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.

One of the few books that really has described the talking therapy reflectively and honestly is Ann France’s Consuming Psychotherapy (1988). This extract, I think, encapsulates the fruitlessness of therapeutic encounter when a patient is overwhelmingly depressed:

I said nothing. I kept wanting to scream, loudly, through sheer frustration. Finally I tried to break the tension by saying, “I feel I’m screaming so loudly, in silence, that the window panes are being shattered.” She did not reply. I could express nothing of what I was feeling, it seemed, and I began to sob uncontrollably…. She said, as so often before, that there was nothing she could do or say to help me in such misery. I wanted to say, “Yes, there is. Come and sit beside me.” But of course I said nothing, and the sobs grew more desperate…. I picked up my coat and left. It was ten minutes before we need have ended.

Later, the author of this committed suicide.

It may simply be realistic that neither Solomon nor Smith puts professional talking therapy at the forefront of recovery. Jeffery Smith, in the end, had to make his way without even anti-depressants; what worked for him, then? Endurance: the country surroundings that had first nurtured him; a growing interest in the “spiritual”—part Buddhism, part Christianity—which encouraged him to think that depressive suffering could make some sense, have some value (the essence of depression being a conviction of the sufferer’s valuelessness); and cultivating his garden. It is Solomon who quotes from the wonderful Charlotte Brontë somewhere, on being advised to cultivate happiness—“What does such advice mean? Happiness is not a potato, to be planted in mould, and tilled with manure”—but Smith did find some help in tilling and manuring. And he had access to that famous but scarce remedy: the love of a good woman. The woman he met and later married, and to whom he dedicates his book, sounds exceptional indeed—not just tolerant and steadfast, but able to do a fine translation of Rilke’s Tenth Elegy, the one that says,

We, who squander our sorrows.

How we look beyond them into the mournful passage of time

to see whether they might end.

But they are seasons of us, yes, our winter—

Abiding leafage, meadows, ponds, landscapes we are born into,

inhabited by birds and creatures in the reeds.

Winter is no bad time, Rilke is saying, with its leaves and grass and creatures living quietly. She chose the right passage.

He feels almost embarrassed by his own story, Smith says.

As I sit here some years later remembering it, imagining you hearing this story, I am still a little red-faced. It is such a conventional, pastoral, prototypically American story: first the woman, then the church, then the garden, saves the man from himself. He runs like any bourgeois philistine from his encounter with nothingness. It wasn’t intellectually reputable; there was nothing ironic or hip about it, nothing smart, nothing unique.

There is nothing smart or ironic or hip about depressive illness, I’m sure New Yorker Andrew Solomon would agree. And Smith goes on to be a little bit ironic himself. “Sounds idyllic, don’t it?” he asks. But it was not always so. Something in him often wanted to run away from happiness, avoid closeness, though he hung on: “Now it was time for all my highfalutin ideas about faith and right living to get out of my head and walk in the world, and it wasn’t working too well…. You can see it, I’m sure: I was afraid. Not to put too fine a point on it, I was scared shitless. I was being seen, and I didn’t have myself pulled together yet. I didn’t feel ready to be seen. I was sure Lisa must think me truly cursed, a loser.”

Neither Smith nor Solomon, I think, would want to title his account (like D.H. Lawrence’s poem) “Look, we have come through!” Both are aware that complacency is a trap, and recovery never to be taken for granted. Neither of them writes in the feel-good, positive-thinking mode of best-selling self-help textbooks. Both, from what they have been through and got into words, must have gained in wisdom—“sitting about head in hand,” in Smith’s words, is a way to learn a lot—the courage and compassion of both is proof of it. But, as Solomon says, it’s a hard way to learn. “Major depression is far too stern a teacher: you needn’t go to the Sahara to avoid frostbite.” About 5 percent of what depressives go through would be quite enough to see to the wisdom side. As Kay Redfield Jamison, professor of psychiatry and sufferer from manic depression herself, has written, “One would put an animal to death for far less suffering.”²

Both authors, Solomon in particular, have much to tell about the long history of melancholia—longer, I should think, than that of almost any other illness. That it should have been recognized as a distinct entity for so many centuries is in itself an answer to people who still lean toward the “pull yourself together” attitude. Jennifer Madden’s handbook of readings opens with Aristotle on the disease of black bile and its relation to genius, and goes on through the centuries—Burton, Saint Teresa, Goethe, Kant, Keats, Baudelaire, Melanie Klein, Julia Kristeva (though not the two great exponents, Shakespeare and Beckett).

The earlier the extracts, the more vivid. The fourth-century monk led into accidie by Satan: he “often goes in and out of his cell, and frequently gazes up at the sun, as if it was too slow in setting, and so a kind of unreasonable confusion of mind takes possession of him like some foul darkness, and makes him idle and useless for every spiritual work.” The melancholic, in a sixteenth-century treatise, is “possessed with the uncheerfull, & discomfortable darkness that obscureth the Sunne and Moone, and all the comfortable planets of our natures, in such sort that they apeare all darke and more than halfe eclipsed of this mist of blacknes.” Another, from the seventeenth century:

His Head is Haunted, like a House, with evil Spirits and Apparitions, that terrify and fright him out of himself, till he stands empty and forsaken…. The Fumes and Vapours that rise from his Spleen and Hypocondries have so smutched and sullied his Brain (like a Room that smoaks) that his Understanding is blear-ey’d, and has no right Perception of any Thing.

With the approach of the twentieth century and its less fanciful notions of physiology, there seems to be correspondingly less humanity. Everything is, or shortly will be, medicalized, explicable, curable, it seems.

But so far it has not really happened, and this makes the public, political side of depression as illness particularly difficult, as Solomon points out. Shame (in the sufferers) and prejudice (in the rest of society) make a bad combination. Heavy depression makes it both hard to hold down a job, and hard to find the energy to protest. American mental health and insurance guidelines, as he expounds them, are unforgiving (and certainly no better in Britain). A few courageous public voices speak out on mental health issues, but they are not popular ones; indeed, the stigma can rub off on the campaigner. Peo-ple link depression with schizophrenia, which is even more cruelly regarded, but does have some (extremely small) risk of violence, while depressives keep such a low profile that they are almost invisible. Where hospital care is readily available, it is often poor; when drugs are prescribed they are not always the right ones, and patients anyway may dislike them. Anything on the lines of tender loving care from nursing staff is rare. Solomon visited some public psychiatric wards, and felt that if he had not had the family support and money to avoid them he would hardly have survived.

Reasons for the willful incomprehension of the public are not hard to grasp. Everyone, after all, has had bad times—bereavement, illness, divorce, job anxieties—and felt absolutely rotten, but more or less pulled through. So they are experts on misery, right? They managed; why can’t others? It’s as though, since everybody has had a dose of mild flu at some time (certainly most unpleasant), they consider themselves experts on some malignant form of it that destroys lives (depression, via suicide, is estimated to have a mortality rate of around 15 percent). And the fact that in public, to avoid boring the non-comprehenders, depressed people generally put up the best façade they can muster, just complicates things a little more. Solomon describes how a friend—after Solomon had published material about his experiences—remarked that he had such a “perfect-seeming” life. Solomon protested:

“I know you were depressed at one point,” [the friend] said, “but it doesn’t seem to have had any effect on you.” I proposed that it had in fact changed and determined the whole rest of my life, but I could tell my words were not getting through…. An editor from the New Yorker recently told me that I’d never really been depressed. I protested that people who have never been depressed don’t tend to pretend about it, but he was not to be persuaded. “C’mon,” he said, “What the hell do you have to be depressed about?… I don’t buy into this whole depression business.”

(Why didn’t Solomon hit him? Why the saintly mildness?) Even depressives themselves can feel confused on this point. If an inner state could be seen as a spectrum, with ideal contentment at one end and suicide at the other, where should they draw the arrow labeled “Now I am ill“? What about years and years of being just able to survive and work, thanks to medication? Is this a life? Health?

It is the innerness of this affliction/ state of mind/temperament that is so destructive and elusive. It is possible to be brave about cancer, pain, even death; these come as attackers from outside, from Fate or Providence or the gods, and a person can have a shot at taking them with courage. But melancholia is the worm right inside the bud, chewing away at courage and self-respect. Several times in these two books, a particular question comes up: “Who am I now? What happened to my self?” “We are told,” Solomon says,

to learn self-reliance, but it’s tricky if you have no self on which to rely …the recurring nightmares are no longer of the things that will happen to me, but the things that happen in me…. Every morning starts off with that breathless uncertainty about who I am, with a check for the cancers of unseemly growth, with a momentary anxiety about whether nightmares might be true.

And Jeffery Smith echoes this:

My “me” was gone, and I wanted it back. For many months it had seemed imperative that I distance my depression—“it”—from “me.” I was determined not to let “it” still “me”; I had too much to do.

But now it seemed there was no escaping “it.” It wasn’t going anywhere; and neither was I. We were either at a standoff, or we were inseparable: was “it” me, or was I “it”?

Hence the depressive sense of shame: nobody need feel guilty about getting diabetes or multiple sclerosis, but if it is the “me” that crumbles, that loses courage and control—mustn’t it be the “me”‘s fault? People certainly make the depressive feel that it is.

It gives him or her an extra social burden. The choice is between avoiding people, boring them—or pretending. When pretending is unavoidable, loneliness becomes all the more acute. The polite mask crushes the face underneath, and the control that society demands splits the “me,” and imposes the false self that R.D. Laing and others have written about. Dickens, irrepressible actor and joker on social occasions, wrote to a friend when he was depressed about his sense of an inner creature who “is crying somewhere, by himself, at this moment. I can’t dry his eyes. He is being neglected by some ogress of a nurse. I can’t rescue him.” The sufferer cracks a joke, the child cries on.

Perhaps it is this inaccessible, preverbal element in melancholia that has made it rather seldom directly described in literature. There are those two sonnets of Hopkins’s, ground out in the poet’s strange versifications:

O the mind, mind has mountains; cliffs of fall

Frightful, sheer, no-man-fathomed

and the other, crying

What hours, O what black hours we have spent This night—

But where I say

Hours I mean years, mean life. And my lament

Is cries countless, cries like dead letters sent

To dearest him that lives alas! away.

More often, the experience has to be a whole landscape or myth or drama. Lear, old and mad and outcast. Coleridge’s mariner, becalmed on a poisonous sea. In Bleak House, a hidden, oozing city graveyard. Underworlds and bells, such as the poet Cowper visioned in the madness of his religious melancholy:

When I traversed the apartment in the most horrible dismay of soul, expecting every moment that the earth would open and swallow me, my conscience scaring me, the Avenger of Blood pursuing me, and the City of Refuge out of reach and out of sight, a strange and horrible darkness fell upon me…. All that remained clear was the sense of sin and the expectation of punishment.

The images are always of darkness and falling, downness. Solomon quotes Emily Dickinson:

And then a Plank in Reason broke,

And I dropped down, and down—

None of these, incidentally, is included in Professor Radden’s collection.

Perhaps, Jeffery Smith says, the leaden body instinctively sinks down toward earth and underworld:

We have all manner of chasms and maws and tunnels and caves of despair; we have the pit of Acheron, the Hades of myth and poetry. Over and again, through all these years, melancholic writers locate themselves in a “sink,” a “pit,” a “slough.”

Both writers ask the questions “Why the chasms, the abyss?” and “Why me?” Smith learns from his grandmother that it is “in the blood”: in grandfather, great-aunt, and a good many more that he never knew about. Solomon does not mention a family history, but suspects that his mother’s life might have been one of covert depression—unconsciously picked up, of course, all too quickly by her children. Nevertheless, both had less early trauma than would be found, I suppose, in most case histories of depressives. And both, even at their lowest, had true and loving support. Indeed, could they otherwise have surfaced to write such wise books?

Psychoanalysts have dabbled in ideas of a depression that goes right back to infancy, but it is not taken very seriously; doctors are content to ascribe a mysterious “colic” to crying babies. But Andrew Solomon, unlike father Freud, has watched a baby closely:

Watching my nephew, born while I was writing this book, in his first month of life, I saw (or projected) struggles and satisfactions that were very much like my own moods and found an apprecia-tion of depression settling on him even in the seconds it might take his mother to lift him to her breast.

The crying child that inhabited Dickens might have been no older than a baby, and the obsessive feeling of falling down into melancholy an instinctive infantile fear. The losing of a “me” that both Solomon and Smith describe could date back to the time when it is scarcely established. I have often wondered—but who would ever take this up?—whether depression should be treated less by medication or by talking therapy than by something very simple that used massage, rocking, warm blankets, soft wrappings, gentle sounds.³

In actual childhood, the fracturing of a “me” by bereavement or separation is certainly accepted as a link to later depression; those people who lost a parent early have high rates of depression and suicide. But as recently as about half a century ago, in the name of throwing out old-fashioned sentimentality, there was still an awful blindness to this: babies must be left alone to cry, children sent away to Dickensian schools to “toughen them up,” children in the hospital not visited because it would only upset them. We owe a lot to the British psychologist John Bowlby for his work from the 1950s to the 1970s on the effects of maternal deprivation and separation—ideas which are taken for granted now, but which were first solidly researched in Bowlby’s rather dense volumes. His colleague James Robertson made a poignant film in 1952 called A Two-Year-Old Goes to Hospital—does it still exist? It was shown around a great deal and had a powerful effect on hospital practice.

There is no shortage of answers, then, to the authors’ question, “Why?” Probably most cases involve several, the facile idea that depression is either endogenous (internally caused) or exogenous (caused by trauma) having faded. And behind all the causes, the symptoms, the patterns of depression, there is a basic fear that is so taboo that it has no single name: horror vacui, the fear of nothingness. People, I think, fall into two categories, either recognizing what this means or being genuinely baffled by it. A patient who described her illness in the phrase “as if everything were going to stop existing” meant this, and Smith when he writes that he felt “ghosted,” and Solomon in the experience he describes of suddenly seeing, at six years old, that the solid surface of life had holes in it that you could slip through.

These two books are important for being, so far as I know, the best yet written on the illness of ingrained sorrow. They are not handbooks for clinicians, or just self-obsessed accounts of a personal experience: both raise questions about suffering that have been with us at least since the Book of Job. Neither book can answer them, of course, but they can make the reader think about the puzzles of being human; about whether suffering can be endured, about when courage works and when it fails to; about using the knowledge extracted from pain to offer to other people. There is a moral dimension to them, something rather sparse and unfashionable at the moment. Solomon refuses to abandon free will:

Being good is a constant struggle…. I think that all of us have from nature a thing called will; I reject the notion of chemical predestination, and I reject the moral loophole it creates. There is a unity that includes who we are and how we strive to be good people and how we go to pieces and how we put ourselves back together again. It includes taking medication and getting electroshock and falling in love and worshiping gods and sciences.

…The medicine will not reinvent you. We can never escape from choice itself. One’s self lies in the choosing, every choice every day.