Between Not Wanting to Live and Not Wanting to Die

I survived a soul-eating depression. But how?

Picture of artwork made by Katrien De Blauwer
Katrien De Blauwer

About the author: Jeffrey Ruoff is a filmmaker, film historian, and professor at Dartmouth College. His latest film is Bon Voyage.

If you are having thoughts of suicide, please know that you are not alone. If you are in danger of acting on suicidal thoughts, call 911. For support and resources, call the National Suicide Prevention Lifeline at 988 or text 741-741 for the Crisis Text Line.

Shortly after 2 p.m. on January 31, 2019, I left my Dartmouth College office to kill myself. It was 11 days after my 57th birthday.

At my desk, I had written and torn up numerous letters to my wife, Glennis, and our daughter, the essence that they remained my be-all and end-all, above and beyond any actions I might take. I realized that no suicide note could alleviate their grief, but—always a perfectionist—I kept polishing drafts. Then I texted and emailed my closest friends and family to say that I loved them, and sent Glennis a more explicit note, asking her to “come home to hold our daughter.” Ten days earlier, my psychiatrist had emailed my psychotherapist to say, “Jeff appears very depressed with suicidal ideation, thoughts of jumping from something high.”

Outwardly, I was surrounded by everything I could possibly want: a happy marriage, a rebellious teenager, a stimulating job, a warm home in rural Vermont, friends near and far. I bathed in love and enjoyed financial security, along with very good health insurance. I wouldn’t have changed anything, except my soul-eating depression.

By January 2019, I had lost all hope for recovery. So many treatments had fizzled. Clinical depression and ordinary life stood across an impassable ravine. When well, I could barely imagine being depressed, and when depressed, I couldn’t remember ever feeling well. In Inferno’s final circle of hell, Dante’s sinners freeze instead of burn, trapped in an icy lake. Depression feels like that. While in a catatonic stupor, I spent months doing crossword puzzles and watching tennis highlights. Anything that helped squeeze the hours forward—time marked by the death of the senses, a quashed libido, the same dirty khakis and T-shirt.

It’s strange how much our minds can hurt us. Each night, as sleep overtook me, my last thought was the hope that I would not wake up again. Any way of dying that would hurt my family less than suicide. But I did wake up, again and again. “In late January,” my medical record states, “Jeff had his first episode of suicidal thinking and related behavior.” From my office, I drove 10 minutes to the White River to throw myself off a bridge and into the ice-cold water.

I grew up one of five brothers. In 2015, the eldest, Bill, killed himself. He was 60 when he jumped from a ledge into one of the gorges for which our hometown, Ithaca, New York, is best known. As kids, we loved to hike those gorges. We crossed the Triphammer bridge countless times—on foot, on bicycles, in cars, day and night, stoned and straight. I was 11 when someone stole my Schwinn bike, built like a tank, and hurled it off that bridge. The cops retrieved it from the gorge below, in fine condition.

For Bill, suicide was the culmination of several years of spiraling paranoia. He’d convinced himself that his wife of 30 years had had an affair, and they underwent a painful divorce. A year before his death, he left his job as a toxicologist in Colorado and transferred to a new position in Pennsylvania, alone. Setting up the empty apartment—all the bedding, furniture, appliances—was too much for him. In an email, he admitted, “There hasn’t been any food in this house in over a week.” On a street corner, the police picked him up during a psychotic episode. They took him to a hospital where he received a full round of electroconvulsive-therapy (ECT) treatments. These proved futile. After more than two weeks in the hospital, he was released with only a Post-it note with the date of a future appointment jotted on it. Pretty quickly, he began a death spiral.

Bill first attempted suicide the evening of his release, when he drank a 12-pack of Budweiser and took a medley of prescription drugs. The next morning, our brother Steve and his wife, Sue, knocked on his door. No answer. They got a key from the apartment manager and found Bill unresponsive on the floor. An ambulance took him to a second hospital. When he returned to his apartment, he made another suicide attempt with identical methods and a similar outcome. This led to a third emergency stay at yet another hospital, with equally disappointing care and results.

After quitting his job, Bill moved back to Ithaca, where he slept on a sofa in our parents’ apartment at a retirement home. His psychiatric treatment waned. He called his 26-year-old daughter to ask her permission to kill himself, which she denied. In our last phone conversation, Bill told me that he was constantly obsessing about suicide. (In retrospect, he had clearly returned to our hometown to take his life.) Helplessness blanketed all of us.

It was spring when he jumped. He left behind two children and four suicide notes: “Please give these to my family. I can no longer endure this terrible pain every moment of every day and evening. I have no hope that I will get better. I do not wish to live a moment longer. Please respect and celebrate my life.”

I wrote his obituary. At our parents’ request, I made no mention of mental illness or suicide.

A suicide in the family significantly increases the chance of a copycat performance. Four years after Bill’s death, I stood on the bridge over the White River. The winter sun couldn’t break through the cold. Was I crying? I can’t recall. I hesitated. Between not wanting to live and not wanting to die, there is a tiny platform, just big enough to stand on. But it’s like standing on burning coals.

Glennis was at the airport, on the way to see her parents, when she got my text message. She phoned me multiple times. I answered the fourth call. She asked where I was, and I told her. Sobbing, she begged me to go to the hospital. She promised me anything if I would just get off that bridge. I hesitated, and backed away from the edge. Did love ground me? Fear? Or some residual hope?

Glennis stayed on the phone with me while I drove to the hospital, making one detour—at my office to shred the letter I’d written. At the hospital, I was stripped of any possessions I could use to hurt myself: coat, belt, watch, khakis. I could keep my iPhone, but worried: How to charge it? The rooms were like prison cells, and my dinner arrived with a cardboard fork.

I convinced Glennis and my psychiatrist that I’d be better off at home than at that forsaken facility, and they reluctantly agreed. But I couldn’t be left alone—not even for an hour. So Glen and I clung to each other on our couch, as seconds crawled to minutes, days to weeks, months, impossibly, into years. My sadness dripped, like an open tap, eventually flooding all the rooms. How do you relax with a suicidal husband at home? When Glennis eventually had to take a trip, Steve came to be by my side.

At Dartmouth, I continued to teach my courses in the department of film and media studies. I felt I was a fraud and an imposter, barely functioning, but my students and colleagues seemed not to notice. Somehow I passed as a fairly normal faculty member on campus. My medical record from that first February reads: “The overwhelming feeling of despair has shifted to numbness.”

In the days after my near-suicide-attempt, another one of my brothers started sending me postcards. I got one every day: from Texas, say, or British Columbia. On a postcard depicting “A Wooden Shoe Tulip Farm,” he wrote, “For the sake of all of us, you don’t have permission to go.” More postcards arrived—of New York, Florida, California. Wherever he bought the postcards, I know he didn’t travel to all these places. On the front of one, a city skyline; on the back, the promise that my pain would one day be “a distant memory.” A sunset complemented a quote from Marcus Aurelius: “Be satisfied with success in even the smallest matters.” An image of “James Bond Island” in Thailand accompanied a blunt insight: “Dad is fucking insane, plain and simple.”

On the sixth anniversary of Bill’s suicide, on a postcard of Mount St. Helens, he confessed that he still felt guilty that he hadn’t done more to try to save our brother. Probably nothing could have helped Bill toward the end, but I remained within reach.

Picture of artwork made by Katrien De Blauwer
Katrien De Blauwer

Mental illness has ravaged my family for generations; nature married nurture and multiplied in toxic ways. My brothers and I grew up in a white, Protestant, middle-class home, at the dead end of a suburban street. We enjoyed arcadian boyhoods, with woods to explore, animals to catch, forts to build and burn down. We also beat the hell out of one another. Parental love came with preconditions, namely educational achievement. We grew accustomed to our father’s response to an A grade: “Why not an A+?” Four of us completed Ph.D.s, including me. The fifth went into business, and made more than the rest of us combined; still, all her life, my mom lamented that “Stephen had slipped through the cracks.”

I don’t remember my mom or dad ever saying a kind word to each other. I saw them embrace once: in the kitchen, Christmas 1969. For years, Mom slept on a couch in the living room, for reasons obscure to her sons. Well-intentioned but anxiety-ridden, she mostly screamed at us. Her childhood had its own troubles. Her mother was born in 1911 in Winter Quarters, Utah. Orphaned at 5, she was taken in by an aunt, who kept her home from school to do housework and locked her in a root cellar, secured by a trap door with a chair on top. She told my mother that at 8 she had been raped by a bishop of the Mormon Church. In her 80s, my grandmother wrote and self-published a memoir, which passed over these childhood traumas. In it, she raves about her son but never once mentions my mother.

My father grew up on a farm in Fort Wayne, Indiana. When he was a teenager in the 1940s, his mother underwent ECT for depression. Pioneered in 1938, ECT was being used more and more, but remained experimental, and I don’t know what effects it imparted, good or bad. As a man, my father had two obsessions: money and science. He was a well-respected engineering professor at Cornell, but he desperately wanted to be rich, and he desperately wanted to win a Nobel Prize, neither of which he achieved.

What he did do was deliver a formidable share of mental illness to our table: the undiagnosed and untreated bipolar condition that formed the jagged backdrop of our childhoods and young-adult years. He gambled on high-stakes investments and mostly lost, terrifying our mother. He never showed emotions other than red-in-the-face anger. After many years of manic activity, my father finally slammed into his first depression when he was in his 50s. His mother had dementia and was accusing him of stealing her money. (Money, his beginning and end.) I was an undergraduate at Cornell at the time, and we met for lunch one day. I remarked that he looked “tired,” his eyes clearly worn by tears. Taken aback, he asked if his fatigue was so blatant. As he talked about his mother, he started to sob. A first.

Unfortunately, my dad wasn’t the kind of man who asked for help; he was in the grin-and-bear-it school of mental illness. It took two more decades, and a catatonic episode, before the family managed to push him into the arms of a psychiatrist. He received a diagnosis of bipolar type I—mania with depression—together with his first dose of lithium. Once on medication, my dad acted in comparatively normal ways—for him, anyway.

In his 90s now, he’s nearly beyond language, beyond being hurt by the words of a recalcitrant son. So I can admit that, as far as I am concerned, he accomplished one cool thing when I was growing up. In his lab at Cornell, he made a synthetic diamond out of a dab of Jif creamy peanut butter, squeezing it under tremendous pressure. I still own that diamond. Who else can claim such a hard-edged heirloom?

The first psychiatric assessment in my medical record, from June 2008, reads: “46 y. o. M with h/o of childhood trauma and anxiety disorder, with elements of GAD, OCD, and subthreshold PTSD, with depressed mood.” A little bit of everything: general anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder. In deference to my authoritarian father, it states, I am “bothered by loud noises, groups of strangers, cars in the rear-view mirror, in general potential ‘male aggression.’” There’s also a visual snapshot: “He is dressed casually in T-shirt and khakis, sneakers without laces. He wears rimless glasses, makes good eye contact, and is pleasant/cooperative, though sporadically tearful and dramatic.” Still today, the portrait stands.

Anxiety and depression sleep together in my bed, but gradually depression stole the covers. Over the years, I struggled with what came to be characterized as “major depressive disorder,” and took a cornucopia of medications. Nortriptyline, paroxetine, venlafaxine, buspirone, sertraline, citalopram, pregabalin, mirtazapine. None worked. Optimistically, I tried lurasidone, bupropion, and vilazodone, followed by aripiprazole, amitriptyline, and zaleplon, which also made no difference. Then Restoril, protriptyline, desipramine, escitalopram. Nothing. My psychiatrist began to talk ominously about “treatment-resistant depression.” Nonetheless, I carried on with fluoxetine, temazepam, triazolam, and trazodone. A perfectionist, I was appalled by my failure to get healthy. I almost came to despise the patients who got relief from these medications.

In addition to the pharmacopoeia, no mental illness would be complete without psychotherapy. I started with hypnosis, now forgotten. Eye-movement desensitization and reprocessing (EMDR) offered better results. EMDR involves recollecting traumatic events while tracing with one’s eyes the back-and-forth movement of, say, a pencil. Research suggests that this engages both hemispheres of the brain, allowing the left side to relieve the right, which somehow can help alleviate anxiety. I also undertook cognitive behavioral therapy, behavioral activation therapy, and acceptance-and-commitment therapy, and practiced mindfulness. Somehow, I never quite learned how to meditate.

Like tennis partners, my psychotherapist and I lobbed thoughts across her coffee table.

Jeff: I feel despondent about teaching this spring; I don’t know how to manage. My memory sucks. How can I teach if I can’t recall who directed Red Sorghum?

Psychotherapist: Try to remember that you have taught these courses many times before … Trust that you will remember how to teach them again.

At wits’ end, in January 2017, we decided to do ECT, often turned to when all other approaches fail. Still controversial, principally because of the resulting short-term-memory loss and the tenacious hangover from One Flew Over the Cuckoo’s Nest, ECT provides a statistically greater success rate than antidepressants. I would receive 13 rounds, over a month.

During each procedure, as I dropped off to sleep, the doctors would verify my medical-record number, 502400442-9, with the end mysteriously pronounced “two check nine.” Waking dazed and confused in the hospital always felt like the end of 2001: A Space Odyssey, when the astronaut comes upon himself in a faux French bedroom. Bit by bit, and then powerfully, ECT brought relief. After the last treatment, my journal reads, I “enjoy listening to music (Leonard Cohen live) for the first time in years.” I stood in our local grocery store in amazement and realized, “The coffee on this shelf is not in pain. And I am not in pain.” An epiphany in aisle two.

The short-term-memory loss was temporary, but real. Behind the wheel, I negotiated our small town with difficulty. I forgot the addresses of friends; I drove the wrong way down one-way streets. At home, routine activities presented challenges. “I cook asparagus on the grill without olive oil and then don’t turn off the burners,” I wrote one day. But there were some advantages to short-term-memory loss, like the opportunity to see great movies twice, such as 20th Century Women and Manchester by the Sea, having no recall of the first viewing. At the same time, my long-term memory dramatically improved. Knowledge of French and Italian, suppressed by chronic depression, flooded back. Che bello.

I felt, suddenly, full of energy. I started spending hours on Facebook, Instagram, and Twitter, divulging intimate details about my life. I got out of bed after four hours of sleep, refreshed, and drove to my office at 3 a.m. I coolly informed my friends that I was a “Renaissance man.” I dyed my hair red and got an ear pierced for a golden ring. I made connections wherever I went, filling my phone with new numbers. And my libido returned with a vengeance. Strolling in downtown Montreal hours before driving our teenage daughter to the airport, I insisted that Glennis try on lingerie at a local shop. When she refused, I slipped into the store to buy some regardless. I kept a running tab of how often we had sex.

These behaviors added up not to mental health, but rather to hypomania, the flip side of a depressive mood. It includes euphoria, extreme talkativeness, inflated self-esteem, excessive sociability, big increases in energy, little need for sleep, hypersexuality, recklessness, and grandiosity, as well as irritability and aggressiveness. I checked off all but the last one.

Depression manifests internally, with its ravages largely hidden from others. Hypomania is the opposite. I felt terrific, like a fish in water. My friends, who saw bits and pieces interspersed with mostly normal conduct, rejoiced in my improved state of mind. But my wife and daughter knew that something was wrong.

When depressed, I had taken a rear seat as a parent, and Glennis had picked up the necessary habit of telling me what to do. Now I became intent on having a greater role in the household, and felt either ganged up on or pushed aside when Glen and our daughter made decisions without me. Frustrated, I grew alienated from my family. They hadn’t even had the chance to process the collateral damage from my depression, and suddenly I was behaving like a different person. And they felt scared.

A month after my “recovery” with ECT, Glennis pointed out that I was easily distracted, repeating myself, talking excessively, and obsessively multitasking—all telltale symptoms of hypomania. She told my psychiatrist that I was “not better.” One evening, after I went on and on about yet another day of walking on water, she screamed, “I don’t care how fucking fantastic your day was!” While flying high, I started to believe that she actually preferred me depressed. With reckless bravado, I proclaimed that I “would be fine if we split up.” The gulf swelled between us.

I want these ups and downs to make sense; I wish that medicine, rather than chance, governed my moods. But after 18 months, my hypomania flattened, providing an opening for a depressive shift. I had gone to Ontario to see Robert Lepage’s Coriolanus. A lost night’s sleep on the floor of the Toronto airport (a curse upon Air Canada) seems the only conceivable trigger, other than a random metabolic shift. Shortly after I returned, I entered this understatement in my journal: “My mood has not been great lately.”

And so began the two years and seven months of my life’s most debilitating depression. As my mood darkened, ECT stepped forward—a “maintenance dose” to set me right. At this point we knew that ECT could induce hypomania, and yet I could not have cared less. But ECT betrayed me; this time it didn’t help.

I turned into a walking shade, uninterested in the world of the living. I stopped hoping that I would get better. Depression was my destiny. And that’s when I started to mull over suicide. In deep winter, I plotted my escape. I had to scale my inertia to get to that bridge, proceeding from contemplating to planning to acting.

As with childbirth, chronic depression can only be experienced, not explained. Dante’s description of the “dark wood” grazes it: “It is so bitter death is scarcely more.” Scarcely more, but more. At the last second, in the face of that greater bitterness, I backed away from the edge. I obstinately opted to carry on through the woods.

Six months later, my psychiatrist prescribed tranylcypromine sulfate, an older kind of antidepressant, which actually provided me some relief. It bumped me up to anhedonia, an intermediary plateau of indifference. I didn’t feel better, exactly, but felt a little less lousy. Thoughts of suicide subsided.

As I meandered in my fog, the coronavirus pandemic unfolded—the masks, the quarantines, the isolation, the sicknesses, the deaths. The pandemic didn’t make my depression much worse; rather, it resembled it. I explored a few more treatments. With the blessings of Blue Cross Blue Shield of Vermont, I got doses of transcranial magnetic stimulation—pulses of electricity to my brain—five days a week over a six-week period. It felt like a little woodpecker was tapping on my head. Cool, but nothing changed. Four doses of ketamine, an experimental treatment for depression, left me floating in oceanic peace for a moment, but I couldn’t fully relax, worried that my tormented mind would run riot. A two-week trial of Subutex, an opioid substitute, caused an uncontrollable need to vomit, but it also gave me one good day. I spent it productively editing videos.

Then, in May 2021, I experienced a revolution. Anhedonia evaporated, and happiness returned. Glennis and I celebrated our 23rd anniversary. I enjoyed salmon, hot showers, and remote garage-door openers. After years of creative barrenness, two ideas for film projects leapt to mind.

Around this time, my diagnosis was updated to bipolar type II—a milder version of what my father has. I was prescribed lithium, which probably helps on the high and low ends. (But it bothers me that, as a side effect, my hands shake, in part because my father’s do, too.) Mental illness robbed me of years of my life and conferred no particular wisdom or virtue. And I can’t assume that it won’t return. But this year’s medical record reads: “59 y. o. Male presents today for f/u of treatment for Bipolar Type II, currently in remission.” Remission never felt better. I’m not euphoric, just happy (knock on wood). I often cross the White River without thinking of what didn’t happen there.

Was this latest turnaround triggered by the springtime? A trip to D.C. with my wife and friends? Trace levels of a new medication? I don’t know. I do know that the idea and the ability to write this essay would have been impossible under other circumstances. I am sharing my story of mental illness because I hope it’s a tale worth telling. My dad might have been ashamed, but I am not. Revealing it is not weakness, but a kind of resilience. I hope my story provides some comfort and solidarity for those who suffer or have suffered.

Over all these years, my brother has kept sending me postcards. I have more than 700 of them now: from all 50 states, Central America, Canada, Asia. Whatever he writes, the message is love. One of my favorites reads, “Snow!” It describes how all day long he kept going out into the freezing yard to poke tiny holes open in the hummingbird feeders so “the little fellers” wouldn’t starve.

Recently, while on a vacation in North Africa, I mailed a postcard, for a change, to him:

I’m in Rabat, Morocco. Just talked with Glennis, on my way home soon. Sitting under the March sun, my back against the wall of the Medina, I’ve found my square meter of happiness. I’m ready for whatever comes next.

Love, Jeff.