family members. Then a seiche, apparently whipped up the day before by a violent storm on the lake, occurred. Her brother, aunt, uncle and cousin drowned.
Triggered by death
“I was the only one who survived. I think it had a powerful effect,” Brekke says. “You lose your innocence. A lot of adults were saying, `Well, they were good people, and they were taken early,’ and I thought well, that must mean I’m bad.”
Two years later, when she was 12, Brekke’s father died. That, she says, was the first time she put on weight. Up until that time she was “very average, just a thin kid.”
Her mother was a “stoic person,” theirs was a large Catholic family and Brekke never had a chance to deal with those tragedies.
“They just always said, `It’s the will of God,’ ” Brekke says.
Years later, another tragedy struck, the kind that can cripple even the most emotionally sound person: Her child died.
“Mark was the fourth, the littlest boy,” she says. “He was a very happy little boy, very sweet baby. It was a crib death. It was devastating. There’s a tremendous sense of guilt, somebody’s only 10 feet from you and this happens. It happened at night, and I found him in the morning. And then you wonder, `Did I do the right the thing?’ That was terrible, I couldn’t deal with it, I didn’t deal with it.”
Brekke says she couldn’t cry and she and her husband couldn’t talk about it. “It doesn’t bring you closer, that’s strictly Hollywood. We couldn’t discuss it with each other. It was years later, when I finally talked about it in therapy,” she says.
A tragedy or loss in itself is not going to create depression, explains Sallas, but how it’s dealt with could certainly play a role in mental health and well-being.
“I’m not saying therapy is the only way to cope with tragedies, but you have to cope with them in some way. You can’t just leave them there. Loss is something that you deal with through grief and need to move through.”
Events never addressed
The tragic events of Brekke’s life certainly exacerbated her depression, says Sallas, because they were never addressed.
“She carried these burdens and they weighed down her life. They never got dealt with. Not that you ever remove them but you certainly can put them in their appropriate perspective and alleviate the depression and the burden that those events lay upon your life.”
Because of her therapy, and her family’s participation in it, Brekke says, “We became a different kind of family.”
“I feel great about my life now,” she says. “We have eight grandchildren and they’re all wonderful.”
Most importantly, because of the counseling, which at one time or another included the other members of her family, Brekke says she and her husband have a healthier relationship with their adult children.
Next year, Brekke and husband Stephen will have been married 50 years. She no longer sees Sallas on a regular basis, but Brekke says she calls her whenever she needs to talk.
For her, the stigma around psychotherapy no longer exists. The rewards of her work far outweigh any reservations she may have had about seeking help. And she now urges anyone who might be hurting emotionally in some way to seek help.
“I feel very good about our marriage, that it succeeded, and finally our children have a father and mother who are in touch with them,” she says. “But it took a long time. I surely wish it could have happened sooner.”
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More information about depression and treatment is available on the NDMDA Web site, www.ndmda.org.
