People who have been through a depression and are stabilized often have a heightened awareness of the joyfulness of everyday existence. They have a capacity for a kind of ready ecstasy and for an intense appreciation of all that is good in their life. If they were decent people in the first place, they may well have become remarkably generous. The same might be said of survivors of other illnesses, but even someone who has miraculously emerged from the worst cancer does not have the meta-joy, the joy in being able to experience or give joy, that enriches the lives of those who have been through major depression. This idea is elaborated in Emmy Gut’s book Productive and Unproductive Depression, which proposes that the long pause that a depression forces, and the rumination that goes on during that pause, often cause people to change their lives in useful ways, especially after a loss.
Our norm as human beings is not reality. What does it mean to develop medications and techniques that mitigate depression and that might ultimately affect even sadness? “We can now control physical pain much of the time,” the evolutionary psychologist Randolph Nesse observes, “and how much of the physical pain that we experience do we really need? Maybe five percent? We need the pain that alerts us to injury, but do we really need persisting pain? Ask someone with chronic rheumatoid arthritis or colitis or migraine headaches! So this is only an analogy, but how much of the psychological pain we experience do we really need? More than five percent? What would it mean if you could take a morning-after pill the day after your mother died and be free of the agonizing and unproductive anguish of grief?” The French psychiatrist Julia Kristeva found a deep psychological function for depression. “The sadness that overwhelms us, the retardation that paralyzes us, are also a shield—sometimes the last one—against madness.” Perhaps it is easier to say simply that we rely on our sorrows, more than we know.
The use of antidepressants is going up as people seek to normalize what is newly classed as aberrant, “popularizing and trivializing,” as Martha Manning, who has written eloquently about her extreme depression, points out. More than 60 million prescriptions were written for the SSRIs in 1998—not to mention a substantial number for non-SSRI antidepressants. SSRIs are now prescribed for homesickness, for eating disorders, for PMS, for household pets who scratch too much, for chronic joint pain, and most of all, for mild sadness and ordinary grief. They are prescribed not only by psychiatrists but also by GPs, by OBGYNs; someone I met had been put on Prozac by his podiatrist. When TWA flight 800 went down, families waiting for news of their loved ones were offered antidepressant drugs with the same palliative expression with which they might have been offered extra pillows or blankets. I have no argument with this broad use, but I think it should be done knowingly, deliberately, reflectively.
It has been said that everyone has the virtues of his flaws. If one eliminates the flaws, do the virtues go as well? “We are only at the dawn of pharmacological exuberance,” Randolph Nesse says. “New medications that are being developed may likely make it quick, easy, cheap, and safe to block many unwanted emotions. We should be there within the next generation. And I predict we’ll go for it, because if people can make themselves feel better, they usually do. I could imagine the world in a few decades being a pharmacological utopia; I can equally easily imagine people so mellowed out that they neglect all their social and personal responsibilities.” Robert Klitzman of Columbia University says, “Not since Copernicus have we faced so dramatic a transformation. In centuries to come, there may be new societies that look back at us as creatures that were slaves to and crippled by uncontrolled emotions.” If so, much will be lost; much will doubtless be gained.
When you have been depressed, you lose some of your fear of crisis. I have a million faults, but I am a better person than I was before I went through all this. I needed to have been depressed before I could want to write this book. Some friends tried to discourage me from entering relationships with the people about whom I was writing. I’d like to say that depression made me selfless and that I came to love the poor and the downtrodden, but that is not quite what happened. If you have been through such a thing, you cannot watch it unfold in the life of someone else without feeling horrified. It is easier for me, in many ways, to plunge myself into the sorrow of others than it is for me to watch that sorrow and stay out of it. I hate the feeling of being unable to reach people. Virtue is not necessarily its own reward, but there is a certain peace in loving someone that does not exist in distancing yourself from someone. When I watch the suffering of depressed people, it makes me itch. I think I can help. Not interfering is like watching someone spilling good wine all over the dinner table. It is easier to turn the bottle upright and wipe up the puddle than it is to ignore what is going on.
Depression at its worst is the most horrifying loneliness, and from it I learned the value of intimacy. When my mother was battling cancer, she once said, “Everything people do for me is wonderful, but it is still so awful to be alone in this body that has turned against me.” It is at least as awful to be alone in a mind that has gone against you. What can you do when you see someone else trapped in his mind? You cannot draw a depressed person out of his misery with love (though you can sometimes distract a depressed person). You can, sometimes, manage to join someone in the place where he resides. It is not pleasant to sit still in the darkness of another person’s mind, though it is almost worse to watch the decay of the mind from outside. You can fret from a distance, or you can come close and closer and closest. Sometimes the way to be close is to be silent, or even distant. It is not up to you, from the outside, to decide; it is up to you to discern. Depression is lonely above all else, but it can breed the opposite of loneliness. I love more and am loved more because of my depression, and I can say the same for many of the people I saw for this book. So many people have asked me what to do for depressed friends and relatives, and my answer is actually simple: blunt their isolation. Do it with cups of tea or with long talks or by sitting in a room nearby and staying silent or in whatever way suits the circumstances, but do that. And do it willingly.
Maggie Robbins, who has had such struggles with manic-depressive illness, said, “I used to get nervous a lot and I would just talk and talk. And then I started volunteering at an AIDS residence. They had teas there, and I was supposed to help get the tea and cake and juice for the patients, and to sit with them and chat, because many of them didn’t have people to visit them and were lonely. I remember one day early on I sat down with some people and tried to kick off a conversation by asking them what they’d done for their Fourth of July. They told me, but they just weren’t keeping up their end of the conversation at all. I thought, this is not very friendly or helpful of them. And then it hit me: these guys aren’t going to make small talk. In fact, after those first, brief answers, they weren’t going to talk at all. But they didn’t want me to leave. So I decided, I’m here with them and I’m going to be with them. It’s simply going to be an occasion where I’m a person who doesn’t have AIDS and doesn’t look really sick and isn’t dying, but who can tolerate the fact that they do and they are. And so I just stayed with them that afternoon, without talking. The loving is that you are there, simply paying attention, unconditionally. If suffering is what the person is doing right then, that’s what they’re doing. You’re being with that—not trying like crazy to do something about it. I’ve learned how to do that.”
The survivors stay on pills, waiting. Some are in psychodynamic therapy. Some are receiving ECT, or having surgery. We go on. You cannot choose whether you get depressed and you cannot choose when or how you get better, but you can choose what to do with the depression, especially when you come out of it. Some people come out for a short time and know they are going to keep going back in. But when they are out, they try to use their experience of depression to make their life richer and better. For others, depression is just a total misery; they never get anything out of it at all. People who are depressed may do well to seek ways that the experience, aft
er the fact, can lead to wisdom. In Daniel Deronda, George Eliot describes the moment when depression turns, the miraculous sensation of it. Mirah has been ready to kill herself and has let herself be saved by Daniel. She says, “But then in the last moment—yesterday, when I longed for the water to close over me—and I thought that death was the best image of mercy—then goodness came to me living, and I felt trust in the living.” Goodness does not come living to those whose lives are utterly placid.
When I had the third breakdown, the mini-breakdown, I was in the late stages of writing this book. Since I could not cope with communication of any kind during that period, I put an auto-response message on my E-mail that said I was temporarily unreachable, and a similar message on my answering machine. Acquaintances who had suffered depression knew what to make of these outgoing messages. They wasted no time. I had dozens and dozens of calls from people offering whatever they could offer and doing it glowingly. “I will come to stay the minute you call,” wrote Laura Anderson, who also sent a wild profusion of orchids, “and I’ll stay as long as it takes you to get better. If you’d prefer, you are of course always welcome here; if you need to move in for a year, I’ll be here for you. I hope you know that I will always be here for you.” Claudia Weaver wrote with questions: “Is it better for you to have someone check in with you every day or are the messages too much of a burden? If they are a burden, you needn’t answer this one, but whatever you need—just call me, anytime, day or night.” Angel Starkey called often from the pay phone at her hospital to see if I was okay. “I don’t know what you need,” she said, “but I’m worrying about you all the time. Please take care of yourself. Come and see me if you’re feeling really bad, anytime. I’d really like to see you. If you need anything, I’ll try to get it for you. Promise me you won’t hurt yourself.” Frank Rusakoff wrote me a remarkable letter and reminded me about the precious quality of hope. “I long for news that you are well and off on another adventure,” he wrote, and signed the letter, “Your friend, Frank.” I had felt committed in many ways to all these people, but the spontaneous outpouring astounded me. Tina Sonego said she’d call in sick for work if I needed her—or that she’d buy me a ticket and take me to someplace relaxing. “I’m a good cook too,” she told me. Janet Benshoof dropped by the house with daffodils and optimistic lines from favorite poems written in her clear hand and a bag so she could come sleep on my sofa, just so I wouldn’t be alone. It was an astonishing responsiveness.
Even in the most desperate plea of the depressive—“Why?” or “Why me?”—lie the seeds of self-examination, a process that is usually fruitful. Emily Dickinson speaks of “that White Sustenance—Despair,” and depression can indeed justify and support a life. The unexamined life is unavailable to the depressed. That is, perhaps, the greatest revelation I have had: not that depression is compelling but that the people who suffer from it may become compelling because of it. I hope that this basic fact will offer sustenance to those who suffer and will inspire patience and love in those who witness that suffering. Like Angel, I have a mission to bring the cure of self-regard to those who do not have it. I hope that they will perhaps learn not only hope, but also some love of themselves from the stories in this book.
There is great value in specific kinds of adversity. None of us would choose to learn this way: difficulty is unpleasant. I crave the easy life and would make and have made considerable compromises in my quest for it. But I have found that there are things to be made of this lot I have in life, that there are values to be found in it, at least when one is not in its most acute grip.
John Milton spoke in Areopagitica of the impossibility of appreciating good without knowing evil. “That virtue therefore which is but a youngling in the contemplation of evil, and knows not the utmost that vice promises to her followers, and rejects it, is but a blank virtue, not a pure; her whiteness is but an excremental whiteness.” So the greatest knowledge of sorrow becomes the basis for a full appreciation of joy; so it intensifies that joy itself. Thirty years later, it was a wiser Milton who wrote in Paradise Lost of the wisdom that came to Adam and Eve after the fall when they learned the full spectrum of humanity:
. . . since our eyes
Opened we find indeed, and find we know
Both good and evil, good lost and evil got,
Bad fruit of knowledge.
There is some knowledge that, for all that it teaches, it would be better not to gain. Depression not only teaches a great deal about joy, but also obliterates joy. It is the bad fruit of knowledge, a knowledge I would prefer never to have contracted. Once one is given knowledge, however, one can seek redemption. Adam and Eve found:
Strength added from above, new hope to spring
Out of despair, joy.
And armed with this new, other human kind of joy, they set out to lead their short, sweet lives:
They looking back, all th’Eastern side beheld
Of Paradise, so late thir happy seat
. . . . . . . . . . . .
Some natural tears they dropp’d, but wip’d them soon;
The World was all before them, where to choose
Thir place of rest, and Providence their guide:
They hand in hand with wand’ring steps and slow,
Through Eden took thir solitary way.
So lies the world before us, and with just such steps we tread a solitary way, survivors as we must be of an impoverishing, invaluable knowledge. We go forward with courage and with too much wisdom but determined to find what is beautiful. It is Dostoyevsky who said, “Beauty, though, will save the world.” That moment of return from the realm of sad belief is always miraculous and can be stupefyingly beautiful. It is nearly worth the voyage out into despair. None of us would have chosen depression out of heaven’s grab bag of qualities, but having been given it, those of us who have survived stand to find something in it. It is who we are. Heidegger believed that anguish was the origin of thought; Schelling thought that it was the essence of human freedom. Julia Kristeva bows before it: “I owe a supreme, metaphysical lucidity to my depression. . . . Refinement in sorrow or mourning are the imprint of a humankind that is surely not triumphant but subtle, ready to fight, and creative.”
I take my mental temperature often. I have changed my sleeping habits. I give up on things more readily. I am more tolerant of other people. I am more determined not to waste the happy time I can find. A thinner and finer thing has happened to my self; it won’t take the kind of punching that it used to take, and little windows go right through it, but there are also passages that are fine and delicate and luminous as egg. To regret my depression now would be to regret the most fundamental part of myself. I take umbrage too easily and too frequently, and I impose my vulnerabilities on others far too readily, but I think I am also more generous to other people than I used to be.
“The house gets messy,” one woman who has battled depression for a lifetime told me, “and I can’t read. When’s it going to come back? When’s it going to hit me again? Only my children keep me alive. I’m stabilized right now, but it never leaves you. You can never forget it, no matter how happy you are in a particular moment.”
“I’m reconciled to a lifetime of medicine,” says Martha Manning, suddenly fervent in a conversation. “And I’m thankful. I’m thankful for it. Sometimes I look at those pills and wonder, is this all that stands between torment and me? When I was little, I can remember, I wasn’t unhappy, but I couldn’t help thinking, I have to live my whole life, maybe eighty years of this or something. It seemed like such a burden. I wanted to have another child recently, but after two miscarriages, I realized I just couldn’t bear the stress. I’ve cut back on my social life. You don’t defeat depression. You learn to manage it and you make compromises with it. You try to stay in remission. You’ve got to have so much resolve, spend so much time not giving in. When you come so close to taking your life, if you get it back, you’d better claim it, you know?”
Striving to claim it
, we hold on to the idea of productive depression, something vital. “If I had it to do over, I wouldn’t do it this way,” said Frank Rusakoff a few months after his brain had been lesioned to effect his cure. I had spent the afternoon with him and his parents and his psychiatrist, and they were discussing the grim reality: that his cingulotomy hadn’t yet worked, and that he might have to have a second surgery. In his gently courageous way, however, he was making plans to be back up and running in six months. “But I think I have gained a lot and grown a lot because of it. I’ve become a lot closer to my parents, to my brother, to friends. I have this experience with my doctor that’s been very good.” The hard-won equanimity rang movingly true. “There really are up sides to depression; it’s just hard to see them when you’re in it.” Later, after the surgery had worked, he wrote, “I said I would do it differently if I had it to do over again. And I guess I would. But, now that I feel like the worst is over, I’m grateful for having been where I’ve been. I do believe I am better off having been to the hospital thirty times and having had brain surgery. I’ve met a lot of good people along the way.”
“I lost a great innocence when I understood that I and my mind were not going to be on good terms for the rest of my life,” says Kay Jamison with a shrug. “I can’t tell you how tired I am of character-building experiences. But I treasure this part of me; whoever loves me loves me with this in it.”
“My wife, to whom I’ve been married just a few years, has never seen me depressed,” says Robert Boorstin. “She hasn’t. And I’ve walked her through it, and I’ve let other people talk to her about what it’s like. I’ve done my best to prepare her, because doubtless I’ll have another depression. Sometime, in the next forty years, I’m going to be crawling across the room again. And it scares me a lot. If somebody said to me, ‘I’ll take away your mental illness if you’ll cut me off your leg’—I don’t know what I would do. And yet, before I was ill, I was intolerant beyond comparison, arrogant beyond belief, with no understanding of frailty. I’m a better person as a result of having been through all this.”
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