Publisher's Weekly Review
Not only a searing account of one man's battle against chronic depression, this deftly crafted memoir is also an intriguing cultural history of melancholy. After methodically planning to drown himself, spurred by a temporary paralysis he attributes to taking three different antidepressant drugs at once, Smith decided to go off his medication cold turkey instead. He initially tried homeopathy, psychotherapy and St. John's wort (a plant believed by some to have an antidepressant effect), with mixed results. Finally, he achieved a breakthrough when a spiritual crisis freed him from narrow self-absorption and instilled a faith that helped him face down existential despair. Far from a born-again confessional, Smith's largely secular philosophical examination of depression ranges across cultures and centuries, from the ancient theory that a humoral imbalance produces a saturnine disposition to the view, shared by Pueblo Indians and the Yoruba of Nigeria, of depression as "soul loss," to the insights of evolutionary biologists and "contemporary humoralists" who believe that some individuals have an innately moody, risk-aversive temperament. Smith's personal odyssey extends from his Ohio Appalachian boyhood to Montana, where he worked as a case manager at a community mental health center, to North Carolina, where he engages in environmental activism. His conviction that depression has a spiritual dimension gives his graceful memoir wide-ranging appeal. (Sept.) (c) Copyright PWxyz, LLC. All rights reserved
Kirkus Review
A provocative, poetic foray into melancholia from both a personal and historical perspective. While working as a psychiatric caseworker in Missoula, Minn., first-time author Smith is thrust into a depression that even the newest antidepressants can't alleviate. In attempting to understand his melancholia, Smith researches this mystifying condition, which continues to afflict people worldwide. Regardless of how it originates, concludes Smith, clinical depression results from biochemical changes in the brain. And half of those with one episode relapse within 18 months, while some will be plagued by depression for life. Smith is particularly effective in describing his own depression, when everyday details overwhelm him and his only company is ``Mr. Shoulder,'' who monitors his every thought and mood to the point of paralyzing him. He writes ``that my life felt distant even to me.'' Also intriguing is Smith's chronicle of society's changing views of depression. In Renaissance Europe, in Elizabethan England, and to the 19th-century Romantics in Germany and Great Britain, depressive illness was deemed a great gift. People even feigned melancholia, because it was considered an experience that deepened and enriched one's soul. With our society's emphasis on productivity, depression is regarded as an unwelcome intrusion that is costly to corporate America. The contemporary solution is a quick fix that allows expedient return to the marketplace. And it's this quick chemical fix that troubles Smith. Only when he abandons medication and allows his illness to awaken him spiritually and metaphysically does he conquer his depression. Smith continues to take jobs to help others with psychological problems and brain injuries, and is critical of patients' families ``who preferred the memory [of the victim when healthy] to the present reality'[and whose] spouses had all filed for divorce.'' Brimming with insight and intelligence, an endearing memoir. (Author tour)
Booklist Review
"In my head some peer sat in judgment . . . Over and again he told me: You are haunted. You are hollow. You are beyond forgiveness and beyond hope." One antidepressant after another failed to relieve Smith's melancholy, and a combination left him briefly paralyzed. Considering suicide, he decided instead to find out: "Without antidepressants to vanquish it, could a person have a life with depression?" For Smith, the answer was "yes"; he found therapy, love, and religious faith; these allowed him to cope with his condition. His book tells his story eloquently but also provides information on depression: its history and myths; what generations of poets and mystics have said of it; what various sciences reveal about it. For Smith, "Melancholia addresses what it means to be human, forces us to reckon with the constraints of the human condition. And like some spiritual principle, it stands opposed to the great icons of our age: the machine, the marketplace, and the self." The book is beautifully written, though Smith's solution will not help all patients. --Mary Carroll
Library Journal Review
Dropping the antidepressant that sent him into paralytic seizure, Smith decided to investigate the cultural history of melancholia. Here is what he found. (c) Copyright 2010. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.
Excerpts
Chapter One I am walking home, I kept telling myself. I live on East Third Street, in Missoula, Montana, and I am walking home, and by the time I get there this will be gone. Or so I kept telling myself. I walked past the convenience store at the corner of Main, and in the light traffic of a Sunday noon, without waiting for the signal to change I crossed to the other side of Orange Street. Truth be told, I didn't believe a word of my little recitation. I wanted to; but by then I knew my enemy--as I called it then--too well to think I could just walk away from it. Earlier that day, to celebrate the coming of summer I'd been to a Sunday gathering with some friends on the west side of town. There in Barbara's yard we sat outside in the sun beneath a large maple tree. All about us the yard was festive with wildflowers: columbine, evening primrose, blue flax. Behind us her raised-bed garden was rich already with herbs and lettuce and greens. Over my shoulder with the breeze came the intimate smell of damp earth, a smell that could usually root any silliness right out of me. But on that day I was unmoved. It was as if all these sights and smells had gone off into some murky distance where none of them would reach me. It was strange, but all too familiar, the way I could see these things but register none of the feeling they typically occasioned. I knew what this meant: it was back. For days before that brunch, there had been little hints and signs, but I'd brushed them off. And that was my inclination yet: it's just a passing mood, I told myself. I breathed in deep, to try to settle my mind. I wanted to believe if I would only focus more intently on the landscape, the gnawing clutter that was moving into my mind would disappear. So I leaned my head back and took in the horizon. Sapphire sky vaulted overhead. All around us the snow-peaked mountain ranges that frame Missoula--the Missions to the east, the Bitterroots to the west. But still I was unmoved. I leaned forward again, returning to this circle of friends. Barbara and I were lovers, and we worked together as case managers at the community mental health center. Rita was also a mental health worker, and with her husband, Chris, I shared an Appalachian boyhood and a love of books. Tommy and Beth and their sons Evan and Campbell had previously lived in Asheville, North Carolina, and so had I. In Asheville I had scarcely known them, but in Missoula we had become close friends. The talk touched on baseball, music, wildlife, gardening, books, life in the southern mountains, religion--things I typically enjoyed talking about, or listening to smart and thoughtful people such as these talk about--and I could not speak; and I could not listen. At one point Tommy turned in my direction. He seemed to be talking to me. Tommy was a kind, perceptive man, and it occurred to me that he must have noticed my trouble, and was trying to draw me into the conversation. I saw his lips moving, but his words were lost on me. I nodded my head, shrugged my shoulders, and turned away. Some other voice held my ear, and my mind was a tangle, a welter of confusion and overwhelm. I could only sit there dumbly. Beth picked her fiddle up off her lap and plucked and bowed it. I didn't care. I couldn't hear her either. So my familiar was stalking me again. I felt its breath on my neck hairs. I could smell it. The spoor was everywhere around me. It was back, and it was nearly the longest day of the year; at our northern latitude the light would blanch the sky until past ten that evening. The idea of abiding that light for ten more hours exhausted me. Maybe, I thought, maybe my familiar won't follow me home; maybe I can stand up and walk away from it. So I quietly took my leave and shanked my way homeward. I continued walking south on Orange Street and crossed the bridge, keeping my eyes on the pavement at my feet. I am walking home, I reminded myself, and once safely across the bridge I ducked under the handrail and sidestepped down the bank to walk along the Clark Fork River. By then I was halfway home. There on the floodplain I tried to sole my feet to the earth's roundness, tried to keep my hold on this quarter of its curve. Instead I felt leaden and fit only to plummet. I leaned back against a cottonwood tree on the riverbank. Shining clear light fell in sheets down the sky. In the breeze the lime-colored cottonwood leaves were all atremble; they shimmered the light in every direction, like some radiant version of glory revealed. I noticed, but I did not see: in my eyes all that sparkle and sinew had gone to blunt and shear, a blare of light. There was no mistaking it now. I knew well enough: it is arrived. I scuffed the toe of my boot into the dirt. I dropped my head to study on the ground, jammed my fists into my pockets, and once again started for home. No external event of weather or circumstance could account for its coming. All I knew was that it came that day rising, as it always did, not falling as if from elsewhere but rising as if it came from within, as inexorable as it was unbidden. I slogged on home and in my dark and damp basement room I crawled into bed. Like light it rises: light so unyielding it will suck all shadow from the earth and wick all moistness clean out of you. However it happens it seems your vital fluid has seeped out some invisible rent in your flesh. Then you become a vassal: the curb-chain clasps about your ankle; the weight gathers you, the thin membrane holding you aloft gives way. You cinch your shawl about your shoulders, and let fall. You let fall, or you prevail upon pills to arrest your falling. I knew what was ahead of me--for most of the previous eighteen months I'd been mired in one depressive episode or another--and I didn't want any part of it. Along the way I had acquired the diagnosis "Severe Depression, Recurrent." Eventually that was amended with the phrase "treatment-resistant," since in that time I had been tried on six different antidepressants. Some of them had not worked at all; others had worked fast and bright, yanking me up almost immediately, and then a week or a month later each one stopped working altogether, and no increased dosages would restore their magic. It was exactly as if I had gone immune to them. But the November before that gathering at Barbara's, my psychiatrist had prescribed Zoloft, one of the "selective serotonin reuptake inhibitors." It began working within a week, I had a glorious reprieve, and my state of mind held for two months, then four and then five and then six. Before the Zoloft began working I was struggling to keep up with a full load of graduate-level courses at the University of Montana, and I was involved, for maybe ten hours a week, with the editing of two literary magazines. Then in December, after the Zoloft kicked in, I accepted a full-time job doing case management at the community mental health center. Behind the Zoloft I had no qualms about adding a job to my workload. I was busier than I'd ever been, but somehow I kept up with it all: got my schoolwork done on time and my magazine work done on deadline; at my new job, I put in my quota of billable hours and then some. I became hale and jocose, outgoing, endlessly social. I scarcely ever sat home of an evening and read. In April I started into the relationship with Barbara, my first attempt at intimacy in two years. For those seven months the Zoloft delivered just what I wanted: I was, I thought, fixed. Normal. But now it too seemed to be failing. I must be some fool, I thought, ever to believe that my familiar was gone for good. Now it seemed he'd been waiting patiently all along, knowing his time would come around again. I wanted that son of a bitch out of my life, and for good. On Monday I called my psychiatrist, who instructed me to double my Zoloft dosage. This was how it always happened: the dreams went first, then sleep itself. It might have been ten days later, or two weeks--I think we were into July, anyhow, and once again I was awake every morning at four, after finally falling asleep just a couple hours before. I was unable to return to sleep, but neither could I will myself out of bed. I couldn't summon the concentration to read, so I would lie abed for three more hours, staring at the ceiling until it was time to go to work. I was exhausted; but I could not get the sleep to remedy it. When it was time to ready myself for work the stairway to the kitchen and bathroom seemed too steep to climb, and then my arms felt too heavy to lift and wash myself in the shower. So I just stood in there under the water. The higher dose of Zoloft had done no good. I ought to have known: all those pretty little sky-blue pills wouldn't ward this off once and for all. It was too good; I had been too happy. It seems remarkable, when the antidepressants reverse these seemingly inevitable and unrelenting episodes; it's common, in fact, for depressives to refer to their effects as a "miracle." Well, it seemed I'd had my miracle, and now it was gone. And now each day passed as if turned on some noisome crank, something slow and tortuous, to be endured but not engaged. Come what may and I did not care. Every moment of it was just one more thing I had to withstand before I could retire to my dim, damp basement apartment and crawl into bed. Outside, the coordinates were all askew. On the Fourth of July I got three blocks away from the house and could not for the life of me figure how to get to the grocery store. Down the street I saw my neighbor approaching on the sidewalk, made like I didn't, and crossed the street. How could I explain that I was lost, in my own neighborhood? I had to check the street signs to discover where I was and direct myself to the store. "Eat well and get some exercise," my friends would tell me. Sensible advice, but there were some problems: first, any such enterprise requires at least a modicum of hope. To pull on sweatpants and sneakers and get out the door you first have to believe that your circumstance might be improved; and I could not convince myself of that. The pills had failed, so why would anything else work? Then, second, there was finding the energy to exercise, when I could hardly get myself up and down the stairs. Third, it was never a good idea to leave the house. In the world without I was a liability, blighted and incompetent. Depression is a state of utter being : I could do nothing. Life had to be reduced to its most basic level: for example, precooked food was essential. When I finally made it home from the store, I opened a can of soup and poured it into a saucepan. Pueblo, the gray tabby who had moved off the street and into my room the summer before, sat on her chair there in the kitchen and watched. I dropped a pat of butter into the cast-iron skillet. I cut some cheddar cheese for a sandwich. When the butter melted I put the sandwich in the skillet to grill. Then I couldn't remember whether or not I'd added any water to the soup. I stood there hovering over the stove and still I could not recall. The looks of the slop in the saucepan told me nothing. I dragged a spoon through it and a taste of it didn't help much either. Finally I walked over to the sink, filled a coffee mug with water, and poured it into the soup. And then acrid clouds of smoke billowed up from the skillet. The smoke alarm started bleating. Pueblo leapt off her chair and scrambled down the basement steps to our rooms. I climbed onto her chair and undid the battery in the smoke alarm. By then the soup was boiling over. So I cut off the burners, and sat down to my dinner: watery lentil soup and a blackened cheese sandwich. (Continues...)