Excerpts from Must Read Books & Articles on Mental Health
Articles- Part XIII
Shock and Disbelief
Daniel Smith, The Atlantic Monthly, February 2001
On the cover of a pamphlet I was sent recently appears a photograph of an elderly man
with bright bolts of electricity shooting outward from his temples. His teeth are
clenched. His eyes are squeezed shut. His hair is standing on end. Holding the man's head
secure is a leather strap that resembles the restraint on a prisoner in the electric
This is electroconvulsive therapy ( ECT) -- the psychiatric use of an
electric current to stimulate a grand mal seizure--as seen through the eyes of the
Citizens Commission on Human Rights, a lobbying group founded by the Church of Scientology
and the most active and well organized anti-ECT group in existence. It is a grim view,
invoking coercion, barbarity, anguish--everything negative that has ever been associated
with psychiatry. It is also the common view.
Last fall I saw a patient receive ECT at McLean Hospital, a private
psychiatric facility in Belmont, Massachusetts. There, in a well-lit treatment room,
attended by a nurse, a psychiatrist, and an anesthesiologist, a middle-aged man suffering
from hallucinations and depression lay unconscious on his back while two electrode paddles
were placed on his head. A button was pressed, and the patient's right foot twitched
lightly. Shortly afterward the patient awoke and was given a snack before being escorted
back to his room.
The contrast between image and reality is surprising. The procedure I
saw at McLean reflects the way ECT has been administered for years, as cautiously and as
formally as any other medical procedure--perhaps even more so, because of the awareness
psychiatrists have of ECT's reputation as savage. Yet the popular image of ECT has
persisted, sustained almost single-handedly, it sometimes seems, by the 1975 movie One
Flew Over the Cuckoo's Nest, the release of which coincided with a decline in the use of
ECT. In 1980 less than three percent of all psychiatric inpatients were being treated with
the procedure, and by 1983, thirty-three states were in some way regulating it.
Although the public seemed willing to let ECT fall into obsolescence,
many psychiatrists felt that they were losing a valuable and irreplaceable treatment. In
1985 the National Institutes of Health, in Bethesda, Maryland, called a three-day
conference on electroconvulsive therapy. The first day of the conference passed without
incident, as experts delivered lectures. On the second day, however, during an open
discussion period, anger erupted on the floor of the conference hall. Former patients and
even a few clinicians began protesting loudly. One of those present was Max Fink, then a
professor of psychiatry at the State University of New York at Stony Brook and a pioneer
in modern ECT research. As Fink remembers it, "They were shouting, 'How dare you even
consider electroshock as a possibility! It has no place in the world! Everybody who does
electroshock should be in jail!"' When the conference resumed, a panel of
"nonadvocate" experts forged a consensus statement in which they observed, with
Electroconvulsive therapy is the most controversial treatment in
psychiatry. The nature of the treatment itself, its history of abuse, unfavorable media
presentations, compelling testimony of former patients, special attention by the legal
system, uneven distribution of ECT use among practitioners and facilities, and uneven
access by patients all contribute to the controversial context in which the consensus
panel has approached its task.
Today ECT has strengthened its position in the profession. Many
psychiatrists, whether or not they actively administer the treatment, have come to
appreciate its ability to ameliorate a range of mental illnesses, from depression to some
forms of schizophrenia and catatonia. A 1993 commentary in The New England Journal of
Medicine stated, "Electroconvulsive therapy is more firmly established than ever as
an important method of treating certain severe forms of depression." The first phase
of a National Institute of Mental Health supported study, to be published this spring,
found that ECT produced a greater than 95 percent remission rate in psychotically
depressed patients--vastly higher than the rate for any drug on the market. When I talked
with Fink recently, he told me, "ECT is the most effective antidepressant,
antipsychotic, anticatatonic we have today." Other psychiatrists have been even more
enthusiastic. One, T. George Bidder, has written that ECT is "one of the most
effective treatments in all of medicine--with a therapeutic efficacy, in properly selected
cases, comparable to some of the most potent and specific treatments available, such as
penicillin in pneumonococcal pneumonia." Such endorsements have led to what looks
like a renaissance for ECT; it is estimated that 100,000 patients are treated with it each
year--nearly triple the number cited for 1980 by the NIMH.
Yet the attacks on the treatment are as virulent as ever. Activists
continue to push for prohibitive legislation. In 1997 a bill that would effectively have
made administering ECT a criminal act, punishable by a fine of up to $10,000 and/or up to
six months in jail, was narrowly defeated in Texas. ECT has virtually disappeared from
state-run psychiatric facilities, owing in large part to government regulation. To be
treated, patients must almost always gain access to a private or academic hospital. This
means that ECT is very rarely an option for poor patients--those without adequate
insurance or access to information, or without the means to travel, for example, to a
distant, well-equipped university hospital. A 1995 article in the American Journal of
Psychiatry found that ECT was unavailable in more than a third of the 317 metropolitan
areas nationwide that it surveyed. "The situation has reversed itself from where it
was decades ago," says Richard Weiner, a professor of psychiatry at Duke University
and the head of the American Psychiatric Association's Committee on ECT. "Many ECT
patients used to be asylum patients. Now it's very hard to get ECT in such places, and its
use has shifted to general hospitals and private psychiatric hospitals."
The stigma attached to ECT is in some ways a holdover from less
scrupulous days of psychiatry. But one of the main reasons many people still consider ECT
to be archaic and even destructive is that it continues to be painted as such by an
unlikely trio of activist groups: a handful of former ECT patients, some dissenting
psychiatrists, and the Church of Scientology. These groups have agitated for the complete
elimination of ECT. They have pushed legislative attempts to limit or ban ECT. They have
initiated and supported lawsuits against psychiatrists, hospitals, and ECT device
manufacturers. They claim that ECT is authoritarian, violent, and representative of
everything that is wrong with the profession of psychiatry. And despite all medical
evidence to the contrary, people are listening to them.
"A CRACK OF ELECTRICITY"
Electroconvulsive therapy emerged during a bleak period for psychiatry. In the
first third of the twentieth century not much could be done for the mentally ill.
Psychoanalysis, the dominant method of treatment, proved helpful to some wealthy patients
complaining of the so-called "minor illnesses": melancholy and neurosis. But it
didn't do much for patients with more systemic afflictions, such as schizophrenia and
manic-depressive illness. These patients were merely warehoused in vast state asylums,
where conditions were appalling. Patients were abused, shackled, even surgically
sterilized. Psychiatry's job seemed to be no more than brutal custodianship; psychiatrists
could do no more than hope that their patients would recover spontaneously from their
illnesses. Under these desperate circumstances some psychiatrists began experimenting with
radical treatments: insulin coma, transorbital lobotomy, malarial fever. One of these
"somatic therapies --Metrazol shock--seemed particularly promising, given the theory
(now known to be untrue) that a "biological antagonism" existed between epilepsy
and schizophrenia. A schizophrenic patient was injected with Metrazol, a drug similar to
camphor. After a few minutes the patient would undergo a full-blown seizure: all the
muscles in his body would convulse violently, his back would arch, his limbs would flail,
his breathing would become shallow. Often he would vomit. It was a gruesome ordeal. The
historian Edward Shorter, in A History (1997), reported that a Swiss psychiatrist
stopped using the treatment because it caused "agonizing fears of dying and crumbling
away," and that a British doctor spoke of "the unseemly and tragic farce of an
unwilling patient being pursued by a posse of nurses with me, a fully charged syringe in
my hand, bringing up the rear." And yet, strangely, Metrazol shock worked pretty well
"Convulsive therapy," as it came to be called, opened wide vistas of
But no one really understood why inducing seizures made patients
better. Even today there are only educated guesses. Some subscribe to the neuroendocrine
hypothesis, which states that seizures cause a shift in the body's hormonal system. Others
subscribe to what has been called the anticonvulsant view, which holds that,
paradoxically, the whole purpose of causing a seizure is to tap into the brain's ability
to stop that seizure naturally. In other words, the brain's anticonvulsant mechanism may
alter the brain's neurochemistry, acting as a built-in antidepressant. Still others
believe that it is the seizures themselves that change the level of chemicals in the
brain. In 1990 a group of articles in the journal Neuropsy examined all three
possibilities without drawing any conclusions.
Regardless, from the beginning convulsive therapy proved promising. Ugo
Cerletti, in the 1930s the chief of the Clinic for Nervous and Mental Diseases at the
University of Rome, was among those who were impressed. But he considered that electricity
might cause seizures more quickly, and thus in a less harrowing manner, than Metrazol.
Earlier Cerletti had tested the neurological effects of electricity by conducting
experiments on dogs. His first attempts were inauspicious: because he put one electrode in
the dog's mouth and one in its anus, the bulk of the current passed through the dog's
heart; half the dogs died of cardiac arrest. Lucio Bini, one of Cerletti's assistants,
solved this problem by transferring the electrodes to the dogs' temples. Cerletti and his
staff worked tirelessly, experimenting on animals that were brought to them each week by
dogcatchers. The results supported their hopes: it seemed that using electricity was an
effective way to produce an epileptic fit. Before applying it to a human being, Cerletti's
assistants visited a Rome slaughterhouse to observe an electrical device that was being
used to incapacitate pigs prior to slaughter. They discovered that there was a wide margin
between the amount of electricity that would create a seizure and the amount that would
In the spring of 1938 "electroshock" as Cerletti called it,
was ready to be tested on a human being. The subject was a Milanese man the Roman police
had found wandering in the train station without a ticket, mumbling gibberish to himself.
Shorter described the inaugural treatment>
The patient, his head shaved, seemed quite indifferent to what was going on. A nurse
placed the electrodes on his temples while an orderly put a rubber tube between his teeth
to prevent him from biting his tongue ... There was a crack of electricity. The patient's
muscles jolted once ... "Let's step it up to 90." said Cerletti. Another
electrical crack. Another spasm. The patient lay motionless for a minute, then began to
sing. "We'll try it one last time at a higher voltage," said Cerletti, "poi
basta [and then enough]." At this point, the patient said, in a perfectly calm and
reasonable voice, as though answering an exam question. "Look out! The first is
pestiferous, the second mortiferous." The residents looked at each other puzzled.
Despite the primitive application, the patient responded quite well. He had ten more
treatments and was released, "in good condition and well-oriented." After a year
he had not relapsed significantly. This was no small feat; no one could remember any
experiment that had shown nearly such promising results. Thereafter ECT spread quickly to
European hospitals. By 1940 it had appeared in the United States. Psychiatrists were
enthusiastic One whom Shorter quoted wrote in the British Journal of Psychiatry,
"Without ECT I would not have lasted out in psychiatry, as I would not have been able
to tolerate the sadness and hopelessness of most mental illnesses."
ECT was a great step up. Patients did not vomit, as they did in the
course of Metrazol shock, and they did not experience as much psychological trauma. But
they did still have to suffer the effects of muscular convulsions, which were frequently
excruciating, and which have contributed to the persistent image of ECT as a brutal form
of treatment. Thrashing around on the treatment table, many patients bit their tongues and
cheeks. Many suffered broken bones or serious spinal injuries. Sometimes a gang of
orderlies and nurses was needed to prevent the patient from tossing himself off the table
altogether. In addition, patients suffered memory loss. They would awake confused, unsure
of where they were or what had happened, often forgetting events of the preceding weeks or
ECT was also drastically overused. Doctors in some hospitals would
treat dozens of patients in one giant room, wheeling the device on a cart from bed to bed;
patients were forced to watch the ordeal of those who came before them. One doctor in
England treated some of his patients more than a thousand times each. In the 1950s Ewen
Cameron, a psychiatrist at McGill University, in Montreal, "depatterned" his
patients by giving them twelve treatments daily. Milledgeville State Hospital, in Georgia,
for a time the largest asylum in the United States, had perhaps the worst history of
abuse: it used what was known as the Georgia Power Cocktail to punish uncooperative
The publicized experiences of famous patients treated privately with
ECT bolstered the evidence against the treatment. The poet Sylvia Plath was subjected to
ECT and wrote about it in her autobiographical novel, The Bell Jar : "Then
something bent down and took hold of me and shook me like the end of the world.
Whee-ee-ee-ee-ee, it shrilled, through an air crackling with blue light, and with each
flash a great jolt drubbed me till I thought my bones would break and the sap fly out of
me like a split plant." (Later in the novel the narrator had a less unpleasant ECT
experience.) Ernest Hemingway underwent a course of ECT at the Mayo Clinic, in Rochester,
Minnesota, and wrote to his biographer, A. E. Hotchner: "What is the sense of ruining
my head and erasing my memory, which is my capital, and putting me out of business? It was
a brilliant cure, but we lost the patient." Soon afterward Hemingway shot himself. In
1972 Senator Thomas Eagleton had to withdraw as the presidential candidate George
McGovern's running mate after it was revealed that he had been treated with ECT. And, of
course, One Flew Over the Cuckoo's Nest bundled all the public's negative associations
into the disturbing image of Jack Nicholson, mocking and playful one moment, writhing on a
table the next, and finally catatonic--the result, in actuality, not of the ECT he
received but of an off-camera lobotomy.
The above text covers the first three pages of this eleven page article. For the remainder, visit the archives of the Atlantic Monthly at www.theatlantic.com.
The Limits of Talk
Mary Sykes Wylie, The Psychotherapy Networker-
Bessel Van Der Kolk likes to introduce his workshops on PostTraumatic
Stress Disorder (PTSD) with medical film clips from World War I showing
veterans diagnosed with what was then called "shell shock."
In these dramatic and riveting clips, one soldier sits hunched over
on his hospital cot, staring blankly ahead, responding to nothing
and nobody until the single word "bomb" is said, whereupon
he dives for cover underneath the small bed. Another man lies almost
naked on the bare floor, his back rigidly arched, his arms and hands
clawing the air as he tries, spasmodically and without success, to
clamber onto his side and stand up. Yet another, who once bayoneted
an enemy in the face, now opens his mouth wide into a gaping yaw and
then closes it, and opens it and closes it, over and over and over
The images are disturbing, heartbreaking,
and all the stranger because these particular men, technically speaking.
are physically unharmed. Their physical symptoms -- paralysis, violent
trembling, spasmodic movements, repetitive facial grimaces, zombielike
demeanor -- look exotic to our eyes because PTSD generally doesn't
show up like this anymore in most clinicians' offices. Time and Western
cultural evolution have changed the way traumatized people express
their distress in a therapist's office. Now, trauma patients may look
fine on the surface, but complain of nightmares, flashbacks, feelings
of numbness, generalized fearfulness, dissociative symptoms, and other
problems that aren't as visible to the world at large. But to van
der Kolk, these old images still represent what he calls the "pure
form" of PTSD. The appearance in these World War I film clips
that the veterans are possessed, mind and body, by invisible demons
still captures the fundamental truth about PTSD -- that it can reduce
its victims to mute, almost animal-like, creatures, utterly isolated
in their fear and horror from the human community.
Van der Kolk first became aware of the
world of trauma in 1978, when he decided to go work for the Veterans
Administration, not to study PTSD (it hadn't been recognized yet as
a formal diagnosis), but to get the government benefits to pay for
his own psychoanalysis. While there, he discovered the reality of
PTSD and the beginnings of a stunning, nationwide phenomenon. "At
that time, tens of thousands of men who'd served in Vietnam suddenly
seemed to come out of the woodwork, suffering from flashbacks, beating
their wives, drinking and drugging to suppress their feelings, closing
down emotionally," recalls van der Kolk. "It was a phenomenon
that spawned a whole generation of researchers and clinicians fascinated
by what had happened to these guys."
Van der Kolk himself soon became intrigued by the mysterious mental
and emotional paralysis that seemed to afflict these traumatized veterans.
Why, he wondered, did many of his patients seem so stuck emotionally
in their horror that they relived it over and over in flashbacks and
nightmares? What kept these men circling round and round on an endless
treadmill of memory, unable to step off and resume life? In spite
of their obvious suffering, why did they seem so obsessively attached
to their traumatic experiences?
In the 25 years since then, the trauma
field has gone from obscurity, if not disreputability, to become one
of the most clinically innovative and scientifically supported specialties
in mental health. Trauma researchers have led the pack in setting
off an explosion of knowledge about psychobiology and the interaction
of body and mind. And van der Kolk, as much as anyone else in the
field, has defined the current framework for understanding trauma.
He's the author of more than a hundred peer-reviewed scientific papers
on subjects such as self-mutilation, dissociation, the therapeutic
efficacy of Eye Movement Desensitization and Reprocessing (EMDR),
the developmental impact of trauma, and the nature of traumatic memories.
He's also been a featured contributor in most of the standard textbooks
in the trauma field. In addition to teaching at Boston University,
Tufts, and Harvard, he directs the Trauma Center in Boston, possibly
the largest trauma specialty center in the country, with 40 clinicians
working with clients who range from infants to geriatrics, from incest
survivors to international torture victims. Inhabiting both the world
of the clinician and the researcher, he also runs a major research
laboratory at the Trauma Center, staffed by 15 researchers who investigate
everything from neuroimaging of treatment effects on the brain to
the effects of theater groups on violent, traumatized teenagers.
Glowing testimonials about his contributions
aren't hard to come by from the field's leading lights. "Very
early on, more than anybody else, he introduced neurobiology to the
trauma field, and helped us see the interaction between mind and body
in trauma," says Charles Figley, professor at the School of Social
Work at Florida State University and Vietnam vet, whose early work
on war trauma is often credited with prompting the inclusion of PTSD
as a diagnosis in the DSM. "He's one of the most generative and
creative minds in the trauma field, and his influence has been pervasive,"
says psychiatrist Judith Herman, renowned trauma expert at Harvard
At the same time, van der Kolk is also
one of the trauma field's most controversial figures. Often prickly,
rarely shy about offering his own opinions, and unafraid of a good
fight, he's scandalized a number of cognitive-behavioral therapists
and academic researchers by openly embracing EMDR, demonstrating an
interest in such truly outre techniques as Thought Field Therapy,
enthusiastically taking up nonstandard somatic therapies, and even
sending his patients off to participate in theater groups and martial
arts training. Van der Kolk's bold criticism of the orthodoxies of
psychotherapy and public advocacy of somatic approaches have, in particular,
outraged many. "Advocating unproven body psychotherapies is professionally
irresponsible," says Edna Foa, professor of psychology in the
psychiatry department at the University of Pennsylvania. "He's
marginalized himself as a scientific thinker -- he's no longer in
the mainstream," adds Richard Bryant, noted trauma researcher
and psychology professor at the University of New South Wales in Australia.
"Until he provides data in support of his new somatic approach,
the field isn't obligated to pay any attention to what he's doing,"
sniffs psychologist Richard McNally, author of the widely cited Remembering
Trauma, a critique of recovered-memory theory.
The intensity of response van der Kolk
kicks up is an indication of the crusader's fervor underlying his
work and his determination to make the field viscerally understand
that trauma isn't simply a neutral mental health issue, but a profoundly
moral concern. Spicing his talks with earthy, Dutch-accented American
slang, van der Kolk regularly reminds his audience in a tone of subdued
indignation that trauma forces the reality of human evil into our
consciousness, often the evil of presumably good and upright people
-- our neighbors, our leaders, our families, and ourselves. It's not
a perspective people always welcome because, as he writes in his book
Traumatic Stress, most of us like to believe "that the world
is essentially just, that `good' people are in charge of their lives,
and that bad things only happen to `bad' people.... Victims are the
members of society whose problems represent the memory of suffering,
rage and pain in a world that longs to forget."
A Diagnosis Non Grata
While trauma is always clinically described as a horrifically abnormal
event, for any casual student of the human condition, it's actually
a perfectly normal feature of history, one that has emotionally scarred
billions of men, women, and children since before the beginning of
recorded time. And yet, while philosophers, writers, and ordinary
people have always known that terrible events can cause a lifetime
of psychological pain, until the latter part of the 20th century,
mental health professionals were oddly blind to this fact of life.
"Psychiatry itself has periodically suffered from marked amnesias
in which well-established knowledge has been abruptly forgotten,"
writes van der Kolk in Traumatic Stress, "and the psychological
impact of overwhelming experiences has been ascribed to constitutional
or intrapsychic factors alone." In other words, a failure to
"get over" a trauma was often ascribed to personal weakness
or an unconscious desire not to recover.
Even the official nosology of the psychiatric
profession reflected this peculiar obtuseness. The 1952 edition of
the Diagnostic and Statistical Manual of Mental Disorders (DSM-1)
had included combat-related stress under the diagnosis of "gross
stress reaction," but this was dropped from the DSM-II in 1968
-- the same year that troop strength reached its peak in Vietnam.
All that was left of trauma in DSM-II was the pallid diagnosis "adjustment
reaction to adult life," under the general heading of "transient
situational disturbance." Adjustment reaction was a grab-bag
diagnosis, including "fear associated with military combat and
manifested by trembling, running and hiding" and "unwanted
pregnancy." It wasn't until 1980, after years of lobbying and
wrangling, that PTSD was included in DSMIII. So when van der Kolk
first went to the VA in 1978, not only was there no official traumatic
stress diagnosis, but the VA assumed that any psychiatric problems
occurring more than one year after discharge couldn't be related to
military service. Besides denying veterans any compensation for delayed
traumatic reactions probably the overriding consideration in the VA's
longstanding lack of interest in the enduring impact of "combat
stress" -- this rule effectively scotched any research or clinical
treatment directly focused on trauma. "When I went to work for
the Boston VA," remembers van der Kolk, "there wasn't a
single book in the library on war neurosis."
Unable to do research on war trauma
because the VA wouldn't fund studies on a diagnosis that didn't exist,
van der Kolk and his colleagues did the first study ever on the real
nightmares the vets had and, in another first, used the Rorschach
inkblot test to reveal the twin pattern of hyperarousal and dissociation
that traumatized vets showed. For van der Kolk, this research pointed
to the paradoxical conundrum at the heart of trauma. "This is
still the issue with traumatized people -- they see and feel only
their trauma, or they see and feel nothing at all; they're fixated
on their traumas or they're somehow psychically absent." In either
case, traumatic memories from the past have utterly usurped the present.
The above text covers the first two pages of this nine page article. For the remainder, visit the archives of the Psychotherapist Networker at www.psychotherapynetworker.org.
Depressed Comedian Hospitalized. Hilarity Ensues.
Jennifer Senior, The New York Times, 11/17/2019
If I were a comedy obsessive, I would have already known about the sneaky
genius of Gary Gulman. He's got a devoted following, a winning smile, a
corkscrew imagination; in 2016, when he did a six-minute bit on "Conan"
about how the states got their two-letter abbreviations, it became a viral
sensation, pure catnip for nerds.
But what I wouldn't have known about Gulman -- because he kept it so
well hidden -- was that he'd spent the bulk of his life trying to subdue an
intractable melancholy. His recent HBO special, "The Great Depresh," joins a
growing family of stand-up performances about mental suffering. (See Chris
Gethard's "Career Suicide" if you want another, or Hannah Gadsby's
"Nanette.") Gulman is unsparing with the details: In 2017, he suffered an
episode of major depression so crippling he checked himself into the
hospital for electroconvulsive therapy. It meant canceling months' worth of
Today, Gulman is "in remish," as he likes to say, and he's made that
depressive episode the centerpiece of his act, demystifying incapacitating
gloominess with sunny and wicked abandon. What popped out wasn't any one
line, though there were many. (Especially devastating: When he channels
friends who question whether antidepressants are worth the potential side
effects, like impotence. "Oh yes. I was having so much sex in the fetal
position.") What stood out instead was a persistent theme: There was a huge
gulf between the Gary Gulman almost everyone saw and the person he knew
himself to be.
He describes his adolescent body, an imposing 6-foot-6, as a "man
costume" belying a gentle boy who preferred to read. When a storied coach
from Boston College came to his house his senior year to recruit him for
football -- "you have an N.F.L. body," he told him -- Gulman had to stifle the
urge to reply, "No more than 10 feet from here, I have a blankie." After his
hospitalization, he got an invitation to attend his 25th college reunion. He
dreaded the prospect of going. "I was so sick of lying about how I felt to
make other people feel less uncomfortable around me," he explains. "People
lie at their reunions even if they're doing well."
observation should ring true to almost any functional depressive. It's work
to seem fine. If you're just well enough to drag yourself to your place of
employment (your thoughts still a sound cloud of distress, but the volume on
low), or if your depression takes the form more of an itchy sweater than a
leaden dentist's apron (which is to say, anxiety), you are forever and
always performing your okayness. Every depressed person has a clandestine
self. I know a thing or two about this. I've always wandered through the
world nerves first. My anxiety can shatter stones, spook ghosts, freak out a
cup of coffee. I jazz-hands my way through it.
thrilling enough that Gulman was calling attention to the depressive's daily
charade. But the more I thought about it, the more I realized he was doing
something else, and it was something quite powerful: He was calling
attention to our culture's daily charade too. His act is a tacit rebuke of
the lacquered fakery of our Instagrammed, brand-conscious lives.
Presentation of Self in Everyday Life," the sociologist Erving Goffman made
the distinction between our "front stage" behaviors -- in which we're
performing for a particular audience, always conscious of being observed --
and our backstage ones, when we peel off the mask.
frontstage in so many ways and across so many platforms that it's utterly
exhausting. We perform the just-right kind of politics. (See my latest tweet
about the latest outrage!) We perform our perfect vacations and Tuesday
night cocktails. (Look at my Instagram, and note that you, dear follower,
were not invited to those cocktails!) We perform our brilliant professional
identities, networking and hustling during hours once devoted to relaxation.
Built into any front-stage setting is the expectation that we'll project
happiness, confidence, success.
Depression is, by definition, a back-stage emotion. It's private,
idiosyncratic, isolating. Those comedians who've elected to discuss it are
still giving performances, ultimately, working off careful scripts and
landing their punch lines; they aren't climbing onstage and actually being
depressed for us.
You could argue that comedians have long made art out of their pain.
The sad clown, the angry comic - it's basically a cliche. But the crop of
comedians making these specials aren't just using their melancholy as
invisible fuel for their art. It's the end-product too, the material itself.
They've made it audible, shareable, knowable. Visible.
discussing it in non-comedy contexts. At roughly the same time Gulman's
special appeared last month on television, the documentary short "Laughing
Matters" appeared online, featuring nearly a dozen comics discussing their
experiences with anxiety and depression. Among them are Sarah Silverman,
Rainn Wilson and Wayne Brady. Gulman's special also contains any number of
scenes offstage -- in his childhood home, in his apartment, in his
psychiatrist's office -- as if to show us: This is what I'm like when I'm not
converting suffering into comic expression. At one point, his wife confesses
she wasn't sure if he was ever going to get better.
people are sick of everyone promoting their best selves," Gulman, 49, told
me in a phone interview, adding that he was lucky to be among a generation
of comics who could speak freely about their imperfect, struggling selves
instead. That was hardly true when he was watching comedy as a kid. "I mean,
comedians were always self-deprecating, but even Rodney Dangerfield's
self-deprecation was so clearly a lie. He's saying he doesn't get any
respect, but he's hosting an HBO show. Everyone admired him, was in awe of
Gulman built his act slowly, first dedicating only 15 minutes to his
depression at the very end of his set. "I felt I'd given everyone enough
pure jokes and entertainment to earn those 15 minutes," he explained. "And
people came up to me afterward. They were just so grateful for that portion,
so appreciative. It led me to believe they were thirsty for it."
And there is
a thirst. When I first reached Gulman, I mentioned that his fans, old and
new, must have lately turned him into their confessor, sharing with him
their private worries and sorrows. I couldn't imagine the burden of being in
such a position. Yet as we were chatting, I found myself doing precisely
that -- peeling off my reporter's mask and sharing stories of my own,
pointing out where I'd identified with him, seconding his observations.
Those undisclosed selves: They really do long to be seen and heard.