The Noonday Demon (31 page)

I was instructed to remove my shoes, and then I was taken to the place where the pots reside. Fresh sand had been spread, and five women had gathered, all in loose-fitting robes with huge necklaces of agate and belts made of cloth pouches like sausages (stuffed with iconic objects and prayers). One, in her late seventies, sported a pair of enormous Jackie Onassis sunglasses. I was made to sit on a mat with my legs straight out and my palms upturned for the divination. The women took quantities of millet and poured them into the threshing basket, then added an assortment of shamanistic power objects—short, fat sticks, someone’s horn, a claw, a small bag tied up with a great deal of thread, a sort of round object made of red cloth with cowrie shells sewn onto it and a plume of horsehair. Then they put a white cloth over me and placed the threshing basket six times on my head, six times on each arm, and so on over my whole body. I was given the sticks to hold and let fall, and the women talked and consulted about the patterns. I did this six times with my hands and then six times with my feet. Several eagles came and perched in the baobab above us; this appeared to augur well. Then the women removed my shirt and put a string of agates around my neck. They rubbed my chest and back with the millet. They asked me to stand up and to remove my jeans and put on a loincloth, and they rubbed my arms and legs with the millet. Finally they collected the millet that had fallen all around and wrapped it up in a piece
of newspaper and told me that I should sleep with it under my pillow for one night and give it to a beggar with good hearing and no deformities the next day. Because Africa is a continent of incongruities, the radio was playing the theme music from
Chariots of Fire
during this entire procedure.

Five drummers arrived about then and began to play the
tama
drums. About a dozen people had already been hanging around, and as the sound of the drums spread, more and more began to gather until there were perhaps two hundred, all come for the
ndeup.
They formed a circle around a grass mat. The ram’s legs had been bound and he lay on his side, looking rather bemused by events. I was told that I must lie down behind him and hold him to me, as though we were spooning in bed. I was covered with a sheet, and then with perhaps two dozen blankets, so that I and the ram (which I had to hold down by the horns) were in total darkness and stifling heat. One of the blankets, which I saw afterward, had the words
Je t’aime
embroidered on it. The drums got louder and louder and the rhythms more inexorable, and I could hear the voices of the five women singing. Periodically, apparently at the end of a song, the drumming would stop; then one voice would begin and the drums would join and the other four voices would join and sometimes the voices of the hundreds of onlookers would also join. All the while the women were dancing around me in a tight circle, and I was embracing the ram, and they kept hitting us all over with what I later discovered was the red cockerel. I could hardly breathe and the smell of the ram was powerful (he had relieved himself again in our little bed), and the ground was shaking with the movement of the crowd and I could barely hold down the ram, which was squirming with increasing desperation.

At last the blankets were lifted and I was raised and led to dance to the drums, which kept increasing in pace. Mareme led the dancing, and everyone clapped as I imitated her stomping gestures and her swipes toward the drummers. Each of the other women in turn stepped forward and I had to imitate them, and then one at a time various women came from the crowd and I had to dance with them too. I was dizzy, and Mareme held out her arms to me and I nearly collapsed into them. One woman was suddenly possessed and danced hysterically, leaping about as though the ground were on fire, and then collapsed completely. I later learned that she had had her
ndeup
just a year earlier. When I was completely out of breath, the drums abruptly stopped, and I was told to remove my underwear as I would be wearing just the loincloth now. The ram was lying down and I had to step over him seven times from right to left and seven times from left to right, and then as I stood with one leg to each side of him, one of the men who had been drumming came and
placed the ram’s head over a metal basin and slit the ram’s throat. He wiped one side of his knife on my forehead and the other on the back of my neck. The blood poured out and soon it had half-filled the bowl. I was instructed to bathe my hands in the blood and to break apart the lumps as they began to congeal. Still dizzy, I did as I was told, as the man beheaded the cockerel and mixed its blood with the blood of the ram.

Then we left the crowd for the area near the pots, the place where I had been earlier that morning. There the women covered me with the blood. It had to be placed on every inch of my body; they rubbed it through my hair and across my face and over my genitals and on the bottoms of my feet. They rubbed it all over me, and it was warm and the semicoagulated parts smushed over me, and the experience was peculiarly pleasurable. When I was fully covered, one of them said it was midday and offered me a Coke, which I gladly took. She let me wash some of the blood off my hand and my mouth so that I could drink. Someone else brought me some bread. Someone with a wristwatch said we might as well relax until three o’clock. A sudden lightness entered into the proceedings, and one of the women tried to teach me the songs they had been singing around me during the morning when I lay under the blankets. My loincloth was soaked through, and thousands of flies began to settle all over me, drawn by the smell of the blood. The ram, meanwhile, had been hung in the baobab, and one of the men was skinning and butchering it. Another man had taken a long knife and was slowly digging three perfectly circular holes, each about eighteen inches deep, near the pots of water from previous
ndeup
s. I stood around trying to keep the flies out of my eyes and ears. At last when the holes were completed and it was three o’clock, I was told to sit down again, and the women fastened my arms and legs and chest with the intestines of the ram. I was told to drive seven sticks deep into each hole, making a prayer or wish with each one. Then we divided the ram’s head into three parts and put one in each of the holes; they added some herbs and a small part of each section of the animal, then small pieces of the cockerel. Mareme and I took turns putting seven cakes of millet and sugar into each of the holes. Then she took out bags of seven different powders made from leaves and bark, and she sprinkled something from each one in each hole. Then we divided and poured the rest of the blood; I was untied; the intestines went into the holes; and Mareme put fresh leaves over everything and she and the man (who kept trying to pinch her bottom) filled the holes; and then I had to stamp on each one three times with my right foot. Then I repeated these words to my spirits: “Leave me be; give me peace; and let me do the work of my life. I will never forget you.” Something about that incantation was particularly appealing to me. “I will
never forget you”—as though one had to address the pride of the spirits, as though one wanted them to feel good about having been exorcised.

One of the women had glazed a clay pot with blood, and it was placed over the area we had just filled in. A club was driven into the ground, and a mixture of millet and milk and water was poured over all the inverted bowls from previous ceremonies and onto the top of the phallic clubs. Our bowl was filled with water and various herbal powders were added to it. By this time the blood on me had hardened and it was like being covered with an enormous scab, my skin utterly constricted. I was told that it was time for me to be washed. Laughing merrily, the women began peeling the blood off me. I stood up and they took mouthfuls of water and spit them over me, and in this fashion and with much rubbing the blood came off. At the end, I had to drink a pint or so of water full of the same leaf powders that Mareme had used earlier. When I was completely clean, and in a fresh white loincloth, the drumming began again and the crowd returned. This time the dancing was celebratory. “You are free of your spirits, they have left you,” one of the women told me. She gave me a bottle of water mixed with leaf powder and told me to bathe myself with this curative potion if the spirits ever troubled me again. The drummers playfully increased rhythms and I had a sportive competition with one of them, who played more and more aggressively while I jumped higher and higher—and then he conceded that it was a match. Then everyone got a few cakes and a piece of the ram (we took a leg to barbecue that evening), and Mareme told me that now I was free. It was after six in the evening. The crowd followed our taxi as long as they could and then stood waving, and we came home with the buoyant feeling of having done something festive.

The
ndeup
impressed me more than many forms of group therapy currently practiced in the United States. It provided a way of thinking about the affliction of depression—as a thing external to and separate from the person who suffers. It jolted the system, which could certainly throw one’s brain chemistry into overdrive—a kind of unplugged ECT. It entailed an intimate experience of community. It included close physical contact with others. It put one in mind of death and at the same time affirmed that one was oneself alive and warm and pulsating. It forced a great deal of physical movement on the sufferer. It introduced the comfort of a specific procedure to follow in the event of a recurrence. And it was bracingly energetic—an absolute tour de force of movement and sound. Finally, it was a ritual, and the effect of any ritual—being covered in the mixed blood of a ram and a cockerel or telling a professional what your mother did when you were small—is not to be underestimated. The mix of mystery and specificity is always enormously powerful.

How is one to choose among depression’s thousand therapies? What is the optimum way to treat depression? And how can one combine these unorthodox treatments with more traditional ones? “I can tell you the answer that was correct in 1985,” says Dorothy Arnsten, an interpersonal therapist who has studied myriad treatment systems. “I can tell you the answer that was correct in 1992; I can tell you the one that was correct in 1997; and I can tell you the one that’s correct right now. But is there any point doing it? I can’t tell you the one that will be correct in 2004, but I can tell you that it will definitely be different from the one that’s correct right now.” Psychiatry is as much subject to trend as is any other science, and one year’s revelation is the next year’s folly.

It is hard to know exactly what the future holds. We have made but small advances in our understanding of depression at the same time that we have made enormous advances in our treatment of depression. Whether treatment can continue to outstrip insight is hard to say, since that kind of development depends to some large extent on luck; and it will take a long time for knowledge to catch up with what we can already do. Of the drugs in late-stage trials now, the most promising is reboxetine, a selective norepinephrine reuptake inhibitor. Norepinephrine, which is boosted by tricyclic antidepressants, is implicated in depression along with serotonin and dopamine, and it seems likely that a norepinephrine booster might work well with SSRIs and perhaps with Wellbutrin, a combination that would attack all the neurotransmitters. Early studies show reboxetine as a good product for raising patients’ energy and improving their social functioning, though it also seems to cause dry mouth, constipation, insomnia, increased perspiration, and accelerated heartbeat. Reboxetine is being produced by Pharmacia and Upjohn. In the meanwhile, Merck has been working on products targeted at another substance in the brain, substance P, which is involved in the pain response and which they believe is implicated in depression. The first substance P antagonist they have developed does not appear to be particularly successful in the treatment of depression, but they are investigating others.

Scientists working on the Brain Molecule Anatomy Project (BMAP) are trying to figure out what genes are involved in brain development and function. They also seek to know when those genes are active. Genetic manipulation will be greatly facilitated by the BMAP. “I’m placing my bets,” Steven Hyman of the NIMH says. “One is on genes. I think once we have a few genes that are involved in mood regulation or in illness, all of a sudden we’ll say, well, what pathway are these in? Might this pathway tell us about what happens in the brain? Therapeutic targets? When
in development are these genes on? Where are they in the brain? What’s the difference in brain function between this version that creates vulnerability to illness and that version that doesn’t? What are the genes that build this part of the brain when? Let’s imagine that we find out that one particular subnucleus of the amygdala is critically involved in the control of negative affect, which is highly likely. What if we have before us every gene that is ever on in that structure through development? Well, then we have a tool kit for investigation. There is no such thing as a mood gene. It’s just shorthand. Every gene that is involved in an illness probably has many other functions in the body or in the brain. The brain is a distributed processor.”

If the human genome is made up of about thirty thousand genes—and that number seems to keep increasing as we discover more and more of them—and if each one has about ten important common varieties, that gives us 1030,000 candidates for human genetic vulnerability to all illnesses. How far is it from identifying some genes to trying to figure out what happens to those genes in different combinations at different stages in the face of different kinds of environmental stimuli? We need brute force of numbers to check out all the combinatorial possibilities. Then we need to see how they play out under various external circumstances. Rapid as our computers are, this knowledge is still an eternity away. Among all diseases, depression must ride near the top of the list for being overdetermined: I am no geneticist, but I would bet that there are at the very least a few hundred genes that may conduce to the development of depressive disorders. How such genes trigger depression would depend on how they interact with external stimuli and with one another. I would guess that most of those genes also serve useful functions, and that simply knocking them out would have significant deleterious effects. Genetic information may help us to control certain kinds of depression, but the chances of eliminating depression through genetic manipulation any time soon are, I believe, thinner than thin ice.