As I read George Scialabba’s new book How To Be Depressed, I recalled that I’d been introduced to his writing almost a decade ago by a schizophrenic, manic-depressive homeless man. R. might have protested that term—technically, he lived in a small garage that a fellow parishioner at the church we all attended let him use. It was shocking to visit him there for the first time; nearly every square inch of the place was filled with musty stacks of the New York Review of Books, assorted newspapers, and books, leaving only a narrow path that led to a mattress. Before adding something to one of these piles, he’d open his latest acquisition and run his finger down its pages, searching for matches or “sparks” that might cause a destructive fire—a phobia caused by a traumatic incident in R.’s childhood.
My friends and I tried to look after R., taking him to dinner or paying his phone bill or letting him do laundry in our homes. I was drawn to R. partly because I couldn’t help but see some of myself in him, and had a gnawing fear that his plight would one day be my own. He was, in his way, an intellectual, who actually read at least a few of the periodicals he collected and enjoyed arguing about politics. I’d often see him in the local used bookstore I frequented, and that must have been where he pressed Scialabba’s What Are Intellectuals Good For? into my hands. “This is the good shit,” he solemnly professed, and he was right. R. had been an alcoholic, and I’d gleaned that when he finally kicked booze the withdrawal caused a breakdown from which he’d never quite recovered. I knew I sometimes drank too much, too, and for the wrong reasons—enough to watch myself. We shared both hypochondria and a dread of visiting the doctor. I wasn’t a manic depressive, but for much of the time I knew R. I was in the throes of the worst severe depression of my life.
One feature of that depression was that I developed an acute fear of becoming homeless—deepened, I think, by my friendship with R. If you spend any amount of time actually getting to know homeless people, you realize how quickly a life can become undone: an addiction that spirals out of control at the wrong time; a mental breakdown without family and friends to sustain you; a bad decision followed by a bad break. The depressed mind, usually so lethargic, nevertheless manages to conjure up the most elaborate scenarios of doom. However ridiculous it might seem, I made a number of my closest friends swear on their honor to take me in if I got to such a point. That fear of falling came back to me when I read this passage from the notes of one of Scialabba’s therapists:
He now has multiple fears of losing control, which he fantasizes would result in his becoming passive, being unable to hold a job, going on welfare or into a hospital, and not being able to take care of himself.
Such consuming worry about “losing control,” about being unable to keep it together, is a recurring theme in the literature about depression—not merely intense sadness, but the threat of personal dissolution. William Styron, in Darkness Visible, relays a conversation with a suffering friend who told him that his depression made him feel “helpless.” An especially wrenching scene in Andrew Solomon’s The Noonday Demon is when his father literally has to feed him. Depression makes ordinary tasks appear as looming impossibilities. Work suffers; social occasions become exhausting burdens; getting out of bed takes heroic effort.
This underlies one of the paradoxes of depression: it renders you unable to do what would help you tame your affliction. When I was depressed, I knew exercise stood a chance of minimizing my symptoms, but summoning the will to go for a jog or head to the gym was often beyond me. For years I resisted trying medication. The thought of finding a doctor, setting up an appointment, and then navigating insurance forms brought me close to panic. I only received treatment after bottoming out, nearly destroying the life I was keeping a tenuous hold on. One morning while lying in bed, not long after spending a night in jail, I had a brief moment of clarity: I crawled over to my desk and emailed my priest, telling him I needed help. Could he arrange for me to see a doctor? I still remember walking out of the doctor’s office a few days later, prescription in hand, crying from relief. It would take weeks for the Lexapro to take effect; the point was that I’d finally done something. For the first time in a long time, I’d moved forward.
As I slowly, if unevenly, learned to deal with my depression, I begged R. to see a doctor too, and perhaps try medication. He refused, pointing me to an old magazine article that cast doubt on such pharmaceutical interventions, while hinting at darker conspiracies about the mental-health profession’s role in our society. We argued and argued. I offered to set up an appointment with the doctor I’d seen, and gave him a blank signed check to cover the cost of his visit. He wouldn’t budge. Depression can leave us not only unable to love, but unable to accept love.