Ideas

Q&A

How depression relates to childhood trauma

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“How would I have turned out if I hadn’t turned out as I am?” wonders Daphne Merkin in her new book, “This Close to Happy.” Talk about a universal and deeply human question. In Merkin’s case, it is a question about how to determine, once and for all, how depression relates to childhood trauma.

She writes of her recurring struggles with depression, encompassing not only numerous hospitalizations, medications, and therapists, but the fundamental question of Merkin’s parents, Orthodox Jews of German extraction, and the loveless home they made for their children. “This Close to Happy” simultaneously excavates her own past and those of her parents, in search of a root cause for her depression. Along the way, she continually wrestles with the possibility of suicide as an escape. During her most recent hospitalization, Merkin was offered electroconvulsive therapy, which has found renewed use as a treatment for depression. Merkin, an acclaimed essayist, ultimately rejects ECT, worrying, among other things, that it would strip her of her ability to write.

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Ideas spoke with Merkin at a restaurant in Manhattan. Below is an edited excerpt:

IDEAS: This book wound up taking you more than 15 years to complete, with a hospitalization, among other events, interrupting your work. How does it feel to reflect on the process?

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MERKIN: It makes me think what a long, shudderingly halting road it was. None of this was planned. I continued to battle depression, and ultimately was hospitalized again, and it was suggested I have [ECT]. And I didn’t want to do ECT. It had been years since I was hospitalized. Since I’m someone, who even depressed, stays “the watching self,” I kept thinking, “Interesting how limited hospitalization is.” I [later] wrote a piece about [whether] depression [was] inherited. A question that with true American reductionism always becomes either/or, when the answer is both.

IDEAS: As you mention in the book, depression is a disease that mostly strikes women. Yet it has been men who have been its primary chroniclers to date.

MERKIN: I think ECT goes more with the male view of depression. Like, “it’s a little external to me, let’s ‘thunk’ it away, and we’ll be back to working in no time.” I see depression as an exponentially developed version of a human condition. Meaning I always think in the end it’s humanizing. People who never suffer from depression I find suspect. I assume Donald Trump is not a sufferer from depression.

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IDEAS: You talk a great deal in the book about the efficacy of medication in assuaging the worst of your depression, while also finding it astonishing that no one knows how the treatments actually work.

MERKIN: Someone said to me they don’t know how aspirin works. But the truth of the matter is aspirin is more benign. This stuff has consequences. One of the ones I’m on, in higher doses, is an antipsychotic, and does have a lot of side effects, including tardive dyskinesia, which I walk around in fear of. If I develop a twitch in the course of the meal, please tell me.

IDEAS: A mere negative interaction between multiple medications could have potentially serious consequences.

MERKIN: And if you happen to have enough, may I say, healthy narcissism and don’t want to gain weight? I know women who’ve gone off only because of that.

IDEAS: Do you find yourself leaning more heavily toward the nurture side of the nature/nurture debate regarding depression, or is it simply the easier part of the equation to discuss?

MERKIN: Since we can’t do anything about the genetic, I think the nurture is underrated. Because nurture is the one you can take account of. I don’t mean simply parent-blaming, because in the end you have to sit and deal with it. It doesn’t help to say, “Oh, my mother was terrible.” I always think, so what if your mother was terrible? You have to deal with the aftermath of that.

I always look to people and think whether they seem well-loved or not well-loved. That’s one way I walk through life. Do they have some core that withstands the ravages? Everyone gets pulled down in life and has good moments. But it always interests me how people withstand things. In the end, my answer would be that nurture has a ton to do with it.

IDEAS: “This Close to Happy” describes a slow transition away from the suicidal thoughts you detail at the outset of the book. How did you decide to carry on, or does it remain mysterious to you?

MERKIN: I think I decided, fairly recently, while writing the book, to put it off the table. To always half have an eye on getting out was, in a way, selling everything short. Me, my life. Also, somewhere along the line, someone said to me you age out of depression.

IDEAS: There is a recurring image in the book of a set of clay pots purchased at a resort, which you find soothing when most depressed, but also serve as a reminder that such small comforts are not enough. Is consumerism able to do anything to offset those dark moments, or are they totally different spheres?

MERKIN: I don’t know if consumerism addresses aches, yearnings. Does consumerism address deprivation? I think small things address deprivation. Not a new coat. That doesn’t do it. A little bit like those little ceramics.

IDEAS: Looking back over your life, does the nature of depression change with the passage of time?

MERKIN: As you get older, it’s more seen as almost a character flaw: “You’re still depressed?” And you’re getting old here. The hope that attaches, that it can be resolved, sort of fades away. I think the experience of depression that I most think remains true throughout the years is it’s very isolating. That to me is its strongest quality. That you’re alone in a room, that you’re cut off, you’re just sort of stuck with it. It puts up a wall. Maybe other people are more hopeful for you when you’re depressed when you’re young.

IDEAS: Do you feel therapy has something to offer to people wrestling with depression?

MERKIN: Yes. I do. I think unfortunately, a little bit like medication, it’s up for grabs who you get. Maybe the profession should be culled for greater skill. But I think if you get the right person, it has a lot to offer in terms of depression, in terms of parsing out some of the factors that lead to depression. I’m not sure it’s great when you’re actually depressed. I always think by then it’s not so great.

IDEAS: Why did you ultimately choose not to make a definitive judgment regarding your parents’ failings here?

MERKIN: I think, to be honest, maybe it would be “healthier” if I could [say] these are crazed, abusive [people]. I think they were in part that, but they were also other things. They were also complicatedly intriguing. My father was sort of witty. My mother I’ll never figure out exactly.

Saul Austerlitz is a writer and critic.
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