This book is the result of an investigation that began soon after that day in 1992, when the mental image of my body falling toward the pavement far below made me realize, eight years out from the hospital, that I was still broken in some fundamental way. I could accept the need for continual medication, but I was far from accepting that each time I pushed the boulder of myself to the top of the hill, it would roll back down again. I was disappointed that after years of psychotherapy I hadn’t been able to escape recurring periods of low mood, energy, and motivation. I began to read widely, in the hope that a better understanding of my disorder would make me feel less frustrated and powerless.
My reading led me to more questions, and eventually to the decision to write a book that would help me come to terms with my experience. I wanted to confront the mystery of how depressive illness permeates and disables the self. But there was a serious problem with this project: I wasn’t comfortable writing about myself. A new journal had taken the place of the one I destroyed on that day in 1984 when I intended to end my life, and I used it in similar ways: to reflect on what I was thinking about or reading, and to worry about what was wrong with me. In college, I was aware that people were taking courses in creative writing, but I never considered doing so myself. I remained under the influence of my family’s taboo on self-expression—their unspoken rule that it was inadvisable to draw attention to yourself, and that self-exposure could only be cause for embarrassment. If, as Phillip Lopate asserted, “To be a writer is a monstrously arrogant act,” one that “presumes that you should be listened to for pages on end,” it was a presumption I had never dreamed of. But the need to write this book never left me because I sensed that writing about depression—and not just for myself—was the only way to wrestle with a subject so difficult to grasp, and an inner experience so continually, unrelentingly frustrating.
At the time that I began my investigation, popular books on depression were only beginning to appear in bookstores. The most prominent and acclaimed among them was William Styron’s memoir Darkness Visible. It recounts the suicidal depression that enveloped Styron at sixty, after poor health had forced him to give up his lifelong habit of heavy drinking. By then the well-connected and successful author of Sophie’s Choice and several other novels, Styron was in Paris to accept an international literary prize when he became certain that he was losing his mind. From there he deteriorated even further, although he never actually attempted suicide. He spent some time in a hospital and recovered. The book appeared at a time when, although the Prozac phenomenon was beginning to make it easier for sufferers to identify themselves, no one of Styron’s stature had given expression to the peculiar, surreal suffering of a person besieged by melancholia.
I was stunned by the beauty of his book’s conclusion, which borrows the end of Dante’s Inferno to compare the recovery from depression to a passage out of hell:
For those who have dwelt in depression’s dark wood, and known its inexplicable agony, their return from the abyss is not unlike the ascent of the poet, trudging upward and upward out of hell’s black depths and at last emerging into what he saw as “the shining world.” There, whoever has been restored to health has almost always been restored to the capacity for serenity and joy, and this may be indemnity enough for having endured the despair beyond despair.
E quindi uscimmo a riveder le stele.
And so we came forth, and once again beheld the stars.
To end on a note of such beauty, offering the counsel of patience and hope—and even joy—to fellow sufferers, was Styron’s gift to the many readers who had no words to describe what they had been through. His title comes from a passage in John Milton’s epic poem Paradise Lost, in which Satan describes Hell, his new home, as a place where “no light, but rather darkness visible, served only to discover sights of woe,” “where hope never comes that comes to all.” In borrowing the language and imagery of not one but two great poets, Styron elevates the horror of suicidal depression and makes its sufferers and survivors, by inclusion in these metaphors, feel heroic.
This poetry was very close to me at the time: I was teaching a course at Columbia that included The Inferno and Paradise Lost the year that I read Darkness Visible. Because it hadn’t been long since I had recovered from my second suicidal episode, nothing Styron wrote or borrowed seemed too dramatic. I was aware, too, that Styron had gotten off relatively lightly when it came to the severity of the episode that put him in the hospital. Mine had gone further, darker, and was more damaging to me as a young woman just starting out in life. Severe depression came to me early enough to seep thoroughly into my sense of self. Other lines in Paradise Lost—Satan’s words, “which way I fly is Hell, myself am Hell”—expressed what it had been like for me, and this feeling returned at intervals to remind me that my ordeal was not over. Nonetheless, at the time Styron’s book was clearly the book on the subject. It seemed to render unnecessary anything that I, someone with no literary connections, no status, and no confidence, might offer. I went to hear Styron speak at a conference on American writers and suicide in November of 1994, just as another serious matter was claiming my attention. It had been two years since I had last miscarried, and I had not become pregnant again.
Jim and I visited a series of specialists. They looked inside my body with ultrasound and a tiny scope, saw nothing out of order, and prescribed monthly supplies of reproductive hormones. They tested Jim as well, and found nothing problematic. Another year passed, and nothing happened. I suspected that my trouble conceiving, my miscarriages, and my depression were all somehow related, but no doctor was willing to enter into that question when I asked. Facing yet another unexplained disorder, I entered a state that felt more like a spiritual crisis than a depressive one. Seeking solace in the face of all this frustration I joined a chorus, and over the next couple of years I joined fifty other people rehearsing and performing works of Bach, Vivaldi, Duruflé, and others. Singing sacred music is a physical experience, and feels exactly like what it is: a powerful, embodied form of communal prayer. I pursued other spiritual remedies as well: I began taking yoga classes in an effort to release pent-up tension from my body. I read books on Buddhism and joined a meditation group, convinced that these practices offered a way of gaining distance from intolerable feelings, only to find that I didn’t have the patience or the discipline to keep up a daily meditation practice.
By then I was thirty-nine, and had been told by each doctor I had seen that my chances of pregnancy were drastically decreasing. The resentful, vestigial Catholic in me still believed that God owed me a child, and all this time I had been set on reversing what had happened over a decade earlier. I believed that if I didn’t have a child, I would never fully recover from that loss. Having tried less invasive and less expensive methods without success, we turned at last to in vitro fertilization. Couples who have gone through IVF know what a commitment of time and money it is, and how awkward, unnatural, and emotionally difficult. Jim and I chose a hospital in New Jersey with the highest IVF success rates, and the procedures began. They shut down my irregular menstrual cycle and started it again so that it would run precisely on schedule, hypercharged for egg production. Several times a week we drove to New Jersey at five in the morning for my ultrasound and bloodwork, making sure we beat the rush-hour traffic coming back so as not to be late to teach our morning classes.
In early November we had four eight-celled embryos. On the day of the transfer, I lay on a table and watched the embryos appear and disappear on the technician’s screen beside me, as one by one an embryologist in the adjoining room drew them from a petri dish into a pipette. As these were transferred into my body moments later, I prayed I would have the chance to give birth again and raise a healthy child. As we were leaving they gave us a picture of our four embryos, each a collection of round blobs. Jim said, “They look just like me.” His sense of humor kept us sane.
Ten days later there was a phone message from the hospital with the results of bloodwork. It began, “You’re pregnant but . . .” One of the hormone levels was lower than they liked, so they were treating the pregnancy “cautiously.” It seemed like a bad sign. I barely slept that night. In the morning we went to the hospital to have blood drawn again. We took a number; there were eighty-eight people in line ahead of us. We waited two hours. Was that a bad sign? We were in the hands of powers whose signs we couldn’t read at all. Was it a good sign when, trying to escape bad fusion jazz on the speaker in the hospital waiting room, I went into another room across the hall where a woman called out to a little girl in pink fuzzy pajamas with feet, “Anna, come here”—and the little girl replied, “Go away, Mama, you stand over there”?
Later that day, to cheer ourselves up, Jim and I went to look at the paintings of Howard Hodgkin. In one of the galleries, a wealthy-looking young woman with a giant stroller-throne was feeding a baby from a jar of baby food. I went into the bathroom a bit later and there was the same woman, changing the baby’s diaper. As she did so, she called the baby Anna. It’s become a popular name, I thought. A beautiful name, a palindrome. A mirror in which, Anna having disappeared, I’m left seeing only myself.
The great question of the weeks that followed was, Good sign or bad sign? Cramping, a little bleeding, nausea? Good or bad? We waited and worried. Will tomorrow be the day of miscarriage, we wondered? Will it be tonight? Will we have to call our doctor’s emergency number? Will we ever stop asking these questions?
I was teaching the Bible at the time, as it happens, and we were reading the Book of Job. After losing all his children, his house, his oxen, sheep, and servants, after being tormented by boils, after listening to his friends argue that he must have done something to deserve all this punishment, Job confronts God himself. God speaks to him from the whirlwind: Where were you when I created everything? I am God. I do what I want. Job says, okay. Once Job attests to the insane, unreasonable power of God, God gives him back all that he has lost. He gives Job ten children. Different children—new ones. It’s a happy ending.
We went for a sonogram on the twelfth of December. Twelve years earlier on that day, Anna was dying. A bad sign. It took the doctor a few beats to find “the pregnancy” in my uterus, and for a few anxious seconds Jim and I stared at darkness, remembering the blighted ovum we had stared at on a similar screen exactly three years earlier—a circle, dark inside. Another bad sign. Then we saw our little creature, the sole survivor of four embryos. A rough outline, not human-looking yet—head, heart, rump, attached to the yolk sac. We saw and heard its robust heartbeat, pounding away. Our spirits lifted as the doctor said, “All looks good.” He told us we could now choose an obstetrician close to home.
On the day of amniocentesis, we waited a long, anxious time in the hallway of the hospital before we were finally admitted into the room for the sonogram. We had decided to have amnio so that if there were some congenital problem we would know what we were facing, and not be taken by surprise when I gave birth. The technician said she was aware that ours was a high-risk pregnancy—my history and IVF both made it so—and was so calm and kind that I felt more relaxed. She proceeded carefully and thoroughly, measuring the baby’s head and femur bones, looking at the spine and ribs, the stomach, liver, heart, brain, bladder. She told us everything looked just fine.
On the monitor the baby was moving its arms and legs, putting one arm over its head, arching its back. Jim asked, “Can you tell if it’s a boy or a girl?” and the woman pointed to the penis, not plain as day exactly, but clearly there. I was a little shocked because I had expected a girl. I was glad to know the baby’s sex, so I could get used to the idea of a boy. This was a good thing, I realized: I would not have another Anna. No repetition, no replacement. He would be himself. We would move into the future together.
I hadn’t taken Prozac during the IVF period—the protocols forbade all medications not absolutely necessary—and I waited as long as possible before I began again, sometime during the third trimester. The sonogram had been so reassuring that until I went into labor and the doctor hooked me up to a fetal heart monitor, I refused to let myself worry about the baby. That would have ruined the pleasure I had in anticipating his arrival. Jim, on the other hand, not usually a worrier, worried a lot. Two friends of his had recently lost babies to cord strangulation, and he feared the terrible things that could take place in the delivery room. Our son arrived a few months after my fortieth birthday, with two knots in his umbilical cord. Our obstetrician marveled at this medical rarity, and kept the cord to show her students. What could have been another devastating situation had not turned into one. Just a little joke. God, chuckling: I do what I want. With the blessed relief of this baby’s good health, the pain of Anna’s death could begin to fade. We named him Luke, from the Latin lux, light.
WE SPENT TIME in Vermont that fall, and on our way home one day we stopped at Anna’s grave. Luke, three months old, was asleep in his car seat. It was dusk when I got out of the car. As I walked through the gate, past the maples and the other graves, I had the sensation of being a moving camera, moving back in time. I knelt and touched the granite stone and brushed my fingers over the incised letters of her name and the words below. “The awakened, lips parted, the hope, the new ships.” Jake and Anna felt so near, yet so far away in the past, as Jim walked up and handed Luke to me. “I wanted Luke to see his sister,” he said, and there were tears in his voice. I stood holding the precious body of my living child—the hope, the new ships—remembering the precious body of my dead one.
At some point in those painful years between Anna’s death and Luke’s birth, I taped a picture to the wall above my desk: a photograph of the statue called “The Angel of the Waters,” seen through a light snowfall. The statue, together with the fountain and pool below it, make up the centerpiece of Central Park’s Bethesda Terrace. In the photograph, only the angel and the snow are visible. I love the angel’s attitude of arrival, its hand lifted in a gesture that seems to say: Be comforted. Be blessed. Sitting at my desk, it made me feel better in those days to gaze at the angel, the blue winter light, and the haze of snow. At its dedication in 1873, its sculptor Emma Stebbins revealed that this was a healing angel, inspired by a passage from the Gospel of John, chapter 5, verses 2–4: “For an angel went down at a certain season into the pool, and troubled the water: whosoever then first after the troubling of the water stepped in was made whole of whatsoever disease he had.” In that expansive, elegant public space completed not long after the end of the Civil War, it conveys to all who see it a message that the pain we endure can be healed. With Luke’s arrival, I was blessed and comforted.
Luke in childhood—the extraordinary, tensile aliveness of his restless little body, his intense brown-eyed gaze, his murmured narration of stories for his menagerie of plastic animals, his desire to be read to every night, his deep capacity for pleasure, his love for his mommy and daddy—all this made being his mother a joyful everyday event. The joy is palpable in our family photographs. I can see it in pictures of the three of us together, and in pictures I’ve taken of Luke. In a series taken on a beach in Ireland, for instance—the beach in my grandfather’s village, when we were visiting with my parents—Luke is running toward me from a long distance with the wide curve of shore behind him, arms waving, the wind pushing at his shirt and hair. I can see him planning mischief as he runs: is he going to stop, or is he going to run right into me? As he gets closer and closer I keep pressing the shutter until his laughing eyes and broad, toothy smile fill the frame.
In second grade, Luke made an abstract painting and called it “Hyper Happy.” When he was in fifth grade his class was studying China and making ink drawing scrolls, and the teacher asked each child to make a name chop, the artist’s signature seal found on ancient Chinese prints. Choosing from among the Chinese characters they had learned, Luke combined the hànzì for sun, mother, and child, and named himself Really Happy Child. Luke was just what I needed: a boy bursting with life, in temperament more like his irrepressible father than his moody mother. He’s in college now, and no less a wonder. To my great relief, he has never shown the slightest sign of the family vulnerability to depression.
The gift of this child, this heartening ascent from darkness, would be a satisfying place to end my story. Raising Luke has given me a more secure stake in the world, but his presence hasn’t magically put an end to my troubles with depression. When he was diagnosed with ADHD at seven I told him that I take medication too, for depression, and that lots of people have conditions that they need some help with. Otherwise I didn’t talk about my depression with him, and it wasn’t a big deal in our family life. So it took me off guard when one day the two of us were eating lunch at the kitchen table and he said “Hey, what’s that scar on your neck?” He was now sixteen, and had never asked me this before. I had begun working on this book, but I was unprepared for the question. Trying to sound nonchalant, I said, “Oh, I don’t remember.” He looked at me, puzzled, and then we talked of something else. I hadn’t ever wanted to tell him about that until he was old enough not to feel threatened that he might lose me to suicide or to a long bout of depression. I’ve always wanted him to see me as strong and capable and reliable. As books have piled up on my desk in the last few years—books on suicide, depression, drugs, shock treatment—I’ve told him what I’m writing about. He knows now that I attempted suicide after Anna’s death. But until he reads this book, he won’t know the details of what happened.
Every day in the bathroom mirror I see the scar that most people never notice, a constant reminder of what, irreversibly, has happened. It’s the sign of a story I’ve kept mostly to myself for over thirty years. But visible scars do tend to provoke the question, “What happened?” Usually, we know how people close to us have come by theirs. There’s the one my sister Kathleen got when her roller-skates went out from under her and the wire points of the cyclone fence she was leaning on pierced the inside of her elbow. I was there, and it was awful. Or the ones my brother Tom has from the time when, airborne in an ultimate Frisbee tournament, a collision left him with a compound fracture of his upper arm and a whole set of plates and screws to put it back together. If we survive the injuries that make them, scars remember dangerous events in our histories. They mark cancer surgeries, car accidents, war trauma, bizarre mishaps, the birth of children.
Perhaps the most famous story of a scar is found in Homer’s epic poem The Odyssey, when the hero Odysseus arrives home as an unrecognizable stranger, planning to attack the men who have occupied his palace in his absence. In twenty years, he’s survived a war, he’s lost his ships and his men, he’s had countless other adventures and misfortunes. An old woman who was his nurse in boyhood is washing his feet when suddenly she recognizes him by the scar on his thigh. The poet leaps back in time to tell the whole complicated tale of how Odysseus was named by his grandfather, and on a visit to this same grandfather, was wounded in a boar hunt. But he also killed the boar, an act that marked his initiation into manhood. The scar is as much a sign of his identity as his name is. He is a hero and a survivor, about to survive the battle for his homecoming.
My scar is not the sign of my identity—I can’t identify with the mind that compelled that action—but it stands for a defining double trauma: the loss of my child, the loss of myself. It’s the sign of an illness that has shaped my history. It hasn’t allowed me to forget the most harrowing days of my life. It has reinforced my sense of shame at being a person who attempted suicide, and it reminds me of my residual anger at those in the hospital who let that happen. The story of my scar isn’t heroic, but, no less than the hero Odysseus, I am a survivor. In the much older body of the desperate young woman who tried to end her life with a piece of broken glass, I am still here.
After bearing this mark in silence for so long, I’ve given myself permission to say what happened. My silence, I now see, has been more than a matter of trauma and shame. I’ve been complicit with all those who don’t want to look squarely at what happens to people under the influence of a depressive disorder. My story is a way of bearing witness, as a person whose illness was diagnosed only after it had already done enormous damage, to the suffering of so many people whose depression goes unrecognized and untreated, and to those who have died by suicide, unable to live another day in a torment they believed would never end. Most importantly, I want to encourage people in the depths of hopelessness to believe that they can come through, and to find help from a compassionate, responsible professional who will care for them until they do. People in the grip of severe depression might take as their mantra a line from Rilke so relevant to all kinds of human trouble that it has become an Internet meme: “Just keep going. No feeling is final.”
As I began this final chapter, I thought again of the closing paragraph of Darkness Visible. Even when I read it the first time, I knew that however beautifully shaped the story of Darkness Visible was, its ending was too good to be true. While the return to mental balance after a suicidal episode can feel, both metaphorically and literally, like you have emerged from the underworld to see the starry sky, it’s quite possible that you’ll be plunged into it again. It’s just not fully within your control.
Styron himself had to face the underworld once more. He had fifteen good years until, at seventy-five, he entered a depression even more severe and longer lasting than the first. He was hospitalized and given shock treatment, but never fully regained his health. He prepared a suicide note, and he asked his biographer Jim West to make sure, in the event that he killed himself, which he feared he would do, that the following message to readers would appear in all future editions of Darkness Visible:
I hope the readers of Darkness Visible—past, present and future—will not be discouraged by the manner of my dying. The battle I waged against this vile disease in 1985 was a successful one that brought me 15 years of contented life, but the illness finally won the war.
Rose Styron says that her husband worried that in ending his book on an optimistic note, “he had misled people.” Styron did not end his own life; six years later, he died of pneumonia at age eighty-one.
I can’t rule out the possibility of a dangerous relapse in my future, but I haven’t had a suicidal thought since that day I looked down from the fifteenth floor in 1992. While the loss or illness of someone close to me, a possibility I don’t wish to contemplate, could put me back in danger, I like to think that I’ll never again be as desperately ill as I was at twenty-seven. My sense of safety has grown with time, but I have no choice but to accept the presence of this disorder, and to remain wary of it. Perhaps living with this challenge has in the long run made me stronger and taught me greater patience and resilience. But I would have given—and would still give—almost anything to be free of it.
Writing this book has made me recognize how thoroughly depression has shadowed my life. Over the years, in periods of great difficulty, feeling the paralysis of ambition and the absence of vitality, I’ve called myself a failure—a boring, vacant, uncreative person—instead of recognizing that depression had taken over once again. I’ve had too little compassion for myself, and my self-condemnation has only made things worse. Serious depression causes useless, prolonged suffering, and—given how common it is—a wasting of human potential on an enormous scale. The World Health Organization figures that among illnesses, depression ranks highest in disability-adjusted life years, which it defines as one lost year of healthy life.
I would love to have some of those years back, but I understand, having lost them, that there’s a reason I haven’t accomplished as much as the people I so admire and envy. People like my husband—a cultural historian who has written six books in the time I’ve known him—or like friends who are novelists, poets, journalists, and artists. I realize that yearning for a more fully lived, fully accomplished life is itself a provocation to sadness. It’s not unlike the mourning of the melancholic, this refusal to lay to rest the imaginary, ideal person you might have been. To harbor the wish that things could have been otherwise prevents me from seeing how undeniably fortunate is the life I do have, and how generously I’ve been blessed and comforted.
The late Leonard Cohen, one of the great songwriters of our time, knew that just about everyone feels broken in some way—not only those of us who have actually cracked up. Rather than obsess about our flaws and failings, we could acknowledge imperfection as the natural and shared condition of being human. He offered us these four lines, the chorus of his song “Anthem”:
Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That’s how the light gets in.
I plan on taking his good counsel as I move into the rest of my life, remembering to let the light in.