The Noonday Demon (26 page)

Eye movement desensitization and reprocessing (EMDR) therapy originated in 1987 for the treatment of post–traumatic stress disorder. The technique is a bit kitschy. The therapist moves his hand at various rates across a field from your right-side peripheral vision to your left-side peripheral vision, so stimulating one eye and then the other. In a variant on the technique, you wear headphones that alternate sounds to stimulate one ear and then the other; or in a third possibility, you hold little vibrators, one in each hand, and they pulse alternatingly. While this is going on, you go through a psychodynamic process of remembering your trauma and reliving it, and at the end of the session you are free of it. While many therapies—psychoanalysis, for example—comprise beautiful theories and limited results, EMDR has silly theories and excellent results. Practitioners of the therapy speculate that it works by stimulating
left and right brain in rapid alternation, so helping to transfer memories from one brain storage center to another. This seems unlikely. Something, however, about EMDR’s oscillating stimulation does have a dramatic effect.

EMDR is increasingly being used for depression. Since the technique uses trauma memories, it is more often prescribed as a treatment for trauma-based depression than for more generalized depression. I tried all kinds of techniques in the course of researching this book, including EMDR. I was convinced that it was a cute but insignificant system and was very much surprised by the results. I had been told that the technique “speeds up processing,” but that did not prepare me for the intensity of the experience. I put on the headphones and tried to think about my memories. I was flooded with incredibly powerful images from childhood, things I hadn’t known were even in my brain. I could form associations in no time at all: my mind became speedier than it’s ever been. It was an electrifying experience, and the EMDR therapist with whom I was working proficiently led me to all kinds of forgotten childhood difficulties. I am not sure that EMDR has much immediate effect on a depression that is not triggered by a single trauma, but it was so stimulating and so interesting that I kept it up for a twenty-session course.

David Grand, a trained psychoanalytic therapist who now uses EMDR with all his patients, says, “EMDR can help a person to do in six to twelve months what couldn’t be done in five years of ordinary treatment. I’m not comparing in the abstract: I’m comparing my work with EMDR to my work without it. The activation bypasses the ego and activates deeply, quickly, and directly. EMDR is not an approach, like the cognitive or the psychoanalytic; it’s a tool. You can’t just be a generic EMDR therapist. You have to be a good therapist first and then figure out how to integrate EMDR. The oddity of it is a turnoff, but I have been doing it for eight years, and I could not go back to doing therapy without EMDR knowing what I know now. It would be such a regression, such a return to the primitive.” I always came out of my EMDR therapist’s office reeling (in a good way); and the things I learned have stayed with me and enriched my conscious mind. It’s a powerful process. I recommend it.

In October 1999, I traveled to Sedona, Arizona, to have four days of New Age massage at a time when I was experiencing great stress. I am in general rather cynical about New Age treatments, and I greeted the “analyst” who would perform my first treatment with some suspicion as she laid out her crystals at the end of the room and told me about her
dreams. I am not persuaded that deep inward tranquillity is an automatic result of being sprayed in sequence with oils from sacred Chaco Canyon and Tibet, and I don’t know that the strand of rose quartz beads she draped like a rosary over my eyes was really connecting with my chakras; nor do I believe that the interpretive Sanskrit chants with which the room was filled were inscribing antidepressant virtues into my meridians. All that being said, four days of gentle handling by beautiful women in an opulent resort did a great deal for me, and I left high on peace. My final treatment—cranial-sacral massage—seemed to have particularly beneficial effects: a certain serenity descended on me and lasted for several days.

I believe that extensive massage, which reawakens the body that depression has cut off from the mind, can be a useful part of therapy. I don’t think my Sedona experience could have done a thing for someone in the depths of major depression, but as a tune-up technique it was pretty terrific. The theorist Roger Callahan claims to mix applied kinesiology and traditional Chinese medicine. Callahan posits that we change on a cellular basis first, then a chemical, then neurophysiological, then cognitive. We have, he says, been working backward in treating the cognitive first and the neurophysiological second; he begins with the mystic realities of muscle responses. He has many followers. Though their practices seem hokey to me, the idea of starting from the physical seems rather intelligent. Depression is a bodily affliction, and the physical helps.

During the Second World War, many British soldiers had to spend extended periods adrift in the Atlantic after their ships had suffered disabling attacks. The soldiers who had the best rate of survival were not the most young and able but the most experienced, who often had a toughness of spirit that transcended the limits of their bodies. The educator Kurt Hahn observed that such toughness had to be learned, and he founded Outward Bound, which is now a large confederation of associations scattered around the globe. Through structured encounters with the wild, Outward Bound attempts to keep to Hahn’s objectives: “I regard it as the foremost task of education to ensure survival of these qualities: an enterprising curiosity; an undefeatable spirit; tenacity in pursuit; readiness for sensible self-denial; and, above all, compassion.”

In the summer of 2000, I went on an expedition with Outward Bound’s Hurricane Island School. I could never have done Outward Bound from the seat of a depression, but doing it when I was not depressed seemed to strengthen the things in me that resist depression. The course was rigorous and sometimes quite punishing but also pleasurable, and it did make
me feel that my life was tied to the organic processes of the larger world. That was a secure feeling: assuming one’s place in the sweep of eternity is enormously comforting. We went sea kayaking, and our days were filled with muscular exertion. On a typical day, we might rise at about four in the morning, then run a mile, then go to a platform some twenty-eight feet above the sea and jump off it into the frigid Maine water. Then we’d strike camp and pack our supplies in our kayaks, then carry the kayaks—two-person boats some twenty-two feet long—down to the sea. We’d paddle perhaps five miles against the tide (going just over a mile an hour) until we reached a place where we could stop for breakfast, and we’d stretch and cook and eat there. Then we’d climb back in the boats and do another five miles of paddling, then arrive at our location for the night. We’d have lunch and then practice assisted rescues, turning our boats over and releasing ourselves underwater from the webbing that held us in, righting the kayaks in the sea, and reentering them. Then we’d be taken individually to separate spots for the night, which we would pass with a sleeping bag, a bottle of water, a plastic tarp, and a piece of string. Fortunately, the sun was shining during my trip; we would have stuck to the same agenda had there been sleet coming down on us. Our instructors were remarkable, people of the earth who seemed to be absolute survivors and strong and even sometimes wise. Through our close encounters with wilderness, and through their careful interventions, we gained some fragment of their intense competence.

At times I wished I had never come and felt that the final mark of my lunacy was that I had consented to let my life be stripped of its luxuries like this. But I also felt myself back in touch with something profound. It smacks of triumph to inhabit the unimproved world of nature, even if you do so in a fiberglass kayak. The rhythm of paddling helps, and so does the light, and the waves seem to pace the blood as it goes to the heart, and sadness ebbs. Outward Bound reminded me in many ways of psychoanalysis: it was a process of self-revelation that pushed out one’s sense of limits. In this, it met the intention of its founder. “Without self-discovery,” Hahn wrote, extending an idea of Nietzsche’s, “a person may still have self-confidence, but it is a self-confidence built on ignorance and it melts in the face of heavy burdens. Self-discovery is the end product of a great challenge mastered, when the mind commands the body to do the seemingly impossible, when strength and courage are summoned to extraordinary limits for the sake of something outside the self—a principle, an onerous task, another human life.” That is to say, one has to do things between bouts of depression that will build up the resilience so that you can survive despair when it comes knocking again—much as we do daily exercise to keep our bodies in shape. I
would not suggest doing Outward Bound instead of therapy, but as a supplement to therapy, it can be powerful; and it is, in its entirety, gratifyingly beautiful. Depression cuts you off from your roots. Though it can feel leaden, depression is also a helium situation because nothing holds you to the earth. Outward Bound was my way into the rootedness of nature, and to have done what I did made me feel, finally, both proud and safe.

Hypnosis, like EMDR, is a tool that can be used in treatment rather than as a treatment itself. It is possible through hypnosis to take a patient back to his early experiences and help him to relive them in a way that brings about some resolution. In his book on the use of hypnosis in depression, Michael Yapko writes that hypnosis works best when the personal understanding of an experience seems to be the source of depression and can be changed to an alternative understanding that feels better. Hypnosis is also used to conjure in the patient’s mind an image of a potential bright future, the anticipation of which may lift him out of current misery and so enable that bright future itself. At the least, a successful hypnosis is useful in breaking negative patterns of thought and behavior.

One of the primary symptoms of depression is a disruption in sleep patterns; really depressed people may have no deep sleep at all and may be spending lots of time in bed without ever getting rested. Does one sleep oddly only because of depression, or does one sink into depression in part because of sleeping oddly? “Grief, which leads to depression, disrupts your sleep one way; falling in love, which can lead to mania, disrupts your sleep another way,” Thomas Wehr, at the NIMH, points out. Even people who do not suffer from depression have had the experience of waking up too early with a sensation of ominous dread; in fact, that fearful despairing state, which usually passes quickly, may be the closest that healthy people come to the experience of depression. Almost all people who suffer from depression feel worse in the morning and better as the day goes on. So Thomas Wehr has done a series of experiments that show that you can alleviate some symptoms of depression with controlled sleep deprivation. It’s not a practical system for the long term, but it can be useful in people who are waiting for the effects of antidepressants to kick in. “By not letting someone go to sleep, you extend the day’s improvement. Even though depressed people seek the oblivion of sleep, it is
in
sleep that the depression is maintained and intensified. What kind of horrible succubus visits during the night and brings about that transformation?” Wehr asks.

E Scott Fitzgerald wrote in
The Crack-Up
that “at three o’clock in the
morning, a forgotten package has the same importance as a death sentence, and the cure doesn’t work—and in a real dark night of the soul it is always three o’clock in the morning, day after day.” That demon of three o’clock has visited me.

When I am most depressed, I do feel a gradual lifting during the day, and though I become exhausted easily, the late, late night is my functional period—indeed, if I were to choose by mood states, I’d live my life at midnight. There has been limited research in this area because it is nonpatentable, but some studies indicate that the mechanisms are complicated and depend on when you sleep, what part of sleep you are in when you wake up, and a variety of other technical factors. Sleep is the primary determinant of circadian body patterns, and altering sleep disrupts the timing of neurotransmitter and endocrine release. But though we can identify much of what happens during sleep and can observe the emotional dip that sleep enables, we cannot yet draw direct correlations. Thyroid-releasing hormone goes down during sleep; is that what causes the emotional dip? Norepinephrine and serotonin go down; acetylcholine goes up. Some theorize that sleep deprivation increases dopamine levels; one series of experiments suggests that blinking causes dopamine release and that a long period of having your eyes shut therefore cuts down on dopamine.

You clearly can’t deprive someone of sleep altogether, but you can keep people from going through the late stage of restless REM sleep by waking them up when it begins, and this can be an excellent way to keep a depression in check. I’ve tried it myself and it works. Napping, which I long to do during depressions, is counterproductive and can undo all the good achieved through being awake. Professor M. Berger of the University of Freiburg has practiced so-called sleep advancement, in which people are put to bed at five in the afternoon and woken up before midnight. This can have a beneficial effect, though no one seems to understand why. “These treatments sound kind of wacky,” Thomas Wehr acknowledges. “But frankly, if you said to someone, ‘I’d like to put some wires on your head and run electricity through your brain and induce a seizure because I think that might help your depression,’ and if that were not a widely practiced and well-established treatment, it might be hard to get it going.”

Michael Thase, of the University of Pittsburgh, has observed that many depressed people have substantially reduced sleep altogether, and that insomnia during depression is a predictor of suicidality. Even for those who can sleep, the quality of sleep is substantially altered during depression. Depressed people tend to have low sleep efficiency; they seldom or never enter the deep-wave sleep that is associated with feelings of
being refreshed and well rested. They may have many brief episodes of REM sleep rather than the fewer and more protracted episodes typical of a healthy individual. Since REM sleep may be described as a minor awakening, this repetitive REM is exhausting rather than restful. Most antidepressants reduce REM sleep, though they don’t necessarily improve the overall quality of sleep. Whether this is part of their mechanism of action is hard to know. Thase has observed that depressives with normal sleep may be more responsive to psychotherapy, and that those with abnormal sleep tend to require medication.