The Noonday Demon (81 page)

I take my mental temperature often. I have changed my sleeping habits. I give up on things more readily. I am more tolerant of other people. I am more determined not to waste the happy time I can find. A thinner and finer thing has happened to my self; it won’t take the kind of punching that it used to take, and little windows go right through it, but there are also passages that are fine and delicate and luminous as egg. To regret my depression now would be to regret the most fundamental part of myself. I take umbrage too easily and too frequently, and I impose my vulnerabilities on others far too readily, but I think I am also more generous to other people than I used to be.

“The house gets messy,” one woman who has battled depression for a lifetime told me, “and I can’t read. When’s it going to come back? When’s it going to hit me again? Only my children keep me alive. I’m stabilized right now, but it never leaves you. You can never forget it, no matter how happy you are in a particular moment.”

“I’m reconciled to a lifetime of medicine,” says Martha Manning, suddenly fervent in a conversation. “And I’m thankful. I’m thankful for it. Sometimes I look at those pills and wonder, is this all that stands between torment and me? When I was little, I can remember, I wasn’t unhappy, but I couldn’t help thinking, I have to live my whole life, maybe eighty years of this or something. It seemed like such a burden. I wanted to have another child recently, but after two miscarriages, I realized I just couldn’t bear the stress. I’ve cut back on my social life. You
don’t defeat depression. You learn to manage it and you make compromises with it. You try to stay in remission. You’ve got to have so much resolve, spend so much time not giving in. When you come so close to taking your life, if you get it back, you’d better claim it, you know?”

Striving to claim it, we hold on to the idea of productive depression, something vital. “If I had it to do over, I wouldn’t do it this way,” said Frank Rusakoff a few months after his brain had been lesioned to effect his cure. I had spent the afternoon with him and his parents and his psychiatrist, and they were discussing the grim reality: that his cingulotomy hadn’t yet worked, and that he might have to have a second surgery. In his gently courageous way, however, he was making plans to be back up and running in six months. “But I think I have gained a lot and grown a lot because of it. I’ve become a lot closer to my parents, to my brother, to friends. I have this experience with my doctor that’s been very good.” The hard-won equanimity rang movingly true. “There really are up sides to depression; it’s just hard to see them when you’re in it.” Later, after the surgery had worked, he wrote, “I said I would do it differently if I had it to do over again. And I guess I would. But, now that I feel like the worst is over, I’m grateful for having been where I’ve been. I do believe I am better off having been to the hospital thirty times and having had brain surgery. I’ve met a lot of good people along the way.”

“I lost a great innocence when I understood that I and my mind were not going to be on good terms for the rest of my life,” says Kay Jamison with a shrug. “I can’t tell you how tired I am of character-building experiences. But I treasure this part of me; whoever loves me loves me with this in it.”

“My wife, to whom I’ve been married just a few years, has never seen me depressed,” says Robert Boorstin. “She hasn’t. And I’ve walked her through it, and I’ve let other people talk to her about what it’s like. I’ve done my best to prepare her, because doubtless I’ll have another depression. Sometime, in the next forty years, I’m going to be crawling across the room again. And it scares me a lot. If somebody said to me, ‘I’ll take away your mental illness if you’ll cut me off your leg’—I don’t know what I would do. And yet, before I was ill, I was intolerant beyond comparison, arrogant beyond belief, with no understanding of frailty. I’m a better person as a result of having been through all this.”

“The most important theme in my work is redemption,” Bill Stein says. “I still don’t know my role in things. I’m drawn to stories of saints and martyrs. I don’t think I could endure what they have gone through. I’m not ready to set up a hospice in India, but depression put me on the right course. I meet people and I know that they don’t have the level of experience that I have. The fact that I got through such a catastrophic
illness has permanently changed my interior landscape. I was always drawn to faith and goodness, but I wouldn’t have had the drive, the moral purpose, without the breakdowns.”

“We walked through hell to find paradise,” Tina Sonego says. “My reward is very simple. I am now able to understand things that I just could not understand before; and the things I don’t understand now, I will in time, if they matter. Depression is responsible for making me who I am today. What we gain is so quiet but so loud.”

“Our needs are our greatest assets,” Maggie Robbins says. If it is through our needs that we come to know ourselves, that we open ourselves up to others, then neediness can breed intimacy. “I am able to just be there with people because of the stuff I’ve needed from people. I guess I’ve learned to give all the things I need.”

“Mood is—another frontier, like deep ocean or deep space,” Claudia Weaver says. “Having so much low mood gives you mettle; I think I deal with difficult losses better than most other people because I have so much experience of the feelings they entail. Depression isn’t an obstacle in my path; it’s a sort of part of me that I carry along down the path, and I believe that it’s supposed to help me at various points. How? That I don’t know. But I believe in my depression, in its redemptive power, nonetheless. I’m a very strong woman, and that’s partly because of the depression.”

And Laura Anderson wrote, “Depression has given me kindness and forgiveness where other people don’t know enough to extend it—I am drawn toward people who might put off others with a wrong move or a misplaced barb or an overtly nonsensical judgment. I had an argument about the death penalty tonight with someone, and I was trying to explain, without being too self-referential, that one can understand horrifying actions—understand the terrible links between mood and job and relationships and the rest of everything. I would never want depression to be a public or political excuse, but I think that once you have gone through it, you get a greater and more immediate understanding of the temporary absence of judgment that makes people behave so badly—you learn even, perhaps, how to tolerate the evil in the world.”

On the happy day when we lose depression, we will lose a great deal with it. If the earth could feed itself and us without rain, and if we conquered the weather and declared permanent sun, would we not miss grey days and summer storms? As the sun seems brighter and more clear when it comes on a rare day of English summer after ten months of dismal skies than it can ever seem in the tropics, so recent happiness feels enormous and embracing and beyond anything I have ever imagined. Curiously enough, I love my depression. I do not love experiencing my
depression, but I love the depression itself. I love who I am in the wake of it. Schopenhauer said, “Man is [content] according to how dull and insensitive he is”; Tennessee Williams, asked for the definition of happiness, replied “insensitivity.” I do not agree with them. Since I have been to the Gulag and survived it, I know that if I have to go to the Gulag again, I could survive that also; I’m more confident in some odd way than I’ve ever imagined being. This almost (but not quite) makes the depression seem worth it. I do not think that I will ever again try to kill myself; nor do I think that I would give up my life readily if I found myself in war, or if my plane crashed into a desert. I would struggle tooth and nail to survive. It’s as though my life and I, having sat in opposition to each other, hating each other, wanting to escape each other, have now bonded forever and at the hip.

The opposite of depression is not happiness but vitality, and my life, as I write this, is vital, even when sad. I may wake up sometime next year without my mind again; it is not likely to stick around all the time. Meanwhile, however, I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, when hell came to pay me a surprise visit. It’s a precious discovery. Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping. For a petrifying instant here and there, a lightning-quick flash, I want a car to run me over and I have to grit my teeth to stay on the sidewalk until the light turns green; or I imagine how easily I might cut my wrists; or I taste hungrily the metal tip of a gun in my mouth; or I picture going to sleep and never waking up again. I hate those feelings, but I know that they have driven me to look deeper at life, to find and cling to reasons for living. I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely and sometimes against the moment’s reason, to be alive. Is that not a rare joy?

Many excellent general books on depression have influenced this book. Among these, I would particularly commend Peter Whybrow’s dignified and accessible
A Mood Apart,
Kay Redfield Jamison’s moving
An Unquiet Mind
and
Night Falls Fast,
Julia Kristeva’s impenetrable but episodically brilliant
Black Sun,
Rudolph and Margot Wittkower’s
Born Under Saturn,
and Stanley Jackson’s rigorous
Melancholia and Depression.
I have identified all direct quotations from printed sources. All other quotations are from personal interviews conducted between 1995 and 2000.

9
The epigraph is from the closing paragraph of Mikhail Bulgakov’s
The White Guard,
page 302.

11
The
New Yorker
article appeared as “Anatomy of Melancholy” in the issue of January 12, 1998.

12
The quotation from Graham Greene comes from his
Ways of Escape,
page 285.

13
My father’s company is Forest Laboratories. The company was not involved in the development of Celexa, though they have worked on producing its enantiomer.

13
The novel to which I allude is
A Stone Boat.

13
Kay Redfield Jamison, Martha Manning, and Meri Danquah are among the authors who have discussed the toxicity of this subject matter.

15
The words
depression
and
melancholy
are grossly general and, despite the efforts of some authors to distinguish between them, are synonymous. The term
major depression,
however, refers to the psychiatric condition defined under the rubric “Major Depressive Disorder” in
DSM-IV,
pages 339–45.

16
I have taken the story of Saint Anthony in the desert from a lecture by Elaine Pagels.

16
The first quotation from
Jacob’s Room
is on pages 140–41. The second is on page 168.

17
For a discussion of “legally dead,” see Sherwin Nuland’s
How We Die,
page 123.

19
Anhedonia is “the inability to experience pleasure,” as defined by Francis Mondimore in
Depression: The Mood Disease,
page 22.

21
The depression formula comes from the 1989 edition of the
Comprehensive Textbook of Psychiatry,
page 870.

24
Both quotations come from Schopenhauer’s
Essays and Aphorisms:
the first is on pages 42–43; the second is on page 43.

25
The number 19 million comes from the NIMH’s Web site at
www.nimh.nih.gov/depression/index1.htm
. That approximately 2.5 million children suffer depression may be adduced through the compilation of a number of statistics. “The MECA Study,” by D. Shaffer et al., in the
Journal of the American Academy of Child and Adolescent Psychiatry
35, no. 7 (1996), found that approximately 6.2 percent of children age nine to seventeen had a mood disorder within a six-month period, and that 4.9 percent suffered a major depressive disorder. This latter percentage, applied to 1990 census statistics for children age five to seventeen (roughly 45 million) equals a rough estimate of 2.5 million. I thank Faith Bitterolf and the Sewickley Academy Library for their help with this matter.

25
The number 2.3 million comes from the NIMH’s Web site at
www.nimh.nih.gov/publicat/manic.cfm
.

25
That unipolar depression is the leading cause of disability in the United States and worldwide for persons age five and up is taken from the NIMH Web site at
www.nimh.nih.gov/publicat/invisible.cfm
. The statistic ranking major depression as second in magnitude of disease burden in the developed world also comes from the NIMH at
www.nimh.nih.gov/publicat/burden.cfm
.

25
That depression claims more years than war, cancer, and HIV/AIDS put together is taken from the World Health Organization’s
World Health Report 2000,
which can be viewed on-line at
www.who.int/whr/2000/index.htm
. The information is taken from Annex Table 4, and is valid for lung cancer and skin cancer, in some mortality strata in the Americas and Eastern Mediterranean, and in all mortality strata in Europe, Southeast Asia, and the Western Pacific. For Annex Table 4 specifically, see
www.who.int/whr/2000/en/statistics.htm
.