IN 2003, AFTER more than a year in the grip of a major depressive episode, I consulted a doctor to discuss my condition. Alone in his surgery, I filled in a multiple-choice questionnaire, answering questions along the lines of ‘Do you feel worthless (a) never (b) sometimes (c) constantly?' and ‘Do you consider suicide (a) never (b) occasionally (c) often?'
After I had completed the test, my doctor returned. His manner was calm and understanding as he told me that yes, I certainly had results that suggested serious depression. Speaking gently, he prescribed a course of SSRIs and I left his surgery.
Given that my doctor's practice is located in Darlinghurst, and caters largely to middle-aged gay men, many of whom have HIV, I'm sure it's a conversation he has had a lot of practice at. And I suppose logically I should have been upset or disturbed by the outcome – I had, after all, just been diagnosed with a mental illness, albeit one that afflicts a surprisingly large portion of the population. But if I felt anything, it was something closer to liberation.
This was not my first experience with medication to control my moods, nor was it the first time I had spoken to a professional about my psychological or emotional state. But it was the first time I had been prescribed one of the family of medications that have transformed our society's attitudes to and treatment of the range of conditions rather glibly described as depressive-anxiety disorder. And, perhaps curiously, it was the first time any of the professionals I had spoken to over the years had used the word ‘depression', or at least the first time I had heard them say it.
The weeks that followed were curious. As the weight of my mood, the distractedness and clawing anxiety I had fought to control for many months began to lift, I felt a sort of dissociation set in. Experience took on a strange glassiness, as if I were outside myself, looking in. It was not a matter of feeling dulled, or anaesthetised, more a sense that I had become less real, or at least less engaged by questions of the self. The effect was not so much unsettling as curious, a process to be observed, a response that was itself an expression of what I was experiencing.
Over time, these feelings grew less pronounced. I stepped back into myself, became whole once more. But simultaneously I was aware that the self which was reintegrating was a different one – subtly perhaps, but different nonetheless.
For all that I knew they were there, the differences were not easy to put my finger on. At first I was mostly aware of a certain hardening of my emotional responses. While even in a non-depressed state my emotional responses are intense and often unpredictable, when I am depressed I am so emotionally labile that even ordinary moments of human life often bring on a raw ache I can barely control, leaving me afraid I will break down and weep in the most inappropriate places. On the medication, my frightening lability was gone – but so too was the sense of sadness and tenderness in the everyday of which I have always been aware.
But this loss of sympathy was not the only change. There was something deeper and more profound as well. In the months leading up to that visit to the doctor, I had been almost unable to write. Whether the stress from problems with the novel I was working on had triggered my depressive episode, or a cyclic depressive episode had affected my writing, for a year or even longer I had been struggling to write.
At first the problem had been confined to the novel on which I was working. After writing a first draft with relative ease, I had become stuck not far into the second. My attempts to resolve a small matter of plotting and pace had somehow begun to unpick the fabric of the whole, until finally it had come unravelled altogether. Despite my efforts, the book's problems only seemed to grow worse with each attempt to repair them. Sections that had slipped easily into each other began to clash and jar; language that had seemed hypnotic and sinuous began to sound stilted and forced. Faced with what seemed increasingly like disaster, I found myself without direction or control, my intuitions and self-belief eroded by an increasingly corrosive doubt in my own abilities, until at last I reached a point where I could barely compose an email or look at my computer without wanting to vomit.
With the SSRIs in my system, I could write again – at least in a superficial sense. But something more fundamental had changed as well. For, while I could make sentences again, form ideas, write coherently and persuasively, the deeper impulse that had led me to write in the first place, that oddly compulsive need to find words to contain and express the things I felt, was gone.
In itself, this was a curious and confronting discovery. The act of writing, the idea of myself as a writer was, I had always believed, so central to my sense of self I could not imagine who I was, what I was, without it. But as the weeks and months went by, I began to wonder whether I might be able to make sense of myself without writing, whether that version of myself who had written might be able to be left behind as well.
MOOD DISORDERS AND madness have long been associated with creativity. In the fourth century BCE, Aristotle argued that an excess of the bilious humour, while causing melancholy, was also a necessary component in creative genius: ‘All those who have attained excellence in philosophy, in poetry and in art, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease.' Likewise, Rufus of Ephesus argued that melancholy, which he believed might be temperamental or acquired through overly heavy consumption of wine and red meat, or excessive intellectual activity, was also a condition to which those of genius are particularly prone.
Yet it was Renaissance writers who gave the first systematic expression to the notion that creativity and melancholy might be intertwined. Marsilio Ficino famously argued that melancholy was the manifestation of a yearning for the great and eternal which, while universal, was necessarily more pronounced in those artists and philosophers seeking to transcend the concern of the everyday, and strive towards the divine. Truth, loss and melancholy are thus indissolubly wound together, the striving for the first both an admission and a consequence of the second and a cause and a function of the last. Robert Burton is more succinct: ‘all poets are mad', he declares in The Anatomy of Melancholy.
But it was the Romantics who gave fullest expression to the notion that madness, melancholia and creativity might be inextricably wound together. ‘We of the craft are all crazy,' Byron famously proclaimed. ‘Some are affected by gaiety, others by melancholy, but all are more or less touched.'
More recently, we have grown less comfortable with the notion that suffering or madness might be connected with creativity. The reasons for this shift in attitudes are complex, and in many ways contradictory. On the one hand, public and private discourse has become increasingly inflected with the jargon of psychology and medical psychiatry. We routinely speak of closure; label our moods depression, our impulses compulsions, our worries neuroses. Yet this language is, for all its semblance of meaning, a jargon that denies complexity and erases individuality, reducing all experience, all suffering to a set of almost programmatic responses. It is impossible to listen to grieving families speaking of their need for closure, or those most unfortunate in our society – the addicts and homeless – who have the most contact with the psychological and social work industries describing their experiences, and not hear the way the glibness of pop psychology obscures as much if not more than it reveals.
Fundamental to the model of human nature contained in this version of psychology is an assumption that happiness is the end to which mental health is directed. Yet this assumption is questionable, both because the model of mental health it relies upon is so narrow and because it is unable to accommodate the idea that agitation and pain, sadness and hurt might be more than mere stages to be overcome on the road to wholeness, or might have positive qualities it cannot describe or explain.
Within such a framework, if creativity is to be something positive, it must by its nature be a manifestation of mental health and happiness, not what it understands as emotional dysfunction or unhappiness. In the place of the tortured genius, we are encouraged to see creativity as essentially therapeutic, or part of a broader program of self-improvement through the pursuit of individual ‘passion', a shift that transforms creative endeavour from a vocation into a lifestyle choice.
This unease is mirrored in our intellectual culture's unease with the Romantic conception of the artist, and more particularly its implicit assertion of a privileged status for certain works and creations. After more than thirty years deconstructing the canon, we are wary of the idea of aesthetic significance, wary of hierarchies of quality. After all, if texts are texts and everywhere, their creation cannot be confined to those of genius.
Likewise, as our public culture has grown increasingly censorious, we have become more suspicious of attempts to excuse bad behaviour as the legitimate expression of the creative life.
Yet alongside this unease there has been a growing resistance to this attempt to reduce human existence to the triteness of pop psychology. Writers as various as Kay Redfield Jamison, Julia Kristeva, Eric G. Wilson, Andrew Solomon and Lewis Wolpert have sought to forge what Jonathan Dollimore describes as a new subjectivity from the experience of breakdown. In different ways, all seek some insight into the nature of existence from the experience of loss, pain and what Lewis Wolpert calls ‘malignant sadness'. As Dollimore correctly discerns, this subjectivity has echoes of Ficino and his belief that melancholia has moral and religious aspects, of the notion that suffering might be virtuous. But, simultaneously, all seek – in different ways – to recover something contemporary culture often seems in danger of losing: a sense of the fleetingness of things, the knowledge of loss that necessarily infects even the most joyous moments, the fragility and preciousness of life and being.
I AM NOT sure that if, fifteen or twenty years ago when I began writing, I was asked whether it was connected with my troubled moods, I would have seen the connection. Yet, looking back, it seems obvious. I came to writing almost by mistake, stumbling on it in my final year at university. At first I wrote poetry, partly as a way of sublimating desire, partly because it seemed to offer the most immediate vehicle for the feelings and experiences I sought to explore. Later, when I began to write fiction, my motivations were more complex, but the writing remained grounded in these same feelings and experiences.
But these feelings and experiences, and more particularly their intensity and what seemed to me their singularity, were inextricably bound up with the cyclic episodes of sadness and irrationality that have afflicted me since I was twelve.
Each episode is different, not only in its duration and intensity, but also in its textures. Sometimes they are preceded by bouts of what is probably hypomania, or close to it – spaces of a few weeks or months in which I feel consistently elated and need little sleep, in which ideas and plans come easily and with confidence. Yet whether or not it is preceded by such an episode, the first sign that the downswing is approaching is usually disturbances in my sleep. At first I will wake early, an hour or two before dawn. Although I am not by nature a good sleeper, there is a particular regularity to these awakenings, often down to the minute, as well as a peculiar sense of stepping out of sleep without warning or transition.
After a few days or weeks, this will be matched by increasing restlessness and wakefulness in the evening. Sleep comes with difficulty, or not at all, leaving me to lie and listen to the circling horrors in my head.
Alongside these nocturnal disturbances, I begin to notice other changes. Sometimes tastes change: flavours I ordinarily enjoy, such as shellfish, mushrooms or Chinese food, become repulsive. At other times I have found myself growing fearful of travel in cars, the potential for death or dismemberment. And then, finally, the shadow will settle, bringing with it anxiety and nervousness, a sense that the tasks that lie before me are insurmountable, a sense of my own uselessness. My emotions become uncontrollable, veering wildly and dangerously out of control. Sometimes it will be anger or frustration that gets the better of me, but mostly it will be sadness and misery, a sense of being enclosed or trapped, of agitation, self-loathing and, most of all, a desire for it to stop – for all of it to stop.
In recent years, the traditional division between what used to be classed as endogenous and exogenous depression has been eroded, replaced by a more nuanced understanding of the complex interrelationship between environmental and biological factors. According to some experts, up to two-thirds of the population possess sufficient vulnerability to become depressed if the right stress factors are in place.
In my case, this vulnerability seems to exist alongside a more cyclic process of fluctuation, a cycle that, like the ‘sea-tides' of melancholy Burton described, I have long assumed to be biological in origin. In part this is a reflection of the fact my family has a history of depressive illness, alcoholism and what my grandfather used to call ‘highly strung' personalities; in part it is a recognition that I suffer from several particular mental tics as well as my bouts of sadness and irrationality. One group is essentially compulsive – counting, creating sums from numbers I glimpse, a maddening and uncontrollable tendency to rhythmically parse sentences in my head as I think or speak, as if I am reading a work of fiction back to myself. These compulsions are related to tiredness and my mental state, worsening when I am depressed, becoming less pronounced when I am not. The other is a repetitive hallucination in which I constantly glimpse people with missing limbs or deformed or injured faces. Usually seen out of the corner of my eye, these people will, when looked at again, be seen to be normal.
Like my moods, this last tendency is transient, manifesting itself for a few weeks or a few months at a time and, for all that I have been experiencing it on and off for as long as I can remember, it remains unsettling to say the least. But it is not unsettling because I am irrational or delusional when it occurs. Rather, it is unsettling precisely because I understand it is an hallucination, at least in its aftermath, and because of the peculiar, creeping horror of seeing that which is not there.
YET IF, AS I suspect they are, my moods are biological in origin, what does that tell me? One answer might lie in the many studies demonstrating a strong association between mood disorders, in particular manic depression and cyclothymia, and creativity. For all that our society has grown increasingly uneasy with the association between what is usually classified as mental illness and creativity, studies have consistently revealed markedly higher levels of mood disorders and suicide amongst creative individuals than in the population at large. One study, carried out at the University of Iowa Writing Workshop, found 80 per cent of the subjects met the criteria for a major mood disorder, as opposed to 30 per cent of subjects in the control population. Other, more rigorously controlled, studies have demonstrated similar results, both in respect of writers in particular, and for individuals who meet more objective tests for creativity more generally.
Similarly, other studies have demonstrated that both mood disorders and creativity are highly hereditable, suggesting a positive and significant link between mental illness and creative ability. Why this might be is unclear, not least because the relationship is a complex one. Simply suffering from a mood disorder does not make one creative, nor is creativity limited to those who suffer from mood disorders. But the two are intertwined, in our genes as well as in our imagination.
But this sort of explanation can only ever be part of the story. Mood disorders are, by their nature, subjective, interior, contagions and afflictions of the self. To be elated, whether in the grip of a creative fervour or for less exalted reasons, is to feel oneself light and quick as fire, to know the unity of thought and action; to be depressed is to feel an emptying out at the heart of things.
Thus the movement between the extremes, whether from the high of mania or from the elevated state most creative individuals associate with lucidity and productivity to the mortification and dissolution of depression, cannot help but reveal the mutability and shifting textures of the self, or to demand of those who experience these changes a degree of understanding of the way the self is itself a sort of fiction, a convenient catch-all for the many aspects that inhabit us all. Keats – who seems to have suffered from the wildly careening moods usually associated with manic depression or cyclothymia as well as the tuberculosis that killed him at twenty-five – wrote of ‘negative capability . . . that is, when a man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact and reason', a state in which it is possible to inhabit other selves and ways of being without judging or defining them.
For my part, this sense of irreality, of the absence of a centre, is a corrosive and often paralysing one. Not for nothing, I suspect, have I returned in novel after novel to characters who shed their names and identities and become other people; not for nothing has my fiction been haunted by a sense of loss, and ending.
Of course, this should come as little surprise. Fiction is, after all, a sort of theatre in which our deepest natures are given voice and substance. Yet the connection is not a simple or a programmatic one. One of the first mistakes most people make when thinking about writing is to imagine it is fundamentally an act of self-expression. This is a mistake made less often when thinking about practitioners in other art forms – painters, composers, photographers – perhaps because these other forms express themselves non-verbally, and so are less easily conflated with the simple act of speaking or explaining oneself.
In fact, the reverse is usually true. In an article published shortly after David Foster Wallace's suicide last year, Daniel Lipsky describes a conversation with Jonathan Franzen about his early encounters with Wallace: ‘We had this feeling that fiction ought to be good for something,' Franzen says. ‘Basically, we decided it was to combat loneliness.' They would talk about lots of Wallace's ideas, which could abruptly sharpen into self-criticism. ‘I remember this being a frequent topic of conversation, his notion of not having an authentic self. Of being just quick enough to construct a pleasing self for whomever he was talking to. I see now he wasn't just being funny – there was something genuinely compromised in David. At the time I thought, "Wow, he's even more self-conscious than I am".'
This sense of being less than real will be familiar to many who suffer from depression. At its worst, it is terrifying – a chasm at the centre of one's self which cannot be bridged; more often, it is simply a sense of absence. Yet it is also, as Franzen himself came to see, inextricably connected to Wallace's writing, his need to use fiction to create a reality that might transcend that absence, which might be authentic. As Wallace himself once declared, he wanted to write ‘stuff about what it feels like to live. Instead of being a relief from what it feels like to live.'
Seen from this perspective, the relationship between writing and mood disorders seems more comprehensible. It is not that being disturbed makes one a writer, nor that to be a writer one must be disturbed, but that for many writers the peculiar pressures associated with mood disorders, the emotional lability and sense of the fragility of the self, the swings and uncertainties in mood, the vulnerability to stress and personal trauma, provide not only the raw material for the process of writing but also the need, the compulsion to control and order the often unbearable pressure of day-to-day existence through the controlling medium of art.
THE LIBERATION I felt upon leaving my doctor's surgery on that day in 2003 arose out of the knowledge that the thing that afflicted me had a name. For almost twenty-five years I had lived with the knowledge that my life would intermittently be dislocated by bouts of what seemed to me close to madness – irrational sadness, agitation, wildly fluctuating moods, acting out. Yet with a single word my doctor had given my condition a name, and told me it was treatable.
But across the weeks and months that followed, I grew less comfortable with the term. In part this was because, like so much of the jargon of psychology, it performs the parlour trick of seeming to offer understanding while actually erasing it. Not for nothing does William Styron rage against it, declaring that: ‘For over seventy years the word has slithered innocuously through the language like a slug, leaving little trace of its intrinsic malevolence and preventing, by its very insipidity, a general awareness of the horrible intensity of the disease itself.'
Nor, as time has passed, have I grown easier with the term. I am not someone with a condition: I am myself. My moods, my inner life, their cycles and their sometimes almost unbearable intensities are not something extraneous, they are part of who I am, of what I am. In The Noonday Demon, Andrew Solomon describes his experience of depression as being intertwined with the other aspects of his nature like the roots of a tree, a feeling I share. I would not be what I am without them, would not know the things I know, could not do the things I do.
Yet for all that my moods are part of me, my knowledge of their extremities, of how easily I can slip, is never far away. I feel it like a chill, shadowing me, even on the brightest days. As Meri Nana-Ama Danquah writes: ‘There are times when I feel like I've known depression longer than I've known myself. It has been with me since the beginning, I think. Long before I learned to spell my name. No, even longer than that. I'm sure that before I could even speak my own name or learn to love the colour of my skin, this hollow heartache was following me.'
More broadly, though, I am uneasy with the collapse of so much of human experience into the rubric of depression. Depression now subsumes so many states and conditions it has become almost meaningless, or would be meaningless were it not for the fact that its expansion underpins the exponential growth in the prescription of powerful psycho-pharmaceuticals and, increasingly, a conception of human nature that is questionable at best, pernicious at worst. Huxley's vision of a society addled on soma and addicted to happiness seems less a fantasy and more a reality with each passing day.
It is, of course, easy to be glib about these questions. As I write this, I am complete, happy, productive, unmedicated. But tomorrow, or the day after, or the day after that this could change as easily as the wind. Would I feel the same then? If I felt that yawning space opening inside me once more, would I be so quick to dismiss the life-buoy of my medication? And what of those close to me? Should they suffer if they find themselves subsiding into depression? If I do not believe there is virtue in pain – and I do not – why try to resist something that will alleviate it?
These are not questions I have answers to. All I know is we as a society are engaged in a social and psychiatric experiment on an unprecedented scale, a project which – whether we see it yet or not – has as its object the elimination of emotional disorder. In its way it is laudable, but it may not be without its costs. For as writers and artists from Shakespeare to Artaud have understood, pain and hurt and the uncontrollable cankers of the mind have always been the fuel for artistic creation. What happens if we medicate them away? Will that mean no more Virginia Woolfs, no more T.S. Eliots, no more David Foster Wallaces?
It is possible, of course, that I am worrying about a form of creativity that is already obsolete. There might be a case to be made that the deep, slow creativity traditionally associated with psychic trauma and mood disorders is a form of creativity with little utility in a world of hyper-consumerism and short attention spans. Maybe the need for that kind of thinking and behaviour is less now, and we can do without it. Just as religion is dying, might not art and creativity be fading?
In my darker moments, this possibility gives me real pause. But in my better moments I know it is wrong, and we are indeed losing something. We should not celebrate pain, nor confuse suffering with virtue, but we must understand that sadness and pain are part of the spectrum of human existence, and that we need them to understand all that is good in ourselves.