Poets on Prozac: Mental Illness, Treatment, and the Creative Process

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FOR THE FORTUNATELY UNINITIATED, it's difficult to comprehend how depression strips you of everything that makes you feel like a creative, contributing member of a family or society. After a severe episode of depression, which kept me home from work for most of a year, colleagues repeatedly asked me, "Were you writing?" For a good deal of my sick leave, I'd been unable to lift a pen, get out of bed, or speak for more than a minute or two. I lived without energy, sense of humor, charm, or any of the imaginative spark that makes the future look like a desirable place to inhabit. I became Woman in a Dressing Gown. At my worst, the duvet on my bed looked like a body bag and I was the corpse inside it.

So, no, I wasn't writing, but I was making mental notes. People who don't have depression are fond of commenting that many of its victims are gifted creatively, as if this made up for the sporadic visits to one's emotional underworld. When I'm well, writing is at the very center of my life and is a powerful force for health. To write, though, I have to be feeling happy, to have a surplus of vitality that allows me to be more alive and quicker than usual, see colors more vividly, hear rhythms more subtly, and have access to all my bodily sensations. In fact, I have to be in a state of hyperawareness that is the direct opposite of the half-life of depression.

Dylan Thomas described the condition of being a poet as walking over broken glass on your eyeballs. Since I was a child, I've lacked an emotional epidermis. This is good for writing-it means I can sense a lot-but bad for one's daily equilibrium. When I was young, my mother would try to "toughen" me up by mocking many of my childish raptures. This had the effect of making me ashamed of my most extreme esthetic reactions. Many years later, when I was a student at Columbia University's Graduate Writing Division, I nearly cried with relief to hear Nobel Laureate Joseph Brodsky warn a class of poets to "beware of the mockers." The last thing a poet needs is to be self-conscious about his or her reactions when they're already considered, let us say, unusual by conventional society. It took me years of therapy and poetic practice to unlearn the habit of self-censorship, particularly in the early stages of composing a poem, when I need to cast my net as widely as possible, without worrying if I'm upsetting anybody else with the material I'm catching. Anything unacceptable can, legitimately, be screened out at the editing stage, but if that full emotion isn't there in the first draft, the poem is very likely to be thin and uninteresting. It will have no subcutaneous fat.

I started writing poetry when I was seven. One rainy Easter holiday, I was bored, stuck inside the house. Suddenly, I started to compose a long rhyming narrative poem about the rain. This activity made me happier than anything I knew. The project of shaping the real world into a pattern that sounded beautiful thrilled me deeply and compensated, in a way, for the washout of a holiday. I showed this epic to my mother, who made corrections to the spelling. She was an English teacher, and this pattern continued for many years, until I learned not to show her my writing. Depression is shot like a dark thread through our family history. My grandmother took to her bed at a young age and used emotional manipulation to keep the rest of the family in line. I grew up observing my mother's crippling episodes, when she would take to her bed for days at a time and the rest of us had to creep around the house, careful not to set off her rage and despair.

Having learned how destructive depression can be, I was horrified to undergo a first episode in my early twenties. By then I had stopped writing altogether and was reading English at Cambridge University, a course of study guaranteed to make one feel creatively inadequate alongside Wordsworth, Keats, and other literary giants. I fell in with a sociable, rackety crowd and stopped studying. I now know that, for me, not writing is as unsafe as driving a car in the dark without headlights: I need to write to be fully conscious of my own life. I suffered a breakdown that led me to repeat my second year of studies, during which I began to realize that if I was to be well in the long term, I needed to rediscover the project of poetry on my own terms. I remember walking down Sidney Sussex Street and knowing that I desperately wanted to understand poetry and that to do so I would need to change my life. So began the long discipline of reading and internal discovery in which I am still engaged today.

After my final exams in Cambridge, I fled on a scholarship to the United States, where I was lucky enough to study with Seamus Heaney, Joseph Brodsky, and Derek Walcott, among other poets. They helped me begin to pick out a way of truth telling in words that would allow me to sidestep my own dishonesties. I consider myself fortunate to have a craft and an artistic tradition that show me how best to embark on such difficult discoveries and allow me to travel in the company of other poets. While we use language, we are never speaking alone.

Poets are constantly translating between nonverbal states of mind and language, but they do this by using poetic meter, which allows them to speak with a sound that, because of its previous use by other poets in a tradition, is larger than their individual voice. Meter, as Joseph Brodsky defined it, is reorganized time, which makes sense of W. H. Auden's statement that "time worships language." But rhyme adds another dimension to the mechanism. Poets don't compose poems starting at the first word and ending with the last (even though this might be the order in which they write them down). When you have reached a certain level of facility, rhymes come faster than grammatical sense, so you often compose your lines backward from the rhyme word. This process gives the poet a fast track to his or her unconscious, allowing surprising and mysterious conjunctions of sound and sense to surface.

Such utterance out of a collective sound gives the poet some kind of proof against the onslaughts of unconscious material that, if faced in a less corporately developed language, might be too much to endure. I was fascinated to hear the late Ted Hughes say that one of his regrets in life was that he had written so much prose. He seemed to imply that, if he'd kept to poetry, he might not have succumbed to the cancer that killed him, as if poetic meter were a lead apron he should have worn when dealing with his radioactive personal life.

By the time I returned to the United Kingdom, to do my doctorate at Oxford, I had established writing poetry as my priority in life but was far from being out of depression's woods. Over the years I had discovered alcohol as a way of self-medicating for low spirits. It stopped me from feeling painful emotions, helped me to sleep, and, in company, gave me false confidence. It was also the drug of choice in the bohemian circles of poets and journalists in which I now turned. For a while I labored under the delusion that being drunk helped me write. After all, hadn't Dylan Thomas achieved good results by translating alcoholic raptures onto the page? I used to keep notes of my altered states of mind under the influence of drink in the hope that they would offer startling new images for poems. They didn't. It was impossible to decipher my handwriting, and I kept throwing up. Another poetic myth bites the dust.

Alcohol is a powerful depressant, and its abuse propelled me into a new spiral of despair. Through my doctor I was referred to the Warneford Hospital for group therapy, which I hated. When I moved back to my home city to live, I was sent to see a psychiatrist who also practiced as a psychotherapist. I couldn't believe my luck when I discovered that this doctor also read poetry and so understood many of my artistic crises. It seems to me miraculous that I was able to have nearly fifteen years of weekly therapy free on the National Health Service, and I took full advantage of it. I'm sure that the chance to have such a high-quality conversation helped, literally, to keep me alive.

When I eventually realized that I had become hooked on alcohol and that my only chance of writing anything was to stop drinking, I was able to use a poem to explore the catastrophic effect of such drugs on creativity. A friend told me that he used to hide a half bottle of vodka in a hedge he knew, so that he could drink from it on the way to work. In "The Hedge" I imagined becoming stuck in a beech border:

... you'd scarcely believe the strength in a hedge that has set its mind on holding a person in its vice of leaves and this one was proving a real bind. With a massive effort, I took the full strain and tore up the hedgerow, which I flicked up behind me, heavy and formal as a wedding train.

The poem tells the fate of a woman who tries to hide her anomalous hair-do but who, as she dies, submits to her addiction as a "narrowness, a slowly closing eye." Without this poem I would never have learned that my own difficulties, of which I'd been ashamed, could be the basis of wildly flamboyant poetry exploring the nature of psychological pain. At readings, more than ten years later, I'm still regularly asked for "The Hedge."

Things went well for me creatively in the nineties. I published six books, three in Welsh and three in English, and was awarded prizes. Having decided that I would rather be employed full time than endure the hand-to-mouth existence of the jobbing poet, I worked in the BBC as a television producer. In the morning I would write before putting on a suit and makeup. Weekends I spent away reading in festivals all over the country and, sometimes, abroad. Leighton, my husband, tried to warn me that I was doing too much, but I was so pleased to be living productively that I thought nothing of running two careers simultaneously.

During this time, I had been working hard in therapy trying to understand why I suffered from a low-grade chronic depression. With my psychotherapist I explored the history of my writing and how that had been co-opted and then rejected by important people in my life who had wanted to control me. I learned how those who are too afraid to put themselves on the line creatively resent a loved one's doing so and can attack poetry as a rival. This was never overt, but the outcome had been devastating for me. Subconsciously I'd equated the part of me that wanted to write with the betrayer of my most intimate relations. Later, I explored this dilemma in a poetic fairy tale, in which a daughter was destroyed by the conflict between two parental figures:

A FANCIFUL MARRIAGE A blank, she became the board for their games: The words on her face were never the same as they played hard scrabble with desperate hands . . . . . . . . . . . . . . . . . . sure that her mirror could save their souls. Till her own went missing. Then, how she ran chasing its radiant flickering down alleys of phantasmagoria . . . . . . . . . . . . glinting through chasms, past chimeras that flayed her of feeling and left her for dead.

You can't manipulate a poet who's fully committed to writing because he or she is listening to a subtle but compelling rhythm that is linked to his or her most authentic self. This is why totalitarian states can't abide poets and sometimes kill those who refuse to serve the state's ideology.

In the face of apparent success, the last thing I expected was to experience an even more debilitating episode of depression. One morning I was driving to work when I began to cry. I went home, put myself to bed, and slept almost continuously for two weeks. It was five months until I began to feel even remotely like myself again and a year before I could return to work. Within hours I knew that my blood chemistry was seriously disordered because of a neurological nausea, a dry retching through all my nerves, which I knew I wouldn't be able to stand without help. I remember screaming at Leighton that, this time, I needed drugs. The next morning we went to my doctor, who prescribed Seroxat (paroxetine). The medication was a blessing in that it opened up a vital space between me and the emotional horrors that were squeezing the breath out of me. My psychiatrist suggested that I keep a mood chart, and because of this, I was able to see when Seroxat stopped working. I changed to venlafaxine (Effexor), which suited me, and I stayed on it for a couple of years.

Because I'd been seeing a psychiatrist weekly for nearly ten years, there was no doubt about the diagnosis of unipolar depression. We had spoken about the possibility of my being bipolar in the past but had used the checklist of symptoms in the Diagnostic and Statistical Manual, 4th edition, to confirm that I am unipolar. We checked this because I do have an unusual amount of energy for long periods and am able to work more productively than many people. This, however, is never without cost, and I pay for prolonged periods of work with equivalent barren periods, during which I have to rest and recover. Over the years I've learned to notice that hyperactivity is a reliable indicator of when I'm about to go down. It's as if my body knows that it won't be able to sustain its current workload for much longer and that if some project needs to be completed, it had better be done quickly. My goal now is to learn how to work more consistently, so that I avoid extremes of workaholism and lassitude, but this self-control is an ongoing struggle. In my case, the fatigue indicator that tells most people that they need to recharge their batteries is broken, so I need another form of discipline to stop me from driving myself into the ground. When I fail at this, my husband resorts to shouting at me, and that usually, though not always, works.

By the time I'd recovered from that episode of depression, I finally understood that writing and working full time was no longer a sustainable combination for me. I took voluntary redundancy from my job and, with the payment, bought a sailing yacht. Leighton and I had always wanted to undertake a long voyage, so we set off to circumnavigate the globe. Neither of us had sailed before, though Leighton had been in the merchant marine, and leaving the United Kingdom for European waters put us through a steep learning curve. Whereas I had been glad to take venlafaxine while I was coming out of my depression, it was only when we were at sea that we noticed the drawbacks of the drug. It seemed to dull the speed of my reactions and make me indifferent to problems. This is useful if you're feeling hysterical but is not a good thing if you're being blown toward a rock and need to think what to do with the sails to avoid the danger of shipwreck. I resolved, with my psychiatrist's agreement, to come off the medication slowly, and I did.

I was not to know that life was about to become ten times harder. Our marriage, which had been extremely happy, seemed to be unravelling under the pressures of a new environment. After a very challenging fifteen months making our way from Cardiff, Wales, to Gibralter, to Ceuta, Spanish Morocco, on the coast of North Africa, we discovered that Leighton was suffering from Stage IV non-Hodgkin lymphoma. Under the stress of feeling so ill, Leighton had turned into a negative, angry man, very different from the person I'd married. It seemed to me that we might well be heading toward divorce. We left the boat in Ceuta, a Spanish enclave in Morocco, and returned to Wales so that he could undergo chemotherapy. I looked after him through this ordeal and was astonished to find that, although I was under substantial stress, I wasn't depressed. Going into winter, with nowhere to live (we'd rented out our house) and uncertain whether Leighton was going to live or die, I still felt alive and could see dark gifts in each day.

During the seven months of Leighton's chemo cycle, I sat at home with him and wrote Two in a Boat, my account of our voyage, using it as a lamp to guide us through what had become very confused emotional waters. For me, the way out of the crisis was directly through that book, and I was aware of trying to sort out for both of us whether or not we should stay together. I showed him each chapter as I finished it. He was subdued to begin with, but then he acknowledged that, painful though it was, what I had written was true. I think that book saved our marriage.

(Continues...)

Excerpted from Poets on Prozac Copyright © 2008 by The Johns Hopkins University Press. Excerpted by permission.
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