The Temptation of Certainty:
David Foster Wallace, Suicide and Psychiatric Drug Withdrawal

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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.

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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!)

 

 

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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.

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21 COMMENTS

  6. Thank you for sharing with all of us. The more I understand about suicide, a word that now, for me, is the worst word in the English language. The very fact that most people are persecuted if they open up about their darkest thoughts and feelings especially talking with MI counselors or staff (if inside a locked unit as my son was twice)for any honesty revealed is rewarded with consequences: more meds, more forced barbaric treatment, longer psych stay. Does this any sense? This is when a person should be celebrated for their honesty, not penalized!
    What a beautiful thing you did for your friend. You truly helped save his life. I just pray wherever your friend is he doesn’t meet the fate that my 25 y/o son met. After being hospitalized in a locked unit, my son was too afraid to share anything dark, again, especially when his psychologist and family believed the “system” was caring and compassionate. It was anything but.
    My son vowed he would never go back inside a psych hospital again. He would die first, and he did.

    Allowing a person to express their darkest, most haunting thoughts, and have another soul just there to listen, to hold their hand or massage their back to me seems the way to provide the best “therapy” of all.

    I hope across America, these kind of dialogues begin. From what I read from the bloggers at MIA, many, many people suffer at some time in their life these foreboding feelings yet somehow live thru it and rise above. This site and people like you and so many other bloggers truly make me feel this tainted industry can right itself.

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    • Larmac,

      I’ve been thinking about your comment for a day now. I’m deeply moved by what you’ve shared. I am so sorry to hear you lost your son to suicide. I cannot imagine what this is like. I wonder if you’ve read Maria Bradshaw’s piece on suicide and grief here on MiA, and if her words resonated with you? They had a tremendous impact on me.

      I agree. The threat of labels and forced intervention so often isolates and shames the person who, like your son, wants and needs to connect with and be heard by another human being.

      I do appreciate your words of encouragement. There are so many incredible people working in all capacites to change the system, offer alternatives, and/or build thriving communities. I’m inspired by what I see. Have more I could say, but got the 5 minute flash indictaor that my time is up at the library…Off for now — Thank you again. Vanessa

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    • Larmac, this is years later, but I am so moved by your comment that I have to say thank you for saying so bravely what needs to be said.

      Thank you for opening your heart to make room for listening. May more of us do so.

      When will “being human” dark and light – whole – be a “normal” state?

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  7. He sounds like a special person who was failed again and again by the psychiatric system. It is interesting in a sickening way how the system is able to spin his story to being about how he shouldn’t have tapered off his antidepressants, when clearly 1) his antidepressants were making him physically ill, 2) his antidepressants were not working to enhance his life anyway, and 3) he continued to receive psychiatric treatment right up to the day he killed himself.

    As I understand it, suicide is a pretty common outcome from multiple ECT “treatments.” It is entirely possible that he suffered not only from brain damage from long-term psych drug usage, but further brain damage from the ECT that contributed to his suicidality. Not to mention the hopelessness that comes along with the message that your brain is broken, and our ‘fixes’ aren’t fixing it.

    Thanks for sharing this very sad and yet beautiful story. I’m glad you can be there with your friend when he needs you. I am sure that you have done more for him than anyone in the hospital will be able to contribute. Your willingness to feel his pain is your strength – revel in it and rejoice that you have it. It is a much rarer skill than perhaps you are aware.

    —- Steve

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    • Hi Steve,

      It’s good to read your comment here. I also believe he was failed by the system. Any one who is told that they have a brain disorder ( as a teenager no less) has been failed by the system.

      I’m glad I was able to be there for my friend too. Often friends and family members don’t get such an opportunity. I feel lucky. I do want to clarify your point about the hospital staff not being able to help. The emergency nursing/MD staff absolutely saved his life. I’m very grateful to them.

      “your willingness to feel his pain is your strength…”.. These words…Yes! I think much of what gets diagnosed at some point as depression is a kind of sensitivity and compassion. An ability to feel other other people’s pain.

      –Vanessa

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  8. Hi
    I am a first time poster and I saw your piece on Facebook. I am in Ireland and I am an advocate of mental health reforms and suicide awareness in my area.
    You intervened at a time when your friend truly needed an intervention and he will always be grateful to you for that, so will his family and friends, and those of us around the world who read this.
    He picked up the phone when he was in a black place and this is difficult to do, I know.
    I raise awareness over here and am organising a vigil on September 10th for International Suicide Day, where we remember those who lost.
    I have also set up a writing intervention which is getting press all over the world, including the US. It is aimed at those who will not pick up that telephone or seek help. You might be interested in it, you can view it on http://www.penrelief.com and I have a Facebook page of the same name. We are all in this fight together and a s a person who survived it this is my way of helping.
    Kind regards
    Gerard

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    • Hi Gerard,

      Welcome to Mad in America! Thanks for taking the time to read comment. I do hope you check out other articles. It’d be great to read more of your contributions around here.

      I checked out PenRelief.com. What an incredible resource! – “1100 visitors a month, from 39 different countries”.

      Thank you for the work you do. I didn’t realize Sept 10th was international suicide day. I’ll be lighting a candle here in the US. – Vanessa

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  10. Dear Vanessa,
    I’m an Italian writer, 51. David Foster Wallace is one of my favourite writers. He is just the last one in a long list of suicides: Ernest Hemingway, Edouard LevĂ©, Primo Levi, Franco Lucentini, Vladimir Majakovskij, SĂ ndor MĂ rai, Yukio Mishima, Guido Morselli, Cesare Pavese, Virginia Woolf, David Foster Wallace. According to my terapist, I’m a suicide still alive myself. Writers often commit suicide and depression is not always the right explanation. Writing is a very peculiar activity: a writer must be alone to write and he must live the life of many different characters on paper. But in his life, he is closed in a room with a computer and nothing else. Paul Auster wrote beautiful lines on this situation. If every day you imagine a better world or – at least – a different world and if you think deeply at life and humanity, well, there’s a good chance that real life will have no interest for you. Alchool and drugs are of course just a way to accelerate the end. If life has a meaning, it’s just the prosecution of life itself. As any agnostic writer, I tend to look forUNKNOWN FRIENDS

    I’m way ahead of you
    on the same path
    we will never meet
    but maybe one day
    you will see my footsteps
    and next
    in the midst of the debris
    one of my books,
    a manuscript,
    a poem.

    I left them for you
    so that
    you could know
    me and my journey
    similar to yours but different
    I left them for us
    because I felt alone
    and I wished we could become,
    for a few steps,
    unknown friends.
    unknown friends (my readers) to share the burden of this lack of meaning. It’s not easy, as you can imagine. Real relationships tend to be a bit too challenging for the narcisitic personality of any artsist. Therapy can give ourselves consciousness, but not always relief. This just to tell you that I’m grateful for your article and I wish we could become unknown friends.

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  11. As an untrained agnostic who fumbles around for better ways to express the nuance that I notice in life, I found your (and Wallace’s) handling of the issue of certainty (and other subjects, really) to be refreshing and insightful. Thanks for the evolution, Vanessa.

    Oh. A brief essay (“An Open Mind”) that I wrote to introduce some of my essays may be found right there on my home page: http://newparadigminsight.wordpress.com

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  12. I continue to ache for the loss of David Foster Wallace as much as I continue to resonate so much with what he wrote, specifically about depression. It’s hard to find those one can open up to without feeling the hot bloom of shame afterwards that is usually strong enough to deter at least me from speaking the whole truth again. So many think we just want attention – as if that’s a bad thing! Paying attention to what’s right in front of us is precisely DFW’s brilliant advice, brilliant because it is so rare anymore. And so many think that it selectively applies – and certainly not to someone in irretrievable-feeling dark who is seriously wondering if they truly are as worthless as they felt.

    One of the most haunting lines in all of poetry in my opinion was written by Mary Karr about DFW in “Suicide’s Note: An Annual”: “I wonder does your death feel like failure to everybody who ever loved you as if our collective CPR stopped too soon…” It takes work to care for depressed, suicidal people. Work that very few seem to want to do, few know how to do and many, mostly probably out of sheer tiredness or ignorance and not malice or ill will, stop doing too soon. At least in my experience.

    DFW’s younger sister, Amy, spoke about him in 2012 and, when asked to describe him to someone who’d never met him, she said, among other things, “He was an alien.” She probably didn’t mean it this way, but it is bone-crushingly lonely to feel like you’re on the wrong planet. She also said that when he tied his long hair up in a topknot, he looked like a starving sumo wrestler. She didn’t it mean it this way, either, but I think this is an apt description of those battling depression as well. At least in my experience.

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  13. Vanessa,
    In your writing above, you use the phrase, “mental health care system”. That’s a dangerous and deceptive misnomer. It’s far more accurate to call it the “Mental Illness Industrial Complex”. The “MIIC” actually creates so-called “mental illness” by the DSM-5, wherein ALL the bogus “diagnoses” were INVENTED, not “discovered”.
    If so-called “mental illnesses” were in fact any more “real” than presents from Santa Claus, then they would have been “discovered”. Something exists *before* it is discovered, but nothing exists before it is *invented*. And looking at the DSM-5, it’s clear that ALL the bogus “diagnoses” in it were invented, not discovered. That’s because psychiatry is a pseudoscience, a drug racket, and a means of social control. It’s 21st Century Phrenology, with potent neuro-toxins. Psychiatry, and the Mental Illness Industrial Complex, have done, and continue to do, far more harm than good. The more psych drugs we have, and the more so-called “mental health care” we have, the more the suicide rate increases.
    As regards David Foster Wallace, there are ONLY 2 possibilities, ONLY ONE of which can be true. (OK, technically, they *could* *both* be true, but it is impossible that they are BOTH false….)
    1. D.F.W. died *in spite* of drugs, Electro-Cution Torture(“ECT”), & etc.,……
    2. D.F.W. died BECAUSE of drugs, electrocution torture, and the Mental Illness Industrial Complex….
    I think #2. What do YOU think, Vanessa?________________________________?

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  14. Thank you for this piece. My heart breaks when I think of our loss of David Foster Wallace. I fantasize if he had only known he had Nardil withdrawal syndrome, his brain wasn’t broken, and he might slowly recover over time, he might not have killed himself.

    After all those drugs and ECT, I can just imagine how terrible he felt. His nervous system must have been shooting off warning signals constantly.

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