LITMIR.BIZ

       I. Intake

       Message from Room 101*

      After reading George Orwell’s 1984 in high school, I would sometimes wonder what was in Room 101. For each person, remember, it was whatever unhinged you, whatever you shuddered at most uncontrollably. “Everyone knows what is in Room 101,” Winston Smith is told. “It is the worst thing in the world.”

      I was a fairly squeamish adolescent, so a good many possibilities suggested themselves, most of them with more than four legs. But I was also devoutly religious, and the hope of Heaven was of infinite comfort, limiting the horror of even the most lurid death. Now I no longer have that faith or that hope, and the question about Room 101 again seems a live one. I think I know the answer. The pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything. Like Winston, I would—at least I might—wish it on those I love, however dearly. But that’s not feasible. The only way to escape it is to inflict my death on them. That is a grievous prospect, and I hope avoidable. But I know that those who do not avoid it cannot help themselves, any more than Winston could help betraying Julia.

      Why? What is so unbearable about this pain? The primary sources are William Styron’s Darkness Visible, Kay Jamison’s Unquiet Mind, the “New York” section of Kate Millett’s The Loony-Bin Trip, and the chapter “The Sick Soul” in William James’s Varieties of Religious Experience. Others will someday improve on these accounts; I cannot. The most useful formulation is James’s. Depression is “a positive and active anguish, a form of psychical neuralgia wholly unknown to normal life.” Every word tells. “Positive and active”: Acute depression does not feel like falling ill, it feels like being tortured. “Psychical neuralgia”: The pain is not localized; it runs along every nerve, an unconsuming fire. In an agitated depression, my kind, it burns fiercely in the solar plexus and flares elsewhere, fed by obsessive fears, regrets, self-loathing. “Unknown to normal life”: Because it feels unlimited in both intensity and duration, it truly is like no other pain. Even though one knows better, one cannot believe that it will ever end, or that anyone else has ever felt anything like it.

      Certainty that an acute episode will last only a week, a month, even a year, would change everything. It would still be a ghastly ordeal, but the worst thing about it—the incessant yearning for death, the compulsion toward suicide—would drop away. But no, a limited depression, a depression with hope, is a contradiction. The experience of convulsive pain, along with the conviction that it will never end except in death—that is the definition of a severe depression. Commissar O’Brien tells Winston that the latter’s dream of proletarian deliverance is a delusion, that his image of the future should instead be “a boot stamping on a human face—forever.” The depressive’s image of the future is “me, writhing in agony—forever.” Flesh on an electrified grid; a dentist’s drill tearing at an exposed nerve; a raging migraine; an implacable metastasis—but never ending.

      How does this nightmare happen? Through an unlucky ratio of stress to strength, circumstance to constitution. The weaker one’s nerves, the less it takes to inflame them. The more fragile one’s neurochemical equilibria, the less it takes to disrupt them. How much you feel the daily slings and arrows depends on how thick your skin is.

      Nature cuts most of us plenty of slack. “Most people,” as Styron observes, “quietly endure the equivalent of injuries, declining careers, nasty book reviews, family illnesses. A vast majority of the survivors of Auschwitz have borne up fairly well. Bloody and bowed by the outrages of life, most human beings still stagger on down the road, unscathed by real depression.” We are all issued neurological shock absorbers, usually good for a lifetime of emotional wear and tear. But if you’re equipped with flimsy ones, or travel an especially rough road, the ride becomes very uncomfortable.

      My shock absorbers seem to be exceptionally flimsy. Both of my parents were depressive: constantly worried, easily discouraged, with little capacity for enjoyment and no appetite for change. Except for a brief trip over the border of the next state to visit relatives, neither of them ever traveled more than fifty miles from where they were born. They were children during the Great Depression of the thirties, so during the Great Boom of the fifties and sixties and the Great Bubble of the eighties and nineties, they left their money—not that there was much of it; they were working-class people, conscientious but uneducated and unambitious—under the mattress or rolled up in the hollow legs of metal chairs. “Chronic severe dysthymia in a severely obsessional character” is my diagnosis and would have been theirs if they’d ever gotten one. It simply means “born to suffer.”

      Still, even with worn-out shock absorbers, life in a rich country is, at least some of the time, like a ride on a freshly paved road. Thanks to undemanding day jobs and a trickle of freelance income, I lived through the worst without institutionalization or destitution. So far. But old age looks grim. Chronic depression is very hard on lifetime earnings; and like many other people’s, my retirement account is in trauma just now. In youth and middle age, one is supposed to store up material and psychic comfort against the years of decline. We all try to, but few people, healthy or ill, can fall back on as many resources as Styron, Jamison, or Millett. All three fully deserve their eminence, their affluence, their sympathetic friends and supportive families, their happy memories. And all, as their accounts make clear, would have died without those things. There is no doubt that good fortune is the best antidepressant.

      But

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