Bethanne Patrick is a literary citizen extraordinaire. She reviews books regularly for The Washington Post, The New York Times, and The Los Angeles Times. She edited the anthology The Books That Changed My Life, and she serves on the board of the Pen/Faulkner Foundation. As @TheBookMaven on Twitter, she created the hashtag #FridayReads. She’s also the mom of two young adult daughters. Underneath and alongside all of these achievements, Patrick has struggled with her mental health. At age 52 she was diagnosed with double depression. Patrick’s new memoir, Life B: Overcoming Double Depression (Counterpoint Press, 2023), is a candid, eloquent retelling of this midlife diagnosis, the familial legacies that contributed to her illness, and her journey to wholeness. “When you can’t see the blackboard in your classroom, you know that your eyes need help; you don’t think that the board itself is the problem,” she writes, in the book’s introduction. “When you can’t see the good in your life, you think your life is all wrong. Depression tells you there is no help to be had, no quarter for refuge, no hand to hold.”
Sarah McCraw Crow spoke with Patrick about Life B, families, and memoir writing. This interview has been edited for content and clarity.
Sarah McCraw Crow: Can you talk a little about double depression? I hadn’t heard of it until I read Life B.
Bethanne Patrick: Double depression has actually been in the DSM (Diagnostic and Statistical Manual) since the early 1980s, but I think a lot of people still don’t know about it, even some psychiatrists and GPs. A person who has treatment-resistant depression and a first-degree relative with bipolar syndrome may be diagnosed as doubly depressed, which means chronic depression with episodes of major depression.
It got particularly noticeable for me during puberty, but I’d always had bad periods of sadness, and always knew that I was often really, really low. Double depression gets worse once you’ve had an episode of major depression. As my psychiatrist said, “You’re beyond the algorithm now, because you’ve had so many clearcut episodes of major depression that you need to be medicated for your entire life. You cannot go back to an unmedicated state.” That was very tough to hear—to know that I have something that can’t be cured, that’s going to be with me forever. Just as someone with lupus or type 2 diabetes has to manage their disease, I know I’ve got to manage my disease.
SMC: Did you get the sense that something had clicked into place with the diagnosis, like puzzle pieces coming together?
BP: Yes, it was a huge relief. I was put on—along with antidepressants—a medication called Trileptol, which is meant to stop the cycling, to keep me from going lower, or slipping into major depression. There are other factors, like not exhausting myself, but once I started taking that medication, it changed my life completely. Not because it by itself is a wonder drug, but because that combination of things finally allowed me to experience joy and contentment, which were two states that I hadn’t had much of. Of course, I’d had moments of joy, like my wedding day, and when our daughters were born. When I say I was depressed every day, it doesn’t mean there weren’t breakthrough moments, just like there are breakthrough problems. But the combination of antidepressants and Trileptol allowed me to see something I hadn’t seen for 52 years.
SMC: You mentioned that Life B grew, in part, out of a 2016 essay you wrote for Elle.com that went viral. Had you considered memoir writing before that?
BP: I always thought at this point that I’d be writing fiction, and that I’d have published more fiction by now. I wasn’t intending to write a memoir at all. But my agent asked what I was really interested in writing about, and we decided this should be a book about depression.
As creative nonfiction, memoir is close to fiction, requiring so much time and rumination. It took five years for me to get the book out of myself. So much of writing nonfiction is the process of learning about ourselves, not just learning how to write. I have miles to go before I sleep in terms of writing, but on the level of knowing yourself, you learn so much while writing a memoir. I had no idea that I was going to write about being able to see myself as a woman who’s mentally ill, but nonetheless whole, and able to live a really good life.
SMC: Inheritance and legacy are a big part of this story, both genetic and cultural. Can you talk a little about that?
BP: My father’s mother was hospitalized for postpartum depression after giving birth to my father’s younger brother. This was in 1932, and it was very shameful. All I can say is that something must have happened to her because I have these pictures of her from when my father was a toddler, and her head is thrown back in laughter. The grandmother that I knew was a woman almost without affect, and the only state she was ever in was a state of nerves. My mother would occasionally say to me, “Oh, your grandmother is a fussbudget, she is so dithery. I just don’t like being around her.” I can see why, because she was just not all there. Maybe she received some kind of early psychiatric treatment that took something away from her.
If I had known earlier in my life about her hospitalization, I might have been able to bring that information to a doctor, and say, “I had two grandmothers who had severe mental challenges.” Initially, I was looking at mentally ill women in my family and thinking, I don’t want to be like you, instead of thinking, How am I like you? What can this teach me?
SMC: You’re a mother of two young adults, and I think many readers will relate to your efforts to get help, learning plans, and eventually ADHD diagnoses when your daughters were younger. I appreciated your candor in recounting conversations with your daughters. For instance, you asked one daughter what she’d missed out on during the years when you were “invisible” because of your depression.
BP: I am so proud of our daughters and the fact that both of them are really intentional and mindful about their own care. They keep up with their medication and they’re able to say, “This is just something I need to do to function well. This is not anything that I need to be ashamed of.” It’s a generational difference. Previously, admitting weakness of any kind was just not possible.
One reader told me that he appreciated that there were times I allowed myself to appear unsympathetic in the book. Still, I didn’t plan on those times or try to create an unsympathetic moment. It’s just the truth. Our little family has healed and changed so much. Certainly since the diagnosis I’ve been able to be so much happier. I still have moments—we all have moments—but we understand, too, that we can’t go back and change the years when I was almost invisible. We have to enjoy what we have now, and really make it count.
SMC: All memoirists struggle with deciding what’s their story to tell and what’s not. How did you approach this?
BP: Very clumsily, and I would do things differently if I were to write again. I’d have both my mother and sister read it through before turning in the final manuscript. But you’re not always going to find the perfect moment to sit down, have a family dinner, and hand out manuscripts. That doesn’t happen.
There was a specific incident that I thought was important because it illustrated something between my mother and sister, but I eventually realized that this was not my story. My sister wanted me to take out the entire chapter called Snake Hill, because there’s a murder in the family, but this chapter stayed in because it’s about my lack of connection to my mother’s side of the family.
I think there are hard things that I say about my marriage. My marriage is strong; we’ve been together 37 years. We’re friends, lovers, all that good stuff, but that doesn’t mean there weren’t hard things. We got married at 22. We were basically each other’s only company. We brought each other up. In a long marriage like mine, you learn you don’t have to be each other’s everything. That’s part of the journey, too.
In writing the memoir, I tried to adhere closely to the ethics of creative nonfiction. I wanted to ensure that I was telling the truth to the best of my ability. If I couldn’t remember it, I said I didn’t know anything more. As my wonderful editor, Dan Smetanka, said, “This is your truth, do not water it down. Be strong enough to see it through.” I think that is great advice for anyone writing a memoir. You know you do have something to say, so say it.
SMC: That advice for the memoir writer—do not water it down, be strong enough to see it through—can be hard to follow.
BP: Yes. This is a hard-won book. It was tough for me to write, and it will be tough for some to read. For others, I hope it will be helpful or resonant. I’m looking forward to writing and talking about ending the stigma around mental illness—especially around family history and mental illness. If we tell the truth, we can heal so much earlier and so much better.