'Less of a wound, more of a scar'

After decades of struggle and dozens of therapeutic interventions, Paul Greenberg is learning to manage his depression and be kinder to himself.

This story contains content about suicide that could be upsetting or triggering for some individuals. Please exercise your best judgment and self care in choosing whether or not to read it. If you need help, call the Suicide Prevention Lifeline at 800-273-8255 or text Crisis Text Line at 741741.

Though he can’t put a finger on a specific trigger or catalyst, Paul Greenberg knows the onset of his depression coincided with adolescence, those pre-teen years when hormones rage and social pressures mount. He just remembers that, not long after his 12th birthday, he started feeling “really terrible.”

“I felt terrible about myself, awful for being alive, felt I wasn’t a good person and nobody liked me and I was having these very intrusive, persistent and consistently negative thoughts,” says the founder and CEO of Butter Works, a digital video firm based in New York City. “When I was 13, it became unbearable.”

That’s when Greenberg, while attending a private school in Washington, D.C., took the necktie he and his male classmates were required to wear, tied it to a pipe in the boy’s locker room, and jumped off a nearby windowsill. The pipe (which contained no water) broke; he fell to the floor unharmed and, terrified, confused and embarrassed, ran away before anyone could discover the evidence. That was the beginning of “a very long journey” for Greenberg, who has been in therapy for most of his 53 years.

Upon learning of his attempt, Greenberg’s parents immediately sent him to a psychiatrist. The sessions helped -- “to an extent,” he says – but over the next 20 years, it was his sheer determination to “push through the pain” that kept most of his high school and college peers from ever guessing his secret struggle. Depressed, they might say in surprise? Not good-looking, smart Paul, who had lots of friends, plenty of dates and DJ’d parties on the weekends.

 “I was just able to birfurcate in my mind the pain of the depression,  that was really constant, by just putting my head down, getting work done and living life as best I could,” Greenberg says reflectively. “I just was lucky that the quality of my depression allowed me to at least get done what I had to get done in my life, even if I felt lousy the whole time. It was really hard, but I guess it didn’t really stop me from doing anything because I met my future wife during that time.”

At 29, he finished business school, ready to “start a new chapter.” He’d been seeing the same psychiatrist for 10 years and while the talk therapy had kept him from acting on his suicidal thoughts, he felt he’d made “almost no progress” toward conquering his illness. At that point, he’d never taken medication for his depression, so he began to see a psychopharmacologist (a physician who studies the effect of medications on mental illnesses) who was “aggressive, but in a good way.”

Over the next four or five years, Greenberg tried dozens of drugs, but his depression remained stubbornly resistant. Eventually his doctor decided to change course. He recommended Greenberg undergo electro convulsive therapy (ECT, once known as shock therapy) and told him he was “a perfect candidate.” Greenberg’s initial reaction was horror.

“I had seen ‘One Flew Over the Cuckoo’s Nest,’” he says of the 1975 film starring Jack Nicholson, set in a rather barbaric mental hospital, “and I said, ‘I’m not doing that!’”

Even after his doctor explained that modern ECT is done under general anesthesia and with muscle relaxants, Greenberg still felt frightened at the prospect. But not enough to outright reject the idea.

“At that point my depression had really taken a turn for the worse and I was at a very low point, very suicidal and I just felt like, ‘This is my last hope. I can’t live like this anymore and if I don’t do this, I’m going to kill myself.’ So it was really out of desperation that I agreed to do it.”

A month later, after a series of 12 sessions, Greenberg was at the playground with his children when he experienced a sensation he’d never felt before.

“I suddenly felt this albatross of depression lift, for the first time in my adult life,” he says. “It was the most remarkable feeling. I actually felt happy, but I didn’t even know what that emotion was, really. It was just this absence of weight and horror and suicidality that I finally broke through. So there was this incredible feeling of relief.”

Though doctors had warned him that ECT was not a permanent fix and that many patients need sporadic “touch ups,” Greenberg was enormously optimistic that he had finally banished his demons. Nevertheless, he returned to talk therapy as well; by that time he’d tried psychoanalysis (“I didn’t like not being able to see my psychiatrist”) and cognitive behavioral therapy (CBT) with minimal benefit but continued to gain insights from traditional psychodynamic psychotherapy.

Then his sister Kathryn, who had also suffered from depression and suicidality from a young age, told him of her positive experience with dialectical behavior therapy (DBT), a process in which therapist and client work to balance acceptance and change-oriented strategies, similar to the philosophical dialectical process of hypothesis, antithesis and synthesis. He also underwent a treatment known as EMDR (eye movement desensitization and reprocessing) which involves bilateral stimulation of the senses. Though some doctors do not recommend doing multiple therapies at once, Greenberg says for him it was the right decision.

“Before, it was almost like there was this brick wall of impenetrable depression that made it so I couldn’t even do the work to figure out what the underlying issues were,” he says. “The depression just took over everything and I couldn’t get past it. Once the depression was cleared away, talk therapy was a lot more helpful. So for me, I think the combination of trying different things was really helpful.”

There were other factors that also aided in his recovery, foremost among them his wife, who moved from being “a shoulder to cry on who withstood a lot of my anger and moods” in the early years of their marriage, to someone who knew him so intimately she could help him process and assimilate the strategies that arose in therapy. It was also during this time that Greenberg learned of psychiatrist George Vaillant’s 40-year longitudinal study which followed more than 700 people for over 60 years to plumb the keys to recovery and happiness. His most basic conclusion? “Happiness is love. Full stop.”

Greenberg says he had successfully embraced two of the three kinds of critical love – loving someone else and being loved by someone else – but he’d always struggled with the third. And failing to love himself had served to keep his depression firmly rooted.

“Self love was very, very hard for me for so many years,” he admits. “I think working on love is absolutely critical and it’s a hard thing to do. I was depressed and I was beating myself up that I was depressed, and I was angry that I couldn’t make it better, which probably made it worse. I had to learn to be kind to myself. Now that I don’t hate myself as much as I used to, I know it’s made a big difference.”

In 2014, when the Robin Williams took his own life after suffering for years with depression and Lewy body disease, Greenberg, who adored the actor and his work, was hit with such a wave of sadness that he sat down and wrote an article about his own struggles. He ended up showing it only to a couple close friends, who reacted supportively. But four years later when, within a week, two other famous personalities – Kate Spade and Anthony Bourdain – also chose to end their lives, he felt he could stay silent no longer.

“I just thought, ‘My god! It’s such an epidemic! And it’s getting worse,” Greenberg says. “And I also saw some trolls online saying, ‘They were so weak, why couldn’t they push through?’ I just thought there’s such a misunderstanding of mental health and mental illness. It needs to be de-stigmatized. So if I can help do that in even a small way by owning up to what I’m going through and showing other people there is a path, that they are not alone, then that was something I really wanted to do.”

Greenberg chose to very publicly  “come out” in a 2018 article in the Hollywood Reporter that detailed his own long mental health journey. He admits this may have been easier to risk given that he had just started his own company, but says he would have done it even if he’d still been working for someone else because “if they were worried it would hurt the image of the company, then it was time to leave that company anyway.”  The “incredibly positive” response he received confirmed his choice and encouraged him to continue his advocacy.

 Since then, Greenberg has embraced every opportunity to share his story in interviews, podcasts and even by talking with other patients considering ECT and, as he had been, frightened by the prospect.

“I will do anything I can do to help people understand this disease and be OK with the fact that it exists and there are a lot of us who live with it,” he says. “I can point out the specific treatments that were helpful to me and share my story and it makes me feel great and hopefully helps me help other people.”

In a Hollywood movie, Greenberg’s story might end there. But real life is seldom so tidy or precise. About five or six years after his ECT sessions ended, Greenberg’s depression resurfaced. By that time, infusions of ketamine, a medication used originally for anesthesia, had begun gaining medical credence for success in treating resistant depression. Again, Greenberg’s doctor told him he was an ideal candidate and that, though the effects are not permanent or even necessarily long term, ketamine might be easier on his body than continued ECT.

“So I tried it and it worked wonders,” says Greenberg, who laughs when he’s referred to as a ‘walking encyclopedia of depression interventions.’ He now gets a ketamine infusion every two weeks and, with the aid of an additional small dose of an atypical antipsychotic, manages to maintain a balanced mood level. Which is not to say he’s found a “cure.”

“At this point, I’ve accepted that this is something I’ll probably be living with for the rest of my life,” Greenberg admits. “There was a point after ECT when I thought, ‘Oh good, I’m done.’ And now I realize I’m not done and I’m never going to be done.  Now it’s all about managing it, staying on top of it, making sure it doesn’t get worse, reopen, or the scab doesn’t fall off. In that sense, it’s become less of a wound and more of a scar.”

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