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I’m Not Mad. Or Am I?

An excerpt from The Noonday Demon: An Atlas of Depression

The Noonday Demon: An Atlas of Depression. Simon & Schuster, 2015. ISBN: 9781501123887.

If my life had been more difficult, I would understand my depression very differently. In fact, I had a reasonably happy childhood with two parents who loved me generously, and a younger brother whom they also loved and with whom I got on well. It was a family sufficiently intact that I never even imagined a real battle between my parents, who loved each other very much indeed; though they argued from time to time, they never questioned their absolute devotion to each other and to my brother and me.

And then in August 1989, when I was 25, my mother was diagnosed with ovarian cancer and my world began to crumble. If she had not fallen ill, if that story had been a little bit less tragic, then perhaps I would have gone through life with depressive tendencies but no breakdown; or perhaps I would have had a breakdown later on as part of a midlife crisis; or perhaps I would have had one just when and as I did.

I will not detail how everything fell apart because to those who have known wasting sickness this will be clear and to those who have not it remains perhaps as inexplicable as it was to me when I was 25. Suffice it to say that in 1991, my mother died. She was 58. I was paralytically sad. Despite tears and sorrow, despite the disappearance of the person I had depended on so constantly and for so long, I did OK in the period after her death. I was sad and I was angry, but I was not crazy.

Depression dawns as gradually as adulthood.

It was not until June 1994 that I began to notice I was constantly bored. My first novel had been published in England and yet its favourable reception did little for me. I read the reviews indifferently and felt tired all the time. I found myself burdened by social events, even by conversation. It all seemed like more effort than it was worth. I began 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 it was depression.

A loss of feeling, a numbness, infected all my human relations. I didn’t care about love, my work, family, friends. My writing slowed, then stopped. ‘I know nothing,’ the painter Gerhard Richter once wrote. ‘I can do nothing. I understand nothing. I know nothing. Nothing. And all this misery does not even make me particularly unhappy.’

I was losing my self and that scared me. I made a point of scheduling pleasures into my life. I went to parties and tried and failed to have fun; I saw friends and tried and failed to connect; I bought expensive things I’d wanted in the past and had no satisfaction from them. 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.’

For me, this point coincided with the publication of my first novel. A good friend had volunteered to throw a book party for me on 11 October. I love parties and I love books and I knew I should have been ecstatic, but in fact I was too lacklustre to invite many people and too tired to stand up much during the party. I remember that party only in ghostly outlines and washed-out colours: 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. No one seemed to notice anything strange. I got through the evening.

When I got home, 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. 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 organise a birthday party for me, but I couldn’t bear the idea and we agreed to go to a favourite 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, 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 that afternoon, I managed to go to the bathroom. I returned to bed shivering. Fortunately, my father called. ‘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. Being anxious at this extreme level is bizarre. You feel all the time that you want to do something, 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.

My father came down to my apartment with a friend of mine, trailing my brother and his fiancée. I had had nothing to eat in almost two days, and they tried to get me to eat a little smoked salmon. Everyone thought I must have some kind of virus. I ate a few bites, then threw up all over myself. I couldn’t stop crying. 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.

The psychopharmacologist seemed to have come out of some movie about shrinks. His office had fading mustard-coloured silk wallpaper and was piled high with books with titles such as Addicted to Misery and Suicidal Behaviour: 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.’Well, well,’ he said calmly as I trotted out my horrors. ‘Very classic symptoms 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.’

On my first day on medication, I moved into my father’s apartment. My father was almost 70 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 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 and took me home with him. I had not brought clean clothes with me, but I didn’t really need them as I was hardly to get out of bed for the next week. Panic was my only sensation.

The days were like this: I would wake up, knowing 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.

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.

Depression minutes are like dog years, based on some artificial notion of time. I can remember lying frozen in bed, crying because I was too frightened to take a shower, and at the same time knowing that showers are not scary. I kept running through the individual steps in my mind: you turn and put your feet on the floor; you stand; you walk from here to the bathroom; you open the bathroom door; you walk to the edge of the tub; you turn on the water; you step under the water; you rub yourself with soap; you rinse; you step out; you dry yourself; you walk back to the bed.

Twelve steps, which sounded then as onerous as the Stations of the Cross. But I knew, logically, that showers were easy, that for years I had taken a shower every day and that I had done it so quickly and so matter of factly that it had not even warranted comment. I knew that those 12 steps were really quite manageable.

So with all the force in my body I would sit up; I would turn and put my feet on the floor; then I would feel so incapacitated and so frightened that I would roll over and lie face down. All over the world people were taking showers. Why, oh why, could I not be one of them? And then I would reflect that those people also had families and jobs and bank accounts and passports and dinner plans and problems, real problems, cancer and hunger and the death of their children and isolating loneliness and failure; and I had so few problems by comparison, except that I couldn’t turn over again, until a few hours later, when my father or a friend would come in and help to hoist my feet back up onto the bed.

I would lie in the safety of the bed and feel ridiculous. And sometimes in some quiet part of me there was a little bit of laughter at that ridiculousness, and my ability to see that, is, I think, what got me through. Always at the back of my mind there was a voice, calm and clear, that said: don’t be so maudlin; don’t do anything melodramatic. Take off your clothes, put on your pyjamas, go to bed; in the morning, get up, get dressed, and do whatever it is that you’re supposed to do.

I heard that voice all the time, that voice like my mother’s. There was a sadness and a terrible loneliness as I contemplated what was lost. ‘Did anyone – not just the red-hot cultural centre, but anyone, even my dentist – care that I had withdrawn from the fray?’ Daphne Merkin wrote in a confessional essay on her own depression. ‘Would people mourn me if I never returned, never took up my place again?’

By the time evening came around, I was able to get out of bed. Most depression is circadian, improving during the day and then descending again by morning. At dinner, I would feel unable to eat, but I could get up and sit in the dining-room with my father, who cancelled all other plans to be with me. I could also speak by then. I tried to explain what it was like. My father nodded, implacably assured me that it would pass, and tried to make me eat. He cut up my food. I told him not to feed me, that I wasn’t five, but when I was defeated by the difficulty of getting a piece of lamb chop on to my fork, he would do it for me.

All the while, he would remember feeding me when I was a tiny child, and he would make me promise, jesting, to cut up his lamb chops when he was old and had lost his teeth. He had been in touch with some of my friends, and some of my friends had called me anyway, and after dinner I would feel well enough to call some of them back. Sometimes, one would even come over after dinner. Against the odds, I could usually even have a shower before bed! And no drink after crossing the desert was ever lovelier than that triumph and the cleanliness. Before bed, Xanaxed out but not yet asleep, I would joke with my father and with friends about it, and that rare intimacy that surrounds illness would make itself felt in the room, and sometimes I would feel too much and begin to cry again, and then it was time to turn off the lights, so that I could go back to sleep.

Sometimes, friends would sit with me until I drifted off. Some evenings, my father read to me from the books he had read me when I was a child.

In the meantime, I still had the reading tour to do. I had to go to bookstores and other venues and stand up in front of groups of strangers and read aloud from the novel I had written. It was a recipe for disaster, but I was determined to get through it. Before the first of these readings, in New York, I spent four hours taking a bath.Then I went and read. I felt as though I had baby powder in my mouth and I couldn’t hear well, and I kept thinking I might faint, but I managed to do it. Then a friend helped to get me home and I went back to bed for three days.

My next engagements were out in California. I thought I could not go; I knew that I could not go alone. In the end, my father took me there. While I was in a Xanax haze, he got me on and off the plane, out of the airport, to the hotel. I was so drugged up that I was almost asleep, but in this state I could manage. I knew that the more I managed to do the less I would want to die, so it seemed important to go.

Doing those readings was the most difficult endeavour of my life. My father joined me for many of the trips; when we were apart, he called me every few hours. A few close friends took on responsibility for me and I was never alone. I can tell you that I was not a fun companion and that deep love and the knowledge of deep love were not by themselves the cure. I can also say that without deep love and the knowledge of deep love, I would not have found it in myself to go through with that tour. I would have found a place to lie down in the woods and I would have stayed there until I froze and died.

The terror lifted in December. Whether that was because the drugs had kicked in or the reading tour was over, I do not know. In the end, I cancelled only one reading and managed to visit 11 cities. I made it through Christmas and New Year and I was acting like some semblance of myself. I had lost 15lbs and now I began to put on weight again. My father and my friends all congratulated me on my astonishing progress. I thanked them.

In my private self, however, I knew that what had gone away were only symptoms. I hated taking my pills every day. I hated that I had had a breakdown and lost my mind. I was relieved to have made it through the tour, but I was overpowered being in the world, by other people and their lives I couldn’t lead, jobs I couldn’t do. I was back to about where I had been at the beginning of the depression, only now I understood how bad it could get. I was determined never again to go through such a thing.

I felt a little bit like my old self, but the year had been so awful, had shaken me so deeply, that though I was now functioning again, I had also realised that I could not go on.This did not feel irrational, like the terror; it did not feel angry; it felt quite sensible. I had had enough of life and I wanted to figure out how to end it with the least possible damage to the people around me. I needed something to show, so that everyone would understand how desperate I was. I had to give up the invisible impediment for a manifest one.

There is little question in my mind that the particular behaviour I chose was highly individual and related to neuroses of my own, but the decision to behave with such a hunger to be rid of the self was typical of agitated depression. 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 could not figure out how to give myself cancer or MS or various other fatal diseases, but I knew just how to get Aids, so I decided to do that. In a park in London, at a lonely hour well after midnight, a short, tubby man with thick tortoiseshell glasses came up and offered himself to me. He pulled down his trousers and bent over. I went to work. I felt as though this were all happening to someone else; I heard his glasses fall off and thought only this: soon I will be dead, so I will never become old and sad like this man. A voice in my head said I had finally started this process and would soon die. I felt such a sense of release and of gratitude. It was not my intention to die slowly of Aids; it was my intention to kill myself with HIV as my excuse.

Over the next three months, I sought out other such experiences with strangers whom I assumed to be infected, taking ever greater and more direct risks. I went once a week, often on Wednesdays, to a spot where I could have an economical experience that would infect me. My situation was so different from the vegetative symptoms that had constituted my break-down that it did not occur to me that I was still in the grip of the same illness as before.

Then one day in early October, after one of my bouts of unpleasant unsafe sex, this one with a boy who had followed me to a hotel and made a beseeching move in the elevator, I realised that I might be infecting others and that was not my agenda. I had wanted to kill myself, but not the rest of the world. It was time to stop before I began to spread disease everywhere. The knowledge that I would die had also lifted the depression I’d felt. I became gentler again. 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.

By the week of the HIV test, I was taking 12 to 16 milligrams of Xanax every day, so that I could sleep all the time and not be anxious. On Thursday of that week, I got up and checked my messages. The nurse from my doctor’s office said: ‘Your cholesterol is down, your cardiogram is normal and your HIV test turned out fine.’ I called her immediately. It was true. I was HIV-negative after all. As Gatsby said: ‘I tried hard to die but have an enchanted life.’

I knew then that I wanted to live and I was grateful for the news. Things got steadily better after that. Late in the autumn, I suddenly found that I was lying awake at night, my body trembling, much as it had done at the lowest points of my depression, but I was awake this time with happiness. Years had passed since I had felt happiness at all and I had forgotten what it is like to want to live, to enjoy the day you are in and to long for the next one, to know that you are one of the lucky people for whom life is the living of it.

I felt safe from myself. I knew that eternal sadness, though very much within me, did not mitigate the happiness. I turned 33 shortly thereafter, and it was a truly happy birthday, at last.

I now have procedures in place for breakdowns. I know which doctors to call and what to say. I know when it’s time to put away the razor blades and keep walking the dog. I call around friends and family and say straight out that I’m depressed.

Here’s what I know that has saved me: act fast; have a good doctor prepared to hear from you; know your own patterns really clearly; regulate sleep and eating, no matter how odious the task may be; lift stresses at once; exercise; mobilise love.

The Noonday Demon: An Anatomy of Depression is published by Chatto at £20.

Andrew Solomon on anti-depressants: do they really work?

I am often asked in social situations to describe my own experiences with depression and I usually end by saying that I am on medication. ‘Still?’ people ask. ‘But you seem fine!’ To which I invariably reply that I seem fine because I am fine, and that I am fine because of medication. ‘So how long do you expect to go on taking this stuff?’ people ask.

Then I say I will be on medication indefinitely. ‘But it’s really bad to be on medicine that way,’ they say. ‘Surely now you are strong enough to be able to phase out some of these drugs!’ If you say to them that this is like phasing the carburettor out of your car or the buttresses out of Notre Dame, they laugh. ‘So maybe you’ll stay on a really low dose?’ they ask. You explain that the level of medication you take was chosen because it normalises the systems that can go haywire and that a low dose would be like removing half your carburettor. You add that you have experienced almost no side effects, and that there is no evidence of negative effects of long-term medication. You say you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication: ‘Well, I sure hope you get off some time soon,’ they say.

‘I may not know the exact effects of long-term medication,’ says John Greden, chair of the department of psychiatry at the University of Michigan. ‘No one has yet taken Prozac for 80 years. But I certainly know the effects of nonmedication, or of going on and off medication, or of trying to reduce appropriate doses to inappropriate levels – and those effects are brain damage. 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 80 per cent relapse rate within a year without medication, and an 80 per cent wellness rate with medication.’ The side effects of these drugs are for most people much healthier than the illness they address.

People who take Prozac should watch in the early stages for adverse responses. The drug can cause facial tics and stiffening of muscles. Anti-depressant drugs bring up questions around addiction. The lowered libido, weird dreams, and other effects mentioned on the labelling can be miserable. I accept that we cannot definitively know the very long-term effect of the medications. It is most unfortunate, however, that some scientists have chosen to capitalise on these adverse reactions, spawning an industry of Prozac detractors who misrepresent the drug as a grave peril foisted on an innocent public.

I deplore the cynics who keep suffering patients from the essentially benign cures that might give them back their lives.