The Christmas after I was discharged from the hospital, my older sister gave me a copy of David Foster Wallace’s collection of essays, “A Supposedly Fun Thing I’ll Never Do Again.” A just-prescribed cocktail of psychiatric drugs made sitting still and sustaining concentration difficult. Short essays were a well-tailored gift.
When I wasn’t sleeping or working nights serving margaritas at the local mexican restaurant I’d read a few pages, laugh, then swap the book out for 30 minutes of TV. Incidentally, it took getting to essay number two – “E Unibus Pluram: Television and U.S. Fiction Writing” – to recognize a part of my teenaged self in his work, “The lonely, like the fictive, love one-way watching… Lonely people tend [sic] to be lonely because they decline to bear the psychic costs of being around other humans. They are allergic to people. People affect them too strongly.”
For a time I had exchanged what felt like a hassle – friendship – for television and print.
This book became my introduction to the award-winning essayist, novelist and short fiction writer who would – over the course of two decades – liven those human experiences that I tried hard and alone bear: self-consciousness, loneliness, fury, compulsion, and sadness.
Today, Wallace’s 2005 commencement speech “This is Water” is arguably his most far-reaching contribution to popular american consciousness. (Though committed readers would likely cite his 1,079 page novel, Infinite Jest.) Last May, an edited version of this speech was released as a short film. This film was viewed over four million times within the week. Be fairly warned, Wallace doesn’t come off as particularly sensitive or heroic. But, he’s himself – acutely thoughtful, addressing a particular audience and a particular kind of suffering in America that heaps of privilege won’t bury. He invites graduates, “To be just a little less arrogant…have just a little critical awareness about myself and my certainties. Because a huge percentage of the stuff that I tend to be automatically certain of is, it turns out, totally wrong and deluded.”
He also challenges his audience not to mistake the temptation of certainty for the wonder of being human,”The really important kind of freedom involves attention and awareness and discipline, and being able truly to care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.”
Notably, this speech – crafted by a man whose work often explored the depths of emotional despair – has been referred to as the most inspirational commencement speech in recent history. Eight years later, these words live on to encourage people to think – and possibly live – just a little differently.
This is no small feat.
In 2008, my sister – who introduced me to Wallace’s work – delivered the news of his suicide. She called from Los Angeles and spoke with my mom while I sprawled on the too-narrow love seat in my parents’ living room, pointing and clicking our TV’s remote control. I’d just returned to the east coast after a decade of life in California. I was between jobs and homes – and smack in the middle of a terrifying phase one of psychiatric drug withdrawal. My thoughts were unpredictable, often dark. My body ached, and pulsed with panic. I had no clue what to expect, how long it would take, or if and when I’d recover. (You can read my story here).
My mom hung up the phone, shuffled over to the couch and regretfully told me the news. Wallace had killed himself. He was 46 years old.
We couldn’t believe it.
Two days later, the New York Times published an obituary that for the first time publicly addressed Wallace’s long-time struggle with a diagnosis of depression. Readers discovered that he’d been on an antidepressant for 2o years when the drug started to produce serious adverse effects. On a doctor’s recommendation, Wallace tapered off. Soon his despair returned. His father, James Wallace, explained to a deeply saddened readership that his son just couldn’t stand it anymore. Ten months post-withdrawal, he was dead.
As Wallace’s diagnosis became public knowledge, his suicide became a cautionary tale: This is what happens when you stop taking your medication. Each story told about his death evoked popular notions of depression as a “brain disorder” that must be treated with medication. The most telling example of this dominant narrative are the words of Wallace’s wife, artist Karen Green. In 2011 she spoke with the UK Guardian in support the recent publication of Wallace’s novel, The Pale King, which he’d left in draft form upon his death. Toward the end of the interview, Green points to a painting of hers, overlaid with segments of a brightly colored MRI scan. She explains, “That’s a depressed brain. It’s coded differently.”
This is an understandable misunderstanding. Patients and family members are shocked to find this story is not true. Though researchers have tried or promised for decades, they have not yet been able to diagnose or predict the presence of what we call depression (or any other diagnosed mental disorder ) using brain scans or other biomarkers.
There is no “depressed brain”.
Last year, T.D. Max’s biography of Wallace, Every Love Story is a Ghost Story: A Life of David Foster Wallace, arrived to bookstore shelves. Admittedly, I felt a bit voyeuristic for wanting to read the intimate details of a writer’s life, which – while living – he’d chosen not to publish. But I did. In part because Wallace’s friends and family had collaborated with the author. This seemed a more respectful arrangement. I also wanted to know more about his life, and to make the impossible attempt to understand exactly why it ended so soon. As a fan, reader of scientific research, and one who personally survived an intrusive period of suicidal feelings in antidepressant withdrawal, I suspected the real picture of his life and death was more complex than its popularized “brain disorder” caption.
Among its many funny, endearing tributes to Wallace, in the end this book depicts a disturbing chain of circumstance. In 2007, Wallace consulted a doctor after experiencing what he feared were the symptoms of a hypertensive crisis associated with the use of Nardil. With the support of a doctor, he tapered off. Wallace was soon hit with enduring withdrawal symptoms. He told a friend, “It’s a bit like I imagine a course of chemo would be.” Within months, Wallace checked into a hospital. Although electro-convulsive therapy damaged his memory in 1988 – Wallace went through 12 more rounds while in withdrawal, hoping to find relief.
But his desperation and frustration continued. Wallace reportedly “rolled his eyes” as doctors prescribed new pills, waiting for a different combination to work. He likened this standard trial-and-error prescriptive practice to, “throwing darts at a dartboard”. A description that rightfully commands an understanding of what it can feel like to be a psychiatric patient: the object of chance and hope-puncturing aggression.
I don’t know if Wallace’s death could have been prevented. But the fact of his suicide, which happened during a high-risk period of withdrawal – at which time doctors initiated more, high-risk treatment – raises a larger, very significant question for the mental health care system.
While increasing numbers of Americans are being prescribed antidepressants, the Centers for Disease Control reports that suicide rates increased 28% from 1999 to 2010. Trained professionals remain unable to predict who is at risk. Their guess is as good as chance.
Additionally, current prescriptive practice is based on an alarming gap in research – and so, in turn, of informed consent and care – on the risks associated with the long-term use of antidepressants (typically, human trials are 6-8 weeks). Practitioners rarely understand that symptoms of post-acute psychiatric drug withdrawal can last for months, even years, and can include reoccurring, even impulsive thoughts of suicide.
Given this gap in knowledge, how can providers understand and support a patient whose withdrawal process includes suicidal feelings – the experience they’ve been trained to see as a brain disorder in need of medication?
I believe Wallace’s own words – which he used to point out our most dangerous liability as human beings – aptly names a large problem with our medical model of mental health care: “Blind certainty, a close-mindedness that amounts to an imprisonment so total that the prisoner doesn’t even know he’s locked up.”
The solution, Wallace suggests, to this problem of certainty, is a humble willingness to pay attention to what’s right in front of us, “and to truly care about other people and to sacrifice for them over and over in myriad petty, unsexy ways every day.”
Yesterday, I sat at my desk for two hours to write then delete the last paragraph of this blog. I wanted to illustrate what might it be like to take Wallace’s advice in service of supporting someone who is depressed, or suicidal. But my memories, old and recent, of being with other people who were feeling suicidal, were hazy or somehow missing. Unable to draw from lived experience, the exercise felt too cerebral.
That’s when my good friend called. I was glad to see his name come up on the caller ID. His humor, our laughter, I thought, would be a welcome break in my labored task and frustration.
I picked up the phone and said, “hello”. In a quiet voice, he explained that the night before he had checked into a hotel and attempted suicide. He was badly hurt, disoriented, and feeling unsteady. He did not want me to call an ambulance. He asked for my help. He gave me the nearby address. My whole body shook, then kind of shut down. I couldn’t believe I had been called to serve a friend in this way, just as I was writing about it.
I stayed on the phone, and walked to meet him.
Within the hour he was resting in a local hospital emergency department bed. A mutual friend of ours and I took turns sitting with him while hospital staff asked questions, drew blood, made plans, and fetched ice chips or cold water.
By the end of the evening, he and I had spent 6 hours together. We had – what felt to me – like a connected, sometimes light, sometimes deeply honest conversation. At 6:00 pm, just as I said “goodbye”, “I love you”, “I’ll be back tomorrow”, his mother arrived to kiss him on the forehead.
I’m still at a loss for words. I love my friend and I don’t want to lose him. When I think about what Wallace wanted to teach us about life, I think this is it. It was yesterday. It was choosing to answer the phone when I might have let it go to voicemail in order to get some important-seeming work done. It was showing up with the intention to be with, and to love another person. It was the unsexiness of not having someone else’s answers, or knowing what they need. It was listening, and doing simple tasks like jotting down phone numbers on the back of my hand. It was making phone calls to someone else’s boss, roommate, and best friend. It was forgiving myself for feeling angry in a moment, and letting love happen in shifts. It was a recognition that the only certainty in life – no matter what I think or want – is that it cannot be lived well alone.
If you or someone you know is experiencing suicidal feelings, you are not alone. Many people survive or live with these feelings. You can watch MIA blogger, educator, and counselor Will Hall, talk inspiringly about finding meaning in them here. If you’re in or near western Massachusetts, check out the Western Mass RLC’s weekly Alternatives to Suicide Group. (Or start one in your area!) You can also listen to Madness Radio interview with survivor and author David Webb on “Talking About Suicidal Feelings”.
If you are in antidepressant withdrawal, connect with people who are in the process at SurvivingAntidepressants.org or PaxilProgress.org. If you’re in the Boston area, check out the new Boston area support group for people coming off or reducing medications. (Or start a group in your area!)
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.