Manufacturing depression (16 page)

Our conversations—“In the past two weeks, Greg, have you been feeling especially self-critical?” “Um, I don’t know, maybe, yeah, I guess so”—were strangely, nearly perversely, at odds with the business at hand. We were talking about my sadness, my disappointment, my self-regard—matters that were not only intimate,
but that seemed to exist primarily in language, in the way I talked to myself about myself—in an almost unimaginably circumscribed manner.

This, much more than being shunted from doctor to doctor, I found hard not to take personally. It was even a little depressing: didn’t they care about me? They didn’t have to get my name right, but didn’t they at least want to hear the story behind the answers, the reasons I felt guilty or self-critical, that I woke up at four in the morning in cold sweats or collapsed into sleep at two in the afternoon? It was a story I’d been assembling over twenty years, that I inevitably thought about on my eighty-mile journeys to Mass General, and that, as these stories go, seemed pretty good to me, certainly deserving of more than a question or two about my guilt or my insomnia, more than a number circled on a page in a loose-leaf binder. It even had an ironic twist at the end of the most recent chapter, the psychiatric version of an O. Henry tale.

I was all dressed up with nowhere to go, and when I wasn’t feeling indignant about this, I found it disheartening. I felt like a fool, and a narcissistic one at that, for thinking that I mattered.

That, by the way, is a classic example of depressive thinking. Something bad happens to you, maybe just a minor insult. A store clerk is unkind. You fight with your wife. A day at work goes badly. You’re looking out your window at a gorgeous spring day, the first strong sun of the season, and you realize that the projects that you abandoned last fall are reemerging from under the receding snow, rebuking you for your disorganization. Or you just feel a twinge in your body, a queasy little ripple, and you would like to ignore it but, as with that funny noise you just heard in your car, you know you’re not making it up and you know it’s not going to just disappear.

Whatever the occasion, it is as if a trap door somewhere inside you opens up and you fall through. You start to think about all your failures, all the mistakes, all the effort and opportunity squandered,
the love lost and withheld, and the time, the irreplaceable, irretrievable time that you have misspent, that you are right now, as you slog through the tar pits of your unhappiness, misspending on self-excoriation and self-reproach and other forms of unpleasant self-absorption, your depression a serpent eating its own tail. (You might even, if you happen to have once gotten a doctorate in psychology or just read the health section of your local paper, know about the studies that show that depressed people have shorter lives. All those stress hormones that you are constantly bombarding yourself with—even if you’re not suicidal, you are surely killing yourself, you jerk.)

The story I would have told Papakostas and Dording was in its broad outlines probably nothing they hadn’t heard before, even if they’d never conducted a therapy session in their lives (and you can get to be a psychiatrist these days without a moment of nodding and stroking your beard). Psychiatrists are, no less than you and I, soaking in the blood of therapeutic confession, veins opened in memoirs and on couches—if not theirs, then Oprah’s. They’ve heard these stories—mine, yours, and anyone else’s on whom they care to risk your empathy—and they all follow the same outlines that Philip Larkin sketches so succinctly in his poem “
This Be the Verse
”:

They fuck you up, your mum and dad.

They may not mean to, but they do.

They fill you with the faults they had

And add some extra, just for you.

But they were fucked up in their turn

By fools in old-style hats and coats,

Who half the time were soppy-stern

And half at one another’s throats.

Man hands on misery to man.

It deepens like a coastal shelf.

Get out as early as you can,

And don’t have any kids yourself.

My version went like this: Mum and Dad were nineteen and twenty-two respectively when they got married. It was no shotgun wedding, just the kids doing what kids in the early fifties did: falling in love, courting, adding it up on paper—two bright Jewish kids, Wellesley and Yale, their ambitions meshing nicely with postwar prosperity, each appearing to be the balm to the other’s loneliness, pulled toward marriage like rocks rolling down a hill. They discovered quickly that they’d made a big mistake.

It took them a couple of decades before they found a way out. When I was young, and they were busy trying to destroy each other while pretending to have a happy family, I would stare at their wedding album, as if I could soak up whatever mutual joy they were feeling then and cast it on our roiling misery.

But I couldn’t, and we careened along from eruption to eruption, and the molten anger poured over us children, burning us in different ways. My sister hid in the shade of powerful men until she found her voice and became proud and ambitious and successful. My brother learned to lie low, to stand at the edge of the fire while he watched and slowly, patiently, inexorably amassed the evidence of who was to blame. I, on the other hand, pursued trouble like a heat-seeking missile. From the earliest age, I learned to enjoy the conflagrations that ensued.

We all became journalists. My sister, a part-timer like me, writes about torture at places like Abu Ghraib and Guantánamo. My brother worked his way up from the bottom to the top of the television news industry, where he produces investigative reports in which he plays the Porfiry Petrovich to all manner of Raskolnikovs. I broke into the business by writing about my long and disturbing correspondence with Ted Kaczynski, using the Unabomber to blast a career opening for me. My sister says this proclivity toward witnessing and revealing violence and injustice is not a coincidence.

As Larkin says, misery of the unhappy family variety deepens invisibly underneath you, as treacherous as a drop-off in the sea. So when I met a beautiful and witty woman in the early 1980s, when I was in my midtwenties, it stood to reason that I’d fail to see certain things. Like that I was in a state of mourning, having just lost the place where I was living—a cabin I’d built in the woods and in which I’d eked out my own Kaczynski-like subsistence (although without the letter bombs)—and that it probably wasn’t such a good time to decide to get married. Or that my intended was like my mother to an extent that was later embarrassing to admit—high-strung, sure that the world owed her a living, prone to rage when it didn’t come through, and most likely to hurt the people closest to her in the process. Or that submerged in my desire to please her, to soothe her, to make her love me, was white-hot rage, hostility bordering on hatred for forcing me to work so hard in the first place.

Which I was pleased to let her act out through all the thousand or so days of our marriage. She broke windows, heaved coffee cups, once even picked up a piano bench and smashed it on the floor. I don’t think she liked being that way, and I’m sure she hated the ways I provoked her to it. That’s probably why it only took her about five seconds to decide what to do when she discovered the Other Woman. And when she left, she took away my opportunity to duck my own anger, my self-loathing, my sadness, all the counterparts inside me to her tempestuousness.

If I’d known what else to do with those feelings, I probably wouldn’t have had to marry her in the first place. Or, after we split, to pummel myself to the floor of my study. Nearly twenty years later, when I turned up at Mass General, I’d managed to marry a grown-up woman, to grow up a little myself, and to limit my exposure to that kind of craziness to my therapy practice, where my ability to withstand the violent emotions conjured by love and loss allowed me to take the risks of empathy. But my misery had a life of its own, and as I got older and my love life settled down, it seemed
most likely to appear as I approached success. Some people thwart their ambitions by getting in their own way, but that wasn’t exactly my problem. Indeed, I was having improbable success, fulfilling ambitions that I didn’t know I had, reaping benefits that I was sure I didn’t deserve, raising expectations that I was sure I could never fulfill.

Like the contract for the book before this one, in which I was going to write a chapter about my visit to a clinical trial, which I expected would yield a mother lode of evidence about the fissures underlying the antidepressant revolution. Signing it set off a barrage of self-criticism and worry and doubt well out of proportion to the difficulty of actually writing the book. I responded in the depressive’s native fashion: I procrastinated. Until I was stuck on the couch, and on an oppressive June day, when I began to feel like I was tumbling down my personal oubliette, I finally reached for the phone and called Mass General.

I’d once written a magazine story about the placebo effect in antidepressant trials. The woman who was the star of that piece had responded so well to her pill that both she and her clinician were shocked to discover that she had been taking a placebo all along. (They wasted no time ignoring that fact; her payment for participation was a year’s worth of Effexor.) She told me that immediately after her initial call to the researchers, she felt better. And when I hung up the phone and right on schedule I felt my mood lift, it was as if I had stumbled into a bad novel, or a parody of a bad novel. The absurdity of my situation—that I had created both the grounds and the opportunity for cure of my depression by endeavoring to write about it—made me laugh, which itself made me feel even better.

Call me self-involved (and after one thousand words of this tale, how could you not?) but I thought this episode made a good story, one that captured the self-consuming experience of my depression, that provided a natural springboard into its history, that commented on my professional interest in the subject and my skepticism about
what the doctors were up to. That’s the one I was prepared to tell my Mass General doctors, had they asked.

In 1971, when Philip Larkin wrote “This Be the Verse,” psychiatrists assuredly would have asked about these particulars and would at least have feigned interest. We lived under a different climate of opinion then, the one that Adolf Meyer, with his focus on personal biography as the source of everyday suffering, did so much to usher in. Larkin, incidentally, stole his title from
Robert Louis Stevenson’s “Requiem”
, written in 1879, a poem that invokes its own climate of opinion:

Under the wide and starry sky,

Dig the grave and let me lie.

Glad did I live and gladly die,

And I laid me down with a will.

This be the verse you grave for me:

Here he lies where he longed to be;

Home is the sailor, home from sea,

And the hunter home from the hill.

Stevenson got his wish; those are exactly the lines engraved on the stone underneath which Larkin no doubt meant to set him spinning. In a century, Larkin was claiming, human life had changed from the celebration of a journey that ends in peace to a calamity that can’t end soon enough.

The novelist Stanley Elkin once wrote, “
Life is either mostly adventure
or it’s mostly psychology. If you have enough of the one then you don’t need a lot of the other.” You can see the truth of this zero-sum equation in the vast difference between Stevenson’s wide-eyed world traveler and Larkin’s grumbling explorer of the interior world, between the man who lives and dies glad to have been given the chance and sees even in death the evidence of benevolence in
the universe, and the man who has no end of complaint about his lousy childhood and, by extension, about the raw deal of human existence.

Whether or not this is
the change in human character
that Virginia Woolf famously claimed occurred on or about December 1910, it is clear that even as Adolf Meyer was democratizing mental illness, a transformation was under way. And while Woolf and her Bloomsbury circle, with their avant-garde literature and art, may have fancied themselves to be at the cutting edge of the change, it was a Viennese Jew who led the Victorians from adventure into psychology by pointing out that our lives were conducted over the deepening shelf of ocean that he called the unconscious.

Without Sigmund Freud, who would think to tell the kind of story I just did about the immolated family? Who would think to locate the source of his misery in the intimate details of his own private past? Like the idea of magic-bullet medicine, the notion that our personal history makes us who we are, that our troubles come from a mum and dad whose troubles were handed to them by theirs, is so much in our bones that it is easy to forget that it once didn’t exist.

Take the idea that depression is anger turned inward, for instance. You’ve probably heard that truism before—maybe from a friend or a therapist, or in a novel or movie—but without knowing that it originates in Freud’s essay “Mourning and Melancholia.” Those two states, Freud says, are clearly related to each other, but in their differences we can see just what the problem is in depression.
Mourning, with its “painful mood
, the loss of interest in the outside world…turning away from any task that is not related to the memory of the deceased” is an extreme state, to be sure. But it also seems in some way fitting—after all, what would it say about love if we did not grieve over the loss of the beloved?—and temporary. It may not be rational in itself, but mourning makes enough sense for doctors to “
consider interfering with it
to be pointless, or even damaging.”