Maps of a Middle-Earth: Some Recent Books on Depression

Unholy Ghost: Writers on Depression, edited by Nell Casey, 299 pp., HarperCollins, 2001, $23.00.

The Noonday Demon: An Atlas of Depression, by Andrew Solomon, 569 pp., Scribner, 2001, $28.00.

I have always loved maps. I must have been very taken by an atlas of the world when I was young. I can picture my delight in tracing irregular shapes, learning the names, sorting out mountain ranges. A map is an antidote to being lost, a guide through the wilderness, and still a source of wonder and pleasure for me.

In recent months, however, I entered new terrain. A major, clinical depression settled in over a close family member. Though I had general notions of depression, I was totally unprepared for a close encounter with the thing itself. It may sound hyperbolic, but it was as if the earth had opened and swallowed us whole. We fell into a strange middle-earth, where everything that had been normal and assumed about life became suddenly and dangerously problematic. For my depressed family member, lethargy replaced ease, and insomnia drove away sleep. Appetite and pleasure disappeared. Decisions became agonizing ruminations. Ordinary anxieties turned into waves of panic, tides of dread. We were lost in this wilderness.

Prison woodcut by Tom Lewis-Borbely from Disciples and Dissidents

On the other hand we were fortunate and privileged. There were caring therapists and the stabilizing pharmacopoeia of our time. As the primary caregiver, however, I constantly wanted maps and more maps of this terrain. I wanted to study them. So I bought book after book, and read about depression with the avid hunger of a child who has just fallen in love with reading. For nearly six months I considered any and all writings on the subject my allies, and Andrew Solomon was one of the best. In 1999 he had published in The New Yorker a long article about his own bouts with clinical depression. This provided me with a frighteningly accurate reflection of the kinds of things my family-member was going through. A few weeks ago Solomon published The Noonday Demon: an Atlas of Depression, a copious, five-hundred page text based on that article. This was the book I had been looking for all along, an encyclopedic set of maps to this whole other world.

Its greatest strength is the same one found in the original article, his weave of his personal narrative with scholarly exposition of the medical facts, all combined with devotion to revealing anecdote and representative interview. Solomon's personal narrative, parts of which are in most of the chapters in the book, tells of his own "breakdowns," his treatments, the support of his family and friends, and above all the unique suffering that comes with major depression. Have no doubt about it. This mental illness has as its hallmark a concentrated suffering, and in Solomon's case it consisted of a jagged movement between piercing anxiety attacks and suicidal despair. His scholarly exposition examines what is known about the precise nature of the disease. Solomon also examines the standard and alternative treatments, the demographics of the disease, and the terrible frequency of suicidality among depressed people. He also does a broad historical scan of past paradigms for understanding the illness, and he periodically weighs in with the meanings he himself has constructed out of his experience. All these topics are explored with vitality, intelligence, compassion, and commitment.

Depression and poverty

The Noonday Demon is not only about depression conceived as the dark night of the individual soul. Early on Solomon notes that "Depression now exists as a personal and a social phenomenon." And throughout the book Solomon is dedicated to an analysis of the context of the individual experience of depression. Two of the best chapters, for example, examine depression in relation to poverty and to American politics in general. Throughout, Solomon reminds us that the individual experience of illness takes its shape from all sorts of social facts, ranging from class, race, and gender to sexual orientation. Moreover, statistics indicate that the illness has created its own new social facts. Twenty years ago, for example, only 1.5 percent of the American population had depression that required treatment. Now it is estimated that "as many as 10 percent of all Americans now living can expect to have a major depressive episode during their life." The most recent research also indicates that "about 3 percent of Americans--some 19 million--suffer from chronic depression."

All these numbers of course can start to overwhelm and inure, but it is to Solomon's credit that he concretizes them in the particular stories of actual and representative individuals. Through them he explores questions of stigma, health insurance, and hospitalization. He points out how little research has been done about depression among the poor. He notes that depression "occurs more often among people living below the poverty line than in the average population; indeed, welfare recipients have a rate of depression approximately three times as high as the general population." He also points out the "poor reasoning" in the assumption that unemployment must be remedied before addressing the mental health questions of the poor. He argues "fixing the mental health problem may well be the most reliable way to return people to the workforce." He does not argue that Prozac is a cure-all for social issues. Instead he is trying to do with poverty and depression what he does throughout this book: to make visible many aspects of an illness that is so easily misrepresented by false assumptions and timid, conventional wisdom.

Writing about depression

Andrew Solomon's The Noonday Demon is the definitive, layman's map of clinical depression for our time. As medical developments unfold, parts if it may go out of date, but the book as a whole is a lasting achievement. On the other hand, it wouldn't be the only book I'd pack for a hike through clinical depression's harshness. I'd also pack Unholy Ghost: Writers on Depression. Edited by Nell Casey, this anthology contains essays and other writings by twenty-five authors. It does not attempt a comprehensive treatment of the subject, but is more a selection of the strong literary work on the subject. There is, for example, a rich excerpt from William Styron's classic memoir, Darkness Visible. There is also an piece by the clinical psychologist Martha Manning, an essay which became the foundation for her exceptionally valuable memoir, Undercurrents. There is also "Writing the Wrongs of Identity," an exquisite essay by an African-American woman, Meri Nana-Ama Danquah, author of a memoir, Willow Weep for Me. In addition, Unholy Ghost presents four sets of paired authors, depressed writers and writings by their primary caregivers, most often a family member. Thus Styron' s piece is accompanied by Rose Styron's reflection on her husband's depressions. The novelist Russell Banks writes of the frustrations he felt as his wife, the poet Chase Twichell sank into depression. Nell Casey writes about her own terrors and hopes as she helped her sister. Each of these is accompanied by the depressed person's account of her or his sufferings, each version of the experience amplifying the other.

These paired writings are love stories. It would be foolish to think that all one needed in the face of this illness was love. On the other hand, it doesn't hurt and so often helps both partners through the ghastliest moments. The best example of this in Unholy Ghost comes from a memoir by the poet Donald Hall, and excerpts from the poetry of his now-deceased wife Jane Kenyon. Married to Hall for twenty-three years, Kenyon died in 1995 from leukemia. It was, however, in the tenth year of their marriage, writes Hall, that he "watched Jane lower into the blackest place," and the "unholy ghost" of depression became "omnipresent for both of us, in dread if not in actuality." After Kenyon's death, Hall himself became clinically depressed, and in an ironic twist, Jane Kenyon's poetry on depression may have helped her bereaved husband survive. Hall quotes the following poem by his wife. It measures how, in the loneliness of this illness, love can sometimes show us all the direction of the way back.

Back

We try a new drug, a new combination
of drugs, and suddenly
I fall into my life again,

like a vole picked up by a storm
then dropped three valleys
and two mountains away from home.

I can find my way back. I know
I will recognize the store
where I used to buy milk and gas.

I remember the house and barn,
the rake, the blue cups and plates,
the Russian novels I loved so much,

and the black silk nightgown
that he once thrust
into the toe of my Christmas stocking.

--Fred Marchant is the director of the Creative Writing Program at Suffolk University in Boston, and is co-chair of the Freedom-to-Write Committee of PEN New England.

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