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The Smart Life above the Pit
An essay about the culture of depression - a connoisseur wallow of depression.
There is this dull headache I have to contend with from time to time. Lately, I have been getting jammed when writing, frustrated with my inability to pick out the precise words, and I keep forgetting words I had looked up in the dictionary only the week before. In my wider life, I have been growing cynical by the day. My temper has become so frayed and prone to trip into rage any minute that my flatmate said the other day, “You need a break, a holiday.” A new girlfriend fails to titillate a sense of anticipation and excitement; I don’t even bother shaving or changing my boxer’s shorts when we meet. I’ve been shrugging off friends with a blunt, irreverent, and unilaterally stubborn attitude – I don’t return calls, and more and more I prefer to wander out alone. My self-indulgence reeks; I am writing too much about myself.
Inexplicable headaches, cognitive hiatus, memory failures, emotional numbness, simmering anger, trite self-indulgence: aren’t these the initial and sure symptoms of depression?
I started working on this piece to answer that question after I woke up one day and found my mind jinxed and bewildered. I remember groaning at the bright and full day intruding into my room, and it took me until after lunchtime to drag myself out of bed. I tottered downstairs, making a coffee, lighting a cigarette, and when I sat down to look at the day’s to-do list, I dawdled. I had worked on my book for two years and now, in the last two-week sprint on its way to print, I felt jaded and unenthusiastic. That afternoon my editor called and called while I left the phone unanswered, listening to her gloomy voice on the answer phone. We were running late on deadline.
Were my expectations to perform at peak levels all the time too ambitious? Is it normal to feel sapped of mental and physical energy on sporadic days? Or was I, as I started to suspect, sliding down the slope into a pit of depression?
Depression is a tricky disease because it grips so many of us and yet we know so little about it. One in ten of us suffer from the condition, and chances are that someone in your office or your family is depressed; the UN’s World Health Organisation reports that in the US and Europe depression is the second most common cause of disability after heart disease. The National Library of US Medicine Health Service defines depression as a “mood disorder as opposed to a normal reaction to life’s difficulties. Not only is the mood affected, but there are often cognitive, behavioural and physical symptoms. The mood disturbance may include apathy, anxiety, or irritability in addition to or instead of sadness.” So what marks the threshold between normal melancholia and chronic depression, or even worse, clinical or acute depression? Your guess is as good as anyone’s, because the medical profession is no wiser than witch doctors.
Doctors can only describe in abstract brushes the emotional bearings of the disease. An MRI scan may reveal that those amoebic-like movements of hot spots diverges from normal patterns, suggesting some abnormal brain metabolism. But before you know for sure, one has to answer this question: is depression a genetic neurological imbalance beyond our control or is it character and emotional rot in the psyche caused by early traumatic incidents and circumstance? The latter influences the former and vice versa, but which comes first? No one knows. Don’t expect a prognosis and a schedule on how the disease will run its course; at best, treatment is experimental. Counselling sometimes works and sometimes compounds more depression by uncovering hidden memories, activating the cascading venom of their remembrance. Treatment with drugs, particularly the large family of SSRIs, is more prevalent these days, but while drugs promise an instant fix, they do little more than numb you into emotional oblivion, and they are as precise as shooting in the dark.
Bruce E Levine, author of the recent book Commonsense Rebellion: Debunking Psychiatry, Confronting Society, is one of the few highly-placed practising psychologists who exposes the debacles of psychiatry over depression. He argues that there is little evidence that suggests that antidepressants work and their popularity – including doctors’ confidence in them – is simply down to the hyperbole stirred up by shrewd marketing. In an interview with Salon.com, the literary New Media newspaper, he swipes more scathing criticism towards pharmaceuticals. “All these new antidepressants increase the level of the neurotransmitter serotonin in the brain. The theory is that this increase fixes depression. But they’ve changed their theory every five or ten years of which neurotransmitter fixes depression. So if you look back twenty or thirty years, they were talking about norepinephrine and that’s why they were giving out things like Toplenal and Elevel. People debate whether they decided before or after Prozac that serotonin was the key to depression. Now they have come out with Wellbutrin – and that affects only dopamine.”
Amid such confusion, it is hardly surprising that we view victims of chronic depression with disbelief and suspicion. For starters, depressed people are often unable to invoke our empathy given their fastidious self-absorption, their childish egocentricity, their inexplicable anger, their unintelligible communication manner, and their incessant yelps for attention. In this age of public self-analysis, the condition seems so much a suspicious masquerade for self-aggrandising attention seeking.
A year ago, a 36-year-old friend slunk away from public life, spending her free time reading, writing, walking in the woods, or drinking herself to sleep. Corroded by unconfidence, she found her job unbearable, her life bleak. A series of relationship breakdowns enforced her self-perception of failure. “I’m fucked up,” she said, “and when men find that out, they run.” She became difficult, easily annoyed, bitter, and I had to counsel her patiently each time she spoke about suicide endearingly. One day, her voice grated as she screamed down the phone at me, pleading me to drop everything and cross London to meet her; when I said I had other commitments, she accused me of insensitivity. Her weekly counselling sessions worsened her situation by dredging up buried emotions of insecurity and frustrated yearnings; she even started resenting her “unloving mother.” Then, one fine day, her face shone, her eyes smiled, her voice sang. She had fallen in love, made plans to move to another country, and the last time I heard from her, she wrote in an email: “Life is great and I am still in love.”
Although so much of depression sounds like a charade, by all indicators, the incidence of the illness is growing. Is that increase the result of the confession societies we’re living in, where we are encouraged to pour out our anguish and itches and hence acknowledge a disease that was previously unrecognised and underreported? Is it a new awareness? Or is something else at play? Either way, the arguments are diverse and impossible to pin down with certainty, but as definitions widen, spurring more forms of depression grazing more of us, a hitherto unknown number of depression sufferers are mushrooming into a community. In a paper called Update on the Neurobiology of Depression, psychiatrists Noha Sadek and Charles Nemeroff reported that “mild depression is indeed associated with significant psycho-social impairment.” The implication is that mild or chronic depression deserves treatment, too.
The term itself is now among the favourite household words – How depressing! – and as we throw it about recklessly, it sticks more and more. It has provoked an uproar akin to sexual child abuse in the 1980s; indeed, as the 1980s were the decade of sexual abuse on children, the 1990s were the decade of depression. We are a generation that examines the self with systematic vigour, and over the past decade many writers have ridden the wave of depression’s cult popularity to write about their experience. Nothing illustrates better the current preoccupation and glamourisation of depression than the recent performances by writers that have packed New York’s club Nell’s for ‘An Evening of Stories on Depression’. If you follow American literature, this summer you can look forward to an anthology of essays titled Unholy Ghost: Writers of Depression.
Throughout the 1990s, memoirs about depression have captivated our imagination, and each book, in its own accumulative way, swells the body of literature about the topic, opening up a new range of daily, popular experience. In Jeffery Smith’s Where the Roots Reach for Water you can read about his long hours contemplating how to best drown himself in the Montana River in Canada, while in the book In the Jaws of the Black Dogs you can almost feel the tautness of John Bentley Mays’ white knuckles as he claws his hands in despair. He wrote, ‘There are a great many books about depression but this is not one of them. It is pain written, not observed; a depressive writer’s writing, a testament transcribed from wounded flesh to paper.’ Both lived to tell the tale, and both are successful writers. Elizabeth Wurtzel, too, shot to fame after writing the bestseller Prozac Nation, the roller-coaster story of her low life and her painful affair with Prozac, the pill that’s been to depression what Viagra has been to impotence.
Now to add to the list we have what claims to be the ultimate book about depression. Published a few months ago, in The Noonday Demon: An Atlas of Depression, Andrew Solomon presents us with a compendium of his suffering and research. His sanity stays afloat thanks to a daily cocktail of drugs, and he has roved the world searching for the elusive cure. What he doesn’t mention is that he is the heir of rich relatives, and it’s hard to have sympathy for someone who has money to splurge and lives in New York with “a staff of two.” He sounds like an impostor to me.
Perhaps the reason why depression has taken such a cultural and lifestyle importance is because it forces us to question, if we look at the wider context, the notion of human capacity for joy, the identity of the self. All political systems and, increasingly, the glittery promises of the good life thrust before us by the media and advertising, are built on the premise that happiness is something we can and should attain while sadness is something we can and should banish. To conform to this view drummed into our psyche we pretend to be joyful and enthusiastic, even when our innards are languishing. We have come to expect to happiness – is this realistic? Is life supposed to be joyful or a struggle? And why are we trying so hard to clutch to such an abstract and slippery a concept as happiness?
“It is un-American to be sad, therefore, or at best, sadness is simply something to be treated with antidepressant medications and otherwise need not be spoken of. However, all emotions are grand, and if sadness is among them, then I embrace sadness.” That was Rick Moody, the American novelist who wandered on the loose for years on end, his depression compounded by alcoholism.
Observers and critics like Levine are beginning to ask some of these wider questions. You only have to consider that the highest increase of mental disorder is among children, and chief among these is attention deficit disorder, which suggests that the blame could be more appropriately laid at the vagaries of the modern life. I have often wondered whether my 36-year-old friend’s bout with depression last year was a scramble for recognition in a subconscious attempt to self-portray a victim worthy of sympathy, love, even pity, which would explain why her problem evaporated when she found the fussy attention of a lover. In our quest for productive and efficient lives, coupled with maximising leisure and good times, we lead breathless and stressful life. We have torn ourselves from familial and community support, and let ourselves loose in a world where capitalism has legitimised greed, and where our insular lives encourage self-absorption, self-gratification, but we have little time for family and friends. No one is around to hold our hand when life looks bleak. Oliver James gave vent to these views in his 1998 book Britain on the Couch. He casts his nets far and wide, building a convincing argument, but these points start to falter under cross-examination, such as asking why, given the choice, a lot of people prefer the struggle of a big city than the serenity of a tiny village.
If anything, the politicisation of the disease is proof of its notoriety, and cultural notoriety often provides the ideal breeding ground. We know from the experience with child abuse that once you start raving about something, once you start planting insinuations into people’s minds and imply that we should do some self-analysis, people start imagining that something. Once you are presented with the possibility and probability again and again, it starts to apply. Abstract concepts are indiscriminate and slippery. Fatigue, anxiety, emptiness, unenthusiasm, forgetfulness, indecisiveness, guilt, hopelessness, workaholicism – one thing after the other begins to slot into place and meaning, with unmistakable lucidity, on the furtive culprit called depression. Or could it be a concoction of imagination? Remember all those cases where people became convinced of sex abuse, someone was imprisoned and years later, as more facts resurfaced, it turned out to be a hoax, no thanks to the fact that imagination is so potent it can mutate into memory. “People are down, they are really hurting,” Levine told Salon. “The issue is whether it is helpful to create a syndrome for it. For some people, it may make them feel better to know that there is a name for what they are going through, and it may make it easier for them to explain their condition to other people.”
I don’t want to propose that all depression is fake (there are serious, helpless cases), but have we created a popular and expedient hoax? Have we created a new subplot of cultural mythology that we’re turning into a lifestyle? Am I imaging my depression?
I’ve had skirmishes with depression in the past. For over two years I suffered a debilitating lower backache. A physiotherapist didn’t help; neither did a chiropractor, nor training at the gym and swimming three times a week. Then one day the pain fizzled out suddenly and completely. Lately, however, there were moments when the pain has returned for a few days at a time; a psychiatrist might raise an eyebrow and hum with a muse – depression? Another time, I lost my ability to have an erection, and after several weeks I dragged my then girlfriend with me to see a sex therapist. He detected an intense anxiety, the bedfellow of depression, and prescribed three types of pills – one to block my adrenalin, a type of Kira pills to sedate my anxiety, and St John’s Wort to ward off mild depression. The first day I took the pills, I was walking to the beach and suddenly felt so exhausted that I fell asleep on a street-bench; when I stirred awake, I looked into a handful of faces staring worriedly into my face, thinking I had had an overdose of something. Then the problem went away as mysteriously as it had come to haunt me.
Before I wrote this piece, I took an online screening test on the website of the US National Mental Health Association. It involved answering a series of questions in multiple-choice format, and my answers generated the following assessment: “Your overall results are not consistent with clinical depression. However, your answers show you might be at risk of harming yourself. You are advised to see a mental health professional immediately for a complete evaluation.” Meaning, I a mildly and chronically depressed.
I remembered a friend of mine whose life and work mirrors mine – at her prime, sexy, writing successfully…then she snapped, last year. Keeping her composure became an unrelenting struggle, and slinking out of bed became a mental puzzle. She abandoned her work and isolated herself from friends. Life in London became claustrophobic, and she started making preparations to move to a tiny, rural village. Then she saw a counsellor, who prescribed drugs that made her flounce out of bed, made her buoyant and gave her that stupid grin, but she felt disassociated too, particularly sexually.
‘I’m naturally private and reserved,’ she told me, ‘but on the drugs sex became such a dispassionate subject that I began talking about sex explicitly, as if I was talking about cooking.’
She tried to have sex, and while she felt mentally alert, her body was switched off, incapable of arousal. Music also failed to stir her emotionally any more: a mishmash of clangs, clatter and jaded voices crooning gibberish – music was a nuisance. She recounted these happy feelings coursing through her, a weird sensation of being floated up to the surface of herself, an uprooted, unmoored feeling, the antithesis of sex because sex is root-based.
“I felt like a freak,” she said.
One day, some months later, her depression evaporated. It just went away, like my back pain, like my dysfunctional erection. I could equally and easily dismiss my condition and chances are I’ll continue to lead a productive, satisfactory life. Writing is damn hard, and it doesn’t get easier with repetition. Life is hard, and when did stoicism stop being a virtue? When did wimpishness become fashionable, spurring an eagerness for instant cures, instant gratifications? Instant gratification is not necessarily a bad idea, but we should be clear about where we’re headed. Psychiatry is in the unfortunate situation of simply responding to trends and clutching to promises of cure by pharmaceutical companies, instead of leading the trends. People complain of depression, demanding an antidote, and psychiatrists opt for a two-pronged approach of counselling accompanied by antidepressants. It’s an approach borne of ignorance, a hit-or-miss strategy whose rationale is that if one does not work, then perhaps the other might. Levine, a fierce critic of many of his peers’ view that mental disorders are triggered by a biochemical and genetic predispositions, told Salon that “you can either believe in numbing or you can believe in healing – it’s very hard to do both.”
Numbing may be an understatement in the wider societal context. The high incidence of depression and its glamourisation is making it part of a lifestyle package, and self-help will be at hand soon: last month Psychology Today announced the soon-to-be-launched international magazine called Blues Busters, promising to be ‘a new antidote to the blues’, akin to a magazine about DIY home-décor. Prescriptions of drugs are so high – sixty million in the US in 1998, the country that is most fond of them – that it amounts to blatant psychological re-engineering. Popular demand and psychiatry have set the goalposts for the condition, and doctors have little choice but to prescribe antidepressants. (In the spirit of research, I visited my GP and in less time it would take you to brush your teeth, I pocketed a prescription for Prozac.)
More and more drugs are being produced, and the cocktail of drugs commonly prescribed is becoming bizarre. Andrea Yates, for example, the disturbed mother (she suffered from postpartum depression) who killed her five children last June in the US was on Wellbutrin and Effexir which, taken together, pep up the levels of dopamine, serotonin and norepinephrine. What few people know is that cocaine triggers the same flush of neurotransmitters, and some psychiatrists have said that Yates might have killed her children after the drugs made her psychotic. In a sense, antidepressants are the twins of illegal drugs through the backdoor, a sanctioned, manufactured, low-intensity high. The pharmaceuticals argued, years ago, that their drugs can’t be compared to recreational drugs because, among other reasons, they are non-addictive; now they have admitted the existence of withdrawal symptoms, but you won’t hear that term – their euphemism is “discontinuation syndrome.” We are led to believe that these are smart drugs, yet no one is sure how they cascade through the body and what other reactions they produce. A little spoken about fact is that the physiological reaction triggered by Prozac on brain cells is uncannily similar to how Ecstasy works, and why the latter is considered dangerous. I am not saying that this is necessarily a problem, but we have to fiddle with the basic makeup of our psyche with clear sight and correct perspective, because what we’re doing, in essence, is experimenting with altered states of mind.
(C) Victor Paul Borg 
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