Psychotic Depression
Excerpt from Infinite Jest by David Foster Wallace (pgs. 692-698)
And re Ennet House resident Kate Gompert and this depression issue:
Some psychiatric patients — plus a certain percentage of people who’ve gotten so dependent on chemicals for feelings of well-being that when the chemicals have to be abandoned they undergo a loss-trauma that reaches way down deep into the soul’s core systems — these persons know firsthand that there’s more than one kind of so-called ‘depression’. One kind is low-grade and sometimes gets called anhedonia[280] or simple melancholy. It’s a kind of spiritual torpor in which one loses the ability to feel pleasure or attachment to things formerly important. The avid bowler drops out of his league and stays home at night staring dully at kick-boxing youtube videos cartridges. The gourmand is off his feed. The sensualist finds his beloved Unit all of a sudden to be so much feelingless gristle, just hanging there. The devoted wife and mother finds the thought of her family about as moving, all of a sudden, as a theorem of Euclid. It’s a kind of emotional novocaine, this form of depression, and while it’s not overly painful its deadness is disconcerting and… well, depressing. Kate Gompert’s always thought of this anhedonic state as a kind of radical abstracting of everything, a hollowing out of stuff that used to have affective content. Terms that undepressed toss around and take for granted as full and fleshy — happiness, joie de vivre, preference, love — are stripped to their skeletons and reduced to abstract ideas. They have, as it were, denotation but not connotation. The anhedonic can still speak about happiness and meaning et al., but she has become incapable of feeling anything in them, of understanding anything about them, of hoping anything about them, or of believing them to exist as anything more than concepts. Everything becomes an outline of the thing. Objects become schemata. The world becomes a map of the world. An anhedonic can navigate, but has no location. I.e. the anhedonic becomes, in the lingo of Boston AA, Unable To Identify.
It’s worth nothing that, among younger E.T.A.s, the standard take on Dr. J. O. Incandenza’s suicide attributes his putting his head in the microwave to this kind of anhedonia. This is maybe because anhedonia’s often associated with the crises that afflict extremely goal-oriented people who reach a certain age having achieved all or more than all than they’d hoped for. The what-does-it-all-mean-type crisis of middle-aged Americans. In fact this is in fact not what killed Incandenza at all. In fact the presumption that he’d achieved all his goals and found that the achievement didn’t confer meaning or joy on his existence says more about the students at E.T.A. than it says about Orin’s and Hal’s father: still under the influence of the deLint-like carrot-and-stick philosophies of their hometown coaches rather than the more paradoxical Schtitt/Incandenza/Lyle school, younger athletes who can’t help gauging their whole worth by their place in an ordinal ranking use the idea that achieving their goals and finding the gnawing sense of worthlessness still there in their own gut as a kind of psychic bogey, something that they can use to justify stopping on their way down to dawn drills to smell flowers along the E.T.A. paths. The idea that achievement doesn’t automatically confer interior worth is, to them, still, at this age, an abstraction, rather like the prospect of their own death — ‘Caius Is Mortal’ and so on. Deep down, they all still view the competitive carrot as the grail. They’re mostly going through the motions when they invoke anhedonia. They’re mostly small children, keep in mind. Listen to any sort of sub-16 exchange you hear in the bathroom or food line: ‘Hey, there, how are you?’ ‘Number eight this week, is how I am.’ They all still worship the carrot. With the possible exception of the tormented LaMount Chu, they all still subscribe to the delusive idea that the continent’s second-ranked fourteen-year-old feels exactly twice as worthwhile as the continent’s #4.
Deluded or not, it’s still a lucky way to live. Even though it’s temporary. It may well be that the lower-ranked little kids at E.T.A. are proportionally happier than the higher-ranked kids, since we (who are mostly not small children) know it’s more invigorating to want than to have, it seems. Though maybe this is just the inverse of the same delusion.
Hal Incandenza, though he has no idea yet of why his father really put his head in a specially-dickied microwave in the Year of the Trial-Size Dove Bar, is pretty sure that it wasn’t because of standard U.S. anhedonia. Hal himself hadn’t had a bona fide intensity-of-interior-life-type emotion since he was tiny; he finds terms like joie and value to be like so many variables in rarified equations, and he can manipulate them well enough to satisfy everyone but himself that he’s in there, inside his own hull, as a human being — but in fact he’s far more robotic than John Wayne. One of his troubles with his Moms is the fact that Avril Incandenza believes she knows him inside and out as a human being, and an internally worthy one at that, when in fact inside Hal there’s pretty much nothing at all, he knows. His Moms Avril hears her own echoes inside him and thinks what she hears is him, and this makes Hal feel the one thing he feels to the limit, lately: he is lonely.
It’s of some interest that the lively arts of the millennial U.S.A. treat anhedonia and internal emptiness as hip and cool. It’s maybe the vestiges of the Romantic glorification of Weltschmerz, which means world-weariness or hip ennui. Maybe it’s the fact that most of the arts here are produced by world-weary and sophisticated older people and then consumed by younger people who not only consume art but study it for clues on how to be cool, hip — and keep in mind that, for kids and younger people, to be hip and cool is the same as to be admired and accepted and included and so Unalone. Forget so-called peer-pressure. It’s more like peer-hunger. No? We enter a spiritual puberty where we snap to the fact that the great transcendent horror is loneliness, excluded encagement in the self. Once we’ve hit this age, we will now give or take anything, wear any mask, to fit, be part-of, not be Alone, we young. The U.S. arts are our guide to inclusion. A how-to. We are shown how to fashion masks of ennui and jaded irony at a young age where the face is fictile enough to assume the shape of whatever it wears. And then it stuck there, the weary cynicism that saves us from gooey sentiment and unsophisticated naïvité. Sentiment equals naïvité on this continent (at least since the Reconfiguration). One of the things sophisticated viewers have always liked about the J. O. Incandenza’s The American Century as Seen Through a Brick is its unsubtle thesis that naïvité is the last true terrible sin in the theology of millennial America. And since sin is the sort of thing that can be talked about only figuratively, it’s natural that Himself’s dark little cartridge was mostly about a myth, viz. that queerly persistent U.S. myth that cynicism and naïvité are mutually exclusive. Hal, who’s empty but not dumb, theorizes privately that what passes for hip cynical transcendence of sentiment is really some kind of fear of being really human, since to be really human (at least as he conceptualizes it) is probably to be unavoidably sentimental and naïve and goo-prone and generally pathetic, is to be in some basic interior way forever infantile, some sort of not-quite-right-looking infant dragging itself anaclitically around the map, with big wet eyes and froggy-soft skin, huge skull, gooey drool. One of the really American things about Hal, probably, is the way he despises what it is he’s really lonely for: this hideous internal self, incontinent of sentiment and need, that pulses and writhes just under the hip empty mask, anhedonia.[281]
The American Century as Seen Through a Brick‘s main and famous key-image is of a piano-string vibrating — a high D, it looks like — vibrating and making a very sweet unadorned solo sound indeed, and then a little thumb comes into the frame, a blunt moist pale and yet dingy thumb, with disreputable stuff crusted in one of the nail-corners, small and unlined, clearly an infantile thumb, and as it touches the paino string the high sweet sound immediately dies. And the silence that follows is excruciating. Later in the film, after much mordant and didactic panoramic brick-following, we’re back at the piano-string, and the thumb is removed, and the high sweet sound recommences, extremely pure and solo, and yet now somehow, as the volume increases, now with something rotten about it underneath, there’s something sick-sweet and overripe and potentially putrid about the one clear high D as its volume increases and increases, the sound getting purer and louder and more dysphoric until after a surprisingly few seconds we find ourselves right in the middle of the pure undampered sound longing and even maybe praying for the return of the natal thumb, to shut it up.
Hal isn’t old enough yet to know that this is because numb emptiness isn’t the worst kind of depression. That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this condition clinical depression or involutional depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of the soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton’s melancholia or Yevtuschenko’s more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.
It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.
It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain[282], a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.
The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it’s a closed circuit: the current is both applied and received from within.
The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who leap from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of the two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to personally be trapped and felt flames to really understand a terror way beyond falling.
But and so the idea of a person in the grip of It being bound by a ‘Suicide Contract’ some well-meaning Substance-abuse halfway house makes her sign is simply absurd. Because such a contract will constrain such a person only until the exact psychic circumstances that made the contract necessary in the first place assert themselves, invisibly and indescribably. That the well-meaning halfway-house Staff does not understand Its overriding terror will only make the depressed resident feel more alone.
One fellow psychotically depressed patient Kate Gompert came to know at Newton-Wellesley Hospital in Newton two years ago was a man in his fifties. He was a civil engineer whose hobby was model trains — like from Lionel Trains Inc., etc. — for which he erected incredibly intricate systems of switching and track that filled his basement recreation room. His wife brought photographs of the trains and network of trellis and track into the locked ward, to help remind him. The man said he had been suffering from psychotic depression for seventeen straight years, and Kate Gompert had had no reason to disbelieve him. He was stocky and swart with thinning hair and hands that he held very still in his lap as he sat. Twenty years ago he had slipped on a patch of 3-In-1-brand oil from his model-train tracks and bonked his head on the cement floor of his basement rec room in Wellesley Hills, and when he woke up in the E.R. he was depressed beyond all human endurance, and stayed that way. He’d never once tried suicide, though he confessed that he yearned for unconsciousness without end. His wife was very devoted and loving. She went to Catholic Mass every day. She was very devout. The psychotically depressed man, too, went to daily Mass when he was not institutionalized. He prayed for relief. He still had his job and his hobby. He went to work regularly, taking medical leaves only when the invisible torment got too bad for him to trust himself, or when there was some radical new treatment the psychiatrists wanted him to try. They’d tried Tricyclics, M.A.O.I.s, insulin-comas, Selective-Serotonin-Reuptake Inhibitors[283], the new and side-effect-laden Quadracyclics. They’d scanned his lobes and affective matrices for lesions and scars. Nothing worked. Not even high-amperage E.C.T. relieved It. This happens sometimes. Some cases of depression are beyond human aid. The man’s case gave Kate Gompert the howling fantods. The idea of this man going to work and to Mass and building miniaturized railroad networks day after day after day while feeling anything like what Kate Gompert felt in that ward was simply beyond her ability to imagine. The rationo-spiritual part of her knew this man and his wife must be possessed of a courage way off any sort of known courage-chart. But in her toxified soul Kate Gompert felt only a paralyzing horror at the idea of the squat dead-eyed man laying toy track slowly and carefully in the silence of his wood-panelled rec room, the silence total except for the sounds of the track being oiled and snapped together and laid into place, the man’s head full of poison and worms and every cell in his body screaming for relief from flames no one else could help with or even feel.
The permanently psychotically depressed man was finally transferred to a place on Long Island to be evaluated for a radical new type of psychosurgery where they supposedly went in and yanked out your whole limbic system, which is the part of the brain that causes all sentiment and feeling. The man’s fondest dream was anhedonia, complete psychic numbing. I.e. death in life. The prospect of radical psychosurgery was the dangled carrot that Kate guessed still gave the man’s life enough meaning for him to hang onto the windowsill by his fingernails, which were probably black and gnarled from the flames. That and his wife: he seemed genuinely to love his wife, and she him. He went to bed every night at home holding her, weeping for it to be over, while she prayed or did that devout thing with beads.
The couple had gotten Kate Gompert’s mother’s address and had sent Kate an Xmas card the last two years, Mr. and Mrs. Ernest Feaster of Wellesley Hills MA, stating that she was in her prayers and wishing her all available joy. Kate Gompert doesn’t know whether Mr. Ernest’s limbic system got yanked out or not. Whether he achieved anhedonia. The Xmas cards had had excruciating little watercolor pictures of locomotives on them. She could barely stand to think about them, even at the best of times, which the present was not.
[280] Anhedonia was apparently coined by Ribot, a Continental Frenchman, who in his 19th-century Psychologie des Sentiments says he means it to denote the psychoequivalent of analgesia, which is the neurologic supression of pain.
[281] This had been one of Hal’s deepest and most pregnant abstractions, one he’d come up with once while getting secretly high in the Pump Room. That we’re all lonely for something we don’t know we’re lonely for. How else to explain the curious feeling that he goes around feeling like he misses somebody he’s never even met? Without the universalizing abstraction, the feeling would make no sense.
[282] (the big reason why people in pain are so self-absorbed and unpleasant to be around)
[283] S.S.R.I.s, of which Zoloft and the ill-fated Prozac were the ancestors.
See also:
- Wireheading Done Right – which steel-mans the case for philosophical and practical hedonism by outlining how to change our reward circuitry in such a way that (1) we never need to feel bad, (2) we move between different varieties of bliss depending on their functional properties, and (3) avoid becoming a pure replicator.
- Tyranny of the Intentional Object – the stories we tell ourselves to explain every sense of pleasure and every sense of pain we feel are all, for the most part, deeply psychotic. That is, in so far as we attribute their valence to external triggers – in truth, every feeling’s valence is the result of the fine-grained structure of the qualia that implements it. You don’t scream at a bullet ant’s sting. You scream at the deep scintillating patterns of qualia shaped by dissonance, shearing, pinching, tearing, etc. (all symmetry breaking effects) that result from the sting.
- Logarithmic Scales of Pleasure and Pain – I like that David Foster Wallace makes a distinction between run-of-the-mill anhedonia and the Great White Shark of clinical depression. More broadly, we ought to realize that bad experiences of pain and suffering are not just a fraction worse than the rest, but they can indeed be orders of magnitude worse. On the flip-side, this is also true for positive experiences, with illustrative examples such as Buddhist Jhanas, temporal lobe epilepsy, and the lucky 5-MeO-DMT-induced state of supreme bliss.
Also relevant: David Pearce‘s Abolitionist Bioethics, Mike Johnson‘s A Future for Neuroscience, and Romeo Stevens‘ post about Core Transformation.
Finally, see Scott Alexander‘s book review of Infinite Jest.
