“That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this condition clinical depression or involutional depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton's melancholia or Yevtuschenko's more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self's most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain, a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who's being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who's not being tortured, however, is psychotic, since the outside parties making the diagnoses can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it's a closed circuit: the current is both applied and received from within.”

“It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul.”

“This story ["The Depressed Person"] was the most painful thing I ever wrote. It's about narcissism, which is a part of depression. The character has traits of myself. I really lost friends while writing on that story, I became ugly and unhappy and just yelled at people. The cruel thing with depression is that it's such a self-centered illness - Dostoevsky shows that pretty good in his "Notes from Underground". The depression is painful, you're sapped/consumed by yourself; the worse the depression, the more you just think about yourself and the stranger and repellent you appear to others.”

“That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorror, all of which, in their right time and season, are normal—unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.”

“Depression is a painfully slow, crashing death. Mania is the other extreme, a wild roller coaster run off its tracks, an eight ball of coke cut with speed. It's fun and it's frightening as hell. Some patients - bipolar type I - experience both extremes; other - bipolar type II - suffer depression almost exclusively. But the "mixed state," the mercurial churning of both high and low, is the most dangerous, the most deadly. Suicide too often results from the impulsive nature and physical speed of psychotic mania coupled with depression's paranoid self-loathing.”

“The depressed person’s therapist was always extremely careful to avoid appearing to judge or blame the depressed person for clinging to her defenses, or to suggest that the depressed person had in any way consciously chosen or chosen to cling to a chronic depression whose agony made her (i.e., the depressed person’s) every waking hour feel like more than any person could possibly endure. This renunciation of judgment or imposed value was held by the therapeutic school in which the therapist’s philosophy of healing had evolved over almost fifteen years of clinical experience to be integral to the combination of unconditional support and complete honesty about feelings which composed the nurturing professionalism required for a productive therapeutic journey toward authenticity and intrapersonal wholeness. Defenses against intimacy, the depressed person’s therapist’s experiential theory held, were nearly always arrested or vestigial survival-mechanisms; i.e., they had, at one time, been environmentally appropriate and necessary and had very probably served to shield a defenseless childhood psyche against potentially unbearable trauma, but in nearly all cases they (i.e., the defense-mechanisms) had become inappropriately imprinted and arrested and were now, in adulthood, no longer environmentally appropriate and in fact now, paradoxically, actually caused a great deal more trauma and pain than they prevented. Nevertheless, the therapist had made it clear from the outset that she was in no way going to pressure, hector, cajole, argue, persuade, flummox, trick, harangue, shame, or manipulate the depressed person into letting go of her arrested or vestigial defenses before she (i.e., the depressed person) felt ready and able to risk taking the leap of faith in her own internal resources and self-esteem and personal growth and healing to do so (i.e., to leave the nest of her defenses and freely and joyfully fly).”