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STEPHEN SMITH: Jane Kenyon grew up in a taciturn Michigan family whose members shared a despair none could speak of. She spent her childhood in depressions house.

JANE KENYON: My father had it. I'm quite sure my grandmother had it. And I'm also quite sure that my father's sister had it with a little soupcon of paranoia thrown in. They thought they were bad people.

My father continually went to the Ann Arbor Public Library and brought home self-help books on psychology. He read them by the stack. He read them by the stack.

And he knew that there was something wrong with the way he was thinking. If he could just correct his thinking, well, then this depression would go away. And of course, it never did.

STEPHEN SMITH: Jane Kenyon is an acclaimed poet whose work charts the gray terrain of depressive illness. She describes the disease as a monster she knows so well, she must write about it.

JANE KENYON: I remember being depressed from my earliest childhood. I remember lying on my bed on my back on a summer evening just being paralyzed by depression, just lying there and thinking I'm in so much pain. How could this happen? Just being so thoroughly in pain in my soul and see, I didn't know that other people didn't feel this too. So I thought it was the way of the world.

BRENDA: "Having it Out with Melancholy" by Jane Kenyon part one, "From the Nursery." "When I was born, you waited behind a pile of linen in the nursery, and when we were alone you lay down on top of me pressing the bile of desolation into every pore. And from that day on everything under the sun and moon made me sad, even the yellow wooden beach that slid and spun along a spindle on my crib.

You taught me to exist without gratitude. You ruined my manners toward God. We are here simply to wait for death, the pleasures of Earth are overrated. I only appeared to belong to my mother, to live among blocks and cotton undershirts with snaps, among red tin lunch boxes and report cards an ugly brown slipcases. I was already yours-- the anti-urge, the mutilator of souls."

[MUSIC PLAYING]

STEPHEN SMITH: Depression is a tricky thing to explain No one really knows what it is or why some of us get it. Dr. Frederick Goodwin Director of the National Institute of Mental Health in Maryland says depression is more than the blues.

FREDERICK GOODWIN: It would be abnormal not to be able to feel depressed mood and depressed thinking and even to feel totally disconnected from life for a while if something terrible happens. The difference is that clinical or major depression goes on relentlessly week after week, month after month. And the mood can go from just depressed to a kind of intense heavy sadness, which is really painful.

STEPHEN SMITH: Experts don't know why some people recover from traumatic life events while others keep spiraling downward. For a long time, depression was thought to be purely psychological, but the illness tends to run in families. So the most accepted theory now is that depression is largely biological. A genetic misprint snarls the mind.

[BUZZING]

If you could eavesdrop on your brain, you would hear a mechanism built of about 10 billion or so neurons buzzing with information. The neurons are bundled into circuits that control virtually all parts of your body-- heart, hands, spleen, and feet. Some circuits also control your mood. Scientists are still trying to figure out how these mood circuits are wired.

JOSE PARDO: The brain is still very much a black box. We really don't understand even the exact location of the neuron or neurons that seem to relate to the mental experience of depression.

STEPHEN SMITH: Dr. Jose Pardo is a psychiatrist and brain researcher at the Minneapolis VA Hospital. He explains that between each neuron in the brain is a tiny gap.

JOSE PARDO: That's called the synapse.

STEPHEN SMITH: The neurons shoot chemical messages to each other across the synapse. A healthy brain produces enough of these chemicals to send clear signals. If the brain produces too much or too little of the neurotransmitter chemical, the message gets garbled. The mixed signals can cause depressive illness, either the vast mood swings of manic depression or the lengthy murk of major depression. Major depression is much more common than manic depression.

The three chemical messengers believed to most influence mood are norepinephrine, dopamine, and serotonin. Antidepressant drugs like Prozac regulate the flow of these chemicals. Jose Pardo says the problem is scientists aren't really sure how either the chemicals or the drugs actually work.

JOSE PARDO: We can't put somebody's brain in a machine and have the machine tell us for this patient, you need to use serotonin. It's really try one and the other and see what works.

BRENDA: "Bottles." [? Belovile, ?] Ludiomil, doxepin, norpipanone, Prozac, lithium, Xanax, Wellbutrin, Parnate, Nardil, Zoloft. The coated ones smells sweet or have no smell. The powdery one smell like the chemistry lab at school that made me hold my breath."

SPEAKER: Can I have you take just the last phrase one more time? And don't breathe for as long as you possibly can.

[LAUGHTER]

SPEAKER: And stand on your head too.

SPEAKER: Oh, OK.

[MUSIC PLAYING]

STEPHEN SMITH: In the recording studio, Anne Baxter appears calm and assured, but she nearly quit her professional oboe career because of two nasty traits that often accompany depression, a sense of worthlessness and a gripping anxiety. Anne plays in a prestigious national orchestra, but as depression set in, the thrill of performance gave way to trembling and nausea.

ANNE BAXTER: I thought I could never play again. It was just too stressful. I swear at times at the worst times, I would hear everything was too loud or distorted or it didn't sound right. And I just thought, I can't do this anymore.

STEPHEN SMITH: The oboe is remarkably difficult to play because it requires strength and delicacy at once. A slouch can't make it to Anne's level of professional success. So one of the things she resents most about depression is that the paralysis wrecked her discipline. She's on medication now, and that's lifted her mood, but the drugs don't always restore a person to full power.

ANNE BAXTER: You go through the motions of doing your job, but what's behind it is there's nothing behind it. And I feel that kind of a hollow shell. I have absolutely nothing to say through the music. I feel totally empty, and that's very sad.

STEPHEN SMITH: Officials at the National Institute of Mental Health say depression is second only to heart disease in causing lost workdays in America. It sidelines more people than lung disease, more than diabetes, more than AIDS. Depression is the leading cause of suicide. A 1993 study published in the Journal of Clinical Psychiatry estimates that depressive illness cost the American economy up to $44 billion a year in sick days, medical care, and lowered productivity. Depression expert Frederick Goodwin adds that the illness can affect the entire body, not just the mind.

FREDERICK GOODWIN: Your appetite is gone often or occasionally people eat too much as if to try to help the pain that way. Your activity is very slowed down. And then people have vague physical aches and pains. They often describe a heaviness in their chest. And of course, for this reason, they often go first to their general physician.

STEPHEN SMITH: For nearly three years, Twin Cities businesswoman [? Kathy ?] [? Stark ?] spent most of each day curled up on the carpeted floor of her basement. Depression struck in her early 30s, and Kathy became immobilized by her obsessive ruminations on death and personal worthlessness.

SPEAKER: If you are able to master the task of getting off the floor, getting clothes on that you think are right, and then go somewhere, now you have the anxiety to deal with, do I look OK? Do I look normal? Can everyone tell that I'm sick? And then, of course, you start to look sick because you're so anxious.

STEPHEN SMITH: A series of traumatic events triggered [? Stark's ?] depression, mainly an abusive marriage that unearthed her memories of childhood sexual abuse. When those memories engulfed her, [? Stark ?] had to leave her job. She tried to force herself to feel better doing things she once enjoyed, but nothing blocked out the despair.

SPEAKER: Why should I get up? I'm never going to be any good. I'm never good enough, whatever good enough is. And now I'm laying on the floor that's more evidence that I'm not any good.

SPEAKER: Suggestion from a friend. You wouldn't be so depressed if you really believed in God.

STEPHEN SMITH: People who have depression say one of the hardest things is getting family members to understand the disease.

SPEAKER: They did not believe that I was depressed and desperate. They believed that I was unemployed and somewhat lazy and sad. That's why I started threatening suicide. I needed to get people's attention.

SPEAKER: My husband is embarrassed. He doesn't even want to hear the word depression. That's for crazy people, the ones that walk down the street and talk to themselves or those are the ones that wear winter coats in 90-degree weather.

SPEAKER: Trying to describe the experience of depression to someone who's never had it is like trying to describe a color to a person who's never had sight

SPEAKER: I don't talk about it, and he doesn't talk about it. I would like to talk about it what's going on in my feelings and everything, but he's not a very understanding person. So I don't talk about it.

STEPHEN SMITH: National Health Statistics suggest that about half of the 18 million Americans suffering in depressive illness never get proper treatment. One reason is the relatively limited coverage for mental illness under many health insurance plans. Research also shows that people with depression are reluctant to seek help because of the social stigma against the disease, the popular belief that people with the illness are just losers.

JANE KENYON: There's even the mistaken notion that people enjoy their depression. There's nothing enjoyable about depression. There's nothing enjoyable about feeling like the living dead, nothing.

STEPHEN SMITH: Once again, writer Jane Kenyon.

JANE KENYON: Depression makes people sick. It absolutely undoes them. It makes them unfit for work. It makes them dangerous to themselves and others.

It makes them wound others at home. It frightens children. It's absolutely devastating. It's going to have to be dealt with.

BRENDA: "In and Out." "The dog searches until he finds me upstairs, lies down with a clatter of elbows, puts his head on my foot. Sometimes the sound of his breathing saves my life-- in and out, in and out, a pause, a long sigh.

[MUSIC PLAYING]

SPEAKER: Maybe we should leave it a little bit longer on top.

SPEAKER: Well, whatever you think.

SPEAKER: OK.

STEPHEN SMITH: The ancient Romans had a saying to warn gossips that they were trading on old news. Every Barber knows that. It's still the same, some people just seem to get confessional when that huge plastic bib is snapped around their neck. Maybe that's why Abbey's customers are always talking about how they've just been diagnosed with depression. Abbey used to roll her eyes when every third person in the chair blurted out he was on the hot new antidepressant Prozac.

SPEAKER: was like, OH, what's wrong with these people? Can't they just deal with their problems? Can't they deal with life? I just thought, are we all going to turn into pods?

SPEAKER: Pods?

SPEAKER: Pods like from the movie, invasion of the body snatchers how everybody we're all pods. And is it just creating this no-mind world?

STEPHEN SMITH: Well, that's how Abbey used to talk. Now she's on a chemical cousin of Prozac called Paxil. It turns out that after the birth of her first child in 1987, Abbey slipped into depression. Her chronic gloom grew especially dark before each menstrual period. Abbey would haul herself home from the salon and flop into a morose heap on the sofa.

SPEAKER: So I decided to try Paxil, and two days after I tried it, I felt better. And after the first week, I felt great. And I thought, is life this good? And I think I just sort of pushed along in life being depressed and not even really being aware of it.

STEPHEN SMITH: Abbey's is the kind of story that makes Prozac, Paxil, and the other new antidepressants controversial. In some people, the new drugs have irritating side effects, like jitters, nausea, and sleep trouble. But Prozac generation drugs have far fewer side effects than older antidepressants.

They also don't appear to be addictive. That means more people with borderline depression are trying the medication. Some critics suspect that the pills are being overprescribed. For example, psychiatrist Edward Posey of Minneapolis isn't against Prozac, but the idea some people have that a pill alone will ease their pain.

EDWARD POSEY: They want the Prozac. They want my Prozac now because that's going to make me happy. And they don't want to look at the reasons why they have encountered any unhappiness in their lives.

STEPHEN SMITH: Medical studies suggest that a combination of drug and talk therapy is the most effective treatment for clinical depression. Abbey, the hairdresser, sees a therapist, takes her Paxil, and feels normal again. She's also read all those magazine articles criticizing antidepressants as in drug for pouting baby boomers. Her response.

SPEAKER: Hey, why not? I'm a product of the '70s, and I smoked pot. What's one more drug, especially if it's supposed to just make you feel just OK?

And I only take a half a dose. It's very minimal dose. If I take it the rest of my life, well, so be it, at least I get to live my life and have a smile on my face. And it's not caused by the Paxil. It's caused because I feel like the chemicals in my body are finely balanced.

STEPHEN SMITH: It's important to note that the long term effects of Paxil, Prozac, and other new antidepressants are not known. The drugs are too new, but so far, they appear to be safe.

BRENDA: "Pardon." "A piece of burned meat where's my clothes, speaks in my voice, dispatches obligations haltingly, or not at all. It is tired of trying to be stouthearted, tired beyond measure.

We move on to the monoamine oxidase inhibitors. Day and night, I feel as if I had drunk six cups of coffee, but the pain stops abruptly. With the wonder and bitterness of someone pardoned for a crime she did not commit I come back to marriage and friends, to pink fringed hollyhocks, come back to my desk, books, and chair."

[MUSIC PLAYI NG]

STEPHEN SMITH: People with depression experience a peculiar kind of interior demolition. Their lives and world cave in like a building wired to implode into its foundation. Still, shards and shrapnel from such a violent disease also spray outward at friends and family. Living near the illness can be hell.

SPEAKER: I came home one day, and I found Steve home curled up on the couch with all the lights off in the fetal position, all the lights off in the house, the blinds were drawn. And it was about 3 o'clock in the afternoon.

STEPHEN SMITH: Lee Heikens speaking about her former husband. Steve and Lee Heikens were a prominent Twin Cities couple-- Lee a successful real estate agent, Steve a respected attorney. In 1988, Steve's glittering legal career faltered when he hit a crippling depression. Their marriage collapsed when the illness spun off into mania.

SPEAKER: And I started doing things like giving eulogies at funerals talking about the benefits of jelly mixed with peanut butter on the roof of your mouth. It doesn't stick. I started buying things.

I'd go to bookstores and buy $2,000 worth of books at a time, went to Saint Martin's with my wife and daughter. And the way they tell it, I rented a Jeep and proceeded while smoking a cigar driving a Jeep standing up to videotape the countryside scaring the hell out of them. I stayed out all night.

I needed one hour of sleep. I'd come home at 6:00 AM, sleep till 7:00 AM, and bounce back up ready to go. My wife to get my attention, took all my new books and put them in the shower and turned the faucet on. And my reaction was to move out. We separated, and three months later, we were divorced.

STEPHEN SMITH: About a third of the people with depressive illness end up with the manic form of the disease, cycling between months of depression and bouts of mania. The mania often starts as a creative and energetic euphoria with the mind racing and the thoughts rattling faster and faster towards madness.

SPEAKER: On my route walking to Minneapolis to IDS Center at 5:00 AM, I would often hear a dog. And I would go in pursuit of that dog. And the dog would lead me to a cat.

And then I would find a tree talking to me down in Minnehaha Parkway. And I would walk down and then start talking to Minnehaha. And the statute spoke to me as freely as you speak to me sitting here.

SPEAKER: Probably the most frustrating part of all this for me was during this time I tried desperately to talk to lawyers who knew him to help him. They knew he was behaving really erratically. They knew he was showing up at the courthouse wearing biker boots and cowboy shirts, but yet nobody wanted to do anything at all.

STEPHEN SMITH: Lee Heikens tried three times to get Steve into a hospital without success. In one of his manic terrors, Steve hit Lee with a car breaking bones in her face, hands, and chest. Even though they were divorced, Lee kept up a long struggle to convince Steve to see a psychiatrist, then to stay on the medication lithium which tames most manic depression. Slowly Steve recovered. Slowly, the couple reconciled, but the work isn't over.

SPEAKER: So often, if I come home to my house and I'm happy, like, my daughter and people like that will ask, you look pretty happy dad. Is everything OK? Did you take your pills today?

Well, as a manic depressive, I resent those questions. Give me a break. I deserve to be happy, too. Why do you have to be suspicious? Well, they come, and that's a uniform reaction. I mean, every manic depressive I know has family who does that.

SPEAKER: Too damn bad. We have every right to be afraid that it'll happen again. And we have every right to know that every measure possible is being followed to make sure it doesn't happen. I mean, I feel badly for him, but it's something he has to learn to live with because we've learned to live with him.

STEPHEN SMITH: Lee and Steve Heikens planned to remarry this summer.

BRENDA: "Credo." "Pharmaceutical wonders are at work, but I believe only in this moment of well being. Unholy ghost, you are certain to come again. Coarse, mean, you'll put your feet on the coffee table, lean back, and turn me into someone who can't take the trouble to speak, someone who can't sleep, or who does nothing but sleep, can't read or call for an appointment for help. There is nothing I can do against your coming. When I awake, I am still with thee."

STEPHEN SMITH: Depression is like an unwanted house guest who leaves his hat behind. You hope he forgets the hat altogether, but he probably won't. Research shows that most people who lived through a major depression will experience several more in their lifetime on average about every 10 years. But statistics from the National Institute of Mental Health show that 80% of people with depression can be treated successfully. Writer Jane Kenyon insists that American society and American health care must recognize that depressed people are sick, not weak.

JANE KENYON: Mental illness is an illness like any other illness, like diabetes, like heart disease. People don't apologize for having pancreatitis. This just is not something that's under your control.

But what if he had a broken leg say to himself or herself, well, it's really up to me to pull myself together here. And there is this bone fragment sticking out of my-- sticking out of my lower leg, but I just tuck it back in and tie it and put a splint on it and keep going. Well, there's no need of it. It's an illness. It's an illness.

STEPHEN SMITH: Kenyon's illness is especially persistent, but she fights it. She's been on a catalog of medications, she monitors her diet, and charts the course of her mood in a ledger. She relies on her husband for help and takes daily walks in the New Hampshire countryside with her dog.

JANE KENYON: And my dog is my spiritual leader. Dogs are optimists. They never give up hope, never.

They think you're charming just the way you are. They always want to run. They love to be silly. I would definitely prescribe Nardil and a dog to anyone who's having a terrible time.

STEPHEN SMITH: To survive depression, one must seize ordinary moments and grip hard. That's how Jane Kenyon ends her poem in nine segments titled "Having it Out with Melancholy."

BRENDA: Nine, "Wood Thrush." High on Nardil and June light I wake it four, waiting greedily for the first note of the wood thrush. Easeful air presses through the screen with the wild complex song of the bird, and I'm overcome by ordinary contentment. What hurt me so terribly all my life until this moment? How I love the small, swiftly beating heart of the bird singing in the great maples-- its bright, unequivocal eye."

[MUSIC PLAYING]

STEPHEN SMITH: A Suffering Mind was produced by Stephen Smith and Bill Catlin, Technical Director John Scherf with help from Paul [? Barron. ?] "Having it Out with Melancholy" is a sequence of poems from a collection of Jane Kenyon's work titled "Constance" published by Graywolf Press. The excerpts were read by Brenda [? Weale. ?] This program is a production of Minnesota Public Radio. I'm Stephen Smith.