My eyes are myopic because of a childhood tendency to read under the covers without the necessary aid of artificial lighting. I didn’t have a lot friends growing up and I lived most of my life in books, eschewing kickball games for Harriet the Spy and assorted children’s editions of classics. I was a lonely and sheltered and bookish in the way that one would expect someone with little natural athletic ability and charisma to be, and I grew up to be, if slightly more refined to social graces, lonelier and more sensitive with the same attachment to fiction. The first meaningful relationships I had were with characters not hewn of flesh and blood, but merely concocted from the whims of Twain and Faulkner, from the Louisa May Alcotts and the Brontes and the Allendes of the world. My world has largely been shaped by words, others’ words, and it is because of this indelible compulsion to subsume these words that I have been able to get through what I know recognize as mental illness.
In the premodern age, tuberculoses and cancer were thought to have arisen from passion, whether in abundance (TB) or in deficit (cancer). As metaphor, TB was thought to have expressed the paradox of sensuality and passion because it also described suppression: it was a disease that affected the most sensitive, but also isolated them from the community. For a time, it was fashionable to be afflicted with TB: Illness became interesting, and sickness, “individualizing”: “Indeed, the romanticizing of TB is the first widespread example of a distinctively modern activity, promoting the self as an image.” In a strikingly different manner, however, cancer became associated with shame, with the sexless, dispassionate body. Its metaphor is one of warfare: ‘invasive’ cells that must be ‘killed’. Cancer then, is a “metaphor for what is most ferociously energetic, and these energies contribute the ultimate insult to natural order.”
The social history of the aforementioned illnesses were of great interest to Susan Sontag, who in her 1978 nonfiction treatise Illness as Metaphor, encouraged readers to avoid the all too human tendency to think of cancer and TB as revealing something about the infirmed person’s character.
Sontag is no longer alive, but I wonder what she would say about mental illness, and specifically depression. She mentions, briefly, in her discussion of romanticizing TB, that depression is “melancholy minus its charms – the animations, the fits”. The modern fascination for psychological explanation of disease and psychologizing them, according to Sontag, seems to undermine the ‘reality’ of the disease and provides a semblance of control.However, when dealing with something such as depression, which seems to inextricably linked to one’s mind – insofar that it is not strictly a somatic disease (though it may manifest itself as such) – how do we comply with Sontag’s injunction?
By the numbers, depression comes in several forms. Among them are dysthymic disorder (chronic mild depression lasting for at least 2 years),major depressive disorder, which accounts for 14.8 million American adults in a given year and is the leading cause of disability in the US for adults aged 15-44. By any other metric, depression is much less precisely understood. Though it can stem from a number of physiological (imbalance of hormones, neurotransmitters, or differences in brain composition), psychological (trauma, abuse, loss), genetic, or circumstantial events (financial problems, high stress, etc.), the cause of depression is still somewhat vague. Treatments for depression – classified a mental illness by the AAP and DSM IV – bridge pharmacology - prescription of drugs MAOIs , SSRIs, and others - as well as psychiatry, such as cognitive behavioral psychotherapy; more extereme cases may call for electrtoconvulsive (shock) therapy and nerve stimulation.
These are all just easily accessible facts. You can Google them and read about them and perhaps understand the basic nature of depression. From my own experience – necessarily subjective, but decidedly not unique – depression is something debilitating, personal, and ineffable. Logically, I can understand that it is a mental illness, some sort of imbalance of neurotransmitters, but the solipsistic nature of the illness is such that I have grown attached to the idea that my mortal pain would be incomprehensible to others even if I were able to escape the limitations of language and articulate just precisely how it feels.
It is for this reason that metaphor, and in particular narrative, seem so appealing. Winston Churchill described his clinical depression as The Black Dog. David Foster Wallace, patron saint of college students with a particular affinity for the tragic incongruities of life, writes of clinical depression alternately as “A level of psychic pain wholly incompatible with human life as we know it,” a “nausea of the cells and soul” and “a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence.” For the world weary existential, these phrasings from Infinite Jest have become Gospel, though they fly in the face of Sontag’s warnings. Their appeal lies in Wallace’s deft ability to approach the onerous task of expressing the nature of depression for those who have never experienced such anguish. In fact, he tackles this ineffability head on through one Kate Gompert:
There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. […] If a person in physical pain has a hard time attending to anything except that pain, a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution.
Both of my parents work in pharmaceuticals, and my father works for the company that produces the drug Lexapro ®, an SSRI prescribed for acute and maintenance treatment of major depressive disorder and generalized anxiety disorder. We have a medicine cabinet full of pills to treat insomnia and indigestion and mild to acute recurring headaches, but my parents are staunchly resistant to the notion of drugs as treatment for something like generalized malaise or acute sadness. There is a host of cultural presumptions attendant to this line of thinking that my parents have brought with them from Bangladesh, much more to unpack than this essay could hope to address, but such a purview is something I had largely internalized for many years.
I can point to certain specific events that might have triggered the onset of depression, but I cannot claim to understand when precisely depression had so consumed my life – or at least felt like it did – to the point where performing routine activities verged on the impossible. The very problem with depression is that, as a mental disorder, it clouds judgment and makes mental comprehension of the disease – the problem at hand – more difficult to understand. Depression is not inherently different from an organic illness like cancer; individual cases seem to feel solipsistic in the sense that it seems impossible for another person to understand the pain. However, as Sontag would assert, depression is equally no more the fault of a person’s character than cancer, though I may be more influenced by certain life events and personal decisions – excessive drinking, trauma, et. al – more so than others.
What’s more is that all aspects of being seem to be affected through the imbalance of one’s mental state. The Black Dog manifests in missed classes, a week spent in bed, the same song played on a loop 300 times, a small scar on my left wrist the exact shape and size of the end of a Marlboro Light 100. These things all make it difficult to comprehend depression as an illness rather than some moral affliction. If I had once romanticized depression as a condition for the brightest and most creative, I no longer am subject to the presumption that I was one of the lucky few.
Yet, when I am caught in a cycle of self-deprecation, I turn to the friends have stayed with me the longest, to narratives that offer an escape from the immediate reality of sadness. If I cannot think of the illness itself as metaphor, then I can turn to the richness of language, to the intricacies offered by others’ metaphors for the world around me, for solace. Philosophers such as Hannah Arendt and Daniel Dennett assert that the tendency to think of our own lives as narratives, to tell stories, is a critical component to understanding ourselves as selves. When we tell and retell stories, we can understand the significance of others’ actions and our own because they are put at a certain distance from what the events described in the narrative. Arendt argues that thinking of our lives as narratives allows truth and significance to pervade our actions, creating inspiration for the future. For Arendt, there is an ethics to narrativity, and though arguments have been made against this style of thinking – Galen Strawson offers a compelling one – the possibility to better understand ourselves through the narratives of others persists. I can’t completely understand how depression has become so pervasive in my life, but I can often relate to the madwoman in the attic, and that alone is reassurance.
The walls of my dorm room are littered with poems and quotes hastily copied onto torn pages from my notebook. Among them is a quote from Mary Ruelfe who writes,
In one sense, reading is a great waste of time. In another sense, it is a great extension of time, a way for one person to live a thousand and one lives in a single lifespan, to watch the great impersonal universe at work again and again, to watch the great personal psyche spar with it, to suffer affliction and weakness and injury, to die and watch those you love die, until the very dizziness of it all becomes a source of compassion for ourselves, and our language, which we alone created…
Sontag urges us to treat illnesses as they really are – not metaphors, not mirrors, but events and instances. Depression is no different in this regard. Though I can understand that depression is neither my fault nor an indication of my personhood, shrinks and prescriptions and journaling have only done so much. That is not to say that for another person they cannot be effective or that they should be avoided; rather, I have found that for me personally, books offer escapism and an understanding that fills the gaps in the understanding of other people, ultimately keeping the Black Dog at bay for at least a little while longer.
 Susan Sontag, Illness as Metaphor. New York: Farrar, Straus, and Giroux, 1978: 32.
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