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 system — 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 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 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 overtly 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 the 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. . . .
* * *
Hal isn't old enough yet to know 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 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 throughly 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 the most 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, 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 a 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 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 have personally been 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 networks 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, the newand 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 their prayers and wishing her all available joy. Kate Gompert doesn't know whether Mr. Ernest Feaster'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.
— David Foster Wallace, Infinite Jest, pp. 692-998 (Little, Brown, 1996). Footnotes omitted.
When I first read Infinite Jest, around 1999, I felt particularly comforted by this passage. I was comforted at seeing the thing It named and described, but on a more practical level, I was comforted by the reminder that I could always try ECT, and maybe even surgery. (I read about the practice of trepanation with longing.) Something about this thought seemed a little traitorous to me, believing as I did at that point that suicide was wrong. Is there, at the most essential level, any difference between suicide on the one hand, and attempting to erase one's experience with electroconvulsive therapy or psychosurgery on the other? What is the difference, if there is one, between suicide and having one's capacity to feel emotion removed?
I suspect that many people who would want to prevent Ernest Feaster from committing suicide would want to allow him to get his desired emotion-destroying psychosurgery. This, I think, is inconsistent.
The most essential thing another human being is to us is a co-experiencer. To experience ourselves and to have a truly human experience of the world, we need to see ourselves and our environments reflected through the eyes of another person. A body without an experiencer within is but an animate doll, of no use to the doll himself, and by that fact of no morally appropriate use to those who love him.
If we want to offer mercy to a man by ridding him of painful aspects of his experience, how different, then, to allow him to rid himself of all aspects of his experience, if all he experiences is pain? What reason, save religion or cruelty, to force a man to experience pain against his will?