Science resists the close study of religion and mental health mostly for methodological reasons. “When you get to things like meditation or prayer, what is the appropriate comparison standard for a double-blind test?” asks Steven Hyman, director of the National Institute of Mental Health. “Praying to the wrong God? It’s the fundamental problem with testing the therapeutic richness of prayer.” The prelate is, in addition to all else, the more acceptable face of the therapist. Indeed, Tristan Rhodes, a priest I know, said that he had for some years treated a psychotically depressed woman who refused psychotherapy but came to confession every week. She told him her stories; he then shared essential information with a psychiatrist friend; and then he reported back the views shared with him by the psychiatrist. She received in the most explicit terms the psychiatric support of the religious context.
For Maggie Robbins, faith and illness have coincided. She has become a High Church Episcopalian—at times a very devout one. She goes to church constantly: evening prayer most weekdays, sometimes two masses on Sundays (one for Communion and one just to listen), a Bible study class on Mondays, and a variety of parish activities the rest of the time. She is on the editorial board of the parish magazine and has taught Sunday school and painted backdrops for the Christmas pageant. She says, “You know, Fénelon wrote, ‘Depress me or raise me up; I adore all your purposes.’ Quietism may be heresy, but that idea is one of the central tenets of my faith. You don’t have to understand what happens. I used to think that we had to make something of life even though it was meaningless. It is not meaningless. Depression makes you believe certain things: that you are worthless and should be dead. How can one respond to that other than with alternative beliefs?” All this being said, in the worst stages of depression, religion did little to help Maggie Robbins. “As I got better I remembered, ‘Oh, yeah, religion—why didn’t I use that to help me?’ But it couldn’t help me at the low points.” Nothing could.
Evening prayer slows her down and helps to keep the chaos of depression at bay. “It’s such a strong structure,” she says. “You get up and say the same prayers every night. Someone has delineated what you’re going to say to God and other people say it with you. I’m laying down these rituals to contain my experience. The liturgy is like the wooden slats of a box; the texts of the Bible and especially of the Psalter are considered to be an extremely good box for holding experience. Going to church is a set of attentional practices that move you forward spiritually.” In some ways this seems pragmatic: it is not about belief but about scheduling and could be accomplished equally well with an aerobics class. Maggie admits that this is partly true, but denies the break between the spiritual and the utilitarian. “I’m sure one could achieve the same depth with some other religions and with some other things than religion. Christianity is just one model. It’s just a model, and when I discuss my religious experience with my therapist, or my experience of therapy with my spiritual director, those models turn out to be quite similar. My spiritual director recently told me that the Holy Spirit uses my unconscious all the time! In therapy I learn to erect ego boundaries; in church, I learn to drop them and become one with the universe, or at least part of the body of Christ. I am learning to keep erecting them and dropping them until I can do it like that.” And she snaps her fingers.
“According to Christian doctrine, you’re not allowed to commit suicide because your life is not your own. You are the steward of your life and your body, but they are not yours to destroy. You don’t end up battling everything out inside yourself; you think you’re battling it out with these other characters, with Jesus Christ and God the Father and the Holy Spirit. The Church is an exoskeleton for those whose endoskeleton has been eaten away by mental illness. You pour yourself into it and adapt to its shape. You grow a spine within it. Individualism, this breaking of ourselves away from everything else, has denigrated modern life. The Church says we should act first within our communities, and then as members of the body of Christ, and then as members of the human race. It’s so non-twenty-first-century American, but it’s so important. I take from Einstein the idea that humans are laboring under an ‘optical delusion’ that each of them is separate from the others, and from the rest of the material world, and from the universe—when in fact we are all entirely interconnected parts of the universe. For me, Christianity is the study of what real love, useful love, consists of—and of what constitutes attention. People think that Christianity is against pleasure, as it sometimes is; but it’s very, very pro-joy. You’re aiming for joy that will never go away, no matter what kind of pain you’re in. But of course you still go through the pain. I asked my priest, when I wanted to kill myself, ‘What’s the purpose of this suffering?’ and he said, ‘I hate sentences that have the word suffering and the word purpose in them. Suffering is just suffering. But I do think that God is with you in this, though I doubt you can sense him at all.’ I asked how I could put something like this in God’s hands, and he said, ‘There’s no “put,” Maggie. That’s just where it is.’ ”
Another friend, the poet Betsy de Lotbinière, has also struggled with faith from within depression, and she used belief as her primary conduit to recovery. In the low part of her depression, she says, “I hate the mistakes of myself, of course, and as I lose tolerance, I lose generosity and hate the world and the mistakes of those around me and end up wanting to scream because there are spills and stains and fallen leaves, parking fines and people who are late or don’t return calls. None of this is good. Pretty soon the children will be crying, and if I ignore that, they’ll end up very quiet and obedient, which is worse because the tears are now inside. Fear is in their eyes and they go silent. I stop hearing their secret hurts that are so easy to right when things are good. I hate myself like that. Depression takes me down and down.”
She was brought up in a Catholic household and married a man of strong Catholic faith. Though she is not so regular a churchgoer as he, she turned to God and to prayer when she felt her grip on reality slipping, when she saw how her despair was destroying her pleasure in her children, and their pleasure in the world. But she did not stay entirely within Catholicism—in fact, she tried twelve-step programs, Buddhist meditation, firewalking, visiting Hindu temples, studying Kaballah, and pretty much anything else that seemed spiritual. “When you say a prayer at a moment of anxiety, of overstriving, it can be like pushing a button and letting out parachutes to stop you from crashing, full force, into a brick wall, or falling down so hard and so fast that all the bones in your emotional body will crush,” she wrote to me in a rough time of my own. “Prayer can be your brake. Or, if your faith is big enough, prayer can be your accelerator, your amplifier in sending out into the universe a message about the direction you would like to go. Most religions of the world involve a form of stopping and accessing the inner being—so there is kneeling and there are lotus positions and there is lying flat on the floor. They also use movement to dislodge the everyday and reconnect with bigger ideas of Being—so there are music and ritual. You need both things to get out of a depression. People with a degree of faith before they reach the gutting darkness of the Abyss have a route out of there. Finding your balance in the dark is the key. This is where religions can be helpful. Religious leaders have practice in giving people some stability as they tread well-worn paths out of darkness. If you can get the hang of this balance outside you, then maybe you’ll manage to achieve balance within. Then you are free again.”
Most people cannot emerge from really serious depression just by fighting; a really serious depression has to be treated, or it has to pass. But while you are being treated or waiting for it to pass, you have to keep up the fighting. To take medication as part of the battle is to battle fiercely, and to refuse it would be as ludicrously self-destructive as entering a modern war on horseback. It is not weak to take medications; it does not mean that you can’t cope with your personal life; it is courageous. Nor is it weak to seek help from a wise therapist. Faith in G
od and any form of faith in yourself are great. You must take your therapies, all kinds, with you into the struggle. You cannot wait to be cured. “Labour must be the cure, not sympathy—Labour is the only radical cure for rooted sorrow,” wrote Charlotte Brontë; it is not the whole cure, but it is, still, the only one. Happiness itself can be a grand labor.
And yet we all know that labor on its own cannot bring about joy. Charlotte Brontë also wrote, in Villette, “No mockery in this world ever sounds to me so hollow as that of being told to cultivate happiness. What does such advice mean? Happiness is not a potato, to be planted in mould, and tilled with manure. Happiness is a glory shining far down upon us out of Heaven. She is a divine dew which the soul, on certain of its summer mornings, feels dropping upon it from the amaranth bloom and golden fruitage of Paradise. ‘Cultivate happiness!’ I said briefly to the doctor: ‘do you cultivate happiness? How do you manage?’ ” Luck plays a significant role, bringing on us as if by chance those dews of happiness. Some people respond well to one treatment, some to another. Some people remit spontaneously after a brief struggle. Some who do not tolerate medication can in fact achieve much through talking therapies; some who have given over thousands of hours to psychoanalysis get better the minute they take a pill. Some people drag themselves out of one episode with one treatment only to descend into another that requires a different treatment. Some people have refractory depression that never lifts, no matter what they do. Some people have dismaying side effects from every form of treatment, and some people never encounter the slightest trouble from hideous-sounding therapies. There may come a time when we can analyze the brain and all its functions, when we will be able to explain not only the origins of depression but also the reasons for all these differences. I am not holding my breath. For the time being, we must accept that fate has given some of us a strong vulnerability to depression, and that among those who carry such a vulnerability, some have treatment-responsive brains and some have treatment-resistant brains. Those of us who can get substantially better in any way must count ourselves, no matter how dire our breakdowns may have been, among the lucky ones. We must, further, treat those for whom there can be no recovery with forbearance. Resilience is a frequent, but not a universal, gift, and no secret in this book or elsewhere can help the unluckiest ones of all.
CHAPTER IV
Alternatives
If many remedies are prescribed for an illness,” Anton Chekhov once wrote, “you may be certain that the illness has no cure.” Many remedies are prescribed for depression—in addition to the standard measures, a stupefying number of alternatives. Some of these are wonderful and may be extremely helpful, most of them selectively. Others are perfectly ludicrous: the emperor has a whole new wardrobe in this business. Anecdotal marvels are everywhere, and people relate them with the ecstasy of the newly converted. Few of these alternative treatments are acutely harmful, except perhaps to the pocketbook; the only real danger comes when fairy-tale remedies are used in place of effective ones. The sheer quantity of alternative therapies reflects a persistent optimism in the face of the intractable problem of emotional pain.
In the wake of prior publications on depression, I have received hundreds of letters from people in nine different countries and most of the fifty states who, touchingly, have wanted to let me know about alternative treatments. One woman from Michigan wrote that after years of trying every medication, she had finally found the true solution, which was “doing things with yarn.” When I wrote back to ask her what she did with yarn, she sent me a remarkable photograph of some eighty identical little bears she had made in rainbow colors and a self-published book about really, really easy weaving. A woman in Montana complained, “You might want to know that all the effects you describe come from chronic poisoning. Look around you. Did you have your house insecticided, your lawn herbicided? Are you living with particleboard subflooring? Until writers such as William Styron and yourself examine their surroundings for such exposures, and remove them, I have no patience with you and your depression narratives.” I would not presume to speak on behalf of William Styron, whose floors may well be leaching Agent Orange, but I can say quite safely that my house, whose innards have been revealed to me during a decade of plumbing and wiring disasters, has only wood floors on a wood frame. Another of my readers thought I had mercury poisoning from the fillings in my teeth (but I don’t have any fillings in my teeth). Someone wrote me an anonymous letter from Albuquerque saying that I had low blood sugar. Someone else volunteered to help me find a teacher if I wanted to try tap-dancing lessons. Someone in Massachusetts wanted to tell me all about biofeedback. A man in Munich asked whether I would like him to replace my RNA, an offer that I politely declined. My favorite came from a woman in Tucson who wrote simply, “Did you ever consider leaving Manhattan?”
My own (and William Styron’s) situation notwithstanding, the effects of formaldehyde poisoning can in fact be similar to the symptoms of depressive illness. So too can the neurotoxicity of mercury poisoning from amalgam fillings in teeth. Low blood sugar is linked to depressed mood. I cannot testify to the therapeutic potential of tap-dancing lessons, but physical activity of any disciplined kind can be a mood elevator. Even the repeated soothing manual occupation of making things from yarn can probably serve a useful purpose under the right circumstances. Leaving Manhattan would most assuredly lower my stress level. My experience is that no one, no matter how lunatic he may seem at first glance, is completely off base. Many people achieve astonishingly good results with batty-sounding projects. Seth Roberts, in the psychology department at the University of California at Berkeley, has a theory that some depression is tied to waking up alone, and that the experience of having a talking head to look at for an hour as you begin the day may help. His patients have videotapes of the kind of talk shows that use a single camera so that the head on the screen stays about life-size. They watch these for the first hour of their day, and a convincing number of them feel miraculously much better. “I never knew that the TV could be my best friend,” one of his patients said to me. The mitigation of loneliness, even in this hokey form, can have a most uplifting effect.
I had a blessed series of encounters with a man I took to calling “the incompetent mystic.” The incompetent mystic wrote me about the energy therapies he practices, and after some considerable correspondence, I invited him to my house to demonstrate his work. He was extremely pleasant and clearly full of good intentions, and after a few minutes of discussion we set to work. He had me hold together the thumb and middle finger of my left hand to make an O and then make a similar O with my right hand. Then he had me link the two Os together. He then asked me to recite a number of sentences, claiming that when I spoke the truth, my fingers would hold firm against his attempts to pull them apart, but that when I lied, my fingers would grow weak. My gentle readers may perhaps imagine the self-consciousness I felt sitting in my own living room saying “I hate myself” while an earnest man in a light blue suit pulled at my hands. To describe the procedures that followed on this set of exercises would take pages and pages, but the high point came when he began a chant over me and forgot halfway through what it was he was supposed to be chanting. “Hold it for just a second,” he said, and searched through his briefcase until he found, “You want to be happy. You will be happy.” I decided that anyone who could not remember those two sentences was a big booby, and with some effort I got the incompetent mystic back out of my house. I have since been told by patients of their better experiences with energy therapy, and I must accept that some do reverse their “body polarity” and arrive at blissful self-love through the inspired practice of such methodologies. I, however, remain very much a skeptic—though I cannot doubt that some quacks are more gifted in their presentation than was mine.
Since depression is a cyclical illness that will go into temporary remission without any treatment, one might credit any sustained useless or useful activity with its eventual amelioration. It is my absolute belief
that in the field of depression, there is no such thing as a placebo. If you have cancer and try an exotic treatment and then you think you are better, you may well be wrong. If you have depression and try an exotic treatment and think you are better, then you are better. Depression is a disease of thought processes and emotions, and if something changes your thought processes and emotions in the correct direction, that qualifies as a recovery. Frankly, I think that the best treatment for depression is belief, which is in itself far more essential than what you believe in. If you really truly believe that you can relieve your depression by standing on your head and spitting nickels for an hour every afternoon, it is likely that this incommodious activity will do you tremendous good.
Exercise and diet play an important role in the progress of affective illness, and I believe that some considerable control can be achieved through good regimes of fitness and nutrition. Among the more serious alternative treatments I count repeated transcranial magnetic stimulation (rTMS); the use of light boxes for people with seasonal affective disorder (SAD); eye movement desensitization and reprocessing (EMDR) therapy; massage treatments; survival courses; hypnosis; sleep deprivation therapy; the plant Saint-John’s-wort; S-adenosylmethionine or SAMe; homeopathy; Chinese herbal medicine; group therapies; support groups; and psychosurgery. Only an infinite book could discuss every treatment that has ever given a reasonable result.
The Noonday Demon Page 19