We pathologize the curable, and what can easily be modified comes to be treated as illness, even if it was previously treated as personality or mood. As soon as we have a drug for violence, violence will be an illness. There are many grey states between full-blown depression and a mild ache unaccompanied by changes of sleep, appetite, energy, or interest; we have begun to class more and more of these as illness because we have found more and more ways to ameliorate them. But the cutoff point remains arbitrary. We have decided that an IQ of 69 constitutes retardation, but someone with an IQ of 72 is not in great shape, and someone with an IQ of 65 can still kind of manage; we have said that cholesterol should be kept under 220, but if your cholesterol is 221, you probably won’t die from it, and if it’s 219, you need to be careful: 69 and 220 are arbitrary numbers, and what we call illness is also really quite arbitrary; in the case of depression, it is also in perpetual flux.
Depressives use the phrase “over the edge” all the time to delineate the passage from pain to madness. This very physical description frequently entails falling “into the abyss.” It’s odd that so many people have such a consistent vocabulary, because the edge is really quite an abstracted metaphor. Few of us have ever fallen off the edge of anything, and certainly not into an abyss. The Grand Canyon? A Norwegian fjord? A South African diamond mine? It’s difficult even to find an abyss to fall into. When asked, people describe the abyss pretty consistently. In the first place, it’s dark. You are falling away from the sunlight toward a place where the shadows are black. Inside it, you cannot see, and the dangers are everywhere (it’s neither soft-bottomed nor soft-sided, the abyss). While you are falling, you don’t know how deep you can go, or whether you can in any way stop yourself. You hit invisible things over and over again until you are shredded, and yet your environment is too unstable for you to catch onto anything.
Fear of heights is the most common phobia in the world and must have served our ancestors well, since the ones who were not afraid probably found abysses and fell into them, so knocking their genetic material out of the race. If you stand on the edge of a cliff and look down, you feel dizzy. Your body does not work better than ever and allow you to move with immaculate precision back from the edge. You think you’re going to fall, and if you look for long, you will fall. You’re paralyzed. I remember going with friends to Victoria Falls, where great heights of rock drop down sheer to the Zambezi River. We were young and were sort of challenging one another by posing for photos as close to the edge as we dared to go. Each of us, upon going too close to the edge, felt sick and paralytic. I think depression is not usually going over the edge itself (which soon makes you die), but drawing too close to the edge, getting to that moment of fear when you have gone so far, when dizziness has deprived you so entirely of your capacity for balance. By Victoria Falls, we discovered that the unpassable thing was an invisible edge that lay well short of the place where the stone dropped away. Ten feet from the sheer drop, we all felt fine. Five feet from it, most of us quailed. At one point, a friend was taking a picture of me and wanted to get the bridge to Zambia into the shot. “Can you move an inch to the left?” she asked, and I obligingly took a step to the left—a foot to the left. I smiled, a nice smile that’s preserved there in the photo, and she said, “You’re getting a little bit close to the edge. C’mon back.” I had been perfectly comfortable standing there, and then I suddenly looked down and saw that I had passed my edge. The blood drained from my face. “You’re fine,” my friend said, and walked nearer to me and held out her hand. The sheer cliff was ten inches away and yet I had to drop to my knees and lay myself flat along the ground to pull myself a few feet until I was on safe ground again. I know that I have an adequate sense of balance and that I can quite easily stand on an eighteen-inch-wide platform; I can even do a bit of amateur tap dancing, and I can do it reliably without falling over. I could not stand so close to the Zambezi.
Depression relies heavily on a paralyzing sense of imminence. What you can do at an elevation of six inches you cannot do when the ground drops away to reveal a drop of a thousand feet. Terror of the fall grips you even if that terror is what might make you fall. What is happening to you in depression is horrible, but it seems to be very much wrapped up in what is about to happen to you. Among other things, you feel you are about to die. The dying would not be so bad, but the living at the brink of dying, the not-quite-over-the-geographical-edge condition, is horrible. In a major depression, the hands that reach out to you are just out of reach. You cannot make it down onto your hands and knees because you feel that as soon as you lean, even away from the edge, you will lose your balance and plunge down. Oh, some of the abyss imagery fits: the darkness, the uncertainty, the loss of control. But if you were actually falling endlessly down an abyss, there would be no question of control. You would be out of control entirely. Here there is that horrifying sense that control has left you just when you most need it and by rights should have it. A terrible imminence overtakes entirely the present moment. Depression has gone too far when, despite a wide margin of safety, you cannot balance anymore. In depression, all that is happening in the present is the anticipation of pain in the future, and the present qua present no longer exists at all.
Depression is a condition that is almost unimaginable to anyone who has not known it. A sequence of metaphors—vines, trees, cliffs, etc.—is the only way to talk about the experience. It’s not an easy diagnosis because it depends on metaphors, and the metaphors one patient chooses are different from those selected by another patient. Not so much has changed since Antonio in The Merchant of Venice complained:
It wearies me, you say it wearies you;
But how I caught it, found it, or came by it
What stuff’tis made of, whereof it is born
I am to learn;
And such a want-wit sadness makes of me,
That I have much ado to know myself.
Let us make no bones about it: We do not really know what causes depression. We do not really know what constitutes depression. We do not really know why certain treatments may be effective for depression. We do not know how depression made it through the evolutionary process. We do not know why one person gets a depression from circumstances that do not trouble another. We do not know how will operates in this context.
People around depressives expect them to get themselves together: our society has little room in it for moping. Spouses, parents, children, and friends are all subject to being brought down themselves, and they do not want to be close to measureless pain. No one can do anything but beg for help (if he can do even that) at the lowest depths of a major depression, but once the help is provided, it must also be accepted. We would all like Prozac to do it for us, but in my experience, Prozac doesn’t do it unless we help it along. Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason. These fortune-cookie admonitions sound pat, but the surest way out of depression is to dislike it and not to let yourself grow accustomed to it. Block out the terrible thoughts that invade your mind.
I will be in treatment for depression for a long time. I wish I could say how it happened. I have no idea how I fell so low, and little sense of how I bounced up or fell again, and again, and again. I treated the presence, the vine, in every conventional way I could find, then figured out how to repair the absence as laboriously yet intuitively as I learned to walk or talk. I had many slight lapses, then two serious breakdowns, then a rest, then a third breakdown, and then a few more lapses. After all that, I do what I have to do to avoid further disturbances. Every morning and every night, I look at the pills in my hand: white, pink, red, turquoise. Sometimes they seem like writing in my hand, hieroglyphics saying that the
future may be all right and that I owe it to myself to live on and see. I feel sometimes as though I am swallowing my own funeral twice a day, since without these pills, I’d be long gone. I go to see my therapist once a week when I’m at home. I am sometimes bored by our sessions and sometimes interested in an entirely dissociative way and sometimes have a feeling of epiphany. In part, from the things this man said, I rebuilt myself enough to be able to keep swallowing my funeral instead of enacting it. A lot of talking was involved: I believe that words are strong, that they can overwhelm what we fear when fear seems more awful than life is good. I have turned, with an increasingly fine attention, to love. Love is the other way forward. They need to go together: by themselves pills are a weak poison, love a blunt knife, insight a rope that snaps under too much strain. With the lot of them, if you are lucky, you can save the tree from the vine.
I love this century. I would love to have the capacity for time travel because I would love to visit biblical Egypt, Renaissance Italy, Elizabethan England, to see the heyday of the Inca, to meet the inhabitants of Great Zimbabwe, to see what America was like when the indigenous peoples held the land. But there is no other time in which I would prefer to live. I love the comforts of modern life. I love the complexity of our philosophy. I love the sense of vast transformation that hangs on us at this new millennium, the feeling that we are at the brink of knowing more than people have ever known before. I like the relatively high level of social tolerance that exists in the countries where I live. I like being able to travel around the world over and over and over again. I like that people live longer than they have ever lived before, that time is a little more on our side than it was a thousand years ago.
We are, however, facing an unparalleled crisis in our physical environment. We are consuming the production of the earth at a frightening pace, sabotaging the land, sea, and sky. The rain forest is being destroyed; our oceans brim with industrial waste; the ozone layer is depleted. There are far more people in the world than there have ever been before, and next year there will be even more, and the year after that there will be many more again. We are creating problems that will trouble the next generation, and the next, and the next after that. Man has been changing the earth ever since the first flint knife was shaped from a stone and the first seed was sowed by an Anatolian farmer, but the pace of alteration is now getting severely out of hand. I am not an environmental alarmist. I do not believe that we are at the brink of apocalypse right now. But I am convinced that we must take steps to alter our current course if we are not to pilot ourselves into oblivion.
It is an indication of the resilience of humankind that we unearth new solutions to those problems. The world goes on and so does the species. Skin cancer is far more prevalent than it used to be because the atmosphere provides us far less protection from the sun. Summers, I wear lotions and creams with high SPF levels, and they help to keep me safe. I have from time to time gone to a dermatologist, who has snipped off an outsize freckle and sent it off to a lab to be checked. Children who once ran along the beach naked are now slathered in protective ointments. Men who once worked shirtless at noon now wear shirts and try to find the shade. We have the ability to cope with this aspect of this crisis. We invent new ways, which are well short of living in the dark. Sunblock or no sunblock, however, we must try not to destroy what’s left. Right now, there’s still a lot of ozone out there and it’s still doing its job moderately well. It would be better for the environment if everyone stopped using cars, but that’s not going to happen unless there’s a tidal wave of utter crisis. Frankly, I think there will be men living on the moon before there will be a society free of automotive transport. Radical change is impossible and in many ways undesirable, but change is certainly required.
It appears that depression has been around as long as man has been capable of self-conscious thought. It may be that depression existed even before that time, that monkeys and rats and perhaps octopi were suffering the disease before those first humanoids found their way into their caves. Certainly the symptomatology of our time is more or less indistinguishable from what was described by Hippocrates some twenty-five hundred years ago. Neither depression nor skin cancer is a creation of the twenty-first century. Like skin cancer, depression is a bodily affliction that has escalated in recent times for fairly specific reasons. Let us not stand too long ignoring the clear message of burgeoning problems. Vulnerabilities that in a previous era would have remained undetectable now blossom into full-blown clinical illness. We must not only avail ourselves of the immediate solutions to our current problems, but also seek to contain those problems and to avoid their purloining all our minds. The climbing rates of depression are without question the consequence of modernity. The pace of life, the technological chaos of it, the alienation of people from one another, the breakdown of traditional family structures, the loneliness that is endemic, the failure of systems of belief (religious, moral, political, social—anything that seemed once to give meaning and direction to life) have been catastrophic. Fortunately, we have developed systems for coping with the problem. We have medications that address the organic disturbances, and therapies that address the emotional upheavals of chronic disease. Depression is an increasing cost for our society, but it is not ruinous. We have the psychological equivalents of sunscreens and baseball hats and shade.
But do we have the equivalent of an environmental movement, a system to contain the damage we are doing to the social ozone layer? That there are treatments should not cause us to ignore the problem that is treated. We need to be terrified by the statistics. What is to be done? Sometimes it seems that the rate of illness and the number of cures are in a sort of competition to see which can outstrip the other. Few of us want to, or can, give up modernity of thought any more than we want to give up modernity of material existence. But we must start doing small things now to lower the level of socio-emotional pollution. We must look for faith (in anything: God or the self or other people or politics or beauty or just about anything else) and structure. We must help the disenfranchised whose suffering undermines so much of the world’s joy—for the sake both of those huddled masses and of the privileged people who lack profound motivation in their own lives. We must practice the business of love, and we must teach it too. We must ameliorate the circumstances that conduce to our terrifyingly high levels of stress. We must hold out against violence, and perhaps against its representations. This is not a sentimental proposal; it is as urgent as the cry to save the rain forest.
At some point, a point we have not quite reached but will, I think, reach soon, the level of damage will begin to be more terrible than the advances we buy with that damage. There will be no revolution, but there will be the advent, perhaps, of different kinds of schools, different models of family and community, different processes of information. If we are to continue on earth, we will have to do so. We will balance treating illness with changing the circumstances that cause it. We will look to prevention as much as to cure. In the maturity of the new millennium, we will, I hope, save this earth’s rain forests, the ozone layer, the rivers and streams, the oceans; and we will also save, I hope, the minds and hearts of the people who live here. Then we will curb our escalating fear of the demons of the noon—our anxiety and depression.
The people of Cambodia live in the compass of immemorial tragedy. During the 1970s, the revolutionary Pol Pot established a Maoist dictatorship in Cambodia in the name of what he called the Khmer Rouge. Years of bloody civil war followed, during which more than 20 percent of the population was slaughtered. The educated elite was obliterated, and the peasantry was regularly moved from one location to another, some of them taken into prison cells where they were mocked and tortured; the entire country lived in perpetual fear. It is hard to rank wars—recent atrocities in Rwanda have been particularly ravaging—but certainly the Pol Pot period was as awful as any time anywhere in recent history. What happens to your emotions when you have seen a quarter of your compatriots
murdered, when you have lived yourself in the hardship of a brutal regime, when you are fighting against the odds to rebuild a devastated nation? I hoped to see what happens to feeling among the citizens of a nation when they have all endured such traumatic stress, are desperately poor, have virtually no resources, and have little chance for education or employment. I might have chosen other locations to find suffering, but I did not want to go into a country at war, since the despair psychology of wartime is usually frenzied, while the despair that follows devastation is more numb and all-encompassing. Cambodia is not a country in which faction fought brutally against faction; it is a country in which everyone was at war with everyone else, in which all the mechanisms of society were completely annihilated, in which there was no love left, no idealism, nothing good for anyone.
The Cambodians are in general affable, and they are friendly as can be to foreigners who visit them. Most of them are soft-spoken, gentle, and attractive. It’s hard to believe that this lovely country is the one in which Pol Pot’s atrocities took place. Everyone I met had a different explanation for how the Khmer Rouge could have happened there, but none of these explanations made sense, just as none of the explanations for the Cultural Revolution or for Stalinism or for Nazism makes sense. These things happen to societies, and in retrospect it is possible to understand why a nation was especially vulnerable to them; but where in the human imagination such behaviors originate is unknowable. The social fabric is always very thin, but it is impossible to know how it gets vaporized entirely as it did in these societies. The American ambassador there told me that the greatest problem for the Khmer people is that traditional Cambodian society has no peaceful mechanism to resolve conflict. “If they have differences,” he said, “they have to deny them and suppress them totally, or they have to take out knives and fight.” A Cambodian member of the current government said that the people had been too subservient to an absolute monarch for too many years and didn’t think to fight against authority until it was too late. I heard at least a dozen other stories; I remain skeptical.
The Noonday Demon Page 4