I have altered some identifying features and written under a penname to preserve my anonymity, in order to protect my children from the contents of the following.
If you would like to respond in any way to this article, I would welcome an email to firstname.lastname@example.org
It was meant to be so wonderful. We had moved to live overseas for a few years and I was full of anticipation for the delights of our new home.
It wasn't to be.
Soon after our arrival, the clouds began amassing and a shadow crept over me. It was imperceptible at first, but then one morning I woke to the recognition that the wonderful new life that was meant to be happening, wasn't.
I didn't know what was wrong with me. Sure there were some disappointments with aspects of our move, but nothing that would generate the level of malaise I was feeling. Besides, they were more than compensated for by all the new experiences and the wonderful place we now lived in.
I threw myself into as many aspects of our new abode as I could. I went exploring. I indulged my passions for photography and music. I made new friends. Things were going quite well.
And then there was another morning, when I again awoke to a recognition. This time it was, inexplicably, that I no longer wanted to continue with my life. Wham. Just like that. I wanted to be dead.
I was ignorant of depression as a clinical illness. And so, it seems was the GP I had the great misfortune to register with. He was – well, I'll keep the language clean and just say he was hopelessly inept. He suggested that my physical weakness and fatigue was simply due to a stomach bug I'd picked up in our travels and that being suicidal was somehow just extreme homesickness, although I had no desire to return home. I had no desire for anything except annihilation.
We lived in an attic and had to climb 53 steps to our door. I had to rest every few steps. A cake of soap in the shower felt as heavy as a brick. I slept in excess of 14 hours each night and was profoundly exhausted. My whole being was flooded with a sadness too deep and too terrible for words.
It was only mid-morning in the "day" of my life, but I was ready for the end of the day. It was time to turn the lights out and go to a sleep that would never end.
There are lists of stress factors that you learn about in stress management courses, with a score or rating assigned to each of the various stressors you may deal with. My accumulated score was way over the danger level when I added up the previous twelve months' events. I was more than vulnerable to any number of complications that may arise from extreme stress.
Add to that a family history of depression, and I had no chance of escape.
The thing that bugs me most about this though, is that I did eventually deal with all those accumulated stresses. I "worked through" them and "resolved" the various issues of pain, disappointment and anger. I "adjusted to change". I exercised all those buzz words, did all that work, and moved on – but the damn depression didn't.
I liken my illness to adult development of a heart condition or perhaps diabetes, where various lifestyle factors, and maybe a hereditary vulnerability, leads to the problem developing. And even when adjustments to lifestyle, diet and all manner of other measures are undertaken, the problem remains. The body somehow doesn't catch on that the original cause or trigger has gone now, and that it can now correct itself and become as it was before the problem began.
So despite the recovery and healing of my emotions and mind, the damage had been done. The uninvited guest had seemingly taken up permanent residence. I was clinically depressed.
The medics aren't really that sure exactly what causes depression, nor exactly why the various treatments available actually work. It's something to do with neurotransmitters – the things in your brain that take messages from one part to the next. And I know that my neurotransmitters are screwed. They don't do everything they're meant to do. Who knows – they may even be doing things they're not meant to do. I don't know what's wrong with them. I just know they don't work properly, with an extraordinary impact on my mood and ability to function as a person.
It means I am unable to respond emotionally to the normal stimuli of life and the world. There is a dull greyness to everything within and around me. I have the same blank response to both wonderful news and devastating news. There is a sadness that is too terrible for words.
During the really bad days or weeks or months, it is almost impossible to describe.
In between the really bad times, there are times when it's still bad, but I'm not right on the brink. I call this the twilight zone, where I just hang around waiting to get better. It is where I spend most of my time. I'm not in crisis mode. Nor am I alive. I'm simply continuing to exist. I am disengaged from the world around me, the people in it, and the events that occur in it.
Then there have been times with definite warmth and colour. I call these my golden moments, for they are glittering jewels brightening the heavy grey manacles of my twelve year journey with this illness.
And then, for a few precious weeks last year, there was a time when those wonderful golden moments paled into insignificance, as I became ME again. There was nothing particularly significant or good happening in my life, but the joy in having it (my life) was overwhelming. I delighted in just being me as I once was. I was so content to be alive. Having an ordinary life again was extraordinarily beautiful.
But the twilight zone and those awesome, plunging depths … these have dominated my existence.
The terms "sad" and "depression" are actually very unhelpful in talking about this illness because normal healthy people use them for everyday life. We all get sad when sad things happen. We all have days when we feel a bit down and the word depressed seems appropriate. This is part of normal, healthy human existence.
But to use the same words "sad" and "depression" in the context of this illness is like using your standard school-issue desk ruler to measure the distance across the Nullarbor, except that the "sad" and "depression" of clinical depression isn't part of the same continuum as the healthy "sad" and "depression" of everyday.
It is a completely different beast for which a whole new vocabulary and measurement is desperately needed.
It's a severe labour contraction as opposed to mild menstrual discomfort.
It's a dangerous asthma attack as opposed to breathing a little heavily after a walk.
It's having your leg blown off as opposed to stubbing your toe.
The nature and degree of the sadness bears no resemblance to what I used to experience in reaction to events in my life. And it comes and goes independently of events in my life.
I am filled with a fathomless sadness for which I can find no fathomable reason. I have many good things in my life, much to be thankful for and very little to be sad about, yet I am unaccountably and deeply sad.
It flouts reason. I'm a logical, analytical person who likes to deal with causes and effects, so you can imagine this has taken some getting used to.
It wipes out my emotional capacity as a person, so I become disconnected from the world and uninvolved with the people in my life. It engenders an unbearable loneliness that nothing can ease, because I am unable to be engaged with any person, thing, event or issue.
It takes me to a place of intense emptiness, a barren void, a bottomless abyss.
And there is nothing I can do to control it.
There are different types of, or aspects to, depression. For some, the illness is primarily physiological or biological, for others it is primarily psychological. The terms sometimes used are "endogenous" and "reactional" for these two types.
Actually, there's been a bit of an unhelpful trend to want to label a depression as being either biological or reactional but not both, and an even more unhelpful trend to make the judgement that those with a significant reactional or psychological component to their depression are somehow more responsible for their illness that those for whom the depression is primarily biological.
Most sufferers have both components, and it is not helpful to talk about the extent to which someone may be responsible for a clinical illness over which they have little control.
Treatment varies according to the severity and where the focus for an individual's depression lies. If it is primarily psychological, then therapies like CBT (Cognitive Behavioural Therapy), stress and anger management techniques and a whole host of other similar therapies may be of enormous benefit. If the illness is primarily biological, then medication may need to be the focus of the treatment.
In the early stages of my illness I was emotionally fragile, very susceptible to difficult incidents in relationships with others, and very easily sent into a downward spiral of despair. CBT was helpful for me then. I gained some useful life skills, developed a thicker skin, and was enabled to work through issues that needed to be worked through. I even learnt to cope with "the boss from hell" – and that was one seriously unpleasant, unlikable individual.
But it seems that now, the dominating focus of my illness is a severe biological condition. I don't believe I have serious childhood traumas for which I need intensive counselling. I am unaware of unresolved anger at anyone or anything. I am not easily stressed, disappointed or made anxious. I don't need a Seven Point Plan To A Healthy Self Esteem stuck to my mirror – at least, not in order to effect a cure for my illness. Like anyone, assistance with these sorts of things doesn't go astray, but it won't treat my illness.
What I need more than anything is to get those neurotransmitters pulled back into line. Maybe further down the track when they're under control and I get my life back, then there'll be time to sniff around for any deep-seated issues waiting to be dealt with. For now, get me the right drugs, and fast.
And while I'm waiting, throw in copious quantities of moral support.
I have had the much-maligned electric shock treatment (ECT). Seven times I went under general anaesthetic to receive the treatment. In my case, the side effects were pretty hard to deal with, although my sudden forgetfulness became something I could laugh at. I would forget things like my address and how to get home, and was easily disoriented and confused. Memories and events and people that used to be connected were no longer associated together in my mind. I now have no recollection of many events that occurred in the six month period around the ECT. But it isn't like this for everyone that undergoes the treatment, and the medics are constantly working on new ways to administer it to reduce the negative side effects. I can say without hesitation that I'd go through it all again if only I was one of the vast majority for whom the treatment is effective. For me, it wasn't.
Subsequent to the ECT, I was a guinea pig in a research trial and received a new course of treatment called Transcrannial Magnetic Stimulation (TMS). It involved a series of ten sessions (once or twice daily) during which a magnetic field was passed into a particular part of the brain, and activity levels of neurotransmitters were affected. I ended up with a whopping headache after each session, but could walk away from the hospital twenty minutes after walking in. This was much more effective than the ECT in shifting the depression, there was no general anaesthetic involved, and none of the other side effects. While it didn't remove the depression completely, or for good, I was significantly better for quite a few months. However, TMS is not available as a treatment in Australia yet – it is still being trialled.
I have sampled the delights of being an in-patient in a psychiatric ward and was sent along to the group therapy sessions. I had to "share" with someone who truly believed he was Shakespeare. He read some of "his" poetry to me. My roommate was unlike anyone I've ever met before. She had an extreme fetish for anything that was blue. Every last stitch of her clothes were blue as she proudly showed me. She had blue soap, toothbrush, everything, and an intense interest in any of my things (personal or otherwise) that were blue.
Then there was the doctor who got me out of a crisis and a few steps further away from the brink of suicide, and who then got sad and morose during my final session with him because he didn't feel needed any more. But I digress.
I have to make a confession.
I am currently seeing "a shrink". Yes, it's true. I am one of "The People Who Need To See A Shrink". It took me a while to come to terms with this. I really did not want to be one of "Them". But the guy I am seeing is an excellent psychiatrist. He appears to know the medical options, seems to be up with all the latest ideas, treatments and medications. He is also incredibly supportive in helping me manage the illness and in making sense of some of the issues I'm having to deal with. I need him, or more specifically, I need the medical expertise and support that he provides, and I have no sense of shame or inadequacy in that.
A patient with a broken leg needs someone to reset the bones and put on a cast, and also needs someone to help deal with the temporary disability (eg, getting used to the crutches/wheelchair) while waiting for the leg to get better.
In the same way, I need someone with the expertise to find and provide the right medical treatment, and I also need someone to help me manage while I'm waiting for the right treatment to be found. The doctor I'm with is competent at dealing with both aspects and I trust him – not because I have no choice, but because he has earned it.
As for the antidepressants – well, they cop unfair press. They get called "happy pills" and are seen as aids to a better but artificial personality. People who are dependent on them are seen as somehow emotionally inferior and inadequate for needing such a crutch.
Antidepressants are not an artificial mood elevator. Instead, when they work, they enable me to have the feelings I should be having, whether happy or sad. They give me back the ability to be emotionally engaged with the world around me. In fact, during a period of relative health recently, one of the things that I was able to do was to feel appropriately sad at some sad news. It was so incredibly exciting! I felt like a real person again – not an artificial one.
It is a myth that antidepressants stop people from being themselves, and the myth must be dispelled. It is not the tablets that stop me from being myself. It is the illness that does that.
When antidepressants work, the patient is not shielded from the normal emotional disappointments in life. Instead, the patient regains the capacity for normal emotional reactions – including those of disappointment.
In taking antidepressants, I am not asking for protection from sad or other negative feelings – I am asking to have feelings, both positive and negative. I'm asking to feel love for my family. I'm asking to feel grief for a dead friend. I'm asking to feel compassion in response to someone's pain. I'm asking to be emotionally whole again.
And labelling antidepressants as a crutch – well, the problem with the label "crutch" is that the term is used disparagingly, with the implied accusation that one shouldn't need such a crutch.
Yes, I suppose you can call antidepressants a crutch. Just like a pacemaker is, or tablets to reduce dangerously high blood pressure, or physiotherapy treatment after a limb is broken, or insulin shots.
My current incapacity is not something I can just snap out of. It's the result of a biological condition, for which medication is required. And I am allowed to need this medication.
The reality is – people with broken legs need crutches.
The prospect of being dependent on antidepressants, potentially for life, is not bad in itself. People have all manner of health problems that mean they need drugs or other medical aids – for life. I think of this illness along the same lines.
My primary goal is to be symptom-free. I just want my Life and my Self back. In comparison to that, being medication-free is very secondary, and not at all high on my agenda.
There is a sore need for the ignorance and suspicion and stigma surrounding mental illness and its treatments to be dissipated. I hope that in writing this I can achieve something towards that goal.
So how do I manage?
What I want to do is stay in bed, shut the world out, and wait for death. Doing anything other than that takes a supreme effort.
But I drive myself to keep going through the motions of an ordinary life. This isn't just for the sake of keeping up appearances and hiding my "condition" from others for fear of their judgement or misunderstanding (although that's probably a factor with some!). It keeps me sane and in touch with my real (former) self. It keeps me from being sucked into the infinite downward spiralling black hole of depression that would be my destiny if I gave up and stayed in bed, or was admitted to hospital.
I push myself to have conversations with my family and friends and to remain in touch with them.
I force myself to get to the office and to maintain a high enough standard of work to keep my job.
I discipline myself to keep doing some of the things I used to love doing, before this twelve year nightmare began.
Most days, it's just one foot in front of another, in autopilot. When I can muster the energy, it seems to help a little to begin the day with some exercise – it gets the blood moving and my mind on things other than how rotten I feel. If I'm able to push myself hard enough it generates endorphins and temporarily drives out a little of that horrid heavy ache that is my daily burden.
Keeping myself fit and healthy with exercise and a good diet is also an attempt to keep the crippling fatigue that accompanies this illness at bay.
And I allow others to help me.
People often ask what they can do to help.
Basically, they can't help my depression go away – at least not in my experience to date. For that, I need medical treatment, and I have someone more than competent taking care of that. But I need the people around me to help lessen my burden and sense of isolation and loneliness by their signs of support.
It's like I have gone into sudden, painful labour at a friend's house, and am in desperate need of serious pain relief – a fast working general anaesthetic preferably. My friend searches all over for help and finally obtains a panadol tablet from a neighbour. It will have a negligible impact on the pain, but I appreciate the effort that has been made for me and will always remember what she did for me in my hour of need.
And of course, I take the panadol. That way, I know that everything that can be done, has been done, and that in itself, also provides a degree of comfort.
So my advice is – search for and find a panadol and bring it to your labouring friend, knowing it probably won't touch the pain, but that it is the very best you are able to offer her, and it will be appreciated.
Take your recently crippled friend out for the evening, knowing that it won't help him walk again, but it may prove to be a temporary distraction from his disappointment.
Think of something to do for your depressed friend, knowing that you may not be helping the illness go away, but there may be some relief for a moment from the worst of the pain.
Your effort is worth it, even if it doesn't seem so at the time. You may provide some respite or distraction or needed practical help. It is possible there may even be some degree of indirect healing as a result. And your friend will remember your effort. When the capacity for feeling is restored, there will be gratitude.
And please – don't ever ask how she can be depressed when she has so much going for her. Trust me, that tortuous question has been asked enough times already.
This illness is an isolating demon that creates a huge gulf between those who live in this hell and those who don't. So above all else, understand that you cannot understand what life is like in a world you haven't been to.
Stand firmly in solidarity with the sufferer of depression – whether parent, sibling, child or friend – barracking for them from the sidelines, even though you cannot accompany them on their lonely journey through The Valley of The Shadow.
Words are an inadequate tool in describing this place, yet I have felt compelled to break out of the stranglehold this illness has on me, to break the silence that surrounds this mental illness and to loudly and boldly name this hell for the world to hear and see.
Light must be shed on this darkest of dark places.
- July 2003 -
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