Book summary “This close to happy”: summary

Introduction

Clinical depression isolates you in a way that physical illnesses rarely do. While society accepts visible physical suffering, profound mental pain often triggers discomfort and demands quick recovery. You might find yourself hiding your despair behind a functional facade, terrified of the stigma attached to true emotional interiority.

Clinical depression is a harrowing, lifelong condition rooted in early childhood emotional deprivation and sustained through a fragile combination of psychiatric medication, psychoanalysis, and the search for approximate contentment.

Daphne Merkin examines this relentless affliction through her own recurrent psychiatric hospitalizations, early neglect, and dependence on antidepressants. The book investigates family trauma, institutional realities, and the mechanics of suicidal ideation. You will explore answers to several critical questions:

• How do early childhood deprivations shape lifelong psychiatric vulnerability?
• What happens when modern psychiatric treatments fail to cure depression?
• How do profit-driven hospitals handle institutionalized patients?
• Why does the allure of suicide persist despite intensive therapy?

1. The Stigma and Reality of Depression

Clinical depression remains a massive global affliction that is heavily stigmatized and misunderstood compared to addiction. Society feels embarrassed by genuine emotional interiority and rigorous self-reflection. You often encounter a culture that treats depression either as a moral failing or as a phantom illness easily dismissed by willpower.

Clinical depression remains a heavily stigmatized affliction where society reacts with discomfort to genuine emotional interiority, creating an intense sense of isolation for sufferers.

Talking about attending rehab is socially acceptable at cocktail parties, but admitting to severe depression causes people to pull away in discomfort. Statistical reality reveals the immense scale of this hidden struggle across populations:

• 350 million people worldwide are affected by depression;
• 16 million people had at least one major depressive episode in the United States in 2012;
• 40,000 deaths by suicide occurred in the United States in 2014.

Gender Dynamics in Sickness

Male and female depression narratives differ sharply. Men often attribute their illness to external factors or genetics, while women tend to internalize it as an inherent personal lack. Male sufferers often sidestep the stigma of moral failing by pointing to a specific external cause or genetic susceptibility. Female writers like Anne Sexton and Sylvia Plath instead take full ownership of their inner malaise.

William Styron linked his severe depression almost entirely to going off alcohol, while Lewis Wolpert preferred a biological explanation rather than a psychological one. You see how these accounts shape public understanding of the dark season, the black dog, and the Age of Indiscretion.

Fifteen years elapsed since the author first agreed to write the book. Writing about depression serves as an effort to exert mastery over personal suffering, battle childhood ghosts, and shatter a restrictive narrative. The author spent this entire period struggling to finish because the process required doing battle with her fear of depression's return and her childhood inhibitions.

Numerous letters arrived from anonymous sufferers over the years, including an inmate in Sing Sing and a golfing buddy of John Updike. These messages confirmed the shared isolation of the condition and the pervasive nature of darkness visible.

2. Childhood Deprivation and the Nanny Dynamic

The author's early years were dominated by an emotionally detached nanny and a traumatized mother, establishing a lasting pattern of tactile starvation and insidious neglect.

You grow up in a wealthy family where material security masks a deep, pervasive void. Financial abundance fails to protect you from severe emotional deprivation within the home.

The Rule of Jane

Jane Van der Ven was hired as a caretaker for six children in a family where the parents traveled extensively. She managed you and your siblings through intimidation, strictness, and physical punishment without offering affection.

Jane came from a family of sixteen children. She lingered in the apartment for fifty years and died in 2004 at eighty-eight years old, having left twenty-one grandchildren in total.

Jane wore pastel baby-doll pajamas, smoked constantly while sitting straight up in bed, and administered full-scale spankings with a Kent hairbrush.

Survivor Guilt and Maternal Detachment

Your mother was emotionally unavailable and shaped by historical trauma. She intentionally hired a cold caretaker to avoid competition in her children's affections.

The mother survived historical catastrophes in Europe and lost close relatives in concentration camps. This history was set in motion when she was sent back to Europe in the 1938 year, before she came to New York in the 1949 year.

The mother casually drew tiny swastikas on the inside of your arm with a ballpoint pen when you were eleven or twelve years old.

Maternal stinginess and strict control stemmed from survivor guilt and resentment of a wealthy lifestyle earned through marriage. The mother rationed food and pared down clothing to prevent her children from taking their privileged background for granted.

• You and your five siblings were fed at a kitchen counter like cabbies.
• You faced strict food rationing and wore stiff unwashed socks.
• You lacked proper parental supervision, contrasting sharply with the abundance seen in friends' homes like Philip Roth's characters.

The mother strictly monitored food portions, limited fresh fruit purchases like cherries and raspberries, and forced her children to wear ragged towels and meager wardrobes. Seventeen children were produced by the mother's three siblings in Israel, compounding a dense network of family anxiety and historical weight that surrounded your upbringing.

3. Childhood Hospitalization and Family Pathology

Severe childhood anxiety and emotional abandonment led to early psychiatric hospitalizations and a profound, permanent trauma-bond with the family household.

Early Psychiatric Interventions

You suffer from debilitating school refusal, insomnia, and endless tears as a young child. Around age eight, you face an abrupt psychiatric hospitalization on a regular pediatric unit at Columbia Presbyterian's Babies' Hospital without any advance warning.

• You spend several weeks in the hospital receiving sleeping pills.
• You experience intense distress during your mother's brief daily visits.
• You write a note on blue-lined paper preceded by Hebrew letters for "Be'ezrat Hashem" expressing fear and emotional abandonment.

Dr. Harry Alpert retrieves this archival note decades later. The text reveals your fear of going home and your confusion over why your mother is only nice to you when you are sick.

Dr. Hanson, a Texan child psychiatrist, advises your mother to shut you in your bedroom when you cry. This mid-century psychiatric approach reinforces rejection rather than applying a family systems model of therapy.

The Demon-Lover Dynamic

Abused or neglected children develop a powerful, paralyzing trauma-bond. You desperately want to escape your parents while remaining terrified of leaving their orbit.

• You fear total collapse without your mother's presence.
• You feel constant pain and insufficiency within the relationship.

You repeatedly flee summer programs and turn down a prestigious acceptance at Cambridge. You feel you will fall apart without your mother to glue you together.

For chronically depressed individuals, severe crisis paradoxically becomes the only vehicle for receiving maternal warmth. Your mother is largely distant during ordinary life but rises to drastic occasions like breakdowns and illnesses.

When you hit your absolute worst, your mother envelops you with reassurances and tucks you into bed. She serves cervelat sandwiches on a tray, making your descent into darkness feel momentarily worthwhile through this demon-lover dynamic. Your father dies in 1999 at the age of ninety-one, and your mother dies of lung cancer in 2006 at the age of eighty-six.

4. Medical Interventions and Alternative Treatments

Managing treatment-resistant depression requires a complex, experimental array of psychiatric drugs, electrical stimulators, and long-term psychotherapy.

You have relied on a complex array of psychiatric medications for 3.5 decades while remaining deeply ambivalent about whether depression is a true brain disease. Starting with Parnate in the 1970s under Dr. Alpert, you progressed through numerous psychotropic drugs. A review by Marcia Angell suggests antidepressants show only 25 percent effectiveness over placebos, while heredity accounts for 50 percent of temperament.

An unthinkably high dose of 80 milligrams of Prozac combined with Desyrel caused urinary retention, requiring you to catheterize yourself for 6 weeks during a hot summer.

Antidepressant Regimens

Despite relying on these drugs to prevent suicide, you attribute much of your condition to childhood trauma rather than pure genetics. MAO inhibitors and other psychotropic drugs form your baseline defense against an unstable interior landscape. You balance these chemical interventions with a deep skepticism regarding the biological model of mental illness.

Technological Devices

Seeking relief from treatment-resistant depression, you experiment with various non-traditional psychiatric technologies and physical devices. Your arsenal includes a light-box for seasonal affective disorder and an electrical microcurrent device called the Fischer Wallace Stimulator worn for 20 minutes daily.

You began using the Fischer Wallace Stimulator, a gizmo resembling a television remote that sends a low current into the brain via water-soaked sponges. You follow a specific routine:

• Soak two round yellow sponges in water.
• Place the sponges inside earphone-type holders wired to the device.
• Slide the sponges under a stretchy headband over your temples.
• Click on the device to initiate pulsing green and blinking yellow lights.
• Wait 20 minutes for the device to emit a slight ping and turn itself off automatically.

Long-term psychotherapy offers valuable tools for self-understanding and survival despite high costs and the painful anxiety of exhuming memories. Having spent four decades in psychiatrists' offices across forty-five- or fifty-minute sessions, you question whether examining the wreckage helps or merely scrapes at raw nerves. A psychiatrist at Payne Whitney bluntly told you that both your parents were crazy, a diagnosis you immediately neutralized by reporting it back to your mother, who dismissed it as Quatsch!

5. Psychiatric Units and Institutional Realities

Modern psychiatric hospitals often function as profit-driven businesses governed by insurance limits rather than genuine therapeutic needs.

You check into facilities with spa-like names, where sharps are confiscated and you are weighed upon arrival. Your length of stay is dictated strictly by corporate insurance coverage rather than clinical recovery.

Patients working blue-collar jobs for companies like IBM and Con Edison are promptly discharged on the exact day their medical insurance runs out. This happens regardless of whether they expressed suicidal thoughts the day before.

You weigh 138 pounds upon checking into the hospital, down from 180 pounds post-pregnancy. Your first stay in the Westchester hospital lasts 5 or 6 weeks.

Inside the Ward

Life inside an unlocked psychiatric ward is characterized by routinized monitoring, timelessness, and a pervasive atmosphere of benign neglect. You find a strange, protective comfort in the unstructured days and the absence of the exhausting daily chore of self-presentation.

You spend hours playing steady volleys of Ping-Pong with Bruce, a heavily sedated patient in his mid-thirties wearing a stained crewneck sweater. You stay on 11 West, which is an unlocked ward with about twenty beds. Dinner is served on the unit at 5:30. Your stay in the midtown Manhattan hospital unit lasts 3 weeks.

Hospital routines like outdoor breaks can feel deeply surreal and disconnected from normal reality. Patients on the psychiatric unit are allotted four smoking and fresh air breaks daily in a fenced-off concrete garden. You spend three weeks on 4 Center.

You compare the fenced-in hospital garden scene to a scene in the movie Blow-Up where characters mime a tennis game without a ball or rackets.

The Stigma of Hospitalization

The intense cultural stigma surrounding mental illness and hospitalization drives many to contemplate suicide over seeking institutional help.

The fear of social and professional ruin creates a severe barrier to treatment. Sometimes death seems preferable to the exposure, privacy invasions, and forced group therapy on a psychiatric ward.

Psychiatrist Kay Redfield Jamison panicked at the thought of hospitalization. She feared her clinical work and privileges would be permanently revoked if her mental breakdown became public knowledge.

Depressed patients often envy patients with eating disorders because their illness is viewed by society with clearer medical legitimacy. While depressed patients are often viewed by hospital staff as intractably and self-indulgently themselves, anorexic patients are seen as victims of a distinct, culturally recognized disease.

You observe younger, scrawny anorexic patients whom a fellow patient refers to as the storks. These patients engage in journaling, art projects, and self-esteem workshops while being required to spend a full half hour at meals.

6. Suicidal Ideation and the Allure of Oblivion

Severe depression frequently gives rise to meticulous calculations regarding suicide methods, driven by an unyielding internal pain and the desire for a clean break from suffering.

Chronic despair possesses its own lunar glow rather than a dull apathy. It strips away the ability to find ballast in art, writing, or daily routines. Life feels intolerably long, prompting constant schemes for self-extinction as a clean break from the roaring mental pain. You carry a heavy burden of pretense, making the prospect of suicide alluring like an Italian grandmother sweeping out accumulated debris.

The Calculus of Death

Severe depression often manifests as an internal, obsessive debate regarding the efficacy and emotional aftermath of various suicide methods. You meticulously weigh methods such as jumping, pills, and slitting wrists. You ultimately fixate on walking into oncoming traffic because it might appear accidental and spare your young daughter the trauma of an explicit suicide.

On one or two occasions when going out alone, you experiment by deliberately crossing the street on a red light against oncoming traffic, prompting an irate driver to screech to a halt and yell at you. Prior to hospitalization, you shed 10 pounds in as many days.

The Bravery of Self-Extinction

You view suicide not merely as cowardice, but as an act requiring a special, aberrant sort of bravery and a steely embrace of self-extinction. You feel fascinated by historical figures, poets, and celebrities who ended their own lives, analyzing methods such as drowning, hanging, and lye. You note the immense physical and logistic determination required, contrasting societal condemnation with the raw desperation that torpedoes all other solutions.

Creative individuals face a high incidence of unipolar and bipolar affective disorders, and surviving recurrent suicidal ideation involves recognizing life's small, sustaining enticements. Virginia Woolf walked into the River Ouse with stones in her pocket at age fifty-nine, the exact age poet Deborah Digges reached when she died. Fashion designer L'Wren Scott had six million dollars of debt in her fashion label before her death. Actress Rachel Roberts swallowed lye at fifty-three, and poet Rachel Wetzsteon died on Christmas Day, 2009, at forty-two. Spalding Gray listed suicide victim as an alternate identity before jumping off the Staten Island ferry. You reflect on these numerous suicides, noting that surviving the dark undertow depends on curiosity, aesthetic experiences, reading, friendship, and the responsibilities of motherhood.

10 Key Ideas

1. Clinical depression remains a heavily stigmatized affliction where society reacts with discomfort to genuine emotional interiority, creating an intense sense of isolation for sufferers.
2. The author's early years were dominated by an emotionally detached nanny and a traumatized mother, establishing a lasting pattern of tactile starvation and insidious neglect.
3. Severe childhood anxiety and emotional abandonment led to early psychiatric hospitalizations and a profound, permanent trauma-bond with the family household.
4. Managing treatment-resistant depression requires a complex, experimental array of psychiatric drugs, electrical stimulators, and long-term psychotherapy.
5. Modern psychiatric hospitals often function as profit-driven businesses governed by insurance limits rather than genuine therapeutic needs.
6. The intense cultural stigma surrounding mental illness and hospitalization drives many to contemplate suicide over seeking institutional help.
7. Severe depression frequently gives rise to meticulous calculations regarding suicide methods, driven by an unyielding internal pain and the desire for a clean break from suffering.
8. Clinical depression is a harrowing, lifelong condition rooted in early childhood emotional deprivation and sustained through a fragile combination of psychiatric medication, psychoanalysis, and the search for approximate contentment.
9. Male and female depression narratives differ sharply, with men often pointing to external factors while women internalize the malaise as an inherent personal lack.
10. Surviving recurrent suicidal ideation and the dark undertow ultimately depends on curiosity, aesthetic experiences, reading, friendship, and the responsibilities of motherhood.