When she first began to be sober, Tina Sonego despaired. “That was the worst depression I ever had. That was when I secluded myself in my apartment, and since I couldn’t make decisions, I just ate turkey and bologna sandwiches for a month. Depression is a search for invalidation. And you can always find as much as you want. When you’re depressed, you keep seeking to prove that you’re unworthy. We had this discussion at AA: Who are our judges? And I realized that if one judge wasn’t giving me the negative response I needed, I’d just find another one. Even now, as I catch on to a rising star, I hear my sister saying, ‘Oh, you’re trying to be bigger than you are.’
“I’ve now been through my fifth, sixth, seventh episodes and it’s like ‘It’s back! I know what’s happening!’ It reminds me of when you’ve been absorbed in a movie and suddenly the credits start to roll and you fall back into your own life. That’s how it feels. Like the movie is over. I still can’t do a thing about it. But you do get to the point where you realize it’s not going to last forever, where you can finally be able to just wait.”
She has continued going to AA meetings for five years now—“it’s like summer camp for your brain,” she says. “I’m tired of trying to find out why. Why did I have breakdowns, become a drunk? It would be interesting to know, but why waste the time: knowing isn’t going to make me feel any better. Sobriety is like a pyramid, and every time we go up a step we feel like we’re getting somewhere, and yet there’s always another step to go. When we look down, we can’t really see the steps we’ve taken and so we feel desperate, but if we look up, we’ll see God’s finger piercing the sky and know we’re going the right way.”
Tina Sonego describes the moment when she felt the drinking and the worst of the depression had lifted. “I was in Japan, and they had these beautiful flowers in the middle of a department store. And I just stopped there and touched these flowers, and I said, ‘I have a relationship with you.’ I looked at those beautiful flowers and said, ‘I’ve got a relationship with you right now.’ It doesn’t mean it has to last forever; it doesn’t mean I have to carry you with me. It’s just, I have a relationship with you right now. And so, to this day, I still remember those flowers. I still remember the joy they gave me for that one moment.” A few years later “I had an epiphany at the Frankfurt airport. I walked around, drank coffee, smoked cigarettes, and just wondered what the hell was going on in my life, because something felt different. And I didn’t know what it was. And then I did. I finally had a voice. I didn’t know what to do with it yet, but I knew I had a voice.”
It is a hard-won voice, but it is a clarion one. Tina Sonego is capable of being amazingly upbeat; she is a trained tap dancer who will go up to the roof of the hotel where she is staying to practice dancing and breathe the night air.
“I miss the hungry years. God, I miss the hungry years. I miss the therapists who just got down on their hands and knees and tried to make me well. And I miss the amount of emotion, even if it was bad emotion. I’ll never again have that amount of emotion unless I crash again. Life will always be an experiment for me after depression, the big Ds. But I have realized the fruits of depression—though I would have slapped the face of anyone who mentioned that idea to me when I was sick. I have this dream, of getting together with a bunch of survivors of serious depression and addiction and spending a night all together dancing and laughing about the big Ds. That’s my idea of heaven.”
I have a fairly nonaddictive personality. I have had withdrawal from certain substances, but I have never had a compulsion to consume anything. A drink does not particularly make me want another drink. A good feeling that I know to be dangerous does not overwhelm me to the point at which I want another good feeling. I had never been very sympathetic with addiction until I started taking Zyprexa. It was not the addiction to Zyprexa that made the difference. No, it was that Zyprexa destroyed the set point of my appetite. Nowadays, I can eat a perfectly normal meal and still be famished, and that hunger can be so extreme as to drive me out of my house in the middle of the night to get food. I sit with my hunger and think about how ugly a paunch can be; I remember hours of exercise that burned only a few calories. Then I feel that if I don’t eat, I’ll die, and I break down, and I go and stuff myself. Then I hate having done it. I don’t make myself throw up because I don’t want to get into a pattern of doing so; and besides, I have an iron stomach and almost nothing makes me throw up. Zyprexa addicted me to food, and at one point I had gained twenty-five pounds because of it. If you could find something that did for libido what Zyprexa does for appetite, you’d be spinning out the Don Juans. I have learned what it is like to have an overpowering, compelling drive toward a self-destructive consuming. Within the normal fluctuations of my moods, a good mood gives me self-discipline and I stave off the chocolate cupcakes; but a depressed mood saps me of that strength. Depression enables addiction. Resisting desires takes so much energy and will, and when you are depressed, it is too hard just to say no—to food, to alcohol, to drugs. It’s really simple. Depression weakens you. Weakness is the surest path to addiction. Why should you say no when no will lead you only to more intolerable misery?
CHAPTER VII
Suicide
Many depressives never become suicidal. Many suicides are committed by people who are not depressed. The two subjects are not parts of a single lucid equation, one occasioning the other. They are separate entities that frequently coexist, each influencing the other. “Suicidality” is one of the nine symptoms of a depressive episode listed in DSM-IV, but many depressed people are no more inclined to end their lives than are people with appalling arthritis: the human capacity to bear pain is shockingly strong. Only if one decides that suicidality is a sufficient condition for a diagnosis of depression can one say that the suicidal are always depressed.
Suicidality has been treated as a symptom of depression when it may in fact be a problem that coexists with depression. We no longer treat alcoholism as a side effect of depression: we treat it as a problem that occurs simultaneously with depression. Suicidality is at least as independent of the depressions with which it often coincides as is substance abuse. George Howe Colt, author of The Enigma of Suicide, says, “Many clinicians believe that if they successfully [treat depression], they’ve treated the suicidal patient, as if suicidality were simply a nasty side effect of the underlying illness. Yet some suicidal patients have no diagnosable underlying illness, and patients often kill themselves shortly after coming out of a depression—or long after a depression has lifted.” A clinician treating someone who is depressed and suicidal will in general focus on curing the depression. While curing the depression may help to forestall the suicide, it will not necessarily do so. Almost half of all suicides in the United States are committed by people who have been in the care of a psychiatrist, and yet most come as a great surprise. There is something wrong with our thinking. One should not assume that suicidality can be lumped in with symptoms such as disrupted sleep; nor should one stop treating suicidality simply because the depression with which it has been associated seems to have lifted. Suicidality is an associated problem that requires its own treatment. Why is it not classed as a diagnosis of its own, related to and overlapping with depression, but essentially distinct from it?
Attempts to define suicidal depression have been singularly fruitless. No strong correlation exists between the severity of depression and the likelihood of suicide: some suicides seem to occur during mild disorders, while some people with desperate situations cleave to life. Some people in the inner cities have lost all of their children to gang violence, are physically disabled, are starving to death, have never known a minute of love of any kind, and yet cling to life with every ounce of energy in them. Some people with every bright promise in their life commit suicide. Suicide is not the culmination of a difficult life; it comes in from some hidden location beyond the mind and beyond consciousness. I can look back now at my own little para-suicidal period: the logic that seemed so abundant
ly reasonable to me at that time now seems as alien as the bacteria that gave me pneumonia a few years earlier. It is like a powerful germ that entered the body and took over. I had been hijacked by strangeness.
There are fine but important distinctions between wanting to be dead, wanting to die, and wanting to kill yourself. Most people have from time to time wished to be dead, null, beyond sorrow. In depression, many want to die, to undertake the active change from where they are, to be freed from the affliction of consciousness. To want to kill yourself, however, requires a whole extra level of passion and a certain directed violence. Suicide is not the result of passivity; it is the result of an action taken. It requires a great deal of energy and a strong will in addition to a belief in the permanence of the present bad moment and at least a touch of impulsivity.
Suicides fall into four groups. The first group commit suicide without thinking through what they are doing; it is as dire and unavoidable to them as breathing. These people are the most impulsive, and the most likely to be spurred to suicide by a specific external event; their suicides tend to be sudden. They make, as the essayist A. Alvarez has written in his brilliant meditation on suicide, The Savage God, “an attempt at exorcism” of the pain that life can blunt only gradually. The second group, half in love with easeful death, commit suicide as revenge, as though the act were not irreversible. Of this group Alvarez writes, “Here’s the difficulty about suicide: it is an act of ambition that can be committed only when one has passed beyond ambition.” These people are not so much running away from life as running toward death, wanting not the end of existence but the presence of obliteration. The third group commit suicide through a faulty logic in which death seems to be the only escape from intolerable problems. They consider options and plan their suicides, write notes, and address the pragmatics as though they were organizing a holiday in outer space. They usually believe not only that death will improve their condition, but also that it will remove a burden from the people who love them (in fact the opposite is usually true). The last group commit suicide through a reasonable logic. These people—because of physical illness, mental instability, or a change in life circumstance—do not wish to experience the painfulness of life and believe that the payoff they might receive in pleasure is insufficient to requite current pain. These people may or may not be accurate in their predictions of the future, but they are not deluded, and no amount of antidepressant medication or treatment will change their mind.
To be or not to be? There is no other subject about which so much has been written and about which so little has been said. Hamlet proposes that the decision may rest on that “undiscover’d country from whose bourn no traveler returns.” And yet men who do not fear the unknown, who gladly venture into territories of strange experience, do not so gladly leave this world of slings and arrows for a state of which nothing can be known, much can be feared, and all can be hoped. In fact, “conscience does make cowards of us all; and thus the native hue of resolution is sicklied o’er with the pale cast of thought.” This is the real question of being and not being: conscience here is consciousness, resisting annihilation not only through cowardice but also through some underlying will to exist, to seize control, to act as it is necessary to act. Moreover, the mind that recognizes itself cannot derecognize itself, and it is contrary to introspective life to destroy itself. The “pale cast of thought” is that within us that keeps us from suicide; those who kill themselves have perhaps felt not only despair, but also the momentary loss of self-consciousness. Even if the choice is simply between being and nothingness—if one believes that there is nothing at all beyond death and that the human spirit is no more than a temporary chemical arrangement—being cannot conceive of not being: it can conceive of the absence of experience but not of absence itself. If I think, I am. My own view when I am healthy is that there may be glory, peace, horror, or nothing on the other side of death, and as long as we don’t know, we should hedge our bets and make the most of the world we inhabit. “There is but one truly serious philosophical problem, and that is suicide,” Albert Camus wrote. Indeed, a large number of French people devoted their lives to this problem in the middle part of the twentieth century, taking up in the name of existentialism the questions religion had once sufficed to answer.
Schopenhauer unpacks the question. “Suicide may be regarded as an experiment,” he writes, “a question which man puts to Nature, trying to force her to answer. The question is this: What change will death produce in man’s existence and in his insight into the nature of things? It is a clumsy experiment to make, for it involves the destruction of the very consciousness which puts the question and awaits its answer.” It is impossible to know the consequences of suicide until one has undertaken it. To travel to the other side of death on a return ticket is an attractive idea: I have often wanted to kill myself for a month. One shrinks from the apparent finality of death, from the irretrievability of suicide. Consciousness makes us human, and there seems to be general agreement that consciousness as we know it is unlikely to exist beyond death, that the curiosity we would satisfy will not exist by the time it is answered. When I have wished not to be alive and wondered what it would be like to be dead, I have also recognized that to be dead would defeat the wondering. It is that wondering that keeps one going: I could give up the externalities of my life, but not the puzzling.
Though brute instinct plays the lead part, the rationale for living is, in a secular society, extremely difficult. “That life is worth living is the most necessary of assumptions,” George Santayana wrote, “and were it not assumed, the most impossible of conclusions.” The many afflictions that assail us must be considered, but perhaps more urgent is the fact of mortality. Death is so alarming and its inevitability such a disappointment that some people feel they might as well get it done with. The idea of an ultimate nothingness seems to negate the value of a current somethingness. In fact, life denies suicide by obscuring, most of the time, the reality of one’s own mortality. If death is not proud, that is because it is so generally disregarded.
I do not believe that you have to be insane to kill yourself, though I think many insane people do kill themselves and that many other people kill themselves for insane reasons. It is obvious that the analysis of the suicidal personality has to be undertaken either retrospectively or after a failed suicide attempt. Freud himself said that “we have no adequate means of approaching” the problem of suicide. One must appreciate his deference to this subject; if psychoanalysis is the impossible profession, suicide is the impossible subject. Is it crazy to want to die? The question is ultimately a religious rather than a medical one, since it depends not only on what lies on the far side of death, but also on how highly we value life. Camus suggested that what is really crazy is the lengths to which most of us go to postpone inevitable death by a few decades. Is life only an absurd deferral of death? I believe that most people, on balance, experience more pain than pleasure in a lifetime, but we hunger for the pleasure and for the cumulative joy it breeds. Ironically, most of the religious faiths that posit eternal life have prohibitions against suicide, prohibitions that prevent the fervent from leaping off cliffs to join the choirs of angels (though religions can celebrate giving up life for the cause, as in Christian martyrdoms or Islamic holy wars).
The power to commit suicide has been lauded by many men who cherished life, from Pliny, who said, “In all miseries of our earthly life, to be able to compass one’s own death is the best of God’s gifts to man”; to John Donne, who wrote in Biathanatos in 1621, “Whensoever any affliction assails me, methinks I have the keys of my prison in mine own hand and no remedy presents itself so soon to my heart as mine own sword”; to Camus. “It will generally be found,” Schopenhauer has declared, “that as soon as the terrors of life reach the point at which they outweigh the terrors of death, a man will put an end to his life.” I have myself experienced in depression a terror of life that was utterly overpowering, and at that time I was dangerously
inured to the fear of dying. I believed, however, that my terror was temporary, and that mitigated it enough to make it bearable. Rational suicide in my view cannot be a present-tense operation; it must be contingent on an accurate assessment of the longer term. I am a believer in rational suicide, which responds to futility rather than to hopelessness. The problem is that it is frequently difficult to see which suicides are rational, and it is, I believe, better to save too many people than to let too many people go. Suicide is famously a permanent solution to an often temporary problem. The right to suicide should be a basic civil liberty: no one should be forced to live against his will. On the other hand, suicidality is often temporary, and vast legions of people are glad to have been pulled back from suicide attempts or constrained from making them. If I ever attempt suicide, I’d like someone to save me, unless I have reached a point at which I accurately believe that the amount of joy left in my life cannot exceed the amount of sorrow or pain.
Thomas Szasz, an influential critic of the mental health establishment who has favored limiting the power of psychiatrists, says, “Suicide is a fundamental human right. This does not mean that it is desirable. It only means that society does not have the moral right to interfere, by force, with a person’s decision to commit this act.” Szasz believes that by intervening forcibly with the suicidal, one deprives them of the legitimacy of their selves and actions. “The result is a far-reaching infantilization and dehumanization of the suicidal person.” A Harvard study gave doctors edited case histories of suicides and asked them for diagnoses; while the doctors diagnosed mental illness in only 22 percent of the group if they were not told that the patients had committed suicide, the figure was 90 percent when the suicide was included in the patient profile. Clearly, suicidality creates a smooth diagnosis, and it is likely that some degree of infantilization—or at least paternalism—occurs. Szasz’s position has some basis in reality, but making clinical decisions on the basis of it can be extremely dangerous. The psychologist Edwin Shneidman, who began the suicide prevention movement, represents the other extreme. For him, self-murder is a mad act. “There is at least a touch of insanity in every suicide in the sense that, in suicide, there is some disconnection between thought and feelings,” he writes. “This results in an inability to label emotions, or to differentiate them into more subtle shades of meaning, and communicate them to others. It is this abnormal ‘split’ between what we think and what we feel. There lies the illusion of control; there lies madness.” This tautological view gives a basis for depriving people of their right to suicide. “Suicide is not a ‘right,’ ” Shneidman has written in pungent opposition to Szasz, “any more than is the ‘right to belch.’ If the individual feels forced to do it, he will do it.” One does, it seems worth noting, have control over belching some of the time, and one does restrain oneself as much as possible in public situations, in deference to others.
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