Literature comforts in a way clinical definitions and diagnoses cannot. It can help people recognize the symptoms of mental illness in themselves long before the predator of suicide pounces. Kristen Davis Schwandes explains why it is vitally important for writers to accurately portray the thought processes involved in mental illness.
A history of severe clinical depression provides me with a finely tuned B.S. detector when it comes to fictional characters who have mental illness. I can tell if they were written by an author who has or has not experienced the symptoms her- or himself. As writers, we have a sacred responsibility to accurately portray the mental processes involved in psychiatric disorders. We must also continually update literature with the most current treatment methods. This can be a matter of life or death.
Part I: Symptoms
Suicide never rears its head out of nowhere. It lurks, stalking its prey’s consciousness for years, waiting for the opportunity to present itself as the best option.
For much of my life, I thought I was destined to die by suicide. I absolutely did not want this fate, but as a teenager I began to feel the painful thought processes that led me in that direction. This mounting pain was both relieved and compounded by stories I read and heard—in literature and in literary lore.
Throughout my teenage years and much of college, I felt paralyzed and unable to tell anyone about my daily mental experience. I had frequent thoughts of death and dying, of profound aloneness, of hopelessness, of different methods I could employ to end or at least dull the abstract pain in my head. But these thoughts were too inconvenient, too embarrassing, too shameful to admit. Guilt compounded my shame because I had all the external factors in my favor: a loving family, a few close friends, a safe community, success in school. I would not learn the biochemical cause of my depression until many years later.
While growing up, as we all do, I looked to stories for guidance on how to conduct my life, searching for clues in both literature and hearsay as to how I might wind up. Secretly, I identified with stories about other people like me—fictional characters and the writers who created them who are all labeled sensitive, creative, literary, and crazy.
These stories were electrifying and horrifying to me. On the one hand, they made me feel less alone: at least there have been others like me; I am not the only one. But on the other hand, I witnessed their unhappy fates. If they did not live in isolation (J.D. Salinger), they were either institutionalized (Zelda Fitzgerald) or died by suicide (Sylvia Plath, Virginia Woolf). It seemed inevitable that at some point in my life, these would be the only choices I would have.
By age 20, I was a full-fledged English major at Duke University. I never contemplated studying anything else because literature was my lifeline. I felt more connected to characters and the authors who created them than to anyone in my daily life—mostly because the characters were honest about their interior experience. But by junior year of college, not even literature could keep me from spiraling. In addition to my depressive thoughts, I had daily anxiety attacks. I lived in terror, thinking that someone was going to break into my apartment and kill me, or worse, that I would be kicked out of school because I was crazy. I was on the verge of my suicidal destiny; the lurking monster was inching closer.
I sought treatment. I tried anxiety medication. But I still could not admit my suicidal thoughts to anyone. I felt like I was standing in a vacuum of empathy. Until I read one of my assignments for my class on fairytales.
Reading the German story “A Wondrous Oriental Fairy Tale of a Naked Saint” by Wilhelm Heinrich Wackenroder, I connected to someone who understood my condition deeply. The title character, the Naked Saint, lives in a cave and cannot do anything but dwell on the “turning wheel of time.” He goes outside only to yell at other people who are preoccupied with petty amusements, such as talking with other people. The cave metaphor described precisely how I felt. He understands! Wackenroder totally gets it!
Later that day, I met up with a friend who had no idea I was depressed. But now, I had a socially acceptable avenue through which I could voice my thoughts.
“So, I read a really cool story for my fairytales class today,” I said.
She was interested. I explained my deep connection to the character. A small fraction of the depressive weight in my chest lifted. Literature had formed a bridge for me between this man who lived in the 18th century and my living, breathing friend who sat next to me in my car. For the first time in years, I had hope that others might understand too.
That summer, I tackled my depression like a full-time student. I saw a new psychiatrist and started taking an antidepressant for the first time. I read every book about mental illness I could get my hands on: The Bell Jar; Girl, Interrupted; Prozac Nation; An Unquiet Mind.
Literature helped me build a community for myself of people who I believed would understand me, even if my only contact with them was through their printed words. Elizabeth Wurtzel’s stability she achieves with Prozac inspired me to stay on my newly prescribed medication. Kay Redfield Jamison’s acceptance of her bipolar illness gave me hope that perhaps I would someday be able to be as candid about my experience.
Literature comforts in a way that clinical definitions and diagnoses cannot. It can help people recognize the symptoms of mental illness in themselves long before the predator of suicide pounces. This is why it is vitally important for writers to accurately portray the thought processes involved in mental illness. Identifying with the writers and characters mentioned above helped me realize my dark thoughts were not unique to me and were not my fault. They were symptoms of a disease that could be treated and managed and discussed with other people.
This genuine connection with others is essential to the process of surviving and healing from mental illness. Therefore, we writers who struggle with mental illness need to be forthright about the daily reality of our interior lives. It's also essential that writers who have not experienced it firsthand must dedicate themselves to thoroughly interviewing people who have. It is not sufficient to merely consult “expert” psychological professionals. Anyone who struggles with mental illness is an expert on their own experience.
Part II: Treatment
My story does not end there. Openness and connection are vital, but not everything. One must also have one’s proper chemicals, I will learn; otherwise, the brain may not be capable of openness and connection.
In 2010, I graduated from Duke and remained on my prescribed medication for four happy, stable years. I told my family members and close friends about my depression. I wrote a book about my experience, hoping to return the favor that all the authors had given me, hoping that talking and writing about suicidal thoughts would banish them for good.
I was wrong.
Just before starting graduate school for journalism, I told my doctor that I wanted to get off of my medication. I was tired of side effects and thought I didn’t need it anymore.
About a month into grad school, the depressive monster returned, and so did the anxiety. I couldn’t concentrate. I couldn’t keep any food down except yogurt. I couldn’t sleep more than three hours a night. I had daily suicidal ideations.
I tried going back on my original medication, but it did not help. My personal archive of stories about other depressives included some about people who had gone off their effective antidepressants, tried to go back on, and then killed themselves because the meds didn’t work anymore—such as David Foster Wallace and also an uncle of mine. My mind told me that this, too, would be my story. I had no other narrative option.
More than ever, suicide was poised and ready to attack.
I had to drop out of graduate school, feeling like the ultimate failure. I attempted suicide, like I always knew I would.
But I also tried everything in my power to help myself. I did not want to die. I just wanted the thoughts to stop. For nearly two years, I was hospitalized in seven different psychiatric facilities in five different states. I underwent two rounds of intensive electroconvulsive therapy. I took over 15 different types of psychotropic medication. I saw over 20 different mental health professionals. Some were compassionate; others treated me like scum.
Throughout all this, I turned to literature. I read and reread books on mental illness, seeking examples of effective treatment. All I could find was medication, talk therapy, and electroconvulsive therapy—none of which did me much good.
Both literature and the medical establishment had failed me. I lost hope that anything could help me. Until I met one progressive psychiatrist who changed everything.
This psychiatrist reassured me that my thoughts were treatable symptoms, not a death sentence. Instead of prescribing medication based on trial and error, he gathered objective data. He performed a blood test that indicated that my serotonin levels were drastically low. Serotonin is the essential “happy chemical.” He also insisted that I get genetic testing, so he could prescribe the precise medications that would work for my brain chemistry.
My genetic testing results revealed precisely why I had gone through what I did. My brain cannot produce adequate amounts of serotonin on its own, especially when I am stressed. My psychiatrist explained that I was indeed destined for a major mental health crisis, and that destiny had been written on my DNA all along.
Based on this information, my doctor prescribed me a new antidepressant that I had never tried before. Over the next few months, the suicidal ideations backed away, slinked off, then vanished.
The new medication and the information genetic testing provided gave me the stability I needed to rebuild my life and create a new narrative for myself. I returned to graduate school—this time for speech-language pathology—and now I am working in the field as well as writing a book about my experience with genetic testing.
The canon of literature on mental illness needs more stories of triumph with the help of the newest technology available. Literature must not only realistically portray the symptoms of mental illness but must also evolve with current science to reflect the most up-to-date treatments. These stories must be told so that people know the full range of narrative outcomes open to them, for we all need stories of light to follow. Finally, for perhaps the first time in human history, we have the medical technology that can stop the incessant stalking of suicide. Those of us who struggle with clinical depression no longer need to fear a destiny that may seem warped by mental illness. It is possible to take control, write the stories we want to write, and live the stories we want to live.
Part III: Literary Critique
As I read more and more books whose main characters have mental illness, I discovered that there is a distinct difference between the way depressive thought processes are portrayed by authors who were inspired by their own experiences and those who were inspired by others’ experiences. The fictional works Thirteen Reasons Why and One Flew Over the Cuckoo’s Nest, which were both written by authors who observed mental illness rather than experienced it, do not come nearly as close to capturing the reality of what goes on in the mind of a severely depressed person as works such as The Bell Jar, Girl, Interrupted, and Prozac Nation.
One Flew Over the Cuckoo’s Nest describes mental illness as a sort of “fog” in the mind, and even at one point the narrator states that slipping into the “fog” is not painful. This could not be further from the truth. Feeling like you are not in control of your own mind is extremely painful, even though it is an abstract kind of pain. The author, Ken Kesey, also seems to frame mental illness in a very misogynistic manner, as if it can be cured by exerting dominance over women. One character states, “… man has but one truly effective weapon against the juggernaut of modern matriarchy…” and reveals that this weapon is sexually mounting the “oppressor.” Really, Ken Kesey, in 1960’s America there was a “matriarchy” that needed overthrowing? What society did you live in?
Thirteen Reasons Why makes the mistake of presenting suicide as if there must be a cogent narrative of perfectly rational “reasons” for making that choice. The main character, Hannah, who recites her “reasons” for choosing suicide, presents her story in a clear, detailed manner. This is virtually impossible for a person who is truly suicidal. The pain in your mind is far too strong and overpowering to be able to narrate such a story. Severe depression is an inherently irrational, not rational state. Furthermore, the predominant “reasons” for depression are usually not external circumstances. Often, the underlying reason is brain chemistry. It is a genetic predisposition, which is exacerbated by environmental circumstances. “Reasons” for suicidal thoughts are concocted by the mind in order to try and justify the hopelessness to which is already prone.
The works written by those who experienced depression, on the other hand, vividly portray the true symptoms of a clinically depressed mind. Below is a list of thought processes with which I could identify while I was depressed.
The Bell Jar:
- Preoccupation with death
- Empty, aimless feeling
- Feeling lack of autonomy
- Easy crying—sadness is not proportional to the stimulus
- Fear of unstructured time
- Inability to concentrate, even on things that you enjoy and are good at
- Lack of hygiene: “The reasons I hadn’t washed my clothes or my hair was because it seemed so silly.”
- Inability to sleep
- Preoccupation with time: “I saw the days of the year stretching ahead like a series of bright, white boxes, and separating one box from another was sleep, like a black shade. Only for me, the long perspective of shades that set off one box from the next had suddenly snapped up, and I could see day after day glaring ahead of me like a white, broad, infinitely desolate avenue.”
- Thinking about suicide methods
- Recognizing symptoms in clinical description of depression
- Not wanting to be a burden on family
- Yearning for release from consciousness
- Slow build up through time to suicide attempt: “Suicide is a form of murder—premeditated murder. It isn’t something you do the first time you think of doing it. It takes getting used to. And you need the means, the opportunity, the motive. A successful suicide demands good organization and a cool head, both of which are usually incompatible with the suicidal state of mind.”
- Internal debate about whether or not to kill yourself; extreme internal reactions to seemingly innocuous stimuli: I think many people kill themselves simply to stop the debate about whether they will or they won’t. Anything I thought or did was immediately drawn into the debate. Made a stupid remark—why not kill myself? Missed the bus—better put an end to it all. Even the good got in there. I liked the movie—maybe I shouldn’t kill myself.”
- Overwhelmingly negative mindset, blaming the world: “My hunger, my thirst, my loneliness and boredom and fear were all weapons aimed at my enemy, the world… [My sufferings] proved my existence. All my integrity seemed to lie in saying No.”
- Heightened sensitivity, easily overwhelmed by stimuli: “There is too much perception, and beyond the plethora of perceptions, a plethora of thoughts about the perceptions and about the fact of having perceptions.”
- Brain concocts reasons for feeling the way it does: “[The mind is] full of claims and reasons. ‘You’re a little depressed because of all the stress at work,’ it says. (It never says, ‘You’re a little depressed because your serotonin level has dropped.’)”
- Self-harm: Face scratching as a way to remind her that she was in pain, even though nobody else could see it.
- Negative, self-defeating thoughts: “No one will ever love me, I will live and die alone, I will go nowhere fast, I will be nothing at all. Nothing will work out.”
- Family history of depression
- Dwelling on death and methods of suicide, but don’t really want to die
- Overanalyzing family dynamics, searching for cause of depression
- Moving to new places and trying to run away from depression
- Lack of hygiene, questioning taking showers: “You know you’ve completely descended into madness when the matter of shampoo has ascended to philosophical heights. So far as I’m concerned, the last shower I took is the last shower I will ever take.”
- Thinking depression is intrinsic part of who you are: “I loved it because I thought it was all I had. I thought depression was part of my character that made me worthwhile.”
If you or someone you know has been experiencing these symptoms of depression, please seek treatment. Thanks to genetic testing, there is an effective way to prescribe medication that can help. Genetic testing also provides information you can use to keep yourself healthy throughout your entire life. Please see “Get Help” on my website for a list of action steps you can take to get genetic testing and start getting healthy. The website also contains more about my story and some FAQ’s about my experience with mental illness, genetic testing, and psychotropic medication.