The Death of David Foster Wallace is a Libertarian Issue

I’m afraid that, for me, the death of David Foster Wallace was much like that of Kurt Cobain: I just wasn’t paying that much attention beforehand. I own two copies of Infinite Jest, and have yet to read either one. (If memory serves, when Cobain died, I had only really listened to Smells Like Teen Spirit from the interior of my best friend’s brother’s car as he drove us home from school.) Even if I had read Jest, I don’t suppose that would qualify me to act as armchair psychiatrist for Mr. Wallace, as so many have tried to do. However, I did pick up a secondhand copy of A Supposedly Fun Thing I’ll Never Do Again and read that straight through, if that helps matters, and I read the Rolling Stone profile, David Lipsky’s The Lost Years & Last Days of David Foster Wallace, while waiting for a smog check. I’ve also gone through many of the less substantial tributes.

But I haven’t read anything that fingers the antidepressants and shock treatment as contributing to Wallace’s demise. For instance, Julian Gough’s The Rest is Silence asserts that it was the academy that killed Wallace:

He was an immensely gifted and original writer, with a brilliant, hyper-analytical mind. The two things such people should avoid are marijuana and universities. He was aware of the dangers of the former (which was not just a threat to his prose—after his first novel he checked into rehab and asked to be put on suicide watch). But he couldn’t escape the warm, welcoming trap of the latter. Only universities will give a job for life and full health insurance to a novelist with heavy-metal hair and a history of depression. He was, as ever, aware of the risk to his fiction. In a brilliant, painful television interview with Charlie Rose in 1997, he said, “Oh boy, don’t even get me started on teaching… The more time and energy spent on teaching, which is extraordinarily hard to do well, the less time spent on your own work… I find myself saying this year the same thing I said last year, and it’s a little bit horrifying.” He looked like a trapped animal. He’d been teaching for four years. Eleven years later, still teaching creative writing, never having written another novel, he killed himself.

Sure, the ivory tower smothers creativity. I’ll buy it. I think it’s worth an article’s measure of argument. But it’s this passage in the Rolling Stone article that just leaps out at me, about Wallace’s attempt to seek help for his suicidal impulses, and the ensuing psychiatric incarceration and medication:

“I got really worried I was going to kill myself. And I knew, that if anybody was fated to fuck up a suicide attempt, it was me.” He walked across campus to Health Services and told a psychiatrist, “Look, there’s this issue. I don’t feel real safe.”

“It was a big deal for me, because I was so embarrassed,” Wallace said. “But it was the first time I ever treated myself like I was worth something.”

By making his announcement, Wallace had activated a protocol: Police were notified, he had to withdraw from school. He was sent to McLean, which, as psychiatric hospitals go, is pedigreed: Robert Lowell, Sylvia Plath, Anne Sexton all put in residences there; it’s the setting for the memoir Girl, Interrupted. Wallace spent his first day on suicide watch. Locked ward, pink room, no furniture, drain in the floor, observation slot in the door. “When that happens to you,” David said, smiling, “you get unprecedentedly willing to examine other alternatives for how to live.”

Wallace spent eight days in McLean. He was diagnosed as a clinical depressive and was prescribed a drug, called Nardil, developed in the 1950s. He would have to take it from then on. “We had a brief, maybe three-minute audience with the psychopharmacologist,” his mother says. Wallace would have to quit drinking, and there was a long list of foods — certain cheeses, pickles, cured meats — he would have to stay away from.

There are so many red flags here that I have yet to see any other eulogist pick up on. For one thing, McLean obviously failed to cure Plath and Sexton of their suicidal tendencies. As with the Nardil, haven’t we as a society come up with anything better to deal with depression and depressed writers since the 1950s? And Wallace had a three-minute consultation for a drug he would take for the next twenty years—years overlapping the period during which he was “still teaching creative writing, never having written another novel.” I would venture that Nardil was just as dangerous, if not far more so, than the marijuana Gough would warn him away from.

Robert Ito, in The Last Days of David Foster Wallace, credits the drug with ensuring Wallace’s very survival:

Unbeknown to most, Wallace had suffered from clinical depression for the past two decades. Family and close friends knew of it, but few others did. Over those years, Wallace had taken powerful anti-depression medication that had allowed him to work and write, according to his father, James Donald Wallace. But recently the drugs had been having very serious side effects. In June of 2007, Wallace and his doctor decided that they would have to try another course of treatment.

Following a bad food reaction, Wallace was indeed taken off the Nardil, and apparently the withdrawal was unbearable:

“So at that point,” says his sister Amy, with an edge in her voice, it was determined, ‘Oh, well, gosh, we’ve made so much pharmaceutical progress in the last two decades that I’m sure we can find something that can knock out that pesky depression without all these side effects.’ They had no idea that it was the only thing that was keeping him alive.”

…That summer, David began to phase out the Nardil. His doctors began prescribing other medications, none of which seemed to help. “They could find nothing,” his mother says softly. “Nothing.” In September, David asked Amy to forgo her annual fall-break visit. He wasn’t up to it. By October, his symptoms had become bad enough to send him to the hospital.

…No medications had worked; the depression wouldn’t lift. “After this year of absolute hell for David,” Sally says, “they decided to go back to the Nardil.” The doctors also administered 12 courses of electroconvulsive therapy, waiting for Wallace’s medication to become effective. “Twelve,” Sally repeats. “Such brutal treatments,” Jim says. “It was clear then things were bad.”

If Wallace had been taking heroin, and attempted suicide upon withdrawal from it, we would blame the drug at least in part—as we did with Cobain. (Well, that or his hapless widow—apparently not an issue in this case, as Wallace’s widow was not famous and therefore not threatening.) Since Nardil was prescribed after such a breathtakingly long and thorough consultation, however, no journalist or even blogger so much as alludes to the drug as a problem rather than a cure. Sure, Lipsky hints at the problem by including the three-minute quote from Wallace’s mother, but it seems far easier to blame the academy, and certainly the depression itself.

In “Who Killed David Foster Wallace?” the author, UD, seems to make some connection between psychotropics and suicide, using the sad example of his own father’s death:

One way we try to neutralize suicide’s threat to our affirmations about life is to medicalize it, and modern psychology has given us all we could ask for along these lines, a pharmacopia of terms and treatments for what, in my suicidal grandmother’s day, people called involutional melancholia. The fact that in many cases anti-depressants recharge depressives’ batteries reassures us that brain chemistry, not philosophy, pertains. But in the case of Wallace, even shock therapy failed to spark him.

Like Wallace, my father — twenty-five years ago — hanged himself. His blood teemed with psychotropics.

But in reading Gough’s article, he comes to the conclusion that the university is the drug to beware:

In a limited sense, though, Gough may be right: If your subject is the dangerous-trance-inducing unreality of affluent, pleasant, postmodern America, you might want to avoid full-time immersion in the particularly narcotic undertow (the phrase is Don DeLillo’s) of the university.

Well, perhaps. But Wallace was in the academy for some time before he became acutely suicidal: according to the Rolling Stone article, he never made any actual suicide attempts until he was in physical withdrawal from Nardil. In college, he reported suicidal feelings that got him locked up and put on drugs, but those fears were entirely verbal, not physical. Perhaps it was the combination of the “narcotic” university and Nardil withdrawal that did Wallace in, but whatever comparison one may make between the university and psychotropic drugs must remain metaphorical.

Involuntary commitment and lockdown has been a libertarian issue for some time, with its most notable figurehead probably the psychiatrist and author Thomas Szasz. For the purposes of this post, I am more interested in the research conducted by doctors like Peter Breggin, who argues that antidepressants are ineffective against depression, may cause cumulative brain damage, and may provoke suicidal feelings upon starting or discontinuation.

In FDA Warns that Paxil Makes Depressed Adults Suicidal, Breggin summarizes the case against SSRI antidepressants. (Nardil is an MAOI, but it affects the same neurotransmitters as the SSRIs.)

In a May 2006 release in collaboration with the manufacturer GlaxoSmithKline (GSK), the FDA has acknowledged the antidepressant Paxil causes a statistically significant increased rate of suicidality in depressed adults as measured in controlled clinical trials. The results are based on a re-analysis of all adult controlled clinical trials that compared Paxil with placebo.

Buried in the FDA/GSK release is an astounding fact: Depressed people are 6.4 times more likely to become suicidal while taking an antidepressant than while taking a sugar pill.

No other antidepressants were mentioned in the FDA’s warning but all SSRI antidepressants share a common profile of adverse mental and behavioral effects, including Paxil, Prozac, Zoloft, Celexa, Luvox, and Lexapro. Several other relatively new antidepressants have also been implicated in producing similar psychiatric abnormalities, including Wellbutrin, Effexor, Serzone, and Cymbalta. All of the newer antidepressants can produce stimulation or activation with the potential for increased agitation, anxiety, mood instability, disinhibition, irritability, aggression, hostility, mania, and crashing into depression and suicide. They can also cause a flattening of emotional responses, including a loss of caring, that can unleash dangerous actions.

…Meanwhile, the antidepressants are very difficult to stop taking. Withdrawal from antidepressants can lead to “crashing,” with agitation, violence and suicide. Withdrawal from these noxious drugs should be done slowly with experienced clinical supervision. These drugs are not only unsafe to start–they are dangerous to stop.

Breggin also addresses the long-controversial use of ECT in Disturbing News for Patients and Shock Doctors Alike, published in April 2007, months before Wallace was to begin debilitating shock treatment:

Something most remarkable and unexpected has occurred in the field of psychiatry. Lead [sic] by a lifelong defender and promoter of shock treatment, Harold Sackeim, a team of investigators has recently published a follow up study of 347 patients given the currently available methods of electroshock, including the supposedly most benign forms–and confirmed that electroshock causes permanent brain damage and dysfunction.

Based on numerous standardized psychological tests, six months after the last ECT every form of the treatment was found to cause lasting memory and mental dysfunction. In the summary words of the investigators, “Thus, adverse cognitive effects were detected six months following the acute treatment course.” They concluded, “this study provides the first evidence in a large, prospective sample that adverse cognitive effects can persist for an extended period, and that they characterize routine treatment with ECT in community settings.”

After traumatic brain damage has persisted for six months, it is likely to remain stable or even to grow worse. Therefore, the study confirms that routine clinical use of ECT causes permanent damage to the brain and its mental faculties.

This is consonant with a description of David given by his father Jim in The Last Days of David Foster Wallace: the ECT “just really left him very shaky and very fragile and unable to sleep.” Fifty-five years after shocking the suicidal poet Sylvia Plath, we know no better than to continue electrocuting our most brilliant writers (and anyone else who’s emotionally troubled)?

In More Reasons Not to Take Psychiatric Drugs, Breggin writes of “organized psychiatry’s” resistance to non-pharmaceutical solutions:

Will the risk of life-threatening dangers caused by psychiatric drugs discourage doctors from prescribing them? Probably not. Organized psychiatry and individual practitioners are wedded to drugs as the solution, and often the only solution, to emotional problems. They know no other solutions but they do have the backing of the multi-billion dollar drug industry.

Any significant curtailment in the prescription of psychiatric drugs will have to come as a result of actions taken outside the medical profession and outside the pharmaceutical industry. Ultimately, it’s up to individuals to decide that there are better ways of overcoming emotional problems than impairing their brain and mind with drugs.

I agree with Breggin that it should be “up to individuals” to resist the collusion of doctors, drug companies and, implicitly, the State when it comes to psychiatric drugging and treatments. But it seems that Wallace, locked up in McLean, was not given a choice—or at least not an informed one—about whether to go on Nardil, the drug that may have played a major role in his suicide. That is why his tragic death is not just a literary but a libertarian issue.

(Also see Rad Geek’s post, “When the State gives doctors power over their patients, the doctors’ primary loyalty will be to the power of the State, not to their patients, or my post, Trusting Doctors, on the blind faith in State-controlled medicine.)