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9 of 104 DOCUMENTS
The New York Times
May 10, 2009 Sunday
Late Edition - Final
A Journey Through Darkness
BYLINE: By DAPHNE MERKIN.
Daphne Merkin is a contributing writer for the magazine.
Her last article was about the Kabbalah Center.
SECTION: Section MM; Column 0; Magazine Desk;
Pg. 30
LENGTH: 7585 words
IT IS A SPARKLING DAY IN MID-JUNE, the sun out
in full force, the sky a limpid blue. I am lying on my back
on the grass, listening to the intermittent chirping of
nearby birds; my eyes are closed, the better to savor the
warmth on my face. As I soak up the rays I think about
summers past, the squawking of seagulls on the beach
and walking along the water with my daughter, picking
out enticing seashells, arguing over their various merits.
My mind floats away into a space where chronology
doesn't count: I am back on the beach of my adolescence,
lost in a book, or talking to my old college chum
Bethanie as we brave the bay water in front of her
parents' house in Connecticut, where she comes to visit
every summer.
In the 20 or so minutes of ''fresh air'' allotted after lunch
(one of four such breaks on the daily schedule), I try to
forget where I am, imaging myself elsewhere than in this
fenced-off concrete garden bordered by the West Side
Highway on one side and Riverside Drive on the other,
planted with patches of green and a few lonely flowers,
my movements watched over by a more or less friendly
psychiatric aide. Soggy as my brain is from being
wrenched off a slew of antidepressants and anti-anxiety
medications in the last 10 days, I reach for a Coleridgian
suspension of disbelief, ignoring the roar of traffic and
summoning up the sound of breaking waves.
I have only to open my eyes for the surreal scene to
come back into my immediate line of vision, like a picnic
area without picnickers: two barbecue grills, bags of
mulch that seem never to be opened, empty planters,
clusters of tables and chairs, the entire area cordoned off
behind a high mesh fence. Looking out onto the highway
overpass there is a green-and-white sign indicating ''Exit
-- West 178th Street''; nearer to the entrance another sign
explains: ''The Patients' Park & Garden is for the use of
patients and their families only, and for staff escorting
patients. It is NOT for staff use.''
I can see R., the most recent addition to our
dysfunctional gang of 12 on 4 Center, sitting on a bench
in his unseasonal cashmere polo, smoking a cigarette and
tapping his foot with equal intensity. On either side of
him are ragtag groups of people culled from several units
of the hospital, including the one I am on, which is
devoted primarily to the treatment of patients with
depression or eating disorders. (The anorexic girls, whom
R. refers to as ''the storks,'' are in various phases of
imperceptible recovery and tend to stick together.) The
garden is also home to patients from 4 South, which
caters to patients from within the surrounding
Washington Heights community, and 5 South, which
treats patients with psychotic and substance-abuse
disorders.
The people on 4 Center, hidden away as it is in a small
building, have next to no contact with the other units; we
might as well be on different planets. Then again, as
those who suffer from it know, intractable depression
creates a planet all its own, largely impermeable to
influence from others except as shadow presences, urging
you to come out and rejoin the world, take in a movie, go
out for a bite, cheer up. By the time I admitted myself to
the hospital last June after a downhill period of six
months, I felt isolated in my own pitch-darkness, even
when I was in a room full of conversation and light.
DEPRESSION -- THE THICK BLACK paste of it, the
muck of bleakness -- was nothing new to me. I had done
battle with it in some way or other since childhood. It is

A Journey Through Darkness The New York Times May 10, 2009 Sunday
an affliction that often starts young and goes unheeded --
younger than would seem possible, as if in exiting the
womb I was enveloped in a gray and itchy wool blanket
instead of a soft, pastel-colored bunting. Perhaps I am
overstating the case; I don't think I actually began as a
melancholy baby, if I am to go by photos of me, in which
I seem impish, with sparkly eyes and a full smile. All the
same, who knows but that I was already adopting the
mask of all-rightness that every depressed person learns
to wear in order to navigate the world?
I do know that by the age of 5 or 6, in my corduroy
overalls, racing around in Keds, I had begun to be
apprehensive about what lay in wait for me. I felt that
events had not conspired in my favor, for many reasons,
including the fact that in my family there were too many
children and too little attention to go around. What
attention there was came mostly from an abusive nanny
who scared me into total compliance and a mercurial
mother whose interest was often unkindly. By age 8 I was
wholly unwilling to attend school, out of some
combination of fear and separation anxiety. (It seems to
me now, many years later, that I was expressing early on
a chronic depressive's wish to stay home, on the inside,
instead of taking on the outside, loomingly hostile world
in the form of classmates and teachers.) By 10 I had been
hospitalized because I cried all the time, although I don't
know if the word ''depression'' was ever actually used.
As an adult, I wondered incessantly: What would it be
like to be someone with a brighter take on things?
Someone possessed of the necessary illusions without
which life is unbearable? Someone who could get up in
the morning without being held captive by morose
thoughts doing their wild and wily gymnastics of despair
as she measures out tablespoons of coffee from their
snappy little aluminum bag: You shouldn't. You should
have. Why are you? Why aren't you? There's no hope, it's
too late, it has always been too late. Give up, go back to
bed, there's no hope. There's so much to do. There's not
enough to do. There is no hope.
Surely this is the worst part of being at the mercy of
your own mind, especially when that mind lists toward
the despondent at the first sign of gray: the fact that there
is no way out of the reality of being you, a person who is
forever noticing the grime on the bricks, the flaws in the
friends -- the sadness that runs under the skin of things,
like blood, beginning as a trickle and ending up as a
hemorrhage, staining everything. It is a sadness that no
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one seems to want to talk about in public, at
cocktail-party sorts of places, not even in this Age of
Indiscretion. Nor is the private realm particularly
conducive to airing this kind of implacably despondent
feeling, no matter how willing your friends are to listen.
Depression, truth be told, is both boring and threatening
as a subject of conversation. In the end there is no one to
intervene on your behalf when you disappear again into
what feels like a psychological dungeon -- a place that
has a familiar musky smell, a familiar lack of light and
excess of enclosure -- except the people you've paid large
sums of money to talk to over the years. I have sat in
shrinks' offices going on four decades now and talked
about my wish to die the way other people might talk
about their wish to find a lover.
Then there is this: In some way, the quiet terror of
severe depression never entirely passes once you've
experienced it. It hovers behind the scenes, placated
temporarily by medication and renewed energy, waiting
to slither back in, unnoticed by others. It sits in the space
behind your eyes, making its presence felt even in those
moments when other, lighter matters are at the forefront
of your mind. It tugs at you, keeping you from ever being
fully at ease. Worst of all, it honors no season and
respects no calendar; it arrives precisely when it feels like
it.
MY MOST RECENT BOUT, the one that landed me on
4 Center, an under-the-radar research unit at the New
York State Psychiatric Institute, asserted itself on New
Year's Eve, the last day of 2007. The precipitating factors
included everything and nothing, as is just about always
the case -- some combination of vulnerable genetics and
several less-than-optimal pieces of fate.
Despite my grim mood, I had somehow or other
managed to put on makeup, pull on clothes, affix pearl
earrings and go to a civilized old-New York type of
dinner, where we talked of ongoing things -- children,
schools, plays to see, reasons to live as opposed to
reasons to die. But even as I talked and laughed with the
other guests, my thoughts were dark, scrambling ones,
ruthless in their sniping insistence. You're a failure. A
burden. Useless. Worse than useless: worthless. Shortly
past midnight, I watched the fireworks over Central Park
and stared into the exploding bursts of color -- red, white
and blue, squiggles of green, streaks of purple, balls of
silver, sparks of champagne. My 17-year-old daughter,
Zoe, was standing nearby, and as I looked into the

A Journey Through Darkness The New York Times May 10, 2009 Sunday
fireworks I sent entreaties into the sky. Make me better.
Make me remember this moment of absorption in
fireworks, the energy of the thing. Make me go forward.
Stop listening for drum rolls. Pay attention to the
ordinary calls to engage, messages on your answering
machine telling you to buck up, it's not so bad, from the
ex, siblings, people who care.
For the next six months I countered the depression with
everything I had, escaping into the narcotic of reading,
taking on a few writing assignments (all of which I
delivered weeks, if not months, late), meeting friends for
dinner, teaching a writing class and even taking a trip to
St. Tropez with a close friend. I gobbled down my usual
medley of pills -- Lamictal, Risperdal, Wellbutrin and
Lexapro -- and wore an Emsam patch. (I have not been
free of psychotropic medication for any substantial period
since my early 20s.) But this was not a passing episode
that a schedule full of distractions and medication could
assuage. Although many depressions resolve themselves
within a year, with or without treatment, sometimes they
take hold and won't let go, becoming incrementally worse
with each passing day, until suicide seems like the only
exit. This was one of those depressions.
In the weeks leading up to my checking into 4 Center, I
had gone from being able to put on a faltering imitation
of mental health to giving up all pretense of a manageable
disguise. Since I found it painful to be conscious, I had
stopped doing much of anything except sleeping.
Mornings were the worst: I got up later and later, first 11,
then noon, and now it was more like 2 in the afternoon,
the day three-quarters gone. ''I wake and feel the fell of
dark, not day,'' observed the poet Gerard Manley
Hopkins, a depressive 19th-century Jesuit priest. I don't
think I've ever met a depressed person who wanted to get
out of bed in the morning -- who didn't experience the
appearance of day as a call to burrow further under the
covers, the better to embrace the vanished night.
When I was awake (the few hours that I was), I felt a
kind of lethal fatigue, as if I were swimming through tar.
Phone messages went unanswered, e-mail unread. In my
inert but agitated state I could no longer concentrate long
enough to read -- not so much as a newspaper headline --
and the idea of writing was as foreign to me as downhill
racing. (James Baldwin: ''No one works better out of
anguish at all; that's an incredible literary conceit.'') I
barely ate -- there is no more effective diet than clinical
depression -- and had dropped 30 pounds. I had
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essentially withdrawn from communication. When I did
speak, it was mostly about my wish to commit suicide, a
wish that was never all that far from my mind but at times
like these became insistent.
Although some tiny part of me retained a dim sense of
the more functioning person I once was -- like a room
with a closed door that was never entered anymore -- it
became increasingly difficult to envision myself ever
inhabiting that version of myself again. There had been
too many recurrent episodes, too many years of trying to
fight off this debilitating demon of a thing. It has been
called by different names at different times in history --
melancholia, malaise, cafard, brown study, the blues, the
black dog, acedia -- and has been treated as a spiritual
malady, a failure of will, a biochemical malfunctioning, a
psychic conundrum, sometimes all at once. Whatever it
was, it had come to define me, filling out all the available
space, leaving no possibility of a ''before'' or an ''after.''
Instead I harbored the hallucinatory conviction that I had
stayed around the scene of my own life too long -- that I
was, in some unyielding sense, ex post facto.
I had also quite literally ground to a halt, like a machine
that had hit a glitch and frozen on the spot. I moved at a
glacial pace and talked haltingly, in a voice that was
lower and flatter than my usual one. As I discovered from
my therapist and psychopharmacologist -- both of whom
argued that I belonged in a hospital now that my
depression had taken on ''a life of its own,'' beyond the
exertions of my will -- there was a clinical name for my
state: ''psychomotor retardation.'' My biology, that is, had
caught up and joined hands with the immediate
psychodynamic stressors that precipitated my nosedive --
the lingering aftermath of the death two years earlier of
my mother, with whom I had a complicated relationship;
the imminent separation from my college-age daughter,
who was my boon companion; therapy that took a wrong
turn; a romance that went awry. (Much as we would like
to explain clinical depression by making it either genetics
or environment, bad wiring or bad nurturing, it is usually
a combination of the two that sets the illness off.)
And yet I resisted my doctors' suggestion that I check
myself into a hospital. It seemed safer to stay where I
was, no matter how out on a ledge I felt, than to lock
myself away with other desperadoes in the hope that it
would prove effective. Whatever fantasies I once
harbored about the haven-like possibilities of a
psychiatric facility or the promise of a definitive,

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once-and-for-all cure were shattered by my last stay 15
years earlier. I had written about the experience, musing
on the gap between the alternately idealized and
diabolical image of mental hospitals versus the more
banal bureaucratic reality. I discussed the continued
stigma attached to going public with the experience of
depression, but all this had been expressed by the writer
in me rather than the patient, and it seemed to me that
part of the appeal of the article was the impression it gave
that my hospital days were behind me. It would be a
betrayal of my literary persona, if nothing else, to go back
into a psychiatric unit.
What's more, after a lifetime of talk therapy and
medication that never seemed to do more than patch over
the holes in my self, I wasn't sure that I still believed in
the concept of professional intervention. Indeed, I
probably knew more about antidepressants than most
analysts, having tried all three categories of psychotropics
separately or in combination as they became available --
the classic tricyclics, the now-unfashionable MAO
inhibitors (which come with a major drawback in the
form of dietary restrictions) as well as the newer
S.S.R.I.'s. and S.N.R.I.'s. I was originally reluctant to try
pills for something that seemed so intrinsic to who I was
-- the state of mind in which I lived, so to speak -- until
one of my first psychiatrists compared my emotional state
to an ulcer. ''You can't speak to an ulcer,'' he said. ''You
can't reason with it. First you cure the ulcer, then you go
on to talk about the way you feel.'' My current regime of
pills incorporated the latest approach, which called for
the augmentation of a classic antidepressant (Effexor)
with a small dose of a second-generation antipsychotic
(Risperdal). From the time I was prescribed Prozac in my
early 20s before it was approved by the Food and Drug
Administration, you could say that the history of
depression medication and my personal history came of
age together, with me in the starring role of a lab rat.
Of course, none of the drugs work conclusively, and for
now we are stuck with what comes down to a refined
form of guesswork -- 30-odd pills that operate in not
completely understood ways on neural pathways, on
serotonin, norepinephrine, dopamine and what have you.
No one, not even the psychopharmacologists who
dispense them after considering the odds, totally
comprehends why they work when they work or why
they don't when they don't. All the while the
repercussions and the possible side effects (which include
mild trembling on the one end to tardive dyskinesia, a
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rare condition that causes uncontrollable grimacing, on
the other end) are shunted to the side until such time as
they can no longer be ignored.
THE ONE THING PSYCHIATRIC hospitals are
supposed to be good for is to keep you safe. But I was
conflicted even about so primary an issue as survival. I
wasn't sure I wanted to ambush my own downward
spiral, where the light at the end of the tunnel, as the
mood-disordered Robert Lowell once said, was just the
light of the oncoming train. I saw myself go splat on the
pavement with a kind of equanimity, with a sense of a
foretold conclusion. Self-inflicted death had always held
out a stark allure for me: I was fascinated by people who
had the temerity to bring down the curtain on their own
suffering -- who didn't hang around, moping, in hopes of
a brighter day. I knew all the arguments about the
cowardice and selfishness (not to mention anger)
involved in committing suicide, but nothing could
persuade me that the act didn't require a perverse sort of
courage, some steely embrace of self-extinction. At one
and the same time, I have also always believed that
suicide victims don't realize they won't be coming this
way again. If you are depressed enough, it seems to me,
you begin to conceive of death as a cradle, rocking you
gently back to a fresh life, glistening with newness,
unsullied by you.
Still, one flesh-and-blood reality stood in my way: I had
a daughter I loved deeply, and I understood the
irreparable harm it would cause her if I took my own life,
despite feeling that if I truly cared about her I would free
her from the presence of a mother who was more shade
than sun. (What had Sylvia Plath and Anne Sexton done
with their guilt feelings? I wondered. Were they more
narcissistic than I or just more strong-willed?) It was
because of my daughter, after all, that I had given voice
to my ''suicidal ideation,'' as it's called, in the first place,
worrying how she would get along without me. At the
same time, I recognized that, for a person who was really
set on ending it all, speaking your intention aloud was an
act of self-betrayal. After all, in the process of
articulating your death wish you were alerting other
people, ensuring that they would try to stop you.
The real question was why no one ever seemed to figure
this grim scenario out on her own, just by looking at you.
This was enraging in and of itself -- the fact that severe
depression, much as it might be treated as an illness,
didn't send out clear signals for others to pick up on; it

A Journey Through Darkness The New York Times May 10, 2009 Sunday
did its deadly dismantling work under cover of normalcy.
The psychological pain was agonizing, but there was no
way of proving it, no bleeding wounds to point to. How
much simpler it would be all around if you could put your
mind in a cast, like a broken ankle, and elicit murmurings
of sympathy from other people instead of skepticism
(''You can't really be feeling as bad as all that'') and in
some cases outright hostility (''Maybe if you stopped
thinking about yourself so much . . . '').
One more factor worked to keep me where I was, exiled
in my own apartment, a prisoner of my affliction: the
specter of ECT (electro-convulsive therapy). My
therapist, a modern Freudian analyst whom I had been
seeing for years and who had always struck me as only
vaguely persuaded of the efficacy of medication for what
ailed me -- when I once experienced some bad side
effects, he proposed that I consider going off all my pills
just to see how I would fare, and after doing so I
plummeted -- had suddenly, in the last 10 days before I
went into the hospital, become a cheerleader for
undergoing ECT. I don't know why he grabbed on to this
idea, why the sudden flip from chatting to zapping, other
than for the fact that I had once wildly thrown it out -- for
the drowning, any life raft will do. Then, too, ECT, which
causes the brain to go into seizure, was back in fashion
for treatment-resistant depression after going off the radar
in the '60s and '70s in the wake of ''One Flew Over the
Cuckoo's Nest.'' Perhaps I had frightened him with my
insistent talk of wanting to cut out for good; perhaps he
didn't want to be held responsible for the death of a
patient who compulsively wrote about herself and would
undoubtedly leave evidence that would tie him to her. But
his shift from a psychoanalytic stance that focused on the
subjective mind to a neurobiological stance that focused
on the hypothesized workings of the physical brain left
me scared and distrustful.
What if ECT would just leave me a stranger to myself,
with chopped-up memories of my life before and
immediately after? I may have hated my life, but I valued
my memories -- even the unhappy ones, paradoxical as
that may seem. I lived for the details, and the writer I
once was made vivid use of them. The cartoonish image
of my head being fried, tiny shocks and whiffs of smoke
coming off it as the electric current went through,
haunted me even though I knew that ECT no longer was
administered with convulsive force, jolting patients in
their straps.
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But in the end, no matter how much I wanted to stay
put, I ran out of resistance. I spent the weekend before
going into the hospital in my oldest sister's apartment,
lost in the Gothic kingdom of depression: I was unable to
move from the bed, trapped in interior debates about
jumping off a roof versus throwing myself in front of a
car. Yet somewhere in the background were other voices
-- my sister's, my doctors' -- arguing on behalf of my
sticking around; I could half-hear them. I wanted to die,
but at the same time I didn't want to, not completely.
Suicide could wait, my sister said. Why didn't I give the
hospital a chance? She relayed messages from each of my
doctors that they would look out for me on the unit. No
one would force me to do anything, including ECT. I felt
too tired to argue.
THAT MONDAY MORNING, I returned home and
packed up two small bags. I threw in a disproportionate
number of books (especially given the fact that I couldn't
read), a couple of pairs of linen pants and cotton T-shirts,
my favorite night cream (although I hadn't touched it in
weeks) and a photo of my daughter, the last with the
thought of anchoring myself. In return for agreeing to
undergo one of several available protocols -- either
switching my medication or availing myself of ECT -- I
would get to stay at 4 Center as long as I needed at no
cost. My sister picked me up in a cab, and as I recall, I
cried the whole ride up there, watching the passing view
with an elegaic sense of leave-taking.
As soon as my sister gave my name to the nurse whose
head appeared in the window of the locked door to the
unit and we were both let in, I knew immediately that this
wasn't where I wanted to be. Everything seemed empty
and silent under the fluorescent lighting except for one
40-ish man pacing up and down the hallway in a T-shirt
and sweat pants, seemingly oblivious to what was going
on around him. Underneath the kind of baldfaced clock
you see in train stations were two run-down pay phones;
there was something sad about the glaring outdatedness
of them, especially since I associated them almost
exclusively with hospitals and certain barren corners of
Third Avenue. And then, in what seemed like an instant,
my sister was saying goodbye, promising that all would
turn out for the better, and I was left to fend for myself.
My bags were taken behind the glassed-in nurse's
station and checked for potential weapons of
self-destruction referred to as ''sharps'' -- razors, scissors,
mirrors -- which were taken away until your departure.

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Cellphones were also forbidden for reasons that seemed
unclear even to the staff but had something to do with
their photo-taking ability. In my intake interview, I
alternated between breaking down in tears and repeating
that I wanted to go home, like a woeful 7-year-old left
behind at sleep-away camp. The admitting nurse, who
was pleasant enough in a down-to-earth way, was hardly
swept away by gusts of empathy with my bereft state.
And yet I wanted to stay in the room and keep talking to
her forever, if only to avoid going back out on to the unit,
with its pathetically slim collection of out-of-date
magazines, ugly groupings of wooden furniture
cushioned with teal and plum vinyl and airless TV rooms
-- one overrun, the other desolate. Anything to avoid
being me, feeling numb and desperate, thrust into a place
that felt like the worst combination of exposure and
anonymity.
I emerged in time for dinner, which was served at the
premature hour of 5:30, as if the night ahead were so
chockablock with activities that we had to get this
necessary ritual out of the way. Since in reality dinner led
to nothing more strenuous than another bout of ''fresh air''
and lots of free time until the lights went out at 11, I
would have thought that it would be a good occasion to
dally. But as it turned out, the other patients were finished
eating within 10 or 15 minutes, and I found myself alone
at the table, not yet having realized that the point was to
get in and out as quickly as possible.
It didn't help that the room we ate in was beyond dismal,
featuring an out-of-tune piano and a Ping-Pong table that
was never used. Or that, despite its being summer, there
was barely any fresh fruit in sight except for autumnal
apples and the occasional banana. There would be
culinary bright moments -- cream puffs were served on
Father's Day, and one Tuesday the staff set up a barbecue
lunch in the patients' park, where I munched on hot dogs
and joined in a charadeslike game called Guesstures --
but the general standard was determinedly low. After a
while, I began requesting bottles of Ensure Plus, the
liquid nutrition supplement that came in chocolate and
vanilla and was a staple of the anorexics' meal plans; if
you closed your eyes it could pass for a milkshake.
It wasn't only the anorexics' Ensure that I coveted. From
the very first night, when sounds of conversation and
laughter floated over from their group to the gloomy,
near-silent table of depressives I had joined, I yearned to
be one of them. Unlike our group, they were required to
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remain at lunch and dinner for a full half-hour, which of
necessity created a more congenial atmosphere. No
matter that one or two had been brought on to the floor on
stretchers, as I was later informed, or that they were
victims of a cruel, hard-to-treat disease with sometimes
fatal implications; they still struck me as enviable.
However heartbreakingly scrawny, they were all young
(in their mid-20s or early 30s) and expectant; they talked
about boyfriends and concerned parents, worked
tirelessly on their ''journaling'' or on art projects when
they weren't participating in activities designed
exclusively for them, including ''self-esteem'' and ''body
image.'' They were clearly and poignantly victims of a
culture that said you were too fat if you weren't too thin
and had taken this message to heart. No one could blame
them for their condition or view it as a moral failure,
which was what I suspected even the nurses of doing
about us depressed patients. In the eyes of the world, they
were suffering from a disease, and we were suffering
from being intractably and disconsolately -- and some
might say self-indulgently -- ourselves.
I SHARED A SMALL ROOM right across from the
nurse's station with a pretty, middle-aged woman who
introduced herself before dinner -- the only one to do so
-- with a remarkable amount of good cheer, as if we were
meeting at a cocktail party. For a minute I felt that things
couldn't be so terrible, that the unit couldn't be as abject a
destination as I conceived it to be if this woman had
deigned to throw her lot in with the rest of us. She wore
''Frownies'' -- little patented patches that were supposed
to minimize wrinkles -- to bed, which only furthered the
impression she conveyed of an ordinary adjustment to
what I saw as extraordinary circumstances. Clearly, she
had a future in mind, even if I didn't -- one that required
her to retain a fetching youthfulness. I hadn't so much as
washed my face for the past few months, but here was
someone who understood the importance of keeping up
appearances, even on a psychiatric unit.
The room itself, on the other hand, couldn't have been
less welcoming. Like the rest of the unit, it was lighted by
overhead fluorescent bulbs that didn't so much illuminate
as bring things glaringly into view. There were two beds,
two night tables and two chests of drawers. In keeping
with the Noah's-ark design ethos, the room was also
furnished with a pair of enormous plastic trash cans; one
stood near the door, casting a bleak plastic pall over
things, and the other took up too much space in the tiny
shared bathroom. The shower water came out of a flat

A Journey Through Darkness The New York Times May 10, 2009 Sunday
fixture on the wall -- the presence of a conventional
shower head, I soon learned, was seen as a potential
inducement to hanging yourself -- and the weak flow was
tepid at best.
I got into bed that first night, under the ratty white
blanket, and tried to calm myself. The lack of a reading
lamp added to my panic; even if my depression prevented
me from losing myself in a book, the absence of a light
source by which to read after dark represented the end of
civilization as I had known it. (It turned out that you
could bring in a battery-powered reading lamp of your
own, albeit with the Kafkaesque restriction that it didn't
make use of glass light bulbs.) My mind went round and
round the same barrage of questions, like a persistent
police inspector. How did I get here? How did I allow
myself to get here? Why didn't I have the resolve to stay
out? Why hadn't anything changed with the passage of
years? It was one thing to be depressed in your 20s or
30s, when the aspect of youth gave it an undeniable
poignancy, a certain tattered charm; it was another thing
entirely to be depressed in middle age, when you were
supposed to have come to terms with life's failings, as
well as your own. Now that my mother was gone -- I
always thought she'd outlive me, but her lung cancer took
precedence over my suicidal impulses -- there was no one
to blame for my depressions, no one to whom I could turn
for some magical, longed-for compensation. But the truly
intolerable part was that I had acquiesced in this
godforsaken plan; there was ultimately no one to blame
for my banishment to this remote-seeming outpost but
myself.
I plumped the barracks-thin pillow, pulled up the sheet
and blanket around me -- the entire hospital was
air-conditioned to a fine chill -- and curled up, inviting
sleep. There was nothing to feel so desperate about, I
tried soothing myself. You're not a prisoner. You can ask
to leave tomorrow. I listened to my roommate's calm,
even breathing and wished I were her, wished I were
anyone but myself. Mostly, I wished I were a person who
wasn't consumingly depressed. All over the city, less
depressed or entirely undepressed people were leading
their ordinary lives, watching TV or blogging or having a
late dinner. Why wasn't I among them? After staring into
the darkness for what seemed like hours, I finally got up
and put on my robe, having decided that I'd overcome my
sense of being a specimen on display -- here comes
Mental Patient No. 12 -- and approach the nurses' station
about getting more sleeping meds.
Page 7
Outside the room the light was blinding. Two of the
aides were at the desk, playing some sort of word game
on the computer screen. They looked up at me
impassively and waited for me to state my case. I
explained that I couldn't sleep, my voice sounding furry
with anxiety. My hands were clammy and my mouth was
dry. One of them got up and went into the back to check
whether the resident in psychiatry who was assigned to
me had approved the request. She handed me a pill in a
little cup, and I mumbled something about how nervous I
was feeling. ''You'll feel better after you get some sleep,''
she said. I nodded and said, ''Good night,'' feeling
dismissed. ''Night,'' she said, casual as could be. I was no
one to her, no one to myself.
I SUPPOSE IT WOULD MAKE for some kind of
symmetry -- a glimpse of an upward trajectory, at least --
if I said that the first night was the hardest, but the truth is
that it never got any easier. My frantic sense of
dislocation and abandonment persisted for the entire three
weeks I spent on 4 Center, yielding only at rare moments
to a slightly less anxious state of hibernation. I would
eventually discover several friendlier nurses or nurses'
aides with whom it was possible to talk about the bizarre
reality of being on a psychiatric unit with a locked door
and fiercely regulated visiting hours (5:30 to 8 on
weekday evenings and 2 to 8 on weekends) without
feeling like an official mental patient. By the end of the
second week, when I was no longer chained to the unit,
one of the male nurses would invite me for coffee breaks
to the little eatery on the sixth floor where the hospital
staff repaired for their meals.
These outings were always kept short -- we never
lingered for more than 15 minutes -- and they always
brought home to me how artificial the dividing line
between 4 Center and the outside world really was. It
could cause vertigo if you weren't careful. One minute
you were in the shuttered-down universe of the verifiably
unwell, of people who talked about their precarious inner
states as if that were all that mattered, and the next you
were admitted back into ordinary reality, where people
were free to roam as they pleased and seemed filled with
a sense of larger purpose. As I cradled my coffee, I
looked on at the medical students who flitted in and out,
holding their clipboards and notebooks, with a feeling
verging on awe. How had they figured out a way to live
without getting bogged down in the shadows? From what
source did they draw all their energy? I couldn't imagine
ever joining this world again, given how my time had

A Journey Through Darkness The New York Times May 10, 2009 Sunday
become so aimlessly filled, waiting for calls to come in
on the pay phone or sitting in ''community meetings,'' in
which people made forlorn and implausible requests for
light-dimmers and hole-punchers and exiting patients
tearfully thanked everyone on the unit for their help.
It wasn't as if there weren't attempts made to organize
the days as they went sluggishly by. A weekly schedule
was posted that gave the impression that we patients were
quite the busy bees, what with therapy sessions, yoga,
walks and creative-writing groups. Friday mornings
featured my favorite group, ''Coffee Klatch.'' This was
run by the same amiable gym-coach-like woman who
oversaw exercise, and it was devoted to board games of
the Trivial Pursuit variety. The real draw was the promise
of baked goods and freshly brewed coffee.
But in truth there was more uncharted time than not,
especially for the depressives -- great swaths of white
space that wrapped themselves around the day, creating
an undertow of lassitude. Forging friendships on the unit,
which would have passed the time, was touch-and-go
because patients came and went and the only real link
was one of duress. The other restriction came with the
territory: people were either comfortably settled into
being on the unit, which was off-putting in one kind of
way, or raring to get out, which was off-putting in
another. I had become attached to my roommate, who
was funny and somehow seemed above the fray, and I
felt inordinately sad when she left, in possession of a new
diagnosis and new medication, halfway into my stay.
Still, the consuming issue as far as I was concerned --
the question that colored my entire stay -- was whether I
would undergo ECT. It was on my mind from the very
beginning, if only because the first patient I encountered
when I entered the unit, pacing up and down the halls,
was in the midst of getting a series of ECT treatments and
insisted loudly to anyone who would listen that they were
destroying his brain. And indeed, the patients I saw
returning from ECT acted dazed, as if an essential piece
of themselves had been misplaced.
During the first week or so the subject lay mostly in
abeyance as I was weaned off the medications I came in
on and tried to acclimatize to life on 4 Center. I met daily
with Dr. R., the young resident I saw the first evening,
mostly to discuss why I shouldn't leave right away and
what other avenues might be explored medicationwise.
She sported a diamond engagement ring and a diamond
wedding band that my eye always went to first thing; I
Page 8
took them as painful reminders that not everyone was as
full of holes as I was, that she had made sparkling choices
and might indeed turn out to be one of those put-together
young women who had it all -- the career, the husband,
the children. During our half-hour sessions I tried to
borrow from Dr. R.'s outlook, to see myself through her
charitable eyes. I reminded myself that people found me
interesting even if I had ceased to interest myself, and
that the way I felt wasn't all my fault. But the reprieve
was always short-lived, and within an hour of her
departure I was back to staving off despair, doing battle
with the usual furies.
One day early into my second week, I was called out of
a therapy session to meet with a psychiatrist from the
ECT unit. I still wonder whether this brief encounter was
the defining one, scaring me off forever. She might as
well have been a prison warden for all her interpersonal
skills; we had barely said two words before she
announced I was showing clear signs of being in a
''neurovegetative'' condition. She pointed out that I spoke
slurringly and that my mind seemed to be crawling along
as well, adding grimly that I would never be able to write
again if I remained in this state. Her scrutiny seemed
merciless: I felt attacked, as if there were nothing left of
me but my illness. Obviously ECT was in order, she
briskly concluded. I nodded, afraid to say much lest I
sound imbecilic, but in my head the alarms were going
off. No, it wasn't, I thought. Not yet. I'm not quite the
pushover you take me to be. It was the first stirring of
positive will on my own behalf, a delicate green bud that
could easily be crushed, but I felt its force.
The strongest and most benign advocate for ECT was a
psychiatrist at the institute who saw me three decades
earlier and was instrumental in convincing me to come
into 4 Center. In his formal but well-meaning way he
pointed out that I lived with a level of depression that was
unnecessary to live with and that my best shot for real
relief was ECT. He came in to make his case once again
as I was sitting at dinner on a Friday evening, pretending
to nibble at a rubbery piece of chicken. The other patients
had gone and my sister was visiting. I turned to her as he
waxed almost passionate on my account, going on about
the horror of my kind of treatment-resistant depression
and the glorious benefits of ECT that would surely
outweigh any downside. I didn't trust him, much as I
wished to. Help me, I implored my sister without saying
a word. I don't want this. Tears trickled down my cheeks
as if I were a mute, wordless but still able to feel anguish.

A Journey Through Darkness The New York Times May 10, 2009 Sunday
My sister spoke for me as if she were an interpreter of
silence. It looked like I didn't want it, she said to the
doctor, and my wishes had to be respected.
I COULD SEE MYSELF LINGERING on in the
hospital, not because I had grown any more fond of the
atmosphere but because after a certain amount of time it
became easier to stay than to leave. The picayune details
of my life -- bills, appointments, deadlines -- had been
suspended during my last few months at home, then left
outside the hospital confines altogether, and it began to
seem inconceivable that I'd ever have the wherewithal to
take them on again. Instead of growing stronger on the
unit, I felt a kind of further weakening of my
psychological muscle. The new medication I was on left
me exhausted, and I took to going back to sleep after
breakfast. I was tired even of being visited, of sitting in
the hideous little lounge and making conversation, of
expressing gratitude for the chocolates, smoked salmon
and change for the pay phones that people brought. I felt
as if I were being wished bon voyage over and over
again, perennially about to leave on a trip that never
happened.
I went out on several day passes in the week leading to
my departure, as a kind of preparation for re-entry, but
none of them were particularly successful. On one, I went
out on a broiling Saturday afternoon with my daughter
for a walk to the nearby Starbucks on 168th and
Broadway. I felt thick-headed with the new sedating
medication I was on and far away from her. When she
left me for a minute to make a phone call on her cell, I
started crying, as if something tragic had happened. I
wondered uneasily what effect seeing me in this state was
having on my daughter, what she made of my being in
the hospital -- did she view me as a burden that she would
need to shoulder for the rest of her life? Would my
depression rub off on her? -- but in between we laughed
at small, odd things as we always did, and it occurred to
me that I wasn't as much a stranger to her as I was to
myself.
With the staff's tentative agreement -- they didn't think I
was ready to go home but had no real reason to prevent
me from doing so -- I left 4 Center three weeks to the day
I arrived, my belongings piled up on a trolley for greater
mobility through the annex to the exit. It was a hot June
day similar to the one I checked in on, the heat pouring
off the windows of parked cars. Everything felt noisy and
magnified. It felt shocking to be outside, knowing I was
Page 9
on a permanent pass this time, that I wouldn't be
returning to the unit.
I was sent home on Klonopin, an anti-anxiety drug I'd
been on forever, as well as a duet of pills -- Remeron and
Effexor -- that were referred to as California rocket fuel
for its presumed igniting effect. As it turned out, the
combo wasn't destined to work on me. At home, I was
gripped again by thoughts of suicide and clung to my
bed, afraid to go out even on a walk around the block
with my daughter. When I wasn't asleep, I stared into
space, lost in the terrors of the far-off past, which had
become the terrors of the present. It was decided that I
shouldn't be left alone, so my sister and my good friend
took turns staying with me. But it was clear this
arrangement was short term, and by the end of the
weekend, after phone calls to various doctors, it was
agreed that I would go back into the hospital to try ECT.
And then, the Sunday afternoon before I planned to
return to 4 Center, something shifted ever so slightly in
my mind. I had gone off the Remeron and started a new
drug, Abilify. I was feeling a bit calmer, and my bedroom
didn't seem like such an alien place anymore. Maybe it
was the fear of ECT, or perhaps the tweaked medication
had kicked in, or maybe the depression had finally taken
its course and was beginning to lift. I had -- and still have
-- no real idea what did it. For a brief interval, no one was
home, and I decided to get up and go outside. I stopped at
Food Emporium and studied the cereal section, as
amazed at the array as if I had just emerged from the
gulag. I bought some paper towels and strawberries, and
then I walked home and got back into bed. It wasn't a trip
to the Yucatan, but it was a start. I didn't check into the
hospital the next day and instead passed the rest of the
summer slowly reinhabiting my life, coaxing myself
along. I spent time with people I trusted, with whom I
didn't have to pretend.
Toward the end of August I went out for a few days to
the rented Southampton house of my friend Elizabeth. It
was just her, me and her three annoying dogs. I had
brought a novel along, ''The Gathering,'' by Anne Enright,
the sort of book about incomplete people and unhappy
families that has always spoken to me. It was the first
book to absorb me -- the first I could read at all -- since
before I went into the hospital. I came to the last page on
the third afternoon of my visit. It was about 4:30, the time
of day that, by mid-August, brings with it a whiff of
summer's end. I looked up into the startlingly blue sky;
 Page 10
A Journey Through Darkness The New York Times May 10, 2009 Sunday

one of the dogs was sitting at my side, her warm body It was a chance that seemed worth taking.
against my leg, drying me off after the swim I had
recently taken. I could begin to see the curve of fall up URL: http://www.nytimes.com
ahead. There would be new books to read, new films to
see and new restaurants to try. I envisioned myself LOAD-DATE: May 10, 2009
writing again, and it didn't seem like a totally
preposterous idea. I had things I wanted to say. LANGUAGE: ENGLISH

Everything felt fragile and freshly come upon, but for GRAPHIC: PHOTOS (pg. MM31)
now, at least, my depression had stepped back, giving me (pg. MM33)
room to move forward. I had forgotten what it was like to (pg. MM36)(PHOTOGRAPH BY DAPHINE MERKIN)
be without it, and for a moment I floundered, wondering DRAWING (DRAWING BY JAMES VICTORE)
how I would recognize myself. I knew for certain it
would return, sneaking up on me when I wasn't looking, PUBLICATION-TYPE: Newspaper
but meanwhile there were bound to be glimpses of light if
only I stayed around and held fast to the long perspective.

Copyright 2009 The New York Times Company