It was raining the day I met Elizabeth Wurtzel. She arrived at our offices wrapped in a wool scarf. I was a newly minted editor at Houghton Mifflin, and we were considering her memoir on depression, then titled “I Feel So Down I Want to Die.” She apologized for being late. She fished in her bag for some pills and asked for water. I noticed her hand tremored when she lifted the glass to her lips. She was warm, funny, sort of absurd.

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I had arrived on the New York publishing scene at twenty-seven. I had no contacts in the business, and no one knew that I had suffered from crushing depressions and destabilizing bouts of mania throughout my teens and early twenties, including a six-month stay on a psych ward while getting an MFA in poetry. Though people in publishing circles regularly referenced their therapists in casual conversation, I knew the difference between sounding chic and sounding unstable. I kept my mental health history to myself.

I aligned with stories that were messy and vulnerable. Writers who were messy and vulnerable.

Enter Elizabeth. The young woman sitting in front of me on that rainy day was flaunting her experience with depression, her week-long stay in a mental health facility. She had no shame; I was filled with shame. She struck me as brave where I felt like a coward. And more, while she had stuck a pen in her vein and hit a gusher, I had completely stopped writing.

We came up with a new title for the book, Prozac Nation. The jacket featured Elizabeth, forlorn in a crop top, behind a grid of barbed wire. The memoir was panned and praised in equal measure. Whatever slings came her way, Elizabeth knew she touched a nerve with her readers. The book became a New York Times Bestseller, and she became the It Girl for depression. When I learned that Elizabeth had breast cancer, I couldn’t believe it. The girl consumed with depression for most of her life had been taken too soon by a demon she didn’t know.

Around that same time, I worked with Lucy Grealy on her memoir, Autobiography of a Face about her experience surviving Ewing’s Sarcoma, a rare childhood cancer. Lucy had undergone multiple surgeries to restore her jaw and reclaim her beauty. I felt a deep connection with the material, at its core a cry for self-acceptance. The pain Lucy withstood, the candor and honesty with which she confronted her feelings about her appearance were searing and stunning. Where Elizabeth forced you to look, Lucy dared you not to.

At the age of 39, eight years after she published her memoir, Lucy Grealy died of an accidental heroin overdose. She’d survived over thirty operations over her life to repair her jaw. I came to see that the surgeries were more addictive than the drug that claimed her life. Her death was devastating to her friends, family and readers. Lucy always seemed more alive to us than almost anyone we knew, charming, disarming and always game. And in this way, she covered her pain, until she no longer could.

As a result of working on those two memoirs, I became known to some as the “pain and suffering editor.” I considered it a badge of honor. I was interested in writing that was intense and costly. I aligned with stories that were messy and vulnerable. Writers who were messy and vulnerable.

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I loved being in the front row to their massive egos and concurrent insecurities. Their brilliant and unquiet minds. I was accused more than once of being too close to my authors. Wasn’t that the point? I believed in their genius, their demons, and I wasn’t afraid of their self-destructive tendencies. It’s true I envied my authors their gifts, but not their sacrifices. I was grateful for my meds, my stability, my paycheck, and health insurance. I knew I would never touch fire again, but I was still drawn to the flame.

I continued to work on an array of memoirs after I transitioned from being an editor to an agent: a son’s violent reckoning with an absentee father, a mother’s anguish over a runaway daughter. I worked with Temple Grandin whose book Thinking in Pictures helped decode the mysteries of autism. And plum of plums, Just Kids by Patti Smith. By then, I’d developed a unified theory about the profound connection between editors and the authors they published. Their books were expressions of our own dreams and obsessions. And for those of us who worked on memoir, the egg we carried was a little more fragile, the pieces we sometimes picked up, the shattered part of ourselves.

Then I met Heather Armstrong, aka Dooce. She was dazzling, the first “mommy blogger” who had electrified the internet with her candid and hilarious posts about motherhood. She was one of the original influencers. Heather had erected an entire online industry around her postpartum depression and became one of its most glamorous and relatable spokespersons. I represented her bestselling memoirs It Sucked and Then I Cried and Dear Daughter. When her depression returned in full force, Heather shared some very rough pages with me about an alternative treatment she was considering that shut down all brain activity for a full fifteen minutes, inducing a temporary coma or brain death before reviving the patient. I turned the project down. It scared me. I thought this alternative treatment was dangerous in the extreme. I didn’t feel comfortable supporting a book about it; it felt too risky, even irresponsible.

Heather went ahead with the treatment. She chronicled her experience in the 2019 memoir The Valedictorian of Being Dead. Four years later, Heather tragically took her life. She was 47 years old. The knowledge that I had turned the book down, and in essence turned Heather away, haunted me. The description on the Amazon page says of the treatment, “a switch was flipped, and Heather hasn’t experienced a single moment of suicidal depression since.” Someone needs to fix that copy.

In helping writers who struggled with mental health over all those years, I saved myself.

I forced myself to listen to the book on audio, read in Heather’s own voice. It was almost unbearable. She described how she agreed to the treatment with great skepticism, but her desperation drove her. At first, the treatment appeared to work. Following each harrowing round of an induced death state, she was starting to experience joy. What I initially thought was crazy, I realized was bravery. She would do anything to stop wanting to die. Following her suicide, I questioned my entire history of working with people who struggled with mental health. Perhaps my career had been one long cry for help.

I quit working on memoirs entirely five years ago when I lost my dearest friend and client George Hodgman to suicide. His memoir Bettyville chronicled his life as a good little closeted boy from Paris, Missouri. George and I met as editorial assistants at Simon and Schuster. George, like me, was a little older than the average assistant. Equally determined to make a career in publishing, we bonded. In the days when I still feared being stigmatized, he was the only person I confided in about being bipolar and the suicidal weeks leading to my hospitalization in graduate school. “Honey,” he said, “It’s never worth it. There’s always something just around the corner.”

George moved on to Vanity Fair as a senior editor where he thrived in the high wire world of celebrity journalism. I also knew that George’s life was chaotic and lonely, that his compulsion to entertain and be funny was covering a fear of not being loveable or worthy. It didn’t matter that Bettyville was a bestseller, that people fawned over George at events and books clubs and award ceremonies, though for a time he basked in the praise. I knew George was relapsing after a long period of sobriety, struggling mightily with pages for a new book. The last time we spoke, he said, “you take care of yourself and that nice husband and daughter of yours.” I had no idea he was saying goodbye.

In helping writers who struggled with mental health over all those years, I saved myself. Medication and therapy and years of vigilance also saved me. I was grateful to be sturdy, reliable, there for them, there for myself. Who is to say why some writers survive fleeting moments or excruciating years of suicidal ideation and others can no longer wage their battle. I will never entirely know what kept me from taking my life when I was so fixated on death. Perhaps life wants you at least as much as death.

Sometimes, I feel as if I am out here all alone on a raft on a lake. How can the water be so still? How long have I been sitting here? I see now that the act of writing a confessional memoir is both a ray of hope and a cry for help. Maybe it’s true that you can only save yourself. I’m not sure. Out here, my survivor’s guilt is tinged with despair. What I know for sure is that writing cannot save a writer; writing doesn’t care.

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For help with suicidal ideation, call or text 988. Or go to SpeakingofSuicide.com/resource

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Shred Sisters by Betsy Lerner is available from Grove Press, an imprint of Grove Atlantic.