Yer Blues

I have of late--but wherefore I know not--lost all my mirth, forgone all custom of exercise; and indeed it goes so heavily with my disposition that this goodly frame, the earth, seems to me a sterile promontory. This most excellent canopy the air, look you, this brave o'erhanging, this majestical roof fretted with golden fire--why, it appears no other thing to me than a foul and pestilent congregation of vapours. What a piece of work is a man! How noble in reason, how infinite in faculty, in form and moving how express and admirable, in action how like an angel, in apprehension how like a god--the beauty of the world, the paragon of animals! And yet to me what is this quintessence of dust? Man delights not me--no, nor woman neither, though by your smiling you seem to say so.

Hamlet


I don't know of a more powerful or compact account of depression than these few words from Shakespeare, and William Styron's Darkness Visible sufficiently conveys the essence of a severe melacholic episode and its treatment. But given the perennial shroud of mystery surrounding depression, I suppose additional memoirs couldn't hurt. So Daphne Merkin provides a narrative of her latest depressive episode, in the Times. I recall reading some years ago an article by her in The New Yorker, and this one generates a sense of deja vu. But given that depression tends to be recurrent, that may be fitting.

We speak much of the bottomless nuance of psychiatry, and the infinite individual variations of its maladies, but when it comes to really debilitating depressions, one is struck by their uniformity. The lethargy, the anhedonia, the leaden numbness, the hopelessness, the sense of utter isolation and estrangement from humanity, the inevitable thoughts of self-extinction. Whatever the myriad causes feeding into depression, its symptoms constitute a universal final common pathway.

As Merkin notes, depressives are always encouraged to seek out social contact and support, but they soon encounter the hard truth that most non-depressed people, beyond a few encouraging words, have little understanding of or patience with depression. The depressive essentially must forge a relatively euthymic facade to gain any real foothold in the social world that may eventually help boost his spirits for real. This masquerade of equanimity can feel dishonest.

She describes the peculiarly disheartening quality of the late middle-aged breakdown. The depression of youth may seem more appropriate--life is hard, and one is after all just learning the ropes, right? But several decades in, shouldn't one have gained some mastery? So the kernel of self-doubt germinates.

I relished Merkin's exasperation with her analytically-inclined therapist, who after long questioning the real helpfulness of medications, suddenly switches course and suggests that she have ECT--this is a nice illustration of the throw-up-your-hands-and-throw-in-the-kitchen-sink aspect of treating depression.

Depression, like most mental disorders, is both illness and meta-illness, sickening the body and mind at the same time that it saps the self's capacity to maintain in all respects. It is a bit like AIDS in this formal respect, an assault on the organism's defenses against all kinds of entropy. It wounds and disarms in one stroke.

Merkin's article contains what by now is the stock account of the dismal psychiatric ward experience. The usual players are here: the execrable decor, the mind-numbing routines, the callous and distant staff, and of course the insipid food. Even the antiseptic fluorescent lighting gets a mention. I'm no fan of psychiatric units, but what exactly is expected here, incandescent lighting? As if inpatient wards, in addition to their other crimes against humanity, should generate unnecessary carbon as well?

What is it about ping pong tables and psychiatric units? It is low-maintenance, offers competitive and enjoyable exercise, and unlike billiard balls, its implements cannot cause harm. The perfect pastime for the bored and potentially suicidal (and I mean this quite seriously).

Her episode ends as many, fortunately, do, more with a whimper than with a bang. Just when things seem bleakest and she is considering a return to the hospital for ECT, the gloom lightens subtly, and all of a sudden the notion of writing, of doing anything, no longer seems absurd or insurmountable. She is on Abilify--can we credit the drug, or did the episode simply wind down of its own accord? Neither she nor her psychiatrist can really know. Take what you can get and keep your fingers crossed.