A tall guy outfitted with a snowboarder hat, a laidback pose and a mellow attitude, Adam* seemed perfectly cool and in control.
But Adam didn't have everything under control. There was something else others couldn't see -- not in Adam's appearance, not in his speech, not in his gait. He was suffering from clinical depression.
The First Signs
It all started during his transition to college, Adam said. He had gone to a high school he really liked and had a girlfriend of two years whom he really liked -- life was peachy. But after graduation, his girlfriend ended up at a school in Boston, while he landed at the University -- a distance that a plane ticket could conquer, but not easily enough. The relationship finally fell apart in the spring of Adam's first year. The breakup, according to Adam, "was partially an impetus that may have started all of this."
Then, to make matters worse, Adam's relationship with his parents soured. After tasting the freedom of University life, he wasn't eager to follow his parents' stringent rules when he returned home for breaks.
That situation "increased tensions with my parents, and so in general I started feeling crappy about a lot of things," Adam said. "Nothing really seemed to be going right."
Soon, typical symptoms of depression started appearing.
"I didn't really feel like eating a lot of the time," he said. "I only really wanted to isolate myself from people and be in room by myself and not do anything, just sleep all the time."
Adam's experience began at the most common age for symptoms of depression to surface, according to Rafael Triana, a clinical social worker and psychoanalyst with the University's Counseling and Psychological Services.
"In late adolescence, there's a number of developmental tasks -- separation from family, beginning to establish new peer relationships," Triana said. "You are one of 3,000 students, and you have to start all over, learning about yourself as a person in terms of your major, vocation or career, aptitude and goals, values, political and religious.
"There's what psychoanalyst Erik Erikson coined, 'consolidating a sense of identity,' who we are, what we want to be, what our goals are," Triana continued. "There's a lot churning developmentally. Those tasks can overtax the psychic economy and bring out earlier unresolved issues from the past. What comes forth are earlier vulnerabilities that become stressed during this late adolescence, and the vulnerabilities become manifested as depression or anxiety or a combination of both."
Adam didn't immediately think his symptoms added up to depression.
"I mean, I figured that maybe I had some form of depression, but that it must be different from everyone else because you just assume no one else feels the way you do about things," he said. "You assume you're different, you're special, so you're like, 'Yeah, other people are depressed, but man, I'm really messed up!'"
Even to an outside eye, Adam's behavior didn't give much away. A close friend and apartment-mate recalled that "he really didn't act any different."
Seeking Help
Eventually, though, Adam started to come to terms with the idea that he might have clinical depression, thanks in part to publicity about the illness.
"I got an e-mail about National Depression Week or something, and it had the list of symptoms, and I realized that I met, like, all of them," Adam said, laughing slightly at the recollection.
That, he said, was when getting help started to look like a good idea.
"It's hard to take the first step because you have to admit, basically, that there's something wrong with you," Adam said. "But I'm really glad I did, and CAPS, even though they can't really give long-term service, they can send you in the right direction."
Adam learned that he had clinical depression through what Triana called a "differential diagnosis." This is a process that CAPS uses to take advantage of the combined training of the staff and avoid misdiagnosing a student. The first part of this process is a "clinical interview," after which, Triana said, "the person should feel like they've told a story of their life rather than being interrogated."
And Adam did indeed feel like an autobiographer.
"One thing that's kind of annoying when you're getting treatment is that every time you see someone new, you have to go through a whole personal history of your life," he said.
But this so-called storytelling is crucial, according to Triana.
"By them telling about the depression in the narrative, we -- because of our training -- can then differentiate the type of depression or anxiety," Triana said. "And then we also do psychological testing, and we consult with each other. We have treatment teams composed of senior clinicians where we discuss cases."
CAPS does not provide long-term care, however. Therefore, Triana explained, the specialists there decide, based on "the nature of the depression or anxiety," on a suitable treatment plan for the student, ensuring first that he or she is in stable enough condition to move on to private care.
That was exactly what they did with Adam, and for a while, the situation seemed under control. CAPS referred Adam to a therapist while he was still at the University, and then over the summer he met with another therapist near his home.
His relationship with his parents wasn't going too badly, either.
"I didn't tell them at first that I was going [to therapy], but then when they needed information from the insurance and everything, I basically just had to tell them," Adam said. "So I said that I was going to a therapist to help me deal with some things, and they were okay with it. And it actually turned out to be funny because my parents were going to a marriage counselor."
Hitting Bottom
Things got worse before they got better, though. The fall semester brought Adam back to his Charlottesville therapist, with whom he said he shared a less than spectacular relationship.
"She'd have me in group therapy and everything, and it wasn't really the right thing for me -- it wasn't really working out," Adam said. "But, you know, instead of requesting a change to a new therapist or something like that, I just went along with it."
So as his therapy stagnated, his depression was free to resume its downward drop.
The crash came when a major argument exploded between Adam and his parents while he was at home for winter break -- a renewed burst of tension that was yet another in a series of stressful events. It was the last straw.
"I was bothered by a lot of other things, so I started having a lot of, like, suicidal thoughts and stuff," Adam said. "Then sometime in January, I guess I just decided I would try and kill myself."
He ended up in his dorm room, overdosing on prescription drugs and washing them down with alcohol.
Although his Charlottesville therapist hadn't helped Adam improve much, she probably saved his life. When Adam didn't come to his appointment that day, she called the police, who quickly found Adam in his room, unconscious. They rushed him to the University hospital.
As soon as he awoke, however, Adam found himself dealing with the responsibility of what he'd tried to do. He had to face not only himself, but also his loved ones -- his mother was on her way.
"They had called my mom, and she was coming," Adam said. "And that freaked me out because, you know, you don't want your mom to come and [the doctors] be like, 'Your son just tried to kill himself.'"
His mother was sympathetic and comforting, but Adam said he still feels guilty about the burden he placed on other people.
"I guess the worst thing about it is the negative effect it had on my family," he said. "I still feel horrible about that because so many people were upset and worried about me. At the same time, my parents were kind of like, 'What did we do wrong?'"
Adam was kept in the psychiatric ward of the hospital until he showed he was stable enough to be on his own. Time in the ward was good medicine, he said.
"I was there for, like, three days, and after a while I realized I just want to get out of here and live my life, you know?" Adam said. "I was so controlled. At first, I had my own room, and there was a video camera directly above the bed, and people would come in and check on you every 10 minutes, and you weren't allowed to have anything metal or sharp or anything. But I had a lot of friends come visit me. That was helpful. I mean, it was good to know that so many people cared so much, even though it had to come out of such a negative thing."
New Insights
After what had happened, Adam's parents encouraged him to take time off from school. Though he was reluctant at first, he eventually consented, and spent the spring semester sorting things out.
With his head clear for a few months, Adam reached some conclusions about what had led to his depression, and more importantly, he realized there were ways he could keep the illness at bay.
"I kind of developed a lot of anxiety based on trying to live up to my parents' expectations," Adam said. "They always had really high expectations of me. So I feel like it's been necessary, for me to get through my depression, to distance myself from them a little bit and just get a hold of my own opinions. That hasn't always been what they've wanted for me, but I've got to do my best."
Distancing himself from his parents may enable Adam to focus on "consolidating a sense of identity," the idea that Triana had mentioned.
"I feel like I'm forming my own image of myself, just doing things the way I want to," Adam said. "[The experience] made me realize that I'd been living my life for other people too much and putting too much emphasis on what other people thought about me, what other people thought I should do. And I realized that if you really hate the way your life is so much that you want to die, then anything is better than that. So don't be afraid to just do whatever until you find something that fits."
Adam has been heeding his own advice and is now back at the University as a full-time student. He attributes much of his success -- despite some shakiness with one of his therapists -- to the fact that he had outside help.
"Without someone to talk me through it, I don't know what I would have done, really, without that support system that we have in place," he said. "Therapists, no matter how 'different' your case seems, they've seen similar things before, so they can lend insight that you might not necessarily be able to come up with yourself."
Triana also stressed the value of seeking help at the slightest sign of depression.
"Early identification of depression or any psychiatric illness is crucial," Triana said. "And even when someone is in doubt, they should come in. The idea of prevention is so important. Early treatment can prevent years of unnecessary suffering for them and their loved ones."
*Note to readers: "Adam" is a fictitious name created to protect the identity of a real man suffering from clinical depression.
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