The Noonday Demon (15 page)

Then, in July, I decided to accept an invitation to go sailing with some friends in Turkey. It was cheaper for me to go there than it would have been for me to be hospitalized, and it was at least three times as effective: in the perfect Turkish sunshine, the depression evaporated. Things got steadily better after that. Late in the autumn, I suddenly found that I was lying awake at night, my body trembling, much as it had done at the lowest points of my depression, but I was awake this time with happiness. I climbed out of bed and wrote about it. Years had passed since I had felt happiness at all, and I had forgotten what it is like to want to live, to enjoy the day you are in and to long for the next one, to know that you are one of the lucky people for whom life is the living of it. As surely as the rainbow covenant that God gave to Noah, I felt I had proof that existence was and would always be worth it, though. I knew that episodes of pain might lie ahead, that depression is cyclical and returns to afflict its victims over and over. I felt safe from myself. I knew that eternal sadness, though very much within me, did not mitigate the happiness. I turned thirty-three shortly thereafter, and it was a truly happy birthday, at last.

That was all I heard from my depression for a long time. The poet Jane Kenyon wrote:

And so it was for me that everything seemed to be returning, started strange, then went abruptly familiar, and I realized that a deep sadness had started when my mother got ill, had worsened when she died, had built beyond grief into despair, had disabled me, and was not disabling me anymore. I was still sad about the sad things, but I was myself again, as I used to be, as I always meant to go on being.

Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication. “Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication. “So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm. “But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh. “So maybe you’ll stay on a really low maintenance
dose?” they ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication: “Well, I sure hope you get off sometime soon,” they say.

“I may not know the exact effects of long-term medication,” says John Greden. “No one has yet taken Prozac for eighty years. But I certainly know the effects of nonmedication, or of going on and off medication, or of trying to reduce appropriate doses to inappropriate levels—and those effects are brain damage. You start to have consequences from chronicity. You have recurrences of increasing severity, levels of distress there is no reason for you ever to experience. We would never treat diabetes or hypertension in this on-again, off-again way; why do we do it with depression? Where has this weird social pressure come from? This illness has an eighty percent relapse rate within a year without medication, and an eighty percent wellness rate with medication.” Robert Post, of the NIMH, concurs: “People worry about side effects from staying on medication for a lifetime, but the side effects of doing that appear to be insubstantial, very insubstantial compared to the lethality of undertreated depression. If you have a relative or a patient on digitalis, what would you think of suggesting he go off it, see if he has another bout of congestive heart failure, and have his heart get so flabby that it can never get back into shape again? It’s not one iota different.” The side effects of these drugs are for most people much healthier than the illness they address.

There is evidence of people having adverse reactions to everything: certainly plenty of people have had adverse responses to Prozac. A certain amount of caution is appropriate when you decide to consume anything, from wild mushrooms to cough syrup. One of my godchildren almost died through exposure to walnuts, to which he is allergic, at a London birthday party; it is a good thing that labeling law now requires products that may contain nuts to indicate as much on their labels. People who take Prozac should watch in the early stages for adverse responses. The drug can cause facial tics and stiffening of muscles. Antidepressant drugs bring up questions around addiction, which I address later on in this book. The lowered libido, weird dreams, and other effects mentioned on the labeling of the SSRIs can be miserable. I am troubled by reports that some antidepressants have been associated with suicide; I believe that this has to do with the enabling quality of the
drugs, which may give someone the wherewithal to do what he was previously too debilitated to contemplate. I accept that we cannot definitively know the very long-term effect of the medications. It is most unfortunate, however, that some scientists have chosen to capitalize on these adverse reactions, spawning an industry of Prozac detractors who misrepresent the drug as a grave peril that is being foisted on an innocent public. In an ideal world, one would not take any drugs and one’s body would regulate itself adequately; who wants to take drugs? But the ludicrous assertions made in such stridently foolish books as
Prozac Backlash
cannot be taken for more than pandering to the cheapest fears of an apprehensive audience. I deplore the cynics who keep suffering patients from the essentially benign cures that might give them back their lives.

Like childbirth, depression is a pain so severe as to be immemorial. I didn’t develop it when a relationship ended badly during the winter of 1997. It was a breakthrough, I told someone, not to have a breakdown during my breakup. But you are never the same once you have acquired the knowledge that there is no self that will not crumble. We are told to learn self-reliance, but it’s tricky if you have no self on which to rely. Others have helped me, and there is some chemistry that has wrought a readjustment, and I feel okay with all of that for the moment, but the recurring nightmares are no longer of the things that will happen
to
me, that happen from outside agency, but the things that happen
in
me. What if tomorrow I wake up and I am not myself but a manure beetle? Every morning starts off with that breathless uncertainty about who I am, with a check for the cancers of unseemly growth, with a momentary anxiety about whether nightmares might be true. It’s as if my self turned around and spit at me and said, don’t push it, don’t count on me for much, I have problems of my own to take care of. But then who is it who resists the madness or is pained by it? Who is it who is spit at? I have done years of psychotherapy and lived and loved and lost, and I have, frankly, no idea. There is someone or something there stronger than chemistry or will, a me that got me through the revolt of my self, a unionist me that held on until the rebel chemicals and their consequent ideation had been brought back into line. Is that self a chemical matter? I am no spiritualist and I grew up without religion, but that ropy fiber that runs through the center of me, that holds fast even when the self has been stripped away from it: anyone who lives through this knows that it is never as simple as complicated chemistry.

One has the advantage during one’s own breakdown of being
in
it, where one can see what’s happening. From the outside, one can only guess; but since depression is cyclical, it can be fruitful to learn forbearance and
recognition. Eve Kahn, an old friend, told me about the toll her father’s depression took on her family: “My father had a hard time, starting early on. My grandfather died, and my grandmother banned religion from the house. She said, if God could take my husband and leave me with four children like this, there is no God. And so she began serving shrimp and ham on all the Jewish holidays! Platters of shrimp and ham! My father’s six foot three, two hundred twenty pounds, was undefeated at handball and also a baseball and soccer player in college, the sort of guy you can’t imagine being fragile. He became a psychologist. Then, I guess when he was thirty-eight or so—the chronology is all messed up because my mother doesn’t want to talk about it and my father doesn’t really remember it and I was a toddler when it started—one day somebody from the clinic where he was working calls my mother and says that my father has disappeared, has left the job, and they don’t know where he is. And so my mother piles us all into the car and we drive around and drive around until we eventually find him leaning against a mailbox and crying. He had electroconvulsive therapy immediately thereafter, and when they were done with him, they told my mother to divorce him because he would never be the same. ‘Your kids won’t recognize him,’ they said. Though she didn’t really believe them, she sat in the car while driving him home from treatment and cried. When he woke up he was like a Xeroxed version of himself. A little fuzzy around the edges, memory not great, more careful with himself, less interested in us. Supposedly he’d been a really engaged father when we were tiny—came home early to see what we learned that day and brought us toys all the time. After the ECT, he was a little bit removed. And then it happened again four years later. They tried medications and more ECT. He had to give up work for a while. Most of the time he was down. His face wasn’t recognizable; his chin had receded into his face. He would get out of bed and kind of helplessly go around the house with his hands shaking, these big hands just hanging there beside his body. You understand where theories of demon possession come in, because someone had taken over my father’s body. I was five years old and I could see it. I remember it really well. He looked the same but there was nobody home.

“Then he seemed to get better and he had a high period for about two years, and then he crashed again. And then he stayed down and down and down. He got a little better eventually and then he crashed again, and then again. He crashed the car around that time, when I was about fifteen years old, because he was so woozy or because he was suicidal—who knows? It happened again my freshman year of college. I got the call; I had to miss an exam and go down to see him in the hospital. They had taken his belt and taken his tie, the whole thing. And then he was in again five years
later. And then he just retired. And he restructured his life. He takes a lot of vitamins and he gets a lot of exercise and he doesn’t work. And anytime anything stresses him out, he leaves the room. My baby daughter cries? He puts on his hat and goes home. But my mother stayed with him through all of this and when he was sane, he was a great husband to her. He had ten good years through the nineties, until a stroke sent him tumbling down again in early 2001.”

Eve has been determined not to put her family through the same problems. “I’ve been through a couple of terrible episodes myself,” she says. “By the time I was thirty or so, I had a pattern of working way too hard, taking on way too much, finishing it, and then staying in bed for a week totally unable to deal. I had been on nortriptyline at one point, which did nothing but make me gain weight. Then in September 1995, my husband got a job in Budapest and we had to move, and I went on Prozac to deal with the stress of moving. Over there, I just lost it completely. I was either in bed all day or irrational. The stress of being nowhere with no friends—and my husband had to work fifteen hours a day when we arrived because some deal had just kicked in. By the time that was finished, four months later, I was completely crazed. I came back to the U.S. to see doctors and I went on a huge cocktail: Klonopin, lithium, Prozac. It was impossible to have dreams or be creative and I had to carry around a gigantic pill case all the time, with pills marked morning, noon, afternoon, and evening because I couldn’t remember what was going on. Eventually, I made a life over there, found some good friends, and got an okay job, so I lowered the meds until I was popping just a couple of pills a night. Then I got pregnant, went off all the drugs, and felt great. We moved back home, and then after I had the baby all those wonderful hormones wore off, and having an infant—I didn’t have a decent night’s sleep for a year—I began to fall apart again. I was determined not to put my daughter through that. I’m on Depakote, which I find less dulling and which is apparently a safe medication to take while breast-feeding. I will do whatever I have to do to give my daughter a stable environment, not to disappear on her, not to walk out all the time.”

Two good years followed my second breakdown. I was content, and overjoyed to be content. Then in September 1999, I had a terrible experience of abandonment in love, by someone I had thought would be with me forever, and became sad—not depressed, just sad. And then a month later, I slipped on the stairs in my own house and dislocated my shoulder badly, ripping a great deal of muscle tissue. I headed up to the hospital. I attempted to explain to the staff of the ambulance and then to the staff of the emergency room that I was eager to thwart a recurrence of depression.
I explained about the kidney stones and how they had triggered a previous episode. I promised to fill out every form in the book and to answer questions on every subject from the colonial history of Zanzibar on down if they would only alleviate a physical agony that I knew was far too powerful for my mind’s peace. I explained that I had a history of severe breakdowns and asked that they look up my files. It took more than an hour to get any pain medication at all; and at that point I received a dose of IV morphine too small to alleviate my pain. A dislocated shoulder is a straightforward matter, but mine was not repositioned until eight hours after I had arrived in the hospital. I did finally have some meaningful pain relief, with Dilaudid, four hours and thirty minutes after my arrival—so the last three and a half hours were not quite so awful as what had gone before.