Anatomy of melancholy By Andrew Solomon January 12, 1998 Depression afflicts millions of American each year, and many don't know where to turn when it strikes. The author recalls the greatest struggle of his life. I did not experience depression until I had pretty much solved my problems. I had come to terms with my mother's death three years earlier, was publishing my first novel, was getting along with my family, had emerged intact from a powerful two-year relationship, had bought a beautiful new house, was writing well. It was when life was finally in order that depression came slinking in and spoiled everything. I'd felt acutely that there was no excuse for it under the circumstances, despite perennial existential crises, the forgotten sorrows of a distant childhood, slight wrongs done to people now dead, the truth that I am not Tolstoy, the absence in this world of perfect love, and those impulses of greed and uncharitableness which lie too close to the heart — that sort of thing. But now, as I ran through this inventory, I believed that my depression was not only a rational state but also an incurable one. I kept redating he beginning of the depression: since my breakup with my girlfriend the past October, since my mother's death; since the beginning of her two-year illness; since puberty; since birth. Soon I couldn't remember what pleasurable moods had been like. I was not surprised later when I came across research showing that the particular kind of depression I had undergone has a higher morbidity rate than heart disease or any cancer. According to a recent study by researchers at Harvard and the World Health Organization, only respiratory infections, diarrhea, and newborn infections cost more years of useful life than major depression. It is projected that by the year 2020 depression could claim more years than war and AIDS put together. And its incidence is rising fast. Between six and ten per cent of all Americans now living are battling some form of this illness; one study indicates that nearly fifty per cent have experienced at least one psychiatric disorder in their lifetime. Treatments are proliferating, but only twenty-eight per cent of all people who have a major depression seek help from a specialist; fifteen per cent of hospitalized patients succeed in killing themselves. Attempting to understand this strange malady, I plunged into intensive research shortly after my recovery. I started by attempting a coherent narrative of my own experience. In June, 1994, I began to be constantly bored. My first novel had recently been published in England, and yet its favorable reception did little for me. I read the reviews indifferently and felt tired all the time. In July, back home in downtown New York, I found myself burdened by phone calls, social events, conversation. The subway proved intolerable. In August, I started to feel numb. I didn't care about work, family, or friends. My writing slowed, the stopped. My usually headstrong libido evaporated. All this made me feel that I was losing my self. Scared, I tried to schedule pleasures. I went to parties and failed to have fun, saw friends and failed to connect; I bought things I had previously wanted and gained no satisfaction from them. I was overwhelmed by messages on my answering machine and ceased to return calls. When I drove at night, I constantly thought I was going to swerve into another car. Suddenly feeling I'd forgotten how to use the steering wheel, I would pull over in a sweat. In September, I had agonizing kidney stones. After a brief hospitalization, I spent a vagabond week migrating from friend to friend. I would stay in the house all day; avoiding the street, and was careful neverto go far from the phone. When they came home, I would cry. Sleeping pills got me through the night, but morning began to seem increasingly difficult. From then on, the slippage was steady. I worked even less well, cancelled more plans. I began eating irregularly, seldom feeling hungry. A psychoanalyst I was seeing told me, as I sank lower, that avoiding medication was very courageous. At about this time, night terrors began. My book was coming out in the United States, and a friend threw a party on October 11th. I was feeling too lacklustre to invite many people, was too tired to stand up much during the party, and sweated horribly all night. The event lives in my mind in ghostly outlines and washed-out colors. When I got home, terror seized me. I lay in bed, not sleeping and hugging my pillow for comfort. Two weeks later — the day before my thirty-first birthday — I left the house once, to buy groceries; petrified for no reason, I suddenly lost bowel control and soiled myself. I ran home, shaking, and went to bed, but I did not sleep, and could not get up the following day. I wanted to call people to cancel birthday plans, but I couldn't. I lay very still and thought about speaking, trying to figure out how. I moved my tongue, but there were no sounds. I had forgotten how to talk. Then I began to cry without tears. I was on my back. I wanted to turn over, but couldn't remember how to do that, either. I guessed that perhaps I'd had a stroke. At about three that afternoon, I managed to get up and go to the bathroom. I returned to bed shivering. Fortunately, my father, who lived uptown, called about then. "Cancel tonight," I said, struggling with the strange words. "What's wrong?" he kept asking, but I didn't know. If you trip or slip, there is a moment, before your hand shoots out to break your fall, when you feel the earth rushing up at you and you cannot help yourself — a passing, fraction-of-a-second horror. I felt like that way hour after hour. Freud once described pleasure as the release of tension; I felt as though I had a physical need, of impossible urgency and discomfort, from which there was no release — as though I were constantly vomiting but had no mouth. My vision began to close. It was like trying to watch TV through terrible static, where you can't distinguish faces, where nothing has edges. The air, too, seemed thick and resistant, as though it were full of mushed-up bread. My father came to my apartment with my brother, his fiancée, and a friend; fortunately, they had keys. I had had nothing to eat in almost two days, and they tried to give me smoked salmon. I ate a bite, then threw up all over myself. The next day, my father took me to my analyst's office. "I need