Under the Skin

Dear Performer(s), As of the time of this writing in August 2024, approximately 264 million people globally suffer from Major Depressive Disorder (MDD), according to data from the World Health Organization (WHO). WHO also reports that approximately 284 million suffer from Generalized Anxiety Disorder (GAD). Comorbidity rates range from 20% to 50%. While these don’t equate to large percentages of the population, one must acknowledge that methodologies of study and data collection differ. Some nations may not report data on these disorders, and citizens may deny their existence due to cultural and political factors. The above figures rise when looking solely at the United States. According to the National Institute of Mental Health (NIMH) and the American Psychiatric Association (APA), roughly 8.4% of adults suffer from MDD (1 in 12), 3.1% struggle with GAD (1 in 32), and comorbidity is around 50% (1 in 24). Given these data, we all likely know at least one person with one or both of these conditions, if we don’t struggle with them ourselves. For those who deal with ADHD, like myself, these numbers climb even higher. Around 30-50% of ADHD er’s are diagnosed with MDD, 25-40% with GAD, and 20-30% with all three disorders. I am a member of this latter club, and I wasn’t diagnosed until I was 28 years old, after completing my doctoral degree and thinking I was “fine.” One may not even know that someone struggles with ADHD, MDD, or GAD, as we are often skilled at masking and/or managing our symptoms. The title, Under the Skin, perfectly captures this reality: there are many “high￾functioning” people who suffer in silence. I have spent a great deal of time learning about these conditions and how they interact. Two books in particular inspired the movement titles of this piece: Andrew Solomon’s The Noonday Demon: An Atlas of Depression and Sarah Wilson’s First, We Make the Beast Beautiful: A New Journey Through Anxiety. I sincerely thank these brave writers for sharing their stories and extensive research. It’s vitally important for the silence and taboo on mental illness to be broken. When my colleague Tim Michling reached out to me about composing a heavy metal piece for the bass oboe, I couldn’t possibly say “no!” Bass oboe?! YES, PLEASE! Luckily, for those without a bass oboe, it also works well on tenor saxophone. Tim and I quickly found out that we both share the trinity of disorders, love progressive metal, and have had strikingly similar life experiences in dealing with them. I and deeply grateful to Tim for the opportunity to create this piece for him. The catharsis I have felt throughout composing it has been immeasurable. The title Under the Skin, in addition to capturing the feeling of living with “the trifecta,” takes its name from a poignant quote in Solomon’s book: “Depression is just under the skin, all the surface of the body has the depression just below it, and we cannot take it out; but we can try to forget the depression even though it is right there.” In other words, some of us will struggle for a lifetime. Others will enter remission with the help of medication and therapy. That noonday demon, that beautiful beast, never really leaves me be. I’m learning to make it my friend. It is a part of me, after all, and we must try to see all parts of ourselves as beautiful, valid, and important even the heavy ones. In “The Noonday Demon,” one can hear the gradual encroachment of a depressive episode; harmonies vary from section to section, interrupted by strange intrusive sections at different tempi and in different time signatures. This is how depression often feels to me: I’ll be okay for a while, and then an undercurrent of dread will begin to build as intrusive thoughts occur more and more frequently. The music in “The Beautiful Beast” is, frankly, relentlessly pissed off, which is how my anxiety usually presents itself. It’s often a reaction to my depression. I get angry at myself for feeling so low when my life is so good. The cycle feeds itself until I am able to break it. I get better at this process every day. “Some people feel like they don’t deserve love. They walk away quietly into empty spaces, trying to close the gaps of the past” (Jon Krakauer, Into the Wild). If you know someone struggling with MDD, GAD, or both, reach out and let them know you love them. If you’re near them geographically, offer to go give them a hug just for being themselves. Depression blinds one to the brightness of love, and every unconditional expression of it can help someone heal. Sincerely, Evan Zegiel