The Noonday Demon

by Andrew Solomon

Since the world is flawed, perfectionists tend to be depressed. Depression lowers self-esteem, but in many personalities, it does not eliminate pride, which is as good an engine for the fight as any I know.

A large proportion of my best friends are a little bit crazy. People have taken my frankness as an invitation to be frank themselves, and I have many friends with whom I have found a trust like that between schoolmates or former lovers, the ease of a vast mutual knowing. I try to be cautious with my friends who are too sane.

All I had to do was to get sick, and that would give me permission. The wish for a more visible illness was, I would later learn, a commonplace among depressives, who often engage in forms of self-mutilation to bring the physical state in line with the mental. I knew that my suicide would be devastating for my family and sad for my friends, but I felt they would all understand that I had had no choice.

I could not really concentrate on anything: I am usually a voracious summer reader, but that summer I couldn’t make it through a magazine. I started doing my laundry every night while I was awake, to keep busy and distracted. When I got a mosquito bite, I picked at it until it bled, then picked off the scabs; I bit my nails so far down that my fingers were always bleeding too; I had open wounds and scratches everywhere, though I never actually cut myself. My situation was so different from the vegetative symptoms that had constituted my breakdown that it did not occur to me that I was still in the grip of the same illness as before.

At my thirty-second birthday, I looked around at the many friends who had come for my party, and I was able to smile, knowing that this was the last one, that I would never have a birthday again, that I would soon die. The celebrations were tiring; the gifts I left in their paper wrapping. I calculated how long I would have to wait. I wrote a note to myself of the date in March when six months would have elapsed from the last encounter, when I could get my test, my confirmation. And all the while, I acted fine.

“I thought, at that point, that I would be mentally ill for the rest of my life. The episode lasted for more than a year. It seemed better to float with the down than to fight it. I think you have to let go and understand that the world will be re-created and may never again resemble what you knew previously.”

He went to the doors of a hospital several times but could not bring himself to register there. He finally signed in at Mt. Sinai Hospital in New York in September of 1986, and asked for electroconvulsive therapy. ECT had helped his father but failed to help him. “It was the most dehumanizing place I can imagine, to go from life on the outside to not being allowed to have your shaving kit or your nail clipper. Having to wear pajamas. Having to eat dinner at four-thirty. Being talked down to, as if you’re retarded in addition to being depressed.

This is not like a normal hospitalization. You are deprived of your rights on the mental health ward. I don’t think the hospital is a place for depressives unless they’re totally helpless or desperately suicidal.”

“I still have to be careful. I always feel as though everyone wants a little piece of me. There’s just so much I can give and then I’ll get really really tense. I think, perhaps wrongly, that people will think less of me if I am completely open about my experiences. I still remember being avoided. Life is always on the edge of falling down again. I’ve learned to hide it, to make it so no one can tell when I’m on three drugs and about to collapse. I don’t think I ever feel really happy. One can only expect that life not be miserable.

In the throes of depression, one reaches a strange point at which it is impossible to see the line between one’s own theatricality and the reality of madness. I discovered two conflicting qualities of character. I am melodramatic by nature; on the other hand, I can go out and “seem normal” under the most abnormal of circumstances. Antonin Artaud wrote on one of his drawings, “Never real and always true,” and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true. It’s very confusing.

I knew that eternal sadness, though very much within me, did not mitigate the happiness.

You have recurrences of increasing severity, levels of distress there is no reason for you ever to experience. We would never treat diabetes or hypertension in this on-again, off-again way; why do we do it with depression? Where has this weird social pressure come from? This illness has an eighty percent relapse rate within a year without medication,

“People worry about side effects from staying on medication for a lifetime, but the side effects of doing that appear to be insubstantial, very insubstantial compared to the lethality of undertreated depression. If you have a relative or a patient on digitalis, what would you think of suggesting he go off it, see if he has another bout of congestive heart failure, and have his heart get so flabby that it can never get back into shape again? It’s not one iota different.”

Like childbirth, depression is a pain so severe as to be immemorial.

He would get out of bed and kind of helplessly go around the house with his hands shaking, these big hands just hanging there beside his body. You understand where theories of demon possession come in, because someone had taken over my father’s body. I was five years old and I could see it. I remember it really well. He looked the same but there was nobody home.

One of the doctors told me, “Pull yourself together and stop feeling so sorry for yourself. There are people in this emergency room who are going through worse things than you are.” And when I said that I knew I had to go through the pain but wanted to take the edge off it before we proceeded, that I didn’t even mind this physical pain so much but was worried about psychiatric complications, I was told that I was being “childish” and “uncooperative.” When I said that I had a history of mental illness, I was told that in that case I could not well expect anyone to take my views on these things seriously. “I’m a trained professional and I’m here to help you,” the doctor said. When I said that I was an experienced patient and knew that what she was doing was in fact injurious to me, she told me that I had not been to medical school and would just have to proceed according to what she judged an appropriate protocol.

The standard textbook on emergency room practice in the United States does not deal with the psychiatric aspects of somatic illness. No one in the emergency room was remotely equipped to deal with psychiatric complications. I was asking for steak at the fishmonger’s.

I am usually able to control suicidality in myself, but, as I pointed out to the hospital staff after the whole episode was finished, refusing to treat the psychiatric complaints of patients can take a relatively insignificant matter such as a dislocated shoulder and make it a fatal disease. If someone says that he is suffering, emergency room staff should respond accordingly. Suicides take place in this country because of the conservatism of doctors such as the ones I encountered in that emergency room, who deal with intolerance for extreme pain (physical and psychological) as a weakness of character.

It seemed to take the most colossal effort to do simple things. I remember bursting into tears because I had used up the cake of soap that was in the shower. I cried because one of the keys stuck for a second on my computer. I found everything excruciatingly difficult, and so, for example, the prospect of lifting the telephone receiver seemed to me like bench-pressing four hundred pounds. The reality that I had to put on not just one but two socks and then two shoes so overwhelmed me that I wanted to go back to bed.

My God, I had forgotten the intensity of depression. It cuts so deep, so far! We are determined by sets of norms that are quite beyond us.

I called one of the people I was interviewing for this book and politely began the conversation by asking how he was. “Well,” he said, “my back hurts; I’ve sprained an ankle; the children are mad at me; it’s pouring rain; the cat died; and I’m facing bankruptcy. On the other hand, I’m psychologically asymptomatic at present, so I’d say all in all that things are fabulous.”

it becomes impossible to remember, when an hour is an honest hour, just how dreadful depression is—eking one’s way through endless minutes. I am so tired, so exhausted of trying to figure out who I am when I’m ‘fine’—what is normal or acceptable for me.”

Laura is constantly hindered; every part of her life is defined around her illness. “As for dating: I need people I date to be a little able to take care of themselves, because me taking care of me takes a lot of energy, and I can’t be responsible for every little hurt feeling someone has. Isn’t that a terrible way to feel about love? It’s hard to manage professionally too—the short-lived jobs, the gaps in between them. Who wants to hear about your hopes for your new medication? How can you ask that anyone understand? Before I’d ever had this illness myself, I had a dear friend who was depressive. I listened to everything he said as if we understood the same language, when what I’ve realized since is that depression speaks, or teaches you, an entirely different one.”

“I only take baths now because the water beating down on me from the shower is too much to deal with in the morning and seems, these days, like a violent way to begin the day. Driving seems like such an effort. So does visiting the ATM, shopping—you name it.”

She complained that even visits to the doctor made her feel bad. “It’s hard to be honest with him about how I’m feeling because I don’t want to let him down.”

I am so aware of it in my life right now I wince every time I hit the ‘I’ key. (Ouch. Ouch.) The whole day thus far has been an exercise in FORCING myself to do the tiniest things and trying to evaluate how serious my situation is—Am I really depressed? Am I just lazy? Is this anxiety from too much coffee or from too much antidepressant? The self-assessment process itself made me start to weep. What bothers everyone is that they can’t DO anything to help other than be present. I rely on E-mail to keep me sane! Exclamation points are little lies.”

There is only so much I can ask for while giving nothing back.

By the description of one tree, it said, ‘ALL PARTS DEADLY POISONOUS.’ I thought maybe I could find the tree, chew on a leaf or two, and curl up under a rock ledge and drift off. I miss the Laura who would have loved to put on her bathing suit and lie in the sun today and look at the blue, blue sky! She has been plucked out of me by an evil witch and replaced by a horrid girl! Depression takes away whatever I really, really like about myself (which is not so much in the first place). Feeling hopeless and full of despair is just a slower way of being dead. I try to work through these large blocks of horror in the meantime. I can see why they call it ‘mean.’ ”

“While I have spent the last week with the falling-backward sensation looming large, it felt great to swing. You get the opposite feeling: a whooshy, light sensation in the middle of your chest, like when you go just fast enough over a hill in the car. It feels good just to do something so simple; I started to feel a little more myself, and a sense of being light and feeling smart and bright came back.

Laura and I had a conversation that drifted in and out of coherence; she seemed to be speaking from some faraway place. And then as we were looking at some photos, she suddenly got stuck. It was like nothing I’d ever seen or imagined. She was telling me who was who in the photos and she began repeating herself. “That’s Geraldine,” she said, and then she winced and began again, pointing, “That’s Geraldine,” and then again, “That’s Geraldine,” each time taking longer to pronounce the syllables. Her face was frozen and she seemed to be having trouble moving her lips. I called her mother and her brother, Michael. Michael put his hands on Laura’s shoulders and said, “It’s okay, Laura. It’s okay.” We eventually managed to get her upstairs; she was still saying over and over, “That’s Geraldine.”

This is my life now. This will always be my life, these terrible plummeting descents into hell. The awful memories. Can I stand to live this way?”

There is such a thing as post–joy stress too. The worst of depression lies in a present moment that cannot escape the past it idealizes or deplores.

For many years, talking about depression was considered the best cure for it. It is still a cure. “Take notes,” wrote Virginia Woolf in The Years, “and the pain goes away.”

“It’s so hard to regulate your life, sleep, diet, exercise, under any circumstances,” comments Norman Rosenthal of the NIMH. “Think how hard it is when you’re depressed! You need a therapist as a sort of coach, to keep you at it. Depression is an illness, not a life choice, and you have to be helped through it.”

Finding a new therapist when you are feeling up and communicative is burdensome and ghastly, but doing it when you are in the throes of a major depression is beyond the pale. It is important to shop around for a good therapist. I tried eleven therapists in six weeks. For each of my eleven, I rehearsed the litany of my woes, until it seemed that I was reciting a monologue from someone else’s play. Some of the potential therapists seemed wise. Some of them were outlandish.

If you think you are smarter than your doctor, you are probably right: a degree in psychiatry or psychology is no guarantee of genius. Use the utmost care in choosing a psychiatrist.

It is important not to suppress your feelings altogether when you are depressed. It is equally important to avoid terrible arguments or expressions of outrage. You should steer clear of emotionally damaging behavior. People forgive, but it is best not to stir things up to the point at which forgiveness is required. When you are depressed, you need the love of other people, and yet depression fosters actions that destroy that love. Depressed people often stick pins into their own life rafts. The conscious mind can intervene. One is not helpless.

People with lots of neurotransmitters bumping around in their heads are not happier than people with few neurotransmitters. Depressed people do not in general have low neurotransmitter levels in the first place.

Elliot Valenstein, at the University of Michigan, adds, “Antidepressants are pharmacologically specific, but not behaviorally specific. The chemistry of products is ever more specific, but God knows what’s really happening in the brain.”