Authors: Andrew Solomon
It was her worst period since high school. Finally, in November, friends persuaded her to return to Western medicine. Her psychiatrist said she was crazy to have stuck it out on homeopathic treatments for so long and gave her forty-eight hours to get her system clean before he started her on Celexa. “It made an instant difference. I could still feel depressive moments and thoughts, and it does kill my sex drive, so that I feel like I have to try hard to do this for my husband—it’s not just interest in sex that goes, but physical trouble, so that I can’t even get wet! I have maybe two percent interest when I’m ovulating, and that’s the high point of the month. But it’s just all so much better. My husband is so sweet; he says, ‘I didn’t marry you for the sex, it doesn’t matter.’ I think he’s just so relieved that I’m not the monster I was from the marriage on. Our lives feel restabilized. I can see the qualities in him that I wanted—the emotional security is back. The snuggling is back. I’m very needy and now he is filling those needs, and he loves the snuggling too. He has made me feel like I’m a good person. And I am happy to be with him again. He loves me and that is such a treasure now. At least eighty percent of our relationship is now wonderful.
“I feel slightly artificially up. When I was ten milligrams lower on my medication, the depressive moments would come in and they were very disturbing and disruptive and really painful and hard to get out of, although I could pull out of them and would. And I feel like I still need that to keep me up. I don’t feel stable. I don’t feel the same sense of smooth sailing that I had while I was planning the wedding. If I felt reasonably safe, I would go off the medicine; but I don’t feel safe. I find it increasingly hard to draw a line between the depressive and the nondepressive me. I think a depressive tendency is much stronger in me even than the actual depressions. Depression is not the be-all and end-all of my life. You know, I’m not going to lie on my bed for the rest of my life and suffer. The people who succeed despite depression do three things. First, they seek an understanding of what’s happening. Then they accept that this is a permanent situation. And then they have to somehow transcend their experience and grow from it and put themselves out into the world of real people. Once you’ve done the understanding and the growth, you realize that you can interact with the world and live your life and carry on your job. You stop being so crippled, and you feel such a sense of victory! A depressive person who can put aside navel gazing is not so insufferable as one who can’t. At first, when I realized I would spend my life doing the mood dance, I was very, very bitter about it. But now I feel like I am
not
helpless. This has become a major focus of my life: How can I grow from this? Maybe this hurts me now, but how can I learn from it?” Claudia Weaver cocks her head to one side.
“I understood that. I’m lucky.” It is her questing spirit as much as any experimental treatment that has allowed her to make it through with a life more or less intact, despite all the difficulties she has faced.
Of the group therapies I studied, the one that seemed to me most subtle and nurturing, the one that brought people closest to resolution, was based on the work of Bert Hellinger in Germany. Hellinger, a former priest who was once a missionary to the Zulu, has a large and devoted following for his Gestalt-style work. One of Hellinger’s disciples, Reinhard Lier, came to the United States in 1998 and conducted an intensive treatment, in which I participated, my natural skepticism giving way to respect for the process as I became more richly enmeshed in it. Lier’s treatment had some effect on me, and I saw that it had enormous effect on others in the group. Like EMDR, Hellinger-style work is probably most effective for people who are dealing with traumas; but for Lier’s purposes, the traumatic thing can be a basic fact—“my mother hated me,” for example—rather than a single event bounded by time.
A group of about twenty of us came together and established trust through some basic exercises. Then each of us was asked to construct a narrative of the thing that was most painful in his or her life. We shared our narratives in basic form and were asked to choose people from the group to represent the other figures in our narratives. Reinhard Lier then choreographed a kind of elaborate dance using these people as physical markers, placing one in front of the other, moving the subject around, and retelling the story toward a better resolution. He called these formations “family constellations.” I chose to work on my mother’s death as the point of origin of my depression. Someone played my mother, someone else my father, someone else my brother. Lier said he wanted my grandparents there as well, the one I had known and the three I had not known. As he shifted us around, I was asked to direct speech to these various figures. “What do you have to say to your mother’s father, who died when your mother was still quite young?” he asked. Of all the work I did on depression, this was perhaps the treatment most contingent on a charismatic leader. Lier was able to arouse a great deal of force in each of us, and by the time I had done twenty minutes of his dance and of saying certain things, I did feel as though I were speaking to my own mother again, and I told her some things I thought or felt. Then the spell broke and I was in a seminar room in a conference center in New Jersey—but I left that day with a feeling of calm, as though something had been resolved. Maybe it was just the very fact of addressing words to these forces to which I never speak, these vanished grandparents and my lost mother, but I was moved by the process and thought it had something
sacrosanct in it. It wouldn’t cure depression, but it could bring some measure of peace.
The most compelling of our group was a man of German extraction who had found out that his parents had worked in a concentration camp. Unable to process this horror, he had become severely depressed. During his speeches to all the different members of his family, who were being physically positioned closer to him and farther away by Reinhard Lier, the man wept and wept and wept. “This is your mother,” Lier said at one point. “She did terrible things. She also loved and protected you when you were a child. Tell her that she betrayed you, and then tell her that you will always love her. Do not try to forgive her.” It sounds contrived, but it was in fact sweetly powerful.
It is hard to talk about depression during depression even with friends, and so the idea of depression support groups seems counterintuitive. Nonetheless, these groups have proliferated as incidents of depression have been more widely recognized, and as funding for therapy has dwindled. I did not go to support groups during my own depression—out of snobbery, apathy, ignorance, and a sense of privacy—but I began to go as I worked on this book. There are hundreds of organizations—mostly hospitals—running support groups across the United States and around the world. Depression and Related Affective Disorders Association (DRADA), at Johns Hopkins, runs sixty-two different support groups, has set up a one-on-one buddy system, and publishes a particularly good newsletter called
Smooth Sailing.
Mood Disorders Support Groups (MDSG), based in New York, is the largest support organization in the United States, running fourteen support groups every week and serving about seven thousand attendees per year; MDSG also sponsors ten lectures a year, each of which is attended by about one hundred fifty people. They publish a quarterly newsletter, which goes out to about six thousand people. MDSG meetings take place in several locations; I went mostly to the groups at Beth Israel Hospital in New York at seven-thirty every Friday night, when most depressed people are not having dates. To enter, you pay $4 in cash and are given a sticky label with your first name only, which you wear during meetings with about a dozen others and a facilitator. First, everyone introduces himself and explains what he wants from the meeting. Then a more general discussion opens up. People tell their stories and offer advice to one another, sometimes playing games of one-downsmanship. The sessions run two hours. They are terrifyingly, addictively heartbreaking, full of treatment-resistant and abandoned people who’ve had severe episodic histories. These groups try to fill in for the increasing impersonality of medical systems; a lot of the people at
them have destroyed relationships in their illness and lost families and friends.
On a typical visit, I went into a room glaring with fluorescent light and found ten people waiting to tell their stories. Depressives are not great dressers, and they often find that bathing uses up too much energy. A lot of this crowd looked as ratty as they felt. I went seven Fridays. The last time I was there, John talked first, because he liked talking and was doing pretty well and had come almost every week for ten years and knew the ropes. John had kept his job, never missed a day of work. Didn’t want to take medication but was experimenting with herbs and vitamins. Thought he was going to make it. Dana was too depressed to talk tonight. She pulled her knees up under her chin and promised she’d try to talk later. Anne hadn’t been to MDSG in a while. She’d had a bad time: took Effexor for depression and it helped a lot. Then when her dose was raised, she’d gone paranoid, “flipped out.” Believed the Mafia was out to get her and barricaded herself in her apartment. Eventually got hospitalized and had “every medication, every single one” and then when none of them helped, she got ECT. Couldn’t remember much from that time; the ECT had wiped out a lot of the memories. She used to be an executive, white-collar. Now she fed people’s cats for a living. Today she’d lost two clients, and rejection was tough. And humiliation. So she’d decided to come by tonight. Her eyes filled with tears. “You’re all so nice, listening to one another,” she said. “Out there, no one listens.” We tried to help. “I had so many friends. They’re all gone now. But I’m making it. Walking around to my different cats is good, it keeps up some movement, the walking helps.”
Jaime had been forced to resign from his job with “a government agency” because he’d missed too many days. He’d been on disability leave for three years. The people he still knew, most of them wouldn’t understand. He pretended still to have his job and didn’t answer the phone during the day. He seemed well tonight, better than I’d seen him. “If I couldn’t keep up appearances,” he said, “I’d kill myself. That’s all that keeps me going.” Howie was next. He had been sitting all evening and hugging a big down coat to his chest. Howie came often and talked seldom. He looked around the room. He was forty years old and had never had a full-time job. Two weeks ago, he’d announced that he was about to take one, have a change in income, be like a normal person. He was on some good medications that seemed to be helping. But what if they stopped working? Could he get back his $85 per-month disability Supplemental Security Income (SSI)? We’d all told him to go for it, to try the job, but tonight he told us he’d turned it down; it was just too frightening
to him. Anne asked whether his moods were constant, whether outside events had any effect, whether he felt different when he took a vacation. Howie looked at her blankly. “I’ve never had a vacation,” he said. Everyone kept looking at him. He shuffled his feet on the floor. “I’m sorry. I mean, I guess I’ve never really had anything to take a vacation from.”
Polly said, “I hear people talking about cycling, about going in and out of moods, and I feel really jealous. For me, it’s never been like that. I’ve always been this way; I was a morbid, unhappy, anxious child. Is there any hope left for me?” She was on Nardil and had found that clonidine in microdoses saved her from the heavy sweating she experienced. She’d originally been on lithium, but it had caused her to gain about fifteen pounds a month, so she’d stopped. Someone thought she should try Depakote, which can be helpful with Nardil. The restricted eating with Nardil was a real pain. Jaime said that Paxil had made him sicker. Mags said she had had Paxil and it hadn’t worked for her. Mags seemed to be speaking through the fog. “I can’t decide,” she said. “I can’t decide anything.” Mags was so apathetic she didn’t get out of bed for weeks at a time. Her therapist had almost forced her to come to this group. “Before medication, I was this neurotic, miserable, suicidal person,” she said. “Now I just don’t care about anything.” She looked around the room as if we were the jury at the Pearly Gates. “Which is better? Which person should I be?” John shook his head. “This is the problem, how the cure’s worse than the disease,” he said. And then it was Cheryl’s turn. She looked around but you could tell that she wasn’t seeing any of us. Her husband had brought her here hoping it would help and was waiting outside. “I feel,” she said in a flat voice like a slowed-down old record-player, “as though I died a few weeks ago, but my body hasn’t found out yet.”
This sad gathering of shared pain was a singular release from isolation for many of the people there. I remembered from my own worst times those eager, questioning faces, or my father saying, “Are you doing any better?” and how disappointing I felt when I said, “No, not really.” Some friends had been fantastic, but with others I had felt obliged to be tactful. And jokey. “I’d love to come, but I’m actually having a nervous breakdown right now, so could we do it another time?” It is easy to keep secrets by being honest in an ironic tone of voice. That basic feeling at the support group—I have my mind today, do you have yours?—spoke volumes, and almost in spite of myself, I began to relax into it. There is so much that cannot be said during depression, that can be intuited only by others who know. “If I were on crutches, they wouldn’t ask me to dance,” said one woman about her family’s relentless efforts to get her to go out and have fun. There is so much pain in the world, and most of
these people keep theirs secret, rolling through agonizing lives in invisible wheelchairs, dressed in invisible bodycasts. We held each other up with what we said. Sue, one night, in anguish, crying through her thick mascara, said, “I need to know if any of you have felt like this and made it. Someone tell me that, I came all this way to hear it, is it true, please tell me that it is.” Another night someone said, “My soul hurts so much; I just need to interface with other people.”