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That Shrinking Feeling

When Andrew Solomon wrote an award-winning book about his battle with depression, he never imagined it would qualify him as the oracle of melancholy to whom fellow sufferers would turn for advice, comfort and the name of a good psychiatrist.

Le bon conseil (Good advice), by Jean-Baptiste Madou, 1871

Le bon conseil (Good advice), by Jean-Baptiste Madou, 1871

When you write a normal book, you meet people under the terms of the social contract. They come up to you after readings and say, “Hi, my name is Suzette and I loved your book”, and you say, “Thanks!” and they ask you to sign the book (in case it becomes collectible) or they want to know how you got your agent (the mysterious secret of your success) or they wonder how you chose the art on the cover (which, in general, you did not choose at all) and it’s all very delightful. This is true even if you’ve written a sad book. But if you write a book about depression, as I did with The Noonday Demon, people come up to you at book signings and say, “Hi, my name is Lauren”, and you say, “Thanks for coming tonight, Lauren”, and they say, “I’m on Cipromil”, and you say, “Wow, that’s a good drug, I hope it’s working”, and they say, “I feel frightened every time I leave the house and I haven’t laughed in two years”, and the conversation takes off in an entirely different and not especially literary direction, and you look at the queue of people and say something pat to Lauren and feel you haven’t really helped her, and try to rev yourself up for the next person, who says, “My son committed suicide last week and I’m hoping that your book will help me understand”, and as you desperately write another blandishment on the flyleaf, you say, “Nothing can really help you understand”, and then kick yourself for destroying the illusion of comfort that might have lifted someone’s malaise even for a second.

Then there are those who suffer under the illusion that I am writing another book on this subject and need more stories. They have a manner of professionalism about them. “Now a lot of people can’t handle this,” they say, “but let me tell you, I’ve been so depressed I couldn’t even laugh at…” and they’re off. These recitations often end with, “Can you believe that anyone has had this experience? People wouldn’t believe it.” I believe it. I’ve been in this business for a while. Others come up to you at parties to tell you that they think about death all the time. They don’t seem to be interested in finding a way not to think about death all the time; they just want to let me know that they think about it. All the time. They make you feel like an extra on The Addams Family. The confidence crowd come up to you in gales of laughter. “I love Prozac!” they shout exuberantly. “I’m divinely happy!” You have to celebrate with them: “That’s so great! You seem happy!” Then there are the ones who talk about people they know in a way that slightly smacks of superiority, and it soon becomes clear that their topic is not the illness of someone else but the wellness of themselves. Finally, there are the protesters. “I’m so interested in your book because, well, I’m just one of those people who never gets depressed. Really! Do you know I’ve never been depressed even once, not even for a day. I felt bad when my baby died from cot death, but you know, it was never anything psychiatric. In fact, I just kept my chin up and kept going. Oh, no, depression wasn’t part of the picture.” They’re in the worst shape of all.

And then there are the interviewers, who are in general very interested in the book for the precise reason that it’s relevant to them. The on-air interviews are particularly indicative. For 40 minutes, you blither on in a radio programme explaining all about your work, and the host maintains an aggressively cheerful radio persona, laughing frantically at rather unfunny remarks and interrupting with anecdotes of people who have been cheered up a lot by raising ducks. Then the interview ends and the microphones go, and the interviewer grabs your hand and says, “I feel terrible, anxious all the time, and I’m lost”, or “My mother has been going to pieces on me. She does nothing but cry all day. What am I to do?”

To tolerate most of this, you have to laugh; you have to make jokes to yourself about the quality of frequent anguish. It’s the only way to get through the reality of your life, which is that you stand under a cavalcade of other people’s pain. It’s overwhelming. Until I published this book, I had no idea there was so much suffering in the comfortable part of the world, and the weight of it sits heavy on my shoulders. Having written a book on depression, you become a sort of priest, for whom there is no escape from the desolation of everything. I make jokes about it and they have some basis in reality, but in fact it is hard to be called by everyone who is in bad shape. I am best friend to people who are not my best friend, and people I’ve met once call me to tell me about the problem their wife’s sister’s niece is having. In my experience, everyone is depressed or knows someone who is depressed, and everyone grasps at such straws as the occasional depression expert has to offer. And the rate of depression in Britain has in fact, by recent broad studies, nearly doubled over the past 10 years. Never before have British people been so prosperous and so unhappy. And the feeling of world turmoil does not help. The war in Iraq had people in knots of frustration, and the advent of SARS escalated anxiety further. People feel acutely vulnerable and expect attack. Personal depression and social instability intersect in a deep feeling of unremitting chaos and loss.

There are a few frequent tasks. The first is giving people permission to seek help. There’s a standard conversation in which I try to tell people who are suffering that they really are in a bad way and that they need to take action. As a matter of convention, these people, after narrating how terrible they feel, go on to say that they’re not that bad. I then tell them that they are in fact that bad, and then make a few routine points: that while medications don’t show any long-term effect on fundamental brain chemistry, repeated depressive episodes cause lesions in the brain; that life is short and you will not get back the time you waste feeling like hell; that if you get treatment and don’t like it, you can always stop; and that their problem has a chemical basis and isn’t their fault. I have to act as though I am deeply invested in their future; I have to beseech them to look for help, so that when they are making that dread first visit to the psychiatrist, they can say to themselves and to others than an expert told them they had to do it. My advice is their armour.

If I got a commission on every patient I’ve recommended to specific psychiatrists I like and trust, I’d be on a yacht in the South Pacific by now. I run an amateur referral service because people have no idea how to find a good doctor. There is good reason for this: psychiatrists are like car mechanics. You go in there and someone tells you what’s wrong and tells you what he’s going to fix and you just pay him and accept his wisdom, because it’s nearly impossible to know whether he’s competent or not (unless you are an amateur mechanic or psychiatrist yourself). I’m alarmed, consistently, by how much psychiatric incompetence there is in the world. We all know how often you take in your car and get a new carburetor which, it seems likely, you didn’t need, only to get home and find that your Honda still makes strange coughing noises and stalls in third. I meet people constantly who are getting the wrong kind of medication at the wrong doses, or who are getting a talking therapy that doesn’t suit them and won’t help them, or who are needlessly going in and out of hospitals.

During the first months after my book came out, I kept saying that I had written about depression but wasn’t a doctor and couldn’t give any real advice. With time, however, I’ve decided that I have a moral obligation to warn people off incompetence. I say, “You might want to get someone else to consult n this”, and I say, “You might ask your doctor whether he’d prescribe a less activating medication than Wellbutrin.” I get some 10 or 12 letters a week, and I’ve had to get help answering them. They are heartbreaking. People ask me for customised advice, and sometimes I can give it, but so often I sit with my head in my hands feeling the impossibility of saying more than I’ve said in my book. I meet the people no one knows, the people who are completely isolated and have no truck with anyone, the people whose great province is loneliness. I wrote and invited confidences, and confidences come with whole people.

But I have also made friends through this process. A book on depression opens the door to intimacies, and while some of them are hard to handle, some of them are very compelling. I hear stories that resonate with my own and with the stories of the people about whom I’ve written, and they really give me a sense of kinship. From the tangle of shared pain comes much pleasure and closeness. There are things that my depression friends understand that my old un-depressed friends don’t. Someone sent me an internet card recently that says, “I thank our mental illness for bringing us together”, and shows a blooming rose garden and, inexplicably, plays Blue Velvet on the harmonium. This is clearly getting a bit carried away with things, but I do now have a world of people I tend to call my depressives, as in, “I can’t come tonight; I’m going to be out with one of my depressives.” Old friends respond to these assertions with a deep ugh of sympathy. But they are not entirely right.

So I have the kinship of depressives; and I also have the hands-on work. Several months ago, a friend made a suicide attempt. I found out about it, and joined up as special forces, cheering her along, calling often, consulting on whether her doctors were doing things right. Then she turned suicidal again. We got her to casualty and put her through the admissions procedure. She has very little family, and her friendships tend to be more social than profound; her aloneness was both the consequence and origin of her depression. There was no shortage of people to send her flowers, but no one else wanted to engage with her inner life in this rough time. I went to visit every day for a week, holding her hand, encouraging her along, talking to her doctors to make sure she was getting the appropriate treatments, persuading her to stay in when she wanted to check herself out, and so on. It’s the obligation that comes with knowing: knowing enough to be useful in a hospital setting, knowing what her condition feels like, knowing when things are getting worse. Having written The Noonday Demon, I become the caretaker to huge numbers of people, guiding them through the depression experience the way that old hands guide novices through their first acid trip. I tell them what to expect, reassure them that their feelings are standard rather than extraordinary. I spend a lot of time on wards; the floor attendants greet me with a welcome-back air at several local hospitals. It’s not what I had in mind when I wrote the book; what I had in mind then was to get the topic out of my system and then perhaps go to the occasional scientific conference and dine out on my work. But it isn’t like that with this topic. There are too many needy, lonely people; once you speak out, you can’t go back.

Over time, I’ve realised that some people with what seem to be rather minor symptoms are none the less overwhelmed by them. They suffer inordinately, and if you ask them to describe their lives, they begin by announcing their depression. Other people seem to have the worst symptoms imaginable: they get regular electroshock treatments, they feel suicidal most of the time, their depressions throw them into catatonia and so compromise their ability to eat that they become emaciated. In spite of this, they have rich and rewarding lives in the intervals between acute episodes, and if you ask them to describe their lives, depression comes quite far down on their list of experiences. What I have found over time is that people who deny their depression and shove it away and try to forget about it are most likely to be disabled by it; it comes out of the crevices of their minds and destroys them. The people who manage best are the ones who look into their depression and try to find some meaning in it. Depression is an atrocious business, but it has its riches. It puts you in touch with the depth of your own emotion; it makes you more empathetic in your dealing with others; it lets you know what part of you is profound and eternal. I’m not saying that depression is so wonderful that everyone should try it; but for those who do have it, it has an element of good in it. I’ve discovered since writing this book how often people have made their lives more reflective in the wake of their breakdowns.

The good thing about writing on depression is that you are seen as a noble and self-sacrificing person, no matter how gratifying the success of your work may be or how prone you may be to material self-indulgence, pomposity and irony. Your work sets a standard to which you must rise, or feel like a complete fraud. My assignment in life is to turn people’s minds on their depression, to help them delve into it and come out stronger. To find strength in the depression, you have to be getting as well as you can; and so the process has to start with getting people to good doctors and ensuring that they’re getting the right combination of medication and talking therapy and whatever else works for them. Once the pragmatics are all in order, the project is hope. Hope comes with knowledge, and because I have assumed a mantle of authority on this subject, I can often persuade people that their darkness will pass, and that when it is past they may see good in it. When I can get that point across, I feel as though the whole business of my weird life of confidences is worth it.