In Einstein’s theory of general relativity, the event horizon is the region in space around a black hole—the “point of no return” beyond which nothing can escape the gravitational pull, not even light. If you were to watch someone fall into a black hole, as they crossed the event horizon their body would seem to slow down, then stop and float, frozen in the void. This phenomenon occurs exactly because light cannot escape from a black hole: as an object gets closer and closer to the event horizon, the light particles that convey its image have to struggle harder and harder to reach you. Eventually, even they cannot move.
Once a person has fallen across the horizon, they are beyond rescue. Even if they could manage to turn around, to scream, to reach out a hand for help, no one would know. No one would even realize they were still alive.
In mental health, there is a disorder that seems to mimic the sensation of falling past the event horizon. I am filled with dread every time I think about it, about how it has overpowered and overwhelmed me. How it has sucked me in with its inescapable pull.
It was August. I hadn’t seen my family doctor in over seven years. Everything in his office looked exactly like I remembered, from the brown padded exam table in the corner, to the copy of Reader’s Digest on his desk. Dr. Moulaison came in, sat down and then asked me how I was doing.
“Good,” I replied. It was an absolute lie. “I kind of wanted to do a physical check-up, seeing as how it’s been ages…” I let the end of the word drag, and looked up at him. He remained silent, blue eyes staring from beneath his glasses and flared, greying eyebrows.
I took a deep breath, then plunged. “And there’s something else. I’ve been depressed, for a long while now.”
He frowned briefly, to focus. “Okay. How long have you been feeling depressed?”
It was a question I had been trying to answer for a while. I knew that I had been feeling increasingly down starting in the spring, as I was finishing my second year of university. I had recognized the sensation of emptiness and being mired in low moods. I was scared to admit, even to myself, that my depression seemed to fit into a greater pattern, one that stretched back far earlier than just the spring. But the clear answer, the one the doctor wanted, eluded me: a blind spot in my brain. “About a year,” I replied to him. “That’s how long I’ve been feeling it, substantially.” It was a guess, not a lie.
We talked a bit about my symptoms. Beyond the feelings of depression, I struggled to describe my experience. The disorder and black holes share one important trait: they are both invisible. They can only be discovered through observation of their effects, how they pull at the world around them, draining motivation and emotion from the mind like stellar gas and plasma from nearby stars.
Finally, Dr. Moulaison brought out a copy of a mental health checklist. It had nine questions, and used a score to gauge a person’s mood over the past two weeks. To each question you could answer “not at all,” (0 points), “several days,” (1 point), “more than half the days,” (2), or “every day,” (3).
How often have you been bothered by any of these problems:
- Little interest or pleasure in doing things
- Feeling down or hopeless
- Trouble falling asleep, or sleeping too much
- Feeling tired or having no energy
- Poor appetite or overeating
- Feeling bad about yourself—or that you have let people down
- Trouble concentrating on things
- Moving or speaking so slowly that others might notice, or the opposite—being overly fidgety or restless
- Thoughts that you would be better off dead
I had been feeling most of these problems every day—not just for the past two weeks, but for the past month, the past year. Dr. Moulaison grabbed a pencil and started adding the numbers.
He finished and took a breath. My score was fifteen, on the higher end of the scale (the highest possible score was 27). I hadn’t had suicidal thoughts in over a month, but every other symptom was there in abundance. As Dr. Moulaison called it, I had “moderate” depression. He set me up with a month-long prescription of escitalopram, an antidepressant, and told me to contact him if I experienced any major side effects.
Escitalopram, often called by its trade name, Cipralex, belongs to the category of antidepressants known as “selective serotonin reuptake inhibitors” (SSRIs), which is a fancy way of saying that they block the brain from reabsorbing a hormone called serotonin. Scientists believe serotonin is directly tied to a person’s mood. Serotonin originates in clusters of nuclei midway up the brainstem. From there, it flows through the brain, pausing at chemical synapses—gaps between the cells. Here, SSRIs prevent serotonin from immediately flowing back into the brain. As Dr. Moulaison phrased it, the pills force the hormone to “sit and soak,” which can boost the person’s mood and alleviate the other side effects, given time.
Scientists have drawn the parallel between depression and black holes before, and their comparisons contain something resembling antidepressants. In 1974, the physicist Stephen Hawking theorized that a black hole does in fact let some matter escape its grasp, in the form of radiation from its event horizon. This radiation, now known as Hawking radiation, is similar to an SSRI in that it defies the once-thought-unavoidable gravity of the black hole, as the SSRI denies serotonin from rushing back into the brain once more. And yet, if a person fell beyond an event horizon, this radiation could not save them. Neither can antidepressants disrupt and reverse a case of depression completely and without error; they are not infallible.
Both my doctor and the pharmacist who filled my prescription warned me that the medication can be known to cause stronger feelings of depression, even suicidal thoughts in some people. The pill bottle came with three pages of information that repeated this warning and listed a number of possible side effects: constipation, insomnia, weight loss, vomiting, and headaches, among others. I trusted my doctor, and felt no fear of the pills or their effects. But I should have.
They were white, like aspirin, and indented so I could break them in half. When I got home that evening, I took half a pill with a glass of water. I didn’t expect to feel anything right away. The next day was the same, as was the next, and the next. Classes began, and still I noticed nothing.
Then, in the middle of September, a phenomenon began. After two weeks of taking half a pill once a day, I had moved up to a full pill as per Dr. Moulaison’s orders. Months later, I wondered if it was directly caused by the switch to the full pill, or if it had built up over time, compounded by each dose.
It was around noon on a Sunday. I had gotten up for breakfast, then gone back to bed to rest some more. Only I couldn’t fall asleep. This was nothing new. Even before I started on the escitalopram, I always had trouble sleeping. I lay there half-conscious, plotting out the week in my head. I noticed that my mind was jumping through the days, rushing to imagine what I had to get done for my classes. I frowned, and tried to clear my head. Immediately, it was empty.
I rolled over in bed and in the half-second it took, I knew something was wrong. My movements were too fast, too jerky. And my mind was keeping pace with them—every thought now raced past, constantly continuing to the next—to the next—to the next—my brain moved as if it were automatic: I felt compelled like clockwork—like my limbs and synapses were bound to hands and gears that were spinning faster and faster the more I thought about them; I couldn’t stop thinking, I couldn’t slow down—I sat up and tried to wave my hand shakily in front of me but it thrust out before my face and darted back and forth like an angry metronome and I just couldn’t stop thinking couldn’t slow down I sat up waved my hand and noticed a pattern to my thoughts now it seemed like my clock hands had made a full circle and would start again—and then I began to realize that my breathing, which had been twitching back and forth in short gasps, had begun to slow; just as swiftly as it began, the clockwork-compulsion had run itself down. And then, suddenly, it was over.
I took a deep breath, carefully got out of bed, and went to the bathroom. I closed the toilet lid and sat motionless on it for at least half an hour. The chill of the porcelain was comforting, an anchor to the moment.
The phenomenon, of which this was the first episode, possessed a suggestion of the black hole in its intensity and suddenness. It absorbed my attempts to describe it. Abstract adjectives from science fiction and horror came to mind: bizarre, grotesque, Lovecraftian. I could not name the phenomenon, and in the hours and days afterward, part of me began to brush it aside, to forget about it. I still don’t know why my brain did this. Perhaps it was trying to protect itself. The process of forgetting reminded me of the way I forget about pain—how I cannot concretely imagine it outside of the experience itself.
Though the phenomenon retreated to the depths of my memory, I continued thinking about my depression, and what the antidepressants were doing for me. One October afternoon, in the break between my classes, I realized that I had mixed up the due date for a take-home midterm essay. Instead of being due on Thursday, three days from then, I was supposed to have it ready in half an hour. I took a deep breath, then got ready to—
And then I stopped. I frowned. I wasn’t panicking. I wasn’t freaking out. I wasn’t even worried. If I had to say how I felt right then, I would have settled with concerned. Why was I so peaceful? A year ago I would have been running for my professor’s office, making up a weak excuse on the fly and preparing to beg for an extension. But today, I was just…placid. A thought floated up from deep in my mind. Everything is going to be okay. I would go to class, explain things to the professor, and let life fall where it would.
This absence of anxiety was refreshing. I kept noticing new patterns of thinking—I no longer obsessed over constructing my route to school ahead of time, trying to account for every hindrance and hurdle. I didn’t count the hours until when I should go to bed, and try to calculate how many of them I should spend on homework. I stopped running to catch the bus, even when I knew I was going to miss it. I even stopped grinding my teeth and chewing my nails and cuticles until they bled. Each effect had benefits and drawbacks. I wasn’t stressing about school, but I also wasn’t getting as much work done, as my fear of missing a deadline was severely diminished. I was getting more sleep, but also sleeping in and skipping some classes.
Halfway through October, the episodes began anew. They started differently this time, and so I didn’t realize what it was until after I was through the worst of it. I was in class, helping a friend edit her essay, when I lost track of my conversation. My friend gave me an odd look, and I realized I had not explained the point clearly enough to her. I started over, but again lost track of my criticism. I kept letting many um’s and ah’s slip into my speech. I started again for a third time, but became so disoriented that my language devolved into all but filler words and misused prepositions. My friend frowned and switched the conversation away from me. I decided to take a break from even trying to speak. Later, on the walk to our next class, she told me that I was acting really frazzled and wasn’t making any sense. I agreed, but couldn’t shed any more light on my behaviour than what she had already said.
The next episode followed a few days later. As I made dinner, I noticed my movements had become rapid and jerky again.
This time, my fully conscious brain called it a nightmare. My head felt like a car stuck in a patch of wet cement—my thoughts, sitting in the driver’s seat, revved the engine and the wheels spun and spun and then stuck—but still they pushed down on the accelerator harder and harder until their feet were against the floor and my body was screaming out against the compulsion, and my mind was roaring, and rolling, and tumbling, and falling. And yet I was also standing still. My arms gripped the counter for support, and went the episode ended I collapsed on the couch in sweat.
Much later, I sat at my desk and tried to write the experience down, so that I could explain it to my friends and my doctor. More so, I wanted to write it down so that this time, I would remember it happened.
It wasn’t at all like my depression. This beast remained unnamed; its shape and geometries alien and out of focus: a blank page in the Bestiary of the Mind. I was unable to quantify it along any scale of the senses—it was not painful, nor was it euphoric. It did not evoke a sense of warmth or cold, loud or quiet, or any of the cardinal directions. In the weeks after, I scrambled insatiably across the Internet in search of another, of anyone who had had the same experience as me. When my searches failed, I turned to the university library and spent hours in the stacks, fingers trailing along shelf after shelf of psychiatric texts.
Eventually, I decided to write my own explanation:
Imagine there is nothing. Darkness. A void, extending endlessly in every direction. Not just the absence of light, but of everything: no matter, no life, no time, no reality. Imagine that nothing exists except for you, that even your own self exists in the void only as a pair of eyes, an observer, nothing more.
Then imagine that there is something behind you.
It is vast. You can feel its presence like the sun on your back, but without light or warmth. You can see it in the corners of your eyes, even though there’s nothing of it to see.
You can feel it everywhere, like static electricity on the back of your neck, like magnets tugging on your hands, on your feet.
In the middle of November, I went back to my hometown for the Remembrance Day long weekend. I had booked another appointment with Dr. Moulaison. Though I had not had another episode since the one in October, they were still floating in the back of my mind, and I was unsure how to describe them.
The appointment took only 15 minutes. Dr. Moulaison conducted the mental health checklist again. This time I scored a five—the same as a person who is not suffering from depression. He then asked me if I had noticed any side effects. I mentioned some of the ones listed in the pamphlet—insomnia, constipation, headaches and loss of appetite.
“But there’s something else,” I finally said to him. “A side effect that I’m having trouble explaining, or even understanding.”
I began describing the incidents to him. After about ten seconds he grimaced and interrupted me. He explained that I had been experiencing episodes of mania. He said that it was a rare side effect of the antidepressants I was on.
“These pills have a tendency of unmasking things in people,” he said. While the term “unmasking” suggested that the source of my incidents had always existed underneath, Dr. Moulaison tried to assuage my concerns. Perhaps he had used the wrong word. He said that because the incidents had been so short and fleeting, it was unlikely that they were anything more than a side effect. He wrote me a prescription for a different antidepressant, and told me to call him if the manic symptoms persisted. In that moment, I wanted to believe him, believe that my episodes were just side effects, so much so that I would have agreed to anything.
One twinge of uncertainty hovered in my mind. Dr. Moulaison had written a prescription for bupropion, a reuptake-inhibiting antidepressant that acts upon the hormones norepinephrine and dopamine rather than serotonin. He had advised me that I could immediately switch off escitalopram and on to the full dosage of bupropion. Torn between trust for my doctor and wariness of the overlapping drugs’ effects, I forgot to ask if bupropion has the potential to cause manic symptoms. And I wanted to ask why the doctor had used the specific word “unmasking,” but I feared the answer. How would I know if the mania was more than just a side effect?
Mania, the word, is transliterated from the Greek μανία, meaning “madness,” “frenzy,” or “enthusiasm.” It is the source of many words associated with insanity—for example, it’s where we get the word “maenad,” for the crazed wild women who cavorted across Ancient Greece with the wine god Dionysus. It’s also why we call criminals “maniacs.”
In mental health, mania is a state characterized by abnormally elevated mood and energy that can escalate into irritable and violent behaviour. It is often called the flip side of depression. People who suffer from bipolar disorder switch between phases of mania and depression—unable to remain in one state or break the cycle of alternation. If depression is a black hole, then mania is the matter sucked into its event horizon. It blazes briefly, moving at a frenetic pace, then crashes head-on into the wall of gravity formed by the horizon, beyond which light cannot escape.
One common symptom of mania is a phenomenon called racing thoughts. An episode of racing thoughts is exactly what it sounds like: a person’s thoughts begin to race faster and faster, overpowering any attempt to regain reason and overwhelming their consciousness.
I thought back to what Dr. Moulaison had said, that my racing thoughts were a “rare” side effect of the escitalopram. I didn’t know where to go from there. I knew I needed more answers, more information about this disorder. I didn’t know why I couldn’t find it before, when I was searching for the words. It should have been in plain sight—in the first episode, my thoughts had raced past. When I thought back to the other effect of the antidepressant, the loss of anxiety, I realized something I’d missed. I had stopped caring. I had stopped thinking about my side effects, about how important it was for me to take charge and talk to my doctor about them. I had become apathetic about my own mental health. I thought back to the warnings made by my doctor and the pharmacist, that antidepressants can be known to cause even stronger feelings of depression—which can manifest as a lack of motivation, or apathy. I hoped that this new prescription would end this cycle of apathy, but I also felt better equipped to get help if it did continue.
A black hole cannot experience depression, nor feel pain nor terror. They are literally apathetic by nature. But they may be able to remember. In January 2016, Stephen Hawking and two other physicists theorized that matter falling into a black hole may leave an imprint of itself in subatomic particles located in the event horizon. They further theorized that Hawking radiation flung from the black hole into space would carry these imprints with them, these memories of what was lost. Though the information conveyed by these imprints would be a chaotic jumble, a person observing the particles would be able to determine that something had been eaten by the black hole—just not what that thing was exactly. When depression sucks us in and drains the light and colour from our life, we know what we have lost, but we cannot imagine life outside of this omnipresent shadow. So we persevere, as best we can, hoping that one day we can build enough gravitational force to finally pull ourselves out, and escape from the black hole.
A version of this essay previously appeared in the 2016 issue of This Side of West.