Debating Depression

March 8, 2010

From 'Living with a Black Dog' by Mathew and Ainsley Johnstone

Is major depression an illness or malfunction of the brain that needs to be cured or is it somehow adaptive in our evolution? (Or even both). The traditional view of mental illness would suggest the former but there’s an argument to be made that depression has some benefits too. This is certainly what writer (and blogger) Jonah Lehrer puts forward in his recent and excellent article ‘Depression’s Upside’ in the New York Times Magazine.

Lehrer takes the work of a psychiatrist and an evolutionary psychologist, Andy Thomson and Paul Andrews, and presents it in a challenging and refreshing way. Their central hypothesis, the ‘analytic-rumination hypothesis’ suggests that being mildly depressed (or even majorly depressed) can help to focus our attention, which in turn makes us more analytical. Here’s an excerpt from Lehrer’s article:

This radical idea — the scientists were suggesting that depressive disorder came with a net mental benefit — has a long intellectual history. Aristotle was there first, stating in the fourth century B.C. “that all men who have attained excellence in philosophy, in poetry, in art and in politics, even Socrates and Plato, had a melancholic habitus; indeed some suffered even from melancholic disease.” This belief was revived during the Renaissance, leading Milton to exclaim, in his poem “Il Penseroso”: “Hail divinest Melancholy/Whose saintly visage is too bright/To hit the sense of human sight.” The Romantic poets took the veneration of sadness to its logical extreme and described suffering as a prerequisite for the literary life. As Keats wrote, “Do you not see how necessary a World of Pains and troubles is to school an intelligence and make it a soul?”

I’m tempted to take that last quote and put in on my business card but I’m sure there are many who would dismiss Keat’s sentiment as dangerously unscientific. What Lehrer (and Thomson and Andrews) don’t do is to downplay the seriousness of depression or to make light of people’s suffering. I’m sure they would have every sympathy for someone like Kay Redfield Jamison (a psychology professor who is herself one of the most well-known bipolar sufferers in the US) who writes the following in her memoir An Unquiet Mind:

Depression is awful beyond words or sounds or images; I would not go through an extended one again. It bleeds relationships through suspicion, lack of confidence and self-respect, the inability to enjoy life, to walk or talk or think normally, the exhaustion, the night terrors, the day terrors. There is nothing good to be said for it except that it gives you the experience of how it must to be old, to be old and sick, to be dying; to be slow of mind; to be lacking in grace, polish and co-ordination; to be ugly, to have no belief in the possibilities of life, the pleasure of sex, the exquisiteness of music, or the ability to make yourselves and others laugh.

She goes on to say that some people say that they know what it’s like to be depressed because they’ve gone through a divorce or lost a loved one or a job. But the intense sadness which most people would feel in such situations is qualitatively different from the suicidal despair of major depression, which Redfield-Jamison describes as “flat, hollow, and unendurable”. Depressed people, like the main character in David Foster Wallace’s story ‘The Depressed Person’, can be tiresome beyond belief, trapped in a seemingly endless loop of whining and pain. Redfield-Jamison again:

People cannot abide being around you when you are depressed. They might think that they ought to, and they might even try, but you know and they know that you are tedious beyond belief: you are irritable and paranoid and humourless and lifeless and critical and demanding.

How could this condition possibly have a plus-side? Well, one answer seems to lie in the fact that the disorder is such a broad one. For those with a milder form of depression or who have the support and intellectual skills to grow through their depressions, the analytic-rumination hypothesis (or ARH) could be more applicable. For many others, though, bouts of depression might just be simply awful with almost no benefits at all.

One of the scientists Lehrer quotes who is sympathetic to the analytic-rumination hypothesis is Randolph Nesse, who suggests that the hypothesis, while admirable, fails to reflect the heterogeneity of depression:

Andrews and Thomson compare depression to a fever helping to fight off infection, but Nesse says a more accurate metaphor is chronic pain, which can arise for innumerable reasons. “Sometimes, the pain is going to have an organic source,” he says. “Maybe you’ve slipped a disc or pinched a nerve, in which case you’ve got to solve that underlying problem. But much of the time there is no origin for the pain. The pain itself is the dysfunction.”

Andy Thomson himself responds to the major criticism of his hypothesis as follows:

“To say that depression can be useful doesn’t mean it’s always going to be useful … Sometimes, the symptoms can spiral out of control. The problem, though, is that as a society, we’ve come to see depression as something that must always be avoided or medicated away. We’ve been so eager to remove the stigma from depression that we’ve ended up stigmatizing sadness.”

This is such an important point and one of the big bugbears that I have with how the discipline of mental health is so often practised. It’s so tempting to stigmatise painful symptoms, be they intense sadness or anxiety or even paranoia.

What I also like about the analytical-rumination hypothesis (or ARH for short) is that it prompts a re-evaluation of depression. Depressives needn’t see themselves as weak and somehow deficient, just perhaps as people whose symptoms can spiral out of control when they are confronted with life’s problems.

Thanks to Ted at BookeyWookey for referring me to this article. It certainly affirms my view that the more I learn about mental health, the more I find out how complex it is.


Shades of Blue

May 3, 2009

“I thought, if I wore the plain dark blue one you would take it as a sign that I was depressed, or rather as a sign that I was giving in to my depression, instead of fighting it. But when I put on the bright one, I thought you would take it as a sign that I’d got over my depression, but I haven’t. It seemed to me whichever tie I wore would be a kind of lie.” Alexandra smiled, and I experienced that deceptive lift of the spirits that often comes in therapy when you give a neat answer, like a clever kid in school.” — from Therapy by David Lodge

I’m starting work at a new sick bay tomorrow and despite the attendant anxieties of having to get up an hour earlier in the mornings and adjusting to new staff and new clients, I’m looking forward to the challenge. Over the last few days I’ve been finishing up my files in preparation of handing over to the new community service psychologist. Quite a lot of work that finishing up turned out to be — and a good indication of how much I have procrastinated over the past year. After a particularly trying session for example, the last thing I felt like doing was writing up my process notes. What I tended to do instead was to leave the rough notes in the file for the day when I would come and tidy everything up. Unfortunately that day arrived on Thursday and as I surveyed the pile of unfinished files (18) and the amount of time remaining in the day (four hours) I knew that I would be working over the long weekend.

I’m almost there and it’s been a good experience mostly. I’ve enjoyed revisiting my (not so) old cases. The nature of this work is that there will be many clients who come for a session or two and then not return and it’s interesting to speculate about why that is. Incidentally, I saw roughly 75 patients over the past 12 months. (I couldn’t give you the average number of sessions per client but the longest period of therapy was probably about 25 sessions.)

As I’ve been tying up loose ends, I thought I’d share a couple of short cases studies here along the lines of “shades of blue”. The title reminds me of the movie named “Three Colours Blue” but I see from a quick Google check that that movie has a different focus.

But before we get to the snapshots of depressed clients, I wanted to make a quick comment on Laurence “Tubby” Passmore, the main protagonist and narrator of David Lodge’s Therapy, whose quote is above. My clients seem to live in an entirely different world to the likes of Laurence Passmore and the main differences have to do with class and race. Wearing a tie to therapy? Does anyone actually do that? Laurence’s therapist Alexandra, whom he describes as “a rather beautiful, long-lashed female giraffe drawn by Walt Disney”, tells him that he could have dispensed with a tie altogether and he has a answer for that which is not relevant here. But I couldn’t help wondering what it would be like to have patients such as this. An educated, articulate patient with not very demanding problems. Perhaps the real problems will emerge (I’m only on page 40).

My patients (on the whole) generally make for less entertaining reading but I often think that some of that heartfelt anguish could translate into powerful narratives. There’s the issue of confidentiality of course and my clients’ stories would also need a lot of work but there’s something therapeutic about the act of writing a story. For today though, I’ll just give two snapshots of two different shades of blue. If the details are scanty, you’ll have to forgive me for not referring back to the files.

Patient 1: The first-year university student

AJ* is a 19-year old male in his first year of a university degree who was referred by his mother for alcohol abuse and depression. She’s worried that he’s failing the year and that he’s drinking too much. He’s also very negative and uncooperative towards her and she’s worried that he’ll just get worse. His dad died about 7 years ago and she thinks that he misses him very much and that this is contributing to his depression.

AJ himself is one of those late adolescents who reluctantly comes along to the session because he realises he doesn’t have much of a choice. He says he’s not abusing alcohol (any more than his classmates) and that it’s true that he’s failing the year but there are problems around computer-access and assignments not handed in and things would be so much easier if his mom just bought him a car and why does he have to work part-time at the supermarket anyhow? He has some symptoms of mild depression but he doesn’t really meet the criteria and his drinking doesn’t really seem to be the issue here either. It turns out that AJ has recently started dating one of his classmates (his first girlfriend) whom he cares for very much and whom he has been dating for about three months. His mother sees the deteriorating grades together with the deteriorating attitude towards her and the increasing time spent with the girlfriend and feels resentful. Why should she, a working single parent, have to slave away for a son who is not pulling his weight? It’s a good question and in the relatively small amount of time I have with them I focus on this point. We hammer out a compromise: she’ll pay for another year’s university fees if he manages to pass (and take more responsiblity). If not, then he’ll have to pay for himself.

Ideally he should also make use of the available counselling to get himself back on track — but transport is an issue and he’s already struggling to make enough time for his studies. The mom is also not willing to come for therapy on her own, or together with him. Why should she? She’s not the one with the problem. True, I want to say, but perhaps there are unresolved issues around her husband’s death that she could explore? There are clearly issues around mother-son communication which could benefit from a neutral counsellor. I get a strong impression that the mother is feeling left out in this scenario. Her son is quite happy to use her money (and cooking and cleaning services) but he’s not her darling little boy anymore. And she’s rightly fed-up.

Patient 2: An SA story

Beauty* is a 36-year old single parent of three boys (18, 7 and 5 years). Her husband died about two years ago of AIDs and she herself is HIV-positive. She also has a poorly-paid job, financial difficulties and family problems. Her 18-year old son is involved in petty crime while her 7-year old is misbehaving at school and is not doing his homework. The doctor writes me a slightly bizarre referral in which he mentions that the patient has difficulty with aggression. He doesn’t pick up any mood symptoms (other than the aggression) but notes the overwhelming stressors. If ever the media wanted a poster-woman for an SA mother being overburdened with stress this woman would fit the bill. Where do we even start? The trauma of being HIV-positive and losing her husband? The behaviour problems of her two eldest boys? The disempowerment of not being able to provide properly for her family, not being able to drive, being stuck in a poorly-paid job? The consequences of being angry all the time?

I do what I can for her, which is to empathise with all her worries and offer regular therapy to help her to contain her emotions. Validation, problem-solving, a place for her to be understood. After a few sessions she doesn’t come back. Perhaps the shoulder to cry on is not enough. Perhaps the travelling time combined with time off work is just not worth the little tangible help that I can provide. In our last session I note her frustration with (Western) doctors who just don’t understand her and who weren’t able to help her. She says she’s going to see traditional healers instead.


Living with a Black Dog

April 24, 2009

black-dog-cover1

This excellently-illustrated book on Depression arrived in my post-box yesterday. Written and illustrated by Matthew (and Ainsley) Johnstone, Living with a Black Dog contains roughly 50 touching illustrations of what it’s like to live with someone who suffers from Depression. (Incidentally I’m not sure that depression warrants a capital letter like that but it does make it look more forbidding. I guess a Black Dog is also a lot more scary than a black dog 😉 )

Anyway, it’s easy to read and communicates valuable insights in a light-hearted way. Perhaps because it’s visual it appeals to our emotions more directly? Matthew has this to say (on his website) about the book: “I gave it to a friend recently to have a look at and he shared it with his wife and he said the biggest thing he got out of it was (a) communication, communication, communication & (b) the sufferer taking a bigger responsibility in getting well.”

I loved the illustrations of the black dog itself and the way the dog mirrored the characters’ situations. I also felt quite sad that the couple wave goodbye to the black dog at the end as it sails away into the sunset. Such a cute dog and they’re letting it go? (Perhaps there’s something in this about how we cute-ify our “dark sides” but it’s Friday afternoon so I’ll let that one go.)

In honour of such creativity (and because I’ve been meaning to tackle this subject for a while), I thought I’d do a quick scan to see what online resources are available on Depression. I’d be interested in any thoughts you have on the topic as well. For example:

1. Any well-known novels and movies that spring to mind on depression?

2. Any well-known writers and poets? (Sylvia Plath, Ernest Hemingway and Virginia Woolf are three that come to mind.)

3. Is it even helpful to separate out “depression” in this way, as something scientific to be diagnosed, rather than focusing on relationships?

Of course that leads to the inevitable question of what is depression and how it differs from distress (or just having a bad day or being down-in-the-dumps). I guess severity and duration are the keys here — and the DSM requires you to have five out of nine symptoms to qualify for a diagnosis of a Major Depressive Episode (MDE).

I also know that it’s not possible to do more than scratch the surface of this topic but I thought I’d at least start the discussion, in part because this is something I’ve wrestled with from time to time. A bit like Matthew, I’m not that comfortable putting it out there for people to see. And I’m also wary of labelling myself in a way which is not helpful. I clearly don’t have MDE now but I’m pretty sure that I would have qualified in my early twenties.

I also know that it’s difficult to talk about losses, even minor ones such as the loss of friendships. Perhaps this is part of what this is about. And another part of it is curiosity (from the personal to the more general) of the types of stories that are out there and the ways that people have of talking about loss and longing and sadness. (And then the myriad ways we have of defending against such feelings.)

There’s a sober topic for a Friday! Have a good weekend now 😉


Diary Monday (on a Tuesday)

October 21, 2008

The nice way of saying this is that younger me (of four years ago) had “anger issues”. (My original comment was that younger me was a jerk.) Prompted by Courtney’s delightful Diary Monday, I went looking back over my old journals to see what I was doing this time four years ago.

I have about 12 to 15 old journals in my cupboard and I keep thinking I should mine them for gems. Then when I actually read them I realise that the gems are few and far between and that there’s a lot of stuff that’s just not that readable anymore. Maybe I used my journal as a sort of punching bag to let out my frustrations of the time. A few entries:

Mon 1st Nov (2004)
Song: ‘Luca’ stuck in my head.
Dream: Hawk chasing a canary. Canary died.

Weds 4th Nov (2004)
Watched US pres election – really depressing. Was depressed all day and really struggled to get any work done. Mood rating = 3/10. … Angry with E for being such a heartless bitch.

[Yes well the rest of this entry doesn’t get much better. My ex-girlfriend had recently broken up with me for the last time and I was feeling quite sore about it. A bit further down I try and cheer myself up with a list of things to feel good about.]

10 things to feel good about:
1. Choc dessert
2. Mashed potato with cream
3. J paid me rent
4. Dog’s leg a bit better today and she didn’t bite the vet
5. Papaya in fridge
6. Seeing friend on Friday – might even get some
7. Made some progress with empowerment stuff today
8. Varicose vein a bit better today – might even cancel op
9. Sitn with P (work colleague) not much worse – stable
10. Rugby test on Sat
11. Saw some beautiful girls at gym

(There you have it – food, girls, my dog’s leg, rugby etc. What a sad life I was leading then. Admittedly I was in a slump which really doesn’t bring out the best in people. But no wonder I didn’t have many friends back then. The relationship trouble with the ex, the work difficulties, the vein problem – the one seems to compound the other and create a spiral of misery. Reading this today I suppose I should be grateful that my life is so different now. Perhaps this time of my life was a bottoming-out which made me realise that I had to make a change. I applied for (and was accepted into) a Clinical Psychology Master’s programme, I resigned my job, moved cities, and spent 18 months in therapy with a good-enough therapist who was able to help me to change for the better. I really did a lot of soul-searching and did a radical overhaul of, well, my personality. Today I look back on that time and I’m anxious about how real that change is. When I’m feeling really cynical I wonder if people can really change. Sure, the best proof I have for that is my own change but I wonder how much of that angry man is still around. One of the best things I learned in my psychology training is that underneath all that anger (and depression) there is anxiety. Address the anxiety and a lot of the anger becomes less important.)


Borderline by Numbers

October 13, 2008

Nick Hornby’s A Long Way Down (2005) is laugh-out-loud funny in parts but I found large parts of it to be terribly dull. Soccer-bore dull, people talking for the sake of talking kind of dull. And for a novel that deals with depression and suicide, it mostly avoids psychology.

“It’s always someone else’s fault. Boo-hoo-hoo. Well, I happen to be one of those rare individuals who believe that what went on with Mummy and Daddy had nothing to do with me screwing a fifteen-year-old.”

The speaker is Martin Sharp, a former morning TV presenter who has served time in prison for having sex with a 15-year old girl. His career is in freefall, his ex-wife won’t let him see his kids and his girlfriend has recently cheated on him. Depressed enough to consider jumping off the top of a London tower block, he dangles his feet off the edge of Toppers’ House and, instead of jumping, meets three other similarly depressed people in Jess (an 18-year old drug abuser), JJ (a has-been American rocker) and Maureen (a single mom with a severely disabled child). The premise of four depressed people meeting up on the roof of a tower-block, having a bonding moment and helping each other out of the depths of their respective depressions is a reasonably good one. Jess comments that the four of them are like the Beatles except without the talent, humour or skill. But scratch the surface of this comical idea and it all starts to seem a little ho-hum.

Hornby’s novel alternates between four narrators (the four would-be suicides) and I think this is part of the problem. As a reader I never really warmed to any one of the charactes because the focus keeps switching between them. The characters also strike me as rather two-dimensional and their back-stories are not developed in any real detail. They also speak directly to the reader rather than to each other, which can make for a rather tedious read.

Jess’s dad is a Junior Minister in Tony Blair’s government and her sister disappeared in circumstances which suggest suicide. Her dad is too busy with his job to provide proper supervision for his daughter and so allows himself to be manipulated into giving her whatever she wants. One glaring omission for me was the absence of Jess’s mother. On the one or two occasions that we do meet her she has a false smile plastered on her face and is little more than a cardboard cut-out of a politician’s wife.

The absence of psychology (except for the self-help kind) in a novel about suicide also puzzled me until I realised that serious psychological engagement with the issues is exactly what Hornby is at pains to avoid. Too unfunny perhaps in the way that considering your characters’ early development is also not likely to result in any one-liners. But in a country which has (as far as I know) largely free counselling services available through the NHS, why would a character such as Maureen not seek some sort of psychological help before deciding to end her life? Similarly, if what Jess is desperate for is connection and a ‘real’ relationship, then why does she not seek some counselling herself?

Jess appears to meet the requirements for Borderline Personality Disorder (BPD) and it’s as if Hornby googled these and fashioned Jess accordingly. However as a psychologist I wasn’t convinced that Jess is actually Borderline. Here are the criteria for BDP:

1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing of scars, or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness, worthlessness.
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms. [DSM-IV, as provided by Wikipedia.]

To qualify for a diagnosis of BPD you need five out of the nine criteria and on superficial consideration Jess meets this requirement. Frantic efforts to avoid real or imagined abandonment? Tick. Impulsivity in at least two areas …? Tick. (And so on).

Leaving aside the difficulties and controversies of a BPD diagnosis (see the Wikipedia article), Jess doesn’t really “fit” the diagnosis of Borderline. For a start she’s a bit too dull:

Jess
You won’t believe this — I don’t think I do now — but in my head, what happened to Jen had fuck all to do with New Year’s Eve. I could tell, from talking to the others and reading the papers, that no-one else saw it that way, though. They were like, Ooooh, I get it: your sister disappeared, so you want to jump off a building. But it isn’t like that. I’m sure it must have been an ingredient, sort of thing, but it wasn’t the whole recipe. Say I’m a spaghetti Bolognese, well I reckon Jen is the tomatoes. Maybe the onions. Or even just the garlic. But she’s not the meat or the pasta.

Jess: If you’d seen me leaning on the wall and looking down at the water, you’d have gone Oh, she’s thinking, but I wasn’t. I mean, there were words in my head, but just because there are words in your head it doesn’t mean you’re thinking, just like if you’ve got a pocket full of pennies it doesn’t make you rich. The words in my head were like, bollocks, bastard, bitch …

That doesn’t strike me as “affective instability”. And to cut a long discussion short, Jess just “feels” all wrong. I would be interested to read “Girl, Interrupted” or another book that effectively describes a young woman’s sense of desperation. Nick Hornby’s book doesn’t evoke a feeling of desperation (other than that of the reader’s wanting the book to end). But I was interested enough to wonder about other post-9/11 novels. The attacks on the Twin Towers get two (very brief) mentions in the novel and, for me at any rate, there’s a sense that those events cast a long shadow over contemporary urban fiction.


Two reviews: J.D. Salinger and “Lost in America”

June 9, 2008

One of the most intriguing opening lines of any novel has to be those of Holden Caulfield in J.D. Salinger’s “The Catcher in the Rye”.

If you really want to hear about it, the first thing you’ll probably want to know is where I was born, and what my lousy childhood was like, and how my parents were occupied and all before they had me, and all that David Copperfield kind of crap, but I don’t feel like going into it. In the first place, that stuff bores me, and in the second place, my parents would have about two haemorrhages apiece if I told anything personal about them.

Given Salinger’s fierce protection of his privacy and his refusal to give interviews or make public appearances over the last 30 years, the “two haemorrhages apiece” could apply equally to him. As openings go, Holden’s lines are a curious mixture of defensive and confessional with a literary reference thrown in for some added intrigue.

Like countless teenagers before me, I was completely captivated by Catcher when I first read it. Rummaging through some of my storage boxes yesterday (looking for Irvin Yalom’s “Love’s Executioner and Other Tales of Psychotherapy”), I came across my old Penguin Modern Classics copy of Catcher together with a battered edition of short stories called, “For Esme With Love and Squalor”. On the inside cover my sister has written a short inscription to me for my 16th birthday when I visited her in Johannesburg in April 1986.

As an adolescent I could totally see myself in Holden Caulfield. We both came from ‘nice’ but dysfunctional families, we both read a lot and both suffered from what one reviewer calls “angst and alienation”. I liked his chatty tone and the way that he has about glossing over difficult things with a shrug. Salinger’s unauthorised biographer, Ian Hamilton, writes that by the late 1950s, Catcher (published in 1951) had “become the book all brooding adolescents had to buy, the indispensable manual from which cool styles of disaffectation could be borrowed”.

Interestingly, Catcher apparently has the distinction of being the most prescribed novel at high school in the U.S. and the most banned. One concerned parent counted 237 appearances of the word “goddam” in the novel, along with 58 “bastard”s, 31 “Chrissakes,” and six “fucks.”

Today, 22 years after I first read it, I find it difficult to read. Perhaps it brings back memories of being defensive and a bit lost as a late adolescent. I also find Salinger’s style a bit self-indulgent. He’s like a teenager who wants to be noticed and told how clever he is, but he doesn’t actually want to engage with his audience. Perhaps that’s too harsh but a brief comparison with another experience of growing up Jewish in New York (Nuland’s ‘Lost in America” below) makes Salinger appear lightweight. Of course that’s an unfair comparison since Salinger’s book was published in 1951 and was groundbreaking for its time (and also captured a sense of the post-war rebellion against authority and ‘phonyness’). I am intrigued by Salinger’s long silence (he hasn’t published since 1965) but reading the Wikipedia article on him here I can see why. His last published story, “Hapworth 16, 1924” was roundly criticised as being far too long, narcissistic and obscure. Sundeep Dougal comments that

The most common complaint against Hapworth has been that it should have been at most half its published length, ending at the point where Seymour finds another pad of paper and takes off again in what has been called “a pompous display of erudition”. The Los Angeles Times commented in 1988 that it “was widely regarded as narcissistic, prolix and ultimately obscure in its intent” …

Here is the opening of Hapworth:

Some comment in advance, as plain and bare as I can make it: My name, first, is Buddy Glass, and for a great many years of my life–very possibly all forty-six–I have felt myself installed, elaborately wired, and occasionally, plugged in, for the purpose of shedding some light on the short, reticulate life and times of my late, eldest brother, Seymour Glass, who died, committed suicide, opted to discontinue living, back in 1948, when he was thirty-one.

Since then, Salinger apparently writes only for himself and a select audience. He is now 89 and, according to his daughter, has a whole filing cabinet of unpublished writing, which is to be published after his death.

Sherwin Nuland’s “Lost in America: A Journey With My Father” (2003) is a moving account of growing up in New York with a father who was disabled as much by physical and emotional afflictions as by an inability to integrate into America. Nuland, who is a surgery professor at Yale, starts off with an extraordinary account of his own depression, which confined him to a mental hospital for a year when he was in his early forties.

I was a bit worried that the author’s depression would bring me down, but so far the book has been mostly about his quirky Russian immigrant father, who clearly had a massive influence on his life. His father, Meyer Nudelman, came to America as a Russian immigrant at the age of 19 but remained largely unassimilated into American society for the rest of his life, speaking his own dialect of Yiddish-English for example. The dust jacket sums it up pretty well:

… Pursuing the immigrant’s dream of a better life but finding the opposite, he [Meyer] lived an endless round of frustration, despair, anger and loss: overwhelmed by the premature deaths of his first son and wife; his oldest surviving son disabled by rheumatic fever in his teens; his youngest son, Sherwin, dutiful but defiant, caring for him as his life, beset by illness and fierce bitterness, wound to its unalterable end. … Lost in America, Nuland’s harrowing and empathetic account of his father’s life, is equally revealing about the author himself. We see what it cost him to admit the inextricable ties between father and son and to accept the burden of his father’s legacy.