“Can you remember what you felt like when you walked through that door?”

“No,” I blubber back.

“You said you were feeling okay. It was just twenty minutes ago.”

“I’m not okay,” I insist, through tears. “I’m not going to be okay.”

It hadn’t been an easy day. I had a total meltdown over the weekend, and was just starting to pull myself together when my psychiatrist summoned me from group. It started off logically enough: I’ve never taken this much medication, I explained, and yet I’m still doing poorly. Ergo, I’m sicker than I’ve ever been. Therefore, I’m getting worse over time. Which means my life is, effectively, over. Cue breakdown.

Luckily, day hospitals don’t demand much in terms of patient behavior. At any given time, half of the group might be napping on mats on the floor, or playing with silly putty, or staring intently at those things that you flip over and can watch some sort of colorful ooze fall from the top to bottom. For my part, when I return, I curl up in a ball, trying to make myself so small I disappear. The therapist wraps a shawl around me and makes me a cup of tea.

And then, inexplicably, it lifted. An hour later, I go to the meeting with my advisor that my psychologist had (understandably) encouraged me to cancel; I feel good, and useful, and supported. Two hours after, I’m running with Marie. In the evening, after a nice dinner, I stare at my DBT “diary card”: should I put a four-point-five (five is the maximum) in the column ranking my “sadness” for the day—to account for how I felt in the afternoon—or a one—which aptly described my evening?

“I hate this thing that invades your brain. It’s pollution… I want to kick it out!”

My partner is trying to console me. We’re nearing the parking lot at the end of a six-hour hike in Tilden. I loved most of it. We are walking with good friends; we’re accompanied by an indefatigably enthusiastic dog; the sun is out and I’m in a t-shirt in the middle of March. Even the moment of adversity—a somewhat-treacherous descent through ankle-deep mud—is mostly just amusing. I’m looking forward to checking off “accumulate positive experiences” as one of my “skills practiced” for today.

But still, I go down the rabbit hole. I realize immediately where my brain is going, and I can’t for the life of me figure out how to arrest it. In thirty minutes, I slide from announcing “I’m feeling a bit anxious” to complete incoherence. My chest tightens, my arms and legs feel heavy, and, after leading the group for five hours, we drop back behind our friends. Marie tries to get me to sing a song, any song; I half-whisper Bad Religion’s “Sorrow” between sobs.

I’m feeling okay by the time we leave for our Saturday night dumpster dive, a few hours later.

“It’s good to see you are yourself again.”

I’m getting that a lot these days. It’s a funny statement, given how much of my adult life has been shaped by depression. Most of my friends talk like depression is some kind of an infection that invades me from the outside. When I have a bit more insight, I consider it more like a cancer; a genetic predisposition towards my brain turning on itself.

There’s this never-ending debate about whether we should say someone “is schizophrenic” or “has schizophrenia.” It’s odd that there’s no equivalent for depression—saying someone “is depressed” does not describe a type of person; it describes a state of being. But in my bad moments, I am not just depressed; I am depression.

“I don’t even feel like I’m the same person in the bad moments. But the problem is, I am.”

I hesitate to say it—I don’t want to pretend I know the kind of suffering that someone with, say, schizophrenia experiences—but depression has become almost a form of madness for me. It wasn’t like that when I first hurt myself at sixteen, or at eighteen when I checked into the campus health center, or at twenty-two when I convinced myself I would drop out of Oxford. I wouldn’t say it’s better or worse than the depression I’ve experienced before, it’s just different.

Somehow, in a few years, depression has gone beyond just being a strong emotion and an overwhelming sense of hopelessness to become an alternative reality. It’s not that I’m delusional about the world around me—as I imagine psychotic people might be. It’s that the world around me—my wife, my family, my friends, my book, my research, my activism—somehow ceases to exist.

Maybe I should tattoo it on my arms, drill it into me, and stick a microchip in my brain, saying on loop:

“This will end. It always ends. You always come back.”