Before I left, one of the attendants said, “You optimistic?” and I shook my head. “Me neither,” he said. “I was for a while, because she isn’t acting crazy like most of ’em. I was wrong. She’s pretty well in touch with reality at the moment, and she’s still so sick.”
Angel said to me, “They got me out of the worst once, so I guess they’ll do it again.”
Within six months, this storm had cleared and she was free again, back in the nice apartment. She was full of good cheer. She finally had a job—bagging groceries—and she was so proud. At the Chinese restaurant, they seemed glad to see us. We avoided words such as always and never when we chatted.
Why, people kept asking me, why are you writing a book about depression? It seemed to them incomprehensible that I would submerge myself in this unpleasant topic, and I must say that as I set about my research, it often seemed to me that I had been foolish in my choice. I came up with a number of replies that seemed to meet the occasion. I said that I thought I had things to say that hadn’t been said. I said that writing is an act of social responsibility, that I wanted to help people to appreciate depression and to understand how best to care for those who suffer from it. I admitted that I had been offered a generous book advance and that I thought the topic might engage the public imagination, and that I wanted to be famous and beloved. But not until I had written about three-quarters of the book did my purpose fully reveal itself to me.
I did not anticipate the intense, shattering vulnerability of depressed people. Nor did I realize in what complicated ways that particular vulnerability interacts with personality. While I was working on this book, a close friend got engaged to a man who used his depression as an excuse for riotous emotional self-indulgence. He was sexually rejecting and cold; he demanded that she provide food and cash for him and run his personal life because it was too painful for him to take responsibility; he brooded for hours while she tenderly reassured him—but he could not remember any of the details of her life or talk to her about herself. For a long time, I encouraged her to put up with it, thinking it would clear with the illness, not recognizing that no cure on earth could transform him into a person of character. Later, another female friend of mine reported being physically attacked by her husband, who beat her head on the floor. He had been acting strangely for weeks—had responded in paranoiac ways to ordinary phone calls, and had been spiteful to the dogs. After his vicious physical attack, she called the police, terrified; he went into a mental hospital. It is true that he had some kind of schizo-affective disorder, but he is still culpable. Psychiatric illness often reveals the dreadful side of someone. It doesn’t really make a whole new person. Sometimes the dreadful side is pathetic and needy and hungry, qualities that are sad but touching; sometimes the dreadful side is brutal and cruel. Illness brings to light the painful realities most people shroud in perfect darkness. Depression exaggerates character. In the long run, I think, it makes good people better; it makes bad people worse. It can destroy one’s sense of proportion and give one paranoid fantasies and a false sense of helplessness; but it is also a window onto truth.
The fiancé of the first friend and the husband of the second have little place in this book. In and out of my research, I met plenty of depressed people for whom I had negative feeling or no particular feeling, and by and large I decided not to write about them. I have chosen to write about people I admire. The people in this book are mostly strong or bright or tough or in some other way distinctive. I do not believe that there is such a thing as an average person, or that by telling a prototypical reality one can convey overarching truth. The quest for the nonindividual, generic human being is the blight of popular psychology books. By seeing how many kinds of resilience and strength and imagination are to be found, one can appreciate not only the horror of depression but also the complexity of human vitality. I had one conversation with a severely depressed older man who told me that “depressed people have no stories; we have nothing to say.” All of us have stories, and the true survivors have compelling stories. In real life, mood has to exist amid the clutter of toasters and atom bombs and fields of gazing grain. This book exists as a more protected environment for the stories of remarkable people and their successes—stories that I believe can help others as they helped me.
Some people suffer mild depression and are totally disabled by it; others suffer severe depression and make something of their lives anyway. “Some people can function through anything,” says David McDowell, who works on substance abuse at Columbia. “That doesn’t mean they’re having less pain.” The absolute measurements are difficult. “Unfortunately,” Deborah Christie, a child psychologist at University College London, observes, “there’s no such thing as a suicide-ometer or a pain-ometer or a sad-ometer. We can’t measure in objective terms how sick people are or what their symptoms are. You can only listen to what people say and accept that that’s how it feels to them.” There is an interaction between illness and personality; some people can tolerate symptoms that would destroy others; some people can tolerate hardly anything. Some people seem to give in to their depression; others seem to battle it. Since depression is highly demotivating, it takes a certain survivor impulse to keep going through the depression, not to cave in to it. A sense of humor is the best indicator that you will recover; it is often the best indicator that people will love you. Sustain that and you have hope.
Of course it can be hard to sustain a sense of humor during an experience that is really not so funny. It is urgently necessary to do so. The most important thing to remember during a depression is this: you do not get the time back. It is not tacked on at the end of your life to make up for the disaster years. Whatever time is eaten by a depression is gone forever. The minutes that are ticking by as you experience the illness are minutes you will not know again. No matter how bad you feel, you have to do everything you can to keep living, even if all you can do for the moment is to breathe. Wait it out and occupy the time of waiting as fully as you possibly can. That’s my big piece of advice to depressed people. Hold on to time; don’t wish your life away. Even the minutes when you feel you are going to explode are minutes of your life, and you will never get those minutes again.
We believe in the chemistry of depression with a stunning fanaticism. In trying to tease out depression from the person who is depressed, we throw ourselves into the age-old debate about the boundary between the essential and the manufactured. In trying to separate the depression from the person and the treatment from the person, we deconstruct the person into nothingness. “Human life,” writes Thomas Nagel in The Possibility of Altruism, “consists not primarily in the passive reception of stimuli, pleasant or unpleasant, satisfying or dissatisfying; it consists to a significant degree in activities and pursuits. A person must live his own life; others are not in a position to live it for him, nor is he in a position to live theirs.” What is natural, or authentic? One would do better to seek the philosopher’s stone or the fountain of youth than to seek the true chemistry of emotion, morality, pain, belief, and righteousness.
This is not a new problem. In Shakespeare’s late play The Winter’s Tale, Perdita and Polixenes debate the limits of the real and the artificial—the authentic and the created—in a garden. Perdita questions the grafting of plants as “an art which . . . shares / With great creating Nature.” Polixenes replies:
Yet Nature is made better by no mean
But Nature makes that mean. So, over that art
Which you say adds to Nature, is an art
That Nature makes. You see, sweet maid. . . . This is an art
Which does mend Nature—change it rather, but
The art itself is Nature.
I am so glad that we have figured out all our ways to impose art on nature: that we have thought to cook our food and to combine ingredients from five continents on a single plate; that we have bred our modern breeds of dogs and horses; that we have forged metal from its ore; that we have crossed wild fruits to
make peaches and apples as we know them today. I am glad too that we have figured out how to make central heating and indoor plumbing, how to build great buildings, ships, airplanes. I am thrilled by means of rapid communication; I’m embarrassingly reliant on the telephone and fax and E-mail. I am glad that we have invented technologies to preserve our teeth from decay, to keep our bodies from certain illnesses, to purchase old age for so large a part of our population. I do not deny that there have been adverse consequences of all this art, up to and including pollution and global warming; overpopulation; war and weapons of mass destruction. But on balance, our art has led us forward, and as we have adjusted to each new development, it has come to seem quite commonplace. We have forgotten that the many-petaled roses we love so much were once an ignominious challenge to nature, which had produced no such flower in the woods of the world until horticulturists meddled. Was it nature or art when the beaver first built his dam, or when monkeys with opposable thumbs peeled bananas? Does the fact that God made grapes that ferment into an intoxicant make drunkenness somehow a natural state? Are we no longer ourselves when we are drunk? When we are hungry, or overfed? Then who are we?
If grafting was the epitome of the seventeenth century’s assault on nature, antidepressants and the genetic manipulation that will become ever more possible are the epitome of the twenty-first century’s assault on nature. The selfsame principles articulated four hundred years ago apply to our newer technologies, which seem similarly to revise the natural order of things. If humanity is of nature, then so are our inventions. Whatever original life force made the first amoebas also made a human brain that could be affected by chemicals and made human beings who could ultimately figure out what chemicals to synthesize and to what effect. When we mend nature, or change it, we do so with techniques that are available to us through our particular combination of ideas from the natural world. Who is the real me? The real me is a person who lives in a world in which all kinds of manipulations are possible, and who has accepted certain of these manipulations. That is who I am. The ailing me is not a more or less authentic self; the therapized me is not a more or less authentic self.
Being good is a constant struggle. Perhaps my friend’s fiancé had no choice but to behave like a jerk; perhaps he had moral turpitude hardwired in his brain. Perhaps the husband of my other friend was born cruel. I don’t think it’s quite so simple. I think that all of us have from nature a thing called will; I reject the notion of chemical predestination, and I reject the moral loophole it creates. There is a unity that includes who we are and how we strive to be good people and how we go to pieces and how we put ourselves back together again. It includes taking medication and getting electroshock and falling in love and worshiping gods and sciences. Angel Starkey, with a steely optimism, went out to give presentations in public on life in Norristown Hospital. With infinite blighted tenderness, she spent untold hours trying to teach her roommate how to peel a cucumber. She took the time to write down her thoughts for me so that she could help me with this book. She scrubs her mother’s house from top to bottom. The depression affects her functioning, but not her character.
One would like to demarcate clearly the boundaries of the self. In fact, no essential self lies pure as a vein of gold under the chaos of experience and chemistry. The human organism is a sequence of selves that succumb to or choose one another. We are each the sum of certain choices and circumstances; the self exists in the narrow space where the world and our choices come together. I think of my father, or of the friends who came to stay with me through my third depression. Would it be possible to go into a doctor’s office and have treatments and emerge capable of such generosity and love? Generosity and love demand great expenditure of energy and effort and will. Do we imagine that someday these qualities will be available for free, that we will be getting injections of character, to make each of us effortlessly into so many Gandhis and Mother Teresas? Do the remarkable people have a right to their own splendor or is splendor too just a random chemical construction?
I read the science sections of newspapers hopefully. Antidepressants will give way to other magical potions. It is no longer inconceivable that we will map brain chemistry and be able to give someone a treatment that will cause him to fall madly in love with an appointed other under appointed circumstances. It is not so long until you will be able to choose between getting a talking cure for a bad marriage and having your infatuation renewed through the intervention of a pharmacologist. What will it be like if we unlock the secrets of aging and the secrets of all our failings and breed a race of gods instead of men, of beings who live forever free from malice and anger and jealousy, who act with moral fervor and practice passionate commitment to the ideal of universal peace? Perhaps all of this will happen, but in my experience, all the medicine in the world can provide no more than a way for you to reinvent yourself. The medicine will not reinvent you. We can never escape from choice itself. One’s self lies in the choosing, every choice, every day. I am the one who chooses to take my medication twice a day. I am the one who chooses to talk to my father. I am the one who chooses to call my brother, and the one who chooses to own a dog, and the one who chooses to get out of bed (or not) when the alarm goes off, and the one who is also sometimes cruel and sometimes self-involved and often forgetful. There is a chemistry behind my writing of this book, and perhaps if I could master that chemistry, I could harness it to write another book, but that too would be a choice. Thinking seems to me less persuasive evidence of being than does choosing. Not in our chemistry and not in circumstance does our humanity lie, but in our will to work with the technologies available to us through the era in which we live, through our own character, through our circumstances and age.
Sometimes I wish I could see my brain. I’d like to know what marks have been carved in it. I imagine it grey, damp, elaborate. I think of it sitting in my head, and sometimes I feel as if there’s me, who is living life, and this strange thing stuck in my head that sometimes works and sometimes doesn’t. It’s very odd. This is me. This is my brain. This is the pain that lives in my brain. Look here and you can see where the pain scratched this thing, what places are knotty and lumped up, which places are glowing.
It is arguably the case that depressed people have a more accurate view of the world around them than do nondepressed people. Those who perceive themselves to be not much liked are probably closer to the mark than those who believe that they enjoy universal love. A depressive may have better judgment than a healthy person. Studies have shown that depressed and nondepressed people are equally good at answering abstract questions. When asked, however, about their control over an event, nondepressed people invariably believe themselves to have more control than they really have, and depressed people give an accurate assessment. In a study done with a video game, depressed people who played for half an hour knew just how many little monsters they had killed; the undepressed people guessed four to six times more than they had actually hit. Freud observed that the melancholic has “a keener eye for the truth than others who are not melancholic.” Perfectly accurate understanding of the world and the self was not an evolutionary priority; it did not serve the purpose of species preservation. Too optimistic a view results in foolish risk-taking, but moderate optimism is a strong selective advantage. “Normal human thought and perception,” wrote Shelley E. Taylor in her recent, startling Positive Illusions, “is marked not by accuracy but positive self-enhancing illusions about the self, the world, and the future. Moreover, these illusions appear actually to be adaptive, promoting rather than undermining mental health. . . . The mildly depressed appear to have more accurate views of themselves, the world, and the future than do normal people . . . [they] clearly lack the illusions that in normal people promote mental health and buffer them against setbacks.”
The fact of the matter is that existentialism is as true as depressiveness. Life is futile. We cannot know why we are here. Love is always imperfect. The isolation of bodily indi
viduality can never be broached. No matter what you do on this earth, you will die. It is a selective advantage to be able to tolerate these realities, to look to other things, and to go on—to strive, to seek, to find, and not to yield. I watch footage of Tutsis in Rwanda or of starving hordes in Bangladesh: people who have, in many instances, lost all family and everyone they ever knew, who have no financial prospects of any kind, who are unable to find food, and who suffer from painful ailments. They are people for whom there is almost no prospect of improvement. And yet they go on living! Theirs is either a vital blindness that makes them keep up the battle of existence or a vision that is beyond me. Depressives have seen the world too clearly, have lost the selective advantage of blindness.
Major depression is far too stern a teacher: you needn’t go to the Sahara to avoid frostbite. Most of the psychological pain in the world is unnecessary; and certainly people with major depression experience pain that would be better kept in check. I believe, however, that there is an answer to the question of whether we want total control over our emotional states, a perfect emotional painkiller that would make sorrow as unnecessary as a headache. To put an end to grief would be to license monstrous behavior: if we never regretted the consequences of our actions, we would soon destroy one another and the world. Depression is a misfiring of the brain, and if your cortisol is out of control you should get it back in order. But don’t get carried away. To give up the essential conflict between what we feel like doing and what we do, to end the dark moods that reflect that conflict and its difficulties—this is to give up what it is to be human, of what is good in being human. There are probably people who don’t have enough anxiety and sadness to keep them out of trouble, and it seems likely that they don’t do well. They are too cheerful, too fearless, and they are not kind. What need have such souls of kindness?
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