Woman Who Thought too Much, The

by Limburg, Joanne

  On 20 October, I wrote: ‘Grief is not clean after all.’ If I had thought about grief at all, I had imagined it as a kind of sacramental, white-robed figure, seated in statuesque dignity, with a single, silent tear running down its marble cheek. As I experienced it, however, grief was more of an irritable, snapping, howling, flailing, red-faced snot-monster. I just didn’t know what to do with it, or myself. Linda helped. Molly and Maria, who had both lost fathers in childhood, were wonderful. My friend and landlord – I’ll call him Neil – was flummoxed, and got the worst of me and my keening snot-monster. We railed at him about the state of the flat, about the noise his music made – as if mine never did – about how he ate too much junk food and watched too much rubbish TV – as if that were any of my business – and, ironic, this, about the unwashed cups and plates lying around the floor.

  In the long run, I would discover that the experience of bigger losses could help to put the smaller ills of life in their proper perspective, but first I had to disentangle myself from the snot-monster, who couldn’t tolerate so much as the tiniest smudge on the corner of a lens, and insisted that my flatmate, who was trying to save on bills, switch the combi-boiler back on so that I could wash my glasses in hot running water right there, right then. One night, we had a party and recorded everyone’s height on the wall on the hallway. Next to my name we’d written ‘Psycho Hormonal Hellbitch’.

  All this time, the bad news kept coming: my mother returned to work after three weeks’ compassionate leave and was immediately called into her new superior’s office to be told she’d been made redundant. Two weeks after that, Uncle Derek died of a heart attack in Spain, leaving conflicting and half-updated wills in several countries, a partner he’d written out of them every time they’d argued and reinstated every time they’d made up, and enough work to keep half a dozen lawyers with half a dozen Dictaphones happily occupied for half a dozen years. My grandfather had a stroke and went into hospital. Then he came out again, but no one could say how long it would be for. Then Marian, who had sympathized over my stomach cramps on the way to the funeral, was diagnosed with ovarian cancer. My best friend fell unexpectedly pregnant, was frightened, nauseous, and frantically busy with her speeded-up wedding preparations. Up in Edinburgh, my friend Catherine’s partner – with whom she now had a child – had been made redundant in the spring and was still looking for work. It was raining knives.

  I only lasted a few more weeks at work. I went along to an interview at Napier University for their careers guidance course, where they looked at my chequered CV and asked if I didn’t think that it indicated some instability, but offered me a place anyway. I went back to work in my smart blue wool dress that my mother had bought for me to mourn in, sat in the office kitchen, and sobbed. Meanwhile, a young work experience girl, who had lost her mother the previous day, was sitting in the tape room quietly getting on with it. I resented it – how admirable she must seem to everyone next to me and the hideous, attention-seeking snot-monster – and I felt ashamed of myself for being so petty. I don’t know what her circumstances were; I don’t know what there was at home that made it more comfortable for her to go into work as though nothing had happened. I understand now that she had to do it her way. I couldn’t help but do it my way, so I took myself off to the doctor.

  My previous encounters with this particular GP had been unsatisfactory and awkward. Somewhere towards the end of my first Scottish summer, I had embarrassed him with my breathless rattling on about why I thought that a summer heat rash on my inner thigh might have been indicative of something sexually transmitted, and he had shoved me into the nurse’s room next door, where she’d had a chat to me about safe sex and given me a vast supply of free condoms, which would sit in the bottom of my handbag until they perished. The following spring, he had examined me when I had complained of ‘severe abdominal pain’, told me that he could feel the hard stools through my skin because I was ‘so lovely and slim’ and prescribed Fybogel, which tasted disgusting and only made me pee a lot. His colleague, of the Christmas tree rash, had been more sympathetic, diagnosed me with irritable bowel syndrome and referred me to a dietician, who said that she wasn’t going to do anything until I’d had some nasty tests done. The nasty tests were never ordered; before long I would move on to Nottingham, a new surgery, new crises, and that would be that.

  So, I got my second choice of GP, but this time it was more straightforward for both of us. I was a young woman far from home who had only just lost her father, and I had no energy left for anything but grief. We both knew that there was nothing abnormal in that, that it was only the reflex response to a painful blow, but it was within his power to sign me off work for a couple of weeks, so he did. He made a point of writing ‘debility’ on my sick note, a term non-specific enough not to stain my medical records, as the word ‘depression’ might have done. Grief looks a lot like depression, but it is not usually labelled as such unless its symptoms – the ‘negative affect’, the guilt, the weeping, the sleeplessness and loss of appetite, the preoccupation with what has been lost, the lack of interest in what remains, the intense anxiety – persist longer than our culture deems appropriate. Reading that last sentence over, though, I think I’m running the risk of making this seem too clear cut, so at this point I’m going to throw in a recognized psychiatric term, ‘reactive depression’, which I would define roughly as ‘depressive symptoms triggered by an external event, generally one that would depress anybody’, and leave you to see if you can sort out the sick from the well. Thanks to the existence of sick leave and the handy word ‘debility’, the doctor and I didn’t have to.

  A fortnight later, I saw him for a follow-up and he agreed to sign me off indefinitely. I spent the remaining few weeks in Edinburgh holed up in my room with the Calor gas heater on and sometimes a throw round my shoulders for good measure, to keep the terrible cold away. I took advantage of the unstructured days, reading a couple of big books, Anna Karenina and The Golden Notebook.

  I accepted a place at Nottingham, applied for a career development loan, and arranged another room to rent. I worked furiously on new poems, and filled page after page in my notebook about my father and how it felt to lose him, trying desperately to catch him between the pages, just in case he should disappear from my memory as suddenly and completely as he had vanished from the world. He was my responsibility now.

  In January, I moved to Nottingham and began a new exercise book. I was thinking mostly of my father, his death and my family. On the fourteenth I wrote sadly that he had ‘shoved himself into a corner of his life, like a scarf in a glove compartment’. Two days later, I recorded a couple of dreams about him.

  16/1

  Dreams:

  Dad alive, grimacing and shouting behind the wheel, as we drove across the border.

  Dad in a nursing home, recovering from heart attack. He flopped. Thought he was pretending to have another. Yelled: ‘How could you! How could you! After all we’ve gone through!’ And shook him but he really was dead, grey, floppy, eyes like a dead kitten.

  A few pages on, I have recorded another dream, this time in just two words: ‘Plastic Sunlight’. I must have seen that doctor already. He was a locum, a retired general practitioner so wonderfully, tweedily decrepit that he looked as if he had been pulled out of some dusty, antique doctor-cabinet. I gave him the sad story: the bereavement, sick leave in Edinburgh, the stress of a new town, a new course, the continued turmoil back in London . . . By this time he was pulling the prescription pad towards him, and clicking his pen into gear.

  ‘Would you say you were depressed?’ he asked. The pen hovered.

  ‘Yes.’

  ‘Maybe some medication – something like Prozac?’

  ‘Yes,’ I said, and the pen came in to land.

  It had only taken a few minutes. He’d got the weeping, blethering girl out of the consulting room and I had my first prescription for mind-altering drugs. I’d lost count of the number of medical appointments I’d had
up and down the country in which I’d complained of being miserable for no reason and been sent on my way; only now that my misery might be said to be proportionate to my circumstances did I get the medication. But then, what else could he do – medicate the circumstances?

  Sometimes I found myself wishing that I were a nineteenth-century lady of similar temperament but probably greater means, who could, whenever life became intolerable, admit herself to a luxury sanatorium for a ‘rest cure’, a term which I understood to mean comfortable beds, good food, chaperoned walks in landscaped gardens, sea air and the care of concerned but respectful nurses who would bring tea, toast and smelling salts at the ring of a drawing-room bell; once a week one of them would show a bearded, whiskered doctor into my room, so that he could take my febrile pulse and tell me not to overexert myself. He would be a little patronizing, maybe, but I wouldn’t mind, just as long as he allowed me to write in my journal once a day, and once or twice a week to compose exquisitely written letters to my literary friends. A hundred years later these letters would be pulled out of their archives and fought over by research students in women’s studies departments. As would the journal.

  If I had been that nervous Victorian lady, nothing much would have been expected of me. In the eyes of my whiskered doctor, I would have been constitutionally weak in body, weak in moral fibre and weaker still in intellect. Had I not tried to step out of my proper sphere with my intellectual strivings, I might not have inflicted so much strain on my poor feminine nerves. He would have advised me most strongly to abandon the writing and the reading of fat, heavy books. He might have permitted me to marry an undemanding husband and live quietly somewhere. Depending on his view of my case, he might also have taken the undemanding husband aside and advised him against getting me pregnant more often than he could help. (Meanwhile, my working-class counterpart would sink, gin-soaked, into an unmarked grave.)

  And if, a hundred years later, a research student in one of the women’s studies departments went to her doctor and complained of symptoms much like those she was reading about in my letters, explaining perhaps how she felt too anxious and too enervated to do what could reasonably be expected of her – work on her thesis, present and defend her work at seminars, travel to conferences, teach undergraduates, take the train to London with her friends for wild nights out, have sex and generally assert herself all over the place – the doctor might agree with her that the depression and anxiety were interfering with what we call her ‘functioning’, and hand her a prescription. Perhaps he – or she – might suggest that our women’s studies student needed to relax now and then and ‘make the time’ to rest, but there would be no question of giving it all up and spending the rest of her life on a day bed somewhere while other people tiptoed around her. That kind of behaviour is dependent, avoidant and passive-aggressive; worse than that, it’s unproductive, so it just won’t wash any more. Pick up thy day bed and function.

  There are people, I know, who can function and grieve at the same time, but I was struggling to do both. The grief work was unavoidable: it could be neither shelved nor postponed. I could have had my place on the course cancelled or deferred, but I was no more able to make such a decision than I had been as a sixth former or an undergraduate. My brother was doing his PhD, my cousins both had their careers, and I had to be seen to be going somewhere too; being bereaved was bad enough, but being a bereaved failure would be intolerable. And doing a course, even a vocational one, would be easier than trying to drag myself to work in the morning. I knew how to be a student. It felt safe. Besides, quitting the course would have meant moving back into my parents’ – now mother’s – house in London, where I had always felt stuck and where my father’s unbearable absence would take over my outer world just as it filled my interior one. But I couldn’t find the brave face I needed to share a house with other students, to get on the bus to the campus, to join in with class discussion and role play, to socialize at lunchtime, to not start crying for no reason, to not sit around staring morbidly into space, to not get irritable, to not go on about my father and my grieving when it wouldn’t be appropriate, to sleep, to feed myself properly, to do what could be reasonably expected of me, to function, so I had gone to the doctor, and the doctor had written a prescription for something which might help.

  On the one hand, I was thrilled to be given that prescription. There was a kind of Woody Allen heroine glamour about it, and I felt as if I had now achieved promotion to some higher order of neurotic. I would get to partake first-hand in a bona fide cultural phenomenon, and that was exciting too. And, not to forget, it might help. On the other hand, I was terrified. I was very protective of my mind, however much gyp it gave me, and very wary of anything that might alter it. I suppose I had a profoundly held belief in the authenticity, the intrinsic value of myself, my thoughts and my feelings even though I frequently felt nothing but contempt for every one of them. So I made an appointment with my course tutor to discuss my dilemma, then I went to Boots to get my prescription made up, and then I shoved it to the bottom of my backpack and made straight for the nearest bookshop.

  I found a book by an American psychiatrist called Ronald R. Fieve. Its title, PROZAC, was printed in tall, dynamic green letters on the cover; it claimed to be A Complete Guide to Today’s Most Controversial ‘Miracle Cure’, so I bought it. I do like the word ‘complete’ in a book title.

  The book was arranged as a series of questions and answers. In response to ‘What causes depression?’ Dr Fieve had written:

  The modern theory of depression hypothesizes that mood disorders are caused by imbalance in the number of small amino acid molecules, called neurotransmitters, that travel between nerves across the so-called synapses in the brain. Synapses are the spaces between two successive nerve fibers.

  According to this theory, known as the biogenic amine hypothesis, the three major neurotransmitters located in brain synapses are: norepinephrine (NE), serotonin (SE), and dopamine (DA). The regulating mechanism is a complex one. It includes a process called uptake, whereby some of the neuro transmitter molecules in the synapse are absorbed back into the original nerve endings, where they either degenerate or are repackaged and sent back out again. Sometimes, as a result of genetic and environmental factors, this process produces imbalances in the amount of neurotransmitters in the synapses. An excess of one or more of the neurotransmitters is thought to lead to mania. A deficiency is thought to result in depression. [pp. 45–6]

  The next question was ‘How do Prozac and other antidepressants work?’ and his answer began:

  Prozac works by specifically inhibiting the uptake of serotonin at the nerve endings in the brain. This results in an increased concentration of serotonin at the synapse, which in turn increases the availability of serotonin at the critically important brain receptor sites, thought to result in normal nervous system transmission.

  Prozac and the other SSRIs are highly specific in blocking the uptake only of serotonin, and not other neurotransmitters; this is why they are known as selective serotonin reuptake inhibitors (SSRIs). Because abnormalities in serotonin function have also been reported in obsessive-compulsive disorder, panic disorder, alcoholism, obesity and other conditions, it is not surprising that some of these disorders have been successfully treated with Prozac and other SSRIs. [p. 46]

  I liked Dr Fieve’s book and still do. One of the reasons I like it is that he does not, in these passages or anywhere else, give the reader any kind of simplistic hard sell. Look at his careful wording: writing for a general reader, he might well have said, ‘Depression is caused by . . .’ Instead he plumps for the far more cautious: ‘The modern theory of depression hypothesizes that . . .’ If I was going to be all picky and perfectionist about it, I might point out that this theory is not held by everybody, and so might be more accurately characterized as, say, ‘The theory of depression which might be said to have gained currency among the majority of psychiatrists, general practitioners and the public in the weste
rn world today [1994] hypothesizes that . . .’ but I’ll resist the temptation. Certainly, he struck me as far more responsible than the author of the book next to him on the Popular Psychology shelf, who advocated exercise and the regular intake of bananas as the best way to raise one’s serotonin levels and thus to become a better and happier human being. Dr Fieve’s ‘hypothesizes’ and ‘is thought to’ and ‘have been reported in’ are good examples of the kind of careful, unsensational language typical of the scientific journals where the results of drug trials and studies are first published for their specialist audiences. By the time these reports get to the newspapers and magazines which the laity read, they have lost a good deal of their specificity and refinement, so what gets fed to us is something like:

  DEPRESSION CAUSED BY LOW SEROTONIN, SAYS TOP PSYCHIATRIST

  Dr Fieve may well be a top psychiatrist, and he seems to have been strongly in favour of the serotonin hypothesis, but that’s still not what he said.

  As I understand it, what we can say is that there is a correlation between low levels of available serotonin in the brain and the presence of some or all of the cluster of feelings, thoughts and observable behaviours which we label ‘depression’. To say that there is a ‘correlation’ between two phenomena is simply to state that they appear at the same time and the same place too often and too consistently for this to be coincidental – probably. A sad person, when tested, might well be found to have low levels of available serotonin trickling about in her brain. Maybe the lack of serotonin made her sad. Maybe her sadness depleted the serotonin. Maybe some other, unknown cause depleted the serotonin and made her sad. There was one obvious cause for the sadness I was feeling in January 1997, and that was the death of my father. On page 42 of Dr Fieve’s book, his patient asks, ‘What are the symptoms of grief or bereavement, and does Prozac help in their treatment?’ To which he replies: