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The suprachiasmatic nucleus (SCN) plays a critical role in maintaining melatonin and sleep-wake cycles.
We report a case of 38-year-old woman who, after gunshot wound to the right temple, developed a sleep complaint of multiple nocturnal awakenings and several naps throughout the day.
Computerized tomography and magnetic resonance imaging revealed bilateral optic nerve and optic chiasm damage. Diagnostic polysomnography and actigraphy revealed an irregular sleep wake rhythm.
We speculate concurrent damage of the SCN and optic nerves bilaterally resulted in the posttraumatic irregular sleep-wake rhythm.
DelRosso LM; Hoque R; James S; Gonzalez-Toledo E; Chesson AL. Sleep-wake pattern following gunshot suprachiasmatic damage. J Clin Sleep Med 2014;10(4):443-445.
A 38-year-old woman presented with a history 4 years earlier of a gunshot wound (GSW) to the right temple with exit wound on the left temple leaving her blind. Computerized tomography revealed a bullet tract damaging the optic nerves bilaterally (Figure 1). Current magnetic resonance imaging revealed damage to the optic nerves and optic chiasm.
(A) Computerized tomography of the head showing damage of the optic nerves bilaterally following a gunshot wound to the right temple. Note bone fragments along the bullet path across the suprachiasmatic area. (B) Axial T2 weighed magnetic resonance imaging (MRI) of the head showing bilateral optic nerve hyper-intensities consistent with nerve damage (circles). (C) Sagittal T1 weighted MRI of the head. The optic chiasm (arrow 1) forms the anterior boundary of the hypothalamus. The infundibulum (arrow 4) to the pituitary gland (arrow 3), and the mammillary bodies (arrow 2) form the inferior boundary of the hypothalamus. The optic chiasm appears thinned along with the adjacent hypothalamus.
Neuroimaging of the brain. (A) Computerized tomography of the head showing damage of the optic nerves bilaterally following a gunshot wound to the right temple. Note bone fragments along the bullet path across the suprachiasmatic area. (B) Axial T2 weighed magnetic resonance imaging (MRI) of the head showing bilateral optic nerve...
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Current sleep complaints consisted of multiple nocturnal awakenings and several naps throughout the day. Her reported bedtime varied from 6 PM to 9 PM, and wake time varied from midnight to 3 AM. She reported sleeping sporadically throughout the day but cannot identify the exact times. She denied snoring or witnessed apnea; and she wakes from sleep unrefreshed. She is single, does not have a bed partner, and is disabled.
Past medical history is significant for depression and headaches. The patient sees a psychiatrist who has ruled out posttraumatic stress disorder. Current medications include acetaminophen, 500 mg as needed, and amitriptyline, 25 mg at night. Prior medications used to consolidate nocturnal sleep were unsuccessful and included clonazepam 0.5 mg at night, melatonin 1 mg at 9 PM and melatonin 9 mg at 9 PM, gabapentin 600 mg at night, and hydroxyzine 25 mg at bedtime.
Physical exam revealed a thin woman in no distress. Oral airway was unremarkable. Pupils were dilated and non-reactive; conjugate extraocular motility was intact in all cardinal directions of gaze. The remainder of her neurological examination was non-contributory.
Limited Epworth Sleepiness Scale score, reflecting the inability to drive or read, was 10/18. Serum basic metabolic panel, complete blood count, liver function panel, prolactin, thyroid stimulating hormone, follicle stimulating hormone, and luteinizing hormone were all normal.
Diagnostic polysomnogram (PSG) data: total sleep time (TST) 325 min; sleep latency 48 min; wake after sleep onset 143 min; N1: 11.7%, N2: 73.9%, N3: 13.1%, REM: 1.3%; sleep efficiency 52%; and TST apnea-hypopnea index 0.3. Two weeks of actigraphy were obtained with the wrist device placed the night of the diagnostic polysomnogram (Figure 2). Actigraphy revealed an irregular sleep wake rhythm (ISWR) with an estimated average total sleep time per 24-h period of 8.8 hours. Figure 3 represents the PSG hypnogram corresponding to day 1 of actigraphy and demonstrates clearly disrupted sleep that was not well defined by actigraphy alone.
Two-week actigraphy does not show three distinct bouts of sleep as required by current criteria for Irregular Sleep Wake cycle.
SpO2, pulse oximetry; HR, heart rate; OA, obstructive apneas; CA, central apneas; MA, mixed apneas; HYPO, hypopneas; Pos, sleep position; S, supine sleep position; R, right lateral decubitus sleep position; L, left lateral decubitus sleep position; MIC, microphone; LegMvt, leg movements.
Hypnogram showing multiple nocturnal awakenings not well identified by actigraphy alone. SpO2, pulse oximetry; HR, heart rate; OA, obstructive apneas; CA, central apneas; MA, mixed apneas; HYPO, hypopneas; Pos, sleep position; S, supine sleep position; R, right lateral decubitus sleep position; L, left lateral decubitus sleep position; MIC, microphone; LegMvt, leg...
As light is the most potent zeitgeber, blindness has been associated with various sleep disturbances. Circadian rhythm disorders, particularly free-running rhythm, have been reported in 27% of blind patients with reduced light perception.1
Light receptors in the retina transmit photic signals to the suprachiasmatic nucleus (SCN) through the retinohypothalamic tract, which travels along the optic nerves; hence, lesions of the optic nerves may result in a free-running circadian rhythm.2 The SCN lies just above the optic chiasm, ventrolateral to the third ventricle in the anterior hypothalamus. Animal studies have demonstrated that complete ablation of the SCN results in abnormal melatonin cycling and irregular rest/activity cycles.3,4 In humans, destruction of the SCN has also demonstrated disrupted patterns of body temperature and behavioral function.5 Destruction of adjacent nuclei, the ventral sub-paraventricular zone, which receives a large number of projections from the SCN, has shown disruption of sleep and activity cycles without affecting body temperature. Damage to the dorsal sub-paraventricular zone, which receives a smaller number of projections from the SCN, has shown to affect body temperature, with a lesser effect on sleep or activity level.6
We speculate that the damage of the SCN or adjacent nuclei after optic nerve transection bilaterally resulted in posttraumatic ISWR. The International Classification of Sleep Disorders, second edition (ICSD-2) criteria for diagnosis of ISWR disorder include: complaints of insomnia, excessive sleepiness, or both; at least one week of actigraphy or sleep logs demonstrating at least 3 irregular bouts of sleep during a 24-hour period; a normal for age sleep time over a 24-hour period; and exclusion of drugs, medications, mental disorders, neurological conditions, or other medical diagnosis.7
The criteria are based on the irregular sleep wake data patterns of elderly patients with Alzheimer disease, which may or may not all qualify for true irregular sleep wake cycle due to degeneration of the SCN. A revision of the criteria may be necessary after new case reports such ours are found in the literature. Our patient does not fit criteria by actigraphy alone, since actigraphy does not show evidence of at least three distinct bouts of sleep. However, concomitant PSG shows multiple sleep-wake transitions that would qualify for ISWR. The absence of multiple awakenings on the actogram could be secondary to low actigraphy sensitivity and is better demonstrated on PSG.
The current practice parameters for evaluation of circadian sleep disorders recommend the use of circadian markers (melatonin secretion) when free-running sleep disorder is suspected in both sighted and unsighted individuals, but there are insufficient data to recommend their use in other circadian disorders (suspected irregular sleep cycle). Melatonin secretion analysis was not performed in our patient.8
Treatment of ISWR entails: exposure to bright light during the day; avoidance of bright light in the evening/night; and structured physical/social activity across the 24 hours. Given that our patient has severely damaged optic nerves, normal cognition, and is able to perform her activities of daily living, we utilized treatment approaches typically reserved for blindness associated free-running type circadian rhythm sleep disorder. These included use of 1 mg of melatonin 1 hour before bedtime, and maintenance of rigid sleep time and wake time.
We also recommended a fixed wake/sleep schedule combined with planned daily social activities. Treatment success for this ISWR has been variable. Our patient continues to experience fragmented sleep all day and was not able to maintain the recommended schedule. Alerting medications were considered, but the patient declined.
We propose that the damage of the SCN or adjacent nuclei in our patient is responsible for the lack of response to typical treatments of circadian rhythm disorders. We will continue to stress the importance of daily social activities. This case demonstrates the importance of an intact SCN in circadian regulation. When not intact, zeitgebers have limited utility.
This was not an industry supported study. This case was presented during the SLEEP meeting, Brown Bag Challenging Cases, Baltimore, 2014. The authors have indicated no financial conflicts of interest. The authors report no off-label/investigational drug uses regarding this manuscript.
Warman GR, Pawley MD, Bolton C, et al., authors. Circadian-related sleep disorders and sleep medication use in the New Zealand blind population: an observational prevalence survey. PloS One. 2011;6:e22073. [PubMed Central][PubMed]
Hannibal J, author. Neurotransmitters of the retino-hypothalamic tract. Cell Tissue Res. 2002;309:73–88. [PubMed]
Reppert SM, Perlow MJ, Ungerleider LG, et al., authors. Effects of damage to the suprachiasmatic area of the anterior hypothalamus on the daily melatonin and cortisol rhythms in the rhesus monkey. J Neurosci. 1981;1:1414–25. [PubMed]
Mosko S, Moore RY, authors. Neonatal suprachiasmatic nucleus ablation: absence of functional and morphological plasticity. Proc Natl Acad Sci U S A. 1978;75:6243–6. [PubMed Central][PubMed]
Cohen RA, Albers HE, authors. Disruption of human circadian and cognitive regulation following a discrete hypothalamic lesion: a case study. Neurology. 1991;41:726–9. [PubMed]
Lu J, Zhang YH, Chou TC, et al., authors. Contrasting effects of ibotenate lesions of the paraventricular nucleus and subparaventricular zone on sleep-wake cycle and temperature regulation. J Neurosci. 2001;21:4864–74. [PubMed Central][PubMed]
American Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Coding Manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine, 2005.
Morgenthaler TI, Lee-Chiong T, Alessi C, et al., authors. Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep. 2007;30:1445–59. [PubMed Central][PubMed]


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On a muggy June morning, in a sprawling, unnamed, and unnumbered red brick building near downtown Charlotte, North Carolina—which serves as the headquarters for Showtime's political-thriller series "Homeland"—tornado warnings were being broadcast on TV. Outside, torrential rain brought traffic to a standstill on the highway. Inside, the cast and crew of "Homeland" were hard at work by 8 A.M., calmly building their own storm for the first episode of the much awaited third season (which will première on September 29th). In the finale of Season 2, the characters had survived "the worst terrorist disaster since 9/11": a car bombing at C.I.A. headquarters that killed more than two hundred people. The emotional weather buffeting them now was contained within a behemoth enclosed wooden set, where the homes of the show's two central figures—the bipolar, transgressive C.I.A. operative Carrie Mathison (Claire Danes) and her suspect, Sergeant Nicholas Brody (Damian Lewis), a captured Marine sniper turned Al Qaeda sleeper—had been meticulously designed, right down to the CDs on Carrie's bureau (the Temptations and John Coltrane's "Newport '63").
In the vastness of the studio, the only sure way to know that acting was taking place was to huddle near the twin monitors behind the set. On the screens, Carrie sat on her living-room sofa, her eyes fixed on her television, where her longtime mentor, Saul Berenson (Mandy Patinkin), now the head of the C.I.A., was being strategically sandbagged at a congressional hearing on the bombing. Danes had no lines in the scene, but as Berenson's testimony shifted from showboating to scapegoating—he referred to a "case officer" who was "unstable"—her face was a barometer of Carrie's interior. Incredulity, sorrow, and humiliation swept over her. The director Lesli Linka Glatter, a noisy dynamo in a T-shirt, vest, and cargo pants, stood so close to a monitor screen that her nose almost touched it, her head rolling with each shift in Danes's expression, as if urging her into every unsettling transition. When Carrie finally sat back on the sofa, with a gesture of abject disbelief, Glatter's arms shot high above her head, as if Danes had scored a goal, which, in a way, she had. "Cut! That's great!" Glatter called, while Danes quietly dried her eyes.
After four takes, four huddles, four different versions of Carrie's chagrin, Glatter declared herself satisfied. She was excited by the spectrum of feelings that Danes had laid out for her to choose from in the final edit. "We talked about how it could land," she explained. "One was anger. The other was a kind of betrayal. To me, the one with the tear—my heart hurt. But I don't know where that's gonna take us." Glatter, who is also a co-executive producer of the show, added, "I always come with a clear plan, but then you have an actress like this who is fearless, and you really want to see what she's bringing to the party."
Eleven director's chairs were arranged in a semicircle around the monitor screens. On some of them, emblazoned in white, were the names of staff grandees. The chair meant for the Emmy Award-winning Danes, however, was marked simply "Carrie"—a sign, if more were needed, that the agitated, wayward espionage agent was more real to those present than the thirty-four-year-old actress who had given life to her in twenty-four previous episodes. Danes, still dressed in Carrie's unassuming mufti of black slacks and white shirt, strode resolutely off the soundstage and settled into her chair. "I didn't think the scene would be very emotional," she said. "But, in the actual playing of it, hurt is sort of unavoidable. I don't really edit as I go along. I leave them to decide."
Although there is nothing domineering in Danes's demeanor on the set—she creates no commotion around herself—onscreen she is capable of what David Harewood, who played the stonewalling deputy director of the C.I.A. in the first two seasons, calls a "tsunami of emotion." In extremis or out of it, her body semaphores feeling. As one "Saturday Night Live" cast member commented during a recent lampoon by Anne Hathaway, "It's like she makes her mouth turn fully upside down. Her eyes seem to be looking five directions at once. It's like her whole face is chewing gum." Danes, speaking of her portrayal of Carrie's manic moments in Season 3, told me, "I don't even know how it happens, but I start shaking. My body expresses it. It's really fun when it starts becoming physicalized. It's not necessarily a conscious decision. It's a little mysterious to me." That kind of porous physicalization comes, in large part, from Danes's early training in dance, which she began at the age of six. "Dancing is a kind of drawing," she said. "I'm interpreting what I'm hearing with my body. Acting is like that, too." She added, "I use my body to generate feelings a lot. If I have a very emotional scene, I'll often walk in circles before. It gets you out of your head. I'm not afraid to use it."
Danes is frequently accused of being over the top. " 'Homeland' is actually TV's best post-9/11 metaphor yet, where Carrie is America and America is a mad, paranoid, overacting blonde," one TV critic wrote of "Homeland" 's first season. But, then, people suffering from psychological disorders often are melodramatic. "We are so much bigger in life than we realize," Danes said. "We're betraying so much more than we think." Over the decades, in her performances, she has explored a full spectrum of disturbance, from spousal abuse, autism, and paralysis to Carrie's bipolar disorder and the paranoia of adolescence. At Harvard last year, to accept the Hasty Pudding Theatricals' Woman of the Year Award, she joked about her penchant for roles that turn acting into an extreme sport. "I'm just working my way through the DSM-V"—the Diagnostic and Statistical Manual of Mental Disorders—she said. "So whatever mental condition you have for me . . ." But, in its silliness, the Hasty Pudding roast—which required Danes to parade down Massachusetts Avenue wedged between two burly drag queens, to read a faux-Shakespearean speech sending up her brief appearance in "The Vagina Monologues" ("To be or not to be an angry lesbian"), and to challenge-dance with a gangly, moonwalking "Virus"—revealed more of her personality than her acting roles do.
In her work, Danes flirts with the darker forces; in her life, she exhibits a wacky charm and a swift, playful mind. She has a particular affection for puns. When she first went to dinner at the home of her friend Jenette Kahn, who was a producer of "The Flock" (2007), in which Danes co-starred with Richard Gere, she arrived with a gift of bespoke lingerie: a camisole with an image of Sigmund Freud printed on it—a Freudian slip. When Patinkin recently sent out an S.O.S. for Danes's roast-chicken recipe, he received a forensic two-page e-mail on how to cook the bird, which ended, "I hope this arrives in time (thyme?)." In June, on a visit to an antique store in Charlotte, Danes couldn't resist buying a hamburger timer in the shape of a hand, with a clock embedded in the palm—a hand burger timer. "I've never seen in any other actor such a divide between the performance and the person in the room," the novelist Michael Cunningham, who became friends with Danes in 2004, during the filming of his screenplay "Evening," said. (In 2009, he officiated at her wedding, in the South of France, to the British actor Hugh Dancy, whom she met on the set of "Evening.") "Claire's buoyancy is real. She's not impersonating a buoyant person." One of the lessons of her adulthood, Danes has said, was "that there is real honor in being a total goofball."
"The central mystery of Claire is, where does she come from?" Cunningham said. "She doesn't match her family. If you gathered into a room two dozen parent-aged people and said, 'O.K., spot the Daneses,' you couldn't do it."
Danes's parents, Chris and Carla, met at the Rhode Island School of Design, in the early sixties. Chris was scrawny, bespectacled, funny, and analytical; he studied engineering and biology at Brown, before transferring to RISD's photography department. Carla was earnest, intuitive, eccentric, and prolix. (One of Danes's friends refers to her as the Queen of Too Much Information.) Both were liberal, former Vista volunteers, and adventurous, and both had been marked by problematic childhoods. Chris's mother died when he was ten; his father, Gibson Danes, a former dean of the Yale School of Art and Architecture, was distinguished but distant. He committed suicide in 1992, along with his third wife, the artist Ilse Getz. Chris "just kind of grew himself up," Carla told me. Carla was the eldest of five children; she spent her childhood helping her mother wrangle her siblings.
The Daneses moved to New York in 1969, and a few years later bought a seven-story building on Crosby Street, in SoHo, with another RISD couple. In order to pay the bills, they had to put their artistic ambitions on hold. Chris became a building contractor. Carla, a textile designer and painter, started a day care that she called the Crosby Street Toddlers Group. "For me, a lot's been about survival," Chris said. "I've been clinging to the edge of the boat and only fairly recently do I realize that I'm inside the boat and I can relax."
Still, Danes's parents retained a playful side. The two-thousand-square-foot loft on Crosby Street, where Danes, who was born in 1979, and her older brother, Asa, grew up, featured a trampoline, a trapeze near the long kitchen table, and a swing suspended from the living-room ceiling in front of high windows. "It felt like you could just fly out onto Lafayette Street," Danes recalled. For the day care, Carla installed a large box of rice, which served as an indoor sand pit, and containers of dress-up clothes. "A huge emphasis was placed on art and creativity," Danes said. At the same time, Danes found herself re-creating Carla's childhood—sharing her mother and her home with a gaggle of younger children. "You get a little lost in the shuffle," she said.
Below the antic surface of family life was an indigestible anxiety. Chris and Carla were lumbered with a sense of not having lived up to their own potential; "both of us were smarter and more imaginative," Carla said. The Daneses felt that they should treat their own children as "unfinished equals," and Danes picked up the message of autonomy early on. "I played grownup—a child's idea of grownup. A little too strict, a little too arch," she said. At the age of three, Danes demanded and was granted the power position at the head of the dinner table. When she was four, and a rogue haircut left her with bangs that she didn't want, she turned furiously to her mother. "Why did you let them do that? It's my body!" she said. "Claire seemed always ready to play the adult," Carla said. "She always seemed to want to be on to the next stage." As a child, Danes became, as she put it, "parentified"—a kind of parent to her own parents, a role that was infuriating, impossible, and irresistible. She described her mother as "very childlike," adding, "She needs mothering herself." Her father, she said, had "lost every parent he ever had. Everybody kind of held vigil over him. I wanted to rescue him from those awful feelings." Danes carried another burden: the name of her father's late mother, of whom he has no memories. Calling his daughter Claire, Chris admitted, was "big" for him. " 'Repair' would be too strong a word, but it had a satisfaction to reach out to this memory I didn't have," he said.
Danes, however, who was "riding the subway alone at the age of eleven," sometimes felt unprotected. "I think they realize that they did ask too much of my brother and me. They regret that," she said. A couple of times in her childhood, Danes had a "dalliance with madness." Terrifying visions of ghosts and gargoyles emerged out of the showerhead and from shapes in the woodwork. "Very O.C.D.," she said. "They were gonna suck me into some horrible place." She briefly saw a psychiatrist. Later, when she was nineteen, famous, living in her own SoHo loft (with a ceiling swing), and coming down from her first and last hit of Ecstasy, Danes was again visited by these emissaries of her unconscious aggression. "They were the same, except smaller," she said. "I was, like, 'Really, guys? You're still here? I'm a grownup. I'm done.' "
Danes discovered the joy of dissimulation at the age of three, when, a chronically bad napper, she passed herself off as asleep. "I'd observed my mother sleeping, and she twitched," she said. "So I kind of did that. It was a pretty refined imitation. I really loved the experience of pretending." When she was five, dancing and singing on her parents' bed while watching Madonna on TV, she first "registered that performing could be a job" and decided that that was what she wanted to do. The next year, she signed up for a class with Ellen Robbins at Dance Theatre Workshop, starting a weekly ninety-minute regimen, which she kept up for a decade. Even then, Danes was drawn to theatrical extremes: she danced a shipwreck, a moth drawn to a flame, a "lazybones" hauling an enormous sack. "She was a risk-taker and improvised full blast," Robbins said.
Around the age of eight, Danes, exasperated by a boy in her class, was spooked by the pleasure she got from her revenge fantasies about him. "Can people read your thoughts?" she asked her mother. "Your imagination is your own. You can do whatever you like with it," Carla answered. The knowledge that "you could be a good person and host lavishly violent acts in your imagination" was, Danes said, a kind of liberation. "I was so happy," she added.
A year or so later, after her best friend, Ariel Flavin, appeared in a film made by a graduate student at New York University, Danes, "burning to have the experience," put herself forward for the student's next project, "Dreams of Love," a film about child abuse. (She auditioned for one of the movie's executive producers, Milos Forman.) Danes thought it "interesting to think about" the rage, loss, and bewilderment a girl would feel at being molested by her father. Onscreen, she found an outlet for her own forbidden feelings. "I loved discovering the camera. It was like a confidant," she said. "To be seen is a crucial part of my attraction to acting." She began to imagine a life as an actress. "Someone told me that actors don't typically make much money," she said. So when people asked her what she wanted to be when she grew up she'd say, "I'm going to be a therapist and act on the side." At ten, however, she formally announced her vocation at the dinner table. "I said, 'You know what? Money or no money, I have to be true to my art. I'm gonna take the risk. There is no plan B. I'm going to act.' "
At twelve, after two years at the Lee Strasberg Institute, Danes was offered a part in the soap opera "One Life to Live." She turned it down. "I was a malleable, unformed actor. I didn't want to develop bad habits," she explained. Then, in December, 1992, on the basis of an appearance on an episode of "Law & Order," the thirteen-year-old Danes was one of two young actresses—Alicia Silverstone was the other—who were called to audition in Los Angeles for a show about American adolescents. The show was being developed by Ed Zwick and Marshall Herskovitz, who had previously hit the mother lode with their exploration of another age group, "Thirtysomething," along with Winnie Holzman, who had been a member of the "Thirtysomething" writing team. "In our heads was some notion of trying to write a more accurate representation of the teen-age experience," Zwick said. Holzman was enlisted to write the pilot, which she began by keeping a journal in a teen-ager's voice, the funny, thoughtful, naïve palaver of fifteen-year-old Angela Chase:
—My mom's a slob. She'll go for like weeks without making her bed, then all of a sudden it'll become like her religion. Make your bed! Make your bed.
—This summer I began to feel really terrible about being white. It just seems like black people have this really hard time. And yet everybody wants to be like them.
Silverstone auditioned first. Zwick, impressed, told Herskovitz, "It's done. Just cast her." But Herskovitz thought she was too pretty for Holzman's messy high-school universe, which included subplots about drug addiction, bullying, binge drinking, promiscuity, and homosexuality. "Alicia is so beautiful that that would have affected her experience of the world. People would have been telling her she was beautiful since she was six years old. You can't put that face in what's been written for this girl," he argued. Linda Lowy, the casting director, suggested that they see Danes before deciding. "From the minute she walked in the room, Claire was chilling, astounding, and silent," Lowy said. "There was so much power coming out of her without her doing much." One of the scenes that Danes read—which involved a nervy bathroom breakup with Angela's best friend, Sharon—required her to cry. "Tell me what I did, Angela. I mean, I would really like to know," Sharon says. "We get to that line and Claire's face turns entirely red," Herskovitz said. "Her body starts to vibrate and tears come into her eyes. You realize that she's having a physical experience that is beyond acting." Even then, Danes's defining quality as an actress—a combination of thoughtfulness and impulsiveness—was on display. "She seemed to have been born fully grown, you know, out of a seashell," Herskovitz said. Zwick claimed that Danes was his first sighting of a "wise child," a rare species that show business occasionally tosses up. As he put it later, "What she knows cannot be taught." Danes also satisfied another quality that Holzman's script called for: her face could transform in an instant from beautiful to ordinary.
Holzman's pilot for "My So-Called Life" (then titled "Someone Like Me") was meant to trap "a naked quality, not a person but a feeling of freedom and bondage, shyness and fearlessness," she said. Holzman found herself staring at this protean paradox in the flesh. Danes "was sexy and not sexy, free and bound up, open and closed, funny and frighteningly serious," Holzman recalled. Her performance freed Holzman's imagination. "We gave birth to each other," she said. "I was looking at someone who literally could do anything, and so I could, too." The novelist and television writer Richard Kramer, who worked on "My So-Called Life," places Holzman's writing for the show on a continuum of original television voices that leads from her to Mike White, Larry David, and Lena Dunham. "Winnie wouldn't be Winnie without Claire," he said. "And Claire wouldn't be Claire without Winnie. There was something mythological about their meeting."
After Danes left the audition room, Lowy recalled, "no one could really speak." In the excitement of the moment, the production team found themselves faced with a conundrum. Silverstone was sixteen and "emancipated," meaning, in Hollywood's piquant terminology, that she could work very long days. Danes was thirteen and, by law, had to go to school. If they cast Silverstone, they could move ahead with the show they'd written; if they opted for Danes, they'd have to adapt later scripts to accommodate her schedule. "We turned to Winnie," Herskovitz recalled. "Winnie said, 'Let's change the nature of the show.' " He added, "In that moment, we decided to include the lives of the parents more."
Danes arrived in Los Angeles on January 18, 1994—the day after the Northridge earthquake. The relocation was thrilling for her, but harder for her parents, who had to cope with suburban isolation. "The power and attention that come with a successful Hollywood thing are like a big wave," Chris Danes said. "For me, a level of success was not letting any one of us get pummelled by it." Carla closed down her day-care business to become her daughter's full-time manager and on-set "supervisor," a role she characterized as "a dog and a shadow." "She'd experienced terrible frustration as an artist and she didn't want me to go through that," Danes said. "She wanted me to have as much creative freedom and opportunity as I could have. I'm so grateful that she did that. I don't know if I would have been able to do it for my child."
"My So-Called Life," which débuted on ABC that August and won Danes the first of her four Golden Globe awards the next year, more or less mirrored her own stressful experience of junior high in New York, where she had difficulty "navigating the social seas." She changed schools twice, "fleeing one mean girl only to find another incarnation of that same girl in the next school." She was targeted for her looks, her nerdy curiosity, her refusal to conform. "I thought it was a crock of shit, all these social games. I couldn't deal," she said. "She was not cool," Flavin recalled. "She just always said what she thought. She raised her hand every time she knew the answer, and she knew the answer every time. So people didn't like her." At school, Danes could also be mouthy and a bit of a hothead. "I went through this vigilante period," she said. "I would see somebody being bullied, and I would get really righteous and intercept." Once, seeing a boy berating a girl after class, she slapped him. "He slapped me back, and we went to the principal's office," she said. When she got the role in "My So-Called Life," Danes said, "I remember being so relieved that I had an opportunity to voice my complaints about my time at school so perfectly and so eloquently, with the right amount of rage and humor."
She continued, "Angela and I were the same age, so we could dance around each other. Sometimes I would have an experience and then it would be articulated in the show. Other times, I would play it out, then experience it personally later." When the script called for Angela, who was besotted with the granite-chinned Jordan Catalano (Jared Leto), "to kiss his face," Danes said, "I was, like, 'kiss his face'? What is that? I had no idea what it meant. Jared had to coach me." In the first Angela-Jordan onscreen meeting, Angela slips and falls in mud at a party and, to get away from everyone, rushes into a room where she comes face to face with her heartthrob, who is watching television. She panics and tries to leave, but the door is stuck. She lets her body go limp, as if she were going to fall to the floor, then pulls herself back up, smiling, and sits down awkwardly beside him. "The whole thing takes a second and a half," Herskovitz said. "It's full of a lifetime of irony and ruefulness and embarrassment. She was fully equipped as a master craftsman." Danes's resourcefulness intimidated the creative team. "I went five days before I gave her a direction," he added.
In 1995, despite an online campaign (the first in the history of television) to save the cult hit, ABC cancelled "My So-Called Life." The show had put Danes into the dream life of the nation; it had also brought her to the attention of film directors. Gillian Armstrong had cast her as the terminally ill Beth in "Little Women" (1994); Francis Ford Coppola hired Danes to play the brutalized wife Matt Damon rescues in "The Rainmaker" (1997); and Baz Luhrmann gave her the chance to play opposite her teen-age crush, Leonardo DiCaprio, in a modern reimagining of Shakespeare's tale of first love, "Romeo+Juliet" (1996). "She was the only girl that looked me in the eye in auditions," DiCaprio said. Danes's performance as Juliet is the most luminous of her early years, an effortless exhibition of her modesty, exuberance, and sensuality.
In 1999, after making thirteen films in five years, Danes enrolled at Yale. She was twenty, celebrated and rich, but she "didn't feel finished as a person." "I didn't have a sensibility, a value system, an aesthetic. I needed that time in school to be clear on who I was and what kind of career I wanted to have," she said. But by the time she left Yale, in 2001, without completing a degree, she felt, she said, removed from acting and from the film industry. "I just felt outside it," she said. "I started to think, How do these actors do it? It seemed alien and incredible. I became self-conscious." Danes found it hard to get roles that tested her range and her resources. She had a couple of solid outings: as a female Shakespearean wannabe in the all-male world of Elizabethan theatre, in Richard Eyre's "Stage Beauty," and as a vulnerable aspiring artist behind the glove counter at Saks, in Steve Martin's "Shopgirl"—both strong performances in weak scripts. But, increasingly, she was cast around the edges of the story (in "Me and Orson Welles," "Evening," "The Hours," "The Family Stone"). Between decent roles, she did business chores, appearing in such movies as "The Mod Squad" and "Terminator 3."
Despondent over the roles she was and was not being offered, she resumed her dance training, after a decade's hiatus, working now with the choreographer Tamar Rogoff, who was the mother of her friend Ariel Flavin, "to learn her body" as a grownup. The two developed an exercise in which one of them danced as the other watched and wrote down free associations; then, after a few minutes, they'd reverse roles. Rogoff challenged Danes to trust her body to communicate for her. "You don't have to tell us what you think," she said. "Just feel it. Your whole body's dramatic." Referring to Danes's long neck and spine, Rogoff told me, "She has a very unusual body. Her spine really bends. She can bow, and then she can be like a warrior. She's willing to abandon style for the essence of something."
Over time, they devised "Christina Olson: American Model," an hour-long solo piece about the paralyzed woman memorialized in Andrew Wyeth's painting "Christina's World," who refused her wheelchair and insisted on crawling everywhere. "I wouldn't let her use her face," Rogoff said. "I said, 'You're gonna be acting with your body.' " Danes performed the piece at P.S. 122, in New York's East Village, in 2005. In footage intercut with a video of the performance, Danes, as Olson, slithers along First Avenue on her belly. Pulling herself up the stairs of P.S. 122, step by step, on her elbows, she crawls into the theatre. "Nobody noticed," Danes said. "Some scrawny white chick dragging herself on the floor in basically no clothing. I thought, Wow! You can get away with a lot more in this town than you realize." ("Make no mistake: She's a dancer," Deborah Jowitt, the dance critic of the Village Voice, wrote.)
A couple of years later, while in London, Danes, then twenty-eight, took a call from the British director Mick Jackson, who told her about an HBO movie that he wanted her to star in, a bio-pic of the autistic professor and animal-welfare activist Temple Grandin. In an interview with the Directors Guild of America, Jackson recalled telling Danes that, in order to play a person with such a limited emotional range, she would have to deny herself "all the things which you use as an actress, the ability to make the audience empathize with you, because this is a character who doesn't empathize with anybody, even her own mother. She cannot bear to be hugged by her own mother." He went on, "You're going to look very unattractive, because it's a person who's loud in conversation, can't modulate her voice, is very awkward in society . . . because she can't think of how other people are looking at her. You're going to have to work without a safety net." Danes, who was speaking to Jackson from a seventeenth-floor apartment, told him that she was looking down to the street below. "I realize that what you're asking me to do is to jump that distance," she said.
Temple Grandin was in her early sixties at the time. "When I heard that Claire Danes was gonna be playing me in the movies, I went to the Internet and looked her up. I saw the long blond hair, and I thought, You gotta be kidding!" she said. Danes invited Grandin to lunch in her New York loft. As Grandin explained what it felt like to be autistic, Danes filmed her and recorded her voice to study. "Temple was so candid, so guileless," Danes said. Grandin could not hear consonants well; she overcompensated by hitting them hard, something Danes picked up on in her voice work. Danes enlisted Rogoff to help teach her Grandin's rigid movements, undergoing a regimen of physical realignment that went on for weeks. "Claire is totally the opposite of Temple. She projects out," Rogoff said. "We had to change the way she held her head. I had to pull her chin all the way back, because if you're autistic you're not communicating with the world—you're communicating within." Together, Danes and Rogoff developed a "panic lock": a hunched, fearful posture, in which Danes's pelvis and rib cage were yoked together so that she moved "like a cow bent heavy under you." To this, they added gestures: hand wringing, leg shaking, hair stroking, downward-searching eyes, hyperventilation. To test Grandin's body language, Danes took walks through Wall Street traffic and into the subway. Being caged inside this unstable physical frame brought her new insights. "Your internal world becomes really vast when you're that disengaged," she said. "I thought that it would be lonely playing Temple, because she's socially isolated. But she's so turned on by her ideas that she has the company of the ideas. She didn't have the same needs that I had. That was an interesting lesson. What I perceive as a loss isn't necessarily a loss for her."
As the first day of shooting approached, Jackson repeatedly asked Danes if she'd like to show him anything. "She said, 'I don't think you'll be disappointed, but I'm not ready to show you yet,' " Jackson recalled. For the first scene of the film, Danes looked at the camera and announced, "My name is Temple Grandin." At that moment, Jackson said, "the hair stood up on the backs of our heads. Not only had she got the booming voice, but when she walked from one corner of the room to the other she strode leading with the shoulders, and I thought, Oh, my God, that's Temple Grandin." Danes didn't imitate Grandin; she channelled her. She found delightful moments of humor in Grandin's gaucheness, and her protean face worked its weird magic. "There are scenes where she looks like a young Grace Kelly and scenes where she looks like an old horse-faced English duchess," Jackson said. Danes refused to watch the rushes. "I think she very much wanted to be in the moment and not to have that moment broken by thinking, How do I look? Is my right profile showing to my best advantage?" Jackson said. "She wants that moment to be sacrosanct—the moment when you're in the character and nothing else in the world matters."
Of the many accolades Danes received for the performance—an Emmy and a Golden Globe among them—the ultimate one was bestowed offstage. When Danes's name was called at the Golden Globes and she rose slowly from her seat in a backless salmon-pink gown, Grandin, seated next to her in Western regalia, stood and embraced her. Grandin keeps a framed note from Danes in her house. "Through you I think I have become a better person," it says.
The day after "Temple Grandin" aired, in early 2010, the television writer-producers Alex Gansa and Howard Gordon, who had worked on "24," sat down to discuss their idea for a new psychological thriller based on the Israeli series "Prisoners of War," by Gideon Raff. "24," a series about the male intelligence officer Jack Bauer (Kiefer Sutherland), a go-it-alone hero who spent as much time fighting red tape as he did fighting terrorism, had premièred two months after 9/11. But eight seasons later, in the world of Abu Ghraib, Guantánamo, and drone strikes, the political landscape was murkier, and it had become increasingly difficult to tell the cowboys from the Indians. "There was this wonderful irony," Gordon said. "The thing that we had to be most afraid of was a monster of our own creation." When he and Gansa conceived their show, which became "Homeland," their primary concern was America's fear fatigue. "The law of unintended consequences had created all this collateral damage," Gordon said. "There were no good answers. We just wanted to dramatize the complexity." Their story, embroidered from the headlines of the day, gave shape to the country's growing skepticism and fear of blowback.
One of the nation's greatest losses on 9/11 was its illusion of invincibility. Carrie Mathison, poised between breakthrough and breakdown, personified the country's deracinating confusion. Both Carrie and Sergeant Brody, who was held hostage by Al Qaeda for eight years, see themselves as patriots; both, in different ways, risk their credibility. "We knew we wanted to create an unreliable narrator, or, at least, someone whom most other people looked at as being unreliable, in part because of her youth, in part because of her record, and in part because of her gender," Gordon said of Carrie. "Unlike Jack Bauer, she is a woman who was marginalized. We reverse-engineered her. We pathologized her to account for her gift."
Gordon and Gansa's early screenplay drafts made no mention of bipolar disorder. "We created Carrie's behavior, then stumbled on the diagnosis," Gordon said. Although the illness elevated Carrie into the realm of the extraordinary—"They fly closer to the sun than the rest of us," Gansa said of bipolar-disorder sufferers—it also gave her a defining obstacle to negotiate, a double time bomb, which threatens at every moment to blow up her mission and her life. "It's her kryptonite," Gordon said, a natural weakness that maximizes her loneliness, her secrecy, and her fear of intimacy.
Gansa and Gordon had seen how in "Temple Grandin" Danes walked the razor's edge between competence and unbalance. "There's something in her that feels a little bit broken," Gordon said. Their new heroine was, similarly, "an extremely intelligent woman freighted with a real emotional problem." The writing team envisaged Danes in the role from the beginning—for the first six drafts of their pilot they called their character Claire. The network argued for an older woman to play Carrie. At the time, TV series such as "Weeds," "Nurse Jackie," and "The United States of Tara" were finding success with actresses in their late thirties and forties. But Gansa and Gordon were adamant. "We wanted Carrie to have this flaw, this illness, but to give her the opportunity to maybe rise above it, to fashion her life in a way that opened up the possibility that she would have another chapter," Gansa said. "If you're forty-five or forty-six, and you've been living with bipolar illness all this time, the story is already written. The audience cannot root for the character in the same way."
Gansa and Gordon finally met with Danes on November 1, 2010, over drinks at the London, in West Hollywood. "We were prepared to have our hearts broken when she said no," Gansa recalled. For her part, Danes was beginning to believe that she'd never again be offered a challenging film role. In the nearly two years since she shot "Temple Grandin," her career had languished. "It was getting painful. I was starting to kind of cry a lot. Sort of uncontrollably," she said. "I'd had such a deeply fulfilling experience that I just was not gonna settle." At the time of her meeting with Gansa and Gordon, she was up for a supporting role as J. Edgar Hoover's secretary, in Clint Eastwood's "J. Edgar." "Here was this F.B.I. story and I was thinking about it in the same weekend as this C.I.A. story," she said. "I was thinking, you know—I could be the secretary or I could be Hoover."
The show's first season opened, in 2011, with an establishing shot of an agitated Carrie Mathison beseeching her controllers to protect her source while impatiently negotiating Baghdad traffic. Viewers were thrust directly into the center of "Homeland" 's two dramas: the one outside Carrie's mind and the one inside it. Danes's job on the show, Gansa said, "was to be an open wound." In the postmodern TV crime thriller—"The Killing," "The Bridge," "Monk"—it's not enough for the detective to solve the problem; the detective also has to have a problem, to struggle both with society and with the self. "It's micro and macro," Danes said. "I thought about it in those terms."
To prepare for the role, Danes read medical texts, consulted with therapists and bipolar patients, and followed the blogs of people in hypomanic states. (Her own bipolar acquaintances, she complained, were all "annoyingly medicated.") "I have always been curious about people who are wired in a fundamentally different way from most of us and was eager to integrate the bipolar condition into the character, without turning it into a gimmick," she told me in an e-mail, adding, of Carrie, "I also appreciated the dichotomy between her obvious flaws and transgressions and her strong moral core. For all her recklessness, she is surprisingly earnest and honest. Another fun paradox: she dedicates herself entirely to the noble cause of protecting her country, but she doesn't do it simply for noble reasons. She is terrified of forging intimate relationships with others—which is, basically, what constitutes a life—because she knows the kind of damage that her condition can wreak. Because she has such an anemic life, it is easier for her to risk losing it on behalf of her cause. While this is an advantage of sorts, she must live with the pain of her loneliness. She is, basically, a classic superhero. Who wouldn't want to play that?"
In Season 3, Carrie blames the C.I.A. car bombing in the Season 2 finale on a lack of vigilance caused by her medicated "normality" and goes off her meds. Danes welcomes the narrative volte-face. "I want to see more of the boring work involved in just maintaining a healthy plateau," she said. "I think we have to see her slog through the daily grind. I think we owe it to audiences."
It is Carrie's fear of intimacy, paired with promiscuity, that shapes the show's steamy romantic subplot—a mystifying game of cat and mouse between Carrie and Brody. "It's a way of getting out of their heads," Danes said of the sexual compulsiveness of some bipolar sufferers. "It's another kind of self-medication." Danes refers to Carrie's exhilarating rounds of slap-and-tickle with Brody as a "slalom." Part of the characters' sparky charisma is due to the transparent opaqueness of Lewis, an Old Etonian playing an American marine. "He has a slightly cheeky, naughty on-set demeanor, which I'm missing now that our characters are so physically estranged in the third season," Danes said. "I can throw hard and fast and he'll always catch the ball and return it in surprising ways." Gordon recalled, "The chemistry between them we saw the first day they were together, but they were adversarial. It really wasn't until Episode 4 in the car park, when Claire puts herself in front of him and plays him, and he scrutinizes her and doesn't quite know what to believe about her—that was where we thought that this was going to be special. It was dangerous; it was electric; it was alive."
The pilot of "Homeland" aired on October 2, 2011, and drew more than a million viewers—the highest-rated début of a Showtime drama in eight years. More than 1.7 million people tuned in for the première of the second season; by the finale, that number had grown to 2.3 million. Danes, who had become an icon for a generation as a teen-ager, reclaimed that stature as an adult. Fans began to approach her "with a rabid look in their eyes." The admiration reached as far as the White House. According to Danes, President Obama, who was given an autographed boxed set of the series, told her when they met, "You're a finer actress than I am President." Danes has a seven-year contract for "Homeland," but she has learned to take nothing for granted. "Who knows if it will last that long," she said. "No character is safe."
On the last day of shooting for the Season 3 première, Danes sat working her iPhone outside a liquor store in the Plaza Midwood area of Charlotte. She had just taped a scene in which Carrie panic-buys tequila, her current self-medication of choice, and is approached by a hunky shopper. Glatter darted out of the store's crepuscular gloom. "I'm gonna miss you," she said to Danes.
"You're around, right?" Danes said, glancing up at her director.
"Oh, yes. Forever. You're stuck with me till November."
Danes was leaving the next day for a trip to her farmhouse, in the Hudson Valley, where she would spend time with her parents and Dancy and their son, Cyrus, who was born last December. (Danes had to use a "belly double" for the final episodes of Season 2, when she was eight months pregnant.) In addition to a newly purchased town house in the West Village, Danes also keeps an apartment on the forty-second floor of a Charlotte skyscraper, and a place with Dancy in Toronto, where he films the NBC series "Hannibal."
"That's perfect," Glatter said. "It'll be nice to have that break before all the emotional stuff to come."
"Yeah, I know," Danes said, fixing her with a look.
Glatter disappeared back into the liquor store, which was also a treasure trove of novelty items: stickers ("Unattended Children Will Be Given Espresso and a Free Puppy"); exotic coffees (Booty Call, Bad Hair Day, and Sexy Power, the blend that Danes bought for Dancy); and specialty wine labels, some of which Glatter broadcast from the air-conditioned store to the sweltering world outside (Naked on Roller Skates, Yard Dog, Broke Ass). After filming her last scene, Danes had lingered in the store to snap a shot of a sticker, which she planned to post to Instagram: "If Women Ruled the World There Would Be No Wars Just a Bunch of Jealous Countries Not Talking to Each Other."
"I'm away from everybody in my life," she said, to explain her attachment to her phone. "Wherever I am, I'm estranged." She elaborated later, "You just have to accept that you're always going to be missing someone. But, as you're missing one set of people, you're getting reacquainted with others. I have dear friends in L.A., in New York, upstate, friends now in Toronto. I had to create a community there when I became a mom."
At her New York town house, Danes keeps drawers full of glitter, pipe cleaners, and fabric paint, and frequently has craft days with friends. Dancy won her heart a few years ago when he helped her throw a Christmas-ornament-decoration party and cut out an intricate pattern of cowboy paper dolls with "Holiday" written on them. "I thought, You can craft? That was it. I was done. I concede myself to you totally and forevermore," she said.
Danes is also an enthusiast of the costume party. "In New York, people tend to party-hop," she said. "If they're in a costume, they're stuck there. It loosens them up." For her thirtieth-birthday party, which was Easter-themed, she dressed up as thirty pieces of silver; Dancy was a severed ear; her father wore an Easter basket on his head; and Michael Cunningham, in a suit, sunglasses, and stigmata, walked around saying, "No, don't thank me. It was nothing. I was glad to do it."
Danes holds an annual Eggathon, in which about a dozen friends come to her place to create exotic Easter eggs. The best of them are photographed for albums curated by Dancy. "It's very competitive who makes the cover, sort of like the swimsuit issue of Sports Illustrated," Danes said. On an April visit to her town house, she took me to the second-floor living room to show off her contribution to the most recent volume, "Oh-Very"—an egg wedged inside a russet Twinings English Breakfast tea-bag wrapper, a bit of Pop Art irony. By general agreement, Dancy's tribute to Marcel Duchamp—an egg in the form of a urinal, signed "R. Butt"—is the high-water mark of the competition so far. But the album had some strong contenders: an Obama egg, an I. M. Pei egg, with large circular spectacles, and a Donald Trump egg, with a shock of big hair.
At some point in the conversation, as the willow tree in her small courtyard played tricks with the afternoon light and Cyrus woke up from his afternoon nap, Danes leaned back on her upholstered sofa and reflected on the career she had chosen as a child. "I think the more whole you are as a person—the more integrated—the deeper you can go into scary territory," she said. "It's just amazing that we have a means of doing that safely. What better thing is there? It's so cool to get that much more of an understanding of what it is to be a person." ♦

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