The Black Hole

In all my years I have heard my patients talk about the dark hole, the dark tunnel. Some permutation, used quite frequently, always similar in its base description but just slightly different when you ask them to give details. Not every patient will talk to you about that dark hole. Not every patient gets that depressed.  Some who come complaining about being suicidal have never put much thought into what they are truly saying. Perhaps attention seeking for some, but thoughts of suicide are a coping skill for many. “If life gets too overwhelming, I always have the realization that if I am dead, I cannot suffer anymore.”  

 

Black holes may not be universal but certainly a common theme. Many patients speak about it.  Why it is so frequent that one has the subjective feeling of being surrounded by darkness, distanced from one’s world when feeling depressed could be debated.  Is it due to a brain starved of serotonergic input? Perhaps the ever so slight lack of oxygen caused by psychomotor retardation affecting one’s vision along with ability to move? It is real enough to one who dwells within.

 

 I have no proof of this, but I wonder if “The Pit” by Edgar Allen Poe was inspired by a depressive episode. Purely speculative, I do not know enough about the author’s personal life to say. I do know that his writings spoke quite frequently of similar themes, being trapped in enclosed spaces, unable to escape. Of course the ever constant ruminations of death and misery are highly suggestive of a depressed mind.

 

One thing I know is no one can fully understand what it feels like at the bottom of that hole unless he or she has been there. Everyone’s hole is their own. Varying in depth, breadth, and feel, they are all unique but somehow have a similar thread. They all come with the same sense of terror looking up at the top, desperately hoping someone will send a rope down, but no one does. You try to call for help, but your lungs will not expand enough to let you draw in the air to scream. Like those nightmares where you can see the shadowy figure in the window outside the door of your house, but you cannot run, cannot call for help, you feel desperate and trapped.  Scared but not sure of what and feeling alone, very, very alone.

 

Part of what keeps me going when I get overwhelmed by difficult patients, conflicts with the system or being overworked in general, it is knowing that I have a role in helping people out of that black hole. Yes, many of them will fall back in at a later date, depression is a frequently chronic illness but so is heart disease and diabetes, but you still treat it with the goal to get your patient  better.  It is possible to escape from the black hole, unlike most Edgar Allen Poe stories.