He went to the doors of a hospital several times but could not bring himself to register there. He finally signed in at Mt. Sinai Hospital in New York in September of 1986, and asked for electroconvulsive therapy. ECT had helped his father but failed to help him. “It was the most dehumanizing place I can imagine, to go from life on the outside to not being allowed to have your shaving kit or your nail clipper. Having to wear pajamas. Having to eat dinner at four-thirty. Being talked down to, as if you’re retarded in addition to being depressed. Seeing other patients in padded cells. You can’t have a telephone in your room because you might strangle yourself with the cord and because they want to control your access to the outside world. This is not like a normal hospitalization. You are deprived of your rights on the mental health ward. I don’t think the hospital is a place for depressives unless they’re totally helpless or desperately suicidal.”
The physical process of the shock treatments was awful. “The man who administered them was a doctor who looked a lot like Herman Munster. The treatments were given in the basement of Mt. Sinai. All the patients who were going to get them went down there, into the depths of hell, and all of us wore bathrobes, and it felt like we were in a chain gang. Since I kept my composure pretty well, they made me the last, and I stood around there trying to comfort all the terrified people who were waiting around, while the janitorial staff came in and shoved past us to get to their lockers, which were also located down there. If I were only Dante, I’d be great explaining what it was like. I had wanted the treatments, but the room and the people—I felt like it was a barbaric Mengele scene of experimentation. If you’re going to do this stuff, do it on the fucking eighth floor with light windows and bright colors! I wouldn’t allow it now.
“I still mourn the loss of my memory,” he says. “I had an exceptional memory, nearly photographic, and it has never come back. When I got out, I couldn’t remember my locker combination, my conversations.” At first, when he came out, he also couldn’t even do filing at a volunteer job, but soon he began to function. He moved to Santa Fe for six months and stayed with friends. In the summer he returned to New York to live alone again. “Perhaps it is just as well that my memory was clearly suffering permanent deficits,” he says. “It has helped me to blunt out some of the lows. I forget them as easily as I forget everything else.” Recovery was gradual. “There is a lot of volition but you can’t control the recovery. You can’t figure out when it will happen, any more than you can predict when someone will die.”
Stein took to visiting a synagogue, going weekly with a religious friend. “I was substantially assisted by faith. It somehow relieved the pressure on me to believe in something else,” he says. “I had always been proud of being Jewish and drawn to things religious. After that big depression, I felt that if I believed hard enough, things might come about that would save the world. I had to sink so low there was nothing to believe in but God. I was slightly embarrassed to find myself drawn to religion; but it was right. It’s right that no matter how bad the week, there’s that service every Friday.
“But the thing that saved me was Prozac, which came along in 1988, just in time. It was a miracle. My head suddenly felt, after all these years, as if there wasn’t a huge crack in it that was being pulled wider and wider. If you had told me in 1987 that a year later I’d be taking planes, working with governors and senators—well, I’d have laughed. I couldn’t even cross the street.” Bill Stein is now on Effexor and lithium. “My biggest fear in life was that I would not be able to handle my father’s death. He died at the age of ninety, and when he died, I was almost euphoric to find that I could handle it. I was heartbroken and I cried, but I could do the normal things: play the son in the family, talk to the lawyers, write a eulogy. I handled it better than I would ever have thought possible.
“I still have to be careful. I always feel as though everyone wants a little piece of me. There’s just so much I can give and then I’ll get really really tense. I think, perhaps wrongly, that people will think less of me if I am completely open about my experiences. I still remember being avoided. Life is always on the edge of falling down again. I’ve learned to hide it, to make it so no one can tell when I’m on three drugs and about to collapse. I don’t think I ever feel really happy. One can only expect that life not be miserable. When you’re hugely self-conscious, it’s hard to be fully happy. I love baseball. And when I see other guys at the stadium, swilling beer, seeming so unconscious of themselves and their relation to the world, I envy that. God, wouldn’t it be great to be like that?
“I always think about those exit visas. If my grandmother had only waited. The story of her suicide taught me patience. There is no doubt that no matter how bad it gets again, I will get through it. But I would not be the person I am today without the wisdom I have gained from my experiences, the shedding of narcissism they’ve brought about.”
Bill Stein’s story has had considerable resonance for me. I have thought of those exit visas often since I first met Bill. I thought of the one that was never used and, also, of the one that was used. Getting through my first depression had involved holding on. A brief period of reasonable peace had followed. When I began to experience anxiety and major depression the second time around—while I was still in the shadow of my first depression and not yet clear where my flirtation with AIDS might have left me—I recognized what was happening. I became overwhelmed by the need to pause. Life itself seemed so alarmingly exigent, to require so much of the self. It was too difficult to remember and think and express and understand—all the things I needed to be able to do to talk. To keep my face animated at the same time was insult added to injury. It was like trying to cook and roller-skate and sing and type all at once. The Russian poet Daniil Kharms once described hunger: “Then begins the weakness. Then begins the boredom. Then comes the loss of the power of quick reason. Then comes the calmness. And then begins the horror.” In just such logical and terrible stages did the second bout of depression begin—exacerbated by real fear of the HIV test I’d scheduled. I didn’t want to go back on medication, and for a while I tried to ride it out. Then one day I realized that it wasn’t going to work. I knew about three days ahead of time that I was heading for rock bottom. I started taking the Paxil I still had in my medicine chest. I called the psychopharmacologist. I warned my father. I tried to make the practical arrangements: losing your mind, like losing your car keys, is a real hassle. Out of the terror, I heard my voice holding on tight to irony when friends called. “I’m sorry, I’ll have to cancel Tuesday,” I said. “I’m afraid of lamb chops again.” The symptoms came fast and ominously. In about a month, I lost a fifth of my body weight, some thirty-five pounds.
The psychopharmacologist thought that, since I had felt light-headed on Zoloft and highly strung on Paxil, it was worth trying something new, so he put me on Effexor and BuSpar, both of which I am still taking, six years later. In the throes of depression, one reaches a strange point at which it is impossible to see the line between one’s own theatricality and the reality of madness. I discovered two conflicting qualities of character. I am melodramatic by nature; on the other hand, I can go out and “seem normal” under the most abnormal of circumstances. Antonin Artaud wrote on one of his drawings, “Never real and always true,” and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true. It’s very confusing.
By the week of the HIV test, I was taking twelve to sixteen milligrams of Xanax (I had squirreled away a small cache of the drug) every day, so that I could sleep all the time and not be anxious. On Thursday of that week, I got up and checked my messages. The nurse from my doctor’s office said: “Your cholesterol is down, your cardiogram is normal, and your HIV test turned out fine.” I called her immediately. It was true. I was HIV-negative after all. As Gatsby said, “I tried hard to die but have an enchanted life.” I knew then that I wanted to live, and I was grateful for the news. But I went righ
t on feeling terrible for two more months. I gritted my teeth against suicidality every day.
Then, in July, I decided to accept an invitation to go sailing with some friends in Turkey. It was cheaper for me to go there than it would have been for me to be hospitalized, and it was at least three times as effective: in the perfect Turkish sunshine, the depression evaporated. Things got steadily better after that. Late in the autumn, I suddenly found that I was lying awake at night, my body trembling, much as it had done at the lowest points of my depression, but I was awake this time with happiness. I climbed out of bed and wrote about it. Years had passed since I had felt happiness at all, and I had forgotten what it is like to want to live, to enjoy the day you are in and to long for the next one, to know that you are one of the lucky people for whom life is the living of it. As surely as the rainbow covenant that God gave to Noah, I felt I had proof that existence was and would always be worth it, though. I knew that episodes of pain might lie ahead, that depression is cyclical and returns to afflict its victims over and over. I felt safe from myself. I knew that eternal sadness, though very much within me, did not mitigate the happiness. I turned thirty-three shortly thereafter, and it was a truly happy birthday, at last.
That was all I heard from my depression for a long time. The poet Jane Kenyon wrote:
We try a new drug, a new combination
of drugs, and suddenly
I fall into my life again
like a vole picked up by a storm
then dropped three valleys
and two mountains away from home.
I can find my way back. I know
I will recognize the store
where I used to buy milk and gas.
I remember the house and barn,
the rake, the blue cups and plates,
the Russian novels I loved so much,
and the black silk nightgown
that he once thrust
into the toe of my Christmas stocking.
And so it was for me that everything seemed to be returning, started strange, then went abruptly familiar, and I realized that a deep sadness had started when my mother got ill, had worsened when she died, had built beyond grief into despair, had disabled me, and was not disabling me anymore. I was still sad about the sad things, but I was myself again, as I used to be, as I always meant to go on being.
Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication. “Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication. “So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm. “But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh. “So maybe you’ll stay on a really low maintenance dose?” they ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication: “Well, I sure hope you get off sometime soon,” they say.
“I may not know the exact effects of long-term medication,” says John Greden. “No one has yet taken Prozac for eighty years. But I certainly know the effects of nonmedication, or of going on and off medication, or of trying to reduce appropriate doses to inappropriate levels—and those effects are brain damage. You start to have consequences from chronicity. You have recurrences of increasing severity, levels of distress there is no reason for you ever to experience. We would never treat diabetes or hypertension in this on-again, off-again way; why do we do it with depression? Where has this weird social pressure come from? This illness has an eighty percent relapse rate within a year without medication, and an eighty percent wellness rate with medication.” Robert Post, of the NIMH, concurs: “People worry about side effects from staying on medication for a lifetime, but the side effects of doing that appear to be insubstantial, very insubstantial compared to the lethality of undertreated depression. If you have a relative or a patient on digitalis, what would you think of suggesting he go off it, see if he has another bout of congestive heart failure, and have his heart get so flabby that it can never get back into shape again? It’s not one iota different.” The side effects of these drugs are for most people much healthier than the illness they address.
There is evidence of people having adverse reactions to everything: certainly plenty of people have had adverse responses to Prozac. A certain amount of caution is appropriate when you decide to consume anything, from wild mushrooms to cough syrup. One of my godchildren almost died through exposure to walnuts, to which he is allergic, at a London birthday party; it is a good thing that labeling law now requires products that may contain nuts to indicate as much on their labels. People who take Prozac should watch in the early stages for adverse responses. The drug can cause facial tics and stiffening of muscles. Antidepressant drugs bring up questions around addiction, which I address later on in this book. The lowered libido, weird dreams, and other effects mentioned on the labeling of the SSRIs can be miserable. I am troubled by reports that some antidepressants have been associated with suicide; I believe that this has to do with the enabling quality of the drugs, which may give someone the wherewithal to do what he was previously too debilitated to contemplate. I accept that we cannot definitively know the very long-term effect of the medications. It is most unfortunate, however, that some scientists have chosen to capitalize on these adverse reactions, spawning an industry of Prozac detractors who misrepresent the drug as a grave peril that is being foisted on an innocent public. In an ideal world, one would not take any drugs and one’s body would regulate itself adequately; who wants to take drugs? But the ludicrous assertions made in such stridently foolish books as Prozac Backlash cannot be taken for more than pandering to the cheapest fears of an apprehensive audience. I deplore the cynics who keep suffering patients from the essentially benign cures that might give them back their lives.
Like childbirth, depression is a pain so severe as to be immemorial. I didn’t develop it when a relationship ended badly during the winter of 1997. It was a breakthrough, I told someone, not to have a breakdown during my breakup. But you are never the same once you have acquired the knowledge that there is no self that will not crumble. We are told to learn self-reliance, but it’s tricky if you have no self on which to rely. Others have helped me, and there is some chemistry that has wrought a readjustment, and I feel okay with all of that for the moment, but the recurring nightmares are no longer of the things that will happen to me, that happen from outside agency, but the things that happen in me. What if tomorrow I wake up and I am not myself but a manure beetle? 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. It’s as if my self turned around and spit at me and said, don’t push it, don’t count on me for much, I have problems of my own to take care of. But then who is it who resists the madness or is pained by it? Who is it who is spit at? I have done years of psychotherapy and lived and loved and lost, and I have, frankly, no idea. There is someone or something there stronger than chemistry or will, a me that got me through the revolt of my self, a unionist me that held on until t
he rebel chemicals and their consequent ideation had been brought back into line. Is that self a chemical matter? I am no spiritualist and I grew up without religion, but that ropy fiber that runs through the center of me, that holds fast even when the self has been stripped away from it: anyone who lives through this knows that it is never as simple as complicated chemistry.
The Noonday Demon Page 11