And that’s what so many people want to get at: the cause of the drug use, the reason people pick up substances in the first place. Anytime I talk about my work informally, I inevitably encounter someone who wants to know why addicts become addicts. They use words like “will” and “choice,” and they end by saying, “Don’t you think there’s more to it than the brain?” They are skeptical of the rhetoric of addiction as disease, something akin to high blood pressure or diabetes, and I get that. What they’re really saying is that they may have partied in high school and college but look at them now. Look how strong-willed they are, how many good choices they’ve made. They want reassurances. They want to believe that they have been loved enough and have raised their children well enough that the things that I research will never, ever touch their own lives.

    I understand this impulse. I, too, have spent years creating my little moat of good deeds in an attempt to protect the castle of myself. I don’t want to be dismissed the way that Nana was once dismissed. I know that it’s easier to say Their kind does seem to have a taste for drugs, easier to write all addicts off as bad and weak-willed people, than it is to look closely at the nature of their suffering. I do it too, sometimes. I judge. I walk around with my chest puffed out, making sure that everyone knows about my Harvard and Stanford degrees, as if those things encapsulate me, and when I do so, I give in to the same facile, lazy thinking that characterizes those who think of addicts as horrible people. It’s just that I’m standing on the other side of the moat. What I can say for certain is that there is no case study in the world that could capture the whole animal of my brother, that could show how smart and kind and generous he was, how much he wanted to get better, how much he wanted to live. Forget for a moment what he looked like on paper, and instead see him as he was in all of his glory, in all of his beauty. It’s true that for years before he died, I would look at his face and think, What a pity, what a waste. But the waste was my own, the waste was what I missed out on whenever I looked at him and saw just his addiction.

43

    Dear God,

The Black Mamba had to work today so Buzz made us dinner. He asked me how school was and when I told him that Lauren made fun of me for wearing clothes from Walmart, he said, “Don’t worry. She’s got a place in Hell with her name on it,” and I know it wasn’t nice but it made me feel better.

Dear God,

Merry Christmas! We put on a nativity play at church last night and I played the part of a lost lamb. It wasn’t a big part or anything. I only had one line: “Behold, the lamb of God.” The rest of the time I was just sitting onstage, saying nothing. It wasn’t special at all, but when it was time for me to take my bow, Buzz gave me a standing ovation.

44

While I was in Ghana, my mother healed at home in Alabama. Her anhedonia was as severe as ever, but her time in the UAB psych ward seemed to have alleviated some of her symptoms. She had stopped going to therapy, but she was at least going to church again. I used to call Pastor John on Sundays, begging for progress reports, but he could tell me little beyond how she’d looked that day, what she’d worn.

That summer, I knew that my mother needed healing, but I didn’t understand what she needed healing from. The only time I heard people talk about depression was when they were using it as a synonym for sadness, and so I never thought of it as a disease. “Gifty, I’m sick,” my mother had said, and I knew it was true, but the how of her sickness, the why of it, I didn’t understand.

When I learned about major depression and anhedonia in college, I started to get a clearer picture of my mother. A few years after my return from Ghana, I asked her to tell me about her time at UAB and about the summer she’d spent alone.

“Why do you want to know about that?” she asked.

“It’s for a class,” I lied.

    She made a noise that sounded like it was halfway between a growl and a sigh. We had been trying something new in our relationship. It involved my mother not evading my questions; it involved telling me the truth. She hated it, but I held more cards than I had in childhood, and so she shared things with me that she never would have back then.

“They wanted me to talk to the doctor, and they gave me some medication to take.”

“Did you take it?”

“Yes, I took them while I was in the hospital and then I kept taking them for a while when you were in Ghana, but they didn’t help so then I stopped.”

“Did you tell them the medicine wasn’t helping? You’re supposed to tell them when the medication doesn’t work so that they can adjust it. The medication doesn’t always work in the beginning. It’s about finding the right combinations of things in the right doses. Didn’t they tell you that?”

“I didn’t want to keep talking to them. I didn’t want to tell them that it wasn’t working because I didn’t want them to shock me.”

It was my turn to growl-sigh.

“I got better, didn’t I?” she said, and I couldn’t argue with that, not yet.

Psychiatric care has come a long way since the days of lobotomies. Back then, in the wild, wild west of neurology and psychosurgery, human frontal lobes were excised with little more gravity than one might exhibit when performing an appendectomy. These were the days of lax trial periods, when people experimented directly on human patients, forgoing the many years of repeating the same experiment on mice and rats. When I think about how slow and tedious my research can be, I am sometimes nostalgic for that bygone era. I think, if only I could inject this virus-packaged opsin directly into human patients, I could turn on that blue light, see what this research can really do. But the thing is, you cannot deliver the light without also delivering the virus. And so while the thousands upon thousands of lobotomized patients sometimes improved in ways that related to the symptoms they once exhibited, they also, just as often, became little more than shadows of their former selves, abandoned to the wasteland of bad, hasty science, left sitting in pools of their own drool. Remembering them makes me thankful for my work, how long it takes, how slow it is.

    The “shocks” that my mother described have come a long way since they were first used in the 1940s and ’50s. We all remember that scene from One Flew Over the Cuckoo’s Nest, when electroconvulsive therapy was used not as a treatment for mental illness, but as a kind of mind control. Back then, the therapy was performed on anyone from the schizophrenics and depressives who needed mental health care to the homosexuals and “hysterical” women who neither needed nor asked for treatment, who simply lived outside the bounds of what society deemed “normal.” It’s hard to shake that image of people being forced to correct something that was never wrong. It’s hard to forget the primitive beginnings of this therapy, to stand by it. For many, like my mother, the “shock” of this treatment, the way it induces a seizure in order to treat something that is impossible to see, and often difficult to accept, feels like a bridge too far. But the truth is that electroconvulsive therapy can work, does work. It is often presented as a last resort, and it is just as often performed because the patient herself requests it in one final attempt to crawl out of the deep, dark tunnel.

The work that Katherine and those of us who are interested in finding bioengineering and neuroscientific interventions to treat psychiatric illness do is in many ways about moving beyond the last resort, the final attempt. When she returned to her practice, Katherine would become a psychiatrist who only accepted patients who had no other options left, patients for whom everything, even death, had failed. In addition to optogenetics, Katherine’s work at Stanford involved improving vagus-nerve stimulation, a treatment for treatment-resistant depression and epilepsy whereby a tiny device is implanted beneath the skin near a patient’s collarbone, delivering electrical impulses to the vagus nerve. It is a charger for the depleted battery of a depressed patient’s body. The frustrating thing about the technology is that, like with DBS for Parkinson’s disease, no one knows exactly why it works, only that it works imperfectly, using electricity that cannot differentiate one cell from another. If we could better understand these treatments, if we could come up with interventions that affected only those specific neurons that are involved in each particular psychiatric illness, then perhaps we could provide something better.

* * *

—

    My mother crawled out of her deep, dark tunnel, but perhaps this phrasing is too imprecise, the image of crawling too forceful to encapsulate the relentless but quiet work of fighting depression. Perhaps it is more correct to say that her darkness lifted, the tunnel shallowed, so that it felt as though her problems were on the surface of the Earth again, not down in its molten core.

My aunt took me to church one last time. The pastor didn’t like me. He was resentful of my many refusals to get up on the stage, receive my healing. That day he preached about how stubbornness is little more than pride in disguise. He looked right at me when he said that the pride of the West was in its inability to truly believe.

“Yesterday, I heard about a miracle, a miracle that reminded me of the miracles we read about in this holy book. Our sister in America could not rise from her bed, and she has now risen. Glory to God,” he said, and the church said, “Amen.”

    “Our sister in America needed the God of miracles and the God of miracles showed up, amen?”