I was in the hospital because I was the worst type of cliché: a miserable college freshman who was borderline suicidal because his high school girlfriend had broken up with him. We went to different schools, which is the only reason why I didn’t pull a “Say Anything” every night outside of her dorm to win her back.

After the breakup, things got so out of control that three months into school, instead of being out drinking and talking to women, I was holed up in my dorm room reading John Cale’s autobiography. I was a wreck, and before long, I was overdosing on pills (well, Tylenol, a pretty lame choice in retrospect), cutting my wrists with the blades of a Gillette razor, and getting forced by a school counselor to admit myself to the local psychiatric center.

The first time around, I spent nine days there, masochistically reading “The Bell Jar” and “Crime and Punishment.” When I went back to school, I seemed sunny and happy, but anyone paying attention would have sensed a lot of misery just beneath the surface — which is why only a short time later, I returned to the hospital after another “incident.” I had resigned myself to a life of misery, one where I wanted attention from the world, especially from my ex, and the only way I knew how to get it was through self-mutilation.

The way movies like “Girl, Interrupted” depict mental hospitals is rather inaccurate: It’s impossible to sneak off at night when you’ve got a nurse checking in on you every hour; non-roommates aren’t allowed to step into your room, even when they’re your parents; and towels smell like old cigarettes. But it wasn’t all bad — you could watch whatever you wanted on the communal TV. And I asked my mom to bring my entire four-binder CD collection and CD player — these were my pre-iPod days — when she visited me for the first time. Although I was only allowed one binder with me in my room (CDs easily become jagged objects), I could still have roughly 100 albums at a time — including “David Bowie.”

Hours after lying to my doctor about my “mellow mood” album, I was listening to an argument in the common room between a pathological liar who swore his girlfriend was a babe and a girl who was upset at the liar because he wore his pants so low that his butt crack was always in sight. I was amused until I realized how sad it actually was.

I went to my room to listen to the album that supposedly made me feel better, beginning with “Love You Till Tuesday,” about a man who claims he’ll love his Saturday girl until Tuesday — or maybe “stretch it ’til Wednesday” — followed by “There Is a Happy Land,” about a place where only children and no grown-ups reside. These were lightweight, fun tracks, and I needed them as a reminder that life could be enjoyable, too, considering I was staying on the floor with a man who had recently received shock treatment and was now a shell of his former self. But the track that hit me hardest was “When I Live My Dream.” The narrator would do anything for his love, including “slay a dragon” and “banish wicked giants from the land,” but all this happens in his dreams, the only place he believes he can get her back because in real life she left, leaving him an “empty man.”

This was, obviously, a song that I related to all too well — and sometimes when you’re feeling that low, you need to listen to someone else who’s going through the same thing. If a friend came up to me and told me, “I know what you’re going through, man,” I wouldn’t have believed him. But when a musician says the same in a song, I do. Music is universal; it can be twisted to fit our own unique situations. And so while “Sell Me a Coat” might remind some people of a loved one leaving them for another in the winter, when I was at the hospital I interpreted the lyrics as saying it’s not worth spending so much pining over a girl stolen by “Jack Frost” because, in Bowie’s case, you can just put on a coat — and, in my case, I could just decide: no more.

Because, really, what the hell was I doing with my life? I was sleeping in an uncomfortable bed with a roommate who once told me that he liked to drink his girlfriend’s blood. I was going to end up like “Uncle Arthur,” a 32-year-old who lives with and “likes his mommy.” The next day, and for the rest of my stay, instead of focusing on my so-called life, I instead thought of “David Bowie,” and how every somber song was offset by a goofy one, and how I had the choice to choose my long-term health over short-term anguish. After my breakup, I had only focused on the miserable parts of life, but that’s less than half the equation — there’s also the fun stuff, and it took Bowie’s most forgotten album to remind me of this.

“I’m a songwriter. I’ve written loads of music. Why would I try to put out a song and think I’m getting one over on everybody? That’s retarded.”

Whoops. For someone whose message is all about how it’s OK to be different, this was definitely a quotable misstep, especially after NME decided to put her r-word comment in the headline of their piece. Gaga has since issued an apology via CNN:

“I consider it part of my life’s work and music to push the boundaries of love and acceptance,” Gaga told CNN in a statement. “My apologies for not speaking thoughtfully. To anyone that was hurt, please know that it was furiously unintentional.”

She continues, “An honest mistake, requires honesty to make. Whether life’s disabilities, left you outcast bullied or teased, rejoice and love yourself today.”

It’s tough, because I don’t think Lady Gaga actually meant to make a demeaning slur. She was angry and cursing up a storm, and that was one of the words that popped out. But just like using “gay” in a negative context, a lot of times the problem is exactly that people aren’t thinking; they’re just using the first words that come to mind from the cultural lexicon.

I doubt anyone thinks Lady Gaga is hating on the mentally handicapped, but as a public figure — especially one who claims to speak for all the “freaks” and “outsiders” — she needs to be even more judicious about what she says. She should talk to Dan Savage, who faced a similar problem back in 2009, when a reader wrote in asking him to stop using the slang word.

That being said, Gaga’s apology was immediate and sincere. Do you forgive her?

Apparently this show has already had a one-hour online premiere in December, and if you’ve already seen it, I am sorry to be so completely baffled this late in the game. If, however, you somehow missed the Internet premiere — maybe because you were too busy trying to sift your way through giant dumpsters in order to find old newspapers to clip — here’s a preview of what to expect from the show.

OK! So, next question! Is this show supposed to glorify these people’s saving habits? Because it kind of looks like “Hoarders,” especially with all the actual hoarding that goes on. And nobody wants to be like those people in “Hoarders,” because those people who sleep on (literal) rat piles. But from the show’s description, “EXTREME COUPONING” is something you’re supposed to aspire to?

Learn how to clip and shop your way to outrageous savings when the all-new series EXTREME COUPONING premieres on TLC starting April 6 at 9/8c. Each episode profiles everyday people in pursuit of extraordinary deals as the country’s best couponers share their shocking stockpiles and dramatic shopping skills. You’ll never look at your Sunday circular the same again.

“Shocking stockpiles.” Again, that sounds like “Hoarders” talk to me. I can see how a less EXTREME version of this would make for a fun, recession-friendly reality show, but as it stands I’m just imagining those poor children in the families, with their billion little paper cuts that keep stinging from all the newspaper ink that seeps into the wounds.

Although a Reuters review of the show tells me not to feel bad about watching these people, because they don’t consider their compulsion a mental illness:

Unlike the mentally ill who are depicted on the show “Hoarders,” or the drug-addicts seen on “Intervention,” the heroines on “Extreme Couponing” are not the least bit ashamed of the obsessive compulsion that has taken control of their lives. As a result, there’s less of voyeuristic queasiness here than in those other shows.

Finally, we’ve found a way to gape at people with “obsessive compulsions” (your words! Not mine!) without feeling guilty. Maybe even learn some tips or two in the process? Because in the end, the real difference between “couponing” and hoarding/drug addiction is that it saves you a lot of money that you can then go use for your children’s therapy.

Honestly, I’ll probably watch it. Especially if it’s a repeat of “Modern Family” tomorrow.

During the interview, Madoff expressed considerable regret for his crimes. He also claimed that the scheme took a psychological toll long before his ultimate downfall; that he didn’t launch the destructive charade with malicious intent; that it was an accident that spiraled out of control, torturing him for years. Madoff insists that he isn’t a sociopath. Even after everything he did, he insists he’s a good person.

All of this has understandably been met with skepticism. In the hopes of shedding some light on Bernie Madoff’s psychological profile, we got in touch with Peter Kramer, clinical professor of psychiatry at Brown Medical School. Kramer is the author of “Listening to Prozac” and “Freud: Inventor of the Modern Mind,” as well as a contributor to Salon. While he took care never to weigh in directly on Madoff’s psychology — “psychiatrists are enjoined from diagnosing people they haven’t interviewed,” he emphasized – Kramer did go into great detail analyzing the nature of sociopathy, the specifics of the Madoff case and the difficulties in identifying the oft-misunderstood psychological condition.

What are the distinguishing features of sociopathy?

First of all, this is something that starts young. The diagnosis, as it stands now, wants you to have some signs of it by age 15. Then there’s this list [of symptoms] that has to do with not conforming to norms, not respecting legal behaviors, repeated deceitfulness, impulsivity, poor planning ability, irritability, aggression, disregard for the safety of others, inconsistent work behavior, irresponsibility, not honoring financial obligations. And then there’s the big one: lack of remorse, indifference, rationalization about people you’ve harmed or mistreated. If we think of some essence of the disease, that has something to do with it — people who just don’t seem to have a conscience, who don’t feel guilt. That’s what we’d like to be the sociopath or psychopath.

When I was reading the article, one of the things that came across was that Madoff articulated a great deal of remorse. The characterization was of him as a person who does express features of empathy. Is it possible for somebody to show the outward affect of having a conscience, of feeling remorse and empathy, and still be a sociopath. Or, is that too simplistic a question?

There’s an inherent problem with asking a sociopath if he’s a sociopath. That’s not to say that Madoff is a sociopath, but let’s imagine for the moment that he is. Sociopaths, on the whole, make their living by being good at fooling people. When we imagine that Madoff is a sociopath, we’re imaging that he is someone in whom people don’t detect that very easily. The testimony that he feels remorse and so on would have to be taken on that basis. It’s said that doctors are not very good at diagnosing sociopaths and that in treating them they often get their hopes up. They see signs of progress and they testify to the court that a person is now better and the person goes out and does something again.

Even when you narrow the consideration to just interviewing the person, you don’t necessarily make a lot of progress on that question. You’ll want to know a lot more about what went on privately over many years. There were some hints in this article — anger, irritability, taking a very superior stance within the family. I suppose you would want to know how characteristic that is [of sociopathy]. This question — of conduct and attention to law and propriety; having a disorder that starts at age 15 — is something you really gather not just by speaking with the person whose diagnosis you’re trying to make.

But I think what’s interesting about the New York magazine article, to get to the heart of the matter — and setting aside our ability to discern the truth, which I think is fairly little based on that set of phone calls and interviews — is that we can imagine. The article gives us the basis for imagining, in fiction, a character who does very terrible things and is not a sociopath. What’s fascinating about the article is that the story it tells is a story that allows us to imagine a different character.

In one of my hats, I’m a writer. And I can imagine that I write a book that’s very successful. Somebody says to me, “Can you write another book on a different topic?” And I know I’m not very good at it. But then the ante is raised: I’m offered more inducements. I’m flattered. Then all of a sudden I find myself in a project where I’m way over my head. The money is coming in. At what point do I say, “There’s no way I can deliver this. I’m just not that kind of a writer.” Of course, what’s hard about it for those of us who have very strong consciences and are very prone to look at the self, is that when we’re writing the most ordinary book, the one we should be writing, we actually feel that way — like we’ve pulled the wool over somebody’s eyes and we’re way out on a limb. Who can we tell? We’d be ashamed to tell our family that we failed at this and don’t want to tell the editor, so we drag it out for another year.

It’s not like that kind of act necessarily means you’re a sociopath; even the failure to confess, or failure to mitigate and make it better along the way. I think when Madoff puts himself in that narrative — it was a little of this, and it was attractive; and if he could hold on for another year or two, if the markets changed, he would make it all right — it’s the scope of the fraud that makes it harder to believe that narrative.

But, on the other hand, in a sense, it’s the commonest thing in the world. If the numbers were smaller and the number of years was smaller, we would be more prone to believe it. Maybe it has to do with the modern world. When you start this sort of thing — communication is so quick and the bankers are so greedy — the story just plays itself out on an enormously larger stage.

That was really what jumped out at me: While the context seems kind of unfathomable and egregious, at the same time, the story he was telling tapped into a number of pretty human experiences and insecurities, just blown up to epic proportions.

Yes. If we were writing a Saul Bellow-slash-Woody Allen comic novel of personalities writ very large, and we take sociopathy per se off the table, but allow a lot of narcissism and a touch of mania and a lot of circumstance, we could make a comic story in which the character would be perfectly convincing to us, yet have a lot of conscience, particularly in certain areas. You could imagine the person doing this act that’s very harmful to many people but at the same time feeling very bad that something’s happened to his dog or his cat or his girlfriend. And, it’s not at all a case of absence of conscience. It’s a case of a blinding self and willful screening-off of the conscience in this particular realm.

That said, to the extent we’re trying to be medical and make a diagnosis, the cliché in medicine is that when you hear the thunder of hooves, think horses, not zebras. The horse in this case, I think, is the sociopath.

Stepping away from Madoff in particular, there’s this archetype that’s developed in recent years of Wall Street sociopaths. Taken to its extreme, there’s the Patrick Bateman character in “American Psycho,” this idea of the evil banker with no conscience or emotions, demonstrating sociopathic tendencies. Do you think there is anything to that idea?

It seems to me that the bigger problem with Wall Street — in the go-go era and somewhat after — is that a culture was created in which all sorts of people could behave in ways that were destructive to society. I don’t think that something flourishes in this way if everybody needs to have the same personality style to make it work. It doesn’t seem to me that you would need to be a sociopath to be a part of an enterprise that takes the whole society through a crash.

This question of conscience, which we think is at the core of this, seems to me more complicated than the diagnosis of sociopathy makes out. I have worked with psychopaths and sociopaths — not often, but they enter my practice for the ordinary reasons — and I think there are people who just make you shiver because it seems like they would do anything to anyone at any moment.

But there are certainly other people who seem to, in their business dealings, have no conscience; but who are also very worried about the health of a relative, seem considerate within a circle of people that they care about, and who can actually be very pleasant in the therapeutic hour. When I say pleasant, that includes some sense of being complexly thoughtful about moral issues. [But] when their own interests are at stake, they seem to be able to do things that most people would say are beyond the pale and would be entirely unwilling to do.

I think there may be a spectrum here, where people aren’t endowed with no conscience at all. It’s a very complicated mixture of nature and nurture and the cultural environment. And it goes beyond a spectrum to this area: The word that comes up in that article is “compartmentalization.”

That being said, I suspect in these cases where things go very, very wrong, the obvious diagnosis remains the likeliest one.

Thanks.

Depressed in Durango

Dear Depressed in Durango,

I like your statement about the grindingness of it. I like that word, “grindingness.” It says a lot. You say you feel “drained and directionless. I go through the motions of each day without any real emotional variation.” That also says a lot.

One thing it says is anhedonia.

Did any of the people you talked to mention anhedonia? You might go back to them and say the word “anhedonia” and see if they do anything. Sometimes when people write to me they uncover clues that may not have emerged in conversations with doctors and therapists. So then you can go back to these experts with a more focused request: Maybe I have anhedonia? Please help me investigate this possibility. Or maybe there is a medical cause. What are the possible medical causes of depression? Please give me all the tests.

I think it is a little early to conclude that you have a mysterious illness that no one can diagnose. I suggest you start from scratch and be systematic. You might begin with this useful survey of depression treatments.

See how broad a field it is?

What I have learned by having chordoma, which is a very rare form of cancer, is that just because something is rare doesn’t mean you can’t have it. Think about the black swan. Examine all rare medical conditions that can cause depression.

Likewise, be thorough in your investigation of possible treatments. For instance, if you haven’t had cognitive behavioral therapy then you don’t know whether it can work for you. You can’t rule it out. If you haven’t tried eating three meals a day, exercising and getting enough sleep then you don’t know that that can’t work for you. If haven’t tried all the possible treatments for a sufficient length of time, then you don’t know what will help. Rigorously investigating treatments means trying things out for long enough to see if they have any effect. It means accurately observing and measuring whether specific changes bring noticeable improvement.

Keep in mind that the people who run the Helpguide Web site, which I link to up above, lost their daughter to suicide. She was depressed. “She stuck with a single therapeutic mode and her prescribed medications,” they write, “even though the combination seemed to just make her worse. Finally in desperation, she attempted suicide twice; the second time she succeeded.”

The fact that you are not having suicidal thoughts now does not mean you won’t have them in the future. This is not something to take lightly.

So that is my concrete advice. Take action in the world. Insist that your doctors help you rule out all possible causes and aid you in trying all possible treatments.

There. I’ve said it.

Now, as you know, I also have wide-ranging opinions and speculations about how one should live and what is wrong with our society and what is wrong with the messages we are given by our society about what will make us happy.

OK. Here are a couple of my thoughts. When you say, “I’m 32, married, educated and employed,” I do not think to myself, wow, that person sounds happy. I think, wow, that sounds dull. There is no joy in the sentence. It sounds, frankly, like depression. It sounds like the airless, pleasureless realm of anhedonia.

I hear sadness. I hear a silenced self. I wonder who that silenced person is. It may be an athlete. It may be an artist. Perhaps there is some striving, messy, error-prone genius in you that is not being heard. Perhaps this genius is angry at you because she’s not being heard.

I would ask this: Why did you choose to create this great-looking surface? What important part of yourself have you betrayed in creating it? What have you sacrificed? What have you allowed to die?

You say, “On the surface, everything looks great.”

A lovely surface is a tragedy. If there is no ugliness on the surface, the the ugliness must be underneath, eating away at us. There is always ugliness. It’s got to be somewhere.

Here’s the other thing. You say that you’re OK feeling like there might be a thousand tiny reasons that all combine to make you depressed. Likewise, a person who is relatively happy may have a thousand tiny sources of happiness. Throughout the day, a person has moments of pleasure. You learn to have these things that get you through. Maybe it is a raisin bran muffin bought from the sliding window of Specialties at Montgomery and Market streets in San Francisco. It tastes good, doesn’t it? Maybe it is the heat on your chilly hands of a medium-size paper cup of drip coffee bought with the muffin and carried into the street. Maybe it is seeing the security guard behind the desk in the lobby of your building, the clack of your heels on the stone floor, shifting your bag with the muffin in it to your left hand and pressing the round button for the 27th floor and seeing it light up.

Maybe it is a song on the radio as you are driving to work. Maybe it is something you have on. 

There have got to be moments in your life that give you pleasure and you have got to pay attention to them.

I think you have made a great beginning by writing this letter. You have begun a journey of self-discovery that will be years unfolding.

And so it begins. Good luck. Don’t take hazy, noncommittal half-truths for answers. This is your life. You deserve to know. That’s the only way you will come alive again.

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