Yaa Gyasi - Transcendent Kingdom

“I don’t know in English. Your mother should teach you these things,” she said.

So, it would be option two.

Later that day I called my mother, something I did once a week. She answered the phone with false cheer in her voice, and I tried to picture which room in our house she might be in. Was she wearing pajamas or proper clothes? Had she gotten her job back?

“She means he’s shy. He’s ashamed,” my mother said.

“Oh,” I said. Nana might have cared how the Chin Chin Man felt, but I didn’t. He was as foreign to me as the language, as foreign as every person who passed me by in Kejetia. I’d felt closer to the dreadlocked man.

“When can I come home?” I asked.

“Soon,” she said, but that word had lost all meaning. I’d heard it from my father and understood it to be an empty word, a lie that parents told their children to soothe them.

—

“Anhedonia” is the psychiatric term for the inability to derive pleasure from things that are normally pleasurable. It’s the characterizing symptom in major depressive disorder, but it can also be a symptom of substance abuse, schizophrenia, Parkinson’s disease. I learned the term in a university lecture hall and immediately felt a shock of recognition. Anhedonia was the feeling of “nothing,” the thing that kept my mother in her bed.

Professionally, I am interested in anhedonia because I am interested in reward-seeking behavior, but personally I have never experienced it to the degree of magnitude of the subjects in the cases I study. It is only a symptom, which means, of course, that something else is the cause. I’m interested in the cause as it relates to psychiatric illness, but I research only one piece, one part of the story.

I know what my family looks like on paper. I know what Nana looks like when you take the bird’s-eye view: black male immigrant from a single-parent, lower-middle-class household. The stressors of any one of those factors could be enough to influence anhedonia. If Nana were alive, if I entered him into a study, it would be hard to isolate his drug use as the cause of this particular portion of his pain. It would be hard even to isolate the cause of the drug use.

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.