The Noonday Demon (9 page)

When I left the hospital, I was afraid all the time. Either the pain or the painkillers had completely undermined my mind. I knew that the stones might still be moving around and that I could relapse. I was frightened of being alone. I went with a friend to my apartment, collected a few things, and moved out. It was a vagabond week; I migrated from friend to friend. These people mostly had to go to work during the day, and I would stay in their houses, avoiding the street, careful never to go too far from the phone. I was still taking prophylactic painkillers and I felt a little crazy. I was angry at my father, angry in an irrational, spoiled, foul way. My father apologized for what I called his uncaring behavior and tried to explain that he had only meant to communicate his relief that I had a nonfatal disease. He said he had believed my relative stoicism on the phone. I entered a hysteria of which I cannot now make any sense. I refused to speak to him or to tell him where I had gone. From time to time, I would call and leave a message on his machine: “I hate you and I wish you were dead” was how they usually began. Sleeping pills got me through the nights. I had one small relapse and went back up to the hospital; it was nothing serious, but it scared me to death. In retrospect, I can say that that was the week I went bananas.

At the end of the week, I headed up to Vermont for the wedding of some friends. It was a beautiful late-summer weekend. I had almost canceled the trip, but after getting details of a hospital near where the wedding was to take place, I decided to try to go. I arrived on Friday in time for dinner and square dancing (I did not do any square dancing), and I saw someone I had known very marginally in college ten years earlier. We talked, and I felt overcome with more emotion than I’d felt in years. I felt myself shining; I felt ecstatic and did not guess how nothing
good was to come of that. I rode from emotion to emotion in a way that was almost absurd.

After the Vermont wedding, the slippage was steady. I worked less and less well. I canceled plans to go to England for another wedding, feeling that the trip was just more than I could handle, though I had, a year earlier, gone back and forth to London regularly without much trouble. I had begun to feel that no one could love me and that I would never be in a relationship again. I had no sexual feelings at all. I began eating irregularly because I seldom felt hungry. My analyst said that it was still depression, and I felt tired of that word and tired of the analyst. I said that I was not crazy but was afraid I could become crazy and did she think I was going to end up on antidepressants, and she told me that avoiding medication was courageous and that we could work everything through. That conversation was the last one I initiated; those were my last feelings for a long time.

Major depression has a number of defining factors—mostly having to do with withdrawal, though agitated or atypical depression may have an intense negativity rather than a flattened passivity—and is usually fairly easy to recognize; it deranges sleep, appetites, and energy. It tends to increase sensitivity to rejection, and it may be accompanied by a loss of self-confidence and self-regard. It seems to depend on both hypothalamic functions (which regulate sleep, appetites, and energy) and cortical functions (which translate experience into philosophy and worldview). The depression that occurs as a phase in manic-depressive (or bipolar) illness is much more strongly genetically determined (about 80 percent) than is standard depression (about 10 to 50 percent); though it is more broadly treatment-responsive, it is not easier to control, especially since antidepressant drugs may launch mania. The greatest danger with manic-depressive illness is that it sometimes bursts into what are called mixed states, where one is manically depressed—full of negative feeling and grandiose about them. That is a prime condition for suicide, and it too can be brought on by the use of antidepressant medications without the mood stabilizers that are necessary parts of bipolar medication. Depression can be enervating or atypical/agitated. In the first, you don’t feel like doing anything; in the second, you feel like killing yourself. A breakdown is a crossover into madness. It is, to borrow a metaphor from physics, uncharacteristic behavior of matter that is determined by hidden variables. It is also a cumulative effect: whether you can see them or not, the factors leading to a depressive breakdown gather over the years, usually over a lifetime. There is no life that does not have the material for despair in it, but some people go too close to the edge and others manage to stay sometimes sad in a safe clearing far from the cliffs. Once you cross
over, the rules all change. Everything that had been written in English is now in Chinese; everything that went fast is now slow; sleep is for clarity while wakefulness is a sequence of unconnected, senseless images. Your senses slowly abandon you in depression. “There’s a sudden point when you can feel the chemistry going,” Mark Weiss, a depressive friend, once said to me. “My breathing changes and my breath stinks. My piss smells disgusting. My face comes apart in the mirror. I know when it’s there.”

By the time I was three, I had decided I wanted to be a novelist. Ever since, I had been looking forward to publishing a novel. When I was thirty, my first novel was published, and I had scheduled a reading tour, and I was hating the idea. A good friend had volunteered to throw a book party for me on October 11. I love parties and I love books, and I knew I should have been ecstatic, but in fact I was too lackluster to invite many people, and too tired to stand up much during the party. Memory functions and emotional functions are distributed throughout the brain, but the frontal cortex and limbic systems are key to both, and when you affect the limbic system, which controls emotion, you also touch on memory. I remember that party only in ghostly outlines and washed-out colors: grey food, beige people, muddy light in the rooms. I do remember that I was sweating horribly during it, and that I was dying to leave. I tried to put it all down to stress. I was determined, at any cost, to keep up appearances, an impulse that was to serve me well. I did it: no one seemed to notice anything strange. I got through the evening.

When I got home that night, I began to feel frightened. I lay in bed, not sleeping, hugging my pillow for comfort. Over the next two and a half weeks things got worse and worse. Shortly before my thirty-first birthday, I went to pieces. My whole system seemed to be caving in. I was not going out with anyone at the time. My father had volunteered to organize a birthday party for me, but I couldn’t bear the idea, and we had agreed instead to go to a favorite restaurant with four of my closest friends. On the day before my birthday, I left the house only once, to buy some groceries. On the way home from the store, I suddenly lost control of my lower intestine and soiled myself. I could feel the stain spreading as I hastened home. When I got in, I dropped the grocery bag, rushed to the bathroom, got undressed, and went to bed.

I did not sleep much that night, and I could not get up the following day. I knew I could not go to any restaurant. I wanted to call my friends and cancel, but I couldn’t. I lay very still and thought about speaking, trying to figure out how to do it. I moved my tongue but there were no sounds. I had forgotten how to talk. Then I began to cry, but there were
no tears, only a heaving incoherence. I was on my back. I wanted to turn over, but I couldn’t remember how to do that either. I tried to think about it, but the task seemed colossal. I thought that perhaps I’d had a stroke, and then I cried again for a while. At about three o’clock that afternoon, I managed to get out of bed and go to the bathroom. I returned to bed shivering. Fortunately, my father called. I answered the phone. “You have to cancel tonight,” I said, my voice shaky. “What’s wrong?” he kept asking, but I didn’t know.

There is a moment, if you trip or slip, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself, a passing, fraction-of-a-second terror. I felt that way hour after hour after hour. Being anxious at this extreme level is bizarre. You feel all the time that you want to do something, that there is some affect that is unavailable to you, that there’s a physical need of impossible urgency and discomfort for which there is no relief, as though you were constantly vomiting from your stomach but had no mouth. With the depression, your vision narrows and begins to close down; it is like trying to watch TV through terrible static, where you can sort of see the picture but not really; where you cannot ever see people’s faces, except almost if there is a close-up; where nothing has edges. The air seems thick and resistant, as though it were full of mushed-up bread. Becoming depressed is like going blind, the darkness at first gradual, then encompassing; it is like going deaf, hearing less and less until a terrible silence is all around you, until you cannot make any sound of your own to penetrate the quiet. It is like feeling your clothing slowly turning into wood on your body, a stiffness in the elbows and the knees progressing to a terrible weight and an isolating immobility that will atrophy you and in time destroy you.

My father came down to my apartment with a friend of mine, trailing my brother and his fiancée. Fortunately, my father had keys. I had had nothing to eat in almost two days, and they tried to get me to eat a little soup. Everyone thought that I must have some kind of terrible virus. I ate a few bites, then threw up all over myself. I couldn’t stop crying. I hated my house but couldn’t leave it. The next day, I managed, somehow, to get to my analyst’s office. “I think I’m going to have to start taking medication,” I said, diving deep for the words. “I’m sorry,” she said, and called the psychopharmacologist, who agreed to see me in an hour. She did at last, however belatedly, see that we had to call in help. In the 1950s, in keeping with the thinking of his time, a psychoanalyst I know was told by his supervisor that if he wanted to start a patient on medication, he would have to stop the analysis. Perhaps it was something old-fashioned that had allowed my analyst to encourage me to avoid medication?
Or perhaps she too bought into the appearances I was struggling to keep up? I will never know.

The psychopharmacologist seemed to have come out of some movie about shrinks: his office had fading mustard-colored silk wallpaper and old-fashioned sconces on the walls and was piled high with books with titles such as
Addicted to Misery
and
Suicidal Behavior: The Search for Psychic Economy.
He was in his seventies, smoked cigars, had a Central European accent, and wore carpet slippers. He had elegant prewar manners and a kindly smile. He asked me a rapid string of specific questions—how did I feel in the morning versus the afternoon? How difficult was it for me to laugh about anything? Did I know what I was afraid of? Had my sleep patterns and appetites shifted?—and I did my best to answer him. “Well, well,” he said calmly as I trotted out my horrors. “Very classic indeed. Don’t you worry, we’ll soon have you well.” He wrote out a prescription for Xanax, then burrowed around to find a starter kit of Zoloft. He gave me detailed instructions on how to begin taking it. “You’ll come back tomorrow,” he said with a smile. “The Zoloft will not work for some time. The Xanax will alleviate your anxiety immediately. Do not worry about its addictive qualities and so on, as these are not your problems at the moment. Once we have lifted the anxiety somewhat, we will be able to see the depression more clearly and take care of that. Don’t worry, you have a very normal group of symptoms.”

My first day on medication, I moved into my father’s apartment. My father was almost seventy at the time, and most men of that age cannot easily tolerate complete shifts in their lives. My father is to be praised not only for his generous devotion, but also for the flexibility of mind and spirit that allowed him to understand how he could be my mainstay through rough times, and for the courage that helped him to be that mainstay. He picked me up at the doctor’s office and took me home with him. I had not brought clean clothes with me, but I didn’t really need them since I was hardly to get out of bed for the next week. For the moment, the panic was my only sensation. The Xanax would relieve the panic if I took enough of it, but enough of it was enough to make me collapse completely into a thick, confusing, dream-heavy sleep. The days were like this: I would wake up, knowing that I was experiencing extreme panic. What I wanted was only to take enough panic medication to allow me to go back to sleep, and then I wanted to sleep until I got well. When I would wake up a few hours later, I wanted to take more sleeping pills. Killing myself, like dressing myself, was much too elaborate an agenda to enter my mind; I did
not
spend hours imagining how I would do such a thing. All I wanted was for “it” to stop; I could not have managed even to be so specific as to say what “it” was. I could not manage
to say much; words, with which I have always been intimate, seemed suddenly very elaborate, difficult metaphors the use of which entailed much more energy than I could possibly muster. “Melancholia ends up in loss of meaning . . . I become silent and I die,” Julia Kristeva once wrote. “Melancholy persons are foreigners in their mother tongue. The dead language they speak foreshadows their suicide.” Depression, like love, trades in clichés, and it is difficult to speak of it without lapsing into the rhetoric of saccharine pop tunes; it is so vivid when it is experienced that the notion that others have known anything similar seems altogether implausible. Emily Dickinson wrote perhaps the most eloquent description of a breakdown ever committed to the page: