by Anna Gekoski
So I think I would say to other sufferers that one person got through: I did. Anybody can; almost anybody. People do get better. But I don’t think you can ever get better just by other people making you better. I think at some point there has to be that personal moment of revelation, which I had moving up here when I saw somehow that the world was more resilient than I thought and I was lifted by that. And that was the nucleus of getting well. If you can reach that with other people’s help that’s fine but I think there is a point where you do have to make a commitment yourself. You can’t simply rely on things like having drugs: you have to want to, you have to make that decision yourself. So I would say you can get better but you need to want to at some point.
***
I’m off-message about depression because I think we regard it too negatively, if it’s possible to say that. The automatic assumption that it is an appalling thing to happen to someone – all the dark imagery and the way people talk about ‘fighting depression’ – that it would be better if it didn’t happen, that it comes in some way from beyond oneself. I got very interested as I was recovering and writing my memoir Nature Cure, in the occurrence of depression in the natural world. What one would call depressive forms. Because whatever its complexities, and whatever its specific causes, depression manifests itself in human beings inside a form which is widespread in the natural world in many living things. The idea that – let’s just stick with humans for the moment – that we react to trouble, to strife, to stress, with the two things we always talk about – flight or fight – is a huge simplification. Throughout the evolution of life there’s been a third way between those two, which is retreat. If fight or flight prove impossible, difficult, incomprehensible, then you retreat into yourself. Playing possum is one. Large numbers of creatures go into conditions of protective unconsciousness when they’re endangered. Their nervous systems, if one was to measure their activity, would very closely resemble those of human depressives: the parasympathetic takes over.
Oliver Sacks is one of the few neurologists who’s written about this wonderfully, in his book on migraines, which he classes as one of those forms of what an earlier psychologist called ‘vegetative retreat’. That is: if you can’t beat them, curl up in a ball and wait ’till it’s gone away. Now this works if you’re a hedgehog and the badger does go away. But when the badger is perhaps metaphorical and doesn’t go away then that’s when we’re in trouble. But I do think that that lesson, that one’s nervous system is not behaving in some unearthly way when these weird things happen to you, but it is an entirely natural response, is useful. It’s a response to a situation that is intolerable but for which you can think of no easy way out – like fighting or flighting – and so you just stick.
So to begin with that and to say: okay, when you’ve gone into this state you’ve actually done something rather sensible and what you need to do now is to listen to that and see that it is a signal. That there is some particle of your life, or existence, or environment, that you need to get away from or change. Just as it would be if you were an animal that had gone into temporary shock, waiting for . . . again, showing psychosomatic symptoms . . . I hadn’t thought of that before, it’s a piece of theatre for the other creatures watching it. And what the process of therapy, or adaptation, then becomes is understanding what it was that, at that moment, caused you to believe that you were unable to do anything about it.
I had some weird, sensory strangenesses during my illness. Auditory hallucinations – no, not hallucinations because I knew they were not real – just auditory phenomena, which, for some reason, my ears had conjured up. And it was quite odd because each ear had its own particular thing. A bass, who could have come from the Russian Orthodox Church, was singing very deeply in one ear and a sort of country band playing light music was playing in the other. Fortunately, they very rarely both did it together! It was an amusing thing, in retrospect. I quite quickly – I wouldn’t go so far as to say saw the funny side of it all – but got to realise that what these anxiety/depression periods are doing to you, is a kind of comedy. It is a disruption of the normal order of your life, which I think is intended for you to – as a really good comedy by Shakespeare would – rethink some of the things that are going on.
Subsequent to having vaguely written something along these lines in Nature Cure, I met a Buddhist psychotherapist. I have no particular feelings about Buddhism one way or another: I think it has a lot of very good points about acceptance, but I don’t like its nihilism and lack of affection for the physical world. But its attitude to depression, I found, is pretty much that you accept the illness as something entirely natural that’s happened to you because you’ve got, or have been put, in a position where you can see no other way out. So the therapy is to, as it were, embrace the depression, not try to fight it, and to work out what the way out is. Which, I suppose, is what all the therapies are, but it just starts from that different position of not regarding the depression as an enemy but as a potential teacher. And I think I’ve come to regard my illness as that: that having recovered from it I learnt an enormous amount about myself.
I don’t think that I really grasped the notion of taking full responsibility for my emotional life until I’d been ill. I think that being ill was the climax of a long build-up of a failure to take responsibility, which in the end forced me to make that decision to take responsibility. So it had a function, it wasn’t a random demonic bolt from the blue. And those failures to take responsibility are linked to that failure to have picked up a positive image of family life, evidenced by the fact of my remaining single for most of my life. I had enormous numbers of relationships but ran away from all of them. I was a classic commitment phobic. And probably really rather nasty in that I think I was quite an attractive guy – I had a number of very glamorous girlfriends – and I entered into relationships with an initial willingness, which in any honest other person would have raised the expectations that things would go further. But as soon as the possibility of a commitment, of living with somebody arose, I panicked and ran away.
I suppose the nest that I’d built for myself in the family home was one place I did feel secure, even though that sounds to contradict what I’ve said about family security. I was still tied to my home, not so much to my mother’s apron strings – because she was getting ill in this process – but I had some secure emotional roots in, as it were, another person’s existence, or another group of people’s existence, which was my family’s home, rather than something which I’d built myself. And a failure to actually generate it for myself, if I am to be tempted into giving an explanation, was because I’d failed to absorb evidence of it being a viable course for me. So I do not regret one second of having been ill because it made me change my life. It made me get out of that enveloped home in which I was locked – which was kind of unconsciousness in itself – and get out and build a life of my own. To fledge, as I put it at the beginning of Nature Cure.
Nature Cure is not a self-help book, it’s a memoir, it’s what happened to me. But I do think that the worst possible way of starting one’s journey back is with the assumption that you are dealing with something diabolic. I don’t mean that literally – diabolic: to do with the devil – but that illness is a merciless enemy that has to be fought off, rather than reflected on. If instead one could say: okay, this is happening, it’s a part of my life, let’s begin by being calm about it. A Buddhist would say thank you for depression. Because it may be about to, as it did for me, prise open something that is wrong with your life and turn it into something new. If you’re lucky; you have to be lucky for that. I know very well that it often goes the opposite way. But it seems to me that’s not a bad way to start. Of course, everybody has to work out their own solution, with the people close to them and with their clinicians. But that would be my philosophy to underpin any therapeutic approach.
So that leaves me in the position of . . . what? Of not wishing depression on anyone as kind of an essential part of
your education – you know, you can’t be a proper human being unless you’ve had a good session of it – but at least saying that if it does happen to you, don’t regard it as the enemy. Don’t regard the experience as necessarily being one of unmitigated disaster, but perhaps begin the long journey back by saying: okay, this has happened to me for a reason which may actually be of help to me as a human being in the end, rather than just wiping out several years of my life. And that’s easier said from a position of having got better, I know, I say that with absolute humility. But for me that’s been true.
The thing that shocked me – that really deeply disappointed me – was when people said to me: ‘You’re so brave to admit all this in Nature Cure.’ It had never crossed my mind that it had anything to do with bravery. Maybe that’s the result of being a writer: that it’s in the nature of things to want to explore them and discuss them publicly, so maybe I’m a special case. But I truthfully had never thought what other people obviously had thought: that there would be consequences of confessing this in public. There weren’t. On the contrary, it was just the opposite, and the idea of the stigma against mental illness – which I know full well exists – is mysterious to me because it’s not something I’ve ever experienced.
I shall always be a little shaky emotionally but the bad days – the bad weeks sometimes – that I have, are never too serious. I always bounce back. I know that it is in my nature to express things that are going wrong in my life physically in some ways. Nothing particularly seriously – I get the full run of chronic ailments that most of us get – but, and again I hope this is consistent, I tend to regard those as: this is me, this is how I work, it’s not an illness. I mean, much of the time I wish it wasn’t there, but I tend to say: ‘Okay, it’s a bit like having one leg longer than the other, it’s a nuisance but it’s who I am.’ So that’s, again, a slightly Buddhist reconciliation with the facts of one’s frailty, that instead of constantly saying: ‘Oh my God, I wish I felt better’ to say: ‘I’ve got a bit of a morning headache, I’m feeling a bit worried today, okay, get on with it, or get over it. It’s not the end of the world. It’s just the continuity of you.’
Afterword
By Dr Richard Bowskill
Reading this collection of powerful and moving personal accounts of well-known individuals’ experiences of mental distress reminds me that being a psychiatrist is a humbling and unique profession. During my day at the office, I have the privilege of treating the whole spectrum of society: from the homeless to the aristocracy, ‘ordinary’ people to ‘celebrities’. Yet despite the differences in people’s circumstances, I regularly hear strikingly similar accounts of the complex and distressing symptoms of mental illness. For mental illness – or the more self-contradictory term of ‘mental health condition’ – is a great equaliser; it respects no boundaries of age, race, culture, wealth, or intellect. Thus, while the accounts in this book may be the experiences of unique people, their stories are common to many.
These testimonies are a valuable contribution to the literature. They give a rich insight into the confusing world of a variety of mental health problems and have the potential to help others manage their distress. Mental illness is part of the human condition and sufferers usually experience a vast and frustrating array of emotions and thoughts. One of the most distressing aspects of mental illness can be the feeling that you are alone with your suffering: that no one understands, that you are the only one to have gone through such discomforting experiences, and the fear that you are descending into madness. Hearing that famous, capable individuals can experience these mental conditions can be a great comfort and ease the burden of solitary suffering.
I also believe that this book will encourage those suffering from mental illness to reach out for support, access and accept treatment, and begin their recovery journeys. There is a myriad of therapies, medications, and self-help techniques available out there and it can be a daunting task to choose between them. So how do people decide how and why to seek help, and what that help might be? In recent research that my colleagues and I conducted on bipolar disorder it rapidly became apparent that individuals do not appraise scientific literature in order to decide whether to take Lithium, or an SSRI, or to undergo art therapy. Instead, decisions about treatment are strongly influenced by anecdote, hearsay, and other people’s accounts of what worked for them. So I believe that these stories – which bring to life celebrities’ personal struggles with a range of common mental illnesses, what treatments they have tried, and their successes and frustrations – will be very powerful tools in motivating others to seek treatment, because: ‘If it works for them, it can work for me.’
These accounts are also helpful on a societal level. For despite the prevalence of mental illness – and the recent advances in understanding and treatment – there remains a widespread social stigma attached to it, born mostly out of ignorance. The mentally ill may no longer be tortured, lobotomised, sterilised, or executed, as in past centuries, but according to a recent survey nearly nine out of ten sufferers still experience negative reactions to their conditions. In extreme cases this is described as worse than the illness itself, discouraging openness, making people feel ashamed, and isolating sufferers. I therefore hope that these stories can help to raise general awareness and knowledge about mental health and dispel some of the more persistent and damaging myths and stereotypes surrounding it.
So what does this book ultimately leave us with? As a practising psychiatrist it reinforces to me how mental illness can affect anyone and, at times, be a source of enormous distress. However, as it further illustrates, those who live with mental illness may still be among the most successful people in their professional fields and lead happy personal lives. Mental disorder is not necessarily a bar to having a fulfilled life. Rather, it is something that can be lived with, treated, recovered and learned from, and in this sense these stories are positive ones of hope and triumph over adversity.
Dr Richard Bowskill, MA MRCP MRCPsych
Consultant Psychiatrist and Medical Director
Factsheets
Depression
What is depression?
Everyone sometimes feels a bit down or blue, but being clinically depressed is something very different. Depression, which is a type of mood (or affective) disorder, may be diagnosed when a person suffers from a low mood that lasts all day every day over a prolonged period of time, or comes and goes repeatedly, adversely interfering with their life.
What are the symptoms of depression?
People suffering from depression may have emotional, behavioural, physical, and cognitive symptoms. These may include feeling sad, having negative and pessimistic thoughts, taking less pleasure in activities that are usually enjoyable, and feelings of low self-esteem and self-confidence. People who are depressed may also have less energy than normal, feel tired all the time, find it hard to concentrate, and suffer from memory problems. They may feel guilty, worthless, numb, in despair, irritable, impatient, restless, anxious, and/or agitated. They may also eat and sleep less or more than normal, cry a lot, lose their sex drive, and have unexplainable physical symptoms. In the most serious cases, sufferers may also have suicidal thoughts and may attempt, or commit, suicide.
Are there different types of depression?
MILD DEPRESSION: People suffering from mild depression usually feel in generally low spirits and have two or three of the symptoms listed above but can continue with most of their day-to-day activities, although these may be more of an effort.
MODERATE DEPRESSION: People suffering from moderate depression frequently have extreme difficulty continuing with their daily lives, and have four or more of the above symptoms.
SEVERE DEPRESSION: People suffering from severe depression have many of the above symptoms, including suicidal thoughts and attempts, and may need to be treated in hospital.
POSTNATAL DEPRESSION (PND): It is thought that up to 85 per cent of women experience a low mood after giving b
irth, commonly called the ‘baby blues’, which usually gets better by itself. However, around 10–15 per cent of new mothers develop PND, which is a more serious and longer-lasting condition. As well as suffering from the usual symptoms of depression, women suffering from PND may also feel unconnected to, or hostile towards, their baby and/or partner. PND may be caused by hormonal changes, a lack of support, major lifestyle changes due to having a baby, social circumstances (such as poor living conditions), and previous mental illness.
How common is depression?
It is thought that around 10 per cent of the general population is suffering from depression at any given time.
Are certain types of people more likely to develop depression?
Anyone can become depressed, including children, adults, the elderly, men, and women. However, it has been found to be more common in females, people of a lower socio-economic status, and those who are unmarried.
Why do people get depression?
Depression is usually the result of a combination of factors:
GENES: Some forms of depression, such as bipolar disorder (see bipolar disorder factsheet), seem to be highly influenced by genes. More common forms of depression have less clear genetic roots, although depression may often appear to run in families.
ENVIRONMENT AND LIFE EXPERIENCES: Distressing events or circumstances as a child (such as poor parenting, sexual and physical abuse) and/or as an adult (such as divorce, bereavement, and work stress) may trigger episodes of depression or make a person more likely to develop it at a later stage.
BODY CHEMISTRY: Abnormal levels of neurotransmitters in the brain (such as lower serotonin levels) and hormonal changes (such as those that occur in pregnancy and menopause) may also trigger depression.