The Endlessly Examined Life: A most chronic depression


George Scialabba in The Baffler (illustration by Brad Holland):

My mental health file whirs to life in 1969 in Cambridge, Massachusetts. I’d recently left Opus Dei, the Catholic religious order to which I’d committed my young soul, and a major depression had followed. The records printed below are out of the mouths of my many caretakers; they chronicle my treatment at various medical offices and psychiatric clinics in the Boston area, from then until 2012.

How did I come by them? As I headed into a depression two years ago, a friend who was helping out thought it would be useful to see my records, so I asked for them. Why publish them now? Certainly not because I think these extracts from my treatment notes display any special literary facility or reveal an exceptionally interesting psyche, nor because I intend the slightest scandal to be visited on my therapists, employers, or insurance company. All proper names have been altered.

Our distractible human intelligence needs as many ways of talking about depression as can be provided—that’s all. Plus, given the longevity of this particular demon, it seems important to try to squeeze some insight from the mass of words and array of prescription drugs applied against its havoc. Even the most comprehensively bureaucratized medical knowledge can be made to speak, if only we are willing to listen closely to the blank spaces, the paraphrases. Even acronyms have feelings.

A note on medications: Fifty-plus years into the Antidepressant Age, it’s still not clear that drugs are better than placebos. There aren’t many long-term studies of efficacy or side effects, and the FDA requires surprisingly few trials before approval. Each of the drugs comes with a more or less plausible scientific explanation for why it should work. But all we know is that some people get better after taking them, some people don’t, and some people get better without taking them.

Of course, from a patient’s point of view, this is all moot. If you’re jumping out of your skin and the doctor says to take some pills, you take them. In my case, none of them worked spectacularly well. But only a couple had intolerable side effects or made the depression worse.

More here.