Sometimes it begins with a pimple. A large shiny spot appears on my forehead. Or it begins with a feeling of heaviness, and I long to wear only loose-fitting clothes. Then my mood plunges, my lower back aches, my insides turn liquid. Stomach cramps come in spasms so painful I sometimes cry out. I lose interest in the things I care about. My family become unbearable, my friends become strangers with dark intentions, and cashiers and waiters seem unforgivably rude.
A furious, righteous paranoia shrouds me: every human being with whom I interact is wrong, either insensitive or ill-willed. I eat mounds of food – I crave greasy stews and fried yams and dense chocolate truffles – or I have no appetite at all, both unusual for a careful, picky eater. My breasts are swollen and taut. Because they hurt, I wear my softest bras – "tender" seems a wrong word for the sharp discomfort. Sometimes they horrify me, so suddenly round, as though from science fiction, and sometimes their round perkiness pleases my vanity. At night, I lie sleepless, drenched in strange sweat; I can touch the wetness on my skin.
I am sitting in a doctor's office in Maryland and reciting these symptoms. On the wall of the bright room, there is a diagram of a lean female, her ovaries and uterus illustrated in curling lines; it reminds me of old pictures of Eve in the garden with Adam. The doctor is a kind and blunt woman, bespectacled, but reading over her lenses the forms I have filled out. When she first asks why I have come to see her, I say, "Because my family thinks I need help." Her reply is, "You must agree with them or you wouldn't be here." Later, it will strike me that this is a quality I admire most in women: a blunt kindness, a kind bluntness.
When she asks questions, I embellish my answers with careful detail – the bigger-sized bra I wear for a few days, the old frost-bitten ice cream I eat because I will eat anything. I make sure to link everything to my monthly cycle, to repeat that I always feel better when my period starts. I make fun of my irritability: everyone I meet is annoying until I suddenly realise that I am the only constant and the problem has to be me! It is, I tell her, as though a strangeness swoops down on me every month, better on some and worse on others. Nothing I say is untrue. But there are things I leave out. I am silent about the other strangeness that comes when it will and flattens my soul.
"It sounds like you have premenstrual dysphoric disorder," she says.
It is what I want to hear. I am grateful because she has given me a name I find tolerable, an explanation I can hide behind: my body is a vat of capricious hormones and I am at their mercy.
But the doctor is not done. Her eyes are still and certain as she says, "But the more important thing is that you have underlying depression." She speaks quietly, and I feel the room hold its breath. She speaks as if she knows that I already know this.
In truth, I am sitting opposite her in this examining room because my family is worried about the days and weeks when I am, as they say, "not myself". For a long time, I have told them that I just happen to have hormonal issues, victim to those incomplete tortures that Nature saves for femaleness. "It can't be just hormonal," they say. "It just can't." Mine is a family full of sensible scientists – a statistician father, an engineer brother, a doctor sister. I am the different one, the one for whom books always were magical things. I have been writing stories since I was a child; I left medical school because I was writing poems in biology class. When my family says it is "not just hormonal", I suspect they are saying that this malaise that makes me "not myself" has something to do with my being a writer.
Now, the doctor asks me, "What kind of writing do you do?"
I tell her I write fiction.
"There is a high incidence of depression in creative people," she says.
I remember a writers' conference I attended in Maine one summer years ago, before my first novel was published. I liked the other writers, and we sat in the sun and drank cranberry juice and talked about stories. But a few days in, I felt that other strangeness creeping up on me, almost suffocating me. I drew away from my new circle of friends. One of them finally cornered me in the dormitory and asked, "You're depressive, aren't you?" In his eyes and his voice was something like admiration, because he believed that there is, in a twisted way, a certain literary glamour in depression. He tells me that Ernest Hemingway had depression. Virginia Woolf and Winston Churchill had depression. Graham Greene had depression. Oh, and it wasn't just writers. Did I know Van Gogh had wandered into the field he was painting and shot himself? I remember feeling enraged, wanting to tell him that depression has no grandeur, it is opaque, it wastes too much and nurtures too little. But to say so would be to agree that I indeed had depression. I said nothing. I did not have depression. I did not want to have depression.
And now, in the doctor's office, I want to resist. I want to say no thank you, I'll take only premenstrual dysphoric disorder please. It fits elegantly in my arsenal of feminism after all, this severe form of premenstrual syndrome, suffered by only 3% of women, and with no known treatment, only different suggestions for management. It gives me a new language. I can help other women who grew up as I did in Nigeria, where nobody told us girls why we sometimes felt bloated and moody. If we ever talked about what happened to our bodies, then it was behind closed doors, away from the boys and men, in tones muted with abashment. Aunts and mothers and sisters, a band of females surrounded in mystery, the older whispering to the younger about what periods meant: staying away from boys, washing yourself well. They spoke in stilted sentences, gestured vaguely, gave no details. Even then I felt resentful to have to feel shame about what was natural. And now here I was, burnished with a new language to prod and push at this damaging silence.
But depression is different. To accept that I have it is to be reduced to a common cliche: I become yet another writer who has depression. To accept that I have it is to give up the uniqueness of my own experience, the way I start, in the middle of breathing, to sense on the margins the threat of emptiness. Time blurs. Days pass in a fog. It is morning and then suddenly it is evening and there is nothing in between. I am frightened of contemplating time itself: the thought of tomorrow and the day after tomorrow, the endless emptiness of time. I long to sleep and forget. Yet I am afraid of waking up, in terror of a new day. Mornings are dark, and I lie in bed, wrapped in fatigue. I cry often. My crying puzzles me, surprises me, because there is no cause. I open a book but the words form no meaning. Writing is impossible. My limbs are heavy, my brain is slow. Everything requires effort. To consider eating, showering, talking brings to me a great and listless fatigue. Why bother? What's the point of it all? And why, by the way, are we here? What is it I know of myself? I mourn the days that have passed, the wasted days, and yet more days are wasted.
The doctor calls these symptoms but they do not feel like symptoms. They feel like personal failures, like defects. I am normally full of mischievous humour, full of passion, whether in joy or in rage, capable of an active, crackling energy, quick to respond and rebuke, but with this strangeness, I do not even remember what it means to feel. My mind is in mute. I normally like people, I am deeply curious about the lives of others, but with this strangeness comes misanthropy. A cold misanthropy. I am normally the nurturer, worrying about everyone I love, but suddenly I am detached. It frightens me, this sense of slipping out of my normal self. It cannot be an illness. It feels like a metaphysical failure, which I cannot explain but for which I am still responsible.
There is an overwhelming reluctance to move. A stolidness of spirit. I want to stay, to be, and if I must then only small movements are bearable. I switch off my phone, draw the shades, burrow in the dim stillness. I shy away from light and from love, and I am ashamed of this. I feel guilty about what I feel. I am unworthy of the people who care about me. I stew in self-recrimination. I am alone. Stop it, I say to myself. What is wrong with you? But I don't know how to stop it. I feel as if I am asking myself to return a stolen good that I have not in fact stolen.
In some of my family and friends, I sense confusion, and sometimes, suspicion. I am known to nurse a number of small eccentricities, and perhaps this is one. I avoid them, partly not to burden them with what I do not understand, and partly to shield myself from their bewilderment, while all the time, a terrible guilt chews me whole. I hear their unasked question: Why can't she just snap out of it? There is, in their reactions, an undertone of "choice". I might not choose to be this way, but I can choose not to be this way. I understand their thinking because I, too, often think like them. Is this self-indulgence? Surely it cannot be so crippling if I am sentient enough to question it? Does the market woman in Nsukka have depression? When I cannot get out of bed in the morning, would she be able to, since she earns her living day by day?
The doctor says, about the high incidence of depression in creative people, "we don't know why that is". Her tone is flat, matter-of-fact, and I am grateful that it is free of fascination.
"Do you think anybody else in your family might have depression?" she asks.
Nobody else does. I tell her, a little defensively, about growing up in Nsukka, the small university campus, the tree-lined streets where I rode my bicycle. It is as if I want to exculpate my past. My childhood was happy. My family was close-knit. I was voted most popular girl in secondary school.
Yet I have memories of slow empty days, of melancholy silence, of perplexed people asking what was wrong, and of feeling guilty and confused, because I had no reason. Everything was wrong and yet nothing was wrong.
I remember a gardener we had when I was a child. A wiry ex-soldier called Jomo. A man full of stories for little children. My brother and I followed him around as he watered the plants, asking him questions about plants and life, basking in his patience. But sometimes, he changed, became blank, barely spoke to anybody. Perhaps he had depression. Later, I will wonder about African writers, how many could be listed as well in this Roll of Depression, and if perhaps they, too, refuse to accept the name.
The doctor says, "I'd recommend therapy, and that you try anti-depressants. I know a good therapist."
A therapist. I want to joke about it. I want to say that I am a strong Igbo woman, a strong Nigerian woman, a strong African woman, and we don't do depression. We don't tell strangers our personal business. But the joke lies still and stale on my tongue. I feel defensive about the suggestion of a therapist, because it suggests a cause that I do not know, a cause I need a stranger to reveal to me.
I remember the first book I read about depression, how I clung to parts that I could use to convince myself that I did not have depression. Depressives are terrified of being alone. But I enjoy being alone, so it cannot be depression. I don't have drama, I have not ever felt the need to rant, to tear off clothes, to do something crazy. So it cannot be depression, this strangeness. It cannot be the same kind of thing that made Virginia Woolf fill her pockets with stones and walk into a river. I stopped reading books about depression because their contradictions unsettled me. I was comforted by them, but I was also made anxious by them.
I am in denial about having depression, and it is a denial that I am not in denial about.
"I don't want to see a therapist," I say.
She looks at me, as if she is not surprised. "You won't get better if you do nothing. Depression is an illness."
It is impossible for me to think of this as I would any other illness. I want to impose it my own ideas of what an illness should be. In its lack of a complete explanation, it disappoints. No ebb and flow of hormones.
"I don't want to take medicine either. I'm worried about what it will do to my writing. I heard people turn into zombies."
"If you had diabetes would you resist taking medicine?"
Suddenly I am angry with her. My prejudices about American healthcare system emerge: perhaps she just wants to bill more for my visit, or she has been bribed by a drug rep who markets antidepressants. Besides, American doctors over-diagnose.
"How can I possibly have PMDD and depression? So how am I supposed to know where one starts and the other stops?" I ask her, my tone heavy with blame. But even as I ask her, I feel dishonest, because I know. I know the difference between the mood swings that come with stomach cramps and the flatness that comes with nothing.
I am strong. Everyone who knows me thinks so. So why can't I just brush that feeling aside? I can't. And it is this, the "cantness", the starkness of my inability to control it, that clarifies for me my own condition. I look at the doctor and I accept the name of a condition that has been familiar to me for as long as I can remember. Depression. Depression is not sadness. It is powerlessness. It is helplessness. It is both to suffer and to be unable to console yourself.
This is not the real you, my family say. And I have found in that sentiment, a source of denial. But what if it is the real me? What if it is as much a part of me as the other with which they are more at ease? A friend once told me, about depression, that perhaps the ancestors have given me what I need to do the work I am called to do. A lofty way of thinking of it, but perhaps another way of saying: What if depression is an integral but fleeting part of me?
A fellow writer, who himself has had bouts of depression, once wrote me to say: remember that it is the nature of depression to pass. A comforting thought. It is also the nature of depression to make it difficult to remember this. But it is no less true. That strangeness, when it comes, can lasts days, weeks, sometimes months. And then, one day, it lifts. I am again able to see clearly the people I love. I am again back to a self I do not question.
A few days after my doctor visit, I see a therapist, a woman who asks me if my depression sits in my stomach. I say little, watching her, imagining creating a character based on her. On the day of my second appointment, I call and cancel. I know I will not go again. The doctor tells me to try anti-depressants. She says in her kind and blunt way: "If they don't work, they don't work, and your body gets rid of them."
I agree. I will try antidepressants, but first, I want to finish my novel.
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