’A Surfeit of Black Bile’

“This is my kind of place”, I thought, and I stayed, week after week, 110 euros at a time (mostly but not entirely reimbursed by my insurance), opening up about myself, little by little, in the only way I know how: by running it all through talk of insects, and painting, and literature, and other such life-of-the-mind matters that mental-health experts in more provincial settings might ignorantly interpret as so much “deflection” and “intellectualizing”.

I would certainly know, for this is hardly my first encounter with the mental-health system, and the branches of it I have known best are indeed the ones where you are exceedingly unlikely to find the works of Freud or Lévi-Strauss, but that exist rather, in the United States, within a triangulated pipeline that also includes prisons and failing public schools at its other nodes: all institutions configured to make you feel you are wrong by definition, even as they pretend to be making you right.

2.

I’ve been on and off meds since I was nineteen, when I was diagnosed with obsessive compulsive disorder — which was the truth, but not the whole truth. How far gone was I back then? When I was driving along the highway, I had to make a swallowing gesture towards every occurrence of the letter “A” on the road signs I saw, and a retching gesture towards every “B”, “C”, “D”, and “F”. If I made a mistake I had to exit at the nearest off-ramp, circle back around, and try again. This is only one small example —one of the funnier ones— of the total system of little superstitions, bubbling up out of some unnamed and constant feeling of dread, that entirely structured my life. I was prescribed a primitive tricyclic with side-effects too improbable to be believed (e.g., spontaneous serial yawning, which in turn triggered lower down a certain entasis sive patratio gaudens that my prudishness compels me to shroud in Latinity). I began flushing them soon enough, mostly for fear that, if they were to work, they would cure me of the tremendous anxiety that alone enabled me to earn perfect grades (“A’s”, as we call them in the United States), and ultimately to get into graduate school and find my way from the quasi-carceral strip-mall psychiatric clinics of inland California to the well-appointed offices of a St. Germain Freudian.

In New York a few years later, my grad-student health insurance afforded me unlimited psychiatric care, on the condition that I accept being paired off with a young psychiatrist-in-training. This part was not so bad; I liked the one I got well enough (Greek, humane). What was intolerable was that I had to go through a good deal more of his training than I cared to see, including, most painfully, therapy sessions that were conducted in an amphitheater of the Columbia University Presbyterian Hospital, in front of his classmates as they dutifully took notes on his questioning technique and on my ridiculous answers. The inevitable problem here, obviously, was that I was not a beaker full of chemicals, but a human being, and so when I was put in front of a crowd of people, I reacted differently than I would when speaking one-on-one with my doctor. I reacted, namely, by performing. The performance was completely improvised, and I really have no idea where it came from within me, but for some reason my frightened ego invented on the spot some sort of Hannibal Lecter-like persona: eloquent, genial, and completely, irretrievably psycho. I quit availing myself of this cut-rate psychiatry not long after.

My subsequent experience in the American Midwest was the absolute nadir of my quest for psychiatric treatment, where I remember meeting no competent mental-health professional, but only sitting in miserable waiting rooms with Jerry Springer at high volume on a TV screen mounted on the wall, numerous other “clients” waiting with me who were quite plainly there as a condition of their parole, and warnings on the walls reminding us that abuse would not be tolerated, and that assaulting an employee could result in fines and a prison sentence of UP TO 5 YEARS. The Columbia psychiatric hospital had at least had a sort of Bellevue-style “looney bin” ambiance to it, and that was in its own way something I could get into with a bit of effort. For I belonged, I had felt, in just the sort of straitjacket-and-rubber-room scenario you might see in a cartoon representation of a proper metropolitan insane-asylum. I needed a looney-wagon to come and fetch me with a dog-catcher’s net, as in a scene conceived by Hanna and Barbera. I did not belong, not on any conception of my life as I understood it, within the organs of a borderline-punitive provincial system existing mostly for the management of social and economic pathologies that, thanks to the ideology perpetuated by the surrounding culture, indeed perpetuated by Jerry Springer on the screen mounted above us as we waited, we were compelled in America to think of as our own personal defects.

3.

The famous “looping effect” in the study, and in the treatment, of human subjects, gives rise to incredible distortions in the would-be object of observation, not only in extreme circumstances like the amphitheater up on 168th St., but always and everywhere. We say different things for different audiences, whether in intimate dialogue with a loved one, or displayed as a curiosity like the eloquent ape in Kafka’s “Report to an Academy”. This means that at least to some extent all life is a “performance”, which we do not have to interpret in any radical way, such as you might have encountered in a graduate seminar in “Performance Studies” at NYU circa 1996. We only need to go as far as Erving Goffman, and to acknowledge that our encounters in everyday life are not just a matter of showing up, of hauling our body out of domestic storage; these encounters are also a “presentation of the self”, which requires at a minimum that a person make choices about how the self is presented, in what light, which angles to showcase, to what ends. It may be that one partially adequate gloss on what it is to be mentally healthy is that this is a state in which the performative quality of quotidian self-presentations retreats into the background, and a person feels as if the self who is coming across to others is naturally and spontaneously the real one (more or less). I can only guess at what that might be like.

For most of my life I have been a “high-functioning” depressive — so high-functioning, in fact, that it will seem implausible to many, even to those who know me fairly well, to learn of my long psychiatric record. But another way of saying “high-functioning” is “high-performance”, which is to say that I have generally been all-too-aware of the Goffmanian performative dimensions of social life, and have mastered my own performance in the same way I mastered my GPA and the various standardized tests I have had to take: propelled forward only by the fuel of anxiety, self-hatred, and certainty of my own fraudulence.

The intake questionnaires have never really captured my subjective experience of “what’s eating me” very well. They ask: “Do you have trouble getting out of bed?” No. “Have you lost your appetite?” I wish. “Are you able to complete your work tasks?” Always. Some diagnosticians, amateur and professional alike, have rushed to DSM-splain to me that I seem to suffer only from “anxiety” and not from “depression”, but this is a meaningless distinction to me, and I don’t see any reason why a manual that in any case is always in the course of revision, and only captures one way of dividing up psychiatric kinds in a certain place and time, should trump the first-person phenomenology of the condition under diagnosis. Anxiety is the opposite of a good feeling; it’s bad. In the end it may be that eudaimonia and kakodaimonia, good and bad “vibes”, are really the only two conditions with any ontological robustness to them. And even these two elementary states shade into one another in ways that make it extremely hard for a lucid observer of his own condition to put feelings into language. Sometimes the condition of the soul gets so bad that it starts to feel like a sort of ecstasy, in which one has circled all the way back around to communion with the good daimon: the horseshoe theory of depression and mental health.

All self-presentation is performance, but to remain hyper-aware of this at all times is handicapping, and leads to a sharp sense of one’s own fraudulence. The watered-down way to speak of this sense, much invoked in online grousing about the stresses of academia, is in terms of “impostor syndrome”, but that doesn’t quite capture the pervasiveness of the feeling. Those who have this syndrome feel out of place in a particular line of work; those who are depressed feel out of place in the world. “Fake it till you make it” is the jocular advice given to people suffering from mild impostor syndrome, and it is implied that this sort of fakery is not just morally tolerable, but laudable. Yet such dishonesty, like “pride”, straddles a boundary between two different and wholly incompatible moral orientations that somehow continue to co-exist in our society. This is the same divide that tells us, in the name of being a morally upstanding person, both to give away our money, and to save it. Bourgeois liberal philosophy will gaslight you into thinking you must simply not be smart enough if you fail to understand how this incommensurability can be smoothed out. But every now and then the voice of a Kierkegaard breaks through, strong enough to make itself heard through the bullshit, to tell us in no uncertain terms that it is impossible to live in this world, that whatever form of life you choose, you will be wrong.

The great comedian Mitch Hedberg, dead of an overdose at thirty-seven, said of addiction that it is a disease, but a weird one: “It’s the only disease people yell at you for having”. Our man is piercing here right into the heart of the incommensurability in question. In the end, if we cannot help but blame others for things that are beyond their control, this may be because wretchedness is our basic condition, as inevitable as it is blameworthy, and only an ideology —such as the one that has reigned throughout modernity— that stresses our earthly perfectibility will place the wretched in the earthly purgatories of rehab clinics and “correctional institutions” and psychiatric outpatient clinics, where in each case the purported goal is to purge the wretchedness right out of a person.

4.

Today we find it easy to mock humoral medicine, such as Robert Burton’s explanation in his Anatomy of Melancholy (1621) of the condition in question as literally a “surfeit of black bile”. But in truth our facile resort today to the idea that depression is nothing more than “a problem with our brain chemistry” is just as worthy of mockery. It marks nothing more thn a shift in the bodily system held responsible for the psychological state, without any clearer understanding of the social and spiritual dimensions of the state. In fact Burton was vastly more sensitive, in his paramedical reflections on the melancholic life, to all the ways such a life is more than just an imbalance of the humors, than your average prescriber of meds today is sensitive to all the ways in which depression is more than just a matter of serotonin reuptake.

I am familiar with the studies that have shown meds to be no more effective than placebos, indeed I talk about these studies with my psychiatrist as he prescribes me meds (at least I think that’s what they are). The whole endeavor might appear as a perfect cocktail of fraudulence: I am tormented by my sense that I am a big fake, so I go get fake drugs from someone who takes money from me in exchange for talking about Russian literature and Greek mythology with him — activities for which, in other circumstances, I’m the one who gets paid to do the talking. The money goes round and round, into the state’s coffers and out again into the private hands of intéllos, supported, for now, by a welfare state that deems all this talking valuable for civic life.

5.

At many points over the past decades I have managed to convince even myself that I am cured. In fact I had managed to do this for almost twenty years, until the beginning of the pandemic, when the repressed returned with a vengeance. I do not believe that I “came down with depression” at that moment, and I especially hate the French habit of speaking of “une dépression”, as if the condition were as individuable and as temporally bounded as a cold. Just as inadequate is the oft-repeated Churchillian metaphor of depression as “the black dog”. If only it were a black dog, I could just kick the fucking thing away. I do not “have” “a” depression, let alone a depression hounding me in the form of an external malevolent agent. Rather, I am depressed, and certain circumstances make this fact less easy to ignore than others. In the event, the circumstances surely had something to do with the first lockdown of March, 2020, which we endured in Brooklyn, right next to the hospital in Fort Greene where they stored the corpses outside in refrigerated trucks. My own experience of covid was mild in its symptoms, but I emerged from lockdown transformed, physically and psychologically.

I will try to describe in a few words what it has been like since then. The most striking thing about this new life is that the whole world looks to me somewhat the way our elementary schools look to us when we revisit them as adults: a place we don’t belong anymore, a place that seems so much smaller and so much more modest than we had once taken it to be, so disenchanted that one is left perplexed as to how it could ever have been the source of such wild flights of the hopeful imagination. Life has a quality now that can only be described as “spectral”. I have sometimes imagined that I must have ended up in one of those refrigerated trucks myself, and everything I’ve experienced since then is just me haunting the old sites of my life, as in the Nicole Kidman vehicle The Others (2001) where she believes her home is infested by poltergeists but slowly comes to realize she and her kids are the ghosts, while the “ghosts” that torment her are just regular human beings.

A second feature of this new “mature” manifestation of depression (as opposed to its “juvenile” expressions in California, New York, Ohio) is what the diagnosticians sometimes call “derealization”. I have moments where I just cannot believe that any of this is real. I used to mock Nick Bostrom’s “simulation hypothesis”; now, most of the time, it seems to me intuitively obvious (if still not for the reasons he thinks) that the world is not at all what we take it to be. This shift manifests itself partly in a collapse of the system of values that had previously enabled me to take seriously all the clamoring after social distinctions —all the prizes and acclaim I used to find it meaningful to seek— that keep our institutions running and our little lives full. But more strongly, at certain moments I find myself literally unable to comprehend how I ever could have taken the social bodies that offer the prizes and acclaim, or indeed the opprobrium and rejection, to be in any sense real.

This derealization surely has something to do with the very real historical process of dematerialization: institutions really are disintegrating as they shift to videoconferencing and e-mail as the primary channels of their endurance. What made universities real for some centuries, for example, were in large part their august edifices. These still exist, generally, but they seem increasingly disconnected from whatever it is we still pretend to be doing under the universitarian banner. Anxiety enables me to keep doing my work under this same banner, but I find myself unable to recall how I once accepted it all, unquestioningly, as real. At its most intense, my incomprehension extends not just to social reality (work, recipes, “sport”, popular entertainments, and most of all politics), but to all reality: I can’t make any sense of what the edifices themselves are supposed to be, or clothes, or utensils. Unlike for Bostrom, most of the time the one thing that does not become “glitchy” for me, does not begin to show signs of its simulated character, is nature. But nature loves to hide, as Heraclitus said, and to have it alone as the one thing that appears real, while suitable for isolated contemplation, is hardly sufficient to provide the experience of community that sustains a properly human life.

A third feature of this mature depression is the way it affects my moral character, no matter how much rhetoric is invested in the idea that it’s “just a disease” like any other. I have already described it as a “disease” that has dishonesty as one of its symptoms. Another symptom is that it makes a person —let’s be frank— a real jerk. In my own case I definitely discern a correlation between the occasional remission of feelings of depression, on the one hand, and my capacity for generosity or big-heartedness on the other. Eric Schwitzgebel has provocatively argued that if you are surrounded by fools, you’re probably a jerk. When I am depressed I tend to conclude from his argument, very much against the grain, that I must be a jerk, because everyone around me is definitely a fool. Schwitzgebel of course means to dispel the idea that others are really fools, by “reducing” their foolishness to a mere effect of the perceiver’s “jerkitude”. But depression militates in favor of a “Copernican revolution” in the new field of jerk theory.

Here is how the foolishness of humanity manifests itself. We have become familiar in the social-media era with the notion of “copypasta”, where people with no real thoughts of their own simply reproduce the language of others, and attempt to pass this off as political engagement, for example regarding the “problematic” character of Disney princesses. But in deep depression, every human utterance sounds like copypasta; everyone sounds as if they are simply channeling the language of others. Proust thus comes to seem a rare and loyal friend to the isolated depressive, when for example his narrator dissects the new phrases and idiosyncracies in the language of Albertine, to discern, in his own internal Académie Française, exactly who she has been seeing since she returned to Paris from Balbec at the end of summer. She thinks she’s just “being herself”, with all that language; he thinks she’s just delivering so much copypasta.

It is terrifying and alienating to apprehend all language in that way, and the easiest reaction is misanthropy. One is wrong, of course, morally wrong, to react in this way, and the Copernican revolution in this case cannot really succeed. It is, as Schwitzgebel claims, jerkitude that gives rise to the appearance of foolishness, and not foolishness that justifies jerkitude. But depression is a strange disease, and we will never be able to adequately deal with it if we pretend it’s just like diabetes or whatever. Depression makes you a jerk. One should not be a jerk. Ergo, if depression is a disease, it is a disease that it is morally wrong to have.

6.

One of the most peculiar expressions I have learned since moving to France is péter un plomb. This means literally “to fart a lead weight”, and so might seem to suggest a meaning similar to the English “to shit a brick”, but in fact describes something closer to failure, or to an irreversible running out of steam, than to the heroic feat of parturition described by the English idiom. Thus for example if you are sitting outside at a café in Paris, and a rough but still handsome beggar comes to your table and, in perfect classical diction, recites a monologue from Molière, you might say after he has moved on: Il a dû péter un plomb. “He must have farted a chunk of lead”. The idea here is that this mendicant thespian clearly used to “be somebody”, but some bug in his internal program caused him at some point to stray from his path and to take up this new lowly position in the world with only faint vestiges of who he once was. High-functioning depressives might do well to adopt as their mantra Samuel Beckett’s famous line: “I can’t go on, I’ll go on”. But if you have farted your chunk of lead in life, you lose the second half, and are left only with this: “I can’t go on”.

I spend a lot of time trying to calculate to what extent my pandemic-era funk results from world-historical events, and to what extent it is simply part of my own “programmed obsolescence”, as we say of our iPhones, which would have happened no matter what the state of the world. I’m fairly certain it’s a bit of both, that I as well have a bug in my program, whose ultimate manifestation was foreshadowed in earlier encounters with the mental-health system, which were nonetheless softer and more hopeful than what I have described of the present, to the extent that they were the juvenile expressions of something that at the time one could still expect to fade away someday.

Do I believe that psychoanalysis works? Of course not. Not in the sense that it will “cure” the symptoms by discovering their causes. As Adolf Grünbaum decisively showed, psychoanalysis is a pseudoscience. But it works, at least, by sustaining the impression, through all the ritual and expense of it, that one is actively “doing something”, and this does help one to “go on”.

7.

There is also writing, which is indeed, however copypasta’d this sounds, a sort of therapy, as it is a mirror of life that can be bent at will to make the light of life refract as one wishes. Why, though, must one write about it for others, as I am doing here? You will notice that I have said very little about the particularities of my case, about the deep causes or about all those symptoms that are significantly more embarrassing than, say, swallowing the letters on roadsigns. I have, rather, sought to share insights that can only be won from a first-person experience of depression, but that may still be hoped to have some sort of universal purchase. This is what the essay, as it has developed from the model laid out by Michel de Montaigne, is ideally expected to do, is it not? The first-person essay is not a juicy confessional, but a stab at characterizing the human through one of its microcosms.

To attempt to do this is hard work, and it can leave one feeling drained, and uncertain as to whether it would have been better not to try at all. This uncertainty in fact is an instance of a more general problem, about which I spend much time reflecting beneath the Francis Bacon painting in my psychoanalyst’s office. I seem constitutionally unable to know moderation; whatever I do, I do too much. If in my mature phase I have more or less settled on asceticism and withdrawal, in a way that seems extreme to many people I know, this is because the alternatives are untenable. I have noticed, especially since I completely stopped drinking one year ago (December 2 is my first anniversary) that there is a strong prejudice in our society against this sort of extremism. This is especially true in France. French people, as true Epicureans, are seldom Heliogabalians. They will open a two-serving jar of ratatouille and literally only eat one of the servings, which I had always presumed to be a mere fiction. French people will “enjoy” wine, which is to say they will stop drinking well before something as temperate as enjoyment has ceased to be the rationale. I have never “enjoyed” wine in this sense. I am one of those people for whom one glass is too much, because ten is not enough.

While it is possible to quit drinking altogether, a considerably greater challenge emerges when one realizes that this experience of “not enough” is a general one. All life seems to be like wine, in that one always wants more; but unlike wine, in that one cannot quit it. Writing in particular seems to be a lot like wine. It’s good, it’s bad. It seems always to cross over, the longer one stays at it, from early enjoyment into something altogether different. I should probably call it a night but I don’t want to.