The Dramas and Melodramas of Depression

Richard Ingram

'Depression' is an increasingly common experience, or set of experiences, in our times. The therapist Lauren Slater estimates that it is "suffered by one in ten Americans" at some point in his or her life. ¹ Behind this apparently unitary concept, however, lies a diverse collection of dramas that are played out, as ways are found--or indeed not found--to weave the term into the life narratives of its victims. While the circle of witnesses to these events is usually limited to a small number of physicians, relatives, and friends, a few cases have been made visible to wider audiences in the form of published diaries and autobiographies. Fictional accounts of similar real or imaginary proceedings have also appeared in print and on the movie screen (the line between what is 'real' and what is 'imaginary' being particularly indistinct for this genre). It is a selection of these personal testimonies that I propose to examine in this paper with the aim of mapping some of the contours of the signifying economy of the depressed subject. The themes that I intend to discuss are: the onset of depression; decisions regarding forms of treatment; the nature of relations between physicians and patients; and explanations that are arrived at for the occurrence of experiences named as 'depression.'

The Onset of Depression: Autobiographical Narratives

(While conducting research for this paper, the author essayed Paxil, nothing, Prozac, and Luvox to counter depression.)

The languages of psychology, psychiatry, and psychoanalysis have permeated everyday life to the extent that people sometimes diagnose their own problems of the mind prior to any consultation with a physician. In these instances a decisive moment in the drama of accommodating the word 'depression' in life narratives is initiated without the intervention of a recognized authority, that is of a professional in the field of treating problems of the mind. For the author William Styron, for example, the loss of lucidity that he was experiencing did not prevent him from reaching the conclusion that he "was suffering from a serious depressive illness." ² His self-diagnosis followed the decision to "read a certain amount on the subject of depression, both in books tailored for the layman and in the weightier professional works including the psychiatrists' bible, DSM (The Diagnostic and Statistical Manual of the American Psychiatric Association)." ³ He therefore produced and claimed his own authority to write depression into his life narrative. This authority derives from identifying his dominant feeling as "a sense of self-hatred--or, put less categorically, a failure of self-esteem" that his reading informed him was "one of the most universally experienced symptoms" of depression. ⁴

Nevertheless, Styron's criteria for depression are characteristically imprecise since there is quite a difference between turning anger or hatred against oneself and experiencing a decline in self-worth. If the latter were taken as the main symptom of depression then the incidence of this problem of the mind would surely be higher than one in ten. Uncertainty about the basic parameters of the condition is a common phenomenon among people who claim the title of depression for their experiences. As Styron observes: "Depression is a disorder of mood, so mysteriously painful and elusive in the way it becomes known to the self--to the mediating intellect--as to verge close to being beyond description." ⁵ The difficulty of describing the descent into depression applies even to professionals in the task of detecting and categorizing problems of the mind. For the practising psychotherapist Martha Manning, diary entries over the course of a few weeks refer to an unfocused state of feeling "foggy and disconnected" ⁶ and to a gradually increasing resistance to social interaction. ⁷ An enigmatic but revealing account appears two months after these early signs of distress during a retreat at a Trappist monastery: "As I slow down, the frantic activity and noise of my life is replaced by a quiet ache, an emptiness I can't quite name. I suspect it's been following me for a while. I've just been able to outrun it." ⁸ As with Styron, therefore, an inaccessible alterity becomes a constant presence in day to day experience. This otherness is at once too remote to put into words and too pressing to ignore. It represents the subject's loss of a centre, but perhaps also a radical attempt to compensate for decentring through the substitution of an inner void.

Another notable effect of the diffusion of the languages of psychology, psychiatry, and psychoanalysis, however, has been to bring suspicion to bear on the authenticity of such experiences. Thus, the art critic, John Bentley Mays confesses that

the forensic language I invoke springs from nothing in my own heart or mind, is no more original than my routine complaining. Rather, it slides down on the page out of clinical case histories and medical records, a portrait of the nobody, nameless, extinguished, who is the topic of the technical literature on depression. ⁹

Depressed subjectivity is surrounded by an aura of simulation arising from a suspicion that its behavior amounts to no more than mimicry of previous cases. Adopting a certain anonymity is a condition for validation as a depressed subject, but also a basis for asking to what extent experiences are being channelled along set paths, as Theodor Adorno has suggested:

Ready-made enlightenment turns not only spontaneous reflection but also analytical insights- whose power equals the energy and suffering that it cost to gain them- into mass-produced articles, and the painful secrets of the individual history, which the orthodox method is already inclined to reduce to formulae, into commonplace conventions. ¹⁰

It is certainly the case that the convenient language of psychology often smothers the particularities of individual experience. Nevertheless, Adorno's theory of the decline of problems of the mind into parodic forms tends, at least in the case of depression, to exclude the possibility that the alienation entailed in occupying a recognizable category can itself act as a means of coping with these 'painful secrets.' A degree of simulation would therefore constitute a defence mechanism against the acknowledgement of particular memories, experiences, or desires. It could even be suggested that familiarity with the 'commonplace conventions' of depressive subjectivity may enable some individuals to avoid the loss of a sense of reality that is said to distinguish 'psychosis' and 'schizophrenia' from 'depression.' For William Styron, for example, reading about depression appears to have helped in arresting his "thought processes" from "being engulfed by a toxic and unnameable tide." ¹¹ If the periods when: "Rational thought was usually absent" ¹² had been witnessed by a psychiatrist, then they might well have been taken as evidence of psychosis, had he not managed to stem their occurrence by means of a strong identification with his self-diagnosis of depression. In discussing the term 'depression,' Styron expresses a preference for the word 'melancholia' that the former has come to replace, explaining that the latter "was usurped by a noun with a bland tonality and lacking any magisterial presence, used indifferently to describe an economic decline or a rut in the ground, a true wimp of a word for such a major illness." ¹³ One attraction of his favoured diagnosis lies therefore in the construction of a worthy enemy against which to be engaged in struggle. By articulating depression or melancholia in this way, the depressive subject produces an internal fissure between a side believed to be capable of recognizing and confronting depression and a threatening other side.

Dramatic Interlude: Decisions Regarding Treatment

(After the onset of depression, we encounter a phase in which life, art, and theory converge in the production of narratives.)

The dramatic interlude is over, but it may be only beginning. There has been a pause in the writing, a break. The break is done. It is through. Hence it could be a breakthrough. It might be the breakthrough to writing.

Who or what grants the authority to write about depression? This debate has taken place many times. In more general terms it is the question of locating an authorization to write. In the context of depression it can become a question of assurance that certain lines of thought are permitted, because depression is part of the same language as harsher words like psychosis and schizophrenia. "It's a slippery slope," as they say about drugs. Take one and you never know where it could lead you. From soft drugs to the hard stuff, the dangerous substances that make people unpredictable.

The author is unauthorized. He is alone in front of a computer screen in an apartment somewhere in a large city, continually mulling over the terms of a decision. The decision recurs. It is the choice, the alternative faced by people who have been recruited to the language of the softer words of depression and melancholia as well as the harsher words that he would prefer not to reflect upon.

Certain states control their populations through the administration of drugs. Such a line of thought, however, borders on impermissible. Once spoken, the lines of thought condense to form a sentence that prompts questions and questioning. For there are agencies that are assigned the task of determining the condition of anyone who thinks in those ways: their task is to locate paranoia, for the paranoid mind is an unstable mind. Its unpredictability renders it a potential threat to any body, even the one that bears it. The point is whether the body that carries the mind can bear these lines of thought, or whether it will slip into commanding, into becoming the author of acts that harm a body, whether its own or that of another.

But where can we locate such a mind? After all, it is a mind that has gone out of control in a body that can be said to be "out of its mind." Consequently, the paranoid mind is nowhere and everywhere.

Pausing only for fish--brain food, so they say--the author tries to pin down, to track down the decision. His finger-pecking on the keyboard nevertheless permits a style once called "stream-of-consciousness." Any style can stand in as an authorizer. Whether through conforming to the Chicago manual, or borrowing a style said to belong to Virginia Woolf or to Friedrich Nietzsche, the 'chosen' style has a recognized and recognizable form. In this way the author is able to escape anyone who questions his authority to think, or to write in this way.

In what way? The author's writing is not theoretical: it does not carry the stamp of authority from theory. For what is theory? This question calls for a theory of theory, and thus threatens an infinite regress. Theory sounds as if it should be universal: can there not be a theory of everything, a theory for everything, a theory that goes along with everything (and anything)? Theory is neutral to the extent that it gains universality. Is it not the case, however, that theory always falls short of being neutral? Theory cannot avoid showing its colours. We have come to know, or at least think that we have come to know, that to the extent that theory can be pinned down or situated, theory is particular.

The question of the universal and the particular tells us that we are in the realm of philosophy. We could also call it the question of the local and the global. Authorization has generally been sought in the larger of these alternative terms, in the global or the universal. Why? Perhaps because they appear to be harder to reach, and so propose themselves as sources from which to draw the authority to create, to be creative.

In his early work, Jacques Derrida went off at a tangent from philosophy, daring not to claim its authority for his words. He wrote in solitude after speaking against his master, Michel Foucault, and described the period of writing as one of intense loneliness. Does the author have the nerve to suggest the proximity of that experience/experiment to depression?

With a burst, three dramatic texts arrived on the scene of theory. They questioned the premise that authority is to be found in the moment of speech, or in the moment of the mind reflecting to itself, upon itself. Rather than according privilege to writing, the point was to find in writing the permission to write. Permission comes from somewhere between, from the double of speech and writing, and from neither term. Did permission come from the performance itself? That is, from the dramatic interlude in which Derrida suffered alone, or from the experience of depression? Is deconstruction merely 'depression' writing? The answer is no, of course, for then depression would be serving as that which is held not to exist, or rather not to be available, the transcendental signified. Depression would attain the status of another god, beyond reach, the ultimate authority for all actions and performances.

Rodolph Gasche has suggested the term 'quasi-transcendentals' for the interrelated words that Derrida will not allow us to use for authorization, for the purpose of authorizing our words. Deconstruction was one of those words, but rapidly became an authority of its own, a place from which to gain permission to think or write freely. Gasche's work, The Tain of the Mirror, was, in spite of its brilliance, a betrayal to the extent that re-inserting Derrida into a history (sic) of philosophy provided another mode of authority from a philosophical tradition.

In "Otobiographies" 'Derrida' returned. The essay, a transcribed oration, asks where authority lies in Nietzsche's works, if indeed it does indeed fall within the works of this 'known madman.' The suggestion is that authorization for the madman's life and works comes only from his future readers, from the readers he awaits. His gamble, therefore, was that his life and work would be shown to have been of value. A terrible gamble: enough to drive anyone mad?

The author is gambling on his sanity. He can turn to the rebels, to the people who resist the language he fears, to provide him with support and reassurance. Perhaps he called one of them this very morning. Or he can remain in the fold, "staying onside," as commentators would say during a game. Staying onside means taking a certain set of drugs. Authorized, permitted, legal drugs. Drugs that tame the mind, that prevent it from becoming an unstable mind. But what would happen if the mind of any other bolted its stable? That would prove only its unpredictability, its capacity to perform any act it saw fit. In other words, that would prove only its capacity for performance.

It seems highly unlikely that the author of this performance could find a way for these kinds of words to appear in print. Yet what are they doing in front of his eyes if not appearing in print? The author lacks a recognized name. And what does any body have aside from its name as its sole possession, almost as its soul? Symbolic interactionists would call the name an "ascribed identity." Claiming to side with agency rather than structure, structures reappear to perform the ascription. There is no solution to the question of agency and structure. Except to believe in secret agents and secret structures. As a secret agent one can never be found out, and one can never find out even if one has agency. For there may indeed be secret structures, unknown, unseen. Fortunately no one believes in secret agents and secret structures.

The author fills time between drug doses. His supply of the drug that keeps the lid on, the drug that dispels 'unwanted thoughts,' that makes Descartes's dream of clear thinking a reality, runs out today. Yet he will return to the fold by staying on the drugs, and will avoid illicit drugs at all costs, knowing the latter to be a gamble not worth taking. The decision regarding his sanity is made by himself as well as by others in every moment. It is then unmade and remade.

In the meantime, thinking, writing, and performing--while the body adjusts, trying to be seated comfortably--are sufficient drugs to remain perfectly stable.

None of this ever happened, of course, because the author has never and will never write fiction.

Back to the main plot, therefore. "Are you seated comfortably? Then we'll begin."

Melodramatic Interlude: Relations between Physicians and Patients

(The finest of lines passes between depression and its other, as between drama and melodrama.)

May 1st, 1998

Dear Drs. X, Y, Z,

In hospital there were nights when my fear knew no bounds. Before this hospital stay--just as during the last stay--I would go to bed not knowing if I would live to see another day. There were many fears, different in shape and size. It seemed as if there was no combination of medications that could induce sleep. Even with all my will and imagination directed towards helping the drugs to take effect, the fear could leap a step by threatening to block creativity in the pursuit of sleep. Were my body and mind together too strong, too stubborn, too wilful to sleep? Would they find ways of resisting medication and refuse the deep rest of sleep that they seemed to crave? Usually we make ourselves tired through activity, by wearing ourselves out. If thoughts still crowd in, then we concentrate on gradually dispelling the anxieties and fears. Or we can welcome the drift of ideas--positive and negative--so that thinking goes wherever it wants until sleep arrives.

What would you recommend when these activities and inactivities, practiced in different orders and disorders, do not bring what is most desired? What happens when sleep is most desirable, but body and mind hold out for something greater, so that sleep does not come? I eventually learned to relax, and to trust that although they were not quite sleep, stillness and calm would be enough to allow body and mind to live another day. In the most desperate moments when trust waned, I would imagine begging for one of you to put me to sleep permanently, as one might do with a sick animal alone in a room, a room not of my own, almost the last place I wanted to be, struggling with these fears. And yet the struggle to overcome such fears appeared to be successful.

There were visitors who arrived unannounced: friends and relatives at any time of day, nurses and security guards checking the rooms through the night. I know better than to name such visits as 'trials,' for trials are a sure sign of paranoia, and so of the need to detain the person longer in hospital.

In a Christian or post-Christian culture the term 'trial' suggests at once ethical, legal, and corporeal events, while also recalling the life of a certain martyred rebel who died a little less than two millennia ago. To speak of 'trials' is still thought by you to demonstrate confusion, and despite the waxing and waning of Christianity in our world this confusion is named as 'delusional.' To confuse oneself in this way is to be 'confused': no form of identification with a god, or with a man thought by many to be the son of a single god, will be tolerated. In your hospitals many of your male patients say through their words or actions that they are that man, or that they are a god, or the god. You take their words or actions as the very basis for a diagnosis of psychosis, and of schizophrenia if the articulations persist.

Disbelief and righteous anger would greet the act of declaring a cure for schizophrenia. There are ways of living with schizophrenia, nevertheless, that are learned, even if they are also unlearned. There is no reason to fear a name, so I teach myself to live without fear, and to accept that it may become one of my names. I declare a theoretical solution to schizophrenia in spite of the apparent incompatibility of theory with such a name. The application of the relational concepts that comprise discourse analysis to the discursive formation that contains names like depression, paranoia, anxiety, psychosis, and schizophrenia demonstrates that each of these names is no more than, but also no less than, an effect of language. If one can live with the phenomenon of communication, and of non-communication as another form of communication, then one can live with schizophrenia. Only in this way is it possible to live with a disease that is held to be incurable. This theory may or may not extend to conditions named by other discourses, for no one knows where the discursive ends and the non-discursive begins.

There are times when I feel like a god to have experienced such thoughts! Thankfully I am not a god: I was born and I will die. To imagine how a god might feel, however, is an aid to dispelling sadness, loneliness, and tears. Would a god not be content at arriving at a solution to the riddle of how to order the universe, that is by allowing the universe to repeat infinitely in infinite variations so that every form of life can eventually experience every single possibility? The universe would begin, expand, and contract; ending so as to begin one more time, to enable all other permutations and combinations of life to occur. Perhaps the being that thinks such a thought is the universe itself, a zero which grows to infinity and returns to zero. Would it not be content at having solved the ultimate puzzle?

Richard

Dr. X (neurologist) notes: Excessive mental activity showing signs of electrical overload in the brain. Recommended action: E.E.G. test (brain wave scan).

Dr. Y (psychiatrist) notes: Persistent irritability in the face of psychiatric treatment forms part of a pattern of fairly standard mood disorder. Recommended action: Continue current medication, adding a mood stabilizer. Monitor the patient closely, however, for signs of loss of unbalanced behavior. A diagnosis of psychosis cannot be ruled out if present trends in the patient's behavior persist.

Dr. Z (psychiatrist) notes: The patient can safely live outside of hospital under the close supervision of a community care team. His progress following the seizure that brought him to hospital makes him an 'atypical' patient.

(In informal discussions with colleagues, Dr. Z observed grimly that 'atypical' could mean perfectly normal or perfectly mad in this case, and that only time would tell.)

Explanations of Depression: Towards a Micro-Discourse Analysis of 'Psych' Discourses

(A response to Slavoj Zizek's question "Why should a dialectician learn to count to four?" ¹⁴ Beyond writing in triplicate!)

• 'Micro-Discourse Analysis' is a name for a discourse that is coming into formation, a name for something that is acquiring a temporary coherence, a name for a conjuncture. It is a theory of events, of forces of attraction that assemble elements from near and far into what is understood as an 'event,' or a time-and-place, and of forces of repulsion that disperse elements to form other events. It can also be a name, therefore, for the operations of memory, whether of the 'individual' body or of the 'collective' body. Whereas Laclau and Mouffe's macro-discourse analysis looks down, from the social down to the local, micro-discourse analysis gazes up, from the personal up to the political.

• The discourses of 'colonialism' have been divided into colonialist, anti-colonialist, and post-colonialist phases, and have encouraged speculation on whether 'our times' can be named with any one of these terms. The phrase 'our times,' however, is merely a stand-in for the questions "who are we?" and "what is our time?" These have been the questions of the twentieth century, as laid out in Martin Heidegger's Being and Time. As the year 2000 approaches, the question of subjectivity weighs heavily on all beings. It is a way of posing the question of the universal and the particular, the question of whether 'we' are one or many. Put differently, it is a way of asking whether globalism is the ultimate millenarian movement. We are in the time of "Troubled Being and Being Troubled."

• In the discourses of 'psych' (that is, of psychiatry, psychoanalysis, and psychology), a similar tripartite division has its uses: we can speak of psych, anti-psych, and post-psych phases. The early work of Michel Foucault and the work of Thomas Szasz belong to the moment of anti-psych, while Persimmon Blackbridge's novel Prozac Highway marks the advent of post-psych. The analogy with 'colonialism' is more than fortuitous since psych discourses are precisely concerned with the colonization of the mind.

• In the discourses of 'academia,' a tripartite division of the pre-modern, the modern, and the post-modern again seems to be exhaustive as the twentieth century comes to a close. We may speak of an academic anxiety in these last two years of the millennium due to the apparent closure of the discourses of the 'modern.' We may also speak of a growing boredom articulated most eloquently in the work of Jean Baudrillard that is inseparable from manic/panic writing that seeks a way out of these tripartite closures.

• A micro-discourse analysis of psych discourses takes its lead from the discourse analysis of Ernesto Laclau and Chantal Mouffe that synthesized the work of Michel Foucault, Jacques Derrida, and Jacques Lacan. Laclau and Mouffe reflect on the persistence of a division between the discursive and the non-discursive in the work of Michel Foucault, and express a preference for Derrida's view in the essay "Structure, Sign and Play in the Discourse of the Human Sciences" that the field of discursivity is exhaustive. ¹⁵ Micro-discourse analysis also follows Judith Butler's return to these questions in Bodies that Matter, where it is asked whether there is any component of sex and/or gender that is non- or extra-discursive. ¹⁶

• Micro-discourse analysis asks whether there is any component of disease and/or illness that is non- or extra-discursive. If there are candidates for a 'something outside of the text,' then surely disease, illness, and death would be among them? Yet this question is not as obvious as it first appears: is disease not simply dis-ease, or a lack of ease? Is illness not simply the absence of health? Do ventures such as cloning and the Human Genome Project not signal the achievement of a form of human immortality? In short, is Friedrich Nietzsche's 'overman' not on the brink of arrival?

• Micro-discourse analysis is applied to problems of the mind because the question of the dualism of mind and body, and of the relations between mind and body, are the very questions of the West, and of its colonization of the non-West.

• Psych discourses are constructed around such floating signifiers as depression, mania, psychosis, anxiety, neurosis, schizophrenia. There are no explanations for any of these 'conditions' because, like all other discourses, there is a play of substitution and exchange among the chain(s) of signifiers. Once it is asked whether there is any difference between floating signifiers and empty signifiers, 'humans' are in fact asking whether a Baudrillardean implosion of psych discourses is occurring. I/we/they are asking whether there is an end to the project(s) of the West, and whether it will arrive before or after the new millennium.

• Micro-discourse analysis is at once sociological and political. It begins with the negative floating signifiers of psych discourses (which can be summarized as 'troubled being' and/or 'being troubled'), and the positive floating signifiers of health discourses (e.g., well-being, ease, happiness, joy, wisdom). It observes that the signifiers of psych discourses can name social conditions as well as personal conditions. The politics of micro-discourse analysis are those of a 'new humanism' that opposes cloning in order to prevent the absolute coincidence of identity and difference.

(The author remains on pills for 'clear thinking'--long live Rene Descartes or Socrates. His personal computer appears to be on the verge of a breakdown--long live Marshall McLuhan.)

1. Lauren Slater, Welcome to my Country: A Therapist's Memoir of Madness. (New York: Anchor, 1996), p. 114.

2. William Styron, Darkness Visible: A Memoir of Madness. (New York: Vintage, 1992), p. 5.

3. ibid., p. 9.

4. ibid., p. 5.

5. ibid., p. 7.

6. Martha Manning, Undercurrents: A Life Beneath the Surface. (San Francisco: HarperCollins, 1994), p. 34.

7. ibid., p. 39.

8. ibid., p. 51.

9. John Bentley Mays, In the Jaws of the Black Dogs: A Memoir of Depression. (Toronto: Penguin, 1995), pp. xiv-xv.

10. Theodor Adorno, Minima Moralia., trans. E.F.N. Jephcott (New York: Verso, 1978), p. 65.

11. Styron, p. 16.

12. ibid., p. 17.

13. ibid., p. 37.

14. Slavoj Zizek, For They Know Not What They Do: Enjoyment as a Political Factor. (London: Verso, 1991), p. 179.

15. Ernesto Laclau and Chantal Mouffe, Hegemony and Socialist Strategy: Towards a Radical Democratic Politics. (London: Verso, 1985), p. 111.

16. Judith Butler, Bodies that Matter: On the Discursive Limits of Sex. (New York: Routledge, 1993), p. 6.