Outrunning Eshu: On Finally Seeking Treatment for Depression

This essay originally appears in New England Review Vol. 38, No. 1.

In July, as Eshu is chasing me down, I stumble across a newspaper article about a group of men in London who like to dress and live like dogs. These men, these members of the “pup community,” spend their time dozing on the floor and leaping around with squeaky toys. They roll in the dirt. They nuzzle their human handlers.

The article makes clear these men seek only acceptance as they are, which I am certainly willing to grant. Still, reading the article I can’t help but think of a phrase from my childhood, a phrase about which I am ambivalent but which I cannot completely disavow. The phrase is this: Now that is some white folks’ mess. “White folks’ mess” was a phrase used often by the adults in my black, southern family—especially the women—a phrase by which a whole host of bewildering behaviors and events could be explained: Pet Rocks and deviant sexual practices, backwoods camping and 50 dollars for a pair of ripped jeans. Kissing your dog. Serial killers. Happy Days and Ronald Reagan and Barry Manilow.

And mental illness. Mental illness, mental disorder of any possible stripe, was definitely white folks’ mess. White people had nervous breakdowns; black folks just got tired of shit. White people had anxiety, black folks had nerves. Black folks got the blues sometimes, but only white people got clinically depressed. White people listened to Prozac. Black folks listened to their mother, their pastor, and God.

All of which explains why, although I don’t precisely remember at what age I came to understand as depression the unpredictable trickster threatening to submerge me, it’s not hard for me to guess the time period. It would not be while I still lived at home under the sole influence of my mother, a tough and (secretly) wounded bird. It would have to be after I was sent, protesting and frightened and in the name of diversity, from Memphis to a predominately rich, predominately New England and very, very white boarding school at the age of 15.

Confirmation arrives in the form of a journal I began keeping my second year:

May 17, 1981: And instead of doing homework I’m writing here. I feel like I’m teetering on the edge of that old familiar feeling of depression and I need something to pull me back. I don’t know what.

Depression: I actually used the word here, just a few days past my birthday.

I had just turned 17.

—*

A few days after reading about the “pup community,” I open a file on my computer and begin writing up drafts of suicide notes.

This is not so much the start of any coherent plan as it is a means of confronting head-on the tricky spirit that has been loping around the past few weeks, sharpening its claws, readying its cruel and damaging pranks. It occurs to me that, for a writer, a suicide note is no minor thing: one’s last literary production, one’s final words to the world. Talk about pressure. What do you say that makes sense that won’t embarrass you in your biography? What do you say even if you know no one will ever write a biography of you?

I decide to do a little research. Famous writers and their suicide notes. I begin, predictably, with Papa.

July 2, 1961. Ernest Hemingway climbs from bed at his house in the Sawtooth Mountains early in the morning, walks to the storage room where his beloved firearms are kept, takes out a double-barreled shotgun, and shoots himself.

I hate guns but Hemingway kept a lot of them. Firearms are, by far, the most common method of suicide: 55 percent of people who take their own lives do so by firearm, according to data from the Centers for Disease Control. Nearly two thirds of the gun-related deaths in the United States each year are suicides, meaning the majority of people who die by gun in America do so at their own hand. Gun suicides are especially prevalent among men.

Hemingway, that man among men, did not leave a note.

In Death in the Afternoon, however, he wrote this: “There is no lonelier man in death, except the suicide, than that man who has lived many years with a good wife and then outlived her. If two people love each other there can be no happy end to it.”

Perhaps Hemingway killed himself because he feared a decline of his vaunted masculinity, or the loss of his prodigious writing skills. Perhaps he feared losing Mary, who lay sleeping upstairs when he pulled the trigger and presumably heard the shot. Perhaps he was just tired, and wanted to go out on his own terms.

Nobody really knows, though plenty of people have speculated. That’s what happens when you don’t leave a suicide note: people can make up any shit they want.

—*

In 2014, an estimated 15.7 million adults (6.7 percent of the adult population) experienced at least one major depressive episode, according to the National Institute of Mental Health. A major depressive episode is defined as a period of two weeks or longer during which a person experiences depression, loss of interest or pleasure in everyday life, and at least four other symptoms that reflect a change in functioning: sleeplessness or excessive sleeping, loss of appetite, or problems with energy, concentration or self-image. (An important note: the nimh did not make exclusions for depression caused by bereavement, substance abuse, or medical illness.)

Women are 70 percent more likely than men to experience depression in their lifetime, says the CDC. On the bright side, depression among women improves after age 60, which is not true of men.

Not surprisingly, people living below the poverty level are more than twice as likely to experience depression as those living at or above the poverty line. The National Survey of American Life finds that African Americans are less likely than whites to experience depression (lasting over two weeks) over their lifetimes. But the US Health and Human Services Office of Minority Health finds that adult African Americans are 20 percent more likely than whites to report serious psychological distress at any given time.

How to make sense of the discrepancy? Perhaps black Americans get depressed more often than their white counterparts but bounce back in less than two weeks. There is some evidence for this—a study by the University of Michigan found the link between depression and hopelessness was stronger among white Americans than black Americans. Or maybe black Americans are simply less likely to admit being depressed. There is evidence too for this theory: black Americans are half as likely as their white counterparts to access mental health services. An estimated 92 percent of African-American men with depression do not seek help, according to the CDC. Which makes it reasonable to consider the statistics off.

Here’s one more statistic from the CDC: the portion of people with depression who will commit suicide is 15 percent.

All of which is of probing, compelling interest to the observer part of me. To observe a thing is to wonder, to wonder is to contemplate, to contemplate is to determine, to determine is to understand. Not that understanding offers a solution or an escape.

The other part of me, the experiencing part, I struggle to name. “Depression,” yes, but how pedestrian and limited that word is. The “monster” I know is too melodramatic and un-ambivalent for such a name. (What did Joan Didion write in Slouching Towards Bethlehem? “I can’t get that monster out of my mind.”)

I try “spirit,” then “satyr,” then “trickster,” but none of those is right. Then it comes to me: Eshu. The trickster god of the Yoruba people. Sly, disruptive, unpredictable, and randomly either helpful or cruel, he serves as a messenger between the people and their gods. Eshu.

The other part of me, the observer who stands outside Eshu and watches him tricking me down into the depths, is easy to name. She’s the Writer. I’ve known her all along.

*

Usually the misery is worse in winter. I am a southern girl, not born for long, dark days of snow and cold. The brief New England summer is usually a blessing, the sun and heat (I never use an air conditioner) like a natural antidepressant buoying me up.

But the year of our Lord 2015 brings reversal. The Boston winter is so off-the-charts unbearable that even the embrace-the-cold types are miserable. And I am strangely okay.

Then comes spring and then summer, blessed summer, and my spirits plunge. May into June, June into sweet, hot July. There are no reasons for my sadness: all is well, if not perfect, in my life. I am blessed with many, many gifts. Yet the days begin in quicksand and grow heavier. I cry consistently. I read the news and see only ugliness: police brutality and racial injustice, war and rampant greediness, babies dying in Chicago and babies washed up on a European beach. A friend has an eleven-year-old son battling cancer and the updates on Facebook wrench my heart. Another friend struggles with financial ruin and a third leaks loneliness. The whole world seems selfish and irredeemably cruel and I feel alone in it: unprotected, un-chosen, unloved.

For my children only I get up off the couch and try the things people who have never been depressed so blithely recommend. I exercise and get some sun, take the dog for long, rambling walks. I focus on others, on my kids and my volunteer work. I go to church and count my blessings and practice gratitude. I try 5HTP, a so-called natural antidepressant. I try saying, lightly, of my yawning, aching loneliness, “Oh well!”

I try to meditate. Psychological research, including a 2014 JAMA Internal Medicine analysis of forty-seven studies, suggests that meditation and mindfulness-based cognitive therapy can be moderately effective in treating depression and perhaps more so at preventing relapse. Then again, psychological research (a 2015 meta-analysis published in the journal Science) suggests that 60 percent of psychological research is, essentially, crap.

Some of these things work temporarily, like licking your lips when they are chapped. Soon enough the relief evaporates. Soon enough the stinging returns.

Near the bottom of the tumble I begin calling on people for help. This  is almost always a mistake. One has to be very careful who one talks to in the midst of a depressive episode; not everyone is your friend, not even your friends. People want to be helpful, but what they think of as help is less like tossing a rope to a drowning person and more like tossing an anvil.

What could possibly be the matter? You’re fine.

It’s always darkest . . . God never closes a door . . . smile and the world smiles . . . Come on! You’re a strong black woman!

This kind of help stems partly from good intentions but also from a pervasive societal belief that depression is really a kind of moral failure: a bad attitude, a shortage of will. (Percentage of people who think depression is a personal weakness according to the US Department of Health and Human Services: 54. Percent of black people who think so: 65.) In the United States of America, land of the eternally young and the eternally cheerful, complexity of feeling is suspect. Anyone disinclined toward the warm bath of relentless happiness risks being branded “negative.” Once, on a date, a man I had just met asked me if  I believed I would find my soul mate. I refrained from saying I didn’t believe in soul mates (or that research shows people who believe in soul mates are less satisfied in their relationships) and said only that while I certainly hoped to find a partner someday, there was no guarantee I would.

He looked at me as if I’d pulled a puppy from my purse and drowned it in my water glass.

“With an attitude like that, I fear for your future!” he cawed. Exact words.

The deep American suspicion of melancholy and its contents is connected to the deep American suspicion of intellect, of complexity of thought and perspective, of wakefulness. Every institution in our culture, every Hollywood movie and major league game, every history lesson and Labor Day sale and political stump colludes to keep the dreamer dreaming, to tuck in the blanket and pat the heads. By default, depressives stand outside of this magical circle, observing. By necessity, they must be bullied back in.

I was probably forty years old before it occurred to me that not everyone felt things as deeply as I apparently do, that not everyone tumbled into canyons once or twice a month. I always just assumed other folks were better at leaping out.

That people should experience physical pain differently is pretty well accepted. Physicians and scientists speak of “pain tolerance” (the maximum level of pain a person is able to tolerate) and “pain thresholds” (the point at which pain begins to be felt) and how these differ in women and men. We understand that physical pain is not only a biochemical/neurological experience but also an emotional one; stick ten different people with a pin and they will experience the pain of that prick in ten different ways. Redheads are more sensitive to pain than others, and right-handed people can tolerate more pain in their right hands than in their left. When my daughter had surgery the pacu nurses kept asking her to rate her pain from one to ten. “Your five might be my eight, but it doesn’t matter,” they said. “It’s how it feels to you that counts.”

The last time I had blood drawn the young woman in the cubicle next to me was so panicky at the thought of the needle piercing her skin she burst into tears. They were still calming her down when I left.

Me, I have no problem with needles. I shrug off headaches, managed a second-degree burn with one dose of Tylenol, gave birth to both my kids without epidurals. Maybe that means I’m tougher than people who scream at cuts or moan at toothaches or demand relief from the agonies of labor. Or maybe that shit just didn’t hurt me as much.

*

One in ten Americans now takes a daily antidepressant medication. Among women in their forties and fifties the number is one in four. The percentage has skyrocketed since the late 1980s and climbs more every day. Pretty much everyone except the makers of Wellbutrin and Paxil (etc.) believes that this is far more than necessary, that physicians have over-diagnosed depression on a massive scale. The Emperor’s New Drugs: Exploding the Anti-Depressant Myth, a 2009 book by Irving Kirsch, expanded on his research that found antidepressants were no more effective than placebo in treating all but the most severe cases of depression. But a new statistical analysis of the data in 2012, led by a researcher at Yale and using a statistical technique known as growth-mixture modeling, found that three-quarters of patients actually did better on medication than placebo—while one-quarter were actually made worse.

Regardless of and despite the overprescribing, and the confusion around efficacy, most mental health professionals agree that many people who meet the requirements for major depression suffer without treatment. This is especially true among African Americans and Latinos, who access mental healthcare services at far lower rates than their white counterparts. Our white counterparts. Eshu visited sporadically but persistently from the time I wrote that journal entry at age 17. In college I sent him packing with panic over finances and crushes on boys and Saturday nights of rum, and still wrote stuff like this: “I’m scared I’ll find there really is no meaning behind it all. Wouldn’t that be funny, a joke on all us aspiring ambitious intellectuals? What if I struggle and fight and finally make it and go home one night to my luxury apartment and sit in the dark with Simon and Garfunkel on my thousand dollar stereo and cry because it doesn’t really matter any damn way?” Ah, youth. (My Bose cost $150.)

Out of college and working I tried once or twice seeing a therapist. These were either kindly old white women in rocking chairs who had not a clue where I was coming from or glossy young white women in stirrup pants and glinting diamond rings who had even less of a clue. I rarely got past session one.

I remember once lying on the floor of an apartment overlooking Broadway and 51st Street, an apartment owned by the New York Times and provided to me for free. I was twenty-seven or twenty-eight, newly married, newly hired by the best newspaper in the land, healthy, competent, and free, and yet I lay on that floor from sundown until past midnight, sobbing, pressed down, unable to move.

The one time during all those years I even considered antidepressants was during the fall of 2001. My husband and I had just moved to Boston and I found myself in a strange, unfriendly city with a toddler and a newborn and no community or family of my own. I struggled.

Worried more about my children, who were both at home all day alone with me, than myself, I finally saw my doctor, who casually prescribed some drug. I don’t remember which antidepressant it was because after the first few doses I gave it up. I feared the drugs were numbing my emotions, stealing my ability to write. Whether this was true or imagined (most physicians believe it takes two to six weeks for antidepressants to have an affect) mattered not. Writing was the very thing that had saved my life all those years: if writing went, I might well die. I stopped taking the drugs, muscled my way through that particular episode.

Muscling one’s way through depression is definitely an option. As long as one’s muscles hold out.

*

March 28, 1941. Virginia Woolf walks out of her house in Sussex and into the River Ouse, her pockets loaded with stones. She leaves a letter for her devoted husband Leonard.

Dearest, I feel certain that I am going mad again. I feel we can’t go through another of those terrible times. And I shan’t recover this time. I begin to hear voices, and I can’t concentrate. So I am doing what seems the best thing to do. You have given me the greatest possible happiness. You have been in every way all that anyone could be. I don’t think two people could have been happier ’til this terrible disease came. I can’t fight any longer. I know that I am spoiling your life, that without me you could work. And you will I know. You see I can’t even write this properly. I can’t read. What I want to say is I owe all the happiness of my life to you. You have been entirely patient with me and incredibly good. I want to say that—everybody knows it. If anybody could have saved me it would have been you. Everything has gone from me but the certainty of your goodness. I can’t go on spoiling your life any longer. I don’t think two people could have been happier than we have been.

—*

It’s late July and I stand in my kitchen, staring at the pile of dishes in the drainer and the crappy counters that won’t get clean no matter how hard I scrub. It’s Saturday afternoon, the children off with their father. The fact that I have managed, with much hard work, to help keep those relationships intact feels like the one success in a life dotted with failure. Which is ridiculous, I know. I know. And yet . . . I stand in the kitchen with my arms crossed tight, holding myself and considering.

There are two doorways, one to the hallway, the other to the dining room; they’d need to be covered up somehow, to keep the gas from spilling all over the house. I open my oven door and peek inside, searching for the pilot light. Do ovens even have pilot lights anymore? Has some enterprising spirit taken away that course? I can’t find one but I do notice the oven is filthy. I should clean it. Grime covers the door.

I call a friend.

I’m really struggling here.

Oh, you’re fine.

No, I’m not.

Yes, you are. You’re fine. You’re beautiful and smart and talented—what could be the problem? You’re a little lonely and sad but you’re fine.

Every day ten people in the United States accidentally drown. The vast majority of these deaths take place in spas and pools, and in many cases, especially with children, other people are present. They stand right there, right within reach, close enough to save the drowning person. If they would only turn around.

But drowning doesn’t look the way it does in the movies. Drowning victims don’t thrash and scream for help. They go down silently, their primal brain focused intently on what is happening. And so the people around them pay no mind.

You’re fine.

My friend tells me I’m fine and I thank her and hang up and look at the draft suicide notes I have stored on my computer:

I’ve said enough. (Pithy and succinct.)

I’ve said enough. No one listened anyway. (Melodramatic and self-pitying.)

Everybody forgets that Icarus also flew. (Stole this from a wonderful poem. But it fits.)

I told y’all I was tired.

The last one is my favorite. Terrible, I know, but reading it makes me laugh.

—*

Not all writers are tortured geniuses. I know many stable writers, levelheaded and content, writers who don’t drink or take drugs or require antidepressants, writers who use, without irony, words like “optimist.”

Still, there’s no denying some subtle connection between creativity and mental anguish. Several studies have confirmed the link (Andresen, 1987; Jamison, 1989; Ludwig, 1995) even if they fail to explain it. The largest study to date to examine the connection was conducted by researchers at the Karolinska Institute in Sweden. That study found that creative types, writers in particular, were overrepresented among people with schizophrenia, depression, bipolar disorder, anxiety syndrome, and substance abuse problems. Writers were also almost twice as likely to commit suicide as the general population.

The question, of course, is why? What’s the chicken and what’s the egg in this riddle? Does who we are determine what we become, or does what we become shape who we are? Are people with a certain way of looking at the world—a way that develops or engenders or supports melancholy, depression, despair—more likely to become writers? Or does being a writer and thus obligated to stare straight at the reality of what it means to be human in this world bum people out?

The great Japanese filmmaker Akira Kurosawa famously said, “To be an artist means never to avert one’s eyes.” How much toll does it take to not look away? Ecclesiastes says: “And I set my mind to know wisdom and to know madness and folly; I realized that this also is striving after wind. Because in much wisdom there is much grief, and increasing knowledge results in increasing pain.”

At the same time, research, including a 2013 study by a neuroscientist at the University of Helsinki published in the Proceedings of the National Academy of Sciences, shows that babies begin learning in the womb; newborns not only recognize and prefer the sound of their mother’s voice but the sounds and rhythms of the language she speaks. Babies actually cry in the accent of their mother; a German baby cries in a different pattern than a French or a Japanese child. Newborns also prefer the sounds their mother heard while pregnant, whether these sounds were pleasant (gentle songs, the roar of the ocean) or not (shrieking sirens or various soap opera themes). Likewise with tastes and smells. A baby whose mother ate licorice will like that taste at just days old, while one whose mother did not will turn away as if it were poison. Babies born to mothers who ate lots of chocolate are happier.

All of which means we come out of the womb not as blank canvases but already primed. Not only a mother’s overall health and diet but also her stress levels—how anxious she is, how loved or unloved—pass on critical information to a fetus, laying down markers for what to expect from the world.

But there’s even more than that. I am fascinated by (what I can understand of) the exploding field of behavioral epigenetics, which posits that the experiences of our recent ancestors leave molecular residue which adheres to their DNA— and therefore to ours. In other words, not just physical but psychological and even behavioral tendencies really can be inherited. If your grandmother or even your great-grandmother struggled with depression because she escaped from the Holocaust, or narrowly avoided a massacre in My Lai, or was enslaved and raped repeatedly or watched her father being lynched—or was simply neglected and unloved during childhood—it matters to you and in you. Whether you know it or not.

The Writer is fascinated by epigenetics. Eshu just laughs.

—*

Late in the day on February 20, 2005, Hunter S. Thompson takes a gun to his head at Owl Farm, his compound in Woody Creek, Colorado. His daughter-in- law and grandson, hearing the gunshot from the next room, mistake it for the sound of a falling book.

No More Games. No More Bombs. No More Walking. No More Fun. No More Swimming. 67. That is 17 years past 50. 17 more than I needed or wanted. Boring. I am always bitchy. No Fun—for anybody. 67. You are getting Greedy. Act your old age. Relax—This won’t hurt.

*

Late July and I begin making a list of how the people I know would respond if I killed myself. This is in response to a friend who, when I call from the pit of my despair, says, “You can’t kill yourself. So many people would be devastated if you did that.”

This strikes me as ridiculous. There are not “so many people.” Maybe a handful. I begin to count.

I create three categories and assign everyone I know:

Devastated.

Wow, what a bummer.

Wow, what a bummer, what’s for lunch?

As might be expected, the vast majority of colleagues and acquaintances and friends and even some family members fall into either the second or the third category. In the first I place only my children, my mother and sisters and brother, a very dear friend. Eight people: more than many, less than some.

I fly to Washington, DC, with my daughter for her college orientation. I am hopeful that travel will turn things around, as it has sometimes in the past. A new perspective, a removal from the rut, the understanding that the world is much bigger than your petty issues and wounds. But after dropping my daughter off I find myself on the side of the road somewhere in northwest Washington, the hot sun beating through the window of the rental car as I sob as though my dog has just died. I stumble to a Panera, go inside for a cup of coffee, and pick up my phone.

For complicated reasons involving the recent retirement of my primary care physician and my health insurance HMO, it takes me 20 minutes, five phone calls, and no few tears to land an appointment with a psychiatrist, an appointment three weeks away. The last of several receptionists I speak to asks if I have immediate thoughts of harming myself. “Not for now,” I tell her, hanging up.

Over the next few weeks I contemplate canceling the appointment several times. It feels both weak and useless to pursue a chemical solution to what, all my life, I have taken to be an issue of personality and temperament and lack of love. Part of me doesn’t believe the pills will work. Part of me fears they will.

A week before the appointment I wake heavy-laden, freighted, and weary, the world’s brutality chilling in my bones. I walk the dog and step in dog shit. I begin raking leaves in the yard and am promptly stung by wasps. Sobbing and despondent, I sit on the floor of my bedroom and call a friend who misunderstands the source of my agony (“just because you don’t have a man?”) and lectures me until I admit that I am silly and hang up. I take a Benadryl and crawl into bed.

When I wake two hours later the depression has broken: I know it the moment I open my eyes. It feels precisely like a fever that has crested, a seizure that has finally stopped. I am astonished at the sharp line of division. In the past the cloud has lifted slowly, imperceptibly, until one day I realized I stood again in the sun. It was never like this.

It is this strange, first-time demarcation, ironically, which keeps me from canceling the appointment. If a depression can break like a fever, maybe it is biological. And maybe some pills can save my life.

—*

May 3, 1991. In his apartment in Manhattan Jerzy Kosiński drinks some booze, takes some drugs, wraps a plastic bag around his head.

I am going to put myself to sleep now for a bit longer than usual. Call it Eternity.

—*

The shrink seems a little hurt when I say, in response to his question, that I chose him because he had the first available opening. He listens to my story with a distant gaze and a practiced half-smile of concern. At one point he stalls on a word and I provide it: enervating. He looks at me again.

He prescribes Wellbutrin. We discuss whether I should begin taking it right away or wait until the next episode, which might not come for weeks  or even months—or, magically, never again. He warns that it takes time for antidepressants to become effective so that waiting is a risk, especially with winter (and an empty nest) coming on. I decide to wait, still hoping to muscle my way through. A few days later I feel the cloud descending again and panic. I call the shrink. He sends the script.

My friend B tells me I will know when the drug kicks in because I will feel a few hours of intense happiness and energy. I do research and find out that this is common when starting Wellbutrin, so common it’s called the Wellbutrin honeymoon. But B is a person who gets so excited at action movies she nearly leaps from her seat. I am fairly sure my biology will not react this way and I am right. I have no Wellbutrin honeymoon, no mania or giddy excitement. For a few nights I have trouble sleeping and my stomach hurts but otherwise life is the same. Except that slowly, slowly I begin to feel a perceptible evenness, a decided leveling out. It is palpable and definite and I am astonished. Is this what most people feel all the time?

I tell my close friends. Their reactions range. As with depression itself, everyone has an opinion on antidepressants and no one is reluctant to share. One friend asks if I have tried talk therapy first. Another says she hates “those things,” that they are used because Americans don’t like expressing their anger. I tell her expressing anger has never been a problem for me.

Two weeks in and I am no longer miserable. Is this really the drug? Irving Kirsch would say not. In The Emperor’s New Drugs he argues that most, if not all, of the improvement people experience from antidepressants is due to placebo effect. One summary of the evidence argues that 25 percent of the observed benefit from antidepressants is due to a direct impact of the medication, 25 percent to spontaneous remission, and 50 percent to the placebo effect. Some researchers believe this means that antidepressants are very effective for treating people with severe depression but no better than placebo for those with mild- to-moderate depression.

All of which means what? Did I fit the imprecise criteria for major depression when I saw the shrink? Probably not. Did I fit it the week before? Possibly. All I know is that I have lived inside this brain for half a century and things have changed.

I enter the cage of my feelings and find them tempered, curled into the corner like obedient dogs. I poke around inside my mind/brain like an archaeologist, assessing the remains. Eshu is gone.

My mind before was full of dark places and sharp corners, wide valleys and glorious peaks. Okay, not that many peaks but the ones that were, were truly glorious, full of fury and insight and consciousness. In the flatness of this new landscape is all of that just gone? I wonder, interested and troubled, though troubled in a remote and distanced way. Because: drugs.

What really has changed? It’s certainly not that life seems more meaningful than before. I still see no giant plan, no reason for everything that happens, no great truth uniting it all. Evil people still get away with evil deeds and good people still suffer, Wall Street hustlers are still rich and the kid I mentored at a school last week is still poor and struggling. War rages and people kill for idiotic reasons. And there is still no guarantee I will find love. So it goes, said Kurt Vonnegut. So it goes.

I guess all that’s different is that when I’m depressed all these things feel overwhelming. But on the drugs they simply are what they are. So I stay on.

I have a few strange instances of stuttering. The first time it happens I am on the phone and I think, “Boy that was weird!” The second time I begin to freak out. Who begins stuttering in adulthood? Is this a brain tumor? Some other strange disease? It takes me a few days to make the connection: start a powerful new brain drug, start stuttering. Duh. I look it up: stuttering is a rare but not- unheard-of side effect of Wellbutrin. I call the shrink, who halves the dose. The stuttering decreases, then disappears.

—*

Three weeks in and it’s Saturday night and I am alone. Normally this would be painful. Normally the loneliness of my empty house and empty heart would be so bad my bones ached, so bad I’d want to chew off an arm. Tonight I am lonely but it’s manageable. I step outside onto the porch and listen to the rain and for a second I smile. It’s not so much that I feel actual gladness at being alive as that I realize I should feel gladness at being alive, and since I don’t feel suffocating despair I am able, at least, to mimic happiness. Fake it till you make it. Welcome to America.

I go back inside and turn on the TV. PBS is playing Simon and Garfunkel’s Concert in Central Park. I stand in my living room and listen to Paul Simon sing poetry about being forsaken and alone and I prepare to dissolve into a puddle of loneliness. But I don’t. I stand there and sing along and it’s as if my emotions are just out of reach. I can see sadness and despair, see their sharp, familiar faces but only from a distance. They’re on the other side of the river, jumping up and down and waving but there’s no bridge between us. They cannot cross.

Is that good? Is that a good and normal thing? It feels somehow false, a simulacrum of living. A simulacrum of the emotions and depth I used to have. The Writer is ambivalent. Though, yeah, I know how that sounds: poor Kim, feeling sad that she’s not as sad as she used to be.

Better living through chemistry.

The next morning, a Sunday, the sadness returns. A wave of despondency descends as I remember that I’m alone not only in my house but in the world, that no matter how prettily I write or prettily I dress no one will ever really give a good goddamn. The tears come, the first in over a month. And then, like a train on the Red Line, they just stop. The waves of existential loneliness recede. I feel them go. I get dressed and take my dog Stella for a walk in the drizzle. She pauses every half block to sniff the grass.

This wave of despair will return randomly over the next few months, sometimes fleeting, sometimes strong enough to knock me down for an hour or two, but always growing lighter. When a woman is on certain versions of the Pill and the estrogen is insufficient she may bleed in between her periods. Gynecologists call this “breakthrough bleeding.” I come to think of these periods of despair as breakthrough depression.

*

One year in now and the evenness holds. It occurs to me that this is a kind of Stella-like levelness, not unintelligent but circumscribed. Stella thinks of food when she’s hungry and water when she’s thirsty and sleep when she needs to sleep, and whatever emotional highs or lows that pass through her head are fleeting. Her needs are easily met, even her need for love and understanding (pet, scratch, hug, go away now), and whatever is happening in Syria or Missouri or the prisons of America or even in the other room is irrelevant to her happiness. Some people might consider this admirable. Stella is either the ultimate Buddhist or the ultimate American.

I do not mean to romanticize depression, and certainly not to romanticize suicide. Suicide devastates those left behind, a tornado through the heart I have seen in my family and among the children of friends. I do not mean to romanticize depression but neither do I mean to demonize it, or at least not to demonize mine. To demonize my depression is to diminish the last 30-so years of my life. To diminish both the suffering and the surviving, the pain and what crawled up from that pain. I do not mean to demonize my depression. Only, for my children, I mean to survive.

Still, sometimes I wonder: all those years of muscling. Did it make me a better person, somehow strengthen my moral or emotional fortitude? Would I have written more novels without Eshu hovering, or fewer? Better novels or worse? Would literature mean as much to me? Would I still love James Baldwin like I love my life?

My plan is to wean myself from the drug next summer There is research to suggest that once a person has been lifted from the chasm of major depression things like meditation and exercise can help prevent a tumble back into the abyss. Or maybe that ultimate of all medications, time, will lend a hand. From here I can almost see my sixties, when depression among women begins to drop.

I hope that’s true, but if it isn’t I will just have to risk the return of Eshu. I won’t be glad to see him but I will know what to do: take up my pen.

*—

Hart Crane, who leapt off a ship:

Goodbye, everybody!