“For we depressives are suspended throughout the vast, shadowy circles of hell; beneath, below and out of sight of even the ‘Purgatorio,’ let alone the ‘Paradiso’ and the stars beyond. Unless rescued, guided onward and upward and out, yanked off the wrong path and into the light (Dante’s ‘shining world’) by pharmaceuticals or the inscrutable natural cycles of ebbing and flowing neurotransmitters or, most finally, released, by our own hands, into oblivion (whether light or yet more dark, we cannot know from this plane), we remain lost, caught in medias res, helpless.” Elizabeth Boleman-Herring
Ruminant With A View
By Elizabeth Boleman-Herring
“Nel mezzo del cammin di nostra vita/Mi ritrovai per una selva oscura,/Ché la diritta via era smaritta.” / “In the middle of the journey of our life/I found myself in a dark wood,/For I had lost the right path.” . . . “E quindi uscimmo a riveder le stele.” / “And so we came forth, and once again beheld the stars.”—Dante
TEANECK New Jersey—(Weekly Hubris)—6/3/2013—Between Dante’s “Nel mezzo . . .” and “E quindi . . .” lies one of the greatest journeys, and extended metaphors, in Western literature.
That the Florentine poet’s Commedia is titled just that—“The Comedy”—and, later, amended by Boccacio to read “The Divine Comedy”—has to do with the stars the protagonist views at the end of his spiritual odyssey.
However, what we remember best about the Commedia is its “dark wood,” its “Inferno,” which is why those who live out their lives, lost again and again and again in that dark wood, in depression, turn so naturally to Dante for words with which to describe their state.
For we depressives are suspended throughout the vast, shadowy circles of hell; beneath, below and out of sight of even the “Purgatorio,” let alone the “Paradiso” and the stars beyond. Unless rescued, guided onward and upward and out, yanked off the wrong path and into the light (Dante’s “shining world”) by pharmaceuticals or the inscrutable natural cycles of ebbing and flowing neurotransmitters or, most finally, released, by our own hands, into oblivion (whether light or yet more dark, we cannot know from this plane), we remain lost, caught in medias res, helpless.
Depression is A State of Utter Stasis
Depression is, foremost, about being stuck.
In that, it resembles Parkinson’s. And, for many unipolar depressives, there is no true awakening. The malady is entropic. Its victims—and, many of us, victims from birth—simply run down and stop. We cease leaving our beds, bathing, washing our faces or hair, speaking, responding, working, creating. We cease being, let alone being ourselves. Our selves evaporate, leaving behind chilly shells. And some of us, many of us, certainly I and several people I love, who have been depressed all our lives, try again and again to end it all.
But we do not want to suffer yet further pain in departing, so we usually make a hash of suicide: most of the methods available to us hurt like hell, or entail even greater suffering if botched (brain and liver damage, encounters with hurtling vehicles that we only half-win, heads blown only half-off, these mishaps leaving us attended only by aghast family and bystanders scarred for life).
One of the “how to” manuals for would-be suicides helpfully suggests death-by-exposure, in the far north, in the depths of winter. (I did, finally, throw out that little primer, just this past winter, but not before reading and highlighting it. I’m a depressive with a side of Obsessive Compulsive Disorder.)
Woe is me.
“Depression,” as a descriptor, so, so, so does not encompass the state we in the unipolar community embody, either. To call our recurring vivisection “depression” is akin to describing napalm as an “irritant.”
Would I switch places with someone afflicted with schizophrenia, Amyotrophic lateral sclerosis (ALS) or Stage 4 pancreatic cancer? No. But depression’s right up there and is, much of the time, if not treated, as surely fatal.
As my last shrink phrased it, the first week I met him, some 14 years ago, “There is no pain, physical or psychic, comparable to that of depression. Suicidal, clinical depression is a hair-on-fire medical emergency.”
Were I still as depressed as I have been, critically, for the past two months, I would not be writing this essay (and you wouldn’t feel compelled to skim it). Were I still as depressed, I’d be down the hall in a darkened room; curled up in bed in the fetal position; snarling and whimpering.
Depression is also like an early Ingmar Bergman film on an endless loop: cries and whispers; snarling and whimpering. Not a musical comedy.
And the Available Meds Really Don’t Cut It
In Having It Out With Melancholy [http://www.poets.org/viewmedia.php/prmMID/15920], Jane Kenyon [http://en.wikipedia.org/wiki/Jane_Kenyon] writes in “Credo”: “Pharmaceutical wonders are at work/but I believe only in this moment/of well-being./Unholy ghost,/you are certain to come again./Coarse, mean, you’ll put your feet/on the coffee table, lean back,/and turn me into someone who can’t/take the trouble to speak; someone/who can’t sleep, or who does nothing/but sleep; can’t read, or call/for an appointment for help./There is nothing I can do/against your coming./When I am awake, I am still with thee.”
In my wallet, I carry a print-out (other unipolar depressives actually wear thumb drives round their necks) with the list of psycho-pharmaceuticals I have tried, and which have failed; and the meds to which, in the lifelong search for a “cure,” I have exhibited allergic responses of one sort or another. The page of information—for the edification of paramedics, emergency room physicians, and even my trusted attending physicians (as I cannot, for the life of me, actually remember the names of all these drugs by now)—is dense and detailed, in 10-point type.
What my mini-unipolar-bio does not state, though, is that none of the meds I currently take actually “suffices;” none actually works.
If, as many now posit, depression is some sort of inherited Ur-Disorder, a pan-inflammatory process affecting very specific neurotransmitters (serotonin NOT first and foremost), a disorder of sleep and mood and, and, and, and, expressed particularly in the anterior cingulate region of the brain, and in the glutamate system, then we have been barking up the wrong trees for about two decades, and downing Prozac and its clones for an illness much better wrangled by such medications as nasally-administered ketamine and low-dose naltrexone [http://www.forbes.com/sites/matthewherper/2013/05/23/johnson-johnson-is-reinventing-the-party-drug-ketamine-to-treat-depression/; http://painsandiego.com/2012/10/05/ketamine-rapidly-relieves-depression-by-restoring-brain-connections/; http://www.solasclinic.com/wordpress/the-beauty-of-low-dose-naltrexone-ldn/].
During this last, ninth-circle-of-hell bout with what I have long called (after Winston Churchill) “My Black Dog,” I threw myself into a study of my own brain chemistry, and believe I have finally figured out the course of treatment I (and others) need to follow. Unfortunately, because Big Pharma cannot make a bundle off out-of-patent substances such as ketamine, naltrexone and N-Acytl-Cysteine, I can today be treated, successfully, in Germany, Australia or Mexico (and, for a price, not covered by my insurance, in La Jolla or Princeton NJ), but not in Englewood at my GP’s office, though it would be an easy lift for my very bright New Jersey internist/geriatrician.
Currently, too, I am awaiting word from Dr. Helen Mayberg, at Emory University Hospital, whose Deep Brain Stimulation Surgery has for many proven another sure way out of refractory depression [http://www.pbs.org/wgbh/takeonestep/depression/video-ch_10.html]. Even if I qualify for the anterior cingulate implant, I may not have the courage to undergo such a radical procedure, but I also know that, day by day, with my depression left untreated, and taking the drugs I do, my grey matter is degenerating, bit by precious bit.
So, at present, for chronic, almost total insomnia, pavor noctis R.E.M. nightmares, and crippling depression, I am taking two very dirty drugs and a third fairly dirty drug, at some expense, and my depression does not, will not, remit.
My faithful and beloved spouse, My Black Dog, and I stumble along, a lonely trio, scouring Google and curb-siding neurologists, trying to gain more knowledge; more light.
Welcome to American health care.
“How Could I Ever Trust You Again?”
My current Siege-by-Dog began with Hurricane Sandy, and it has been all downhill for eight months.
There were “triggers,” as though a hurricane destroying the state in which I live weren’t harbinger enough. But, there were other grievous losses and fallings-away.
My closest friend and confidante of some 30 years, having received joint emails from Black-Dog-et-Moi, severed our longstanding friendship. She said, “How could I ever trust you again after this?”
At about that time, I shut down communications with the world at large, to protect my small circle of friends, and to spare myself the solicitous abuse by others.
Donald Hall, poet Jane Kenyon’s husband, writes of Jane in the depths: “One of the hardest things, if you are depressed, is to try to hold yourself up in the presence of others, especially others whom you love. I remember a birthday for granddaughters at my daughter’s house. Jane stood looking on, wretched, hardly able to speak. She was quiet, there were many people, and she practiced invisibility. My daughter looked at her and said, “You’re miserable, aren’t you? When Jane nodded, Philippa spoke with sympathy and left her alone. You do not try to cheer up depressives; the worst thing you can do is to count their blessings for them.”
Or take them shopping, I might add.
When I was in my teens and 20s, and beginning to come to grips, intellectually, with the condition I had experienced from infancy, my mother would try to get me out of the house. We would go, say, to a mall in Atlanta—Buckhead’s most upscale emporium, where, in happier times, she and I would lunch together at Niemann-Marcus, always ordering the chicken-pecan salad, apricot mousse and pop-overs.
When accompanied by my ravenous Chien Noir, however, I would begin sobbing as we walked—crying so hard I would throw up; unable to care who saw me or how they might see me—and my mother would have to usher me, blinded by tears and humiliation, back to the car, home, and a darkened room.
To attempt to explain this condition to civilians—and my own depression comes seasoned with PTSD, ADD and Stage Four Sleep Disorders—is to make a stab at explaining a fourth dimension to those blessed to inhabit only three.
It cannot be done. I no longer try.
One friend phones me every day, still, though, for months, I have not picked up the phone and our land-line answering-machine message clearly states that I am no longer talking (let alone writing, sleeping, moving, smiling, laughing, focusing on anything resembling work, practicing Yoga, etc., etc.).
But . . . I cannot make anyone understand where I go when I go. I can assure them, however, that when I go, I am gone. And I have no idea if or when or how I will return.
Writer Meri Nana-Ama Danquah [http://www.danquah.com/] states: “There are times when I feel like I’ve known depression longer than I’ve known myself. It has been with me since the beginning, I think. Long before I learned to spell my name. No, even longer than that. I’m sure that before I could even speak my own name or learn to love the color of my skin, this hollow heartache was following me, patiently awaiting the inevitable crossing of our paths, planning my future unhappiness. I’ve always been aware that something in my life was not quite right, if not totally wrong. My scales were never balanced. For every twelve joys, I had 25 sorrows. And each sorrow was like a song. A melodious seduction bringing me closer and closer to this terrible sickness which has cost me lovers and friendships, money and opportunities, time and more time. So much wasted time.”
When I went down to Washington DC’s hallowed NIMH to enter a clinical trial offering minute quantities of ketamine to a group of genius-level unipolars (and, to give us, this rarefied group of lab rats, just one dose of intravenous ketamine was the moral equivalent of finding people dying of dehydration in the Gobi and offering them each a thimble of water), I was asked by Dr. Carlos Zarate, who was running the study, how my life had been blighted by depression [https://weeklyhubris.com/one-flew-out-of-the-cuckoo%E2%80%99s-nest-or-a-human-lab-rat-takes-on-the-n-i-h-%E2%80%99s-%E2%80%9Cclinical-trial-culture%E2%80%9D/].
Dr. Zarate is not a nice man, and he is accustomed to running his little ketamine fiefdom like a Persian despot his silent harem.
I responded that I would have written more books. With dripping sarcasm, he asked if I’d ever written a book. I answered, “Twelve.”
He really had no clue who he was dealing with: the group I met, caught in the web down at Zarate’s NIMH trial, included at least three people fully capable of having earned multiple PhDs; written many more books than I. All of us, however, have been compelled to limp through life, packs of wild dogs taking us off at the ankles again and again. It’s a miracle we’re still standing. After a fashion, standing.
So, generally, I try to lay low when my canine companion is in attendance. It’s the best I can do for all concerned.
When—as now—the words begin, again, mirabile dictu, to flow from my fingers, I know I’ve been granted a breather. But, until I can write more than simply sputtering first-person non-fiction, I’m still in the woods.
Writer and mental-health scholar Joshua Wolf Shenk [http://www.shenk.net/biography.htm], author of Lincoln’s Melancholy: How Depression Challenged a President and Fueled His Greatness, writes about the failure of language to express, to describe, to encompass the reality of depression.
“The failure begins when the 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 in translation and, at times, that effort can seem impossible. But poems, lyrics, and 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.”
For now, I am sequestered, watching Seasons 1 through 5 of “True Blood,” the HBO series which is such an apt objective correlative for my life as a “Supe”(r-natural): half human, half raging black hound.
I speak only to other “Supes,” just now, or I go out on brief errands, incognito, wearing a brittle almost-me-but-not-really mask.
I trust only my husband to enter the darkened room where I await deliverance. Via email, I trust “in” only my bi-polar friend, who knows this territory well; and my friend the angst-ridden hoarder, who is pleased if I manage to type in monosyllables.
Very recently, a new psychologist informed me that I am a genius or a near-genius. Such information never mattered to me much before but, as I’ve felt my grip on sanity and sentience slide in toto over the past all-but-year, now, it is a comfort to know that, though grey cells are dying by the daily bread-basket, perhaps I can afford to lose them.
And, if what I’ve been reading about ketamine and naltrexone and N-A-C is true, and I am able to find a neurologist willing to have a go at treating my glutamate system, then my neurons will regenerate; even proliferate.
Much stranger things have happened.
I would not say I’m optimistic. Oh no, that’s not how I roll. But I do know there may be some doors opening in and out of my darkened room. Meanwhile, though, the kennel is still pretty much off-limits to civilians; those with only two paws.
Clinical psychologist, author, and unipolar depressive Martha Manning writes: “Anyone who has ever been seriously depressed knows that [asking us to articulate what is wrong] is as daunting as asking a lame man to tap-dance. In addition, it leads to mutual frustration, anger, and ultimately helplessness . . . . In depression, the lights are off, but somebody’s definitely home. She just can’t make it to the door to let you in.”
And, if you try to come in before she can open the door, herself, you risk being mauled by a huge, snarling canine over which she has no control at all
Note: For more of Pierre Cambon’s spectacular photography, go to: http://www.photodigest.be/photo-exhibitions/pierre-cambon-engraved-photographs-paris/#.UZ-5Bdg8CSp; and http://lejournaldelaphotographie.com/entries/10919/pierre-cambon-jeter-l-encre. The four images that illustrate this essay comprised part of Cambon’s series, “Couples.”
Also: For an introduction to Dante Alighieri and his Commedia, begin with https://en.wikipedia.org/wiki/Dante_Alighieri.
To: For information about one California clinician doing pioneering work with ketamine for PTSD and depression, got to http://painsandiego.com/2012/10/05/ketamine-rapidly-relieves-depression-by-restoring-brain-connections/.
Most: of the quotes used throughout this essay derive from Editor Nell Cassidy’s spectacular compilation, Unholy Ghost: Writers on Depression [http://books.google.com/books/about/Unholy_Ghost.html?id=7VFPzaAWy38C].