I wanted to point out that my own bleak experience had convinced me that virtually all the commonly prescribed minor tranquilizers (also known as benzodiazepines) are of questionable value even for healthy people; for those suffering from depression they should be shunned like cyanide, and of them all the most indisputably monstrous is a tiny gray-green oval called triazolam, better known by the brand name Halcion.
Halcion has become a kind of famous national gargoyle, part nightmare, part joke. People who haven't heard of Listerine know the name Halcion. Wasn't Halcion the sleeping medicine George Bush was on when he barfed in the lap of the prime minister of Japan? TV comics have made sport of it. But Halcion is not a very funny pill, as I discovered through personal experience. I took this tranquilizer as a remedy for the insomnia that so often accompanies depression. Although the depression I describe in my book was not directly caused by Halcion, and I said as much, I've become convinced that the pill greatly exaggerated my disorder, intensified my suicidal feelings, and finally forced me to be hospitalized. I was not aware of this cause-and-effect relationship at the time, for when my illness occurred, in 1985, Halcion had yet to be implicated as the origin of such dire mischief, and I made no connection myself.
Five years later, however, when I was writing Darkness Visible, I was able retrospectively to perceive the connection, greatly helped by the amount of information that was suddenly being made public concerning Halcion's malign effects. When the book was published I was stunned by the volume of mail I received, but nothing impressed me more than the large number of correspondents—I would estimate perhaps as many as fifteen or twenty percent—who spoke of their own Halcion-induced horrors, homicidal fantasies, near-suicides, and other psychic convulsions. This outpouring has given me a rare perspective on all aspects of depression, including the effect (or non-effect) of medications. Other pills were mentioned, notably Prozac, the antidepressant, which appears to be beneficial for many people; the spontaneous testimonials in favor of that medication convince me that, if my thick archive of correspondence is a revealing cross section, Eli Lilly's bonanza drug cannot be lightly dismissed. But Prozac, scarcely an all-purpose miracle medicine, is merely an improvement on an old formula. What is distressing is the fact that a significant number of people do have very bad reactions to Prozac, chiefly suicidal impulses (the letters to me reflect this), and it is Lilly's concerted efforts to minimize such sinister side effects that remain even now indefensible.
In a recent Nation column (“Beat the Devil,” December 7, 1992), Alexander Cockburn describes how Lilly, annoyed by evidence that its remedy might cause such harmful reactions (while already suffering a $150 million lawsuit based on this proposition), and further distressed by attacks on their product by the Church of Scientology, turned matters around by enlisting the press in a campaign that resulted in lurid onslaughts against the church in The Wall Street Journal and in Time, where the church was the subject of a cover story. There were other craftily orchestrated PR tie-ins, but this was basically the old chronicle of overpowering corporate muscle and deafening propaganda, successfully applied. Meanwhile, the advisory committee of the Food and Drug Administration that was organized to study Prozac—five of whose eight members, according to Cockburn, had “serious conflicts of interest, including substantial financial backing from Lilly”—gave the medication its OK.
I'm afraid my esteem for the Church of Scientology, unlike that of Cockburn, is lower even than my esteem for Time. The church's indiscriminate attacks on virtually all psychiatric medicines is nothing but medieval zealotry, and one would wish that the adversarial voice raised against Lilly were backed by credentials sounder than those deriving from L. Ron Hubbard's loony theology. While Cockburn's attempt to incriminate Lilly for its sorry excesses is a worthy one, he never addresses the nature of Prozac, which for many people is a very effective antidepressant. It is not a wonder drug, but it is by no means without value, and, as I say, my correspondence has reflected this fact. Lilly's wrong springs not so much from its product as from a hucksterism that admits to no deficiencies.
But no one who wrote to me had anything but ghastly tales to tell about Halcion, and in my Washington talk it seemed necessary to focus on my own devastating experiences with this pill, made by the Upjohn Company. Many years ago the phrase “ethical drug manufacturers” came into being as a result of the industry's justifiable desire to differentiate its members from the patent-medicine makers, ostensibly ethical cretins, who peddled Lydia E. Pinkham's Vegetable Compound, snake oil, Dr. Moog's Love Balm, magic crystal beads, Spanish fly, Peruna, and other shady nostrums. But even the noblest ethics suffer attrition, and it is plain that various corporations have become less ethical than others, some to the point of knavery. If there are the Tiffanys of the trade—I've heard people in the know about such topics murmur Merck with reverence—there are also those at the bottom end, and there Upjohn is clearly the Crazy Eddie of the industry. Not long ago The Nation ran a piece describing the disgraceful hype Upjohn brought to bear in advertising its potent and (like all benzodiazepines) potentially hazardous anti-anxiety drug Xanax, another multimillion-dollar winner, attempting to make it appear as free of the need for precaution as Gatorade. (See Cynthia Cotts, “The Pushers in the Suites,” Nation, August 31/September 7, 1992.) Even closer to its snake-oil origins is Upjohn's recent campaign for liquid Rogaine, an only marginally effective treatment for baldness whose capacities, according to Consumer Reports, the company has attempted to inflate by putting it into a totally ineffective shampoo called Progaine.
But beyond this relatively commonplace sleaze lies Upjohn's refusal to face up to the Frankenstein's monster its Kalamazoo laboratories let loose in the shape of Halcion. Public awareness of the dangers of the pill dates back to 1979, when a Dutch psychiatrist, Dr. C. van der Kroef, disquieted by the psychotic symptoms reported by many patients taking Halcion, carried out an in-depth investigation and sounded the alarm; the pill was soon categorically banned in the Netherlands. Shamefully, Upjohn's own awareness of the serious risk inherent in its medication goes back to the early 1970s, when the company's experiments with a volunteer group of inmates at the Jackson State Prison in Michigan came up with disturbing—or what should have been disturbing—results. The human guinea pigs developed all sorts of aberrant reactions—memory loss, paranoid feelings—that were not consonant with the safe, readily tolerated hypnotic that Halcion was intended by its makers to be.
About a year ago, both in a 60 Minutes program and a BBC documentary (in which I had a cameo role as a damaged but recovered victim), evidence that can only be described as revolting revealed that Upjohn had had full knowledge of the injurious nature of its product but put it on the market anyway. After that, sales of Halcion, which had been a top earner for years, were mercifully slowed by the adverse publicity it received; the pill has been implicated in numerous suicides and acts of violence, including several murders, the most recent of which, in Dallas County, Texas, resulted in a jury deciding that the drug was partly responsible for the killing.1
Halcion has now been banned in Britain and four other countries. Despite this and its appalling record, and the obvious fact that other readily available tranquilizers don't produce such calamitous side effects, Halcion last spring was once more approved by the ever-supine Food and Drug Administration, which insisted only that Upjohn strengthen its warning about dosage. In fairness, it should be pointed out that it is frequently an inadvertent overdose—though more often than not an extremely small one, amounting to a fraction of a milligram—that produces these evil reactions. Even so, the normally prescribed dosage has many times precipitated disastrous behavior. In any case, viewing the FDA's cavalier decision, one wonders how long aspirin would remain on the market if a small overdose of one more than the commonly recommended two tablets caused some people to lapse into paranoia and violence.
At the beginning of his new novel, Operation Shylock, which I’ve read in manuscript and which will
be published this year, Philip Roth has a brilliant and harrowing description of Halcion-induced madness, based on his own experience in 1988, when he had been innocently taking the pill for sleep after minor knee surgery. “I thought about killing myself all the time. Usually I thought of drowning: in the little pond across the road from the house…if I weren't so horrified of the water snakes there nibbling at my corpse; in the picturesque big lake only a few miles away…if I weren't so frightened of driving out there alone. When we came to New York that May…I opened the window of our fourteenth-floor hotel room…and, leaning as far out over the interior courtyard as I could while still holding tight to the sill, I told myself, ‘Do it. No snakes to stop you now.’ ”2
Withdrawal from Halcion invariably results in a disappearance of the symptoms, and Roth of course survived, as did I. But the ordeal verges on being beyond description in its nearly unalleviated anguish. Like Roth, I thought about drowning. And like Roth's, my own trial began with a surgical problem: A long-ago injury to my neck, received when I was a marine in the Korean War, had caused a nerve compression that resulted in my losing much strength in my right arm. An operation in Boston was imperative but was delayed, and during the two-week wait I had time to brood and was ravaged by anxiety. The anxiety began to hinder sleep, and to conquer the sleeplessness I commenced taking Halcion, still serenely unaware of the pill's involvement in my breakdown four years before, which was described in Darkness Visible. I had gone to California, fulfilling an obligation to teach at Claremont College. There, in that sunny landscape, I was all but totally consumed by thoughts of suicide that were like a form of lust. Somehow I managed to get through my classroom duties, but my mind was never free of exquisite pain, a pain that had but one solution—self-extinction. One night, visiting at my daughter's house in Santa Monica, I stayed awake for hours thinking only of walking out into the ocean and being engulfed by the waves. At Claremont, I kept constant schemes in mind to have my wife lured away so I could secrete myself in a closet and end it all with a plastic bag.
I held on to my sanity long enough to fly back to Boston for the operation. Although the procedure was a complete success, the raging depression hung on during the postoperative convalescence. Many times I contemplated sneaking out of the hospital and leaping into the Charles River from the bridge I could see from my window. Then suddenly a curious intervention occurred. I was consulting with a staff psychiatrist, and he asked about my sleeping habits. I told him that I was sleeping poorly but that what sleep I did get was courtesy of Halcion. The eyes of the doctor, a man plainly privy to the latest pharmaceutical alarms, sharpened interestingly, and it required no more than a few seconds for him to tell me that he was switching me immediately to a new drug. A day or two later, peering into my shaving mirror, I realized the bizarre configuration around my lips was a smile. Thus began my education about Upjohn's baneful remedy, and my shaky and haunted but eventually full recovery….
This was the chronicle I related to the audience in Washington, not the gladdening sermon that had been expected of me, perhaps, but a cautionary tale that I felt very much needed telling. But I must back up for a moment. Just a few days before my appearance, the lecture agent who had arranged my visit called me with some stimulating but hardly surprising news. The fee I was receiving for my lecture, he said, would be paid by Eli Lilly and Company, makers of Prozac, which was underwriting the symposium. Did I have any qualms about the pharmaceutical tie-in? Not really, I said, though it might depend on the company; I'd never take a penny from Upjohn. Drug companies often finance psychiatric conferences. It was not a practice I was enthusiastic about, and if I were in the profession I might feel embarrassed; as a layperson, however, I would feel compromised only if an attempt was made to censor or fiddle around with what I had to say. I told the lecture agent that I planned to make a vigorous attack on Halcion. I heard the agent catch his breath, saying he was happy the pill wasn't made by Lilly.
The word of my coming animadversions must have been leaked in advance. Minutes before the lecture I was confronted by a gentleman who identified himself as the acting director of the National Institute of Mental Health. Although friendly enough, he appeared a little distracted and nervous. After my talk, which was in a hotel ballroom, there was a press meeting billed as “A Conference with William Styron.” At the conference, where there was a microphone and podium, I faced twenty-five or thirty journalists, most of them reporters from medical and other scientific publications. They seemed generous in spirit and attentive as I approached the podium, and I felt they had reacted with considerable interest to my talk. I sensed the acting director hovering near. The first question was, “Mr. Styron, that was quite a story about Halcion. Now, what is your opinion concerning Prozac?” I replied that I had very mixed feelings about Prozac. Although I had never used it myself, I had gained contradictory evidence that it was quite beneficial for many people, while for some others it had no effect at all; for a significant few it produced sinister reactions, primarily suicidal fantasies. The many letters I had received, I continued—
But I got no further. Courteously, the acting director of the National Institute of Mental Health edged me away from the microphone. Every medication has unpredictable side effects, he said, in an I'm-taking-charge voice, but it has been clearly determined that Prozac is virtually free of the serious reactions that have plagued antidepressants in the past. No safer and more reliable treatment for depression has ever been available to therapists and physicians—a truly remarkable development in psychopharmacology. Any more questions?
There were, indeed, quite a few more questions, but none were—or could be—addressed to me, since the microphone had been, as far as I could tell, unbudgeably preempted. As the minutes ticked past I found myself sidling ever more lonesomely off to the side of the podium. The gathering had become a conference with the acting director of the National Institute of Mental Health. There was no more talk of Halcion but a great deal of talk about Prozac, most of it from the acting director, all of it fulsome and rich with commendation. After fifteen minutes the acting director briskly declared the meeting closed. As I wandered out I felt so ludicrously discomfited that I barely heard the canny, sympathetic Deep South voice of one of the journalists: “Boy, the guv'ment sure did shut you up, didn't they?”
[Nation, January 4/11, 1993.]
“Interior Pain”
The harrowing episodes I experienced during my period of grave depression eight years ago were so numerous that I could not possibly have recorded them all in Darkness Visible. But if I were revising the book, I would include my memory of an excruciating evening a week or so before my suicidal impulses overwhelmed me and I committed myself to a hospital. My wife and I had been invited to dinner with half a dozen friends at a fine Italian restaurant in New York. I very much feared the hour. The majority of people suffering from depression go through their worst pain in the morning. As the hours wear on there is some alleviation, and, with effort, they are often able to cope. With me this situation was reversed. Beginning in midafternoon the anxiety and gloom would slowly accelerate, until by dinnertime I felt virtually suffocated by psychic discomfort. Of course, that evening I could have stayed at home. Anyone suffering the equivalent pain of almost any other disease would surely remain in bed, or at least sequestered from social life. But in depression the anguish is lodged in the mind, so it matters little where the corporeal self is located; one will feel equal desolation at home in one's armchair or trying to eat dinner at La Primavera.
I say “trying” to eat dinner because my appetite had decreased over the previous week to a point where I was eating purely for sustenance. Two of my table companions were charming friends I had known for years. I picked at what must have been excellent pasta without tasting it. For no particular reason, the sense of encroaching doom was especially powerful that night. But the demented stoicism that depression imposes on behavior caused me to register scarcely a flicker of this inner devastation. I c
hatted with my companions, nodded amiably, made the appropriate frowns and smiles.
The restroom was nearby, down a flight of carpeted stairs. On my way there the fantasies of suicide, which had been embedded in my thoughts daily for several weeks, and which I had kept at bay during the dinner conversation, returned in a flood. To rid one's self of this torment (but how? and when?) becomes the paramount need of all people suffering depression. I wondered desperately whether I would make it through the rest of the evening without betraying my condition. On my return to the floor above I astonished myself by expressing my misery aloud in a spontaneous utterance which my normal self would have rejected in shame. “I'm dying,” I groaned, to the obvious dismay of a man passing down the stairway. The blurted words were one of the most fearsome auguries of my will to self-destruction: within a week I would be writing, in a stupor of disbelief, suicide notes.
Some months later, after I had been hospitalized and recovered from the illness, my two table companions recollected that I had appeared to be behaving quite normally. The monumental aplomb I exhibited is testimony to the almost uniquely interior nature of the pain of depression, a pain that is all but indescribable, and therefore to everyone but the sufferer almost meaningless. Thus the person who is ill begins to regard all others, the healthy and the normal, as living in parallel but separate worlds. The inability to communicate one's sense of the mortal havoc in one's brain is a cruel frustration. Sylvia Plath's bell jar is an apt metaphor for the isolation one feels, walled off from people who, though visible and audible, are essentially disconnected from one's own hermetically sealed self.
In recent months the press has engaged in an orgy of speculative stories about the circumstances surrounding the death of Vincent Foster.* What has been largely forgotten is that there were clear signs in the months leading up to his suicide that he was suffering from a major depression. He had reportedly lost his appetite and his weight had dropped by fifteen pounds, he had developed insomnia, he had spoken of feeling worthless, he had felt his concentration diminish—all signs of a serious affective illness. His closest friends seem to have been aware of his despondency and mystified by it.
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