In his seminal short novel, “Breakfast at Tiffany’s,” Truman Capote’s lead character, Holly Golightly, explained the difference between the blues and the mean reds.
With the blues, she pointed out, “You are sad, that’s all. But the mean reds are horrible. You’re afraid and you sweat like hell, but you don’t know what you are afraid of. Except that something bad is going to happen, only you don’t know what it is.”
Anyone who has suffered from either one of these conditions knows exactly what Golightly described — in her off-hand, colloquial fashion, she nailed the distinction between depression and panic attacks.
Given that the book was published in November, 1958, Capote was remarkably prescient.
Our scientific comprehension of those specific disorders at that time was rudimentary: Capote had an intimate knowledge of what he was writing, hence the accuracy.
Gerald Clarke’s fine authorized biography, “Capote,” painstakingly illuminates the author’s clash with these demons, including his lengthy history of self-medication (drugs, both legal and otherwise, as well as a copious consumption of alcohol).
When Capote passed away at the age of 59 in August of 1984, the cause of death was listed as liver disease, complicated by phlebitis and multiple drug intoxication. The stark truth is the mean reds got him: his struggles with depression and addiction led to what amounted to be a slow suicide.
It is a story that is repeating itself today, in staggering numbers. The World Health Organization asserts that some 300 million people on the planet have problems with depression. The best estimates for those cases who live in the United States run in the neighborhood of 40 million.
And the link between depression and serious anxiety conflicts is well established: at least 50 percent of depressives have disabling anxiety episodes.
In short, depression and anxiety are among the most common emotional illnesses in our society today. The numbers do not make for a pretty picture.
The 2018 final report issued by the Center for Disease Control and Prevention was a shocker: there were 47,000 suicides in this country last year, the highest in 50 years.
Drug overdose claimed more than 70,000 lives.
Due to these extraordinary totals, life expectancy in this country — a great snapshot of our overall health — is declining.
Dr. Robert Redfield of the CDC said it best: “we are losing too many Americans too early and too often to conditions that are preventable.”
There are even more statistics which are alarming: the treatment of depression is essentially a $200 billion industry. With almost 300 million prescriptions for antidepressants filled each year, it is estimated that one of six of us is regularly medicating for this malady. And of those taking antidepressants, approximately eight out of ten are long-term users.
The relationships between statistics are complex, sometimes driving different conclusions. It is generally agreed, however, that over 60 percent of the nation’s victims of suicide have suffered from mood disorders such as depression.
The other interesting piece of data is that 80 percent of suicide casualties were found to have substances such as alcohol and/or opioids in them at the time of death.
Psychologists, who have done considerable thinking about these matters, posit that the presence of substances suggests that in our stressful world, drug intake is, unfortunately, viewed as one of the few available coping mechanisms for the depressed. Killing the pain ultimately ends up killing the person.
A hopeful light in this bleak tunnel is that society is becoming more aware of the epidemic cycle of suicide/drug addiction — at the same time, the scientific community is also more informed about the causes of these illnesses.
When antidepressants were first introduced 60 years ago, we had only touched the surface in understanding depression and its etiology. Chemical imbalances, genetic vulnerability, medication mismanagement, poorly formed cognitions about the way the world works — these are some of the contributory factors in depression, many of which we have only identified in recent times.
Because we understand causation so much better, we also have developed improved treatment options. Psychotherapy, plus the correct medication and even hypnotherapy aimed at dealing with anxiety have had promising results, as have other modalities.
These understandings lead experts like Dr. Redfield at the CDC to use terms like “preventable.”
The bottom line is that the mean reds that Truman Capote wrote so evocatively about years ago have come into much clearer focus — but they are just as mean and just as lethal as they ever have been.