The Frontal Cortex

Rolling Stone recently published a truly excellent article by David Lipsky on the struggles, triumphs and suicide of David Foster Wallace. It's a heart-breaking read, a chronicle of a genius done in by a mental illness. (It reminded me, in parts, of Woolf's diaries: the acute self-consciousness, the Sisyphean struggle against this internal shadow, the inevitability of a tragic ending.) I didn't know, for instance, that Foster-Wallace's final bout of depression began after he was taken off Nardil, an old-school monoamine oxidase inhibitor.

In June of 2007, Wallace and Green were at an Indian restaurant with David's parents in Claremont. David suddenly felt very sick -- intense stomach pains. They stayed with him for days. When he went to doctors, he was told that something he'd eaten might have interacted with the Nardil. They suggested he try going off the drug and seeing if another approach might work.

"So at that point," says his sister Amy, with an edge in her voice, it was determined, 'Oh, well, gosh, we've made so much pharmaceutical progress in the last two decades that I'm sure we can find something that can knock out that pesky depression without all these side effects.' They had no idea that it was the only thing that was keeping him alive."

Wallace would have to taper off the old drug and then taper on to a new one. "He knew it was going to be rough," says Franzen. "But he was feeling like he could finally afford a year to do the job. He figured that he was going to go on to something else, at least temporarily. He was a perfectionist, you know? He wanted to be perfect, and taking Nardil was not perfect."

That summer, David began to phase out the Nardil. His doctors began prescribing other medications, none of which seemed to help. "They could find nothing," his mother says softly. "Nothing." In September, David asked Amy to forgo her annual fall-break visit. He wasn't up to it. By October, his symptoms had become bad enough to send him to the hospital. His parents didn't know what to do. "I started worrying about that," Sally says, "but then it seemed OK." He began to drop weight. By that fall, he looked like a college kid again: longish hair, eyes intense, as if he had just stepped out of an Amherst classroom.

When Amy talked to him on the phone, "sometimes he was his old self," she says. "The worst question you could ask David in the last year was 'how are you?' And it's almost impossible to have a conversation with someone you don't see regularly without that question." Wallace was very honest with her. He'd answer, "I'm not all right. I'm trying to be, but I'm not all right."

He would later submit to twelve courses of electroconvulsive therapy. But nothing worked. The depression only grew darker. Obviously, it's impossible to know what was happening inside Foster Wallace's mind, but I think his suicide is a sad, sad reminder of just how difficult it is to change anti-depressant prescriptions, especially when the patient has been on a prescription for years. (Although we tend to talk about many of these drugs as interchangeable, as if all SSRI's or MAOI's are the same, it's clear that we really don't understand the differences and distinctions.) The brain, we are reminded, depends on an exceedingly delicate chemical equilibrium, and even minor shifts can have dramatic repercussions. We lose our balance and, for people like Foster Wallace and Woolf, that loss can be irrevocable.