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David Foster Wallace — chronicle of a death retold (Updated)

On March 19th covering

Reading D.T. Max’s New Yorker article on the writing life and bitterly sad death of David Foster Wallace, I cannot escape a nagging question: Through the years of pharmacotherapy, did anybody try to talk to the guy? By which I mean a sustained, serious, patient psychotherapy. As a marker of where we are as a culture — is it that the biological explanation of human nature has taken hold so throughly that a major cultural figure can suffer unto death without it apparently occurring (publicly) to anybody that a full-court press for depression includes deep psychotherapy? If only to maintain human connection while all the medical things are being tried, and perhaps for something much more.

It is gauche to wonder about his, and horribly unfair to Wallace’s family and his doctors over the years because I don’t know what was tried or what they tried to persuade him to try. Second-guessing from a safe distance is cruel and transparently self-serving. Everything I have read indicates that his family and wife were remarkably attentive and patient, and that he deliberately misled them at the end so he could slip away to the only relief he could imagine. Even if they had been somehow deficient in their help for him, it would be none of my business.

Also, my own feelings of sorrow are such that I cannot pretend to any objectivity. It makes my stomach hurt to know Wallace (who, like Obama, is a little younger than me) is gone – not just his brilliance, but his great, searching humanity. My mind seeks a way to “say it ain’t so”. There is the magical wish that if we can come up with a cure retroactively, he won’t be dead any more. I am no more immune to this departure from reality than anybody else.

But in the frank discussion of all of the medical interventions that he tried, including ECT on at least two occasions, there haven’t been any published mentions of psychotherapy that I have seen. This passage from the short story “The Depressed Person” was used by Max to give the tenor of Wallace’s real-life treatment:

Paxil, Zoloft, Prozac, Tofranil, Wellbutrin, Elavil, Metrazol in combination with unilateral ECT (during a two-week voluntary in-patient course of treatment at a regional Mood Disorders clinic), Parnate both with and without lithium salts, Nardil both with and without Xanax. None had delivered any significant relief from the pain and feelings of emotional isolation that rendered the depressed person’s every waking hour an indescribable hell on earth.

What I have read gives a convincing account of Wallace’s excruciating depression since his teen years. I think it was his sister who pointed out that he held off from suicide to a heroic degree, that it’s selfish of us to ask him to “hold out a little longer” because he did hold out a helluva lot longer.

. . . . . . . .

Wallace would have been a tough customer in psychotherapy. Never mind that his planet-sized intellect would allow him to run rings around practically anybody. It would take a skilled person to avoid being caught in intellectualizing distractions with him, or the seductions of his storytelling and verbal virtuosity.

He portrays the psychotherapy situation as pointless and cruel in both the Depressed Person and Infinite Jest , and the therapist as either a smug dispenser of advice or a literal fraud. The psychotherapy situation is evoked in the numerous torture scenarios in his big novel. Psychotherapy and those of us who do it have always been fat targets for lampooning, that’s fair enough. But one feels there is something dark and beyond-cynical in the glimpses we have in his fiction.

Wallace brought us inside characters in states so extreme and painful that they were blotted out by them. He seemed to be constantly saying: “how can we stand it?” His portrayal of psychotherapy echoes the accusation of every patient: “How can you possibly help me?”. The only answer I know to this is “let’s take some time and we’ll see”.

There is a terrific conundrum in attempting to help someone in such pain. Like a burn victim — anything intended to comfort is likely to hurt. Yet, the humane impulse is to swing into action to make it better. This urgency to do something can be dangerous. The Depressed Person shows a therapist who encourages the sufferer to use her pain as a weapon of entitlement to coerce people to cater to her – which propels her into a spiral of hostile dependency as she becomes more isolated and repulsive to others.

This is a devastating critique of various supportive and “solution-focused” approaches, and might reflect what Wallace may have experienced by way of talk therapy here and there, perhaps in a short-term hospital stay. There is a drawback to technique-oriented cognitive interventions, in that the patient can feel under pressure to perform. A bright and depressed friend wrote to me about his encounter with treatment:

I told them it hurts when I go like this and they said “don’t go like this”.

My friend wanted to understand himself and be understood. He felt the rush to apply techniques was a command to shut him up. It is hard to hear the suffering of another without probing for good news and reassurance.

When I make a therapy blunder it’s usually something like this. My nerve fails me and I try to do something to try to diminish suffering in a way that’s premature and out of sync. The patient correctly feels this as my unwillingness to hear them out for the moment — it’s really for my benefit and not theirs. Then the treatment is upset and we need to work it through and get it back. Some whole approaches to treatment never recognize these dimensions, preferring to exploit social pressure for the sake of compliance with protocols.

Psychoanalyst T.M. Main said (quote from memory — will fix later)

a sufferer in the hands of a healer who is keen to heal, and who does not improve, is likely to receive primitive human behavior disguised as treatment

. . . . . . . .

The point is not to argue that my flavor of psychotherapy — psychoanalysis — would have prevented this tragedy and allowed this man to find the pleasure and satisfaction in a long life that he deserved. This wouldn’t make me appreciably different from all of the very bright women (and men) with advanced degrees who secretly feel (perhaps with justification) that they could have saved Wallace (the object of many grad-school crushes) with their extravagant love and understanding.

It’s about speaking up for the need to preserve psychotherapy as a refuge of human understanding, and to keep alive the knowledge in the big world out there that this form of help is real and available. There are constant pressures to make psychotherapy something technocratic and depersonalized — a “procedure”. The reason I value (and practice) psychoanalysis is because it is the discipline that best values and makes room for human understanding, as far as I know. Psychoanalysis as a clinical process gives a framework that allows certain powerful human things to happen. Once that is underway, it becomes possible to glimpse unconscious feelings and fantasies, note the hopes, fears and fantasies that emerge in the interpersonal force-field of the analytic relationship, and catch bits of memory that suddenly are remembered to illuminate the present.

Back to the lamented Mr. Wallace. He was able to partake of some of the human understanding he found in 12-step groups with people much less sophisticated than himself. Infinite Jest contains loving appreciation of the helpful wisdom that comes wrapped in corny slogans, and the real caring and contact of 12-step communities, including the combined terror and relief of being understood by another person.

A profound psychotherapy, such as a psychoanalysis, can take this even further. There is the chance that had this been possible, it might have ameliorated the disturbing and excruciating pain that he felt in the form of panic and depression. I’m not vending a specific theory of Wallace’s malady — this doesn’t interest me. I’m saying that a process of being deeply, patiently understood in this disciplined way, in a way a spouse or family member can’t offer because of who they are, might have, over time, allowed a path to something changing. It would have been a harrowing ride. Wallace was a world-class overthinker. He might have feared it would have made him worse, and the glimpses in his fiction suggest to me he would have found it terrifying. Maybe it wasn’t possible for him to trust another person to cut through his obfuscation and pull him back from the brink of solipsism.

. . . . . . . .

Severe and unremitting depression is frightening to be around. It is hard to encourage the patience it takes for the open-minded exploration of a serious psychotherapy. This is hard to tolerate while in pain, or in the presence of great pain. It can feel like offering long-term investments to a person who is on fire. It can feel like offering a twig to someone lost in mid-ocean. But it’s a place to begin.

It’s tempting to think of emotional pain as simply a chemical, metabolic problem. Even where it is in large part a metabolic problem, there’s also a human being in there who needs to live with their experience. Biology has become the explanatory myth of our time, and it actually interferes with using medication in a sober and clear-minded way. It offers the reassuring hope that it’s just a matter of getting the meds right. But when this hope crumbles, it really crumbles. At the end, Wallace complained that the pharmacologists were “throwing darts”. And then he was gone.

Wallace was known to say

Fiction’s about what it is to be a fucking human being

which is also what psychoanalysis is good for.

UPDATE:

The autho of the New Yorker Piece, D.T.Max, did an online Q and A on the article. (Via Kottke)

Here’s the last exchange:

Q: The thing that I’ve been wondering about since learning of Wallace’s suicide is the extent and nature of his psychotherapy. In this article there are references to psychopharmacologists. Wallace had, to understate it radically, an incredible facility with words, and I’m wondering if he ever underwent psychoanalysis, a form of therapy that, more than anything, is language-based. Did he ever attempt a talking cure?
Lee Klare
Chicago, I.L.

A: I don’t know whether he tried psychoanalysis itself. I can’t imagine he wasn’t curious about it.

One Response

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matt b

Mar 2 at 21:08

#155

It’s hard for me to imagine him in psychotherapy–partly because I believe he could verbally destroy most of them and partly because I think he was stubborn. He also discusses a struggle with analysis in “Good Old Neon” – “Later I was in analysis, I tried analysis like everybody in their late twenties who’d made some money or had a family or whatever they thought they wanted and still didn’t feel that they were happy. A lot of people I know tried it. It didn’t really work, although it did make everyone more aware of their own problems and added some useful vocabulary and concepts to the way we all had to talk to each other to fit in and sound a certain way.”

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