A few days ago I posted about my Black Dog (insomnia.) and that I was working with a psychologist. So I was heartened to read this in a post by Ariana Huffington:
CBT-I [cognitive behavioral therapy – insomnia] is the most effective psychology-based treatment for a health problem and has consistently been proven to be the most effective first-line treatment for chronic insomnia. It improves sleep in 75 to 80 percent of insomnia patients and reduces or eliminates sleeping pill use in 90 percent of patients. It is so effective that I am surprised if my patients do not report improvement in sleep, or a reduction or elimination of sleeping pills, from CBT-I. And in three studies published in major medical journals that directly compared CBT with sleeping pills, including my study at Harvard Medical School, CBT-I was more effective than sleeping pills. CBT-I also has no side effects and maintains improvements in sleep long-term, and new research shows that CBT-I doubles the improvement rates of depression compared with antidepressant medication alone in depressed patients with insomnia.
In contrast to CBT-I, sleeping pills do not greatly improve sleep. Objectively, newer-generation sleeping pills such as Ambien are no more effective than a placebo.
I’m having trouble again with insomnia. Last night I didn’t get to sleep until 3:00 AM. The night before I took an hour to get to sleep. I thought I’d turned the corner and was on my way to ending this problem. Abe Lincoln and Winston Churchill had periods of severe depression and called these episodes The Black Dog. I am going to use the same name for my insomnia problem. I won’t presume that I can come up with a better name than Lincoln or Churchill.
I’ve been following all the rigid rules set forth by Dr. Davig, the sleep psychologist I’m working with, yet still The Black Dog hangs around plaguing me in the dark reaches of the night.
I copied The Black Dog image from Google. Apparently it is now common to refer to depression as The Black Dog. Google Images is chock-a-block with black-dog images, too many of which are too light-hearted. The Black Dog, whether it is my insomnia or someone else’s relentless depression, is not light-hearted. It is fearful.
I decided to do a bit more research on “black dog”. I found “‘Black dog’ as a metaphor for depression: a brief history“, a paper by Paul Foley. I found the paper on the website of The Black Dog Institute, an organization dedicated to improving the lives of people affected by mood disorders. Foley defines depression to fit the black-dog metaphor, and insomnia is not a lot different:
an ever-present companion, lurking in the shadows just out of sight, growling, vaguely menacing, always on the alert; sinister and unpredictable, capable of overwhelming you at any moment.
Churchill definitely used “black dog”; Lincoln perhaps not:
Abraham Lincoln is occasionally said to have referred to his depression as his ‘black dog’, but a precise source is never given.
Churchill did not coin the phrase. He heard it from “his beloved childhood nanny”.
It is ultimately unlikely that ‘black dog’ was a specific term for depression before Churchill used it, but was rather a vague reference to anything which rendered someone less than congenial, whether ill temper, fear, guilt or, indeed, melancholy; as recently as 1956, it was defined simply as ‘peevish fit’, especially in children. Other terms which also began their ascent in the 18th century – the ‘blue devils’ (1780s), ‘the blues’ (1740s) and more general descriptions of depressed spirits – were more frequently recorded, at least in published texts, and generally retained a more specific relationship with ‘depression’. Adoption of ‘black dog’ by Churchill (and by those who write about him) thus represented a turning point for the beast; and once the adoption became public, whatever it was exactly that Churchill meant, ‘black dog’ could assume its now secure place in English
I don’t want to end on a note of depression. I know that I am going to banish my black dog to the nether regions with help from Dr. Davig. I’ll let Churchill end on a more upbeat note.