In a locked psychiatric facility you’re obliged to keep living — unless, that is, you’re extraordinarily desperate and creative about instruments of self-destruction: a half-pint milk carton, a Chutes and Ladders game board, a plastic spoon. Your safety and well-being are the staff’s primary concern. If you’re suffering from severe depression, like me, you may not consider this a benefit. If you believe your depression is incurable, you may even feel deprived of the one escape you had. Life is hard, and then you can’t kill yourself.

In the autumn of 2003, at the age of thirty-seven, I find myself entering such a facility in New York City, four hundred miles from my home in Morgantown, West Virginia. My brother-in-law works as a psychologist in a different section of the same hospital and has arranged for me to be part of a group that receives free care in exchange for being available, though not obligated, to participate in experimental treatments and drug trials.

On my first day I attend Art Therapy. The eleven other patients and I click self-portraits with an old camera, then watch the pictures develop in a darkroom. The smell of the chemicals reminds me of the basement darkroom my father, a journalist and photographer, used three decades ago.

For most of my life I have feared and distrusted my father. As a young parent he had a temper and was often hard on me. When I was in elementary school, he once left the kitchen trash can on my bed after I’d failed to haul it to the curb the previous night. When I was thirteen, he sold me his lawn mower for my budding lawn-care business but didn’t refund any of the money I’d paid him when, two weeks later, it broke down. (“Looks like I got the better end of that deal,” he said.) He’d been a college athlete, and when, as a high-school student, I veered away from baseball and basketball and toward books, he didn’t hide his disapproval. As he’s aged, however, he’s become more easygoing and more interested in me. These changes make me hopeful about the future of our relationship. But now the kidney cancer he thought he beat a couple of years ago has metastasized, and he is dying.

I suspect my father’s cancer is one reason for my recent slide into a profound and hope-killing darkness. Other possible reasons? The recent death of my maternal grandmother, who loved my poetry. A creeping sense that my two young daughters will inherit a world so damaged by global warming and terrorism as to be unlivable. My apprehension about my body’s decline. Or perhaps I owe my depression only to the chemicals in my brain, which I’m told have become unbalanced, like a canoe in which one of the paddlers has suddenly stood up and stomped his feet.

When my self-portrait is fully developed, I see my father’s chin and my mother’s cheeks but nothing of myself. The art therapist asks us to use magic markers to color our black-and-white photos. I use a single marker: blue.

A recovering drug addict named Adam, who also lives in the facility, is mystified by my condition, especially when he discovers I’ve written and published two books. “You can’t feel sad if you’ve written two books!” he announces. He prints pages from Amazon’s website to attest to my accomplishments and tapes them to the wall of my bedroom: reminders of a life I’m convinced I’ll never recapture. They only reinforce my depression.

Adam is my height (six feet) but ten years younger and thirty pounds heavier, with a fringe of black beard. He lusts after Erica, one of the nurses. He confides to me that when blond, buxom, soft-spoken Erica is behind the counter distributing medicines, he sometimes knocks his pills to the floor just to see her bend over to retrieve them. “You should try it,” he says, grinning. I remind him I’m married. I don’t tell him that if my sex drive were a car, it would be sitting abandoned on the side of the road, rusting.

Adam is glad he’s a drug addict, he tells me, instead of a depressive. “Your misery,” he says, “is worse than mine.” I’m not sure it’s so clear-cut. One night, while I’m struggling to sleep, I hear the heroin addict in the room next to mine vomiting and defecating with a violence I wouldn’t have thought possible. His agony lasts for hours.

Before long Adam’s affections shift from Erica to Emily, a twenty-year-old anorexic. Emily and her fellow anorexics participate with the rest of us in groups — Art Therapy, Self-Esteem, Readjustment to Society — but they must spend an hour after every meal confined to the day room, under a nurse’s watchful eyes, lest they sneak off to the bathroom to throw up. As they show signs of recovery, they are allowed small privileges, such as the right to visit the cafe on the third floor. The cafe is the site of Adam and Emily’s dates. After a couple of weeks, however, Adam confesses to being bored. “It’s so easy,” he says. “She’s so full of longing. They all are.”

Despite their alarming thinness, the anorexics are beautiful. Among themselves they seem to speak a secret language. I don’t know whether it’s the language of anorexia or simply of youth. None is older than twenty-one.

The Readjustment to Society group, whose name might have been invented by George Orwell’s Ministry of Truth, is run by a short woman in her late sixties named Mrs. Edelstein. She wears glasses and looks as if she might once have taught second grade. One morning she asks each of us to recount something joyful in our lives. I can’t complete the assignment. To conjure such a moment from my past is also to mark how far it is from how I’m feeling now. When it’s my turn, I say, “I don’t remember.”

“You must remember something joyful,” Mrs. Edelstein says. “What about the birth of one of your daughters?”

“After my second daughter was born,” I say, “I sat in a chair at the foot of my wife’s hospital bed and thought, Now I know who will bury me.” As I tell it, the anecdote seems morbid, and maybe unintentionally funny. But, in fact, the thought had been peaceful: My wife and I planned to have no more children. Our family was complete. Should death allow my children to outlive me, I knew who would be at my graveside.

Mrs. Edelstein looks at me with concern. “What about the birth of your first daughter?” she asks.

“I cried,” I say. The session ends before I can specify that they were tears of joy.


Because it’s a teaching facility, I see dozens of psychiatrists-in-training. I have the same conversation countless times:

“How are you feeling?”


“Have you noticed any change in your mood?”


There’s one exception. A month into my stay, I am seen by a psychiatry resident who has a degree from Harvard, like me. Instead of asking how I feel, he asks what year I graduated, where I lived on campus, and whether we might know anyone in common. We trade names but find no mutual connections. It’s the kind of awkward conversation I usually have with people at parties or conferences, and it highlights the gap between where I think I, as a Harvard graduate, ought to be and where I am. (Of course, more Harvard grads have ended up in the nuthouse than in the White House.)

During free hours, when I’m not pacing the hallways — the medication I’m being given makes me unable to sit still for long — I occasionally participate in the residents’ favorite card game: Crazy Eights. (Only much later will I laugh at the irony of our choice of leisure activity.)

The Recreation group is held in a basement gym run by a man in his midtwenties named Pedro. I go there and play basketball by myself, pretending, as I did when I was eight years old, to be different players on a team that competes against NBA all-stars. I revive my made-up dream team’s players: Carl “Peanut” Carson, Alex “Shorty” Johnson, John “Too” Long. I imagine that the October light slipping through the gym’s lone, large window is really beaming from the rafters at Madison Square Garden. These days I doubt I would win a game of Twenty-One against my eight-year-old self, who would have the advantage not only of youth but of enthusiasm.

After several weeks of my lethargic, one-on-none games, Pedro hands me a pair of ten-pound dumbbells and sits me down on a bench in the weight room. He becomes my personal trainer, encouraging me and pushing me out of complacency and torpor. If I could, I would lift the whole building for him. He’s that inspiring. But of course I’m not inspired.

My wife calls me every day. One night she puts our older daughter, who is two and a half, on the phone. “I miss you, Daddy,” she says. Irrationally, because depression induces irrationality, I detect both disappointment and reproach in her voice. I am sure I will be a bigger disappointment to my daughters than my father ever was to me. After the call I retreat to my bedroom, where I picture my depression as a boxing opponent. I swing wildly, furiously, desperately until I exhaust myself and collapse onto my bed. The next day I ask my wife about our daughter’s comment. No doubt sensing my anxiety, she says, “Don’t worry about it, sweetheart. She says, ‘I miss you,’ to everyone. Today it was the woman who bagged our groceries at Giant Eagle.”

My wife brings our daughters to visit me in November, after I’ve been at the facility for about a month. We gather in the family room, an eight-by-ten cell with brown carpet and a single window. When our younger daughter settles into my lap for me to read to her, I feel nothing but despair. I am convinced again that I am incurable, that my affliction will persist indefinitely, that I am a colossal failure. I am relieved when the hour ends and I am called into Group Therapy.

I eat the same meals every day: cereal for breakfast, a sandwich for lunch, chicken for dinner. I don’t taste any of it, which is a commentary not on the food but rather on how dulled my sense of taste has become. Thanksgiving passes. Christmas arrives. From the facility’s staff I receive a long-sleeved red shirt. They know me well; it fits perfectly.

My steadfast but frustrated wife says she can’t understand why the treatments I’ve received over the past ten weeks have brought me no closer to my old self. “I think we need to consider ECT,” she tells me over the phone one night. Electroconvulsive therapy, or, as it’s still sometimes called, “shock therapy.”

Early in my depression I resisted even antidepressants, believing they would kill my creativity. As I wandered the corridors during my first week in the facility, a fellow patient — a middle-aged woman who had lost all her top teeth when she’d tried to kill herself by driving into a tree — pegged me as a candidate for ECT. To me, however, ECT seems extreme, dangerous, and destined to fail. (I’ve seen One Flew Over the Cuckoo’s Nest, after all. Jack Nicholson’s character doesn’t exactly find happiness in the wake of his electroshock therapy.) But now anything short of a lobotomy seems reasonable if it will bring me relief.

My wife arranges a meeting with the facility’s ECT doctors. My mother, my sister, and my brother-in-law are also there. I am too terrified and defeated to take in much of what’s said. I understand there are risks to the procedure, such as memory loss. And even after twelve treatments I might not feel any better. Predictably I believe this will be the outcome.

“I have no faith,” I tell my wife.

“Trust mine,” she says.

A week later, as I am lying on the ECT table, electrodes stuck to my head, the anesthesiologist notes that his daughter and my younger daughter share a first name. I can recognize his comment as an effort to make a connection, however slight, but in my current mental state I wonder how he learned my daughter’s name and what else he and the rest of the ECT team know about me and what they might do with this information. He asks me to count backward from ten. At three I’m out.

I wake up in a recovery room, my wife by my side, and inexplicably I start crying. One of the nurses blames the anesthetic. (Later I’ll wonder if I wept because I’d recognized the remarkable: I was feeling better.) My wife escorts me to my room, where I sleep the deepest, most rejuvenating sleep I’ve had in a year.

Over the weeks of my ECT treatments, I suffer occasionally from headaches and short-term memory loss. I read an entire Louise Erdrich novel but forget the plot and characters as soon as I close the book. (Under the circumstances, I am surprised I am able to read at all.) But beyond these side effects I feel extraordinary relief and exhaustion. After each of my twelve procedures — and after dinner, when there are no groups to attend or psychiatrists to see — I slip back to my room and sleep. I am, I understand, catching up after months of mind-crushing insomnia.

By mid-January, after my last ECT treatment, I’ve made an amazing recovery. I taste my meals. I see how fragile the young anorexics are, downing their bottles of Ensure and vowing to stop their clandestine nighttime exercising. But I also see how they’re like other women their age in their reverence for certain movies and TV shows and pop songs. I lift more weights for Pedro and am, at last, able to thank him genuinely for his help.

I am well enough to receive an overnight pass — dusk to dawn in New York City. My wife and I borrow a friend’s apartment for the night, and there we make love cautiously, braced for failure — like Odysseus and Penelope once her suitors have been slain. The gods smile on us.

After three and a half months at the facility, I’m scheduled to be discharged. I spend my last night in the cafeteria with Rachel, who is sixteen and a cutter. She’s devoted to books and ideas and reminds me of myself at her age. She points to the George Washington Bridge, which looms outside the cafeteria window. “Would you die if you jumped from it?” she asks.

“I think so,” I say, then find myself wondering why anyone would want to die.

When I get home, I will begin rebuilding a life I hope will be free from catastrophic depression. I’m aware there will be no guarantees, even with the antidepressant and the lithium I’ve been prescribed, even with the therapist and the psychiatrist my wife has made an appointment for me to see. Toward the end of “Sonny’s Blues,” the classic short story by James Baldwin, Sonny admits to his older brother that, although he appears to have kicked his heroin habit, “it can come again.” So, too, could my depression. (Sometimes even now, ten years later, I feel it, like a darkness at the edge of my vision, like a slow whirlpool in my heart.)

In the early morning, before my wife arrives to take me home, I lift one more round of weights with Pedro. When I’m done, we step out of the weight room and into the gym. Lara, one of the anorexics, has been allowed to exercise again. Before coming to the facility, she was a ballerina. She’ll be leaving in a few days, she has told me. The gym’s single window lets in a shower of warm yellow light. Illuminated, Lara dances and leaps, and suddenly I don’t want to leave. I just want to stand and delight in the beauty of her movements, which means I’m ready to go.