THE NUMBERS ARE SOBERING. In any given year, about 16 million Americans, almost seven percent of the population, experience a major depressive episode: the lifetime risk is 17 percent. Globally, an estimated 350 million people suffer from depression, which, according to the World Health Organization, is “the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.” In the United States, the cost of care and loss of productivity resulting from depression, the leading cause of disability in adults aged 15 to 44, is estimated at $210 billion a year. Depression affects women disproportionally, especially women who have just given birth, and younger people, especially young adults, increasingly. It is implicated in more than half of the suicides in the United States, over 20,000 victims a year. And chronic depression, which affects some three million Americans, can — and often does — last a lifetime.

The news isn’t all bad. In the majority of cases, depression can be successfully treated. We live in a golden age of scientific research and pharmaceutical breakthroughs, and there’s a growing awareness of the disease. And it is a disease, not laziness or lack of initiative, not a willful choice, although one of the most maddening things about depression, especially in our intensely competitive society, is the way it is often conflated — not only in the minds of the general public but also in the minds of the people who suffer from it — with these (and other) negative traits. But depression, with its wide range of symptoms, is notoriously cagey. Hopelessness, lethargy, loss of productivity; the inability to feel pleasure, sexual or otherwise; sadness, guilt, irritability; hypochondria, insomnia, and suicidal thoughts. The symptoms of depression impact nearly every aspect of life — work, family, friendships, self-esteem. It pushes people into the shadows, which makes them difficult to reach and treat. It takes a heavy toll on people who are close to those who suffer from it. And it has a dramatic effect on future generations: the chances that the child of a depressed parent will suffer from depression are two to four times as high as that of a child whose parent is not. I’m no mathematician, but if you run the numbers, it seems like a heavy cloud could eventually cover the nation; that, bit by bit, we’ll all become depressed.

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There are ample references to depression in the letters, journals, and biographies of writers and artists, who seem to suffer from it more frequently. In fiction and poetry, it’s an age-old theme. But there are few chronicles of the actual experience of the disease, which seems dauntingly difficult to write about. As William Styron said in Darkness Visible, his 1990 memoir of a crippling depression he went through at the height of his career, the disease is “so mysteriously painful and elusive in the way it becomes known to the self — to the mediating intellect — as to verge close to being beyond description. It thus remains nearly incomprehensible to those who have not experienced it in its extreme mode.” Depression, you could say, has a PR problem, which makes it difficult for people to understand the disease, empathize with those who are suffering from it, and help them get the care they need.

My own example, I think, is instructive. It wasn’t obvious to me at the time, but it’s clear, in retrospect, that I lived from an early age with a person who was deeply depressed. In my 20s and 30s, I went through two intense, if short-lived, depressive episodes. Yet none of these experiences proved to be of much use when it became clear that someone close to me was suffering from — sometimes drowning in — a stubbornly chronic depression. My ignorance (or willful denial) of the disease often led to anger and frustration. I had a limited ability to understand, tolerate, or confront the problem. Thankfully, this period in my life coincided with a small but powerful wave of books about depression, many of them personal narratives, that began to surface in the 1990s, the writers helped along, in some cases, by successful first-generation selective serotonin reuptake inhibitors (SSRIs) like Prozac that revolutionized the treatment of depression and enabled many of the people who suffered from it to step back from the brink, recover enough to return to their daily lives. In the wake of Darkness Visible, there was Elizabeth Wurtzel’s memoir-cum-cultural critique Prozac Nation, Andrew Solomon’s excellent (and exhaustive) tome The Noonday Demon: An Atlas of Depression, Rick Moody’s free-ranging “memoir with digressions” The Black Veil, which — a digression of my own — has one of the most powerfully unexpected endings of any book I’ve ever read, and W. G. Sebald’s seemingly autobiographical fiction.

But the writing that I most remember from that time — I’d say it marked the turning point in my ability to think and talk about depression in a frank, everyday way — was Daphne Merkin’s 2009 New York Times Magazine article, “A Journey Through Darkness: My Life with Chronic Depression,” which recounts Merkin’s history of depression and the details of a particularly bad episode she’d gone through a few years before, including hospitalization and thoughts of electroconvulsive therapy (ECT), one of the last resorts in severe, treatment-resistant depression. In page after page of simple, lucid prose, Merkin turns a writerly eye on the minutiae of her experience — we see the “baldfaced clock” and “run-down pay phones” in the hallway when she first arrives at the locked hospital unit; we hear the stark lingo of psychiatric hospitals where “storks” are anorexics and “sharps” are objects the patients could use to harm themselves. Throughout the piece, Merkin writes with unflinching candor about her thoughts and emotions — the “Coleridgian suspension of disbelief” she strives for on a brief sojourn in the hospital garden, the envy she feels toward a young female doctor whose wedding ring suggests a full and happy life. By the end of the article, Merkin has accomplished what Styron said was so hard to do: she makes depression intelligible. I still remember the clarity — the relief — I felt when I read this piece. It quantified the horror, brought it into the light, made light of what could be made light of, gave the reader a vocabulary — the vocabulary of everyday life — to use to talk about it, codify it, begin to think about how to best live with it or live with someone who was suffering from it.

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For more than 30 years, Daphne Merkin has been an astute observer of literary and cultural life in the United States, especially New York, her native city, where she’s also worked as an editor. She is the author of a novel and two critically acclaimed essay collections and has written with wit, verve, and a finely honed intelligence for numerous publications — from The New Yorker to Elle to the Partisan Review — about a myriad of topics including writers, actors, women, Hitler, spanking, and the Song of Songs. Her latest book, This Close to Happy: A Reckoning with Depression, was just published by Farrar, Straus and Giroux. Building on her New York Times Magazine article and an earlier piece in The New Yorker called “The Black Season,” This Close to Happy chronicles Merkin’s lifelong struggle with depression; its origins in her unhappy childhood; its effects on her life, family, and career; and the many ways she’s tried to keep it at bay.

Merkin grew up in Manhattan, one of six children of successful German Jewish parents. Her mother, whose love and attention she perennially longed for, was often cold, sometimes cruel; her father was distant, her siblings unsympathetic; and the children were cared for by an overworked nanny who was frequently abusive (it seems to have only happened once, but there’s a scene of the nanny banging Merkin’s head against the wall that is very difficult to read). The family was well-off — her parents were philanthropists who spent a lot of time working for Jewish and Israeli causes — but, according to Merkin, they often skimped on basic things like food and clothing for the children. Whether this was an expression of the more frugal and formal European norms her parents had been raised with or some deep-seated psychological neglect, intentional or not (Merkin’s mother, who barely escaped “her beloved Frankfurt,” may have suffered from survivor’s guilt and/or depression herself), these contradictions spelled trouble for Merkin, who, from an early age, envied her classmates their warm homes and generous American families. By the time she was eight, Merkin suffered from insomnia, anxiety, dread, and loneliness and was such an “unstoppable fount of tears” that she was hospitalized for psychiatric observation. Over the next few years, she took refuge in the homes of friends (who nonetheless continued to fill her with envy), saw a psychiatrist, and immersed herself in books and literature. She eventually went to Barnard, became a writer, married briefly, and had a daughter, whose appearance in the book is almost always an occasion for love and hope and joy. Still, as Merkin says, “unhappy childhoods […] tend to stay with you,” and she repeatedly returns to scenes from her early life, especially the many entanglements she had with her mother, to tease out their relationship to the chronic depression that continued to plague her as an adult.

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The book gets off to a rocky start — Merkin jumps around a lot, trying out an awkward second- and third-person narration before settling comfortably into a more obvious first — but after that, she moves easily between the present and the past, between her personal story and the more general observations and concerns she has to share about her disease.

Above all, Merkin, like Styron, wants us to understand what it means to be depressed. In scene after scene, she shows us how insidiously depression invades her thoughts, the impact it has had on her career, and the many ways it strains her relationships with family, friends, and lovers. Some of the book’s most dramatic moments have to do with Merkin’s daughter, Zoë. When Zoë is born, Merkin is thrilled, but she soon falls into a severe postpartum depression that lands her in the hospital. Her symptoms include the recurring thoughts she has about harming Zoë, something Merkin does not shy away from showing us:

Part of me loves Zoë and everything about her […]
But I also feel hemmed in by her, overwhelmed by the constant presence of such a needy being. And right underneath this feeling, I feel enormous rage at my own unabated neediness […] Surely there is not room enough for both of us in this world […] Surely she’d be better off if she’d never been born. I envision cradling Zoë’s tiny body in my arms and pushing her head under the bathwater, how trusting she would be.

It’s one thing to talk about drowning yourself, as Merkin does elsewhere, quite another to document such graphic thoughts about drowning your newborn daughter, and scenes like this are a testament to Merkin’s commitment to capturing the grim distortions that depression can produce. One of the pleasures of the book — and there are some pleasures — is seeing Merkin rally in defiance, as when the distaste she feels for a rude psychiatrist who tries to convince her to undergo ECT, which she’s been desperately trying to avoid, momentarily stirs her out of her torpor: “Back off, lady. I’m not quite the pushover you take me to be.

Merkin eventually recovers from this episode and, although she will be hospitalized several more times before her daughter goes to college, there are plenty of good times as well (unlike her own mother, Merkin comes across as a warm, gregarious mother who carefully tries to shield her daughter from the worst of her depressions even as she sometimes leans on her existence as a reason to go on). But as Merkin points out, even when you aren’t in the thick of it, depression is always lurking in the background, waiting to reappear. And when it does, you’ve got to put everything on hold to deal with it, as we see in a scene that takes place on New Year’s Eve, when her daughter is a teenager. Merkin is feeling lousy, on the edge of depression, trying to talk herself out of it:

I stare into the exploding bursts of color: red-white-blue, squiggles of green, streaks of purple, balls of silver, sparks of champagne. Zoë is standing nearby, with my friend B., and as I look into the fireworks I send out entreaties into the sky. Make me better. Make me remember this moment of absorption in fireworks, the energy of the thing. Stop listening for drum rolls. Pay attention to the ordinary calls to engage, messages on your answering machine telling you to buck up, it’s not so bad—from the ex, siblings, friends who care. Make me go forward.

For those of us who’ve lived in close proximity to depression, this recurring loop of doom and reassurance is an everyday — often hourly — occurrence, as is the dreadful experience of being in the ghostly presence of someone who, caught up in what a friend of mine calls “maintaining,” is there but also not.

In addition to showing us what it’s like to experience the disease, Merkin talks about how depression is perceived — the way people blame you or are blind to what you’re going through. (I was disturbed as I read by the way I sometimes tried to diagnosis her, to “help” or second-guess her — if only she would do this, why doesn’t she do that? — it’s a common impulse.) She also talks about shame, especially the shame of going public with the illness. She talks about loneliness — what it feels like when your friends and family can’t listen to you anymore — and she talks about pain, a pain that’s almost physical, a point that’s driven home late in the book when she’s prescribed small doses of OxyContin by one of her shrinks “on the sly.” Nor does she shy away from talking about suicide or cataloging her own wide-ranging suicidal thoughts, reminding us in an early section of the book, one that almost reads like a mantra, of people who have gone ahead and done it — well-known figures like Robin Williams and Virginia Woolf (in one of the book’s creepier moments, we learn that Merkin’s mother once gave her a Virginia Woolf doll, whose pockets she would sometimes fill with stones) as well as anonymous victims like the woman with “two inches of gray” in her roots who jumped off the roof of a friend’s building on the Upper East Side. Styron does something similar in Darkness Visible, and it’s not just to feel less alone. Both writers do this, I think, to bear witness, to remind their readers, that despite their inordinate focus on their own problems — a regrettable reality of depression — they’re not just talking about themselves.

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Late in the book, offering up some terms by which we might judge her account, Merkin, who is rereading Play It as It Lays, has this to say about Didion’s depressed protagonist:

Can you be Maria Wyeth, a laconic thirty-one-year-old divorcee who cruises the freeways of Los Angeles to escape her pain, and an astute observer of Maria Wyeth at the same time?
That is my dilemma in a nutshell.

It’s a valid question to ask of any memoir, especially one that’s about something as all-consuming as depression. And in this sense, Merkin sets herself a tricky task — to be depressed is to be repetitive, unable to entertain an alternative point of view, trapped within a maddening insistence on one’s misery — and there are times when, instead of stepping back to observe her depression, she gets bogged down in it. She revisits too many events in her early life one-sidedly, harps on family members who did her wrong, some of whom we later see caring for her in her worst moments. When Merkin quotes her mother in the eulogy she gives at her mother’s funeral — “remember: no one wants to hear another word about your childhood” — you have to chuckle (although this is only because Merkin’s mother has evolved, over the course of the book, from a cold, unlikeable antagonist to a sympathetic character who takes care of Merkin, faces illness and old age with dignity, and seems to be carrying around some baggage of her own, all of which we know because Merkin is a good writer who can create and sustain a complex arc of character). Still, “[o]ne is what one is,” as Kay Redfield Jamison, a clinical psychologist and author of An Unquiet Mind, an excellent memoir about manic depression, says about her decision to reveal her illness publicly. And if Merkin, of a younger, more open generation than her mother, American not European, secular no longer Orthodox (as she was raised), may sometimes lack perspective, may occasionally be messy, her messiness, I think, is not only illustrative of a certain reality of the experience of depression, one that no honest account of it can avoid, but also part of a larger trend of hard-won transparency that has been essential to important social changes including the recognition and treatment of mental illness in this country.

That said, Merkin’s occasional lack of perspective can be jarring. She’s aware of the economic privileges she’s had in life (not that they make up for the emotional turmoil she suffered as a child), but she does little to contextualize her family’s socioeconomic situation, and I wonder how much of her upbringing, on which she blames a lot of her depression, was part and parcel of upper-class mores of the time. My mother has similarly miserable stories about her Waspy upbringing: a cold, absent mother who pitted her children against each other; soggy egg salad sandwiches for lunch, straight from the freezer; an appalling lack of supervision. And what about Merkin’s parents’ philanthropy, which consumed so much of their time? Who were they helping? War refugees? Merkin’s family life was obviously tumultuous, but how might something like that weigh against her unmet needs?

The devil is in the details, and some readers will lose patience with the juxtaposition of the emotional privations Merkin so painstakingly describes and the privileges she so casually reveals: the summer houses, the chauffeurs, the trips to Europe and Israel. Most galling is when she complains about a three-bedroom apartment on the Upper East Side that her parents help her and her husband buy. In exchange, her father insists they keep kosher, which, being unobservant, they refuse to do, but they get the apartment anyway even though Merkin is furious with her father and doesn’t like the apartment, which “boasted an imposing entry that gave the impression of leading on to a much larger apartment than it actually did.” On another note, she’s inexplicably hard on her ex-husband, mocking him for seemingly insignificant (and intimate) things like the underwear he buys for their wedding night, his love of papaya, and his insistence on feeding their daughter broccoli. And when, in a passage about her nieces and nephews, she mentions a game she invents in which she plays the role of a tyrannical headmistress vaguely reminiscent of her abusive nanny, we marvel that she doesn’t see the irony.

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Still, these moments do little to diminish the power of Merkin’s depiction of her valiant struggle against depression, which comes across as a truly monstrous character: insidious, shape-shifting, relentless, unforgiving. And Merkin is not just interested in her own experience. She’s particularly cognizant of the connections between depression and gender. She grew up in an Orthodox family, where “the ‘boys’ […] seem to have done better than the ‘girls’” and regrets that, as a girl, she wasn’t allowed to participate more fully in religious life, which appealed to her intellectually, a slight that feels more devastating when we learn that shul is one of the few places where her depression sometimes “evaporates.” She connects depression to childbirth and onerous social judgments about women’s appearance and their relationships (or lack thereof) with men; in a particularly insightful section, she mines the differences in the way men and women think and write about depression. Most of these ideas aren’t new, but Merkin particularizes them in a way the prevailing discourse often fails to do.

She also raises important questions about the way depression is treated. Most experts agree that depression is caused by a combination of biochemistry, family history, and larger social forces, but it’s difficult to understand how these forces interact to trigger a depressive episode. Worse, we don’t understand how some of the medications that are used to treat depression actually work, if and when they do. So, as Merkin rightly points out, if you don’t know what you’re treating — nature or nurture, a chemical imbalance or childhood trauma — and you don’t know how the medication works, how do you know how to treat it? There’s a difference between a doctor tweaking a medication for an illness like high blood pressure, which can be quantitatively measured, and a doctor making decisions about a withdrawn or potentially suicidal patient, whose symptoms rely on self-reporting. When people who are depressed spiral into crisis, even those who are lucky enough to have access to regular psychiatric treatment, family and friends are often left to bolster and/or judge their loved one’s fragile attachment to life: it’s one of the most frightening aspects of the disease. Furthermore, doctors themselves, even when their patients stick with them (which seems to be an issue with chronic depression), are far from perfect, as we see in several disturbing examples that Merkin describes, including a therapist (and hospital director) who tells her that her husband isn’t “up to” her, that she “deserve[s] something better” when she is hospitalized with postpartum depression and her husband is home taking care of their infant daughter. In this regard, there are episodes in the book that are truly alarming: times when I feared for Zoë, for Merkin, for the tiny sliver of hope that kept her from jumping out the window, throwing herself in front of a bus, or slitting her wrists in the bathtub, all ideas she has entertained at various points in her life.

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I’ve talked about some grim realities in this review, and Merkin talks about them too, but This Close to Happy is more than a memoir of mental illness. Merkin is a good writer — perceptive, provocative, relentlessly interrogative of her own experience — and despite her difficult subject matter, she does, in this memoir, what good writers do: she sends urgent, cogent dispatches from another world, a protracted battlefield that we might not otherwise know about. And make no mistake about it: depression is a battlefield. At stake are lives, careers, marriages, and children’s futures. When depression hit my family, threatening to unravel the rich and busy life we’d begun to build for ourselves, it was writers like Merkin (and Styron and Wurtzel and Solomon) who enabled me to see and understand the nature of the beast in ways I’d been unwilling or unable to do: I wish I’d read them sooner.

Depression isn’t easy to treat. It’s not easy to live with, in oneself or others. It’s not even easy to recognize, if you don’t know what you’re looking for. But it’s all around us, and the number of people who are affected by it is growing exponentially. Read the book. Make it part of your vocabulary. Be on the lookout for depression in your life and the lives of those around you. You never know when you’ll need to understand the story Merkin so generously shares with us here.

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Lisa Fetchko has published essays, fiction, reviews, and translations in a variety of publications including Ploughshares, n+1, AGNI, and Bookforum. She teaches at Mount Saint Mary’s and Orange Coast College.