The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.
The most honest authorities face up squarely to the fact that serious depression is not readily treatable. Failure of alleviation is one of the most distressing factors of the disorder as it reveals itself to the victim, and one that helps situate it squarely in the category of grave diseases.
One by one, the normal brain circuits begin to drown, causing some of the functions of the body and nearly all of those of instinct and intellect to slowly disconnect.
Inadvertently I had helped unlock a closet from which many souls were eager to come out. It is possible to emerge from even the deepest abyss of despair and “once again behold the stars.”
Nearly 30 years ago, the author William Styron outed himself as mentally ill. “My days were pervaded by a gray drizzle of unrelenting horror,” he wrote in a New York Times op-ed article, describing the deep depression that had landed him in the psych ward. He compared the agony of mental illness to that of a heart attack. Pain is pain, Whether it’s in the mind or the body. So why, he asked, were depressed people treated as pariahs?
A confession of mental illness might not seem like a big deal now, but it was back then. In the 1980s, “if you were depressed, it was a terrible dark secret that you hid from the world,” according to Andrew Solomon, a historian of mental illness and author of “The Noonday Demon.” “People with depression were seen as pathetic and even dangerous. You didn’t let them near your kids.”
From William Styron’s Op-Ed on Depression. “In the popular mind, suicide is usually the work of a coward or sometimes, paradoxically, a deed of great courage, but it is neither; the torment that precipitates the act makes it often one of blind necessity.”
The response to Mr. Styron’s op-ed was immediate. Letters flooded into The New York Times. The readers thanked him, blurted out their stories and begged him for more. “Inadvertently I had helped unlock a closet from which many souls were eager to come out,” Mr. Styron wrote later.
“It was like the #MeToo movement,” Alexandra Styron, the author’s daughter, told me. “Somebody comes out and says: ‘This happened. This is real. This is what it feels like.’ And it just unleashed the floodgates.”
Readers were electrified by Mr. Styron’s confession in part because he inhabited a storybook world of glamour. After his novel “Sophie’s Choice” was adapted into a blockbuster movie in 1982, Mr. Styron rocketed from mere literary success to Hollywood fame. Meryl Streep, who won an Oscar for playing Sophie, became a lifelong friend, adding to Mr. Styron’s roster of illustrious buddies, from “Jimmy” Baldwin to Arthur Miller. He appeared at gala events with his silver hair upswept in a genius-y pompadour and his face ruddy from summers on Martha’s Vineyard. And yet he had been so depressed that he had eyed the knives in his kitchen with suicide-lust.
James L.W. West, Mr. Styron’s friend and biographer, told me that Mr. Styron had never wanted to become “the guru of depression.” But after his article, he felt he had a duty to take on that role.
His famous memoir of depression, “Darkness Visible,” came out in October 1990. It was Mr. Styron’s curiosity about his own mind, and his determination to use himself as a case study to understand a mysterious disease, that gave the book its political power. “Darkness Visible” demonstrated that patients could be the owners and describers of their mental disorders, upending centuries of medical tradition in which the mentally ill were discredited and shamed. The brain scientist Alice Flaherty, who was Mr. Styron’s close friend and doctor, has called him “the great god of depression” because his influence on her field was so profound. His book became required reading in some medical schools, where physicians were finally being trained to listen to their patients.
Mr. Styron also helped to popularize a new way of looking at the brain. In his telling, suicidal depression is a physical ailment, as unconnected to the patient’s moral character as cancer. The book includes a cursory discussion of the chemistry of the brain neurotransmitters, serotonin and so forth. For many readers, it was a first introduction to scientific ideas that are now widely accepted.
For people with severe mood disorders, “Darkness Visible” became a guidebook. “I got depressed and everyone said to me: ‘You have to read the Bill Styron book. You have to read the Bill Styron book. Have you read the Bill Styron book? Let me give you a copy of the Bill Styron book,”’ Mr. Solomon told me. “On the one hand an absolutely harrowing read, and on the other hand one very much rooted in hope.”
The book benefited from perfect timing. It appeared contemporaneously with the introduction of Prozac and other mood disorder medications with fewer side effects than older psychiatric drugs. Relentlessly advertised on TV and in magazines, they seemed to promise protection. And though Mr. Styron himself probably did not take Prozac and was rather skeptical about drugs, his book became the bible of that era.
He also inspired dozens of writers including Mr. Solomon and Dr. Flaherty to chronicle their own struggles. In the 1990s, bookstores were crowded with mental-illness memoirs, Kay Redfield Jamison’s “An Unquiet Mind,” Susanna Kaysen’s “Girl, Interrupted” and Elizabeth Wurtzel’s “Prozac Nation,” to name a few. You read; you wrote; you survived.
It was an optimistic time. In 1999, with “Darkness Visible” in its 25th printing, Mr. Styron told Diane Rehm in an NPR interview: “I’m in very good shape, if I may be so bold as to say that.” He continued, “It’s as if I had purged myself of this pack of demons.”
It wouldn’t last. In the summer of 2000, he crashed again. In the last six years of his life, he would check into mental hospitals and endure two rounds of electroshock therapy.
Mr. Styron’s story mirrors the larger trends in American mental health over the past few decades. During the exuberance of the 1990s, it seemed possible that drugs would one day wipe out depression, making suicide a rare occurrence. But that turned out to be an illusion. In fact, the American suicide rate has continued to climb since the beginning of the 21st century.
We don’t know why this is happening, though we do have a few clues. Easy access to guns is probably contributing to the epidemic: Studies show that when people are able to reach for a firearm, a momentary urge to self-destruct is more likely to turn fatal. Oddly enough, climate change may also be to blame: A new study shows that rising temperatures can make people more prone to suicide.
With suicidal depression so widespread, we find ourselves needing new ways to talk about it, name its depredations and help families cope with it. Mr. Styron’s mission was to invent this new language of survival, but he did so at high cost to his own mental health.
When he revealed his history of depression, he inadvertently set a trap for himself. He became an icon of recovery. His widow, Rose Styron, told me that readers would call the house at all hours when they felt suicidal, and Mr. Styron would counsel them. He always took those calls, even when they woke him at 3 in the morning.
When he plunged into depression again in 2000, Mr. Styron worried about disappointing his fans. “When he crashed, he felt so guilty because he thought he’d let down all the people he had encouraged in ‘Darkness Visible,’” Ms. Styron told me. And he became painfully aware that if he ever did commit suicide, that private act would ripple out all over the world. The consequences would be devastating for his readers, some of whom might even decide to imitate him.
And so, one dark day in the summer of 2000, he wrote up a statement to be released in the event of his suicide. “I hope that readers of ‘Darkness Visible’ past, present and future will not be discouraged by the manner of my dying,” his message began. It was an attempt to inoculate his fans from the downstream effects of his own selfdestruction.
Mr. Styron’s family described this sense of his that succumbing to depression a second time made him a fraud.
A MEMOIR of MADNESS
For the thing which I greatly feared is come upon me, and that which I was afraid of Is come unto me. I was not in safety, neither had I rest, neither was I quiet; yet trouble came. -Job
IN PARIS ON A CHILLY EVENING LATE IN OCTOBER OF 1985 I first became fully aware that the struggle with the disorder in my mind, a struggle which had engaged me for several months, might have a fatal outcome. The moment of revelation came as the car in which I was riding moved down a rain slick street not far from the Champs Elysées and slid past a dully glowing neon sign that read HOTEL WASHINGTON. I had not seen that hotel in nearly thirty-five years, since the spring of 1952, when for several nights it had become my initial Parisian roosting place.
In the first few months of my Wanderjahr, I had come down to Paris by train from Copenhagen, and landed at the Hotel Washington through the whimsical determination of a New York travel agent. In those days the hotel was one of the many damp, plain hostelries made for tourists, chiefly American, of very modest means who, if they were like me, colliding nervously for the first time with the French and their droll kinks, would always remember how the exotic bidet, positioned solidly in the drab bedroom, along with the toilet far down the ill-lit hallway, virtually defined the chasm between Gallic and Anglo-Saxon cultures.
But I stayed at the Washington for only a short time. Within days I had been urged out of the place by some newly found young American friends who got me installed in an even seedier but more colorful hotel in Montparnasse, hard by Le Dome and other suitably literary hangouts. (In my mid-twenties, I had just published a first novel and was a celebrity, though one of very low rank since few of the Americans in Paris had heard of my book, let alone read it.) And over the years the Hotel Washington gradually disappeared from my consciousness.
It reappeared, however, that October night when I passed the gray stone facade in a drizzle, and the recollection of my arrival so many years before started flooding back, causing me to feel that I had come fatally full circle. I recall saying to myself that when I left Paris for New York the next morning it would be a matter of forever. I was shaken by the certainty with which I accepted the idea that I would never see France again, just as I would never recapture a lucidity that was slipping away from me with terrifying speed.
Only days before I had concluded that I was suffering from a serious depressive illness, and was floundering helplessly in my efforts to deal with it. I wasn’t cheered by the festive occasion that had brought me to France. Of the many dreadful manifestations of the disease, both physical and psychological, a sense of self-hatred, or, put less categorically, a failure of self-esteem, is one of the most universally experienced symptoms, and I had suffered more and more from a general feeling of worthlessness as the malady had progressed.
My dank joylessness was therefore all the more ironic because I had flown on a rushed four day trip to Paris in order to accept an award which should have sparklingly restored my ego. Earlier that summer I received word that I had been chosen to receive the Prix Mondial Cino del Duca, given annually to an artist or scientist whose work reflects themes or principles of a certain “humanism.” The prize was established in memory of Cino del Duca, an immigrant from Italy who amassed a fortune just before and after World War II by printing and distributing cheap magazines, principally comic books, though later branching out into publications of quality; he became proprietor of the newspaper Paris-Jour.
He also produced movies and was a prominent racehorse owner, enjoying the pleasure of having many winners in France and abroad. Aiming for nobler cultural satisfactions, he evolved into a renowned philanthropist and along the way established a book publishing firm that began to produce works of literary merit (by chance, my first novel, Lie Down in Darkness, was one of del Duca’s offerings, in a translation entitled Un Lit de Ténébres); by the time of his death in 1967 this house, Editions Mondiales, became an important entity of a multifold empire that was rich yet prestigious enough for there to be scant memory of its comic book origins when del Duca’s widow, Simone, created a foundation whose chief function was the annual bestowal of the eponymous award.
The Prix Mondial Cino del Duca has become greatly respected in France, a nation pleasantly besotted with cultural prize giving, not only for its eclecticism and the distinction shown in the choice of its recipients but for the openhandedness of the prize itself, which that year amounted to approximately $25,000. Among the winners during the past twenty years have been Konrad Lorenz, Alejo Carpentier, Jean Anouilh, Ignazio Silone, Andrei Sakharov, Jorge Luis Borges and one American, Lewis Mumford. (No women as yet, feminists take note.)
As an American, I found it especially hard not to feel honored by inclusion in their company. While the giving and receiving of prizes usually induce from all sources an unhealthy uprising of false modesty, backbiting, selftorture and envy, my own view is that certain awards, though not necessary, can be very nice to receive. The Prix del Duca was to me so straightforwardly nice that any extensive self-examination seemed silly, and so I accepted gratefully, writing in reply that I would honor the reasonable requirement that I be present for the ceremony. At that time I looked forward to a leisurely trip, not a hasty turnaround. Had I been able to foresee my state of mind as the date of the award approached, I would not have accepted at all.
Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self, to the mediating intellect, as to verge close to being beyond description.
It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode, although the gloom, “the blues” which people go through occasionally and associate with the general hassle of everyday existence are of such prevalence that they do give many individuals a hint of the illness in its catastrophic form. But at the time of which I write I had descended far past those familiar, manageable doldrums. In Paris, I am able to see now, I was at a critical stage in the development of the disease, situated at an ominous way station between its unfocused stirrings earlier that summer and the near violent denouement of December, which sent me into the hospital. I will later attempt to describe the evolution of this malady, from its earliest origins to my eventual hospitalization and recovery, but the Paris trip has retained a notable meaning for me.
On the day of the award ceremony, which was to take place at noon and be followed by a formal luncheon, I woke up at midmorning in my room at the Hétel Pont Royal commenting to myself that I felt reasonably sound, and I passed the good word along to my wife, Rose. Aided by the minor tranquilizer Halcion, I had managed to defeat my insomnia and get a few hours’ sleep. Thus I was in fair spirits.
But such wan cheer was an habitual pretense which I knew meant very little, for I was certain to feel ghastly before nightfall. I had come to a point where I was carefully monitoring each phase of my deteriorating condition. My acceptance of the illness followed several months of denial during which, at first, I had ascribed the malaise and restlessness and sudden fits of anxiety to withdrawal from alcohol; I had abruptly abandoned whiskey and all other intoxicants that June.
During the course of my worsening emotional climate I had read a certain amount on the subject of depression, both in books tailored for the layman and in weightier professional works including the psychiatrists’ bible, DSM (The Diagnostic and Statistical Manual of the American Psychiatric Association). Throughout much of my life I have been compelled, perhaps unwisely, to become an autodidact in medicine, and have accumulated a better than average amateur’s knowledge about medical matters (to which many of my friends, surely unwisely, have often deferred), and so it came as an astonishment to me that I was close to a total ignoramus about depression, which can be as serious a medical affair as diabetes or cancer. Most likely, as an incipient depressive, I had always subconsciously rejected or ignored the proper knowledge; it cut too close to the psychic bone, and I shoved it aside as an unwelcome addition to my store of information.
At any rate, during the few hours when the depressive state itself eased off long enough to permit the luxury of concentration, I had recently filled this vacuum with fairly extensive reading and I had absorbed many fascinating and troubling facts, which, however, I could not put to practical use.
The most honest authorities face up squarely to the fact that serious depression is not readily treatable. Unlike, let us say, diabetes, where immediate measures taken to rearrange the body’s adaptation to glucose can dramatically reverse a dangerous process and bring it under control, depression in its major stages possesses no quickly available remedy: failure of alleviation is one of the most distressing factors of the disorder as it reveals itself to the victim, and one that helps situate it squarely in the category of grave diseases.
Except in those maladies strictly designated as malignant or degenerative, we expect some kind of treatment and eventual amelioration, by pills or physical therapy or diet or surgery, with a logical progression from the initial relief of symptoms to final cure. Frighteningly, the layman sufferer from major depression, taking a peek into some of the many books currently on the market, will find much in the way of theory and symptomatology and very little that legitimately suggests the possibility of quick rescue. Those that do claim an easy way out are glib and most likely fraudulent. There are decent popular works which intelligently point the way toward treatment and cure, demonstrating how certain therapies, psychotherapy or pharmacology, or a combination of these, can indeed restore people to health in all but the most persistent and devastating cases; but the wisest books among them underscore the hard truth that serious depressions do not disappear overnight.
All of this emphasizes an essential though difficult reality which I think needs stating at the outset of my own chronicle: the disease of depression remains a great mystery. It has yielded its secrets to science far more reluctantly than many of the other major ills besetting us. The intense and sometimes comically strident factionalism that exists in present day psychiatry, the schism between the believers in psychotherapy and the adherents of pharmacology, resembles the medical quarrels of the eighteenth century (to bleed or not to bleed) and almost defines in itself the inexplicable nature of depression and the difficulty of its treatment. As a clinician in the field told me honestly and, I think, with a striking deftness of analogy: “If you compare our knowledge with Columbus’s discovery of America, America is yet unknown; we are still down on that little island in the Bahamas.”
In my reading I had learned, for example, that in at least one interesting respect my own case was atypical. Most people who begin to suffer from the illness are laid low in the morning, with such malefic effect that they are unable to get out of bed. They feel better only as the day wears on. But my situation was just the reverse. While I was able to rise and function almost normally during the earlier part of the day, I began to sense the onset of the symptoms at midafternoon or a little later, gloom crowding in on me, a sense of dread and alienation and, above all, stifling anxiety. I suspect that it is basically a matter of indifference whether one suffers the most in the morning or the evening: if these states of excruciating near paralysis are similar, as they probably are, the question of timing would seem to be academic. But it was no doubt the turnabout of the usual daily onset of symptoms that allowed me that morning in Paris to proceed without mishap, feeling more or less self-possessed, to the gloriously ornate palace on the Right Bank that houses the Fondation Cino del Duca. There, in a rococo salon, I was presented with the award before a small crowd of French cultural figures, and made my speech of acceptance with what I felt was passable aplomb, stating that while I was donating the bulk of my prize money to various organizations fostering French-American goodwill, including the American Hospital in Neuilly, there was a limit to altruism (this spoken jokingly) and so I hoped it would not be taken amiss if I held back a small portion for myself.
What I did not say, and which was no joke, was that the amount I was withholding was to pay for two tickets the next day on the Concorde, so that I might return speedily with Rose to the United States, where just a few days before I had made an appointment to see a psychiatrist. For reasons that I’m sure had to do with a reluctance to accept the reality that my mind was dissolving, I had avoided seeking psychiatric aid during the past weeks, as my distress intensified. But I knew I couldn’t delay the confrontation indefinitely, and when I did finally make contact by telephone with a highly recommended therapist, he encouraged me to make the Paris trip, telling me that he would see me as soon as I returned. I very much needed to get back, and fast.
Despite the evidence that I was in serious difficulty, I wanted to maintain the rosy view. A lot of the literature available concerning depression is, as I say, breezily optimistic, spreading assurances that nearly all depressive states will be stabilized or reversed if only the suitable antidepressant can be found; the reader is of course easily swayed by promises of quick remedy. In Paris, even as I delivered my remarks, I had a need for the day to be over, felt a consuming urgency to fly to America and the office of the doctor, who would whisk my malaise away with his miraculous medications. I recollect that moment clearly now, and am hardly able to believe that I possessed such ingenuous hope, or that I could have been so unaware of the trouble and peril that lay ahead.
Simone del Duca, a large dark-haired woman of queenly manner, was understandably incredulous at first, and then enraged, when after the presentation ceremony I told her that I could not join her at lunch upstairs in the great mansion, along with a dozen or so members of the Académie Frangaise, who had chosen me for the prize. My refusal was both emphatic and simpleminded; I told her point-blank that I had arranged instead to have lunch at a restaurant with my French publisher, Frangoise Gallimard. Of course this decision on my part was outrageous; it had been announced months before to me and everyone else concerned that a luncheon, moreover, a luncheon in my honor, was part of the day’s pageantry. But my behavior was really the result of the illness, which had progressed far enough to produce some of its most famous and sinister hallmarks: confusion, failure of mental focus and lapse of memory. At a later stage my entire mind would be dominated by anarchic disconnections; as I have said, there was now something that resembled bifurcation of mood: lucidity of sorts in the early hours of the day, gathering murk in the afternoon and evening. It must have been during the previous evening’s murky distractedness that I made the luncheon date with Frangoise Gallimard, forgetting my del Duca obligations. That decision continued to completely master my thinking, creating in me such obstinate determination that now I was able to blandly insult the worthy Simone del Duca. “Alors!” she exclaimed to me, and her face flushed angrily as she whirled in a stately volte-face, “au revoir!”
Suddenly I was flabbergasted, stunned with horror at what I had done. I fantasized a table at which sat the hostess and the Académie Frangaise, the guest of honor at La Coupole. I implored Madame’s assistant, a bespectacled woman with a clipboard and an ashen, mortified expression, to try to reinstate me: it was all a terrible mistake, a mixup, a malentendu. And then I blurted some words that a lifetime of general equilibrium, and a smug belief in the impregnability of my psychic health, had prevented me from believing I could ever utter; I was chilled as I heard myself speak them to this perfect stranger.
“I’m sick,” I said, “un probleme psychiatrique.”
Madame del Duca was magnanimous in accepting my apology and the lunch went off without further strain, aIthough I couldn’t completely rid myself of the suspicion, as we chatted somewhat stiffly, that my benefactress was still disturbed by my conduct and thought me a weird number. The lunch was a long one, and when it was over I felt myself entering the afternoon shadows with their encroaching anxiety and dread. A television crew from one of the national channels was waiting (I had forgotten about them, too), ready to take me to the newly opened Picasso Museum, where I was supposed to be filmed looking at the exhibits and exchanging comments with Rose.
This turned out to be, as I knew it would, not a captivating promenade but a demanding struggle, a major ordeal. By the time we arrived at the museum, having dealt with heavy traffic, it was past four o’clock and my brain had begun to endure its familiar siege: panic and dislocation, and a sense that my thought processes were being engulfed by a toxic and unnameable tide that obliterated any enjoyable response to the living world. This is to say more specifically that instead of pleasure, certainly instead of the pleasure I should be having in this sumptuous showcase of bright genius, I was feeling in my mind a sensation close to, but indescribably different from, actual pain.
This leads me to touch again on the elusive nature of such distress. That the word “indescribable” should present itself is not fortuitous, since it has to be emphasized that if the pain were readily describable most of the countless sufferers from this ancient affliction would have been able to confidently depict for their friends and loved ones (even their physicians) some of the actual dimensions of their torment, and perhaps elicit a comprehension that has been generally lacking; such incomprehension has usually been due not to a failure of sympathy but to the basic inability of healthy people to imagine a form of torment so alien to everyday experience.
For myself, the pain is most closely connected to drowning or suffocation, but even these images are off the mark. William James, who battled depression for many years, gave up the search for an adequate portrayal, implying its near-impossibility when he wrote in The Varieties of Religious Experience:
“It is a positive and active anguish, a sort of psychical neuralgia wholly unknown to normal life.”
The pain persisted during my museum tour and reached a crescendo in the next few hours when, back at the hotel, I fell onto the bed and lay gazing at the ceiling, nearly immobilized and in a trance of supreme discomfort. Rational thought was usually absent from my mind at such times, hence trance.
I can think of no more apposite word for this state of being, a condition of helpless stupor in which cognition was replaced by that “positive and active anguish.”
And one of the most unendurable aspects of such an interlude was the inability to sleep. It had been my custom of a near lifetime, like that of vast numbers of people, to settle myself into a soothing nap in the late afternoon, but the disruption of normal sleep patterns is a notoriously devastating feature of depression; to the injurious sleeplessness with which I had been afflicted each night was added the insult of this afternoon insomnia, diminutive by comparison but all the more horrendous because it struck during the hours of the most intense misery. It had become clear that I would never be granted even a few minutes’ relief from my full-time exhaustion. I clearly recall thinking, as I lay there while Rose sat nearby reading, that my afternoons and evenings were becoming almost measurably worse, and that this episode was the worst to date. But I somehow managed to reassemble myself for dinner with, who else? -Francoise Gallimard, co-victim along with Simone del Duca of the frightful lunchtime contretemps.
The night was blustery and raw, with a chill wet wind blowing down the avenues, and when Rose and I met Francoise and her son and a friend at La Lorraine, a glittering brasserie not far from L’Etoile, rain was descending from the heavens in torrents. Someone in the group, sensing my state of mind, apologized for the evil night, but I recall thinking that even if this were one of those warmly scented and passionate evenings for which Paris is celebrated I would respond like the zombie I had become. The weather of depression is unmodulated, its light a brownout.
And zombielike, halfway through the dinner, I lost the del Duca prize check for $25,000. Having tucked the check in the inside breast pocket of my jacket, I let my hand stray idly to that place and realized that it was gone. Did I “intend” to lose the money? Recently I had been deeply bothered that I was not deserving of the prize. I believe in the reality of the accidents we subconsciously perpetrate on ourselves, and so how easy it was for this loss to be not loss but a form of repudiation, offshoot of that seIf-loathing (depression’s premier badge) by which I was persuaded that I could not be worthy of the prize, that I was in fact not worthy of any of the recognition that had come my way in the past few years. Whatever the reason for its disappearance, the check was gone, and its loss dovetailed well with the other failures of the dinner: my failure to have an appetite for the grand plateau de fruits de mer placed before me, failure of even forced laughter and, at last, virtually total failure of speech.
At this point the ferocious inwardness of the pain produced an immense distraction that prevented my articulating words beyond a hoarse murmur; I sensed myself turning walleyed, monosyllabic, and also I sensed my French friends becoming uneasily aware of my predicament. It was a scene from a bad Operetta by now: all of us near the floor, searching for the vanished money. Just as I signaled that it was time to go, Francoise’s son discovered the check, which had somehow slipped out of my pocket and fluttered under an adjoining table, and we went forth into the rainy night. Then, while I was riding in the car, I thought of Albert Camus and Romain Gary.
WHEN I WAS A YOUNG WRITER THERE HAD BEEN A stage where Camus, almost more than any other contemporary literary figure, radically set the tone for my own view of life and history. I read his novel The Stranger somewhat later than I should have, I was in my early thirties, but after finishing it I received the stab of recognition that proceeds from reading the work of a writer who has wedded moral passion to a style of great beauty and whose unblinking vision is capable of frightening the soul to its marrow.
The cosmic loneliness of Meursault, the hero of that novel, so haunted me that when I set out to write The Confessions of Nat Turner I was impelled to use Camus’s device of having the story flow from the point of view of a narrator isolated in his jail cell during the hours before his execution. For me there was a spiritual connection between Meursault’s frigid solitude and the plight of Nat Turner, his rebel predecessor in history by a hundred years, likewise condemned and abandoned by man and God.
Camus’s essay “Reflections on the Guillotine” is a virtually unique document, freighted with terrible and fiery logic; it is difficult to conceive of the most vengeful supporter of the death penalty retaining the same attitude after exposure to scathing truths expressed with such ardor and precision. I know my thinking was forever altered by that work, not only turning me around completely, convincing me of the essential barbarism of capital punishment, but establishing substantial claims on my conscience in regard to matters of responsibility at large. Camus was a great cleanser of my intellect, ridding me of countless sluggish ideas, and through some of the most unsettling pessimism I had ever encountered causing me to be aroused anew by life’s enigmatic promise.
The disappointment I always felt at never meeting Camus was compounded by that failure having been such a near miss. I had planned to see him in 1960, when I was traveling to France and had been told in a letter by the writer Romain Gary that he was going to arrange a dinner in Paris where I would meet Camus. The enormously gifted Gary, whom I knew slightly at the time and who later became a cherished friend, had informed me that Camus, whom he saw frequently, had read my Un Lit de Te’nebres and had admired it; I was of course greatly flattered and felt that a get-together would be a splendid happening. But before I arrived in France there came the appalling news: Camus had been in an automobile crash, and was dead at the cruelly young age of forty-six. I have almost never felt so intensely the loss of someone I didn’t know. I pondered his death endlessly. Although Camus had not been driving he supposedly knew the driver, who was the son of his publisher, to be a speed demon; so there was an element of recklessness in the accident that bore overtones of the near-suicidal, at least of a death flirtation, and it was inevitable that conjectures concerning the event should revert back to the theme of suicide in the writer’s work.
One of the century’s most famous intellectual pronouncements comes at the beginning of The Myth of Sisyphus: “There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.” Reading this for the first time I was puzzled and continued to be throughout much of the essay, since despite the work’s persuasive logic and eloquence there was a lot that eluded me, and I always came back to grapple vainly with the initial hypothesis, unable to deal with the premise that anyone should come close to wishing to kill himself in the first place.
A later short novel, The Fall, I admired with reservations; the guilt and seIf-condemnation of the lawyer-narrator, gloomily spinning out his monologue in an Amsterdam bar, seemed a touch clamorous and excessive, but at the time of my reading I was unable to perceive that the lawyer was behaving very much like a man in the throes of clinical depression. Such was my innocence of the very existence of this disease. Camus, Romain told me, occasionally hinted at his own deep despondency and had spoken of suicide. Sometimes he spoke in jest, but the jest had the quality of sour wine, upsetting Romain. Yet apparently he made no attempts and so perhaps it was not coincidental that, despite its abiding tone of melancholy, a sense of the triumph of life over death is at the core of The Myth of Sisyphus with its austere message: in the absence of hope we must still struggle to survive, and so we doby the skin of our teeth.
It was only after the passing of some years that it seemed credible to me that Camus’s statement about suicide, and his general preoccupation with the subject, might have sprung at least as strongly from some persistent disturbance of mood as from his concerns with ethics and epistemology. Gary again discussed at length his assumptions about Camus’s depression during August of 1978, when I had lent him my guest cottage in Connecticut, and I came down from my summer home on Martha’s Vineyard to pay him a weekend visit. As we talked I felt that some of Romain’s suppositions about the seriousness of Camus’s recurring despair gained weight from the fact that he, too, had begun to suffer from depression, and he freely admitted as much. It was not incapacitating, he insisted, and he had it under control, but he felt it from time to time, this leaden and poisonous mood the color of verdigris, so incongruous in the midst of the lush New England summer. A Russian Jew born in Lithuania, Romain had always seemed possessed of an Eastern European melancholy, so it was hard to tell the difference. Nonetheless, he was hurting. He said that he was able to perceive a flicker of the desperate state of mind which had been described to him by Camus.
Gary’s situation was hardly lightened by the presence of Jean Seberg, his lowa-born actress wife, from whom he had been divorced and, I thought, long estranged. I learned that she was there because their son, Diego, was at a nearby tennis camp. Their presumed estrangement made me surprised to see her living with Romain, surprised too, no, shocked and saddened, by her appearance: all her once fragile and luminous blond beauty had disappeared into a puffy mask. She moved like a Sleepwalker, said little, and had the blank gaze of someone tranquilized (or drugged, or both) nearly to the point of catalepsy. I understood how devoted they still were, and was touched by his solicitude, both tender and paternal. Romain told me that Jean was being treated for the disorder that afflicted him, and mentioned something about antidepressant medications, but none of this registered very strongly, and also meant little.
This memory of my relative indifference is important because such indifference demonstrates powerfully the outsider’s inability to grasp the essence of the illness. Camus’s depression and now Romain Gary’s, and certainly Jean’s, were abstract ailments to me, in spite of my sympathy, and I hadn’t an inkling of its true contours or the nature of the pain so many victims experience as the mind continues in its insidious meltdown.
In Paris that October night I knew that I, too, was in the process of meltdown. And on the way to the hotel in the car I had a clear revelation. A disruption of the circadian cycle, the metabolic and glandular rhythms that are central to our workaday life, seems to be involved in many, if not most, cases of depression; this is why brutal insomnia so often occurs and is most likely why each day’s pattern of distress exhibits fairly predictable alternating periods of intensity and relief. The evening’s relief for me, an incomplete but noticeable letup, like the change from a torrential downpour to a steady shower, came in the hours after dinner time and before midnight, when the pain lifted a little and my mind would become lucid enough to focus on matters beyond the immediate upheaval convulsing my system. Naturally I looked forward to this period, for sometimes I felt close to being reasonably sane, and that night in the car I was aware of a semblance of clarity returning, along with the ability to think rational thoughts. Having been able to reminisce about Camus and Romain Gary, however, I found that my continuing thoughts were not very consoling.
The memory of Jean Seberg gripped me with sadness. A little over a year after our encounter in Connecticut she took an overdose of pills and was found dead in a car parked in a cul-de-sac off a Paris avenue, where her body had lain for many days. The following year I sat with Romain at the Brasserie Lipp during a long lunch while he told me that, despite their difficulties, his loss of Jean had so deepened his depression that from time to time he had been rendered nearly helpless. But even then I was unable to comprehend the nature of his anguish. I remembered that his hands trembled and, though he could hardly be called superannuated, he was in his mid-sixties, his voice had the wheezy sound of very old age that I now realized was, or could be, the voice of depression; in the vortex of my severest pain I had begun to develop that ancient voice myself. I never saw Romain again. Claude Gallimard, Francoise’s father, had recollected to me how, in 1980, only a few hours after another lunch where the talk between the two old friends had been composed and casual, even lighthearted, certainly anything but somber, Romain Gary, twice winner of the Prix Goncourt (one of these awards pseudonymous, the result of his having gleefully tricked the critics), hero of the Republic, valorous recipient of the Croix de Guerre, diplomat, bon vivant, womanizer par excellence, went home to his apartment on the rue du Bac and put a bullet through his brain.
It was at some point during the course of these musings that the sign HOTEL WASHINGTON swam across my vision, bringing back memories of my long ago arrival in the city, along with the fierce and sudden realization that I would never see Paris again. This certitude astonished me and filled me with a new fright, for while thoughts of death had long been common during my siege, blowing through my mind like icy gusts of wind, they were the formless shapes of doom that I suppose are dreamed of by people in the grip of any severe affliction. The difference now was in the sure understanding that tomorrow, when the pain descended once more, or the tomorrow after that, certainly on some not too distant tomorrow, I would be forced to judge that life was not worth living and thereby answer, for myself at least, the fundamental question of philosophy.
TO MANY OF US WHO KNEW ABBIE HOFFMAN EVEN slightly, as I did, his death in the spring of 1989 was a sorrowful happening. Just past the age of fifty, he had been too young and apparently too vital for such an ending; a feeling of chagrin and dreadfulness attends the news of nearly anyone’s suicide, and Abbie’s death seemed to me especially cruel.
I had first met him during the wild days and nights of the 1968 Democratic Convention in Chicago, where I had gone to write a piece for The New York Review of Books, and I later was one of those who testified on behalf of him and his fellow defendants at the trial, also in Chicago, in 1970. Amid the pious follies and morbid perversions of American life, his antic style was exhilarating, and it was hard not to admire the hellraising and the brio, the anarchic individualism.
I wish I had seen more of him in recent years; his sudden death left me with a particular emptiness, as suicides usually do to everyone. But the event was given a further dimension of poignancy by what one must begin to regard as a predictable reaction from many: the denial, the refusal to accept the fact of the suicide itself, as if the voluntary act, as opposed to an accident, or death from natural causes, were tinged with a delinquency that somehow lessened the man and his character.
Abbie’s brother appeared on television, grief, ravaged and distraught; one could not help feeling compassion as he sought to deflect the idea of suicide, insisting that Abbie, after all, had always been careless with pills and would never have left his family bereft. However, the coroner confirmed that Hoffman had taken the equivalent of 150 phenobarbitals.
It’s quite natural that the people closest to suicide victims so frequently and feverishly hasten to disclaim the truth; the sense of implication, of personal guilt, the idea that one might have prevented the act if one had taken certain precautions, had somehow behaved differently, is perhaps inevitable. Even so, the sufferer, whether he has actually killed himself or attempted to do so, or merely expressed threats, is often, through denial on the part of others, unjustly made to appear a wrongdoer.
A similar case is that of Randall Jarrell, one of the fine poets and critics of his generation, who on a night in 1965, near Chapel Hill, North Carolina, was struck by a car and killed. Jarrell’s presence on that particular stretch of road, at an odd hour of the evening, was puzzling, and since some of the indications were that he had deliberately let the car strike him, the early conclusion was that his death was suicide. Newsweek, among other publications, said as much, but Jarrell’s widow protested in a letter to that magazine; there was a hue and cry from many of his friends and supporters, and a coroner’s jury eventually ruled the death to be accidental. Jarrell had been suffering from extreme depression and had been hospitalized; only a few months before his misadventure on the highway and while in the hospital, he had slashed his wrists.
Anyone who is acquainted with some of the jagged contours of Jarrell’s life, including his violent fluctuations of mood, his fits of black despondency, and who, in addition, has acquired a basic knowledge of the danger signals of depression, would seriously question the verdict of the coroner’s jury. But the stigma of selfinflicted death is for some people a hateful blot that demands erasure at all costs. (More than two decades after his death, in the Summer 1986 issue of The American Scholar, a one time student of Jarrell’s, reviewing a collection of the poet’s letters, made the review less a literary or biographical appraisal than an occasion for continuing to try to exorcise the vile phantom of suicide.)
Randall Jarrell almost certainly killed himself. He did so not because he was a coward, nor out of any moral feebleness, but because he was afflicted with a depression that was so devastating that he could no longer endure the pain of it.
This general unawareness of what depression is really like was apparent most recently in the matter of Primo Levi, the remarkable Italian writer and survivor of Auschwitz who, at the age of sixty-seven, hurled himself down a stairwell in Turin in 1987. Since my own involvement with the illness, I had been more than ordinarily interested in Levi’s death, and so, late in 1988, when I read an account in The New York Times about a symposium on the writer and his work held at New York University, was fascinated but, finally, appalled. For, according to the article, many of the participants, worldly writers and scholars, seemed mystified by Levi’s suicide, mystified and disappointed. It was as if this man whom they had all so greatly admired, and who had endured so much at the hands of the Nazis, a man of exemplary resilience and courage, had by his suicide demonstrated a frailty, a crumbling of character they were loath to accept. In the face of a terrible absolute self-destruction, their reaction was helplessness and (the reader could not avoid it) a touch of shame.
My annoyance over all this was so intense that I was prompted to write a short piece for the op-ed page of the Times. The argument I put forth was fairly straightforward:
The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.
The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain. Through the healing process of time, and through medical intervention or hospitalization in many cases, most people survive depression, which may be its only blessing; but to the tragic legion who are compelled to destroy themselves there should be no more reproof attached than to the victims of terminal cancer.
I had set down my thoughts in this Times piece rather hurriedly and spontaneously, but the response was equally spontaneous, and enormous. It had taken, I speculated, no particular originality or boldness on my part to speak out frankly about suicide and the impulse toward it, but I had apparently underestimated the number of people for whom the subject had been taboo, a matter of secrecy and shame. The overwhelming reaction made me feel that inadvertently I had helped unlock a closet from which many souls were eager to come out and proclaim that they, too, had experienced the feelings I had described. It is the only time in my life I have felt it worthwhile to have invaded my own privacy, and to make that privacy public. And I thought that, given such momentum, and with my experience in Paris as a detailed example of what occurs during depression, it would be useful to try to chronicle some of my own experiences with the illness and in the process perhaps establish a frame of reference out of which one or more valuable conclusions might be drawn.
Such conclusions, it has to be emphasized, must still be based on the events that happened to one man. In setting these reflections down I don’t intend my ordeal to stand as a representation of what happens, or might happen, to others. Depression is much too complex in its cause, its symptoms and its treatment for unqualified conclusions to be drawn from the experience of a single individual. Although as an illness depression manifests certain unvarying characteristics, it also allows for many idiosyncrasies; I’ve been amazed at some of the freakish phenomena, not reported by other patients, that it has wrought amid the twistings of my mind’s labyrinth.
Depression afflicts millions directly, and millions more who are relatives or friends of victims. It has been estimated that as many as one in ten Americans will suffer from the illness. As assertively democratic as a Norman Rockwell poster, it strikes indiscriminately at all ages, races, creeds and classes, though women are at considerably higher risk than men. The occupational list (dressmakers, barge captains, sushi chefs, cabinet members) of its patients is too long and tedious to give here; it is enough to say that very few people escape being a potential victim of the disease, at least in its milder form. Despite depression’s eclectic reach, it has been demonstrated with fair convincingness that artistic types (especially poets) are particularly vulnerable to the disorder, which, in its graver, clinical manifestation takes upward of twenty percent of its victims by way of suicide.
Just a few of these fallen artists, all modern, make up a sad but scintillant roll call: Hart Crane, Vincent van Gogh, Virginia Woolf, Arshile Gorky, Cesare Pavese, Romain Gary, Vachel Lindsay, Sylvia Plath, Henry de Montherlant, Mark Rothko, John Berryman, Jack London, Ernest Hemingway, William Inge, Diane Arbus, Tadeusz Borowski, Paul Celan, Anne Sexton, Sergei Esenin, Vladimir Mayakovsky, the list goes on. (The Russian poet Mayakovsky was harshly critical of his great contemporary Esenin’s suicide a few years before, which should stand as a caveat for all who are judgmental about self destruction.)
When one thinks of these doomed and splendidly creative men and women, one is drawn to contemplate their childhoods, where, to the best of anyone’s knowledge, the seeds of the illness take strong root; could any of them have had a hint, then, of the psyche’s perishability, its exquisite fragility? And why were they destroyed, while others, similarly stricken, struggled through?
WHEN I WAS FIRST AWARE THAT I HAD BEEN LAID low by the disease, I felt a need, among other things, to register a strong protest against the word “depression.” Depression, most people know, used to be termed “melancholia,” a word which appears in English as early as the year 1303 and crops up more than once in Chaucer, who in his usage seemed to be aware of its pathological nuances. “Melancholia” would still appear to be a far more apt and evocative word for the blacker forms of the disorder, but it was usurped by a noun with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness. It may be that the scientist generally held responsible for its currency in modern times, a Johns Hopkins Medical School faculty member justly venerated, the Swiss born psychiatrist Adolf Meyer, had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering “depression” as a descriptive noun for such a dreadful and raging disease. Nonetheless, for over seventy-five years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.
As one who has suffered from the malady in extremis yet returned to tell the tale, I would lobby for a truly arresting designation. “Brainstorm,” for instance, has unfortunately been preempted to describe, somewhat jocularly, intellectual inspiration. But something along these lines is needed. Told that someone’s mood disorder has evolved into a storm, a veritable howling tempest in the brain, which is indeed what a clinical depression resembles like nothing else, even the uninformed layman might display sympathy rather than the standard reaction that “depression” evokes, something akin to “So what?” or “You’ll pull out of it” or “We all have bad days.” The phrase “nervous breakdown” seems to be on its way out, certainly deservedly so, owing to its insinuation of a vague spinelessness, but we still seem destined to be saddled with “depression” until a better, sturdier name is created.
The depression that engulfed me was not of the manic type, the one accompanied by euphoric highs, which would have most probably presented itself earlier in my life. I was sixty when the illness struck for the first time, in the “unipolar” form, which leads straight down. I shall never learn what “caused” my depression, as no one will ever learn about their own. To be able to do so will likely forever prove to be an impossibility, so complex are the intermingled factors of abnormal chemistry, behavior and genetics. Plainly, multiple components are involved, perhaps three or four, most probably more, in fathomless permutations.
That is why the greatest fallacy about suicide lies in the belief that there is a single immediate answer, or perhaps combined answers, as to why the deed was done.
The inevitable question “Why did he, or she do it?” usually leads to odd speculations, for the most part fallacies themselves. Reasons were quickly advanced for Abbie Hoffman’s death: his reaction to an auto accident he had suffered, the failure of his most recent book, his mother’s serious illness. With Randall Jarrell it was a declining career cruelly epitomized by a vicious book review and his consequent anguish. Primo Levi, it was rumored, had been burdened by caring for his paralytic mother, which was more onerous to his spirit than even his experience at Auschwitz.
Any one of these factors may have lodged like a thorn in the sides of the three men, and been a torment. Such aggravations may be crucial and cannot be ignored. But most people quietly endure the equivalent of injuries, declining careers, nasty book reviews, family illnesses. A vast majority of the survivors of Auschwitz have borne up fairly well. Bloody and bowed by the outrages of life, most human beings still stagger on down the road, unscathed by real depression.
To discover why some people plunge into the downward spiral of depression, one must search beyond the manifest crisis, and then still fail to come up with anything beyond wise conjecture.
The storm which swept me into a hospital in December began as a cloud no bigger than a wine goblet the previous June. And the cloud, the manifest crisis, involved alcohol, a substance I had been abusing for forty years. Like a great many American writers, whose sometimes lethal addiction to alcohol has become so legendary as to provide in itself a stream of studies and books, I used alcohol as the magical conduit to fantasy and euphoria, and to the enhancement of the imagination. There is no need to either rue or apologize for my use of this soothing, often sublime agent, which had contributed greatly to my writing; although I never set down a line while under its influence, I did use it, often in conjunction with music, as a means to let my mind conceive visions that the unaltered, sober brain has no access to. Alcohol was an invaluable senior partner of my intellect, besides being a friend whose ministrations I sought daily, sought also, I now see, as a means to calm the anxiety and incipient dread that I had hidden away for so long somewhere in the dungeons of my spirit.
The trouble was, at the beginning of this particular summer, that I was betrayed. It struck me quite suddenly, almost overnight: I could no longer drink. It was as if my body had risen up in protest, along with my mind, and had conspired to reject this daily mood bath which it had so long welcomed and, who knows? perhaps even come to need. Many drinkers have experienced this intolerance as they have grown older. I suspect that the crisis was at least partly metabolic, the liver rebelling, as if to say, “No more, no more”, but at any rate I discovered that alcohol in minuscule amounts, even a mouthful of wine, caused me nausea, a desperate and unpleasant wooziness, a sinking sensation and ultimately a distinct revulsion. The comforting friend had abandoned me not gradually and reluctantly, as a true friend might do, but like a shot, and I was left high and certainly dry, and unhelmed.
Neither by will nor by choice had I became an abstainer; the situation was puzzling to me, but it was also traumatic, and I date the onset of my depressive mood from the beginning of this deprivation. Logically, one would be overjoyed that the body had so summarily dismissed a substance that was undermining its health; it was as if my system had generated a form of Antabuse, which should have allowed me to happily go my way, satisfied that a trick of nature had shut me off from a harmful dependence. But, instead, I began to experience a vaguely troubling malaise, a sense of something having gone cockeyed in the domestic universe I’d dwelt in so long, so comfortably. While depression is by no means unknown when people stop drinking, it is usually on a scale that is not menacing. But it should be kept in mind how idiosyncratic the faces of depression can be.
It was not really alarming at first, since the change was subtle, but I did notice that my surroundings took on a different tone at certain times: the shadows of nightfall seemed more somber, my mornings were less buoyant, walks in the woods became less zestful, and there was a moment during my working hours in the late afternoon when a kind of panic and anxiety overtook me, just for a few minutes, accompanied by a visceral queasiness, such a seizure was at least slightly alarming, after all. As I set down these recollections, I realize that it should have been plain to me that I was already in the grip of the beginning of a mood disorder, but I was ignorant of such a condition at that time.
When I reflected on this curious alteration of my consciousness, and I was baffled enough from time to time to do so, I assumed that it all had to do somehow with my enforced withdrawal from alcohol. And, of course, to a certain extent this was true. But it is my conviction now that alcohol played a perverse trick on me when we said farewell to each other: although, as everyone should know, it is a major depressant, it had never truly depressed me during my drinking career, acting instead as a shield against anxiety.
Suddenly vanished, the great ally which for so long had kept my demons at bay was no longer there to prevent those demons from beginning to swarm through the subconscious, and I was emotionally naked, vulnerable as I had never been before.
Doubtless depression had hovered near me for years, waiting to swoop down. Now I was in the first stage, premonitory, like a flicker of sheet lightning barely perceived, of depression’s black tempest.
I was on Martha’s Vineyard, where I’ve Spent a good part of each year since the 1960s, during that exceptionally beautiful summer. But I had begun to respond indifferently to the island’s pleasures. I felt a kind of numbness, an enervation, but more particularly an odd fragility, as if my body had actually become frail, hypersensitive and somehow disjointed and clumsy, lacking normal coordination. And soon I was in the throes of a pervasive hypochondria. Nothing felt quite right with my corporeal self; there were twitches and pains, sometimes intermittent, often seemingly constant, that seemed to presage all sorts of dire infirmities. (Given these signs, one can understand how, as far back as the seventeenth century, in the notes of contemporary physicians, and in the perceptions of John Dryden and others, a connection is made between melancholia and hypochondria; the words are often interchangeable, and were so used until the nineteenth century by writers as various as Sir Walter Scott and the Brontés, who also linked melancholy to a preoccupation with bodily ills.) It is easy to see how this condition is part of the psyche’s apparatus of defense: unwilling to accept its own gathering deterioration, the mind announces to its indwelling consciousness that it is the body with its perhaps correctable defects, not the precious and irreplaceable mind, that is going haywire.
In my case, the overall effect was immensely disturbing, augmenting the anxiety that was by now never quite absent from my waking hours and fueling still another strange behavior pattern, a fidgety restlessness that kept me on the move, somewhat to the perplexity of my family and friends. Once, in late summer, on an airplane trip to New York, I made the reckless mistake of downing a scotch and soda, my first alcohol in months, which promptly sent me into a tailspin, causing me such a horrified sense of disease and interior doom that the very next day I rushed to a Manhattan internist, who inaugurated a long series of tests. Normally I would have been satisfied, indeed elated, when, after three weeks of high-tech and extremely expensive evaluation, the doctor pronounced me totally fit; and I was happy, for a day or two, until there once again began the rhythmic daily erosion of my mood, anxiety, agitation, unfocused dread.
By now I had moved back to my house in Connecticut. It was October, and one of the unforgettable features of this stage of my disorder was the way in which my old farmhouse, my beloved home for thirty years, took on for me at that point when my spirits regularly sank to their nadir an almost palpable quality of ominousness. The fading evening light, akin to that famous “slant of light” of Emily Dickinson’s, which spoke to her of death, of chill extinction, had none of its familiar autumnal loveliness, but ensnared me in a suffocating gloom. I wondered how this friendly place, teeming with such memories of (again in her words) “Lads and Girls,” of “laughter and ability and sighing, and Frocks and Curls,” could almost perceptibly seem so hostile and forbidding. Physically, I was not alone. As always Rose was present and listened with unflagging patience to my complaints. But I felt an immense and aching solitude. I could no longer concentrate during those afternoon hours, which for years had been my working time, and the act of writing itself, becoming more and more difficult and exhausting, stalled, then finally ceased.
There were also dreadful, pouncing seizures of anxiety. One bright day on a walk through the woods with my dog I heard a flock of Canada geese honking high above trees ablaze with foliage; ordinarily a sight and sound that would have exhilarated me, the flight of birds caused me to stop, riveted with fear, and I stood stranded there, helpless, shivering, aware for the first time that I had been stricken by no mere pangs of withdrawal but by a serious illness whose name and actuality I was able finally to acknowledge. Going home, I couldn’t rid my mind of the line of Baudelaire’s, dredged up from the distant past, that for several days had been skittering around at the edge of my consciousness: “I have felt the wind of the wing of madness.”
Our perhaps understandable modern need to dull the sawtooth edges of so many of the afflictions we are heir to has led us to banish the harsh old-fashioned words: madhouse, asylum, insanity, melancholia, lunatic, madness.
But never let it be doubted that depression, in its extreme form, is madness. The madness results from an aberrant biochemical process. It has been established with reasonable certainty (after strong resistance from many psychiatrists, and not all that long ago) that such madness is chemically induced amid the neurotransmitters of the brain, probably as the result of systemic stress, which for unknown reasons causes a depletion of the chemicals norepinephrine and serotonin, and the increase of a hormone, cortisol.
With all of this upheaval in the brain tissues, the alternate drenching and deprivation, it is no wonder that the mind begins to feel aggrieved, stricken, and the muddied thought processes register the distress of an organ in convulsion. Sometimes, though not very often, such a disturbed mind will turn to violent thoughts regarding others. But with their minds turned agonizingly inward, people with depression are usually dangerous only to themselves. The madness of depression is, generally speaking, the antithesis of violence. It is a storm indeed, but a storm of murk. Soon evident are the slowed-down responses, near paralysis, psychic energy throttled back close to zero. Ultimately, the body is affected and feels sapped, drained.
That fall, as the disorder gradually took full possession of my system, I began to conceive that my mind itself was like one of those outmoded small town telephone exchanges, being gradually inundated by flood waters: one by one, the normal circuits began to drown, causing some of the functions of the body and nearly all of those of instinct and intellect to slowly disconnect.
There is a well known checklist of some of these functions and their failures. Mine conked out fairly close to schedule, many of them following the pattern of depressive seizures. I particularly remember the lamentable near disappearance of my voice. It underwent a strange transformation, becoming at times quite faint, wheezy and spasmodic, a friend observed later that it was the voice of a ninety year old. The libido also made an early exit, as it does in most major illnesses, it is the superfluous need of a body in beleaguered emergency. Many people lose all appetite; mine was relatively normal, but I found myself eating only for susistence: food, like everything else within the scope of sensation, was utterly without savor. Most distressing of all the instinctual disruptions was that of sleep, along with a complete absence of dreams.
Exhaustion combined with sleeplessness is a rare torture. The two or three hours of sleep I was able to get at night were always at the behest of the Halcyon, a matter which deserves particular notice. For some time now many experts in psychopharmacology have warned that the benzodiazepine family of tranquilizers, of which Halcion is one (Valium and Ativan are others), is capable of depressing mood and even precipitating a major depression. Over two years before my siege, an insouciant doctor had prescribed Ativan as a bedtime aid, telling me airily that I could take it as casually as aspirin. The Physicians’ Desk Reference, the pharmacological bible, reveals that the medicine I had been ingesting was (a) three times the normally prescribed strength, (b) not advisable as a medication for more than a month or so, and (c) to be used with special caution by people of my age. At the time of which I am speaking I was no longer taking Ativan but had become addicted to Halcion and was consuming large doses. It seems reasonable to think that this was still another contributory factor to the trouble that had come upon me. Certainly, it should be a caution to others.
At any rate, my few hours of sleep were usually terminated at three or four in the morning, when I stared up into yawning darkness, wondering and writhing at the devastation taking place in my mind, and awaiting the dawn, which usually permitted me a feverish, dreamless nap. I’m fairly certain that it was during one of these insomniac trances that there came over me the knowledge, a weird and shocking revelation, like that of some long beshrouded metaphysical truth, that this condition would cost me my life if it continued on such a course. This must have been just before my trip to Paris.
Death, as I have said, was now a daily presence, blowing over me in cold gusts. I had not conceived precisely how my end would come. In short, I was still keeping the idea of suicide at bay. But plainly the possibility was around the corner, and I would soon meet it face to face.
What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience.
The gray drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immediately identifiable pain, like that of a broken limb. It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this caldron, because there is no escape from this smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion.
. . .
DARKNESS VISIBLE. A MEMOIR of MADNESS
by William Styron
get it at Amazon.com