To those of us who have suffered severe depression, the general unawareness of how relentlessly the disease can generate an urge to self-destruction seems widespread; the problem badly needs illumination.

Suicide remains a tragic and dreadful act, but its prevention will be hindered, and the age-old stigma against it will remain, unless we can begin to understand that the vast majority of those who do away with themselves do not do it because of any frailty, and rarely out of impulse, but because they are in the grip of an illness that causes almost unimaginable pain. It is important to try to grasp the nature of this pain.

In the winter of 1985-86, I committed myself to a mental hospital because the pain of the depression from which I had suffered for more than five months had become intolerable. I never attempted suicide, but the possibility had become more real and the desire more greedy as each wintry day passed and the illness became more smotheringly intense.

What had begun that summer as an off-and-on malaise and a vague, spooky restlessness had gained gradual momentum until my nights were without sleep and my days were pervaded by a gray drizzle of unrelenting horror. This horror is virtually indescribable since it bears no relation to normal experience.

In depression, a kind of biochemical meltdown, it is the brain as well as the mind that becomes ill — as ill as any other besieged organ. The sick brain plays evil tricks on its inhabiting spirit. Slowly overwhelmed by the struggle, the intellect blurs into stupidity. All capacity for pleasure disappears. The smallest commonplace of domestic life, so amiable to the healthy mind, lacerates like a blade.

Thus, mysteriously, in ways difficult to accept by those who have never suffered it, depression comes to resemble physical anguish. Most physical distress yields to some analgesia — not so depression. Psychotherapy is of little use to the profoundly depressed, and antidepressants are, to put it generously, unreliable. Even the soothing balm of sleep usually disappears. And so, because there is no respite at all, it is entirely natural that the victim begins to think ceaselessly of oblivion.