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The Crack-Up

Our times have been called, among other things, the Age of Depression: incidence seems constantly to rise, laboratories to bring out more and more new medicines. But in Where the Roots Reach for Water Jeffery Smith argues that it is more an Age of Anti-Depression. The old illness of melancholia, as Jennifer Radden’s collection of readings, The Nature of Melancholy, shows, could formerly be taken seriously for its religious or moral meanings. But with religion went some of the legitimation of private grief; instead, what William James (with some skepticism) called “the religion of healthy-mindedness”1 has made headway for at least a century, from Mary Baker Eddy’s Christian Science to New Age fads. (What William could have made of them!) In the cold fluorescent light of the modern workplace, melancholia is unproductive, subversive, anti-capitalist even. “Cheer up, it may never happen!” is the jocular shout common here in Britain, one directed at me more often than I care to remember. In radio programs of popular classics, Smith notes, movements in a minor key even tend to be deleted (can this really be so?). “In spite of all available evidence,” he goes on, “modern-day Americans keep trying to convince ourselves that happiness is the natural state of our species. Our kind was meant to conquer and work and laugh and spend, we believe; not to sit about head in hand.” The stigma of depression is as bad as it ever was.

It is a real breakthrough, then, to have two such outstanding books as Smith’s and as Andrew Solomon’s The Noonday Demon coming out at around the same time. Both are wonderfully well written, in quite different ways. Both, as well as recounting their own experiences of depression, look at history, causes, treatments, and social attitudes. The Noonday Demon, as its subtitle says, is something of an atlas, wide-ranging and comprehensive. Solomon has read hugely, but because he has the gift of the gab (novelist, New Yorker contributor) he is seldom boring, wherever you choose to open a page. He says that he didn’t write the book as therapy for himself, found it in fact a painful task, but wanted to spread knowledge; so he is owed thanks. He has gone the extra mile, too. Though from a comfortable metropolitan background himself, he has talked to Inuit people in Greenland and to trauma survivors in Cambodia, as well as to horrifically deprived depressed patients in poor regions of the United States. (When he first submitted material on these latter people to an editor, he was told to lighten up—nobody would believe the stuff.) He says he really minds that, without any real understanding or treatment, the “terrible, wasteful, lonely suffering” in these dark corners will go on and on. Those who don’t live on the margins of society, who can read a newspaper and more or less pay their bills, don’t of course escape the suffering, but they can at least give it a name and know where to look for help.

Solomon had a pretty normal upbringing himself, he believes, though shy at school and confused about his homosexuality. His crash came very suddenly: his mother had died; a partner left him; his analyst was preparing to leave town; the pain of getting kidney stones scared him. He came home one day, fell into bed, and couldn’t move:

There is a moment, if you trip or slip, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself, a passing, fraction-of-a-second terror. I felt that way hour after hour after hour…. Your vision narrows and begins to close down; it is like trying to watch TV through terrible static, where you can sort of see the picture but not really; where you cannot ever see people’s faces, except almost if there is a close-up; where nothing has edges. The air seems thick and resistant, as though it were full of mushed-up bread. Becoming depressed is like going blind, the darkness at first gradual, then encompassing; it is like going deaf, hearing less and less until a terrible silence is all around you.

Not all experiences of depression, of course, are like this: this is the Big Crash, when a lifetime of keeping going, keeping the show on the road, falls in like a circus tent that crushes audience and animals and spangled performers all at once. Much more common are the slow creeping growths of pain, the bereavement griefs that won’t pass, the discouragement that slides slowly into paralysis.

In his illness Solomon had to be fed, and washed, and dressed. After a time his pills began to help, and he was able to pretend to be well. So he came off medication in cold turkey fashion, “to find out who I was again”—depressives usually long to be drug-free and their “real” selves again. He did find out who he was: a person in despair. The minimal energy that returns after a first crash into the misery-illness often is just enough for thinking out a suicide plan, which was too difficult beforehand. Solomon’s plan was a bizarre and, to my mind, rather repellent one: he decided to die of AIDS. He claims that he pursued a deliberate six months of unprotected anal sex with strangers—and failed to catch the virus.

He seems glad that he survived, but has no illusions about the fragility of his mental health. There have been some books, generally by scientists or other academics, written on the lines of “how I had my nervous breakdown”—depression seen as something external like a bad attack of shingles, not really something that gets inside the competent, intellectual personality. Solomon, however, is well aware that after experiencing the collapse of everything, you are never safe again: “You are never the same once you have acquired the knowledge that there is no self that will not crumble.” And yet, thinking around this, he comes upon something that might be a sort of permanence. When his father was feeding him small pieces of food during his first collapse, he was able to say to him that he’d like to live long enough to feed his father in his old age if he needed to. This wish was perhaps the “ropy fiber that runs through the center of me, that holds fast even when the self has been stripped away from it.” I like that.

In Where the Roots Reach for Water, Jeffery Smith describes a background that could not be more different from Solomon’s, though he too feels that he had a happy enough start in life, not one to cause his depressive illness. He was born in the Appalachian hills of West Virginia, among the cornfields and hollows and creeks. His relatives had been settled there for several generations; there was a rocking chair on the porch and Grandma’s homemade jams stacked in the cellar. The country boy discovered books, went to college, got a job in social work. But the same ominous symptoms, tremors heralding an earthquake, began for him as they had for Solomon. He started to cry a lot, couldn’t sleep; took vitamins, recited poetry to keep other thoughts out of his mind; eventually and reluctantly, went to the doctor and got anti-depressant medication.

For two months it worked—until it didn’t any longer. He tried out five further types of pill. Finally one of them worked for him, and he got seven months’ reprieve. Then this medication, too, failed to have any effect. He tried the complementary therapies without any success.

It is unusual for someone with severe depression not to find some long-term help from medication. Solomon is certainly an advocate of medication himself, though not an enemy of psychotherapy. In The Noonday Demon he quotes an 80 percent relapse rate within a year without medication and an 80 percent wellness rate with it, and considers himself committed to a drug regime. Patients’ problems are more often with side effects, and with fear of lifelong addiction. Jeffery Smith does not claim to have given up on medication out of high-mindedness; no doubt if he had found the right magic bullet he would have kept on taking it.

Both these authors are very aware of the implications of taking a chemical “cure” for what seems a soul sickness, of the insoluble puzzle of relating body to mind. There is no more than a rough idea of how the various anti-depressants work, and some were originally developed for quite other conditions. “Surely you can phase these drugs out now?” is how friends react to Andrew Solomon. No, he believes: knowing what happens when he drops them, he expects to continue them for perhaps a lifetime. But even the drug route is not an easy one. There has hardly been time to find out yet what long-term usage implies; side effects can be a high price to pay for mood relief; relapses can happen for no very clear reason. “You take antidepressants like people take aspirins for a headache,” Solomon says the doctors tell him—but he disagrees. It’s more like having radiation for cancer: “None of it is easy and results are inconsistent.”

Jeffery Smith is particularly aware of the pills bypassing the soul. “It has reduced the ancient melancholic narrative”—a long, distinguished history—“to one story,” he says. I am not sure that someone being given an injection for toothache would worry about that—besides, it is not true, or else these two sensitive and searching books would not have been written. The ancient narrative still has to probe the very roots of what it is to be human, to be well or ill, to be body or mind, to feel normal grief or suffocating pain. Didn’t Freud say that what he wanted to do was change neurotic misery into ordinary unhappiness? And there is such a thing as extremity, as suicide by depressives shows, at the very least. I am reminded of a friend who told me that the best, the very best moment of her life was being given an anesthetic after forty-eight hours in the second stage of labor. And of myself finding, waking up, that a biochemical shift out of hell had happened, and a transcendent sentence formulated itself: “I think I could eat a little bit of toast.”

As well as the antidepressants, Smith and Solomon took in some talking therapy, though they say remarkably little about it. One can see why the therapists themselves are lukewarm about antidepressant medication: since it reduces the pain, it is likely to reduce urgency and commitment. Solomon, for instance, casually mentions that he would never be able to open up to an analyst as he does to his brother. But can psychoanalysts and therapists go right out to meet the primitive, bodily desperation of severe depression, and within fifty minutes; and with the succeeding appointment scheduled for next week? Attempts have been made by alternative therapies to improve on the dry verbal texture of psychoanalysis, but they have tended to substitute synchronized screaming, or going through “rebirth” in batches of ten.

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    It is to be hoped that we all have some friend, perhaps more often feminine than masculine, and young than old, whose soul is of this sky-blue tint, whose affinities are rather with flowers and birds and all enchanting innocencies than with dark human passions.” The Varieties of Religious Experience, Chapter 4.

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