Bellow was on his own—his fourth wife, a mathematician, was off in the Schwarzwald—and I felt a little like Tuptim in The King and I, who is brought to the King to satisfy his roving eye. Harriet waited hand and foot on her most important client, literally sitting before Bellow and holding open hard-bound copies of “The Silver Dish,” a short story of his that had appeared in The New Yorker and had now been published in a limited edition, for him to autograph. Bellow turned his considerable charm on me, going so far as to share his secret recipe for tuna fish, which included a dollop of ketchup, and playing his favorite classical records for my cultural edification. But I found myself resistant to his need for—rather, insistence on—adulation, and kept escaping the psychologically sweltering atmosphere of the house for long walks by myself.
By the weekend’s end Bellow seemed puzzled, almost hurt, and I in turn felt that I had failed to live up to my part of the bargain, whatever it was supposed to have been. Shortly before I left, we were standing in his garden when he suddenly turned to me and said: “Be kinder to the male gender.” I kissed him good-bye on the cheek and got into Harriet’s rented car, where I immediately burst out crying. Despite all his show of masculine ego, I had suddenly felt Bellow’s vulnerability. That, and the fact of my own frightened, armored response to his wish to be fussed over, overwhelmed me with sadness.
During this same period, I attended a dinner party given on Martha’s Vineyard by Diana Trilling, the widow of the critic and teacher Lionel Trilling and a formidable critic in her own right. Diana was then in her early seventies; she was a vigorous hostess and excellent cook who had slightly bulging, hyperthyroidic eyes and a habit of pronouncing upon people and society in a way that brooked no disagreement. She had begun airing her outspoken views as a fiction reviewer for The Nation in the 1940s, where she deemed Saul Bellow “talented and clever” but his Dangling Man “not the kind of novel I like,” and judged Vladimir Nabokov’s Bend Sinister as having had “by my count … four successful moments.” Diana went on to write essays on the counterculture, included in a collection called We Must March My Darlings, although there would always be those among the backstabbing, self-enamored tribe known as the New York intellectuals, like Mary McCarthy and Hannah Arendt, who regarded her effort to obtain cultural eminence with suspicion and thought she did better at cooking than cogitating.
As I came to know her better, I discovered that beneath her highbrow stance, Diana also had an endearingly robust appreciation of the less exalted aspects of life, such as diets and movie stars and good gossip; this side of her can be seen in her 1981 book, Mrs. Harris, about the seamy murder trial of Jean Harris, a former headmistress who had killed her faithless lover, Herman Tarnower, also known as the Scarsdale Diet Doctor. Diana and I would eventually develop a close if complicated friendship—she would become something of a mentor and over the years we would spend Thanksgivings and share many long late-night conversations together—but on that first occasion I found her mostly intimidating, someone who crackled with energy on all fronts.
I was in my mid-twenties that summer of 1979, slim and tanned, with a fetching Jean Seberg haircut and a head full of Roland Barthes and esoteric film theory. I was staying with my friend Leon Wieseltier at the Vineyard home of the historian Daniel Bell and his wife, Pearl, although I was careful to disabuse onlookers of the notion that Leon and I were lovers—we weren’t—by insisting on a room to myself. I remember Diana was particularly nonplussed by our sleeping arrangements; in her plummy voice, with its slightly Britishified accent, she expressed a mixture of amusement and dismay that my relationship with Leon was not sexual in nature.
At Diana’s dinner, I met William Phillips, co-editor of Partisan Review, a publication the name of which rings an ever-fainter bell but which occupied a position of cultural prominence in the mid-twentieth century. Phillips had a kind of laconic, shrewd intelligence and I think he initially sized me up as brimming with possibility, someone who had begun to make a name for herself as a writer at an impressively young age. I would go on to publish poetry and a couple of essays in Partisan Review, but after a while I would agree to write a piece only to stagger off with a clutch of new novels that suggested a trend toward, or away from, Realism, or Minimalism, without much intention of actually producing anything. True, I was unclear, once again, who actually read the magazine and the pay was dishearteningly minimal. But what really stopped me was the underlying sense of futility that plagued me whatever I did—the thought of making all that effort, like finally getting to a standing position in the playpen, without anyone to applaud me at the end of it. Phillips knew none of this, but he saw what he saw: “You’re scattered like dust,” he told me. He said it affectionately—I don’t think he ever quite lost his faith in my native ability—but it echoed like a death knell.
16
It is early winter 2012. At a dinner party I go to, the subject of antidepressants comes up and an excoriating critique of them that had appeared months earlier is quoted approvingly by several of the people present. The piece in question is a two-part attack in The New York Review of Books, written by Marcia Angell, a former editor-in-chief of the New England Journal of Medicine. It had cited the usual evidence for the prosecution, including the claim, based on clinical trials submitted to the Food and Drug Administration in the late 1980s and 1990s by companies seeking approval for new drugs, that antidepressants were only 25 percent more effective than placebos.
As I listen to the conversation I sense an unspoken investment in holding depression up to censure, as though it were still, after all these years, a fraudulent bundle of symptoms, an inflated case of malingering that everyone suffers from but that only a select, self-indulgent few choose to make a big deal about. No wonder people keep it a secret, especially people who are celebrated in some way, like the fashion designer Alexander McQueen, and have something to lose by revealing that they do battle with what continues to be treated as a suspect malady, Prozac Nation notwithstanding. I have often wondered whether it is depression’s very failure to fit into a neat, easily recognizable category that contributes to the ongoing stigma that attaches to it. It never ceases to surprise me the way it brings out the partisan in people, leading them to diehard positions, to swear for or against it as a real disease, for or against medication. One of the guests speaks up weakly for his own regimen of Paxil but I say nothing, unwilling on this particular occasion to enter the fray.
Although I have been on antidepressants for three and a half decades, I continue to feel defensive about them, as though I were the scientific version of a fashion victim. I think protectively of my own panoply of multihued pills: pale pink and taupe, apricot and carnelian red, with a dash of light blue, a sophisticated amalgam of serotonin- and dopamine-tweaking agents (Effexor and Wellbutrin) along with a small dose of an antipsychotic (Abilify), which also works on neuroreceptors, as well as some uppers (Vyvanse, Dexedrine), which release dopamine into the brain to get my mood rolling in the right direction. Even as I faithfully took my pills I couldn’t help wondering: Was I medicating a bad childhood or a chemical irregularity? And did it matter what the cause was if the drugs helped keep me going, steered me away from the thoughts of suicide that had haunted me ever since I was a young girl?
Then again, there are many factors that make depression and the chemical treatment for it uniquely vulnerable to questioning in a way that schizophrenia, for instance, is not. Depression is viewed as being on a continuum with normal sadness or unhappiness—“Everyone,” an actress I interviewed once told me, “is a little depressed”—so there is far more latitude in not viewing it as a true pathological condition. Because its symptoms don’t involve seeing green Martians or hearing robotic commands, it is easier to disguise—and harder for other people to detect. On top of which, not everyone who is seriously depressed is a depressive type per se, walking around with a hangdog expression, a shuffling gait, and an air of great suffering. I have hurled all the charm and wits I have at my d
isposal against my proclivity to depression, such that it would be difficult for even close friends of mine to detect how low I am at any given time. I can be near-catatonic, paralyzed by misery, an hour before I go out to dinner and still manage to hold up my end of the conversation with gusto. It’s only after I get home and am stuck inside my own head again that I begin to sink. And it’s only when I begin to sink that I remember why I am on antidepressants to begin with, which is that they seem to keep me from hitting rock bottom, sliding a floor under me so that my downward trajectory goes so far and no farther.
Still and all, here is a piece of heretical personal truth: despite the fact that I have been on antidepressants for much of my adult life, I have never been entirely convinced that there is something seriously amiss with my brain chemistry. (I have never been entirely convinced that depression is a “disease” as such, either, but more on that later.) I say this in part because I don’t believe that it all comes down to genetics in any case—only 50 percent of our temperament can be traced back to our heredity—and I am enough of a believer in the effects of early experience to attribute a great deal of my chronic depression to an emotionally traumatic childhood.
I also recognize, however, that you can talk yourself blue in the face in a therapist’s office about crucial failures of love or nurturance with little effect on the inner blackness you carry around with you. As a result, you might be pointed in the direction of medication, as I was by Dr. Alpert, the psychiatrist with a red beard and an intense gaze who explained to me when I was an anguished person in my early twenties, talking longingly of suicide, that my depression was an entity in and of itself, regardless of its root cause, and needed to be treated as such. Meaning that even if my original brain chemistry was fine, somewhere along the way it had been altered by my environment, so that I now needed this same brain chemistry to be re-jiggered once again.
Parnate was the first of a long succession of pills I was put on, after Dr. Alpert succeeded in convincing me over several sessions that even if it was my lousy childhood that had made me want to die in the present, these feelings had taken on a chemical life of their own. Dr. Alpert has been dead for decades, but I have never forgotten that what clinched the deal for me—made me willing, that is, to at least give medication a try—was his comparing my emotional state to an ulcer. “You can’t speak to an ulcer,” he said. “You can’t reason with it. First you cure the ulcer, then you go on to talk about the way you feel.”
Still, it was hard for me to agree to try medication for something that seemed so intrinsic to who I was—not something out there, like having a case of measles, but the state of mind in which I lived, so to speak, however negatively. This was back in the 1970s, before Prozac arrived and changed everything, when mood medication was still associated with bored housewives and Valley of the Dolls psychodrama, and psychoanalysis was still in fashion. But I had already put in fifteen-odd years in psychiatrists’ offices by the time I saw Dr. Alpert and I was tired, unbelievably tired, of wanting to kill myself.
The theoretical view of depression on which most antidepressants are based is that something is amiss with the biochemical system—that not enough of one kind of neurotransmitter, or too much of another kind of neurotransmitter, is being released into the synaptic spaces in the brain. Parnate is one of a small group of antidepressants technically referred to as MAO inhibitors, which includes Marplan and Nardil as well. These pills have a sturdy, albeit unglamorous, reputation, but they come with a major drawback in the form of the dietary restrictions they entail—no red wine, hard cheese, pastrami, dark chocolate, or soy sauce—which one is free to ignore at the risk of provoking a potentially lethal hypertensive reaction. That first exposure to Parnate was something of a revelation: I was able to get up in the morning without feeling as though I were being torn, limb by limb, from bed, and I could entertain unhappy thoughts without getting stuck in a stranglehold of despair.
I have been taking one or another variety of antidepressants ever since, keeping apace on a personal level with the larger changes in the thinking about psychotropic medication. This included being a guinea pig for the aforementioned Prozac, a serotonin reuptake inhibitor, in my late twenties before it was FDA-approved, at a point when Parnate no longer seemed to be effective. I was writing Enchantment, my highly autobiographical first novel, and involved with the man I would eventually marry, and by all rights I should not have felt as blue as I did. I was put on an unthinkably high dose of Prozac (eighty milligrams), and in a matter of weeks it had me so wired that I needed a sedating antidepressant—Desyrel—in order to fall asleep at night.
This particular combination of drugs ended up causing a severe case of urinary retention—paralyzing my urethral sphincter muscle so that I could no longer pee on my own—and for six weeks one hot summer I had to catheterize myself several times a day. I also wore a plastic bag to catch urine that was connected to a Foley catheter and taped high up on my thigh, which made for an attractive sight when I went swimming. (Snapshots of me looking slim and tanned in a bathing suit with the unwieldy bag and its bright yellow liquid contents actually exist.)
For a while it appeared that my situation couldn’t be reversed. My mother, as was her habit when it came to medical problems, acted weirdly nonchalant, as though the possibility of my remaining on a catheter for the rest of my life weren’t worth bothering about. It was only due to the concerned intervention of my fatherly employer that I consulted a series of urologists, one of whom was completely stymied and another of whom blithely suggested that I learn to accommodate myself to life on a catheter—“Just go into the ladies’ room in Saks Fifth Avenue and put it in,” he advised in a strong New York accent. I finally found a doctor who experimented with various medications and succeeded in getting me to urinate on my own again. The whole situation was a hazardous one, inducing many a grim thought, but if this malfunction didn’t put me off medication forever, I suppose nothing will.
Many years later, I continue to look upon my meds with a wary eye, and what should by now have become a reflexive gesture, part of my daily routine, is an action still weighted with unease and ambivalence. For one thing, no one, not even the psychopharmacologists who dispense them, studying their intake jottings and considering the odds, seems clear as to how these drugs work when they work or what damage they might inflict on their way to doing good. (In my case, I have a sky-high liver count, which is partially attributable to my meds.) If any of them worked conclusively, the researchers at Pfizer and Lilly and Merck wouldn’t keep trying to find a better, newer, more lucrative drug, like Heinz’s 57 varieties. So for now we are stuck with what comes down to a refined form of guesswork—a selection of some thirty-odd pills that affect neural pathways—dopamine, serotonin-reuptake and noreprinephrine levels and what-have-you—in not completely understood ways. There are, of course, new treatments for depression being developed all the time, including the use of the onetime party drug ketamine, as well as electrical implants that provide deep brain stimulation, DBT (dialectical behavioral therapy), and new forms of CBT (cognitive behavioral therapy). Not to overlook ECT, or shock therapy, which I have always been afraid to try but which my psychopharmacologist insists is “the most effective antidepressant we have,” adding with a triumphant flourish, “It reboots the system.” Then again, when I press him, he admits: “We don’t know how it works … It’s like hitting the brain with a sledgehammer.”
As for the repercussions, the possible side effects of various medications, these are shunted to the side until such time as they must be dealt with. I have wondered variously over the more than three decades I’ve been on them whether I might one day keel over from some errant brain function, or suddenly start slurring my words. Then, too, there is a sense that I have ceded part of my autonomy in exchange for some incalculable relief from the burden of self—my self, such as it is. I fight against this perception by arbitrarily not taking my pills for a day or two at a time, or taking one and not the othe
rs in a forlorn effort to prove myself independent of their sway. On a number of occasions I’ve even gone off drugs altogether, sometimes at the suggestion of a shrink, sure that they are causing me irreparable harm in the form of weight gain, incessant fatigue, or memory blips. But, invariably, the effect has been unfortunate; I sink perilously downward before finding my way back to them again.
In the here-and-now, loaded up on drugs as I am—Effexor (450 milligrams), Wellbutrin (300 milligrams), Abilify (5 milligrams), Dexedrine (30 milligrams), not to overlook the medication I take at night, Klonopin and Restoril and on occasion trazodone—I’m not sure what else there is to be done to stave off what seems to be another bout of potentially immobilizing depression coming my way, flexing its muscle once again, lest I think it gone forever. On my desk sits one of those artificial light-boxes you’re meant to use for twenty minutes every day to help battle SAD (seasonal affective disorder) and brighten your mood, which I avail myself of erratically, as I do everything. I’ve put it on today, hoping by flooding my brain with fake sunshine it will be fooled into thinking I am lying on a beach, but the hour is all wrong—afternoon instead of morning—and the warmth is faint, reminding me of the sun’s heat not at all.
Lately I’ve also added something new to my regimen: an electrical device called the Fischer Wallace Stimulator that comes packaged in a sleek black leather pouch, like a Prada makeup bag. It consists of two round yellow sponges you soak in water and place inside earphone-type things that are wired to a gizmo that resembles a television remote; you then slide the sponges under a stretchy headband that holds them in place over your temples. After you click on the device, a pinprick of green light begins pulsing on and off, followed by a blinking yellow light, which sends a low current into your brain; twenty minutes later, there’s a slight ping and the device turns itself off. I was apprehensive at first and kept thinking of it as a mini session of shock therapy, but it actually feels entirely benign. The device is supposed to help with all sorts of problems, like anxiety and mood and sleep, but at moments like these it’s hard to believe that anything would help short of a new brain or at the least a different childhood, so that I wouldn’t find myself in these straits to begin with.
This Close to Happy Page 11
