A woman who was a patient advocate-liaison affiliated with the Centre for Addiction and Mental Health had put me in touch with her as someone who could talk to me about falling through the chasms in the health system. As she reconstructed her wrap, she asked me about myself, my job, my reasons for writing this book. The first time she asked I said something about the gap in depression discourse, the need for a clear-eyed, critical but measured examination of what we know and don’t know and the ways we fail to use the already inadequate resources we have to treat people who need help now, not when we come up with something better. But the second time she asked I mentioned my own experience and she fixated on the first suicide attempt and my time in the psych ward. “But why did you try to kill yourself? What was going on in your life? What happened in your childhood?” She decided I must be bipolar, because “I can see you’re manic. You’re all hyped up. And I know these things. You laugh, but I know.” She decided writing this book was a terrible idea—“You aren’t well. And asking questions like this, you’re going to trigger other people”—and that, moreover, I should march myself into hospital right away because I needed to be committed, maybe for a while. She was in rough shape, struggling with more than just her mind: she was painfully thin—crepe skin stretched over spindly bones as she picked at her food. She’d spent years in and out of inpatient anorexia treatment, being force-fed daily. She said she now had an obstructed colon that prevented her from eating. But her ability to demolish me was masterful. She expertly pinpointed every agonizing weakness in my self-view, every self-doubt that kept me awake at night and paralyzed me in the morning, and prodded each one of them to the point of incapacitation. Finally, an hour and an eternity after I’d sat down, it was almost over. She asked me to walk her to her appointment and then help her find her psychiatrist’s office. I stumbled away drunk on self-loathing. I felt crazy and stupid and liable to harm others, driving them, through my clumsy insensitive privacy invasions, to kill themselves. And that’s the greatest fear, right? That disclosure will turn against you. That my literary exercise could be responsible, even indirectly, for the anguish or, god forbid, suicide deaths of other human beings.
I needed to talk to Andrew Solomon about how he does it. And why he decided to tell everyone about all this awful personal stuff in his world-shifting book The Noonday Demon. He was kind enough not only to respond but also to invite me over for a chat at his beautiful house in lower Manhattan. I brought fresh croissants because I know you can’t show up at someone’s house empty-handed but then was so agog at his study I left them in their buttery paper bag by my plush chair while we talked and I tried not to ogle the wall-to-wall books too obviously or enviously. He spoke slowly, thoughtfully, as though taking a topic he knew backwards and looking at it anew.
“I think there’s a kind of social responsibility to being open and public insofar as you are able to be, and different people are able to be to different degrees. I live in a city, occupy a context and work in a field where I wasn’t going to lose a lot of credit because I had been depressed. So I felt like I had less to lose than other people would. If I weren’t going to talk about it, then who would?”1
He’d also already emerged from one closet and wasn’t prepared to spend his life sequestered in another. “I felt that, as a gay person, I had lived a life for quite a while in which I had a secret, and some people knew and other people didn’t know, and I’d finally come out of the closet….I had decided I wanted never to have a secret again where I had to wonder, ‘Do those people know that those people have told those people?’ And I think that, a lot of the time, people who are depressed devote so much energy to secrecy that could be better devoted to getting better.”
Truth. The relief I feel from being able to tell people—or even from not having to hide how I’m doing or make up alternative reasons for psychiatric appointments or drugs or impossible mornings—draws me almost as powerfully as the self-destructive fear that disclosure will mean recrimination, will shaft opportunity or connection or prompt polite insidious shunning at best. It’s painful. I live in fear I’ll regret it. But, often, it’s too important not to.
“Telling the whole world can be a stressful operation, and I’m not necessarily recommending it for everyone,” he says. “It seems to have worked out reasonably well for me to do so.” The response he got has been overwhelming. He figures he gets twenty, thirty emails a week from people who’ve read his book and want to talk to him about their depression, about their child’s or spouse’s or sibling’s. Seeking help or commiseration: Does he know a good psychiatrist in their small hometown? Can he tell them what drugs might work? Sharing their own stories. “I give them advice within the limits of my ability to give advice….I don’t want anyone who feels abandoned by and disconnected from the world to get another experience of abandonment from me. So even when they’re people who don’t particularly stir my sympathies, I always try to deal with them as kindly as I can and to say as much as I can about helping them.”
He tells me that today his bottom-feeder psycho-emotional lows aren’t as severe as they once were. His husband and two young kids and their Manhattan house help act as ballast for a forward-moving existence. “I have a much more solid life than I did when [the depressive demons] first came. But, yes. It rears up. And every time it does, it’s shocking all over again. I mean, I wrote a whole book about this. I have to give public lectures about it. And I’m still overwhelmed by how painful it is when it comes back again.”
It’s been almost eight years since I first tried to kill myself and more than four years since I first started poking at the idea of writing a book about this basket-case condition, and there are days I wake up and any possibility of improvement, any chance that I could ever get better, is drowned in the undertow of despair. But not every day is like that. Most days I make it into the newsroom at Reuters, where I work. Most days I work, and it feels good—like I’m building ground beneath my feet even as I struggle to keep from plummeting. I couldn’t tell you if I’m any better off than I was the September of my first suicide attempt. I know I’ve gone through periods, some quite recent, where I was worse. But work on this project gave me something to cling to and build on. It was validating. Almost every interview I did reinforced that this shit sandwich of an illness is genuine and genuinely awful and affects many, many more people than me. Those were days that made it seem worth plugging away.
* * *
—
ONE OF THE DANGERS of recognizing that your depression and its dreary behavioural accoutrements constitute an extrinsic pathology rather than intrinsic failure is that, in trying to disentangle what’s actually you from what’s your soul-destroying disorder, it’s tempting to tell yourself that everything you dislike about yourself is due to depression. It’s tempting to tell myself I’ll get completely better and will be fantastic and personable and accomplished and attractive. And I know that’s not how it works. Even if treatment can alleviate the psychomotor retardation that keeps me bedridden, apartment-ridden and slow, I’m not going to magically run marathons. Even if it no longer required wrenching fortitude just to get out of bed and out the door in the morning, I know I’d still have to set multiple alarms and reminders for myself if I’m ever going to be on time. Even if I can someday countenance group social interactions without dread filling my chest like thick cold smoke, I’m not going to be the bubbly life of the party. I’ll probably never get rid of self-loathing and self-doubt; but I can try to neutralize their effects.
Brain-stimulating, mind-mapping Helen Mayberg of Mount Sinai’s Center for Advanced Circuit Therapeutics sees that. “There are people who think a stimulator [implanted in their brain] is going to give them a life transplant. It doesn’t. It takes away depression. So what is it that you imagine of yourself if you weren’t depressed? Some people have realistic expectations of what that means. If you haven’t worked in five years, you’re not going to be CEO of the company that you used to work in the mailro
om for. So who do you think you are as you emerge from depression?”2
That question can horrify. There are days when I can’t conceptualize a self I would want to remain alive to be. Other days I can imagine that person but can’t bear the trek it would take to become her. Other days, the trek seems doable.
* * *
—
THIS IS NOT a triumphant book. No one finds herself; no one is saved, although some remarkable people do incredible things. There is no happy ending. It’s an uncomfortably personal exploration of a sickeningly common illness no one likes talking about, one that remains under-treated and poorly treated and grossly inequitably treated in part because of our own squeamishness in confronting it or our own denial of its existence as an illness and the destruction it wreaks when left to its own devices.
It doesn’t have to be this way. There are pathways to compassionate, equitable, informed care for an illness that pummels too many for too long without respite. But we need to act like this is something we care about.
Again and again and again and again, when an interview went from need for reform to methods of reform and then to the public pressure and political will needed to achieve reform, I asked how to muster the latter, and clinicians and researchers threw it back at me: “That’s your job.”
I’m torn on that front. I’m a journalist, not an advocate or an activist. But I can inform, I can document, I can explore, I can provoke, I can punch in the face with words. The topic of depression in the context of my writing this book is complicated by my conflict of interest: I want this stuff to change; I want to change discourse and attitudes and, as a result, alter outcomes. I want someone to come up with new medical interventions that work magic. This disorder that I have corrodes the sense of self and destroys the desire to live; hope in recovery, of getting “better,” diminishes to nothing, a sliver of sandcastle in a rising tide. But if I kill myself, if I don’t achieve and maintain remission, it won’t be because the system that fails millions daily has failed me: the system’s treated me just fine; it just isn’t good enough yet.
Our failure to address this illness is a systemic fuckup with an enormous impact; it compounds marginalizations of race and income, and harms most those least able to advocate for themselves. It’s inadequately explored and conversation on the subject, as with so many systemic fuckups, is too often dominated by platitudes and siloed extremes.
For a society that’s gone so far in so many civil and scientific arenas, there are some things we still do astonishingly badly. Treating the most debilitating chronic illness out there is one of them.
So let’s fix this, goddammit, and move on to bitching about something else.
Resources and Further Reading
For immediate help:
www.crisisservicescanada.ca
1-833-456-4566 (in Quebec: 1-866-277-3553)
or text 45645 between 4 p.m. and 12 a.m. ET
For youth:
kidshelpphone.ca
1-800-668-6868
Or text CONNECT to 686868
Or text (778) 783-0177 between 6 p.m. and 12 a.m. PT
For suicide survivor support:
www.suicideprevention.ca/Survivor-Support-Centres
To learn more about suicide, mental illness and mental health care options:
www.camh.ca (Centre for Addiction and Mental Health)
cmha.ca (Canadian Mental Health Association)
mdsc.ca (Mood Disorders Society of Canada)
www.nimh.nih.gov (The National Institute of Mental Health)
mindyourmind.ca
www.suicideinfo.ca
teenmentalhealth.org
Help Lines:
First Nations and Inuit Hope for Wellness Help Line (24/7) 1-855-242-3310
Trans Lifeline 1-877-330-6366
Alberta Crisis Line 1-403-266-4357
British Columbia Crisis Line 1-800-SUICIDE
BC211 Referral Hotline (24/7) Dial 211
Manitoba Crisis Line 1-877-435-7170
New Brunswick Crisis Line 1-800-667-5005
Newfoundland and Labrador Line 1-888-737-4668
NWT Help Line (24/7) 1-800-661-0844
Nova Scotia Crisis Line 1-888-429-8167
Nunavut Line (7 p.m.–11 p.m., EST) 1-800-265-3333
Ontario Crisis Line 1-866-531-2600
Good2Talk Ontario Post-Secondary Student Helpline 1-866-925-5454
Prince Edward Island Crisis Line 1-800-218-2885
Quebec National Crisis Line 1-866-277-3553
Saskatchewan Crisis Line 1-306-525-5333
Yukon Crisis Line (7 p.m.–12 a.m., PST) 1-844-533-3030
Further Reading:
Willow Weep for Me: A Black Woman’s Journey through Depression by Meri Nana-Ama Danquah
Freshwater by Akwaeke Emezi
Faces in the Water by Janet Frame
To the River: Losing My Brother by Don Gillmor
American Melancholy: Constructions of Depression in the Twentieth Century by Laura D. Hirshbein
One Flew Over the Cuckoo’s Nest by Ken Kesey
My Lovely Wife in the Psych Ward by Mark Lukach
Committed: The Battle Over Involuntary Psychiatric Care by Dinah Miller and Annette Hanson
The Bell Jar by Sylvia Plath
Madness in Civilization: A Cultural History of Insanity by Andrew Scull
The Noonday Demon: An Atlas of Depression by Andrew Solomon
Darkness Visible: A Memoir of Madness by William Styron
All My Puny Sorrows by Miriam Toews
American Psychosis: How the Federal Government Destroyed the Mental Illness Treatment System by E. Fuller Torrey
Prozac Nation: Young and Depressed in America by Elizabeth Wurtzel
Acknowledgements
A reporter’s only as good as her sources and here I’ve been exceptionally fortunate. I want to thank, sincerely and obstreperously, everyone who gave me their time, experience and expertise in my pursuit of this book—everyone who talked to me, met with me, sent me papers, showed me their brain banks, recalled for me the worst moments of their lives. Thank you. You give me reasons to wake up in the morning.
I want to thank my expert readers, geniuses in their fields who took the time to read, comment and give feedback on my manuscript. Irfan Dhalla, Marcia Valenstein, Paul Kurdyak, Sarah Lisanby and Kwame McKenzie—you made this book so much better.
I owe an incalculable debt of gratitude to Louise Dennys, the brilliant powerhouse who brought this beast into being.
To Rick Meier, a stalwart and one of the first to wrestle with this creature, and Angelika Glover, a pro who gets it.
To the arts councils of Toronto, Ontario and Canada, who taught me humility by turning me down for every grant I applied for but one, and to Denis De Klerck, who convinced Ontario to give me $1,500. You were among the first to believe in this thing.
To José Silveira, who teaches me to make life worth living and who, let’s face it, puts up with a lot.
To Omar El Akkad, the human being I want to be.
To Brendan Kennedy, who keeps saving my life.
To Richard Warnica, who makes me keep chasing.
To Allison Martell, who inspires me.
To Leslie Young, who keeps me grounded.
To Amran Abocar, who makes a day job possible.
To Jennifer Griffiths, a visual wizard.
And to Heather Cromarty, a true ally.
To Gram, who was right all along, who made me a writer. And to Grandma Ruthie, who shows me what strength is.
To my beloved baby siblings, Daniel and Juliet Paperny, my muses and partners in crime. And to their partners, Lindsay Paperny and Jaylen Gadhia, masters of fortitude. And to Zoe, my little rock star.
And, above all, to my parents, Audrey Mehler and David Paperny, who support me when I need it most and want it least, who teach me resilience through unconditional love and inappropriate jokes.
Thank you.
Notes
CHAPTER 1: CA
TACLYSM
1. Jayme Poisson and Curtis Rush, “Toronto Police Shoot and Kill Man with Scissors Wearing Hospital Gown,” Toronto Star, February 3, 2012.
2. Tim Alamenciak and Hamida Ghafour, “Who Was Sammy Yatim?” Toronto Star, August 24, 2013.
3. Richard Warnica, “The Life and Bloody Death of Andrew Loku,” National Post, July 17, 2015.
4. Anna Mehler Paperny, “Ontario NDP Unveils Platform, Includes Corporate Tax Hikes and Contingency Cushion,” The Globe and Mail, September 25, 2011.
CHAPTER 2: WHEN YOU TRY TO DIE AND DON’T
1. Ontario Mental Health Act, 1990, www.ontario.ca/laws/statute/90m07.
2. www.sse.gov.on.ca/mohltc/ppao/en/Pages/InfoGuides/2016_Form1.aspx.
3. https://www.sse.gov.on.ca/mohltc/ppao/en/Pages/InfoGuides/2016_Involuntary_Patients.aspx.
4. Heather Stuart, “Violence and Mental Illness: An Overview,” World Psychiatry, June 2003.
5. Omar El Akkad, “Steve Jobs: The Man Who Changed Your World,” The Globe and Mail, October 5, 2011.
6. James A. Kruse, “Methanol and Ethylene Glycol Intoxication,” Critical Care, 2012.
CHAPTER 3: PSYCH-WARD SOJOURN
1. Ontario Consent and Capacity Board Annual Report, 2016/2017, www.ccboard.on.ca/english/publications/documents/annualreport20162017.pdf.
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