One Friday in April, A Story of Suicide and Survival
New York: Norton, 2021
The Afterlife, A Memoir
New York: Farrar, Straus and Giroux, 2006.
Darkness Visible, A Memoir of Madness
New York: Random. 1990.
Can we speak about suicide as if it were one thing? As if a young boy, bullied at school, an unlocked gun at home, is the same as an 80-year-old woman who’s ill and stashing sedatives? And what do these two have in common with a middle-aged man, battered from a traumatizing childhood, now suffering persistent bouts of panic and sleeplessness followed more and more with what turns out to be an intractable and unending depression?
Some might say that suicide is a rejection of the future, a future real or imagined. But this middle-aged man—say, the celebrated writer Donald Antrim—experiences the constraint of suicide as a state, an encasement, not in historical time. He feels he’s sunk in eternal dying. It’s different from depression. He’d call this person “the suicide,” no bones about it.
Antrim writes memoirs and short stories, often published in The New Yorker magazine. His early fiction has a surreal quality, not to my taste. Then I read his new memoir, One Friday in April: A Story of Suicide and Survival, of a time when he found himself in a dark wood. He’d finished but not yet published The Afterlife, a memoir of life with his mother, Louanne Antrim, a gifted tailor, a professor of fashion history, and a high-functioning alcoholic, who became increasingly hapless and delusional before sobering up in her last years.
His father was a T.S. Eliot scholar, also alcoholic. The family trailed the father’s career up and down the eastern seaboard, from Florida to Virginia and back. Along the way, the parents fought: the mother attacking, the father rueful and withdrawn, the knives resting ominous in the kitchen drawers. The young Antrim suffered with asthma, with back spasms, with allergies, retching in the toilet upstairs while the parents argued through the night downstairs. They divorced, remarried each other, only to divorce yet again.
It was left to Antrim and sometimes his sister to manage the mother’s spiraling eccentricities. In The Afterlife, even as an adult, Antrim was embarrassed by the strange clothing Louanne began to sew. She grew isolated and delusional, hair askew, and came to suffer, she believed, because of her visionary work. Sober in her last years, she at one point convinced herself that she’d been offered a solo show for her textile art. When Antrim arrived with her at a local gallery, he realized she’d conjured an imaginary offer out of a polite remark from the art dealer. Louanne died of lung cancer, 65 years old, downstream of a long trawl of cigarettes and booze, of bad luck and hyperbolic judgment.
Six years later, one Friday in April, on the eve of the publication of The Afterlife, Antrim found himself on the high roof of his Brooklyn apartment, pacing around, climbing over to hang off the fire escape, pulling himself back up, hands scraped and black from the efforts, lying down on the silver roof, curling into a ball, then up and pacing, socks torn, climbing down again onto the fire escape.
“I was on the roof. I couldn’t stand straight. I couldn’t walk straight. I couldn’t pull my shoulder back, or take a deep breath,” he writes. Then he dollies out for a bigger view: “I was forty-seven, middle-aged, in the time of life when, for men living on their own, the incidence of suicide rises.” Then back again to the rooftop, to the sounds of children at recess in a nearby school. “I could see the city in all directions.” He stayed there for hours, paralyzed and agitated both. Night fell. He was suffering, he’d say, for writing about his mother, “a ruthless act,” a betrayal.
“I wanted a bullet,” he writes. “I had wanted one since Christmas, to eliminate an itch behind my temple.” He reasoned his death might be better for others, “for all the people who have made the mistake of loving [me], or who one day might.” And: “I ruin everything.” His friends protested, no, no. “I’ve ruined myself,” he would insist.
Most symptoms of depression and bipolar disorders are well known even outside the field of psychotherapy: ruminating in a loop about failure and guilt, about being a hopeless burden, about health problems—a diving, unstoppable swarm of negative thinking, “bad imaginings.” Also well known are feelings of sadness, irritability, the loss of pleasure.
There are tormenting physical symptoms as well—loss of appetite, fatigue, restlessness, agitation, an engulfing paralysis. Antrim’s personal list: leaden legs, bad balance and tipping this way and that, difficulty standing, eczema, burning sensations, sunken and tight chest, tight jaw, voice high and flat, a feeling of weakening joints, spasmodic arms, trembling hands, tingling feet. Also: can’t walk straight, can’t tolerate touch, can’t hold a head up, can’t hold a pen well, can’t read, can’t write, can’t move and, paradoxically, can’t stay still.
American writer William Styron’s memoir, Darkness Visible, of his suicidal depression, also included descriptions of so many distressing physical sensations that a suicidal person (or, as Antrim would say, “the suicide”) might come to believe there must be something else going on, say a vascular problem. It was like, Antrim told a friend, rigor mortis, if one were able to experience that.
Despite the occasion for despair, Antrim is easy to read. A master of distraction, he takes the reader into a swift vignette of his father’s new wife or a doctor’s office with frayed upholstery or his bon vivant but perverse uncle—only to drop us yet again onto the high roof, or downshift into another moment in the long and desperate quest for a help he could not imagine. He possesses a singular skill to mimic a tiresome and foreshortened thinking growing out of touch with reality, the imploded stuckness of “the suicide”—the writing itself becoming not tiresome but fast and elegant, courageous, a document of both pratfalls and epiphanies. A clinical student could learn a lot from this book; a supervisor could teach from it.
Much of the drama of Antrim’s story depends on his haphazard reckoning with the vagaries and successes of treatment, starting with his own obliviousness: “my apprehension of suicide first came as a denial of it.” In the years building up to that one Friday in April, he hardly knew the direction he was heading. He experienced a little help here, help there, a therapist moving away, a doctor’s breezy indifference to dosages, red pills, yellow pills, pills for sleep, Valium, Ativan, Wellbutrin, Lamictal, Klonopin, not to mention arriving in clinics with unspecified ailments to see uncomprehending doctors.
Once off the high roof, he got critical sleep during a short hospitalization, but when he left the hospital a few days later, “the world did not look right.” There was another trip to an emergency room, a shaming and oblivious doctor. Mercifully, he remembered a friend from college who’d become a psychiatrist. He phoned her; she asked the right questions; she sized it up. “I promised her I was not thinking of hurting myself, although dying was my only thought,” he writes. She wasn’t fooled, and referred him to a competent therapist, Dr. T, who convinced him he was in big danger.
By the end of that week, Antrim found himself in a taxi on the way to Columbia Presbyterian. A team came together of compassionate, experienced people: doctors, nurses, technicians, even some of the patients admitted to the hospital. Not a cuckoo’s nest, they were instead a community devoted to safety—and patience. On the ward at last, Antrim portrays himself not as the lone, misunderstood rebel of ’60s fiction, but as a humble guy, shaggy and thin, shivering on a sofa day after day, lying with his back to the common room, his mouth dry, his nails yellow and thickening, and relieved not to be in immediate danger—something he hadn’t felt for a long time.
Slowly, he found that the reassurances of the doctors and nurses mattered to him, and the company of evening visitors mattered—even though all these helpful, caring people existed in a time that wasn’t his time, the eternal time of suicide, unreachable, unabating. In July, after the memoir of his mother came out, along with eczema on his “third eye” (over the medial prefrontal cortex, devoted to “bonding with others and our safety in the world,” Antrim notes), he introduces an empathic first-person plural voice, a “we,” into his writing. That communal voice denotes, I think, how much Antrim was becoming a citizen of the hospital, a “therapeutic city,” sharing its “fantasies of wellness.” He writes, “We live among people trained to relieve our crises. . . . Some of us had been sexually or otherwise violently abused—hit, bullied, intimidated. Some of us had been left by loved ones. Some didn’t know what had happened.”
He lands on the word asylum, but not the hell station of “halfway naked people” slumped over in hospital corridors. An asylum can serve refugees, political prisoners; it’s not so much a building as a “provision,” he writes, something legislated and granted, a protection from harm. “Coherent bonding is difficult for those of us who ‘lose our minds.’ For us, the loss of community is the symptom of an illness that only grows as the personal isolation intensifies.” People who suffer from the extremities of psychosis and severe depression in Western cultures have but one asylum: the hospital.
In a special quiet room, Antrim sobbed on the mattress for his betrayal of his mother, for choosing to write, for old loves, for the cats he’d cradled: Zelda, F. Scott, Pippin. The nurses urged him up, up, join a cooking class, but he couldn’t engage. His beard turned wiry; his calves looked blue; the hair on his arms seemed to rustle. Maybe he needed another kind of medicine, another doctor; something was wrong medically: yes, it must be a rheumatological disease, not a psychiatric disease.
One day on the ward, he saw his misshapen skull in the polished metal of a mirror, the eye sockets empty, “a moment of death imagined.” He’d been two months in the hospital, safe but not really getting better and sometimes getting worse. A few days later, after an uncharacteristically crazy outburst at the nurses’ station—Why was I being held against my will? Why would no one help me?—he found himself facing a jury-like team of doctors and nurses. There was someone he didn’t recognize, a frank woman in a Chanel suit (the suit he recognizes, given the love of tailored clothes he’s inherited from his mother); she told him he was sick and needed electroconvulsive therapy (ECT). Frightened, convinced that ECT would destroy his personality, his ability to write, he wandered around the ward, crying, wailing.
Then, in the best use of deus ex machina ever—a god arriving on the scene to head difficult things in a good if unlikely direction—the writer David Foster Wallace called him on the patient phone. Antrim had read Wallace, had a passion for his brilliant, manic writing, but didn’t know him. Yet a mutual friend had told Wallace what was going on with Antrim. Wallace asked, did he mind hearing from him? No, he did not. “I’m calling to tell you that if your doctors recommend ECT, then I want you to do it,” Wallace said, speaking from his own hard experience. He said it over and over, I want you to do it, because, Antrim writes, “he knew I was ruminating, and that I would not be able to believe him for long, just a few minutes.” Afterward, Antrim dialed his girlfriend. “I’m going to have ECT.”
Far from a scary and primitive technique, feared to be a diabolical effort at social control, ECT is a small, electrically induced seizure now used widely and effectively for intractable depression. Most people who need it won’t get a call from a famous writer to convince them to do it, but if they were to read Antrim’s account, they’d likely be convinced by its earnest specificity of the experience, his shifting into the intimate second-person you. He starts, “You lie in your gown and your socks on the table.” And in this way, for a few pages, readers can inhabit the experience of the procedure itself: the oxygen meter on your finger, the blood pressure cuff on your ankle, the sweet smell of the anesthetic. The ECT nurse holds your hand because you ask them to do it. The convulsion itself lasts, say, half a minute, but you’re gone before that and wake up wondering, “Are we ready to begin?”
After five weeks of ECT, after new medications, after adjustments of this and that, both Antrim and the staff could see that he was slowly getting better. “The muscles in my neck and face loosened and relaxed, and my breathing got easier. . . . My voice grew deeper, and I wasn’t clumsy, only nicely depleted from the treatment.” He joined the cooking class; they made hamburgers. Furthermore, “I realized that I had not destroyed my life by writing about my mother.”
In the days of recovery, there were hitches to come, but he was patient. Unshackled from the physical weight in his chest, the juddering gait, the trembling hands, slowly the narrow, negative thinking softened. Finally back home, he found he could make a bed, wash a dish, tuck in his shirt. Then: eat a donut in a coffee shop, browse in a bookstore, even though he could barely read, much less write. “In the hospital,” he writes, “I had been certain my life had been defined by errors and mistakes, but now I was not so sure.” He felt safe, safe to be vulnerable.
Antrim continued to go up and down; he had another four-month return to the hospital after a breakup with a girlfriend, more ECT. He got better at recognizing the looping thoughts, the strange physical constrictions, the paralyzing fears rising. He got better at knowing what to do: get help, get back on medications, remember feeling healthy, notice how attachments help regulate oneself, never a done deal. When William Styron reached this point in his own recovery, he felt that he’d been saved from the siege of suicide, believing most people survive and live “as happily as their unaffected counterparts.” But Styron’s magisterial memoir devotes at best only 14 pages to his time in the hospital.
Antrim has a wider vision of the contributing social factors, a clearer, more detailed account of how depression and bipolar disorder can be sequels to early trauma and neglect. “We don’t understand, as children, that our loneliness and lack of care will become a fate,” he writes. If you put together One Friday in April with The Afterlife, you’d have a report on the prequels, for example, the role of addictions, their trickster energies, their generational cascades. Or the family system of a son condemned by both his father’s and his own inability to rescue an enlivening mother from her growing dishevelment. Psychodynamically speaking, you might say Antrim was both “innocent,” helpless at the hands of his parents, and “guilty” for abandoning the two of them—a harsh and paradoxical judgment that grew in power with the press of delirium and psychosis. Styron, however, doesn’t seem fully aware that as “the suicide,” he’d all along been in a conversation with his mother, not the way Antrim is sensible to it.
Antrim is a first-class writer and thinker, able to puzzle out his own confusions, the volatile enmeshments, his absorption of parents and others taken in to join the voices and gestures and arguments that form the illusive experience of a “self.” So I can imagine him being interested in all such iterations, but he arrives at an understanding of “the suicide” that goes beyond personal history.
To that end, we should note that in the long horror of people dying by suicide, everywhere, in all cultures, there’s been an argument going on. We say that people kill themselves, that they commit suicide, moreover that they commit successful suicides. We ascribe an invariant agency. It’s a mortal sin, some say, a murder. Or a crime to be punished. The life insurance industry argues that suicide is a worldly choice—a bad choice for sure—to be settled by the accountant. A more ordinary response might be that suicide is a blot on an otherwise worthy life, a moral failing, a lack of character, a drunken moment, or a history of weakness revealed. Or suicide could be a failure to reckon courageously with life’s absurdity, as Albert Camus claimed, suicide being an “insult to existence.” Or, contrariwise, as the psychiatrist and for-sure-contrarian Thomas Szasz always argued, suicide might be a good choice, a moral choice, a voluntary death, certainly not a disease process to be controlled by patronizing doctors. All these fictive stories are ways to imagine that suicide is a choice “as if some part of us exists outside the illness, unaffected, taking in the situation and making rational decisions.” So while we may not deserve our suffering, we deserve our solution.
Suicide does not seem like a choice to Antrim. He was, he says, not on the roof to jump: “I was there to die, but dying was not a plan. I was not making choices. . . . I did not want to die, only felt that I would, or should, or must, and I had my pain and my reasons, my certainties.” He’d say suicide is a condition, like diabetes or cancer, an affliction—and truly we would not say a diabetic person had “committed” diabetes. The suicidal state is not the result of pain, but is itself the pain. The suicide, Antrim insists, is trying to survive.
David Foster Wallace died of suicide in 2008. “I felt I’d lost a comrade in survival,” Antrim writes. The question of choice deserves a lot more space than this short review, but it’s one thing to be in the middle of delusions and intense thoughts of suicide arising from a psychotic depression, and another thing to have dealt with that psychosis, deciphered it, recovered from it, and then to confront its return, over and over, with fewer and fewer successes with treatments.
Reading One Friday, I found myself struck yet again about how atomized our understanding of suicide has been, where we prioritize, say, personality flaws, or personal history, or personal thinking itself. As much as Antrim reckons with the impact of his childhood, he doesn’t stop at laying out a dramatic family history, but rather visits and revisits that April Friday on the high roof, enters and reenters the scenes in the hospital until the whole shebang is held in a complex, increasingly inclusive understanding. He learns over and over again to situate himself in other, healthier social systems, say, the holding environment of a hospital ward, or the compelling advice from people he comes to respect. Or the social system involved in the care of a dog or a marriage.
The short stories that Antrim has written since his hospitalizations look to me to be different from his previous fiction—more compassionate, for one, more soulful and forgiving. I wish Antrim happiness and send him gratitude for his self-deprecating humor, his lionhearted courage, his amplitude for ambiguity and revelation both.
Molly Layton has been writing for the Psychotherapy Networker for over 25 years. Her short stories have been nominated for a Pushcart Prize and included in the Writing Aloud Series at the InterAct Theater in Philadelphia. She has a private practice in Erdenheim, Pennsylvania.