Darkness Visible: A Memoir of Madness (5 page)

VII

I
T WAS DR. GOLD, ACTING AS MY ATTENDING PHYSICIAN
, who was called in to arrange for my hospital admission. Curiously enough, it was he who told me once or twice during our sessions (and after I had rather hesitantly broached the possibility of hospitalization) that I should try to avoid the hospital at all costs, owing to the stigma I might suffer. Such a comment seemed then, as it does now, extremely misguided; I had thought psychiatry had advanced long beyond the point where stigma was attached to any aspect of mental illness, including the hospital. This refuge, while hardly an enjoyable place, is a facility where patients still may go when pills fail, as they did in my case, and where one’s treatment might be regarded as a prolonged extension, in a different setting, of the therapy that begins in offices such as Dr. Gold’s.

It’s impossible to say, of course, what another doctor’s approach might have been, whether he too might have discouraged the hospital route. Many psychiatrists, who simply do not seem to be able to comprehend the nature and depth of the anguish their patients are undergoing, maintain their stubborn allegiance to pharmaceuticals in the belief that eventually the pills will kick in, the patient will respond, and the somber surroundings of the hospital will be avoided. Dr. Gold was such a type, it seems clear, but in my case he was wrong; I’m convinced I should have been in the hospital weeks before. For, in fact, the hospital was my salvation, and it is something of a paradox that in this austere place with its locked and wired doors and desolate green hallways—ambulances screeching night and day ten floors below—I found the repose, the assuagement of the tempest in my brain, that I was unable to find in my quiet farmhouse.

This is partly the result of sequestration, of safety, of being removed to a world in which the urge to pick up a knife and plunge it into one’s own breast disappears in the newfound knowledge, quickly apparent even to the depressive’s fuzzy brain, that the knife with which he is attempting to cut his dreadful Swiss steak is bendable plastic. But the hospital also offers the mild, oddly gratifying trauma of sudden stabilization—a transfer out of the too familiar surroundings of home, where all is anxiety and discord, into an orderly and benign detention where one’s only duty is to try to get well. For me the real healers were seclusion and time.

VIII

T
HE HOSPITAL WAS A WAY STATION, A PURGATORY
. When I entered the place, my depression appeared so profound that, in the opinion of some of the staff, I was a candidate for ECT, electroconvulsive therapy—shock treatment, as it is better known. In many cases this is an effective remedy—it has undergone improvement and has made a respectable comeback, generally shedding the medieval disrepute into which it was once cast—but it is plainly a drastic procedure one would want to avoid. I avoided it because I began to get well, gradually but steadily. I was amazed to discover that the fantasies of self-destruction all but disappeared within a few days after I checked in, and this again is testimony to the pacifying effect that the hospital can create, its immediate value as a sanctuary where peace can return to the mind.

A final cautionary word, however, should be added concerning Halcion. I’m convinced that this tranquilizer is responsible for at least exaggerating to an intolerable point the suicidal ideas that had possessed me before entering the hospital. The empirical evidence that persuades me of this evolves from a conversation I had with a staff psychiatrist only hours after going into the institution. When he asked me what I was taking for sleep, and the dosage, I told him .75 mg of Halcion; at this his face became somber, and he remarked emphatically that this was three times the normally prescribed hypnotic dose, and an amount especially contraindicated for someone my age. I was switched immediately to Dalmane, another hypnotic which is a somewhat longer-acting cousin, and this proved at least as effective as Halcion in putting me to sleep; but most importantly, I noticed that soon after the switch my suicidal notions dwindled then disappeared.

Much evidence has accumulated recently that indicts Halcion (whose chemical name is triazolam) as a causative factor in producing suicidal obsession and other aberrations of thought in susceptible individuals. Because of such reactions Halcion has been categorically banned in the Netherlands, and it should be at least more carefully monitored here. I don’t recall Dr. Gold once questioning the overly hefty dose which he knew I was taking; he presumably had not read the warning data in the
Physicians’ Desk Reference.
While my own carelessness was at fault in ingesting such an overdose, I ascribe such carelessness to the bland assurance given me several years before, when I began to take Ativan at the behest of the breezy doctor who told me that I could, without harm, take as many of the pills as I wished. One cringes when thinking about the damage such promiscuous prescribing of these potentially dangerous tranquilizers may be creating in patients everywhere. In my case Halcion, of course, was not an independent villain—I was headed for the abyss—but I believe that without it I might not have been brought so low.

I stayed in the hospital for nearly seven weeks. Not everyone might respond the way I did; depression, one must constantly insist, presents so many variations and has so many subtle facets—depends, in short, so much on the individual’s totality of causation and response—that one person’s panacea might be another’s trap. But certainly the hospital (and, of course, I am speaking of the many good ones) should be shorn of its menacing reputation, should not so often be considered the method of treatment of last resort. The hospital is hardly a vacation spot; the one in which I was lodged (I was privileged to be in one of the nation’s best) possessed every hospital’s stupefying dreariness. If in addition there are assembled on one floor, as on mine, fourteen or fifteen middle-aged males and females in the throes of melancholia of a suicidal complexion, then one can assume a fairly laughterless environment. This was not ameliorated for me by the subairline food or by the peek I had into the outside world:
Dynasty
and
Knots Landing
and the
CBS Evening News
unspooling nightly in the bare recreation room, sometimes making me at least aware that the place where I had found refuge was a kinder, gentler madhouse than the one I’d left. In the hospital I partook of what may be depression’s only grudging favor—its ultimate capitulation. Even those for whom any kind of therapy is a futile exercise can look forward to the eventual passing of the storm. If they survive the storm itself, its fury almost always fades and then disappears. Mysterious in its coming, mysterious in its going, the affliction runs its course, and one finds peace.

As I got better I found distraction of sorts in the hospital’s routine, with its own institutionalized sitcoms. Group Therapy, I am told, has some value; I would never want to derogate any concept shown to be effective for certain individuals. But Group Therapy did nothing for me except make me seethe, possibly because it was supervised by an odiously smug young shrink, with a spade-shaped dark beard
(der junge Freud?),
who in attempting to get us to cough up the seeds of our misery was alternately condescending and bullying, and occasionally reduced one or two of the women patients, so forlorn in their kimonos and curlers, to what I’m certain he regarded as satisfactory tears. (I thought the rest of the psychiatric staff exemplary in their tact and compassion.) Time hangs heavy in the hospital, and the best I can say for Group Therapy is that it was a way to occupy the hours.

More or less the same can be said for Art Therapy, which is organized infantilism. Our class was run by a delirious young woman with a fixed, indefatigable smile, who was plainly trained at a school offering courses in Teaching Art to the Mentally Ill; not even a teacher of very young retarded children could have been compelled to bestow, without deliberate instruction, such orchestrated chuckles and coos. Unwinding long rolls of slippery mural paper, she would tell us to take our crayons and make drawings illustrative of themes that we ourselves had chosen. For example: My House. In humiliated rage I obeyed, drawing a square, with a door and four cross-eyed windows, a chimney on top issuing forth a curlicue of smoke. She showered me with praise, and as the weeks advanced and my health improved so did my sense of comedy. I began to dabble happily in colored modeling clay, sculpting at first a horrid little green skull with bared teeth, which our teacher pronounced a splendid replica of my depression. I then proceeded through intermediate stages of recuperation to a rosy and cherubic head with a “Have-a-Nice-Day” smile. Coinciding as it did with the time of my release, this creation truly overjoyed my instructress (whom I’d become fond of in spite of myself), since, as she told me, it was emblematic of my recovery and therefore but one more example of the triumph over disease by Art Therapy.

By this time it was early February, and although I was still shaky I knew I had emerged into light. I felt myself no longer a husk but a body with some of the body’s sweet juices stirring again. I had my first dream in many months, confused but to this day imperishable, with a flute in it somewhere, and a wild goose, and a dancing girl.

IX

B
Y FAR THE GREAT MAJORITY OF THE PEOPLE WHO
go through even the severest depression survive it, and live ever afterward at least as happily as their unafflicted counterparts. Save for the awfulness of certain memories it leaves, acute depression inflicts few permanent wounds. There is a Sisyphean torment in the fact that a great number—as many as half—of those who are devastated once will be struck again; depression has the habit of recurrence. But most victims live through even these relapses, often coping better because they have become psychologically tuned by past experience to deal with the ogre. It is of great importance that those who are suffering a siege, perhaps for the first time, be told—be convinced, rather—that the illness will run its course and that they will pull through. A tough job, this; calling “Chin up!” from the safety of the shore to a drowning person is tantamount to insult, but it has been shown over and over again that if the encouragement is dogged enough—and the support equally committed and passionate—the endangered one can nearly always be saved. Most people in the grip of depression at its ghastliest are, for whatever reason, in a state of unrealistic hopelessness, torn by exaggerated ills and fatal threats that bear no resemblance to actuality. It may require on the part of friends, lovers, family, admirers, an almost religious devotion to persuade the sufferers of life’s worth, which is so often in conflict with a sense of their own worthlessness, but such devotion has prevented countless suicides.

During the same summer of my decline, a close friend of mine—a celebrated newspaper columnist—was hospitalized for severe manic depression. By the time I had commenced my autumnal plunge my friend had recovered (largely due to lithium but also to psychotherapy in the aftermath), and we were in touch by telephone nearly every day. His support was untiring and priceless. It was he who kept admonishing me that suicide was “unacceptable” (he had been intensely suicidal), and it was also he who made the prospect of going to the hospital less fearsomely intimidating. I still look back on his concern with immense gratitude. The help he gave me, he later said, had been a continuing therapy for him, thus demonstrating that, if nothing else, the disease engenders lasting fellowship.

After I began to recover in the hospital it occurred to me to wonder—for the first time with any really serious concern—why I had been visited by such a calamity. The psychiatric literature on depression is enormous, with theory after theory concerning the disease’s etiology proliferating as richly as theories about the death of the dinosaurs or the origin of black holes. The very number of hypotheses is testimony to the malady’s all but impenetrable mystery. As for that initial triggering mechanism—what I have called the manifest crisis—can I really be satisfied with the idea that abrupt withdrawal from alcohol started the plunge downward? What about other possibilities—the dour fact, for instance, that at about the same time I was smitten I turned sixty, that hulking milestone of mortality? Or could it be that a vague dissatisfaction with the way in which my work was going—the onset of inertia which has possessed me time and time again during my writing life, and made me crabbed and discontented—had also haunted me more fiercely during that period than ever, somehow magnifying the difficulty with alcohol? Unresolvable questions, perhaps.

These matters in any case interest me less than the search for earlier origins of the disease. What are the forgotten or buried events that suggest an ultimate explanation for the evolution of depression and its later flowering into madness? Until the onslaught of my own illness and its denouement, I never gave much thought to my work in terms of its connection with the subconscious—an area of investigation belonging to literary detectives. But after I had returned to health and was able to reflect on the past in the light of my ordeal, I began to see clearly how depression had clung close to the outer edges of my life for many years. Suicide has been a persistent theme in my books—three of my major characters killed themselves. In rereading, for the first time in years, sequences from my novels—passages where my heroines have lurched down pathways toward doom—I was stunned to perceive how accurately I had created the landscape of depression in the minds of these young women, describing with what could only be instinct, out of a subconscious already roiled by disturbances of mood, the psychic imbalance that led them to destruction. Thus depression, when it finally came to me, was in fact no stranger, not even a visitor totally unannounced; it had been tapping at my door for decades.

The morbid condition proceeded, I have come to believe, from my beginning years—from my father, who battled the gorgon for much of his lifetime, and had been hospitalized in my boyhood after a despondent spiraling downward that in retrospect I saw greatly resembled mine. The genetic roots of depression seem now to be beyond controversy. But I’m persuaded that an even more significant factor was the death of my mother when I was thirteen; this disorder and early sorrow—the death or disappearance of a parent, especially a mother, before or during puberty—appears repeatedly in the literature on depression as a trauma sometimes likely to create nearly irreparable emotional havoc. The danger is especially apparent if the young person is affected by what has been termed “incomplete mourning”—has, in effect, been unable to achieve the catharsis of grief, and so carries within himself through later years an insufferable burden of which rage and guilt, and not only dammed-up sorrow, are a part, and become the potential seeds of self-destruction.

In an illuminating new book on suicide,
Self-Destruction in the Promised Land,
Howard I. Kushner, who is not a psychiatrist but a social historian, argues persuasively in favor of this theory of incomplete mourning and uses Abraham Lincoln as an example. While Lincoln’s hectic moods of melancholy are legend, it is much less well known that in his youth he was often in a suicidal turmoil and came close more than once to making an attempt on his own life. The behavior seems directly linked to the death of Lincoln’s mother, Nancy Hanks, when he was nine, and to unexpressed grief exacerbated by his sister’s death ten years later. Drawing insights from the chronicle of Lincoln’s painful success in avoiding suicide, Kushner makes a convincing case not only for the idea of early loss precipitating self-destructive conduct, but also, auspiciously, for that same behavior becoming a strategy through which the person involved comes to grips with his guilt and rage, and triumphs over self-willed death. Such reconciliation may be entwined with the quest for immortality—in Lincoln’s case, no less than that of a writer of fiction, to vanquish death through work honored by posterity.

So if this theory of incomplete mourning has validity, and I think it does, and if it is also true that in the nethermost depths of one’s suicidal behavior one is still subconsciously dealing with immense loss while trying to surmount all the effects of its devastation, then my own avoidance of death may have been belated homage to my mother. I do know that in those last hours before I rescued myself, when I listened to the passage from the
Alto Rhapsody
—which I’d heard her sing—she had been very much on my mind.