At the end of the week, I headed up to Vermont for the wedding of some friends. It was a beautiful late-summer weekend. I had almost canceled the trip, but after getting details of a hospital near where the wedding was to take place, I decided to try to go. I arrived on Friday in time for dinner and square dancing (I did not do any square dancing), and I saw someone I had known very marginally in college ten years earlier. We talked, and I felt overcome with more emotion than I’d felt in years. I felt myself shining; I felt ecstatic and did not guess how nothing good was to come of that. I rode from emotion to emotion in a way that was almost absurd.
After the Vermont wedding, the slippage was steady. I worked less and less well. I canceled plans to go to England for another wedding, feeling that the trip was just more than I could handle, though I had, a year earlier, gone back and forth to London regularly without much trouble. I had begun to feel that no one could love me and that I would never be in a relationship again. I had no sexual feelings at all. I began eating irregularly because I seldom felt hungry. My analyst said that it was still depression, and I felt tired of that word and tired of the analyst. I said that I was not crazy but was afraid I could become crazy and did she think I was going to end up on antidepressants, and she told me that avoiding medication was courageous and that we could work everything through. That conversation was the last one I initiated; those were my last feelings for a long time.
Major depression has a number of defining factors—mostly having to do with withdrawal, though agitated or atypical depression may have an intense negativity rather than a flattened passivity—and is usually fairly easy to recognize; it deranges sleep, appetites, and energy. It tends to increase sensitivity to rejection, and it may be accompanied by a loss of self-confidence and self-regard. It seems to depend on both hypothalamic functions (which regulate sleep, appetites, and energy) and cortical functions (which translate experience into philosophy and worldview). The depression that occurs as a phase in manic-depressive (or bipolar) illness is much more strongly genetically determined (about 80 percent) than is standard depression (about 10 to 50 percent); though it is more broadly treatment-responsive, it is not easier to control, especially since antidepressant drugs may launch mania. The greatest danger with manic-depressive illness is that it sometimes bursts into what are called mixed states, where one is manically depressed—full of negative feeling and grandiose about them. That is a prime condition for suicide, and it too can be brought on by the use of antidepressant medications without the mood stabilizers that are necessary parts of bipolar medication. Depression can be enervating or atypical/agitated. In the first, you don’t feel like doing anything; in the second, you feel like killing yourself. A breakdown is a crossover into madness. It is, to borrow a metaphor from physics, uncharacteristic behavior of matter that is determined by hidden variables. It is also a cumulative effect: whether you can see them or not, the factors leading to a depressive breakdown gather over the years, usually over a lifetime. There is no life that does not have the material for despair in it, but some people go too close to the edge and others manage to stay sometimes sad in a safe clearing far from the cliffs. Once you cross over, the rules all change. Everything that had been written in English is now in Chinese; everything that went fast is now slow; sleep is for clarity while wakefulness is a sequence of unconnected, senseless images. Your senses slowly abandon you in depression. “There’s a sudden point when you can feel the chemistry going,” Mark Weiss, a depressive friend, once said to me. “My breathing changes and my breath stinks. My piss smells disgusting. My face comes apart in the mirror. I know when it’s there.”
By the time I was three, I had decided I wanted to be a novelist. Ever since, I had been looking forward to publishing a novel. When I was thirty, my first novel was published, and I had scheduled a reading tour, and I was hating the idea. A good friend had volunteered to throw a book party for me on October 11. I love parties and I love books, and I knew I should have been ecstatic, but in fact I was too lackluster to invite many people, and too tired to stand up much during the party. Memory functions and emotional functions are distributed throughout the brain, but the frontal cortex and limbic systems are key to both, and when you affect the limbic system, which controls emotion, you also touch on memory. I remember that party only in ghostly outlines and washed-out colors: grey food, beige people, muddy light in the rooms. I do remember that I was sweating horribly during it, and that I was dying to leave. I tried to put it all down to stress. I was determined, at any cost, to keep up appearances, an impulse that was to serve me well. I did it: no one seemed to notice anything strange. I got through the evening.
When I got home that night, I began to feel frightened. I lay in bed, not sleeping, hugging my pillow for comfort. Over the next two and a half weeks things got worse and worse. Shortly before my thirty-first birthday, I went to pieces. My whole system seemed to be caving in. I was not going out with anyone at the time. My father had volunteered to organize a birthday party for me, but I couldn’t bear the idea, and we had agreed instead to go to a favorite restaurant with four of my closest friends. On the day before my birthday, I left the house only once, to buy some groceries. On the way home from the store, I suddenly lost control of my lower intestine and soiled myself. I could feel the stain spreading as I hastened home. When I got in, I dropped the grocery bag, rushed to the bathroom, got undressed, and went to bed.
I did not sleep much that night, and I could not get up the following day. I knew I could not go to any restaurant. I wanted to call my friends and cancel, but I couldn’t. I lay very still and thought about speaking, trying to figure out how to do it. I moved my tongue but there were no sounds. I had forgotten how to talk. Then I began to cry, but there were no tears, only a heaving incoherence. I was on my back. I wanted to turn over, but I couldn’t remember how to do that either. I tried to think about it, but the task seemed colossal. I thought that perhaps I’d had a stroke, and then I cried again for a while. At about three o’clock that afternoon, I managed to get out of bed and go to the bathroom. I returned to bed shivering. Fortunately, my father called. I answered the phone. “You have to cancel tonight,” I said, my voice shaky. “What’s wrong?” he kept asking, but I didn’t know.
There is a moment, if you trip or slip, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself, a passing, fraction-of-a-second terror. I felt that way hour after hour after hour. Being anxious at this extreme level is bizarre. You feel all the time that you want to do something, that there is some affect that is unavailable to you, that there’s a physical need of impossible urgency and discomfort for which there is no relief, as though you were constantly vomiting from your stomach but had no mouth. With the depression, your vision narrows and begins to close down; it is like trying to watch TV through terrible static, where you can sort of see the picture but not really; where you cannot ever see people’s faces, except almost if there is a close-up; where nothing has edges. The air seems thick and resistant, as though it were full of mushed-up bread. Becoming depressed is like going blind, the darkness at first gradual, then encompassing; it is like going deaf, hearing less and less until a terrible silence is all around you, until you cannot make any sound of your own to penetrate the quiet. It is like feeling your clothing slowly turning into wood on your body, a stiffness in the elbows and the knees progressing to a terrible weight and an isolating immobility that will atrophy you and in time destroy you.
My father came down to my apartment with a friend of mine, trailing my brother and his fiancée. Fortunately, my father had keys. I had had nothing to eat in almost two days, and they tried to get me to eat a little soup. Everyone thought that I must have some kind of terrible virus. I ate a few bites, then threw up all over myself. I couldn’t stop crying. I hated my house but couldn’t leave it. The next day, I managed, somehow, to get to my analyst’s office. “I think I’m going to have to start taking medic
ation,” I said, diving deep for the words. “I’m sorry,” she said, and called the psychopharmacologist, who agreed to see me in an hour. She did at last, however belatedly, see that we had to call in help. In the 1950s, in keeping with the thinking of his time, a psychoanalyst I know was told by his supervisor that if he wanted to start a patient on medication, he would have to stop the analysis. Perhaps it was something old-fashioned that had allowed my analyst to encourage me to avoid medication? Or perhaps she too bought into the appearances I was struggling to keep up? I will never know.
The psychopharmacologist seemed to have come out of some movie about shrinks: his office had fading mustard-colored silk wallpaper and old-fashioned sconces on the walls and was piled high with books with titles such as Addicted to Misery and Suicidal Behavior: The Search for Psychic Economy. He was in his seventies, smoked cigars, had a Central European accent, and wore carpet slippers. He had elegant prewar manners and a kindly smile. He asked me a rapid string of specific questions—how did I feel in the morning versus the afternoon? How difficult was it for me to laugh about anything? Did I know what I was afraid of? Had my sleep patterns and appetites shifted?—and I did my best to answer him. “Well, well,” he said calmly as I trotted out my horrors. “Very classic indeed. Don’t you worry, we’ll soon have you well.” He wrote out a prescription for Xanax, then burrowed around to find a starter kit of Zoloft. He gave me detailed instructions on how to begin taking it. “You’ll come back tomorrow,” he said with a smile. “The Zoloft will not work for some time. The Xanax will alleviate your anxiety immediately. Do not worry about its addictive qualities and so on, as these are not your problems at the moment. Once we have lifted the anxiety somewhat, we will be able to see the depression more clearly and take care of that. Don’t worry, you have a very normal group of symptoms.”
My first day on medication, I moved into my father’s apartment. My father was almost seventy at the time, and most men of that age cannot easily tolerate complete shifts in their lives. My father is to be praised not only for his generous devotion, but also for the flexibility of mind and spirit that allowed him to understand how he could be my mainstay through rough times, and for the courage that helped him to be that mainstay. He picked me up at the doctor’s office and took me home with him. I had not brought clean clothes with me, but I didn’t really need them since I was hardly to get out of bed for the next week. For the moment, the panic was my only sensation. The Xanax would relieve the panic if I took enough of it, but enough of it was enough to make me collapse completely into a thick, confusing, dream-heavy sleep. The days were like this: I would wake up, knowing that I was experiencing extreme panic. What I wanted was only to take enough panic medication to allow me to go back to sleep, and then I wanted to sleep until I got well. When I would wake up a few hours later, I wanted to take more sleeping pills. Killing myself, like dressing myself, was much too elaborate an agenda to enter my mind; I did not spend hours imagining how I would do such a thing. All I wanted was for “it” to stop; I could not have managed even to be so specific as to say what “it” was. I could not manage to say much; words, with which I have always been intimate, seemed suddenly very elaborate, difficult metaphors the use of which entailed much more energy than I could possibly muster. “Melancholia ends up in loss of meaning . . . I become silent and I die,” Julia Kristeva once wrote. “Melancholy persons are foreigners in their mother tongue. The dead language they speak foreshadows their suicide.” Depression, like love, trades in clichés, and it is difficult to speak of it without lapsing into the rhetoric of saccharine pop tunes; it is so vivid when it is experienced that the notion that others have known anything similar seems altogether implausible. Emily Dickinson wrote perhaps the most eloquent description of a breakdown ever committed to the page:
I felt a Funeral, in my Brain,
And Mourners to and fro
Kept treading—treading—till it seemed
That Sense was breaking through—
And when they all were seated,
A Service, like a Drum—
Kept beating—beating—till I thought
My Mind was going numb—
And then I heard them lift a Box
And creak across my Soul
With those same Boots of Lead, again,
Then Space—began to toll,
As if the Heavens were a Bell,
And Being, but an Ear,
And I, and Silence, some strange Race
Wrecked, solitary, here—
And then a Plank in Reason, broke,
And I dropped down, and down—
And hit a World, at every plunge,
And Finished knowing—then—
There has been relatively little written about the fact that breakdowns are preposterous; seeking dignity, and seeking to dignify the sufferings of others, one can easily overlook this fact. It is, however, real and true, and obvious when you are depressed. Depression minutes are like dog years, based on some artificial notion of time. I can remember lying frozen in bed, crying because I was too frightened to take a shower, and at the same time knowing that showers are not scary. I kept running through the individual steps in my mind: you turn and put your feet on the floor; you stand; you walk from here to the bathroom; you open the bathroom door; you walk to the edge of the tub; you turn on the water; you step under the water; you rub yourself with soap; you rinse; you step out; you dry yourself; you walk back to the bed. Twelve steps, which sounded to me then as onerous as a tour through the stations of the cross. But I knew, logically, that showers were easy, that for years I had taken a shower every day and that I had done it so quickly and so matter-of-factly that it had not even warranted comment. I knew that those twelve steps were really quite manageable. I knew that I could even get someone else to help me with some of them. I would have a few seconds of relief contemplating that thought. Someone else could open the bathroom door. I knew I could probably manage two or three steps, so with all the force in my body I would sit up; I would turn and put my feet on the floor; and then I would feel so incapacitated and so frightened that I would roll over and lie facedown, my feet still on the floor. I would sometimes start to cry again, weeping not only because of what I could not do, but because the fact that I could not do it seemed so idiotic to me. All over the world people were taking showers. Why, oh why, could I not be one of them? And then I would reflect that those people also had families and jobs and bank accounts and passports and dinner plans and problems, real problems, cancer and hunger and the death of their children and isolating loneliness and failure; and I had so few problems by comparison, except that I couldn’t turn over again, until a few hours later, when my father or a friend would come in and help to hoist my feet back up onto the bed. By then, the idea of a shower would have come to seem foolish and unrealistic, and I would be relieved to have been able to get my feet back up, and I would lie in the safety of the bed and feel ridiculous. And sometimes in some quiet part of me there was a little bit of laughter at that ridiculousness, and my ability to see that, is, I think, what got me through. Always at the back of my mind there was a voice, calm and clear, that said, don’t be so maudlin; don’t do anything melodramatic. Take off your clothes, put on your pajamas, go to bed; in the morning, get up, get dressed, and do whatever it is that you’re supposed to do. I heard that voice all the time, that voice like my mother’s. There was a sadness and a terrible loneliness as I contemplated what was lost. “Did anyone—not just the red-hot cultural center, but anyone, even my dentist—care that I had withdrawn from the fray?” Daphne Merkin wrote in a confessional essay on her own depression. “Would people mourn me if I never returned, never took up my place again?”
By the time evening came around, I was able to get out of bed. Most depression is circadian, improving during the day and then descending again by morning. At dinner, I would feel unable to eat, but I could get up and sit in the dining room with my father, who canceled all other plans to be with me. I could a
lso speak by then. I tried to explain what it was like. My father nodded, implacably assured me that it would pass, and tried to make me eat. He cut up my food. I told him not to feed me, that I wasn’t five, but when I was defeated by the difficulty of getting a piece of lamb chop onto my fork, he would do it for me. All the while, he would remember feeding me when I was a tiny child, and he would make me promise, jesting, to cut up his lamb chops when he was old and had lost his teeth. He had been in touch with some of my friends, and some of my friends had called me anyway, and after dinner I would feel well enough to call some of them back. Sometimes, one would even come over after dinner. Against the odds, I could usually even have a shower before bed! And no drink after crossing the desert was ever lovelier than that triumph and the cleanliness. Before bed, Xanaxed out but not yet asleep, I would joke with my father and with friends about it, and that rare intimacy that surrounds illness would make itself felt in the room, and sometimes I would feel too much and begin to cry again, and then it was time to turn off the lights, so that I could go back to sleep. Sometimes close friends would sit with me until I drifted off. One friend used to hold my hand while she sang lullabies. Some evenings, my father read to me from the books he had read me when I was a child. I would stop him. “Two weeks ago, I was publishing my novel,” I would say. “I used to work twelve hours and then go to four parties in an evening, some days. What’s happened?” My father would assure me, sunnily, that I would be able to do it all again, soon. He could as well have told me that I would soon be able to build myself a helicopter out of cookie dough and fly on it to Neptune, so clear did it seem to me that my real life, the one I had lived before, was now definitively over. From time to time, the panic would lift for a little while. Then came the calm despair. The inexplicability of it all defied logic. It was hellishly embarrassing to tell people I was depressed, when my life seemed to have so much good and love and material comfort in it; for all but my close friends, I developed an “obscure tropical virus” that I “must have picked up last summer, traveling.” The lamb-chop question became emblematic to me. A poet friend, Elizabeth Prince, wrote:
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