Communicating the Uncommunicable Reality of Depression
by Joshua Wolf Shenk
After he has awoken, from uneasy dreams, to find himself transformed in his bed into a giant insect, Gregor Samsa’s first encounter with the world outside his bedroom comes in the form of his mother’s voice. “Gregor,” she says. “It’s a quarter-to-seven. Hadn’t you a train to catch?” When he opens his mouth to answer, Gregor hears a peculiar sound. The voice is “unmistakably his own” but has a “persistent horrible twittering squeak behind it like an undertone that left the words in their clear shape only for the first moment and then rose up reverberating round them to destroy their sense.” And so, having at first thought that he would “explain everything,” Gregor says only this: “Yes, yes, thank you Mother, I’m getting up now.”
In The Metamorphosis, a story about alienation, the first rupture is one of language. Gregor Samsa cannot make himself known to the world. Just as his body has become unrecognizable, inexplicably Other, so has his voice. In this image–more clearly, even, than in Gregor’s grotesque physical form–I feel the presence of the author. “I am constantly trying to communicate something incommunicable, to explain something inexplicable,” Kafka wrote of himself. He was alienated from language, and even felt trapped by it. But words, metaphors, and stories were his only way out.
When I was a small child, about eight I think, I ripped apart my bedroom in a frenzy. I threw the pencil sharpener off my desk. I pulled the sheets and blankets off my bed and turned over the mattress. I pulled clothes out of their drawers, drawers out of the bureau. Eventually the bureau itself toppled. A few moments later, my mom stood in my doorway and said, with aplomb, “Looks like a tornado has been through here.”
Five years later, I stood on the lawn of my father’s house, just home from summer camp. My oldest brother drove up the dead-end street in his gray Fiat, and turned left into the short driveway. I ran over to see him. I recall, as I ran, feeling a false expansiveness. I wore a too-wide smile, like a clown scripted for a pratfall. As I began toward the car, my brother leaned over and rolled up the window on the Fiat’s passenger side. Then he backed down the driveway and drove away.
When I was seventeen, I carried these and other fragments up the stairs of an old Victorian home in Cincinnati. As I sat in the waiting room of a psychiatry practice, I knew I was lonely, unhappy, even desperate. I did not know I was depressed. But that was the word that waited for me, a diagnosis that physicians since Hippocrates have been trying to elucidate and one that I would inherit.
The Hippocratic writers believed that gloom, abnegation, and misanthropy could be traced to excesses of black bile. Unlike the other three bodily humors (blood, phlegm, and yellow bile), black bile was never actually observed. Today, we know no such substance ever existed. Still, the Greek words–for black ( melan ) and bile ( khole )–dominated the language of inner states for more than two millennia.
In 1905, the influential American psychiatrist Adolf Meyer proposed that “melancholy” and “melancholia” be retired from the clinical vocabulary. He believed that the terms were used too broadly. They described “many dissimilar conditions” and also “implied a knowledge of something that we did not possess”–that is, the causal role of black bile. Meyer preferred the word depression. Other physicians followed him, as did medical texts and the lay culture.
In the hands of modern writers, “melancholy” has recently experienced a renaissance. In Darkness Visible, William Styron charges that Meyer “had a tin ear for the finer rhythms of English and therefore was unaware of the semantic damage he had inflicted by offering ‘depression’ as a descriptive noun for such a dreadful and raging disease.” The word depression, Styron continues, has “slithered innocuously through the language like a slug, preventing, by its very insipidity, a general awareness of the horrible intensity of the disease when out of control.”
It strikes me as telling that writers–for whom words are tools and imprecision deathly–knowingly use a term that is literally untrue; and that they use “depression,” “melancholy,” and other imperfect words interchangeably. These are two of many indications that the experience they describe has no true name. Styron, for instance, readily concedes the paradox that his memoir of melancholia is but a hazy shadow of something “indescribable.” Most accounts of depression will have this sort of disclaimer. Others disclaim implicitly through dependence on metaphor and allusion.
Perhaps depression is simply hard to convey–even, as Styron says, “indescribable.” But I’d like to suggest another possibility: That what we call “depression,” like the mythical black bile, is a chimera. That it is cobbled together of so many different parts, causes, experiences, and affects as to render the word ineffectual and perhaps even noxious to a full, true narrative.
It is ironic, given the criticism directed at him, that Adolf Meyer seemed to have in mind the limits of single-word diagnoses when he proposed that depression replace melancholy. Meyer believed the former word, obviously inadequate, would force doctors to tailor their descriptions to individual cases. “Nobody would doubt that for medical purposes the term would have to be amplified so as to denote the kind of depression,” Meyer wrote. (Italics added.) Perhaps Meyer even liked the insipid quality of “depression,” believing it would announce (like a blank canvas or the blue screen on a film set) the absence of material to come.
If so, what transpired over the century can be counted among the great tragicomedies in the history of language: Somehow, we have come to believe that “depression” is the art, is the phantasm of special effects, is the evocative detail or phrase or story rather than a mere placeholder. The DSM-IV lists only a few qualifiers for “major depressive disorder.” Psychiatrists and medical texts treat depression as a discrete entity, and assume it adheres to a particular course and treatment. Ads for drugs, herbal remedies, and nutritional supplements refer to depression as though it is a foreign invader, unrelated to the authentic self.
In lay culture, meanwhile, the word is often used with no context at all. A New York Times report on the rising suicide rate in Japan notes that the cause might be “depression,” but does not offer even a single phrase to elaborate. In conversation, otherwise imaginative, articulate speakers toss around the words “depressive” and “depressed” as if they capture a person’s essence. In his story “The Depressed Person,” David Foster Wallace gives the eponymous character no other name, which I take as sardonic reflection on the way we drape over diverse sufferers a label that hides more than it reveals.
Perhaps, for many, staying hidden is part of the point. I think of Tipper Gore, who first spoke publicly of her depression in a front-page interview with USA Today. After her son recovered from a nearly fatal accident, Gore explained, she saw a social worker and was told she “had a clinical depression and one that I was going to have to have help to overcome.”
She continued, “What I learned about it is your brain needs a certain amount of serotonin and when you run out of that, it’s like running out of gas, it’s like you’re on empty. When you get to this point of being seriously depressed or what we call ‘clinically depressed,’ you just can’t will your way out of that or pray your way out of that or pull yourself up by the boot straps out of that. You really have to go and get help, and I did. And I was treated for it successfully, I’m happy to report.”
Gore did not describe in what way she felt depressed, nor how it affected her life only that she had a “clinical depression . . . and I was treated for it successfully.” Her reticence might have been motivated by discretion, or a wish for privacy, and I do not begrudge her these. I appreciate her candor, insofar as many would choose to say nothing. Still, like so many public figures who have made similar confessions, she hinted at intimacy then quickly withdrew behind a wall. The word depression was that wall.
It is inevitable that we abbreviate and simplify. (It is apparent even in this essay that I see no way around the words “depression” and “melancholy.”) But it is one thing to use shorthand while straining against the limits of language. It is quite another to mistake such brevities for the face of suffering. Each year, seventeen million Americans and one hundred million people worldwide experience clinical depression. What does this mean, exactly? Perhaps they all have deficits of serotonin, feel hopeless, ruminate on suicide. But why? What wrinkles crease their minds? How are they impaired? For how long–two weeks? a month each year? an entire life? And from where does this depression come?
Rather than acknowledge these variations and uncertainties, many react against them, taking comfort in language that raises the fewest questions, provokes the least fear of the unknown. Such is the case with the equation of emotional problems and mechanical failure. Phrases like “running out of gas,” “neurotransmitter deficits,” “biochemical malfunctions,” and “biological brain disease” are terribly common, and are favored by well-intentioned activists who seek parity between emotional and somatic illnesses. Pharmaceutical companies also like machine imagery, since they manufacture the oils, coolants, and fuels that are supposed to make us run without knocks or stalls.
This language not only reflects, but constructs, our reality. When we funnel a sea of human experience into the linguistic equivalent of a laboratory beaker, when we discuss suffering in simple terms of broken and fixed, mad and sane, depressed and “treated successfully,” we choke the long streams of breath needed to tell of a life in whole.
Just as we hear music through intervals, experience is often easiest to understand in terms of contrast. And so despair is often best expressed in terms of what has changed. “I used to relish crowds on the street, but now people repulse me.” Or, “I used to wake up with a feeling of expectancy. Now I can only wrap the pillow around my head and pray for more sleep.”
When I began psychotherapy late in high school, I had a clear and persistent sense that something was wrong with me, but no vocabulary with which to describe it. I could not draw on contrast because I didn’t remember a time when I felt differently or better. I did not have seasons of happiness followed by epochs of misery, or fall off cliffs and climb back up among the daisies. I felt as I felt for as long as I could remember. I did not go to therapy to understand, or to get through, an episode. I needed to understand and get through my life.
Since my “condition” is so deeply rooted, much of my personality grew out of it and developed to cloak it. This made expressing myself even harder. I did well in school, stayed out of trouble, behaved like a son my parents could be proud of. I wrapped myself in a skin of normalcy and success but grew more hidden, from others and from myself. In high school, I wrote in a poem that I wished “to be a slug,” to have an exterior that expressed what I felt. Like Gregor Samsa, I greatly desired to speak the whole truth. Instead, much of the time, I merely said, Thank you, thank you, I’m getting up now–going to school, going eventually to college and the bright future that everyone expected. But the present, which I tried so hard to dodge, could not be dodged.
In Seeing Voices, his book on the language of the deaf, Oliver Sacks notes that philosophers have long dreamed of “a primordial or original human language, in which everything has its true and natural name; a language so concrete, so particular, that it can catch the essence, the ‘itness,’ of everything; so spontaneous that it expresses all emotion directly; and so transparent that it is incapable of any evasion or deception. Such a language would be without (and indeed would have no need for) logic, grammar, metaphor, or abstractions–it would be a language not mediated, a symbolic expression of thought and feeling, but, almost magically, an im mediate one.”
I hoped for such fluid, full, direct communication in therapy. I tried to express the relentless stream of criticism that I directed at myself and others, the way I felt split in two, the dull and sharp aches that moved around my body as though taunting me. I wished to plug a probe from my brain to the doctor’s, so that he could see–without mediation–how I stood outside myself, watching and criticizing, and could never fully participate in a moment. How I felt bewildered, anguished, horrified.
Instead, I often found myself silent. When I spoke, it was with stumbles and stammers. Words– unhappy, anxious, lonely –seemed plainly inadequate, as did modifiers: all the time, without relief. Ordinary phrases such as I feel bad or I am unhappy seemed pallid. Evocative metaphors– My soul is like burnt skin, aching at any touch; I have the emotional equivalent of a dislocated limb –were garish. Though this language hinted at how bad I felt, it could not express what it felt like to be me.
I suppose the combination of words, body language, and silence did in some measure convey the message, because my first therapist was able to offer me a helpful phrase. “Is it,” he asked, “as though you have a soundtrack of negative thoughts in your head–the volume rising or falling, but never going silent?” I pictured an old reel-to-reel tape machine, sitting alone on a table in an empty room. I lingered over the image, comforted especially by the acknowledgment that it never stopped. And I felt a spark of recognition, a kind of introduction to the meaning of my own experience.
The soundtrack image was an imperfect one, as I do not “hear voices” in the sense of hallucination; nor are the bad feelings that echo inside me always in words; nor can I always discern the difference between “self-criticism” and observation, between a gratuitous self-slap and a guide to truth.
But of several hundred afternoons in that Cincinnati office, this moment stands out–the offer and acceptance of a liberating, idiosyncratic metaphor, one that would need many revisions, but at least got me on the page. By contrast, I have no memory of hearing the word “depressed,” which was how I was described at that time to my parents and to insurance companies.
In his exhaustive survey, Melancholia & Depression: From Hippocratic Times to Modern Times, the historian Stanley W. Jackson concludes that “no literal statement” can convey the experience. But he found that, over 2,500 years, two images recur most often: “being in a state of darkness and being weighed down.” If we consider “melancholy” and “depression” as condensations of these images–as more than diagnoses–they retain enormous power. One of my earliest attempts at essay writing dwelled at length on an image of a dark room lit only by the space beneath the closed door. I did not make a habit of spending time in such rooms. The image of darkness imposed itself upon me, as it has for so many, as a symbol of distress.
And my dislike for the word “depression” does not mean that it has no application to my life. I am often “bowed down greatly” (from Psalm 38), feel weighed upon, feel myself on lower than level ground. Compared with others, it seems, I get less pleasure from what’s pleasurable and have a harder time with what’s hard. My sex drive is often muted (even without antidepressant medication, which exacerbates this problem). Work and activity that require some suspension of self-consciousness–like playing team sports–are difficult, bordering on impossible. I’ve tended toward activities in which self-criticism can be an asset, like writing. A tightness, an anxiety, a desperation usually grips me when I wake, relaxes its hold only occasionally through the day, and accompanies me when I lie down.
But, even as metaphors, these words are too thin to contain a life. For example, the times when I do pass from withdrawn to talkative are often quite unpleasant. Darkness aches, but light blinds.
At this point I encounter in the margins a note from my editor asking for further explanation of what is written above. And I shudder from the memory of moments like this: I am trying to explain myself and I encounter “Why?s” and “What do you mean?s” questions I fear can’t be answered. I imagine the seams of this essay splitting, and the meaning and emotion I am struggling to convey here falling out like beans from a sack.
And so I remind myself: An imperfect word is sometimes better than silence, a pale metaphor better than suicide. Researchers and therapists want to understand problems in their broad dimensions; families and friends want to make sense of their afflicted loved ones; and, of course, those who suffer in isolation, starved for connection, mad with the sense that they will never be understood and never find relief, need to say something, even if it’s wrong, or not wholly right.
Still, while we cannot be silent, or forsake the available word or metaphor for the perfect one that eludes us, we also cannot stop at those less-than-perfect words and metaphors. Insufficient or overused phrases–which resolve eventually into clicheÂ´s–lose their power to evoke a fresh, startling image. They stop tapping into the field of primal meaning that precedes language and to which, through language, we are forever trying to return. Worse, poor language can cripple the capacity to imagine. “A man may take to drink because he feels himself to be a failure,” George Orwell writes, “and then fail all the more completely because he drinks.”
The failure begins when words intended to codify or categorize, what Maurice Merleau-Ponty calls “empirical speech,” actually disrupts or preempts “creative speech,” or “that which frees the meaning captive in a thing.” Every breath and word is an effort at translation and, at times, that effort can seem impossible. But poems, lyrics, stories can do an end run around the stubborn distance that separates us, helping us feel what it is to be alive. Words can create meaning, teach us our own thoughts, and perhaps even describe a life. But we have to plumb, with curiosity sustained over time, with toleration of uncertainty, the unsettling, elusive stories that make us who we are.
Letters form meaning from lines and curves. Words form meaning from letters. Metaphors form meaning from words. None of these units are large enough to encompass, to identify, to “diagnose” a person. If pressed, one could call Ahab “mad,” or Bartleby “depressed.” But to know these characters, you must read the story. To tell a life, you must tell a story.
Which is not by any means a straightforward task. Freud’s idea of “repression” suggests that unconscious experience is like water pressed against a dam, that we need only remove the blockage and allow our memories to pour out. This is a dominant image of emotional healing in our culture. I think of it as the Hawkeye Pierce model of psychotherapy, after the last episode in M*A*S*H, in which Alan Alda’s character has been confined in an asylum and is coaxed into retelling a traumatic episode. One by one, the authentic details emerge until he remembers the repressed memory of a small child’s death. He cries. He is healed.
The psychoanalyst Donnel Stern, in his book Unformulated Experience, suggests another way of thinking about “repression.” He uses the metaphor of the rock at the bottom of a lake, which requires great and sustained effort to recover. Perhaps our lives are many such rocks. Perhaps we have to raise the ones we can, imagine the rest and then, with these images and memories and emotions laid before us, find the patterns and shapes.
We are all natural storytellers. Even as we think we are just seeing a concrete image or hearing a distinct sound, we are in fact filling in gaps, putting material in context, constructing a narrative. That muted howl from the apartment next door–is it a woman crying, or a child laughing, or the laugh track from a television set? We make such choices at every moment, usually without conscious thought. We tell stories about other people, and we tell one big story about ourselves.
But sometimes, for some people, the story is torn. The essential sense of who we are, of what the world means, becomes lost. All the bits of life’s evidence that must be sifted, digested, or passed over, instead fly like shrapnel. This happened to me a long time ago. In high school, when I first saw my name over small stories and articles, those words “Josh Shenk”–in ink against newsprint–struck me with dumb shock. I was thrilled and horrified at a small glimpse of what it meant to be real. It may seem strange that someone haunted by the inadequacy of words would become a writer, but I’ve often felt no other choice but to struggle and claw for what should be a simple birthright: to tell myself and others who I am.
Like everyone, I start with a handicap, which is that I don’t know my own beginnings. Births and early infancy precede memory. Many later memories, which we should in theory have access to, are still as elusive as mist. So we become historians of our own lives, dependent on unreliable, reluctant sources. I can describe with precision the home I grew up in, its brown paint and simple brick, the gnarled limbs on the trees outside. But what did it feel like to live there? How did it form me?
I need to find these feelings, because the facts communicate so little. For instance, I was the youngest of three children and my parents divorced when I was seven. This is a story too common to be distinctive, but too important to be ignored–the slow leakage of affection and kindness from my parents’ marriage, the grim entrance of resentment, confusion, and anger. The unspoken rules of the house forbade expressing these emotions, and this remained true after the divorce.
My brothers fled the home as best they could. I, the adoring younger brother, tried to follow them. But they had no interest in me, except as an occasional object of humiliation. I suppose I reminded them of what they hated in themselves: the vulnerable, longing, suffering son of their parents.
When I tried to let out my own feelings–tearing apart that room, for instance–my family pretended they were invisible. I learned to not speak how I felt, soon stopped knowing, and slowly but certainly developed a way of being–a sense of being split, an aching numbness, a cascade of critical voices–that would keep things that way. Some psychiatrists have described this as “depersonalization.” It is a diagnosis listed in the DSM-IV in the category of dissociative disorders, along with post-traumatic stress and what used to be called multiple-personality disorder. Depersonalization, the manual says, is characterized by persistent or recurring feelings of “detachment or estrangement from one’s self, a sensation of being an outside observer of one’s mental process, one’s body, or parts of one’s body.”
“Often,” the manual continues, “individuals with Depersonalization Disorder may have difficulty describing their symptoms.”
No diagnosis can tell my story. Still, depersonalization has the advantage of nicely announcing what is missing. To treat this “disorder” requires nothing less than removing the “de” to find the person–whatever is real beneath.
There is no drug for depersonalization, which leaves me adrift in an era where pharmaceuticals offer identity: If Ritalin or lithium or Xanax ease your symptoms, you can fit into the narrative of the corresponding disorder (attention deficit, bipolar, anxiety). If an anti-depressant helps, you can toss off the four letters preceding the hyphen and proudly affix to yourself the word that remains. I haven’t been helped by medication. Many have. But I wonder if all of us are depleted by the way brand names, dosages, and combinations have eclipsed talk of agonies, fears, and dreams. Good stories must be reined in from chaos (the whole truth), which our imaginations are too feeble to comprehend. But good stories are never simple or precise. To shape and order our lives, without molding them into caricatures, is to hew a course between the poles of chaos and cliche–the course of authenticity.
This is a truncated memoir, an introduction to my own introduction to my story. I still need to imagine my life, to find my story by living it, following moments of emotional clarity through life’s maze. I look for help in therapy, in relationships, and faith in its broadest sense–the faith of the gardener, the faith of the lover, the faith of the writer. The faith that I can experience what is real about the world, that I can hurt plainly, love ravenously, feel purely, and be strong enough to go on.
At the end of As You Like It, Shakespeare’s famous “melancholy” character Jaques hears that a duke has “put on a religious life/ And thrown into neglect the pompous court.” Jaques instantly declares, “To him will I/ Out of these convertites/ There is much matter to be heard and learn’d.” It is a striking contrast to his earlier cynicism that “All the world’s a stage/ And all the men and women merely players.” It is the declaration of a character intent on finding some meaning.
But, in contrast to the smug assurance that passes for faith on the “700 Club,” the truest faith reckons with uncertainty. It must account for the inevitable mystery, must survive the tension between the familiar and the shocking unknown (and the shocking unknowable). If one were forced to choose a single word to describe Jaques–who anguishes at the death of animals, wishes for love, longs for a fool’s easy laughter–perhaps “melancholy” or “depressed” would be a good choice among poor options. Shakespeare chose “melancholy,” but then had Jaques proclaim that he has neither the scholar’s melancholy, nor the musician’s, nor the courtier’s, nor the soldier’s, nor the lawyer’s, nor the lady’s, nor the lover’s. Jaques has, he insists, “a melancholy of mine own, compounded of many simples, extracted from many objects.” And off the stage he walks. Having hinted at his story, he goes to live it.
Joshua Wolf Shenk has contributed articles, essays and reviews to Harper’s Magazine , The Nation , The Economist andÂ The New York Times . He is a past fellow in mental health journalism at the Carter Center. He lives in New York City and teaches writing at the New School University. His first book, The Melancholy of Abraham Lincoln , will be published in 2002 by Viking Press. Address c/o Psychotherapy Networker, 7705 13th Street, N.W. Washington, D.C. 20012; e-mail address: email@example.com. This essay first appeared in the recently published Unholy Ghost: Writers on Depression (William Morrow, an imprint of Harper Collins), edited by Nell Casey, and is reprinted by permission. Letters to the Editor about this article may be sent to Letters@psychnetworker.org.