Lester now has a job folding aprons in a laundry. He gets picked up by a special bus for the disabled and he goes in every day. He washes the dishes at home, and sometimes he can even help vacuum. With disability, he brings in $250 a week, on which they live.
“I never abandoned him,” Theresa said. Pride suddenly came back to her. “They told me I was gonna burn out, but we’re going so strong now. We can talk about anything. He was a redneck from hell, and now he’s turned liberal. I’ve cleaned out some of that prejudice and hatred he grew up with.” Lester has learned to urinate by himself, and he can almost get dressed with one hand. “We talk every day and every night,” Theresa said. “And you know what? He is the one true love of my life, and even if I regret a lot of what happened, I wouldn’t want to give up anything about us and this family. But if it wasn’t for Marian, I’d have waited until I could bleed to death and that would have been it.”
At this statement, Leslie climbed up into Theresa’s lap. Theresa rocked her back and forth. “And this year,” Theresa said, suddenly elated, “I found my mama. I looked up her last name in the phone book, and after about fifty calls I found some cousin and did some detective work, and when she answered the phone, she said she’d been waiting for me all these years, hoping I’d call. Now she’s like my best friend. We see her all the time.”
“We love Grandma,” Leslie announced.
“Yeah, we do,” Theresa confirmed. “She and I got the same rough treatment out of my daddy and his family, so we got a lot in common.” Theresa said it was unlikely she’d be able to stand and do factory labor again. “Someday, when Leslie can take care of Lester in the evenings, and if they let me move around a little more, if they manage to contain the hemangioma, I’m going to finish high school doing night classes. I learned about art and poems and music from a black lady teacher, Miss Wilson, at my high school. I’m gonna go back and learn more about the writers I love most, Keats, Byron, Edgar Allan Poe. I read Leslie ‘The Raven’ and ‘Annabel Lee’ last week, didn’t I, honey, when we got that book from the library.” I looked at the prints up on her walls. “I love Renoir,” she said. “Don’t think I’m pretentious, but I really love that, and that one of the horse, by an English artist. And I love music too, I like to listen to Pavarotti when he’s on.
“You know what I wanted when I was a little girl in that horrible house? I wanted to be an archaeologist and go to Egypt and Greece. Talking to Marian helped me stop wigging out and all and it also got me thinking again. I’d missed using my mind so much! Marian’s so smart, and after years with only Leslie and a husband who never finished ninth grade and can’t talk . . .” She drifted off for a minute. “Boy, there are these beautiful things waiting out there. We’re gonna find them, Leslie, aren’t we gonna find them all? Like we found those poems.” I began to recite “Annabel Lee,” and Theresa joined in. Leslie looked up attentively as her mother and I drummed through the first few of those American lines. “ ‘But we loved with a love that was more than love,’ ” Theresa said, as though describing a journey of her own.
Part of the difficulty in getting better services to these people is the blockade of disbelief. I wrote an early version of this chapter as a feature for a wide-circulation newsmagazine, and they told me that I had to rewrite it for two reasons. First, the lives I described were implausibly horrendous. “It becomes comical,” one editor said to me. “I mean, no one can have all this stuff happening to them, and if they do, it’s no surprise they’re depressed.” The other problem was that the recovery was too quick and too dramatic. “This whole thing about suicidal homeless women becoming virtually hedge-fund managers,” the editor said somewhat acidly, “comes off as pretty ludicrous.” I tried to explain that this was in fact the strength of the story, that people in authentically desperate situations had had their lives changed beyond recognition, but I got nowhere. The truth I had discovered was intolerably stranger than fiction.
When scientists first observed the Antarctic hole in the ozone layer, they presumed their observational equipment was flawed because the hole was so enormous as to be unbelievable. It turned out that the hole was real. The hole of indigent depression in the United States is also real and gigantic, but unlike the hole in the ozone layer, this one can be filled. I cannot imagine what it was like for Lolly Washington, Ruth Ann Janesson, Sheila Hernandez, Carlita Lewis, Danquille Stetson, Fred Wilson, Theresa Morgan, and the tens of other people I interviewed at length among the indigent depressed. But I do know this: we have been trying to solve the problem of poverty by material intervention at least since biblical times and have in the last decade tired of such intervention, realizing that money is not a sufficient antidote. We have now overhauled welfare with the cheery thought that if we don’t support the poor, they’ll work harder. Is it not worthwhile giving them the support, medical and therapeutic, that would allow them to function, that could free them to make good on their lives? It is not so easy to find the social workers who can transform the lives of this population; but without programs of raised consciousness and allocated funding, those who have the gifts and the devotion to work with such people have scant means to do so, and the terrible, wasteful, lonely suffering goes on and on and on.
CHAPTER X
Politics
Politics plays as big a role as science in current descriptions of depression. Who researches depression; what is done about it; who is treated; who is not; who is blamed; who is coddled; what is paid for; what is ignored: all these questions are determined in the sancta of power. Politics also determines fashions in treatment: Should people be placed in institutions? Should they be treated in the community? Should the treatment of the depressed remain in the hands of doctors, or should it be assumed by social workers? What kind of diagnosis is necessary to warrant a government-funded intervention? The vocabulary of depression, which can be enormously empowering to marginal people who have no way to describe or understand their experiences, is endlessly manipulable. Those more advantaged members of a society experience their illness through that vocabulary, which is nonconspiratorially spun by Congress, by the American Medical Association, and by the pharmaceutical industry.
Definitions of depression strongly influence the policy decisions that in turn affect the sufferers. If depression is a “simple organic disease,” then it must be treated as we treat other simple organic diseases—insurance companies must provide coverage for severe depression as they provide coverage for cancer treatment. If depression is rooted in character, then it is the fault of those who suffer from it and receives no more protection than does stupidity. If it can afflict anyone at any time, then prevention needs to be taken into consideration; if it is something that will hit only poor, uneducated, or politically underrepresented people, the emphasis on prevention is in our inequable society much lower. If depressed people injure others, their condition must be controlled for the good of society; if they simply stay home or disappear, their invisibility makes them easy to ignore.
U.S. government policy on depression has changed in the last decade and continues to do so; substantial shifts have occurred in many other countries as well. Four principal factors influence the perception of depression—and thus implementation of policy relating to it—at the governmental level. The first is medicalization. It is deeply ingrained in the American psyche that we need not treat an illness that someone has brought on himself or has developed through weakness of character, though cirrhosis and lung cancer at least are covered by insurance. A general public perception persists that visiting a psychiatrist is a self-indulgence, that it’s more like visiting a hairdresser than like visiting an oncologist. Treating a mood disorder as a medical illness contravenes this folly, takes away responsibility from the person who has that illness, and makes it easier to “justify” treatment. The second factor to shape perception is vast oversimplification (curiously out of keeping with twenty-five hundred years of not much clarity about what depression is). In particular, the popular suppos
ition that depression is the result of low serotonin the same way that diabetes is the result of low insulin—an idea that has been substantially reinforced by both the pharmaceutical industry and the FDA. The third factor is imaging. If you show a picture of a depressed brain (colorized to indicate rate of metabolism) next to a picture of a normal brain (similarly colorized), the effect is striking: depressed people have grey brains and happy people have Technicolor brains. The difference is both heartrending and scientific-looking, and though it is utterly artificial (the colors reflect imaging techniques rather than actual tints and hues), such a picture is worth ten thousand words and tends to convince people of the need for immediate treatment. The fourth factor is the weak mental health lobby. “Depressed people don’t nag enough,” Representative Lynn Rivers (Democrat, Michigan) says. Attention for particular illnesses is usually the result of the concerted efforts of lobbying groups to raise awareness of those illnesses: the terrific response to HIV/AIDS was spurred by the dramatic tactics of the population that had the illness or was at risk for it. Unfortunately, depressed people tend to find everyday life overwhelming, and they are therefore incompetent lobbyists. Moreover, many of those who have been depressed, even if they are doing better, don’t want to talk about it: depression is a dirty secret, and it’s hard to lobby about your dirty secrets without revealing them. “We get blown away when people come to their representatives to proclaim the severity of a particular illness,” says Representative John Porter (Republican, Illinois), who, as the chair of the Labor, Health and Human Services Appropriations Subcommittee, dominates House discussions of budgets for mental illness. “I have to fight off amendments brought to the floor to reflect someone’s excitement about a story he’s been told, earmarking a particular disease for a particular sum. Members of Congress often try to do that—but seldom for mental illness.” However, several mental health lobbying groups in the United States do champion the cause of the depressed, the most noteworthy being the National Alliance for the Mentally Ill (NAMI) and the National Depressive and Manic-Depressive Association (NDMDA).
The greatest block to progress is still probably social stigma, which clings to depression as it clings to no other disease, and which Steven Hyman, director of the National Institute of Mental Health, has described as a “public health disaster.” Many of the people with whom I spoke while I was writing this book asked me not to use their names, not to reveal their identities. I asked them what exactly they thought would happen if people found out that they’d been depressed. “People would know I am weak,” said one man whose record of fantastic career success despite terrible illness seemed to me to be an indication of terrific strength. People who had “come out of the closet” and spoken publicly about being gay, being alcoholics, being victims of sexually transmitted diseases, in one instance being a child abuser, were still too embarrassed to talk on record about being depressed. It took considerable effort to find the people whose stories feature in this book—not because depression is rare, but because those who will be frank about it with themselves and the outside world are exceptional. “No one would trust me,” said a depressed lawyer who had taken some time off the year before “to make plans about the future.” He had invented an entire history for himself to fill in the months he’d missed and used considerable energy (including some trumped-up holiday pictures) to win credence for his tales. Waiting for the elevator in the large office building where I had just interviewed him, I was accosted by one of the junior staff. My alibi was that I’d had to see a lawyer about a contract, and the young staffer asked me what I did. I said that I was working on this book. “Oh!” he said, and named the man I had just interviewed. “Now there’s a guy,” he volunteered, “who went through a real, total breakdown. Depression, psychosis, you name it. Completely bonkers for a while. He’s actually still kind of weird; he has these bizarre beach photos sitting out in his office and he sort of makes up these stories about himself? In a kind of bananas way? But he’s back at work, and professionally speaking, he’s batting a thousand. You should really meet him and find out about it if you can.” In this instance, the lawyer seemed to enjoy more prestige for his skill in battling depression than stigma for the disease itself; and his dissembling was an unsuccessful dishonesty on a par with a poor hair transplant—a far more ridiculous fact than anything nature could have manufactured. But the secrecy is ubiquitous. After my New Yorker article was published, I had letters signed “From One Who Knows” and “Sincerely, Name Withheld” and “A Teacher.”
I have never in my life worked on a subject that invited so many confidences as this one; people told me the most amazing stories at dinner parties and on trains and anywhere else where I admitted to my subject, but almost all of them said, “But please don’t tell anyone.” One person I’d interviewed called and said that her mother had threatened to stop speaking to her if she let her name be included in this book. The natural state of minds is closed, and deep feelings are usually kept secret. We know people only by what they tell us. None of us can break through the barrier of another’s fathomless silence. “I never mention this,” someone once told me in relation to his struggle, “because I don’t see the use in it.” We are blind to the epidemic proportions of depression because the reality is so seldom uttered; and the reality is so seldom spoken in part because we do not realize how common it is.
I had an extraordinary experience during a house-party weekend in England. I had been asked what I was doing and had dutifully admitted that I was writing a book about depression. After dinner, a rather beautiful woman with long blond hair tied up in a tight coil behind her head approached me in the garden. Gently placing a hand on my arm, she asked whether she might speak to me for a moment, and for the next hour we paced the garden as she told me of her terrible unhappiness and her battles with depression. She was on medication and it was helping somewhat, but she still felt unable to cope with many situations, and she feared that her state of mind would ultimately destroy her marriage. “Please,” she said as we finished our talk, “don’t tell anyone any of this. Especially not my husband. He mustn’t know. He wouldn’t understand it and couldn’t tolerate it.” I gave my word. It was a good weekend of bright sunshine and cozy fires in the evenings, and the group of people, including the woman who had confided in me, kept up a totally delightful banter. On Sunday, after lunch, I went riding with the husband of the depressed woman. Halfway back to the stables, he suddenly turned to me and said awkwardly, “I don’t say this much.” And then he stopped both his sentence and his horse. I thought he was going to ask me something about his wife, with whom he had seen me talking on various occasions. “I don’t think most blokes would really understand.” He coughed. I smiled encouragingly. “It’s depression,” he finally said. “You’re writing about depression, eh?” I answered in the affirmative and waited another moment. “What brought someone like you to that kind of topic?” he asked. I said that I’d had a depression of my own and began my usual explanation, but he cut me off. “You did? You had a depression and now you’re writing about it? Because here’s the thing, and I don’t like to say this much, but it’s the truth. I’ve been having an awful time. Can’t think why. Good life, good marriage, good kids, all that, very close to everyone, but I’ve actually had to go and see a psychiatrist, and he’s put me on these bloody pills. So now I’m feeling a bit more like myself, but you know, am I actually myself? If you see what I mean? I wouldn’t ever tell my wife or my children because they just wouldn’t get it, wouldn’t think me much of a paterfamilias and all that. I’m going to stop taking them soon, but you know, who am I here?” At the end of our little talk, he swore me to secrecy.
I did not tell the man that his wife was on the same medication as he; nor did I tell the wife that her husband would have been able to understand her situation only too well. I didn’t tell either of them that living with secrets is taxing, and that their depression was probably exacerbated by shame. I didn’t say that a marriage in which
basic information is not exchanged is weak. I did, however, tell each of them that depression is often hereditary and that they should look to their children. I commended openness as an obligation to the next generation.
Recent dramatic statements by a broad range of celebrities have certainly helped to destigmatize depression. If Tipper Gore and Mike Wallace and William Styron can all talk about being depressed, then perhaps less visible people too can talk about it. With the publication of this book, I forsake an expedient privacy. I would have to say, however, that talking about my depression has made it easier to bear the illness and easier to forestall its return. I’d recommend coming out about depression. Having secrets is burdensome and exhausting, and deciding exactly when to convey the information you’ve kept in check is really troublesome.
It is also astonishing but true that no matter what you say about your depression, people don’t really believe you unless you seem acutely depressed as they look at and talk to you. I am good at masking my mood states; as a psychiatrist once said to me, I am “painfully over-socialized.” Nonetheless, I was startled when a social acquaintance of mine called me to say that he was going through AA and wanted to make restitution to me for his sometime coldness, which was, he said, the consequence not of snobbery but of a deep jealously of my “perfect-seeming” life. I did not go into my life’s innumerable imperfections, but I did ask him how he could say he envied me my New Yorker article, express interest in the progress of this book, and still think my life seemed perfect. “I know you were depressed at one point,” he said, “but it doesn’t seem to have had any effect on you.” I proposed that it had in fact changed and determined the whole rest of my life, but I could tell my words were not getting through. He had never seen me cowering in bed and he couldn’t make any sense of the image. My privacy was bewilderingly inviolate. An editor from the New Yorker recently told me that I’d never really been depressed. I protested that people who have never been depressed don’t tend to pretend about it, but he was not to be persuaded. “C’mon,” he said. “What the hell do you have to be depressed about?” I was swallowed up by my recovery. My history and my ongoing intermittent episodes seemed quite irrelevant; and that I had publicly stated that I was on antidepressants seemed not to faze him. This is the strange flip side of stigma. “I don’t buy into this whole depression business,” he said to me. It was as though I and the people I wrote about were conspiring to wrest more than our share of sympathy from the world. I’ve run into this paranoia again and again, and it still astonishes me. No one ever told my grandmother that she didn’t really have heart disease. No one says that increasing rates of skin cancer are in the public imagination. But depression is so scary and unpleasant that many people would just as soon deny the disease and repudiate its sufferers.
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