Captives of the Mind

Addiction, depression, self-harm, hypochondria—all share a common cause, says a new view of mental distress.

By David R. Kessler M.D., published on May 2, 2016 - last reviewed on May 4, 2016 

 

He left more than a dozen lamps burning in his workroom. They shone upon the desk, and on the unfinished manuscript neatly stacked on top of it. Next to the manuscript was a two-page letter. This was the scene on the evening David Foster Wallace hanged himself. Wallace’s 2008 suicide at the age of 46 devastated the literary community. He was, at the time, acclaimed as the boldest, most innovative writer of his generation. His novel Infinite Jest was widely lauded by critics and thought to have redefined postmodern American fiction. The manuscript on the desk, which he despaired of ever completing, would be published posthumously as The Pale King. Though it was fragmentary, the novel contained some of his best work, many came to believe. Despite Wallace’s frustration with his inability to complete the book, in some ways his life had never been better. He had married four years earlier and was comfortably settled in California, with a teaching job he loved. Why, then, did he take his own life?
It’s not that Wallace’s suicide came as a surprise to anyone who knew him well. He had been troubled since adolescence: brilliant, yet stricken with self-doubt and, at times, a paralyzing self-awareness. As a young man, he depended on alcohol and marijuana to dampen his constant anxiety. He had come close to suicide before, and in his fiction he had written of the state of mind that drives one to that abyss. Yet he had also tried to save himself. He had been prescribed antidepressants in college and continued taking them throughout the rest of his life. At the time of his death, he was a dedicated member of Alcoholics Anonymous, having successfully left behind both alcohol and marijuana years before. Though prone to fits of anger and reclusive behavior, he fought his self-destructive impulses and sought community with his fellow AA members, devoted students, and literary colleagues.
The questions remain: Why would someone who struggled so long not just to stay alive but also to stay vital and connected end his life so violently? Why would someone with such recognized talent choose not to go on? What was it that was beyond the grasp of his clearly formidable intellect and will? What was the underlying cause of the depression that governed Wallace’s deep unhappiness? “Depression” is a label used to describe a group of symptoms. It is not a cause.
From childhood on, Wallace wanted to be exempt from the ordinary. He wanted to excel—first as a student, and later as a writer—and he wanted others to recognize his genius. Yet, as soon as he succeeded—if he earned an A-plus or received critical acclaim—he grew uneasy, and then despairing. He wanted to be a good person, but suspected something crooked about the way in which he’d achieved success, something false in himself.
Those closest to Wallace recall that this inner conflict developed in boyhood. From a very young age, Wallace was bent on impressing his parents, two highly intellectual people with their own rigorous standards. His father, James, was a dedicated academic who, with a quiet passion, worked on the same set of difficult philosophical problems for decades. His mother, Sally, was a professor of English at Parkland College, a community college in Illinois, and a commanding presence in the household. She loved wordplay and the sounds of certain phrases. She was also fiercely passionate about grammar, and in 1980 she wrote a textbook called Practically Painless English, designed to teach grammar and composition in a lighthearted manner. She shared these interests with her young children; Wallace responded enthusiastically. The two would make private jokes to each other, playing with the meaning and spelling of words. “He really did seem so badly to want to make my parents proud of him,” his sister, Amy, told me. “He thought that my parents didn’t appreciate how intelligent he was.”

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Illustration by Matt Dorfman

Contradictory impulses—yearning for greatness yet feeling like a fake with every new achievement—pushed him further into himself. He wrote about the phenomenon in his short story “Good Old Neon,” in which an advertising executive describes his own suicide posthumously: “The more time and effort you put into trying to appear impressive or attractive to other people, the less impressive or attractive you felt inside—you were a fraud. And the more of a fraud you felt like, the harder you tried to convey an impressive or likable image of yourself so that other people wouldn’t find out what a hollow, fraudulent person you really were.”

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Occasionally Wallace worked double-time in order to bend reality to meet his fears, employing a kind of metalogic reminiscent of his fiction. “A lot of his criticism wasn’t that he was stupid in the whole bell curve of the population, but that what he was really good at was pretending to be really smart,” the novelist Mark Costello told me about his old friend and college roommate. “The way Dave kept self-pessimism alive was by creating this other narrative where he said, ‘Well, actually, what I am is . . . a false sort of smart.’ ”
Wallace was haunted by the “fraudulence paradox,” as he called it in “Good Old Neon.” As an adult, he was always on high alert, always sensitive to signs of the beguiling impostor that, though he must have known exists in all of us, he could not allow for in himself. He once scribbled in the margin of a book, “Grandiosity- the constant need to be, and be seen as, a superstar.” Something about this notion stuck and became a reflexive thought—one that made him feel very bad—when he encountered something that threatened his sense of credibility.

David Foster Wallace:  The writer had his own way of "fracturing reality." As he once said, "Whatever you get paid attention for is never what you think is most important about yourself."

And any number of things could threaten his sense of credibility: critical praise, academic success, romantic attention, somebody laughing at his jokes. These were all land mines and, prompted by them, Wallace felt an immediate split between how he was perceived and who he really was. In such moments, his life became a lonely performance. Everything else receded into the background. The feeling encompassed him more strongly each time he experienced it, gaining traction in his mind.
Depression involves a continual focus on negative thoughts, experiences, memories, and feelings to the exclusion of all else. As a person narrows his or her attention, focusing on only the most negative stimuli, the mind slowly devours itself. This process seemed to be particularly true for Wallace. It is impossible to know just how, and in how many ways, he was gripped by self-doubt, but it seems fair to say that he was seized by his self-destructive refrain. He knew it, but felt powerless to change it. “What goes on inside,” he wrote in “Good Old Neon,” “is just too fast and huge and all interconnected for words to do more than barely sketch the outlines of at most one tiny little part of it at any given instant.”
For more than two decades, I have researched the ways in which certain substances—specifically, tobacco and food—come to influence and, in some cases, control our actions. What most fascinates me is how these substances seem to override both reason and will, directing our thoughts, feelings, and behavior, apparently without our consent. Nobody ever decides he’s going to smoke 780,000 cigarettes over the course of a lifetime—people think they’re going to try smoking once, or perhaps a few times, to see what it is like. We don’t want to eat until we feel sick, but many of us do it anyway. What else, I wondered, could exert such control over our thoughts and actions? Is it possible that the same biological mechanism that selectively controls our attention and drives us to chain-smoke or overeat—in other words, to behave in ways that are not beneficial to our well-being—is also responsible for a range of emotional suffering?
After years of research, I have come to the conclusion that there is, in fact, a common mechanism underlying many of our emotional struggles and mental illnesses. Simply put: A stimulus—a place, a thought, a memory, a person—takes hold of our attention and shifts our perception. Once our attention becomes increasingly focused on this stimulus, the way we think and feel, and often what we do, may not be what we consciously want. I have termed this mechanism “capture.” Capture underlies many forms of human behavior, though its effects may be detrimental or beneficial.
Viewing our behavior through this lens helps explain the power that capture has over us when it drives us to destructive impulses. The theory of capture is composed of three basic elements: narrowing of attention, perceived lack of control, and change in affect, or emotional state. When something commands our attention in a way that feels uncontrollable and, in turn, influences our behavior, we experience capture.
But capture entails more than just that initial marshaling of our attention. Capture changes our mood by evoking memory or imagination, desire or fear. When I am captured, I think that the person calling my name in a certain tone is not simply saying my name but offering an implicit criticism or personal slight that makes me feel insecure or anxious; soon, it is all I can think about.

Illustration by Matt Dorfman

Capture seizes our attention quietly. We may sense a mental shift, but we do not understand where it comes from. The experience occurs outside our conscious control, and we surrender to it before we perceive it. It is the result of something—an idea, sensation, person—that comes to dominate our minds, thrusting aside all else and occupying the center of our consciousness. Cues that are associated with the source of capture can become as significant as the source itself, whether a perfume scent or a song, the sound of a helicopter or the sight of a fire truck, a good grade on a test or the prospect of making a speech. Even the briefest encounter with one of these cues can narrow our attention and affect the way we feel.
When we are drawn to a particular stimulus, we act in response to a feeling or need aroused by it. Every time we respond, we strengthen the neural circuitry that prompts us to repeat these actions. As we continue to react in the same ways to the same stimulus over time—thereby sensitizing the learning, memory, and motivational circuitry of our brains—we create emotional and behavioral patterns. Our thoughts, feelings, and actions begin to arise automatically. What started as a pleasure becomes a need; what was once a bad mood becomes continual self-indictment; what was once an annoyance becomes persecution. This process of neural sensitization occurs, and grows stronger, over the course of a lifetime. It becomes increas-ingly difficult to resist its pull. Eventually, what captures us can become so concentrated and overwhelming that, in its most drastic forms, it feels as if we are being driven by something outside our control.
What is clear from my conversations with Wallace’s parents, however, is their penetrating awareness of the negative loop in which their son was caught. No matter what his success, either personal or professional, Wallace filtered out everything that reflected well on him and took in everything that could be construed badly. This kind of detrimental filtering can only lead to crushing self-doubt. In this heartbreaking life, a self-perpetuating spiral led to suicide. In other instances, it can lead to self-harm of different kinds, or to violence against others, even homicide.
I asked Steve Bunney, professor emeritus of psychiatry at Yale, about the nature of Wallace’s pain. Why does this feeling become crippling for some people but not for others? “For someone like Wallace, in the simplest form, it is about a disconnect between the person you want to be and the person you perceive yourself to be,” Bunney posited. “There is a feeling of losing control. If you don’t have control, then that’s when you can get into trouble—whether you have anxiety or depression or whatever, because that can be a threat to your very existence. Suicidal people feel there is no other way to escape from the negative thoughts and feelings. One of the paradoxes of suicide is that it becomes the last and only way that a person can exert control.”
Bunney pointed out that it’s not uncommon for successful people from all walks of life to feel a similar kind of distress. Research has shown that highly accomplished people often report the feeling of being a fraud. Many successful people grow concerned, as Wallace did, that if people really knew them, they’d realize they weren’t deserving of their achievements. “So it’s not uncommon—and in some ways it’s useful, I suppose, this self-doubt,” Bunney said. “But it can also become a pathology, dangerous, even fatal if it gets out of control.”

Illustration by Matt Dorfman

Capture is predicated on our ability to selectively attend to specific stimuli. When something grabs our attention, such as when the lights come up on Bruce Springsteen in concert as he counts off the opening notes of “Born to Run,” our neurons respond more vigorously to that particular stimulus than to the push of the crowd around us or the heat in the arena. As Springsteen starts to sing, we focus on specific stimuli because the networks of neurons that allow us to make sense of the world do not respond equally to everything in our environment. Rather, they permit us to distinguish between what matters more or less at a given moment, what is out of place or what is threatening—and to channel our attention in the appropriate direction. This is called selective attention; it is the gateway to awareness.
So many objects fall within our visual field that we cannot process all of them at once: There are simply too many stimuli competing for our attention at all times. We use the mechanism of selective attention to amplify neuronal signals so that certain stimuli become more insistent—or we inhibit signals that we do not need to consider.
Whatever we are paying attention to at a given moment (whether an external stimulus, such as food, or an internal stimulus, such as self-doubt or regret) initially resides in working memory— short-term memory, essentially a mechanism for keeping at hand information we’ve recently learned or experienced. Over time, unless a competing goal redirects our attention, our response eventually becomes so instinctive that our brains no longer mobilize to create a new or different reaction. Our response becomes automatic—and when our response is discordant with our conscious intentions, we feel as if we’re losing control. This loss of control is a key feature of capture.
We are not always conscious of the stimuli that command our focus and, ultimately, come to steer our thoughts, attitudes, feelings, and behavior. A good deal of new learning is implicit, so subtle as to be imperceptible to the conscious mind. If you feel a surge of self-doubt every time you are about to speak publicly, it is very likely that your anxiety is based on a previous response to a similar experience. Subsequent related experiences, or thoughts and feelings that evoked those experiences, allowed this learned response to gain even more traction along the way. This is how we come to develop patterns of behavior and emotional response without being aware of their taking hold.
Always the process of capture begins outside awareness. As capture takes hold and narrows our attention, we may begin to feel as if our thoughts are beyond our control—a sensation that may induce fear or even panic. Alternatively, capture can allow for an experience of flow, the sense that all consciousness is channeled in a single direction in an uninterrupted manner for positive effect.

Illustration by Matt Dorfman

We are all vulnerable to capture; we all need to find meaning in the random flux of stimuli that bombard us at every moment. Yet, for most of us, this susceptibility is offset by our ability to redirect the wanderings of our attention.
David Foster Wallace’s life offers an example of what can happen when capture is directed toward the self: when extreme sensitivity becomes striving perfectionism, which evolves into relentless self-criticism and becomes coupled with an uncanny ability to analyze the flaws in one’s own analysis. Suffering becomes indistinguishable from our frantic attempts to evade it. Wallace was caught by this very loop, which resulted in a despair that ultimately he could not conceive of ever escaping. Yet, swimming upstream through his own torrent of disapproval, Wallace always hoped for more: more achievement, more recognition, more love.
“The fear and the tightening circles, the anxiety, the inability to enjoy things or even to see things or notice them—that was how Dave’s symptoms presented,” Costello explained. “I’ve known people who are depressed, and for them, it is just more like the air goes out of the balloon and they can’t get out of bed. But for Dave, it took the form of racing energy in this sort of negative and circular way. Dave was built to rev at a very, very high level, and his emotional drivers were very closely harnessed by a really powerful intellect, sort of an epical intellect.”
Wallace’s focus rarely shifted from his tormenting thoughts. He felt as though he existed within a “dark world, inside, ashamed, locked in.” What some might view as narcissistic behavior, the torment of an artist seeking praise and perfection, is more accurately understood, in Wallace’s case, as an overwhelming, debilitating sense of anxiety and unhappiness.
There were many times when Wallace was funny, happy, and loving. Yet he was never able to shift his attention away for long from what made him feel bad. He could not, as he once wrote, “perceive any other person or thing as independent of the universal pain...everything is part of the problem.”