The harrowing episodes I experienced during my period of grave depression eight years ago were so numerous that I could not possibly have recorded them all in Darkness Visible. But if I were revising the book, I would include my memory of an excruciating evening a week or so before my suicidal impulses overwhelmed me and I committed myself to a hospital. My wife and I had been invited to dinner with half a dozen friends at a fine Italian restaurant in New York. I very much feared the hour. The majority of people suffering from depression go through their worst pain in the morning. As the hours wear on there is some alleviation, and, with effort, they are often able to cope. With me this situation was reversed. Beginning in midafternoon the anxiety and gloom would slowly accelerate, until by dinnertime I felt virtually suffocated by psychic discomfort. Of course, that evening I could have stayed at home. Anyone suffering the equivalent pain of almost any other disease would surely remain in bed, or at least sequestered from social life. But in depression the anguish is lodged in the mind, so it matters little where the corporeal self is located; one will feel equal desolation at home in one's armchair or trying to eat dinner at La Primavera.
I say “trying” to eat dinner because my appetite had decreased over the previous week to a point where I was eating purely for sustenance. Two of my table companions were charming friends I had known for years. I picked at what must have been excellent pasta without tasting it. For no particular reason, the sense of encroaching doom was especially powerful that night. But the demented stoicism that depression imposes on behavior caused me to register scarcely a flicker of this inner devastation. I chatted with my companions, nodded amiably, made the appropriate frowns and smiles.
The restroom was nearby, down a flight of carpeted stairs. On my way there the fantasies of suicide, which had been embedded in my thoughts daily for several weeks, and which I had kept at bay during the dinner conversation, returned in a flood. To rid one's self of this torment (but how? and when?) becomes the paramount need of all people suffering depression. I wondered desperately whether I would make it through the rest of the evening without betraying my condition. On my return to the floor above I astonished myself by expressing my misery aloud in a spontaneous utterance which my normal self would have rejected in shame. “I'm dying,” I groaned, to the obvious dismay of a man passing down the stairway. The blurted words were one of the most fearsome auguries of my will to self-destruction: within a week I would be writing, in a stupor of disbelief, suicide notes.
Some months later, after I had been hospitalized and recovered from the illness, my two table companions recollected that I had appeared to be behaving quite normally. The monumental aplomb I exhibited is testimony to the almost uniquely interior nature of the pain of depression, a pain that is all but indescribable, and therefore to everyone but the sufferer almost meaningless. Thus the person who is ill begins to regard all others, the healthy and the normal, as living in parallel but separate worlds. The inability to communicate one's sense of the mortal havoc in one's brain is a cruel frustration. Sylvia Plath's bell jar is an apt metaphor for the isolation one feels, walled off from people who, though visible and audible, are essentially disconnected from one's own hermetically sealed self.
In recent months the press has engaged in an orgy of speculative stories about the circumstances surrounding the death of Vincent Foster.* What has been largely forgotten is that there were clear signs in the months leading up to his suicide that he was suffering from a major depression. He had reportedly lost his appetite and his weight had dropped by fifteen pounds, he had developed insomnia, he had spoken of feeling worthless, he had felt his concentration diminish—all signs of a serious affective illness. His closest friends seem to have been aware of his despondency and mystified by it.
The pattern of each person's depression is different, but there are also marked similarities. The psychic torment of depression is, quite simply (albeit mysteriously, defying analysis or explanation), as exquisite as any imaginable physical pain. I recall telling my daughter with desperate seriousness, while in the depths of my own illness, that I would greatly prefer to undergo amputation. It was reported that Foster, during the weekend before the Tuesday that he killed himself, visited friends in Maryland, where he jogged, learned to crack crabs, and talked sports. To nearly everyone this conjures up a congenial image of summertime pleasure, but to those who themselves have confronted the horror, there is the almost certain knowledge that the jogging session was beset by demonic imaginings, the cracking of crabs was accompanied by thoughts of doom, and the sports talk became a conversational mask hiding a frantic inner quest for oblivion. A close friend of Foster's has confided that, though he was clearly depressed, he never mentioned suicide, but this tells us little. Many people who kill themselves fail to give a hint of their intentions.
If Foster had suggested aloud that he was thinking of doing away with himself, would it have made any difference? Psychiatry cannot assure victory over depression, especially in its severest form, but its strategies, both pharmacological and psychological, have shown considerable success in recent years. A person suffering from depression who consults a psychiatrist has commenced a process that, however faltering, can be one of catharsis and psychic ventilation.
Like many men, in particular certain highly successful and proudly independent men, Vincent Foster may have shunned psychiatry because, already demoralized, he felt it would be a final capitulation of his selfhood to lay bare his existential wounding in front of another fallible human being. When my own depression engulfed me, I had to overcome a lifelong skepticism and mistrust of the psychiatric profession in order to seek help. A Southerner like Foster, I attended the same college he graduated from—Davidson, in North Carolina, a small Presbyterian institution of outstanding academic quality. The college's venerable Calvinism, although liberalized in recent decades, has inculcated in its students a belief that hard work, material success, civic virtue, and creative achievement are the real guarantors of mental health. Although Foster himself was Roman Catholic, there is little doubt that Davidson's values left their mark.
The South, including Arkansas, is not fertile ground for psychiatry, and lawyers and writers who have been brought up in the tradition of Southern Presbyterianism are reluctant candidates for therapy. It has been said that Foster had been given the names of two psychiatrists whom he never contacted. Among the most troubling details in his sad chronicle is the one concerning his consultation by telephone, only the day before his death, with his family physician back in Little Rock, who prescribed an antidepressant. This long-distance procedure would seem to be appallingly insufficient, and not only because of the absurd insufficiency of antidepressant medication at that critical moment. Foster was near the brink. He needed to see a skilled practitioner who most likely would have insisted that he go to a hospital, where he would be safe from himself. There, after treatment but, as importantly, after relief from the fierce pounding of the partly real but mostly imagined afflictions he had endured, he would have eventually recovered, as the vast majority of people do. Far from destroying him, his breakdown would have been a deliverance. In a Washington he had learned to hate, the failure to survive his career in government would have been seen, after time, as of no consequence.
There remains only the need to ask why Vincent Foster became one among the legions of men and women who have suffered this shipwreck of the soul. One of the hallmarks of depression is the way it causes its victims to magnify troubles out of all proportion to their true measure. Paranoia reigns, harmless murmurs are freighted with menace, shadows become monsters. Such harassments as Foster endured in Washington could not have been entirely negligible, and they plainly triggered his collapse. One can understand why he felt betrayed and maligned, why his sense of self-worth may have been compromised. Countless stories have been written since the insinuating Wall Street Journal editorials about Foster. The articles claim that he must have feared exposure for some misconduct, probably connected to the Whitewater affair. But even an anxiety like this rarely leads to thoughts of drastic solutions in a normal mind. Only in someone vulnerable to depression would such worries give rise to the dementia that leads to self-murder. Foster may well have been at risk since infancy. If—as in many such cases—he had a genetic predisposition toward depression, he would always harbor the potential for chaotic behavior in the face of crisis. This was no defect of character but one symptom of a complex and mysterious illness that afflicts millions.
The fact that Foster's destruction took place in Washington rather than Little Rock could have also been, in the end, a mere quirk of geography, for though it is unlikely that in the placid landscape of Arkansas, had he stayed there, he would have met the pressures and anxieties that so bedeviled him, it is not inconceivable. A hometown scandal, some sudden fiasco, an unforeseen grief or loss (such as his father's recent death)—any of these might have caused in Foster the same devastation. One thing, in any event, is certain: it was not Washington that became the real proscenium for Vincent Foster's tragedy. It was the stage inside the mind upon which men and women enact life's loneliest agony.
[Newsweek, April 18, 1994.]
* Foster, a deputy counsel at the White House early in the first Clinton administration, committed suicide on July 20, 1993.—J.W.