Book Report: On the Edge of Darkness

On the Edge of Darkness: Conversations About Conquering Depression
Kathy Cronkite

I. About the book and authors
1) Concept of book
§ Cronkite cast a wide net to talk with dozens of people who have in some way experienced depression, and gets their thoughts on a variety of topics. There are celebrities (very successful people), mental health professionals, family members of people with depression.
§ Many of the entries are, as the title suggests, very conversational—they are probably transcriptions of interviews. Many of the more professional opinions are better organized, and obviously have more scientific research behind them. It’s interesting to see the clinical view and the layman’s view laid side-to-side on so many topics.
2) About Kathy Cronkite
§ Former sufferer of unipolar depression, and currently an advocate for depression awareness, here in Austin as latest I can track. She is an author, has had a few other jobs in shows business, and is Walter Cronkite’s daughter.




II. Summary of Book
1) Chapter 1: The Dog and I
§ Cronkite talks about two images of depression: a black hole, and Churchill’s image of a black dog. She prefers this second image—something with you that people not might realize is even there, but you’re constantly aware of it. She gives the straightforward history of her lifelong suffering of depression and the relief when she finally was able to treat is successfully. It depended on her recognizing that it was a chronic illness that she would always be recovering from.
2) Chapter 2: It Takes One to Know One
§ Since it was Mike Wallace’s admission of having depression that gave her courage, she starts off with his account of his own depression. It is interesting that as the accounts progress through the book, one emerging theme is that they list all of the things that were bothering them at the time—in Mike Wallace’s case, a lawsuit, and some worry about his career. But as he and others eventually determine, these things are separate from the disease itself. Everyone has hard things that they have to suffer through in life, but not everyone is victim to the hopeless despondency of depression that renders them incapable of dealing with the issues. Wallace’s account focuses more on his physical symptomotology than his mental state
3) Chapter 3: What Is Depression?
§ A discussion on the colloquial use of the word “depressed,” versus the actual clinical disease. As comes up many times later in the book, this overlap may lead to misunderstandings about what depression actually is.
§ In this chapter, Cronkite mainly talks about bipolar and unipolar. Bipolar has a strong genetic component, and occurs by some studies more or less equally in men. Women are much more likely to suffer from unipolar depression (1:4 by one study). See also the attachment at the end of this book report, with the most up-to-date clinical diagnostic tools for various types of depression.
§ Depression can kill you if untreated. Some of the contributor’s discussions in this chapter made some clear metaphors that opened my eyes—I will stick with the metaphor of diabetes (II). There is a strong genetic component. But people do have some control over whether or not it manifests; but even people who avoid sugar all their lives can still succumb. It also can be treated with ongoing care, but can easily kill you if ignored. This made me think of a literary work, The Sorrows of Young Werther, by Goethe. It comes at the end of a longer conversation, also interesting, but the gist is captured here:"Human nature," I continued, "has its limits. It is able to endure a certain degree of joy, sorrow, and pain, but becomes annihilated as soon as this measure is exceeded. The question, therefore, is, not whether a man is strong or weak, but whether he is able to endure the measure of his sufferings. The suffering may be moral or physical; and in my opinion it is just as absurd to call a man a coward who destroys himself, as to call a man a coward who dies of a malignant fever."Later in the book, there is a moment with Cronkite heard a woman on a radio show arguing that if assisted suicide is okayed for people with chronic disease, people with depression should have the right to make this choice, too. This may have been somewhat the case in Goethe’s time, but the Cronkite wanted very much to make the argument to the caller that 80-90% of cases are successfully treated. There is some more discussion of this in chapter 9, but that chapter is more focused on individual’s experiences with it (but obviously with no one who attempted successfully).
§ This is the first chapter that has a lot of different voices giving their experience. It drives home that depression can have a lot of varying symptoms and degrees of intensity, and one can see why it might not be a simple diagnosis. There is also distinction between sadness and depression.
4) Chapter 4: Black Dog, White Dog
§ Short chapter on bipolar disorder. I found the chapter by Susan Crosby (Lindsay Crosby’s wife) a more interesting examination of the phenomenon. It was interesting that even though bipolar people sometimes will not want to treat their illness because they miss the “highs” and the energy and feeling of accomplishment, it was the highs, and not the lows, that were completely devastating to the Crosbys.
5) Chapter 5: Effects on a Career
§ This and the next chapter on the stigma go together hand in hand. A lot of the discussion in this chapter was about how sufferers had to hide their depression and treatment from employers, mostly out of fear of judgment.
§ Aside from the stigma, however, there is discussion about the difficulty of carrying on a career with consistency with an untreated affective disorder. The Styrons (writers) had to kind of reset their lives when William came down with an unexpected case of severe unipolar depression late in life.
§ One weakness I found in the book was so many of the contributors had rather atypical careers. A lot of them were in show business or politics. And while I did come to see how those particular freelance-esque careers, when you deal with constant judgment by others, could easily precipitate a depression, for the purposes of looking at it from a management perspective, I think the book misses out a lot on the experience of how everyday life depression would exhibit, in and office for instance. The discussions from psychiatric professionals picked up the slack here, but the first-person accounts still seemed unbalanced.
6) Chapter 6: Overcoming the Stigma and the Shame
§ There are a lot of connections between this chapter and chapter 13, which deals with men and women’s different “relationship” to the disease.
§ Many of the accounts say it’s more than just the stigma of a “mental illness.” Whether true or not, many felt there was less stigma with coming out with a substance abuse disorder. Some felt they would still be judged as having a “moral failing,” rather than a disease. One doctor has heard people call it a “wimp’s disease.”
7) Chapter 7: Substance Abuse
§ Several of the contributors had some substance abuse issues as well. There is an interesting discussion about the connection between substance abuse and depression---and how difficult it can be clinically to determine which is the cause and which is the effect. Or if one is masking another completely. Kitty Dukakis’s story most clearly showed how important it is to get to the root diagnosis to really help someone. Substance abuse can be a way of self-medicating a depression, and then can be a way of prolonging it.
8) Chapter 8: Love’s Labour’s Lost: Susan Crosby
§ Susan Crosby tells the story of her marriage to Lindsay Crosby, son of Bing Crosby, who suffered from bipolar disorder. Interesting points: she spent years and years getting herself therapy to figure out why she was so bothered by things (for instance, his sleeping with other women, going on rampant horse-buying binges). There is more discussion of women’s “place” in society and how it relates to depression (she also exhibited signs of depression eventually). Also interesting that as a celebrity and trust-fund kid, Lindsay was surrounded by false friends who just liked him when he was high and fun, and didn’t try to get him help. In fact, they got him out of the psychiatric ward early before he eventually killed himself. Susan blamed this entourage phenomenon on why it took so long to get him treated.
§ On the celebrity phenomenon, in modern terms: it’s not surprising that Brittney Spears is getting treated for bipolar disorder—would it have gone untreated this long if she hadn’t been a celebrity? Because at the same time, she had more opportunities to exhibit her mania—possibly her symptoms wouldn’t have been so pronounced and easily diagnosable if she hadn’t had lots of money and documentation of her every move.
9) Chapter 9: Suicide
§ One repeated theme in the accounts from everyone is that they all had fleeting glimpses of suicide. For some it was just a thought that it would be great if they never woke up. What’s also interesting, since these are all survivors of depression, is what things prevented it in the end. Personal connections, even though they are hard to maintain as a depressive, are important. While one person did owe a friend her life after an actual attempt, more of them explained that there was just enough of the rational sense of them to realize how much it would have broken their families, or anyone left behind.
§ Joan Rivers’s account of her husband’s suicide, and her own subsequent, eventual suicidal thoughts reminded me of another theme that creeps up throughout the book: that in many ways, depression is contagious. While there are clear studies on the strong genetic component of bipolar disorder, unipolar depression is more common, and does occur in families. The idea of how it can effect friends and families is dealt with in chapter 17.
10) Chapter 10: Leslie Garis
§ An short individual account of a woman’s experience with a very long depression, until she sought treatment successfully.
11) Chapter 11: Ya Gotta Have Heart
§ There is a connection between heart disease and depression. In fact, most patients who have had heart attacks or heart surgery are specifically counseled to be on the lookout for depression.
§ Discussion about whether this is because people are facing their own age and mortality.
§ Cronkite mentions that there is frequently a form of post-traumatic stress syndrome when people undergo any surgery, from discussions half-overheard while anaesthetized.
§ While most of the medical professional in the book have been in mental health, there is an account here from a cardiologist that seems to lack some of the empathy of the others. There is definitely an implication from him that heart disease is a more real disease than depression. Naturally, there can be arguments about whether it is more urgent, or more serious. But this is one time where the conversational tone of the book fails—people aren’t given the succinctness to really state their cases, and some sections, taken out of context, might be misinterpretable.
12) Chapter 12: Living with Loss
§ Death and true loss of course cause sadness. This is normal. One difficulty is deciding when a despondency has become a diagnosable depression that should be treated. There are some arbitrary cut-offs (“three months”) for clinicians, but the chapter does drive home that even though there is a difference between normal sadness and depression, it’s still a gradient, and the line is still something drawn by we humans.
13) Chapter 13: Being Woman, Hard Beset
§ Simplified: is the prevalence of unipolar amongst women hormones or society? There is definitely evidence that there is some connection to hormones (women on birth control pills experience atypical depression more often, pregnant women are least likely to experience depression, and postpartum depression is common).
§ Because of the discussion on hormones, a discussion on seasonal affective disorder (SAD) is brought in here because it is believed to be a hormonal issue (in this case, melatonin).
14) Chapter 14: Lifting the Fog
§ Various treatments for depression: drugs vs. cognitive therapy. Strongest evidence is that both combined is much more effective than either separately.
§ One lesson to take away from this chapter’s testimonies is that treatment is not always straightforward or simple, even once the diagnosis is correct. Many doctors don’t have a clear grasp of drug interactions, which can be particularly problematic if a patient is simultaneously undergoing substance abuse treatment.
§ Cognitive therapy: Cronkite had almost been offended that this could work because it seems like someone telling the patient to will themselves out of it, which she had not ever been successful at doing, until she started medication. The lesson is that the treatment will not be the same from one person to the next, but it’s important to believe that there is something that can work.
15) Chapter 15: Beauty and the Beast
§ Are artists more prone to affective disorders? Does it improve their art?
§ Answer: Artists with bipolar disorder can have great productivity as they enter into their manic phases, and this can give them a creative advantage, because their every thought is sped up.
§ Answer: No, artists are only more susceptible to depression because they feel things more deeply, and sense things more acutely as a matter of course in their work.
§ Answer: Artists are constantly exposing themselves to criticism, which may act as a precipitating event, which would make them more likely to suffer.
§ I didn’t find this chapter particularly enlightening—I think this debate can be very interesting. Artists are by definition atypical. People with mental illness are by definition atypical. How much is this coincidence, and do we as society have something to gain (art, beauty) by an artist’s disease remaining untreated?
16) Chapter 16: Existential Blues
§ How do psychology and spirituality overlap? Some might interpret depression as a distance from god. The author’s experience with religion was helpful to her personally, but ultimately she knew it was a separate issue from her depression, and it remained dangerous to go off her medication.
17) Chapter 17: The Black Dog at Home: Support of Family and Friends
§ This chapter was interesting—it was one of the chapters where there was some disagreement within the testimonies. Sufferers of depression and medical professionals talked about what it was best to do if you suspect or know someone is depressed. Some felt it was best to act as if everything was normal. Some felt it was important to recognize that they are suffering from a disease, and to get them help accordingly.
§ There wasn’t as much discussion as I would have thought about protecting yourself from a depressed family member. It had been mentioned in other places in the book. Obviously, in cases of manic patients, physical protection is necessary. But the potentially “contagious” effects of depression are real, with the learned helplessness of dealing with and caring for someone who just won’t get better.
18) Chapter 18: It Tolls for Thee
§ Depression and marriage. A more specific discussion than the previous chapter. Spouses must be patient, but if they are willing to understand the disease, they can be important in helping wit the diagnosis. They may notice early warning signs before a sufferer does.
§ Mostly this chapter seemed to be a way for the contributors to thank their husbands and wives for putting up with a lot and helping them through.
19) Chapter 19: Families in the Dark
§ A chapter introducing the importance of recognizing that depression can run in families, and why talking about the disease can help make diagnosis, and therefore treatment, easier. It’s a bit of a lead-in to the following two chapters.
20) Chapter 20: Children of Depressed Parents
§ Of all the feelings of helplessness that family members can undergo (see previous chapter), it’s the most crucial time for children. If they don’t understand what’s going on (if the parents doesn’t know, or if the parent is too ashamed to explain), they can easily blame themselves for the irrational moods. Several accounts give what they think is the best way to approach the subject with kids. Several accounts show kids who are still afraid of the disease, and who don’t want to talk about it (Cronkite points out it’s important to explain that it’s a treatable disease, something she feels she may have forgotten to stress to her kids).
§ Cronkite’s son: “One thing [that has changed since finding out about the disease]: I’ve known what’s going on, which has made it a whole lot easier on me. Like if you’re on the fourth floor of a building and there’s an explosion, you have no idea what’s happening, but if you heard on the radio that there’s a bomb in that building or a technical explosion, or something, you’d be less scared because you’d know what was going on.”
21) Chapter 21: Children with Depression
§ People have relatively recently begun diagnosing and really accepting that children can be depressed. It is hard to sort out a depression in a kid, because so much diagnosis is based on criteria like “less interest than normal,” when a kid hasn’t been around long enough to have established a normal baseline.
22) Chapter 22: Old Dogs, New Tricks
§ Deals with depression in older people. Again a more difficult diagnosis than with the mainstream population, for one thing because it’s hard to parse out from dementia. They have a few overlapping symptoms, but more difficult is they often occur at the same time (similar to substance abuse—it’s hard to figure out cause, effect, and treat both effectively).
§ Discussion about whether sadness is a normal part of the aging process. There is, after all, loss—loss of youth, and eventually loss of most friends. Again, the distinction has to be made about when it’s time to cut them off, define it as depression, and get them treatment.
§ The longest essay is from Jennie Forehand, who had one other long entry in the book. Her experience with her mother, who was kicked out of assisted living places and suspected of psychotic disorders before she was diagnosed with depression, was fascinating.
23) Chapter 23: Advice to the Players
§ This short chapter is mostly of very short urgings by many of the contributors to get help for the disease if you have it. The advice ranges from “make sure to take care of yourself” to “see a psychiatrist as quickly as you can.” One doctor stresses the importance of both—he believes in alternative therapies, yoga and meditation for instance, but thinks these are largely just a palliative, while medical treatment can offer a real cure.
§ This is an interesting distinction (palliative vs. cure): if depression is just overwhelming sadness, isn’t something that takes one away from the sadness a cure? No, the argument is again, there is something more basic to depression than just the outside emotions, and with a medical origin, it needs a medical cure (see next chapter).
24) Chapter 24: Healing
§ This chapter stresses that the “cure” makes the recovery sound quick, when in reality it’s a long process and involves a lot of work from the patient. Medication may be necessary, but it doesn’t mean it will work like a switch—it will just make it possible for the patient’s willpower to have some effect.
25) Chapter 25: Ad Astra per Aspera
§ “To the stars through difficulty” (uplifting conclusion)

III. Other themes of the book
1) Images of depression
§ Black dog (Churchill)
§ “mist seeping slowly” (p48); hangover/residue (p49); “dark cloudy gauze” (p118); smoky room (p144); “When I would try to explain to people my experience last time I sobered up, I would tell them about a famous painting traditionally called Nightwatch in Amsterdam. It was painted by Rembrandt. It’s a scene of a bunch of seventeenth-century gentleman on the wall of a fortress keeping watch during some battle. For hundreds of years, it has been assumed that it was a night [scene], because it was so dark, until they cleaned it about ten years ago. To everyone’s amazement, it’s actually a day portrait. That’s what it’s like when alcoholics stop drinking. Everything is still there, the way is still there, the kids are still there, all the same people are still there, it’s just a lot lighter than you thought it was.” (Mary Jones, p93)
§ The comparison to diabetes and other diseases.
§ Moral weakness (p78) (this reference made more in relation to the stigma, not any contributor’s actual view)
§ Disconnect from the rewards system (p91) (one of the more clinical assessments, but very a very interesting way to view it)
§ On sadness vs. depression: like a hangnail versus a shotgun wound (p111)
§ The book of Job as a parable about suffering from depression.
2) Arbitrary distinctions that must be made, or things that exist on a continuum
§ Biological vs. psychological (“the brain is the organ of the mind” p31-2)
§ Beck Inventory—one of the most common ways to measure depression. A 21-question quiz
§ Feeling vs. thinking (p49)
§ Schizophrenia vs. bipolar (p57)
§ Alcoholism <-> depression (p88)
§ A call for help vs. a “genuine” suicide attempt
§ Mind/body/spirit