April 1, 2003
After reading George Orwell’s 1984 in high school, I would sometimes wonder what was in Room 101. For each person, remember, it was whatever unhinged you, whatever you shuddered at most uncontrollably. “Everyone knows what is in Room 101,” Winston Smith is told. “It is the worst thing in the world.”
I was a fairly squeamish adolescent, so a good many possibilities suggested themselves, most of them with more than four legs. But I was also devoutly religious, and the hope of Heaven was of infinite comfort, limiting the horror of even the most lurid death. Now I no longer have that faith or that hope, and the question about Room 101 again seems a live one. I think I know the answer. The pain of a severe clinical depression is the worst thing in the world. To escape it, I would do anything. Like Winston, I would—at least I might—wish it on those I love, however dearly. But that’s not feasible. The only way to escape it is to inflict my death on them. That is a grievous prospect, and I hope avoidable. But I know that those who do not avoid it cannot help themselves, any more than Winston could help betraying Julia.
Why? What is so unbearable about this pain? The primary sources are William Styron’s Darkness Visible, Kay Jamison’s Unquiet Mind, the “New York” section of Kate Millett’s The Loony-Bin Trip, and the chapter on “The Sick Soul” in William James’s Varieties of Religious Experience. Others will someday improve on these accounts; I cannot. The most useful formulation is James’s. Depression is “a positive and active anguish, a form of psychical neuralgia wholly unknown to normal life.” Every word tells. “Positive and active”: acute depression does not feel like falling ill, it feels like being tortured. “Psychical neuralgia”: the pain is not localized; it runs along every nerve, an unconsuming fire. In an agitated depression, my kind, it burns fiercely in the solar plexus and flares elsewhere, fed by obsessive fears, regrets, self-loathing. “Unknown to normal life”: because it feels unlimited in both intensity and duration, it truly is like no other pain. Even though one knows better, one cannot believe that it will ever end, or that anyone else has ever felt anything like it.
Certainty that an acute episode will last only a week, a month, even a year, would change everything. It would still be a ghastly ordeal, but the worst thing about it—the incessant yearning for death, the compulsion toward suicide—would drop away. But no, a limited depression, a depression with hope, is a contradiction. The experience of convulsive pain, along with the conviction that it will never end except in death—that is the definition of a severe depression. Commissar O’Brien tells Winston that the latter’s dream of proletarian deliverance is a delusion, that his image of the future should instead be “a boot stamping on a human face—forever.” The depressive’s image of the future is “me, writhing in agony—forever.” Flesh on an electrified grid; a dentist’s drill tearing at an exposed nerve; a raging migraine; an implacable metastasis. But never ending.
How does this nightmare happen? Through an unlucky ratio of stress to strength, circumstance to constitution. The weaker one’s nerves, the less it takes to inflame them. The more fragile one’s neurochemical equilibria, the less it takes to disrupt them. How much you feel the daily slings and arrows depends on how thick your skin is.
Nature cuts most of us plenty of slack. “Most people,” as Styron observes, “quietly endure the equivalent of injuries, declining careers, nasty book reviews, family illnesses. A vast majority of the survivors of Auschwitz have borne up fairly well. Bloody and bowed by the outrages of life, most human beings still stagger on down the road, unscathed by real depression.” We are all issued neurological shock absorbers, usually good for a lifetime of emotional wear and tear. But if you’re equipped with flimsy ones, or travel an especially rough road, the ride becomes very uncomfortable.
My shock absorbers seem to be exceptionally flimsy. Both my parents were depressive: constantly worried, easily discouraged, with little capacity for enjoyment and no appetite for change. Except for a brief trip over the border of the next state to visit relatives, neither of them ever travelled more than fifty miles from where they were born. They were children during the Great Depression of the thirties, so during the Great Boom of the fifties and sixtiess and the Great Bubble of the eighties and nineties, they left their money—not that there was much of it: they were working-class people, conscientious but uneducated and unambitious—under the mattress or rolled up in the hollow legs of metal chairs. “Chronic severe dysthymia in a severely obsessional character” is my diagnosis and would have been theirs, if they’d ever gotten one. It simply means “born to suffer.”
Still, even with worn-out shock absorbers, life in a rich country is, at least some of the time, like a ride on a freshly paved road. Thanks to undemanding day jobs and a trickle of freelance income, I’ve lived through the worst without institutionalization or destitution. So far. But old age looks grim. Chronic depression is very hard on lifetime earnings; and like many other people’s, my retirement account is in trauma just now. In youth and middle age, one is supposed to store up material and psychic comfort against the years of decline. We all try to, but few people, healthy or ill, can fall back on as many resources as Styron, Jamison, or Millett. All three fully deserve their eminence, their affluence, their sympathetic friends and supportive families, their happy memories. And all, as their accounts make clear, would have died without those things. There is no doubt that good fortune is the best anti-depressant.
But what about the unfamous, solitary, low-income depressed? We must suffer, and why shouldn’t we? Life is unfair, after all. No talent, no distinction; no charms, no love. Natural enough: how else could admiration and affection, and the consolations they entail, possibly be distributed? Even to save a depressed person’s life, you cannot admire or love him at will. In the trough of the illness, the sufferer’s wheeze, shuffle, torpor, unvaryingly anguished expression, frequent humiliating flubs, and exasperating indecision rapidly exhaust any but the most heroic devotion. Few of us can claim such devotion.
Money is different, though. There is no natural way to apportion it. Some wealth, we all recognize, is unearned (quite a bit, if you go into the matter); and what is earned is not always deserved. No one can take credit for her own genetic endowment or early environment. Perfect markets do not and cannot exist. How we produce and distribute is a political question—economics is politics all the way down. Whether our current drastic inequality is fairer and more productive than our former moderate inequality depends entirely on what we’re aiming to produce—and become.
People fall ill emotionally for any number of reasons, of course. As Robert Lowell remarked, if we all had a little button on our forearm that we could press for a painless and instantaneous death, very few of us would reach old age. In some cases of severe depression, like mine, financial insecurity is central; in others, less so or not at all. There is always some way to help, and though nearly every way costs money, some would cost very little. Even a minimal government could afford them. Exercise, for example, is highly therapeutic for depression, but it is just what severely depressed people cannot force themselves to do. Young persons doing a year of national service could drag such people out for a vigorous walk each day, or do an hour of yoga with them. Or call them a few times a day to remind them to drink water—depressed persons nearly always dehydrate. Or drive them to a therapist—climbing the Himalayas is easier in some states of mind than getting out the front door is in others. The quantity of suffering diminished per dollar expended in these ways would be impressive.
Or you could give them money. As I slid into my most recent episode, tormented by money worries, I saw an article by Robert Reich in The American Prospect. He proposed exempting the first $20,000 of income from the payroll tax, the most regressive of all taxes. This would save 130 million American households an average of $5,000 per year. You could pay for this fully, he pointed out, by retaining the estate tax, the most progressive of all taxes, which affects only 2% of American households. Five thousand dollars a year would save a lot of ordinary people a lot of grief, and incidentally fix the economy. It might even save some lives.
Suicide, Camus wrote, is the supreme philosophical problem. It is also, at least from the depressive’s point of view, a political problem. The official figure for suicides in the United States is 30,000, generally thought to be an understatement. Call it 40,000. I’ve read that two-thirds of these are severely depressed—say 25,000. Ten to fifteen percent of severely depressed people, it seems to be agreed, will eventually kill themselves. So—very, very approximately—each year 250,000 of your fellow citizens, one in nine hundred American adults, will be at risk of death from the protracted indescribable pain of severe depression.
Reich’s article mentions that half of the estate tax, or around $350 billion, is paid by only 3,300 families. That’s roughly one in 40,000 American households. If that money were simply handed over to the severely depressed, they would receive $1 million each. Bound to save some lives, though one should not underestimate the pain of lost Alpine ski vacations, designer clothes, and recreational drugs to the children of the super-rich.
In the same issue of the same magazine, another writer cites now commonplace figures on President Bush’s income tax cut: $1.5 trillion over ten years, forty percent of it, or $600 billion, going to the richest one percent of taxpayers. Six hundred billion dollars over ten years works out to a little more than $200,000 for each suicidally depressed person. Once again, many lives saved, much agony averted or diminished.
Also around this time, the philosopher John Rawls died. Everything is grist for one’s obsessions, it’s true; but the connection with Rawls is not really so far-fetched. Standing behind Rawls’s famous veil of ignorance, you face a choice: You can accept one chance in nine hundred of being locked screaming in Room 101, together with one chance in 40,000 of avoiding all taxes on a huge estate. Or you can escape Room 101, and save many others from it, by giving up a negligible chance of enriching hypothetical heirs, not exorbitantly (that would still be permitted) but ultra-exorbitantly. Rawls would have thought the right choice obvious, and I suspect most Americans would agree with him, even if their elected representatives don’t.
Admittedly, there are other, perhaps worthier candidates for relief. Severe depression almost always ends, usually non-fatally. For many other people—a billion or so—illiteracy, malnutrition, diarrhea, infection, and other conditions far more easily preventable or curable than depression do not end. Even if these people’s nerves are not on fire, Rawls might have judged theirs the more pressing claim. I think I could accept that judgment, even if for me it meant another spell in Room 101.
Why, you may be wondering, was this long whine ever written down? It’s not a memoir, not an argument—what is it, anyway? The first draft—very much shorter and even more purple—was a suicide note, to be left behind on the riverbank or rooftop or night table. Emotional blackmail in a good cause, I told myself; though perhaps it was only spite, the feeble revenge of the ill on the well. In any case, I dithered. Like many other acutely depressed people I was, fortunately, too exhausted and disorganized to plan a suicide, much less compose an eloquent rebuke to an uncaring world. And then, very slowly, the fire died down. My viscera gradually unknotted, my energy seeped back, speech became less effortful, the world regained three dimensions. Blessedly, miraculously, everyday unhappiness returned.
Then why persist with the blackmail fantasy? Why risk bathos rather than keep a stoical and dignified silence? This was my third devastating depression, and probably not my last. I hope and intend to survive the coming ones, but already it seems urgent to try to salvage something from these ordeals. The conjunction of my pecuniary panic with a large-scale transfer of our national wealth to the already rich seemed to make an occasion. The vast popularity of depression memoirs and manuals in recent years suggests that there must be tens or hundreds of thousands of others whose sufferings, as intense as mine, would also have been lessened by crumbs of that wealth. And behind them, endless legions of the merely miserable. Perhaps they would want someone to say all this, however ineptly and futilely. If so, I won’t have come back from hell empty-handed.