It’s a race against time and the big question being debated in the US is who will reach the finishing line first: the man on Mars or the man on Earth getting cured from manic depression

The heart of another is a dark forest
— Ernest Hemingway

“NOW it is necessary to get to the grindstone again. I would like to live long enough to write three more novels and 25 more stories. I know some pretty good ones,” wrote the reporter Hemingway in 1938. And indeed he did write and bagged the Nobel Prize for Literature 16 years later. Only to kill himself seven years thereafter.

And thus ended the life of America’s best known writer of his generation. His younger brother, Leicester Hemingway, also took his own life. And so did his granddaughter, Margo.

Battling the Hemingway curse today is actress Mariel Hemingway, born the year her grandfather committed suicide. “I spent a great deal of my life being afraid of depression, quite frankly (her mother tried killing herself, too). And I believe that environment and lifestyle and nutrition and things have a lot to do with setting it off, if you don’t have it yet. I know that my grandfather couldn’t write any longer, and his passion in life was writing. So he took his life.”

Depression is described as: No news is good news; nothing can please you when you’re....

What exactly is depression?

“Depression is a biological illness that affects an awful lot of people. It’s very common. It’s very treatable. It’s characterized by a real slowing down of everything, a tremendous depression of mood, and hopelessness and disinterest in things that people ordinarily find pleasurable. It’s a terrible, terrible illness, a real disruption of sleep. But again, the good news is it’s very treatable,” says professor of Psychiatry at Johns Hopkins, Dr Kay Jamison.

Former CEO of CNN, Tom Johnson, adds meat to the bare bone definition further by saying that he felt very down over a prolonged period of time. “I lost interest in many of the things that I loved doing most. I found myself withdrawing from people and from events.” He just felt a prolonged period of sadness. “I tried exercise. I tried dieting. I did not know what it was. I was having a tough time getting up and out of bed.”

And the most intriguing part as publisher of The Los Angeles Times and as chairman of CNN, Johnson lived in the pressure-cooker but faked joviality! “I kept mine secret, quite frankly, because you are expected to be a super-person in the workplace, to be a strong leader. And this is seen as a disease that means that you are in some ways weak.”

So what should a doctor be looking for? “Well, he or she would know by taking a very extensive history, and that would include a family history because of the genetic basis. It would include a history of the symptoms, what kind of symptoms you had in terms of changes in thinking and sleeping and eating and energy levels. And then they would also check to see how long the symptoms have gone on and what pattern they had been and what kind of history you had of depression beforehand. So there are a lot of things that we know about depression, and a good clinician will be able to, you know, check that out. And it should be a very thorough and expensive history.”

Head doctors always want an X-ray of their patient’s brain before they can make a prognosis. Most are averse to doing the initial digging themselves to get to the root of the problem. Re-treading the past is often left to the family who is expected to clinically sift through the debris of the disease for answers. But it’s not always easy to trace back the origins of thought and why, when, where and how they go off the track and begin to malfunction. Genetics can be a tricky business.

Besides, those suffering from depression and their family members are sworn to secrecy because of the social stigma this mental illness carries. Despite one in four Americans suffering from it, rarely do people come out of the closet to say that depression is their demon.

George W. Bush’s mother, former first lady Barbara Bush, perhaps puts it best: “I would have gotten help, but I was too sort of proud to get help. And George (her husband) was the only person I told. I didn’t tell my closest friend in the world. I didn’t tell anybody.”

It’s the toughest on the family. If someone has cancer or some other terrible disease, you can talk about it, but how does one deal with mental illness? What does one tell others?

Many people who suffer from depression and bipolar disorder and those kinds of things mask it through substance abuse. And worse still is manic depression: you also have mania, which is characterized by a very elevated mood or extremely irritable mood, paranoia very often, racing thoughts, very high energy level, not needing to sleep, buying a lot of things, a lot of very bad judgment. It’s as speeded up as depression is slowed down, and it’s even more associated with drug abuse and with alcoholism.

And that’s one reason one must really go to somebody who knows a lot about the interaction of various drugs, to a pharmacologist, the doctor who will prescribe a cocktail of drugs based on their properties and reactions, specially with relation to their therapeutic value.

Dr Kay Jamison takes Lithium, which once was known as a wonder drug in treating bipolar disease. And how does the psychiatrist from Johns Hopkins describe depression? “When you’ve got it, if there were a magic wand across the room on the table that would make you happy and give you everything you want, it would be too much trouble to cross the room and pick it up!”

Many people suffering from depression told Kay Jamison that they could identify with this metaphor she sketches.

Because depression is a genetic illness, there’s every reason to have a lot of hope that in fact there will be certainly much more specific diagnosis probably before too long. There are a lot of laboratories around the world that are trying to isolate the genes responsible for manic depressive illness, she says.

“And once that’s done, then much more accurate diagnosis will be possible, and then after that, much more specific and accurate tailor-made, as it were, treatments. And then ultimately, probably a cure. I don’t think that’s out of the question at all. It just will be quite a while from now.”

A cure?

Meanwhile psychiatrists never give you the answer (if they were to, then who would seek their help?) They keep telling their patients to try different drug combinations, go to different antidepressants and mood stabilizers like Lithium and other new drugs doing the rounds in the marketplace.

In America — can’t say the same about Pakistan — the stigma that mental illness carries with it may be beginning to lift, just a wee bit. A programme for fellowships for journalists wanting to focus on all aspects of mental illness is enjoying success. “The media has such an influence on what people think about mental illness and people with mental illness, we thought we’d try to develop a cadre of journalists who knew the issues, could report accurately about them and have some influence on their peers. And this year we’ve had over a hundred applications,” says the director of this innovative project put into place by none other than the former First Lady, Rosalyn Carter.

Media exposure — more articles in newspapers and magazines regularly shine light on stories concerning mental illness and people suffering from it.

It’s a race against time and the big question being debated in the US is who will reach the finishing line first: the man on Mars or the man on Earth getting cured from manic depression?

Any second guesses?