The Noonday Demon (33 page)

The literature makes much of the distinctive qualities of women’s depression and says very little about any distinctive qualities of men’s depression. Many depressed men are not diagnosed because they tend to deal with feelings of depression not by withdrawing into the silence of despondency, but by withdrawing into the noise of violence, substance abuse, or workaholism. Women report twice as much depression as men, but men are four times as likely to commit suicide as women. Single, divorced, or widowed men have a much higher rate of depression than married men. Depressed men may show what is somewhat euphemistically called “irritability”—they lash out at strangers, beat their wives, take drugs, and shoot people. The writer Andrew Sullivan recently wrote that injecting himself with testosterone, which he was doing as part of a regimen of HIV treatment, increased his tendency toward violence. In a series of interviews I did with wife batterers, I found consistent complaints of organic depression symptoms. “I get home and I feel all tired out the whole time,” one man said, “and there is that woman asking me all these damn questions, and the noise of it just starts thumping in my head like hammers. I can’t eat with it, I can’t sleep with it, it’s just she’s there the whole time. I don’t wanna hurt her but I gotta do something, I’m going crazy, you understand?” Someone else said that when he saw his wife he felt “so worthless on this earth I might never do nothing again if I don’t fire out a punch or something.”

Wife battering is obviously an inappropriate response to feelings of depression, but frequently the syndromes are closely tied. It seems
likely that many other confrontational, injurious behaviors are manifestations of male depression. In most Western societies, admissions of weakness are held to be feminine. This has a negative effect on men, preventing them from crying, making them feel shame in the face of irrational fear and anxiety. The batterer who believes that hitting his wife is the only way for him to exist in the world manifestly buys into the idea that emotional pain is always a call to action, and that emotion without action negates him as a man. It is unfortunate that many men who—in the broadest sense—behave badly are not given antidepressant treatment. If women exacerbate their depression because they are not as happy as they think they should be, men exacerbate their depression because they are not as courageous as they think they should be. Most abuse is a form of cowardice, and some cowardice is a reasonable symptom of depression. I should know: I was once afraid of a lamb chop, and it’s a very disempowering feeling.

I have had several episodes of violence since my first depression, and I have wondered whether these episodes, for which there was no precedent in my life, were connected to depression, were part of its aftermath, or were somehow to be associated with the antidepressants I have taken. As a child, I seldom hit anyone except my brother, and the last time I did that was when I was about twelve. And then one day when I was in my thirties, I became so irrationally angry that I began plotting murders in my mind; I eventually off-loaded that anger by smashing the glass on a series of pictures of myself that hung in a girlfriend’s house, leaving the broken glass on the floor and the hammer in its midst. A year later, I had a serious falling-out with a man whom I had loved very much and by whom I felt profoundly and cruelly betrayed. I was already in a somewhat depressed state, and I became enraged. I attacked him with a ferocity unlike any I had experienced before, threw him against a wall, and socked him repeatedly, breaking both his jaw and his nose. He was later hospitalized for loss of blood. I will never forget the feeling of his face crumpling under my blows. I know that right after I hit him I had his neck in my hands for a moment and that it took a powerful summoning of my superego to save me from strangling him. When people expressed horror at my attack on him, I told them almost what the batterer told me: I felt as though I were disappearing, and somewhere deep in the most primitive part of my brain, I felt that violence was the only way I could keep my self and mind in the world. I was chagrined by what I had done; yet though one part of me regrets the suffering of my friend, another part of me does not rue what happened, because I sincerely believe that I would have gone irretrievably crazy if I had not done it—a view that this friend, to whom I am still close, has since come to accept. His emotional
and my physical violence achieved a curious balance. Some of the feeling of paralytic fear and helplessness that afflicted me around that time was alleviated by the act of savagery. I do not accept the behavior of wife batterers and I certainly do not endorse what they do. Engaging in violent acts is not a good way to treat depression. It is, however, effective. To deny the inbred curative power of violence would be a terrible mistake. I came home that night covered with blood—mine and his—and with a feeling of both horror and exhilaration. I felt tremendous release.

I have never hit a woman, but about eight months after the jaw-breaking episode, I yelled at one of my closest friends and humiliated her terribly and publicly because she wanted to reschedule a dinner plan. I have learned that depression can easily erupt as rage. Since I’ve got out of the deepest trough of depression, those impulses are under control. I am capable of great anger, but it is usually tied to specific events, and my response to those events is usually in proportion to them. It is not usually physical. It is usually more considered and less totally impulsive. My attacks have been symptomatic. That does not relieve me of responsibility for violence, but it does help to make sense of it. I do not condone such behavior.

No woman I have met has described these feelings in quite this way; many depressed men I have met have had similar impulses toward destructiveness. Many have been able to avoid acting on them; many others have acted on them and felt release from irrational terror as a result of doing so. I do not think that depression in women is different from what it is in men, but I do think that women are different from men, and that their ways of handling depression are frequently different as well. Feminists who wish to avoid pathologizing the feminine and men who believe that they can deny their emotional state are looking for trouble. It is interesting that Jewish men, who are as a population particularly disinclined to violence, have a much higher rate of depression than non-Jewish men—in fact, studies show them having about the same rate of depression as Jewish women. Gender, then, plays an elaborate part not only in who gets depressed, but also in how that depression manifests itself and, consequently, how it may be contained.

Depressed mothers are usually not great mothers, though high-functioning depressives can sometimes mask their illness and fulfill their parenting roles. While some depressed mothers are easily upset by their children and behave erratically as a consequence, many depressed mothers simply fail to respond to their children: they are unaffectionate and withdrawn. They tend not to establish clear control or rules or boundaries. They have little love or nurturance to give. They feel helpless in
the face of their children’s demands. Their behavior is unregulated; they become angry for no apparent reason and then, in paroxysms of guilt, express extravagant affection for equally indistinct reasons. They cannot help a child to regulate his own problems. Their responses to their children are not contingent on what the children are doing or on displays of neediness. Their children are weepy, angry, and aggressive. Such children are often themselves incapable of caring behaviors; sometimes, however, they are too prone to caring behaviors and feel responsible for all the suffering of the world. Little girls are particularly likely to overempathize and so make themselves miserable; because they experience no lift in the mood of their mothers, they lose the capacity for elasticity of mood themselves.

The earliest manifestations of childhood depression, which are found in infants as young as three months, occur primarily in the offspring of depressed mothers. Such children do not smile and tend to turn their head away from all people, including parents; they may be at greater ease when they are not looking at anyone than when they look at their depressed mother. The brain-wave patterns of such children are distinctive; if you successfully treat the depression in the mothers, the brain-wave patterns of the children may improve. In older children, however, adjustment difficulties may not lift so readily; school-age children of a depressed mother were shown to be severely maladjusted even a year after their mother’s symptoms had been alleviated. The children of parents who have been depressed are at a significant disadvantage. The more severe the depression of the mother, the more severe the depression of the child is likely to be, though some children seem to pick up on maternal depression more dramatically and empathetically than do others. In general, the children of a depressed mother not only reflect but also magnify their mother’s state. Even ten years after an initial assessment, such children suffer significant social impairment and are at a threefold risk for depression and a fivefold risk for panic disorders and alcohol dependence.

To improve the mental health of children, it is sometimes more important to treat the mother than to treat the children directly; to try to change negative familial patterns to incorporate flexibility, hardiness, cohesion, and problem-solving ability. Parents can team up well for the circumvention of depression in their children even if their relationship to each other is highly flawed, though a single, clear front can be challenging to sustain. Children of depressed mothers have more difficulties in the world than do children of schizophrenic mothers: depression has a singularly immediate effect on the basic mechanisms of parenting. Children of depressed mothers may suffer not only depression but also attention deficit disorder,
separation anxiety, and conduct disorder. They do badly in social and academic situations, even if they are intelligent and have some attractive qualities of personality. They have unusually high levels of physical complaints—allergies, asthma, frequent colds, severe headaches, stomachaches—and complain of feeling unsafe. They are often paranoid.

The University of Michigan’s Arnold Sameroff is a developmental psychiatrist who believes everything in the world is a variable in every experiment; all events are overdetermined; nothing can be understood except by knowing all the mysteries of God’s creation. Sameroff would suggest that though people have certain complaints in common, they have individual experiences, with individual constellations of complaints and individual networks of causes. “You know, there are these single-gene hypotheses,” he says. “Either you have the gene or you don’t, and those are very attractive to our quick-fix society. But it’s never going to work.” Sameroff has been looking at the children of people with major depression. He has found that these children, even if they start on a cognitive level with their peers, go downhill beginning around age two. By the age of four, they are distinctly “sadder, less interactive, withdrawn, and low-functioning.” For this he proposes five primary possible explanations, all of which, he believes, come into play in various mosaics: genetics; empathetic mirroring, kids repeating back what they experience; learned helplessness, ceasing to attempt to connect because of lack of parental approval for emotional outreach; role-playing, as the child sees the advantages an ill parent gets from being too ill to do unpleasant things and decides to take on the illness role; and withdrawal, as a consequence of seeing no pleasure in communication between unhappy parents. Then there are all the subexplanations: depressed parents are more likely to be substance abusers than are other parents. What kind of treatment or trauma does a child experience at the hands of substance abusers? That would lead us right into stress.

A recent study has listed two hundred factors that may contribute to high blood pressure. “At a biological level,” says Sameroff, “blood pressure is really pretty simple. If there are two hundred factors influencing it, think how many factors must influence a complex experience such as depression!” In Sameroff’s view, the coincidence of a number of risk factors is the basis for depression. “Those people who get a group of risk factors all glommed together are the ones who have what we call a disorder,” Sameroff says. “We found that in terms of depression, heredity was not nearly as strong a predictor as socioeconomic status. The interaction of heredity and socioeconomic status was the strongest predictor of all, but then what were the key components of low socioeconomic status that made small children get so depressed? Was it lack of parental
education? Lack of money? Low social support? Number of kids in the family?” Sameroff made a list of ten such variables and then correlated them with degrees of depression. He found that any negative variable on its own was likely to contribute to low mood, but that any group of such variables was likely to produce significant clinical symptoms (as well as lowered IQ). Sameroff then did research that showed that the child of a seriously ill parent was likely to do better than the children of a moderately ill parent. “It turns out that if you’re really, really ill, someone picks up the load. If there are two parents, the one who isn’t ill knows he has to do the work. And the child has a way of understanding what’s going on in the family; he grasps the principle that one of his parents is mentally ill and he isn’t left with all the unanswered questions that afflict the children of the mildly mentally ill. So you see? It’s not predictable according to a simple linear system. Every depression has its own story.”

While poor parenting or depressed parenting may cause depression in children, good parenting may well help to allay or alleviate it. The old Freudian blame-your-mom principle has been discarded, but the world of children is still defined by their parents, and they can learn some degree of resilience or debility from their mother, father, and other caretakers. Indeed many treatment protocols now involve training parents in therapeutic interventions with their children. Those interventions must be based on
listening.
The young are a different population and cannot be treated as though they were just dwarfish adults. Firmness, love, consistency, and humility must come together in parental approaches to depressed children. A child who has watched a parent solve a problem gains enormous strength from that.