Darkness Visible

For the thing which I had greatly feared is come upon me,
And that which I was afraid of is come unto me.
I was not in safety, neither had I rest, neither was I quiet;
Yet trouble came. Job

For years admired I have admired the essays and articles of Daphne Merkin. Never once did I sense she was engaged in a life-long battle with chronic depression. As she notes in her frank and brutally candid account of her experience in the Sunday Times Magazine, she was good at “adopting the mask of all-rightness that every depressed person learns to wear in order to navigate the world.”

She reports that as early as 5 or 6 she “had begun to be apprehensive about what lay in wait” and by 10 had been hospitalized for frequent bouts of crying. At times she has felt suicidal and at others times simply unable to escape from the darkness and despair that permeated every cell in her body, lying in bed for days at a time, unable to read, eat, or do anything but sleep. Merken confesses she had quite literally ground to a halt.

For over four decades she has been going to psychotherapists and has tried every medication and combinations of medications that have been prescribed since her early 20s. None of the therapists or drugs had done much for her. “What’s more, after a lifetime of talk therapy and medication that never seemed to do more than patch over the holes in myself, I wasn’t sure that I still believed in the concept of professional intervention.”

“In some ways, the quiet terror of severe depression never entirely passes once you’ve experienced it. It hovers behind the scenes, placated temporarily by medication and renewed energy, waiting to slither back in, unnoticed by others. It sits in the space behind your eyes, making its presence felt even in those moments when other, lighter matters are at the forefront of you mind. It tugs at you, keeping you from ever being fully at ease.”

The precipitating events are never clear to her. As she puts it, they include “everything and nothing, as is just about always the case—some combination of vulnerable genetics and several less-than-optimal pieces of fate.” About her most recent return to a psychiatric hospital, she writes, “I wanted to die, but at the same time, I didn’t want to, not completely. Suicide could wait my sister said.”

She says the first night was the hardest, but then later says they never got any better. The lack of a reading lamp added to her panic. She writes, “the absence of a light source by which to read after dark represented the end of civilization as I had know it.”

Throughout this time (3 weeks) the major issue for Merken was whether she would undergo ECT, a treatment with a checkered history that currently finds some favor and was recommended by her psychiatrist to pull her out of her “neurovegetative” condition. Merkin resists. And then one day she says, “something shifted ever so slightly in my mind.” She had replaced one of her medications with a new one but really had no idea what led to the change. She speculates, “Maybe it was the fear of ECT, or perhaps the tweaked medication had kicked in, or maybe the depression had finally taken its course and was beginning to lift…”

Merken began to feel a little better, better at least to leave the hospital and try to reenter her life. “I had things I wanted to say” and new books to read and films to see. Still she said everything felt fragile and while her depression had taken a time out, she knew full well it could return at any time without warning. This is the underlying terror of chronic depression.

I have known people who have journeyed through life with this affliction, people who I have lived with and loved. And what I have observed is that there is no escaping the internal “dungeon” through which they must travel. Nothing they try works. Not the drugs, the new and the old, and their limitless combinations. Not the year after year of therapeutic treatments or the hospitalizations, regardless of how long or short or where they are located. And not the ECT no matter how often it is administered or how it is tweaked.

Chronic depression appears to come and go on its own. Merken writes, “Worst of all it honors no season and respects no calendar; it arrives precisely when it feels like it.”