Depression Studies

On my way to kill myself one hot day in July 1991, I stopped to fill up with the petrol necessary to see the job through. An old woman with heavy shopping bags was trying to cross the road. She was staggering and in danger of being run down. I offered help. She asked me to call a taxi to take her home. There was no phone so I offered to take her myself. With difficulty I got her into the car. She put the hosepipe on her lap. Half a mile up the road she said: ‘The shops were so crowded, but then there’s only four days to go. Still, I’ve got all my shopping done now.’

‘Four days to go to what?’ I asked.

‘Christmas,’ she replied.

As I drove I could feel her scrutinising me suspiciously: ‘I hope you’re not on drugs, young man.’

I asked her again where she lived. She directed me, with great confidence, into a cul-de-sac, only to declare that this, obviously, wasn’t where she lived. We tried again, with the same result. Impatiently and desperately, I told her I couldn’t take her home if she couldn’t tell me where she lived. I felt that the terrible resolve I’d screwed up for this second suicide attempt was dissipating. She replied with equal impatience: ‘Are you a complete stranger to this area?’

‘Yes,’ I replied weakly, now wishing I’d left her to her own devices. Without a moment’s pause, she said, ‘Well you can’t be a complete stranger, because you’re here now,’ and laughed. After a while we happened on the road where she lived. She offered me a ten pound note, which I had to decline several times. Realising I wasn’t going to take it, she said brightly: ‘Oh well, never mind – I’ll see you again.’

See me again? I resumed my journey wondering if she’d been sent to save me. No: my resolve to die was the greater for having met her. I didn’t want to end up like her. Depression is like that – it attaches to the negative in anything. Still, I had wanted to help her; something resembling sympathy was still alive in me. So what is the answer to the question increasingly asked of depression today: is there anything ‘positive’ to be gained from it? A question which only arises if you survive it.

In periods of depression I’ve certainly had a keener sense of the misery of others. I would often wake to wish I hadn’t, and then weep when hearing the morning news – nothing exceptional, just the usual catalogue of misery and violence. If this was empathy it was subordinate to a powerful overflow of self-pity, and present when I was at my most incapable. So one shouldn’t sentimentalise it: empathy that derives from the chronic impotence of depression doesn’t add up to much. Later, when I’d more or less recovered, I was, like most ‘together’ people, capable of absorbing news as background information while eating breakfast, driving to work, or performing any number of ordinary tasks which had previously defeated me – academic administration is one that sticks in the mind. And with such pressing tasks to complete, elderly people would be left to the traffic. If there is a selfishness in ‘mental health’ it has less to do with conscious callousness than with defending oneself against reality. To be without the defences of sanity and psychic health is not necessarily a gain, although some would claim that it is and those who have written most eloquently about depression impute an almost spiritual dimension to it. On the one hand, depressives are seen to suffer from an illness treatable by medication, no different in principle from asthma or kidney disease: on the other, the experience of depression has once again become the stimulus for self-scrutiny and social critique, in the best tradition of Renaissance melancholy. There’s a dark night of the soul aspect to it – a sense that if we can survive it, spiritual gain will follow.

In the second half of the last century philosophical movements such as Existentialism and libertarian movements celebrating sexual freedom were trenchantly anti-religious. In retrospect we can see that they nonetheless contained quasi-religious tendencies, most notably the quest for truth-in-selfhood: existential bad faith and sexual hypocrisy were seen as evasions of an authenticity which could save the self if not society. Reading the growing ‘confessional’ literature of depression, culminating in Andrew Solomon’s The Noonday Demon,* I find myself wondering if depression isn’t becoming the focus for the stubborn Western quest for authentic being. In depression, Solomon writes, ‘I learned … the full extent of my soul.’ Depression is taken to be the condition from which those aspects of contemporary life which thwart the secular soul are felt most acutely. We already have Depression Studies but, were we short of ‘isms’, we might see this development as something rather different, something like depressionism. It’s a worldview that presupposes both an experience of the illness sufficiently severe to be life-threatening and life-changing, and a remission sufficiently prolonged to allow a reflective, exploratory writing about it to emerge; which believes, in short, that there is much more than illness to depression. There are indeed religious echoes here, but only echoes. First, the soul in question is fragile, in danger of being thwarted to the point of destruction, or rather self-destruction. Second, there’s no possibility of conversion and every likelihood of relapse – nothing to convert to, only something to escape from, and for most the escape is never permanent. About nine out of ten people who have experienced depression once will do so again.

The idea that melancholia may stimulate, or be the price of, deep understanding and creative endeavour goes back beyond Ficino, and in recent times has been explored by Julia Kristeva (Black Sun: Depression and Melancholia), Kay Redfield Jamison (Touched with Fire) and others. It seems that a new subjectivity is being forged from the experience of breakdown. It goes hand in hand with a sense that the depressed are especially vulnerable to the crazy pace and technological chaos of life, the alienation that results, and the breakdown of traditional belief and family structures. But almost a century ago Freud was citing contemporary ‘nerve specialists’ who believed that late 19th-century modernity exacerbated the incidence of ‘modern nervous illness’ to a dangerous degree. W. Erb, for example, attributed such illness to ‘the immense extension of communications … that encircle the world … All is hurry and agitation.’ Erb is not talking about the Internet, only the telephone and the telegraph. Freud, as we know, saw the main cause as the high degree of sexual repression in modern civilisation.

There is a tendency to collapse all kinds of human misery into depression. A century ago many symptoms now allied to depression would have been attributed to hysteria or neurasthenia, and more recently to one or more kinds of phobia. The sheer diversity of causes and symptoms now associated with depression is bewildering: loss is a classic cause, most obviously bereavement, but so are job loss and loss of self-esteem. But then something like the exact opposite of loss can also be a cause for depression: having a baby, getting a promotion, a new job, the achievement of something long worked for. Similarly with symptoms: in some people depression produces loss of appetite, loss of libido or insomnia; in others compensatory over-eating, heightened libidinal activity, or sleeping excessively. For some, depression can come suddenly and apparently from nowhere quite late in life; for others, it’s an intensification of a lifelong melancholy. Can it really be the same ‘illness’ that’s involved?

And are the statistics trustworthy? Here’s a sample of some of the more cautious figures presented by Solomon: worldwide, depression is the leading cause of disability for people over the age of five. It claims more ‘years’ than war, cancer and Aids combined. Manic depression is the second highest killer of young women, the third of young men. Half of those with manic depression and one in five of those with major depression will make a suicide attempt. Previous attempts are the strongest factor in predicting suicide. Untreated depresssion has a mortality rate of between 10 and 20 per cent. Nineteen million Americans suffer from severe depression; 28 million – one in ten – are on Prozac or its like. Some scientists claim the rate of depression is doubling every twenty years. If one takes into account the fact that other diseases, from alcoholism to heart disease, mask the depression which causes them, depression, Solomon writes, may turn out to be ‘the biggest killer on earth’.

We should be sceptical about depression as the catch-all for human misery. Following Foucault, we might even detect something quite insidious: a new classification of illness which is about empowering the professionals who treat it as much as those who suffer from it. Foucauldians also point out that the classification tends to be self-fulfilling: we find ourselves ill according to the labels; hysteria has indeed mutated into depression. Anti-capitalists will brood on the profits of the companies that provide the drugs which, increasingly, are used to treat depression, while conspiracy theorists may believe that the professionals and the drug companies work together.

After more than thirty years of recurrent depression I’m less sure now than ever why it comes. The psychiatrists who dispense me drugs believe it’s biochemical. Friends who are followers of Freud know it’s coming from my unconscious and believe that analysis is the only answer. Relatives who disapproved of my homosexuality believe that to be the problem. My older brother concluded it was the dubious company I kept at university; an obese neighbour was sure it was a combination of bad diet and late nights; and a neurotic American friend that it was a lethal combination of drinking coffee and not jogging.

I’m the only one who still doesn’t know. I do know that there’s something deeply mysterious about it. For reasons one never fully understands, it begins with an inability to get pleasure from anything, followed by an inability to carry through even – or especially – the most mundane tasks. From there, experience differs widely but many people end up having thoughts of suicide, attempting it and sometimes succeeding. That final phase is the most terrifyingly mysterious of all: it’s not so much that the life force has been extinguished; rather, it seems to have been turned against itself. Tolstoy describes it like this: ‘The force that drew me away from life … was a force like that of my previous attachment to life, only in a contrary direction.’ Maybe the will to live and the wish to die share the same obscure origins. I suspect Byron was saying something like this, as well as writing from his own depression, when, in Don Juan, he says that ‘life’s strange principle will often lie/Deepest in those who long the most to die.’

The mystery is there, too, in the loneliness of the experience, in its being beyond the reach of communication or even expression. Those who have had it struggle for the right analogy without ever feeling they’ve found it. Lewis Wolpert begins his study Malignant Sadness by telling us bluntly that the experience was more terrible than watching his wife die of cancer. If that is a shocking admission, it’s also an honest attempt to convey a pain beyond expression.

In that prolonged depression of mine during 1990-91, I tried three times to kill myself. The first attempt was, in that trite but accurate phrase, a cry for help. Though I overdosed a little I didn’t really want to die, and I certainly didn’t want to do the killing. With the second, a few days later, I wanted to die but still didn’t want to do the killing. With the third attempt, shortly after that, I wanted to die and was now prepared to do the killing, washing down a huge overdose of pain-killers with whisky. I recovered consciousness later, amid a lot of vomit. I was seeing a psychiatrist at the time, and managed to get an unscheduled meeting with him. He told me he had a patient who’d overdosed on the same drug and lived, but only a vegetable existence. Maybe he was trying to frighten me. Certainly my greatest fear was to botch the attempt and survive in a damaged state. I threw the rest of the tablets away. Of the several psychiatrists I’d seen in my life I felt indebted to this one, who didn’t conceal the anger he felt about those of his patients who had succeeded in killing themselves: among his colleagues, he had the lowest suicide rate and this was a measure of professional success – a record he wanted to keep. He struck a deal with me: if I promised not to try suicide again, he wouldn’t section me.

With psychiatrists, you tend to know where you stand. Sometimes this is because they are stupid. I think the first one I encountered – I was about 21 – had aspirations to upgrade to analyst status. She kept wanting to know why I came to see her dressed in black leather. I rode a motorbike, I explained, and it was the only way of getting to see her. Having already had one serious accident, which left a lot of my skin on the tarmac, and put me in hospital for weeks, I was now inclined to be cautious. She was convinced there was more to it. In the end I took off the leathers in the hospital carpark, leaving them with the bike, only to find them stolen when I returned. Perhaps she had a point: years later a real analyst told me he thought I treated life like a motorbike – ‘something on which to roar off into the distance’. I wondered about the films he’d been watching. He thought it inadvisable to begin therapy at that stage, fearing it might throw up something too distressing and that I’d try and kill myself again. I was willing to take the risk but he wouldn’t budge. I felt it was cowardice on his part rather than concern for me: suicide isn’t good business for the analyst any more than it is for the psychiatrist. Behind the severity of the psychoanalyst I’ve often detected a professional timidity.

Depression may strip away one’s defences against reality, but it can encourage its own illusions. I’ve wanted to believe my own depression to be biological, chemical or hereditary, because that way I could stop searching for the cause, stop trying different cures, and hand myself over for treatment in good faith, as one might with any other illness. One of my symptoms is chronic fatigue, and doctors have often tested my blood for illnesses associated with that condition. I’ve been disappointed when they’ve found nothing, being willing to exchange depression for even a serious ‘physical’ illness that was explicable and treatable.

Probably my most sustaining illusion grew from my first devastating depression around the age of twenty, which led to a suicide attempt that I only just survived. In a car in a lay-by on a country road I took an overdose and cut my wrists. I was unconscious for hours. A man noticed the car in the early morning on his way to work. Becoming uncharacteristically ill later in the day, he decided to go home. The car was still there and he became suspicious. The ambulance crew apparently thought I was dead, and in the difficult years that followed I came to believe that to have survived such a close brush with death, both then and in my various road accidents, meant it was my destiny to survive. It may have been grandiose, but for a while it was a sustaining illusion, and I don’t regret it.

It was my version of the common belief that there is some meaningful connection between depression and the better things about us and our lives. Kay Redfield Jamison, who wrote about her own manic depression in An Unquiet Mind: A Memoir of Moods and Madness, resisted drug treatment because she knew that during her mild highs she was most intensely alive. The melancholy thinkers of the Renaissance believed they were treading a painful path to metaphysical insight. Later, artists wrote of resigning themselves to suffering in order to drive their art to daemonic heights. Today the religious and romantic echoes remain but the gain of depression is more than ever to do with a feeling of inner wellbeing. And if this resembles rather closely that state of wellbeing which, according to the newspaper supplements, we can get with rather less stress through gardening, we might want to consider those earlier times, and to remember the obvious but significant fact that most religion, much philosophy and a good deal of art grew from the experience of suffering. There is indeed a connection between suffering and intellectual and artistic production, but it makes little sense to insist that it always involves depression. Andrew Solomon describes an ‘acute awareness of transience and limitation’ as a ‘mild depression’. Which would mean that most writers in the Western tradition were clinically depressed. As for the idea that one can learn from depression, the same is potentially true of any acute or prolonged illness, or indeed any unusual experience, especially if it confronts us with the prospect of death.