Henry J. Friedman on “This Close to Happy”

‘This Close to Happy’

To the Editor:

In his detailed and positive review of “This Close to Happy,” Daphne Merkin’s exploration of her lifelong struggle with a major depressive illness (Feb. 5), Andrew Solomon correctly identifies Merkin’s unrelenting honesty about herself as distinguishing her memoir from other tales of depression that are self-promoting or encourage the reader to admire the author. Reading Merkin’s book as a psychiatrist-psychoanalyst, I agree with Solomon’s praise for her unusual frank, self-critical voice, but I would locate the book’s strength in her attempt to differentiate developmental and emotional elements in determining her depression from genetic factors that can result in bipolar or unipolar depression.

A book like “This Close to Happy” is not only a moving personal account of depression by a writer with an unusual ability to describe the inner state that characterizes the severely depressed individual, it is, in addition, a skilled account of the dilemma that all who treat severely depressed and suicidal individuals must grapple with in their clinical work. At what point does their patient’s depressive pain move beyond the reach of words and the therapeutic relationship? If, in addition to the patient being beyond therapy, anti-depressive medication fails, what are the alternatives that might well save a suicidal patient’s life?

Merkin provides no definitive answer to these questions, but she raises them with such precision and elegance that psychiatric readers will come away from her book with a new appreciation for the task that faces them when dealing with profoundly depressed patients.

HENRY J. FRIEDMAN

CAMBRIDGE, MASS.

The writer is an associate professor of psychiatry, part time, at Harvard Medical School.

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