In July of 2003, my neurological colleague Orrin Devinsky and I were consulted by Spalding Gray, the actor and writer who was famous for his brilliant autobiographical monologues, an art form he had virtually invented. He and his wife, Kathie Russo, had contacted us in regard to a complex situation that had developed after Spalding suffered a head injury, two summers earlier.

In June of 2001, they had been vacationing in Ireland to celebrate Spalding’s sixtieth birthday. One night, while they were driving on a country road, their car was hit head on by a veterinarian’s van. Kathie was at the wheel; Spalding was in the back seat, with another passenger. He was not wearing a seat belt, and his head crashed against the back of Kathie’s head. Both were knocked unconscious. (Kathie suffered some burns and bruises but no permanent harm.) When Spalding recovered consciousness, he was lying on the ground beside their wrecked car, in great pain from a broken right hip. He was taken to the local rural hospital and then, several days later, to a larger hospital, where his hip was pinned.

His face was bruised and swollen, but the doctors focussed on his hip fracture. It was not until another week went by and the swelling subsided that Kathie noticed a “dent” just above Spalding’s right eye. At this point, X-rays showed a compound fracture of the eye socket and the skull, and surgery was recommended.

Spalding and Kathie returned to New York for the surgery, and MRIs showed bone fragments pressed against his right frontal lobe, though his surgeons did not see any gross damage to this area. They removed the fragments, replaced part of his skull with titanium plates, and inserted a shunt to drain away excess fluid.

He was still in some pain from his hip fracture, and could no longer walk normally, even with a braced foot (his sciatic nerve had been injured in the accident). Yet, strangely enough, during these terrible months of surgery, immobility, and pain, Spalding seemed in surprisingly good spirits—indeed, his wife thought he was “incredibly well” and upbeat.

Over Labor Day weekend of 2001, five weeks after his brain surgery, and still on crutches, Spalding gave two performances to huge audiences in Seattle. He was in excellent form.

Then, a week later, there was a sudden, profound change in his mental state, and Spalding fell into a deep, even psychotic, depression.

Now, two years after the accident, on his first visit to us, Spalding entered the consulting room slowly, carefully lifting his braced right foot. Once he was seated, I was struck by his lack of spontaneous movement or speech, his immobility and lack of facial expression. He did not initiate any conversation, and responded to my questions with very brief, often single-word, answers. My first thought, and Orrin’s, was that this was not simply depression, or even a reaction to the stress and the surgeries of the past two years—to my eye, it clearly looked as if Spalding had neurological problems as well.

When I encouraged him to tell me his story in his own way, he began—rather strangely, I thought—by telling me how, a few months before the accident, he had had a sudden “compulsion” to sell his house in Sag Harbor, which he loved and in which he and his family had lived for five years. He and Kathie agreed that the family needed more room, so they bought a house nearby, with more bedrooms and a bigger yard. Nonetheless, Spalding had resisted selling the old house, and they were still living in it when they left for Ireland.

It was while he was in the hospital in Ireland following his hip surgery, he told me, that he finalized a deal to sell the old house. He later came to feel that he was “not himself” at the time, that “witches, ghosts, and voodoo” had “commanded” him to do it.

Even so, despite the accident and the surgeries, Spalding remained in high spirits during the summer of 2001. He felt full of new ideas for his work—the accident, even the surgeries, would be wonderful material—and he could present them in a new performance piece, entitled “Life Interrupted.”

I was struck, and perhaps disquieted a little, by the readiness with which Spalding was prepared to turn the horrifying events of the summer to creative use. Yet I could also understand it, because I had not hesitated, in the past, to use some of my own crises as material in my books.

Indeed, using one’s own life (and sometimes others’ lives) as material is common among artists—and Spalding was a very special sort of artist. Although he acted in television and films from time to time, his true originality was expressed in the dozen or so highly acclaimed monologues that he performed onstage. (A number of these, such as “Swimming to Cambodia” and “Monster in a Box,” were filmed.) His stagecraft was stark and simple: alone on a stage, with nothing but a desk, a glass of water, a notebook, and a microphone, he would establish an immediate rapport with the audience, spinning webs of largely autobiographical stories. In these performances, the comedies and mishaps of his life—the often absurd situations he found himself in—were raised to an extraordinary dramatic and narrative intensity. When I inquired about this, Spalding told me that he was a “born” actor—that, in a sense, his whole life was “acting.” He wondered sometimes if he did not create crises just for material—an ambiguity that worried him. Had he sold his house as “material”?

One of the special features of Spalding’s monologues was that, onstage at least, he rarely repeated himself; the stories always came out in slightly different ways, with different emphases. He was a gifted inventor of the truth, of whatever seemed true to him at the moment.

The family was due to move out of the old house on September 11, 2001. By then, Spalding was already consumed with regret over selling it, a decision he regarded as “catastrophic.” When Kathie told him about the attack on the World Trade Center that morning, he barely registered it.

Ever since, Kathie told me, Spalding had been sunk in depressive, obsessive, angry, guilty rumination about selling the house. Nothing could distract him from it. Scenes and conversations about the house replayed incessantly in his mind. All other matters seemed to him peripheral and insignificant. Previously a voracious reader and a prolific writer, he now felt unable to read or write.

Spalding had had occasional depressions, he said, for more than twenty years, and some of his physicians thought that he had a bipolar disorder. But these depressions, though severe, had yielded to talk therapy, or, sometimes, to treatment with lithium. His current state, he felt, was different. It had unprecedented depth and tenacity. He had to make a supreme effort of will to do things like ride his bicycle, which he had previously done spontaneously and with pleasure. He tried to converse with others, especially his children, but found it difficult. His ten-year-old son and his sixteen-year-old stepdaughter were distressed, feeling that their father had been “transformed” and was “no longer himself.”