Internal and external reality exist on a continuum. What happens and how you understand it to have happened and how you respond to its happening are usually linked, but no one is predictive of the others. If reality itself is often a relative thing, and the self is in a state of permanent flux, the passage from slight mood to extreme mood is a glissando. Illness, then, is an extreme state of emotion, and one might reasonably describe emotion as a mild form of illness. If we all felt up and great (but not delusionally manic) all the time, we could get more done and might have a happier time on earth, but that idea is creepy and terrifying (though, of course, if we felt up and great all the time we might forget all about creepiness and terror).
Influenza is straightforward: one day you do not have the responsible virus in your system, and another day you do. HIV passes from one person to another in a definable isolated split second. Depression? It's like trying to come up with clinical parameters for hunger, which affects us all several times a day, but which in its extreme version is a tragedy that kills its victims. Some people need more food than others; some can function under circumstances of dire malnutrition; some grow weak rapidly and collapse in the streets. Similarly, depression hits different people in different ways: some are predisposed to resist or battle through it, while others are helpless in its grip. Willfulness and pride may allow one person to get through a depression that would fell another whose personality is more gentle and acquiescent.
Depression interacts with personality. Some people are brave in the face of depression (during it and afterward) and some are weak. Since personality too has a random edge and a bewildering chemistry, one can write everything off to genetics, but that is too easy. "There is no such thing as a mood gene," says Steven Hyman, director of the National Institute of Mental Health. "It's just shorthand for very complex gene-environment interactions." If everyone has the capacity for some measure of depression under some circumstances, everyone also has the capacity to fight depression to some degree under some circumstances. Often, the fight takes the form of seeking out the treatments that will be most effective in the battle. It involves finding help while you are still strong enough to do so. It involves making the most of the life you have between your most severe episodes. Some horrendously symptom-ridden people are able to achieve real success in life; and some people are utterly destroyed by the mildest forms of the illness.
Working through a mild depression without medications has certain advantages. It gives you the sense that you can correct your own chemical imbalances through the exercise of your own chemical will. Learning to walk across hot coals is also a triumph of the brain over what appears to be the inevitable physical chemistry of pain, and it is a thrilling way to discover the sheer power of mind. Getting through a depression "on your own" allows you to avoid the social discomfort associated with psychiatric medications. It suggests that we are accepting ourselves as we were made, reconstructing ourselves only with our own interior mechanics and without help from the outside. Returning from distress by gradual degrees gives sense to affliction itself.
Interior mechanics, however, are difficult to commission and are frequently inadequate. Depression frequently destroys the power of mind over mood. Sometimes the complex chemistry of sorrow kicks in because you've lost someone you love, and the chemistry of loss and love may lead to the chemistry of depression. The chemistry of falling in love can kick in for obvious external reasons, or along lines that the heart can never tell the mind. If we wanted to treat this madness of emotion, we could perhaps do so. It is mad for adolescents to rage at parents who have done their best, but it is a conventional madness, uniform enough so that we tolerate it relatively unquestioningly. Sometimes the same chemistry kicks in for external reasons that are not sufficient, by mainstream standards, to explain the despair: someone bumps into you in a crowded bus and you want to cry, or you read about world overpopulation and find your own life intolerable. Everyone has on occasion felt disproportionate emotion over a small matter or has felt emotions whose origin is obscure or that may have no origin at all. Sometimes the chemistry kicks in for no apparent external reason at all. Most people have had moments of inexplicable despair, often in the middle of the night or in the early morning before the alarm clock sounds. If such feelings last ten minutes, they're a strange, quick mood. If they last ten hours, they're a disturbing febrility, and if they last ten years, they're a crippling illness.
Copyright © 2001 by Andrew Solomon
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