Apr 12

“This Close to Happy” By Daphne Merkin: Severe Recurrent Depression

The opposite of depression is not a state of unimaginable happiness…but a state of relative all-right-ness. Daphne Merkin, author of This Close to Happy

I think the experience of depression that I most think remains true throughout the years is it’s very isolating. That to me is its strongest quality. That you’re alone in a room, that you’re cut off, you’re just sort of stuck with it. It puts up a wall. Maybe other people are more hopeful for you when you’re depressed when you’re young. Daphne Merkin (Boston Globe)

As introduced by the publisher of Daphne Merkin‘s This Close to Happy: A Reckoning with Depression (2017):

Daphne Merkin has been hospitalized three times: first, in grade school, for childhood depression; years later, after her daughter was born, for severe postpartum depression; and later still, after her mother died, for obsessive suicidal thinking. Recounting this series of hospitalizations, as well as her visits to myriad therapists and psychopharmacologists, Merkin fearlessly offers what the child psychiatrist Harold Koplewicz calls ‘the inside view of navigating a chronic psychiatric illness to a realistic outcome.’ The arc of Merkin’s affliction is lifelong, beginning in a childhood largely bereft of love and stretching into the present, where Merkin lives a high-functioning life and her depression is manageable, if not ‘cured.’

Publishers Weekly on Merkin’s past and its possible effects on her mood disorder:

Merkin arrives at no easy conclusions about childhood trauma or biological circumstances. She writes candidly about her lonely childhood with Holocaust survivor parents who were forced to fight their own demons. Despite her family’s wealth, Merkin and her siblings were subjected to austerity and abusive caretakers, and their mother was emotionally absent. Merkin’s exploration into her complicated yet unconditional devotion to her mother is rendered with compassion and profound perception.

Andrew Solomon, another who’s written eloquently about personal depression (The Noonday Demon), praises This Close to Happy (New York Times), noting that “(t)his is not a how-to-get-better book, but we hardly need another one of those; it is a how-to-be-desolate book, which is an altogether more crucial manual.”

Which is not to say that Merkin doesn’t tell readers about her struggles to get better, which have included medication and therapy. Kirkus Reviews:

She believes in the benefits of decades of therapy and medication, without which it’s doubtful she would have been able to write this book…Hospital stays (the last was eight years ago) have provided respite and occasionally companionship, but circumstances have been rarely much better upon her exit. Merkin has deeply ambivalent feelings about electroshock treatment, resisting a doctor’s suggestion of how much she would benefit and then regretting her refusal.

Selected Praise

Glen O. Gabbard, MD: “This beautifully written tale of Daphne Merkin’s depressive demons is by far the most accurate and human account of depression and its impact that I have ever read. I highly recommend it, both to those in the mental health professions and to those who care about the suffering of their loved ones.”

Adam Phillips, therapist: “D. W. Winnicott wrote that depression is the fog over the battlefield. In this extraordinarily lucid and moving book, Daphne Merkin illuminates the dark and desperate battle that depression can be. This is a book for all those who know nothing about depression and for those who know too much.”

Carol Gilligan: “This Close to Happy belongs on the shelf with William Styron’s Darkness, Visible and Andrew Solomon’s The Noonday Demon. It brings a stunningly perceptive voice to the forefront of the conversation about depression, one that is both reassuring and revelatory.”

Jun 17

“The Noonday Demon”: Andrew Solomon Examines Depression

Listen to the people who love you. Believe that they are worth living for even when you don’t believe it. Seek out the memories depression takes away and project them into the future. Be brave; be strong; take your pills. Exercise because it’s good for you even if every step weighs a thousand pounds. Eat when food itself disgusts you. Reason with yourself when you have lost your reason. Andrew Solomon, The Noonday Demon

Recently I posted about Andrew Solomon‘s new TED talk “Forge Meaning, Build Identity.” Also pertinent to Minding Therapy is his 2001 The Noonday Demon: An Atlas of Depression, a book that’s both personal and sociocultural in scope.

Solomon’s own severe bouts of depression began in his senior year of college. Jan Scott, M.D., The New England Journal of Medicine, explains:

By his own account, he grew up as a healthy, happy, white American from a privileged background. He enjoyed positive relationships with his family and had a strong network of friends. Yet, in the early 1990s, depression crept up on him and took over his life, so that even getting out of bed and going to take a shower became an overwhelming challenge that he frequently failed to overcome. Despite success in his career, he became unable to undertake the simplest tasks, had frequent periods of intense anxiety, and avoided social contact with friends. Solomon can give no easy explanation of why he is vulnerable to recurrent depression, and he does not associate any specific events with the onset of the episode he describes in detail. However, he clearly had all the classic symptoms of a major depressive episode and was so debilitated by this disorder that he returned to live with and be cared for by his 70-year-old father. Solomon describes the incredible sense of loneliness that characterized this time in his life, and he writes graphically about the despair and hopelessness he felt. He tried a number of treatments, including psychoanalysis (which he says was ‘like firing a machine gun at the incoming tide’) and various types of medication (some of which he used simply to obliterate the day). Not wishing to kill himself by more conventional means, he decided, with the logic that characterizes a man on the edge, that indulging in frequent unsafe homosexual sex with strangers would put him at high risk for AIDS. He reasoned that if he contracted AIDS, he could finally escape his miserable existence, but he could also die in a way that would cause his family less distress than a sudden suicide and, he believed, would be more acceptable to the rest of society.

Last year he gave the following TED talk, “Depression, The Secret We Share”:

If you’ve neither watched the above talk nor read The Noonday Demon, you may be interested in some of these quotes from The Noonday Demon:

The Opening Lines

“Depression is the flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.”

The Nature of Depression

“Antonin Artaud wrote on one of his drawings, ‘Never real and always true,’ and that is how depression feels. You know that it is not real, that you are someone else, and yet you know that it is absolutely true.”

“Grief is depression in proportion to circumstance; depression is grief out of proportion to circumstance.”

“The most important thing to remember about depression is this: you do not get the time back. It is not tacked on at the end of your life to make up for the disaster years. Whatever time is eaten by a depression is gone forever. The minutes that are ticking by as you experience the illness are minutes you will not know again.”

What Helps Depression  

“The people who succeed despite depression do three things. First, they seek an understanding of what’s happening. They they accept that this is a permanent situation. And then they have to transcend their experience and grow from it and put themselves out into the world of real people.”

“A sense of humor is the best indicator that you will recover; it is often the best indicator that people will love you. Sustain that and you have hope.”

“It is important not to suppress your feelings altogether when you are depressed. It is equally important to avoid terrible arguments or expressions of outrage. You should steer clear of emotionally damaging behavior. People forgive, but it is best not to stir things up to the point at which forgiveness is required. When you are depressed, you need the love of other people, and yet depression fosters actions that destroy that love. Depressed people often stick pins into their own life rafts. The conscious mind can intervene. One is not helpless.”

Being on Medication

“Since I am writing a book about depression, I am often asked in social situations to describe my own experiences, and I usually end by saying that I am on medication.
“Still?” people ask. “But you seem fine!” To which I invariably reply that I seem fine because I am fine, and that I am fine in part because of medication.
“So how long do you expect to go on taking this stuff?” people ask. When I say that I will be on medication indefinitely, people who have dealt calmly and sympathetically with the news of suicide attempts, catatonia, missed years of work, significant loss of body weight, and so on stare at me with alarm.
“But it’s really bad to be on medicine that way,” they say. “Surely now you are strong enough to be able to phase out some of these drugs!” If you say to them that this is like phasing the carburetor out of your car or the buttresses out of Notre Dame, they laugh.
“So maybe you’ll stay on a really low maintenance dose?” They ask. You explain that the level of medication you take was chosen because it normalizes the systems that can go haywire, and that a low dose of medication would be like removing half of your carburetor. You add that you have experienced almost no side effects from the medication you are taking, and that there is no evidence of negative effects of long-term medication. You say that you really don’t want to get sick again. But wellness is still, in this area, associated not with achieving control of your problem, but with discontinuation of medication.
“Well, I sure hope you get off it sometime soon,” they say. ”Life with Recurrent Depression

“The opposite of depression is not happiness, but vitality and my life, as I write this, is vital even when sad. I may wake up sometime next year without my mind again; it is not likely to stick around all the time. Meanwhile, however, I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, when hell came to pay me a surprise visit. It’s a precious discovery. Almost every day I feel momentary flashes of hopelessness and wonder every time whether I am slipping. For a petrifying instant here and there, a lightning-quick flash, I want a car to run me over…I hate these feelings but, but I know that they have driven me to look deeper at life, to find and cling to reasons for living, I cannot find it in me to regret entirely the course my life has taken. Every day, I choose, sometimes gamely, and sometimes against the moment’s reason, to be alive. Is that not a rare joy?”