The recent suicides of Kurt Cobain, Vince Foster and Washington, D.C., Council Chairman John Wilson expose a tragic flip-side to their impressive public lives. All were too paralyzed by depression to get help.
Other public figures with histories of clinical depression, however, have not only sought help but are sharing their torments and triumphs with the world.
Spurred by their recovery, William Styron, Mariette Hartley, Patty Duke, Kathy Cronkite and Julia Thorne have told their tales in a slew of recent books.
On air or in print, Mike Wallace, Frances Lear, White House adviser Bob Boorstin, Art Buchwald, Dick Cavett, Jose Canseco and Kitty Dukakis also have gone on record about their depression.
Collectively, such disclosures -- plus first-person testimonials by ordinary people and the success of psychiatrist Peter Kramer's best seller, "Listening to Prozac" -- point to a new era, one in which the stigma of depression is being supplanted by acceptance and understanding. For the approximately 11.5 million Americans who suffer from depression each year -- two out of three of whom do not seek treatment -- this new honesty holds promise that they, too, can find a path to recovery.
"We're in the first waves of a sea change in public attitude about mental health in general," says Dr. Frederick K. Goodwin, director of the National Institute of Mental Health. "Depression is leading that sea change, reflecting[the fact that] highly successful treatments have now been established widely enough. There's a large number of people who have been well long enough that they can trust they're going to stay well. They're willing to take the risk of speaking out."
The suicides of Mr. Foster, Mr. Cobain and Mr. Wilson, as well as the attempted suicide of City Comptroller Jacqueline F. McLean, have also spurred extensive media examination of depression in an informed fashion, Dr. Goodwin says.
The mini-deluge of published accounts of depression are a positive development, agrees Gina White, spokeswoman for the National Mental Health Association.
"I think there is almost a domino effect in terms of people talking about depression," she says. "As more and more celebrities are coming out and talking about it, it creates an environment in which it's OK to talk about the fact that you have depression. That's exciting."
As depression's stigma erodes, its reputation as a character flaw will no longer be operable, says Dr. Richard Perlmutter, a senior psychiatrist at the Sheppard and Enoch Pratt Hospital. "People are sort of stumbling upon an illness model that's more useful than a weakness model. It's a model that's not only more compassionate for the sufferer, but also holds within it some potential for cure."
The fates of certain politicians provide a telling example of how the depression model has evolved.
In 1972, vice presidential candidate Tom Eagleton was forced off the Democratic ticket after revelations that he had been treated for depression with electric shock therapy. In 1990, Florida voters, aware that candidate Lawton Chiles had been successfully treated for depression with Prozac, elected him governor.
Once they have conquered their illness, former sufferers often instinctually seek to share with others their cathartic journey from despondency to joy. Recent books about depression -- including "On the Edge of Darkness," by Kathy Cronkite; "You Are Not Alone," by Julia Thorne; "A Brilliant Madness: Living with Manic-Depressive Illness," by Patty Duke; and "Darkness Visible: Memoir of Madness," by William Styron -- "tend to tell stories of transformative dimensions of change," Dr. Perlmutter says.
Actress Mariette Hartley's 1990 book, "Breaking the Silence," written with Anne Commire, exposed her "soulless," alcoholic and suicidal family and her own bouts with alcoholism and
intense psychic pain. Revealing one's past in print and in public appearances is vital but difficult, she says.
"In the beginning, it was devastating for me," Ms. Hartley says. "I really believed that one should worship secrets and keep that family code a secret. That's just what you do. [It's] this Midwestern and Eastern seacoast Calvinistic kind of thing.
"As I began to talk, my knees would literally shake. Gradually, I saw how deeply important it was for others who were struggling with the same stuff to hear the story."
Books such as Ms. Hartley's, often penned with a missionary zeal, are "very appealing and certainly very prevalent in our mythology," Dr. Perlmutter says. "There is something very magnetic, pulling and attractive about the issue of transformation. [People who] used to think of themselves as nothings, weak moral burdens on society, [are elevated] to almost heroes in that they have conquered this huge dragon called depression."
That "someone bright and creative and successful is admitting depression adds to the sense of hope in those reading the words that they can be there, too," Dr. Perlmutter says.
But these triumphant accounts also may set readers up "for disappointment and more depression when [unlike the authors] they can't have the whole package."
With their redemptive focus, books such as "Breaking the Silence" adhere to a familiar "soul-searching" literary pattern, says Larzer Ziff, chairman of the English department at Johns Hopkins University. The plunge into despair, the recovery process and the epiphany of wellness seem "to be a continuation of what was called the spiritual autobiography. It goes back to St. Augustine's confessions, where the writer, the self-examiner, is anxious about the condition of his soul."
While Puritan diarists such as Cotton Mather and Jonathan Edwards couched their travails in spiritual language, contemporary writers, such as Ms. Hartley, speak in more
secular terms, Dr. Ziff says.
"What today we call depression would [in the past] be termed as feelings of abasement and humiliation, contrition for what they've done wrong," says Mr. Ziff. But the intent, to cleanse oneself of shame, remains the same, he says.
Books dealing with depression sell well, according to both Dee xTC Peeler, book buyer for Greetings and Readings, and Christopher Brenchley, of Borders Books & Music.
"For years, depression wasn't discussed, and there were very few books," Ms. Peeler says. Today, the climate is more open and "a lot of doctors are recommending books to their patients."
For a book like "Listening to Prozac" to "spend that much time on the best seller list," she says, "tells you there are a lot of people dealing with this."
TO LEARN MORE
To learn more about the Depression Awareness, Recognition and Treatment Program operated by the National Institute of Mental Health, call (301) 443-4140. For a free brochure about depression, call toll-free, (800) 421-4211.
Free information on depression is also available by calling the National Mental Health Association information line. The toll-free number is (800) 228-1114.