Shoot the Damn Dog: A Memoir of Depression

by Sally Brampton

  Usually, we only act when things become too difficult to bear. By then, we are sometimes sicker than we need have become, and often too lost to help ourselves. Many depressives say they find a second episode of the illness easier to deal with simply because they know the symptoms and get help earlier.

  As with most other illnesses, if the early warning signs are caught early enough and treated accordingly, it may be possible to avert the full-blown disorder. Or, at least, to head off some of its most devastating consequences. A reactive (as in a reaction to life events) or moderate depression is much easier to treat than major depression which, once it is present, can assume an independent, violent life of its own. Nobody quite knows why.

  The origins of depression are both vague and complex. The symptoms, however, are not and it is as well for us all to know them, so we can seek help sooner rather than later.

  So here they are, as defined by The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM—IV) which is used by most psychiatrists and mental health experts to diagnose depressive disorder.

  Mild to moderate depression includes the first two symptoms and at least one other. Severe depression is the first two symptoms and at least five others. For depression to be diagnosed, the symptoms would occur together and for at least two weeks without significant improvement.

  Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., I feel sad or empty) or observation made by others (e.g., appears tearful). In children and adolescents, this can manifest as irritable mood.

  Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either a subjective account or an observation made by others).

  Significant weight loss when not dieting, or weight gain (e.g., a change of more than five per cent of body weight in a month), or a decrease or increase in appetite nearly every day. In children, this could show as a failure to make expected weight gains.

  Insomnia or hypersomnia (sleeping excessively) nearly every day.

  Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).

  Fatigue or loss of energy nearly every day.

  Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).

  A diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).

  Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation (thinking about it constantly) without a specific plan, or a suicide attempt or a specific plan for committing suicide.

  I wish I had sought help more urgently, wish I had known or even understood the symptoms. I waited—for a year—for my mood to lift, telling myself that I was just a bit low or tired, waking day after day convinced that soon I would be right again. In that state of passive ignorance, I had no idea of the demons that were waiting for me and that, once they captured me, would not let me go without a catastrophic struggle.

  They finally got me in the January of 2001. By then, I was lost. Each day hurt, each breath, each step I took. I wanted only to be dead. It was the only thing I could think about.

  Sometimes, the final realisation that you can no longer function or continue with life is called a breakdown. It’s a phrase rarely used by mental health professionals; it’s considered too patronising or demeaning. It’s sufferers themselves who use the expression most often, perhaps because it perfectly describes that state of total collapse. You no longer have control over anything: thoughts, emotions, sleep, appetite. You are, quite literally, broken down. To me it felt like the total disintegration of everything I had ever known about myself.

  Someone once asked me how it felt. I lost my balance, I said. It felt as if I lost my balance. I fell flat on my face and I couldn’t get up again. And if that implies a certain grace, a slow and easy free-fall, then you have me wrong. It was violent and painful and, above all, humiliating.

  People rarely discuss the absolute humiliation of severe depression, the punishing helplessness, the distressing, childlike impotence. When well-intentioned friends and family say to the depressive, ‘pull yourself together’, they may as well be saying it to the baby crying in its cot.

  We cannot. It is not that we don’t want to. We simply can’t. But, unlike the baby in the cot, our adult brain is sufficiently engaged to know that we should, to believe that if we tried hard enough, we could. Then every attempt and every failure brings with it its own, additional depression, its own profound and hopeless despair. And every contemptuous glance, every irritated sigh from family and friends drives us still further out into the cold, black night.

  Depression has its own pathology and self-absorption is part of that pathology. Telling somebody who is in the grip of severe depression that they are being selfish and self-pitying is like telling somebody with asthma that they have breathing difficulties. It is meaningless except as a statement of fact or an expression of the symptoms affecting them. They are lost in a place without boundaries or borders, where the concept of self has no meaning. They have lost their very self.

  The first time I truly realised how lost I had been was when I was better, and out walking with a friend. It was a beautiful, sunny day and we had not seen each other for some time. I was talking fast, falling over my own words, trying to cram all my news into the short time we had stolen away from work and children. When we were parting, she grabbed me in a fierce hug. ‘You’re back,’ she said, ‘you’re really back. Welcome home.’

  Until then, I had not realised how far I had gone, or how long I had been away. I understand it when people say they just want us to be ‘back to our old selves’ and the terrible confusion of coming up against the stranger standing in our place. I’ve been around enough depressives, myself included. There have been times when I’ve wanted to shake them (myself) or shout at them (or myself) to snap out of it. I understand those gauche, clumsy attempts to bring us to our senses, know they are born simply out of fear and frustration. Most of all, I know how those emotions make unintentional bullies of us all.

  Even, of depressives themselves.

  Here’s an example. I am sitting in group therapy, in a psychiatric unit. There are twelve of us. We are each expected to speak; a therapist is present to guide the process, to stop any one person from dominating the group, and to encourage others who retreat into silence.

  We sit on moulded, grey plastic chairs in a circle, facing the therapist. The walls are painted in cream gloss with a green border, the shabby carpet is a utilitarian grey. The room is cold, empty save for a flipboard. There are no potted plants to fill the emptiness, no paintings to add colour to the walls. The atmosphere is clinical. There is no suggestion that we are here to do anything but work.

  We are, literally, a motley crew; a disparate bunch of people with nothing in common but our illness. We look peculiar, some shabby, some smart, according to our status in the hospital. Some of us wear coats. A few are dressed in suits, the women in formal skirts and high heels. They are the outpatients, attending what is known as ‘after-care’, which is a daily, two-hour session of group therapy, designed to make the transition of leaving the psychiatric unit and moving back into normal life as seamless as possible. They look glossy and polished, as if they do not belong in here with us, the inpatients. You would not, if you passed them in the street, point them out as mental patients.

  By their chairs are handbags or briefcases, plastic carrier bags filled with paperwork and sandwiches, bottles of water, cans of Coke. This is lunch, to be snatched on the run after the therapy session, before an afternoon at work. We are not allowed to eat or drink during group; nothing is allowed to distract us from the task in hand—which is us.

  They are the elders of the group; they know the ropes, have served
their time and done well enough to be granted certain privileges. They have been allowed to take a step out into the world.

  The inpatients watch the outpatients with a mixture of envy, respect and fear—of leaving this safe, cloistered community and going back out there, into that place where the terrors and pressures of life conspired to bring us down. How would we manage out there? How does anyone? Some of us may have run our own business, some of us are husbands or wives or parents. We have all, at one time, managed our own lives.

  Now we are too frightened to walk down a street alone.

  I am an inpatient, dressed in a pair of old jeans and a hooded top, bare feet shoved carelessly into old, battered trainers. There is a strict dress code for inpatients in this hospital: dressing gowns and slippers are not allowed. We make jokes about it, someone suggests a sign for the door: ‘No Jim-Jams here.’ You can be as mad as you like, but you’ve got to get dressed in the morning.

  Some of us have brushed our hair. Often, the first sign of life, or a coming back to life is a comb dragged through hair or a shaky lipstick line. Some days, I could not manage to brush my teeth, on others I would achieve a passing semblance of mascara and eyeliner. It does not go unnoticed.

  ‘You’re wearing make-up! Well done! You must be feeling better.’

  It is halfway down my face before we have even finished group therapy. Nobody cares. Tears are normal in a place where normal has many different interpretations.

  Susie is talking. She is frail and intensely thin, suffering from an anxiety disorder so violent that she used to vomit into wastepaper bins at work, which was in a bank. Young and pretty, with brilliant dyed red hair, she has a manic laugh and an addiction to fluorescent trainers, fluffy pink jumpers and false nails painted a glittery mauve. Susie worries about everything: her mum, her brother (with good reason, he is a soldier, posted to Iraq), her sister, her niece, her mum’s dog, her future, her past. Most of all, she worries about her cleverness.

  She stops me in the corridor one day. ‘I’m not like you, Sal. I don’t know words. I don’t know how to say what’s in my head.’

  I say that, even though I do know words, all the words in the world still cannot explain what’s in my head. Susie laughs so hard I think she’s heading for another panic attack.

  ‘We’re right ones, we are,’ she says, at last. ‘Right fucking loonies.’

  ‘It’s what’s in your heart, Susie. That’s what matters,’ I say.

  Her blue eyes fill with tears. ‘That’s not right either,’ she says. ‘My heart’s not right at the moment.’

  ‘It is, Susie,’ I say. ‘It is.’

  And I know that it is because, after we leave the hospital, I take her into my house, sometimes for days, sometimes for weeks. I like to have her there. She likes to be there. ‘It’s like a holiday,’ she says, ‘from my life.’

  She scarcely takes up any room, and there is no spare bed to give her so she just curls up in the corner of the sofa like a small, elegant cat. On the table in front of her is a mug of tea, a packet of the rich tea biscuits she loves and on which she seems to exist, and a constant cigarette, smoking in the ashtray.

  She never seems to sleep at night, although she has pills to knock her out. I am usually awake too, despite the pills I take to stun me into sleep, and often I will stumble groggily out of my room and see the dead blue light of a television flickering under the door and know that Susie is staring at the screen, the sound turned down so low (she does not like to disturb me or Molly) it’s a wonder she can hear anything at all.

  What she likes most is to clean. I always know when Susie is feeling low. Her head appears around my door and she says, ‘Sal, is it all right if I hoover?’

  The flat sparkles, but we can never find anything. Susie likes all surfaces to be clean of everything, not simply dust.

  ‘Has Susie been cleaning again?’ Moll asks when she gets home from school and searches, fruitlessly, for a book or a clean T-shirt.

  ‘Yes.’

  Moll nods sympathetically. ‘Must have been a bad day.’

  Susie’s hiding places are creative. But they make sense to her. Her mum often telephones to say, ‘Can you ask Susie where she’s put the shampoo? I’ve searched all day and I still can’t find it.’

  Susie and Molly love each other. I often find them curled up together on the sofa, heads bent towards each other as they chatter endlessly or clutch each other in helpless laughter.

  ‘I don’t think Susie’s a grown-up at all,’ Moll says.

  In group therapy, Susie’s words are jumbled, often interrupted by tears. Sometimes the tears win and she sobs helplessly, unable to speak. After a while she starts to shout, at herself.

  ‘Shut up, shut up, you’re pathetic,’ she cries. ‘Stop crying, you’re being ridiculous.’ Every fresh outburst brings a fresh spate of tears until, frustrated and humiliated, she begins to slap herself in the face, at first gently, and then harder and harder.

  ‘Stop it! Stop it!’ she shouts.

  Slap, slap.

  ‘Shut up!’

  Slap, slap.

  Finally, the therapist says to Susie, ‘Why are you doing that?’

  Susie keeps crying but she stops slapping herself. Nobody moves to comfort her or offer her a tissue. Or, some do, but the therapist stops them with a warning glance. In group therapy, to comfort somebody is to get them to shut up. The goal is to get them to express their feelings, however painful. The way to do that is to leave them alone. It sounds tough. It is tough. Our instinct is to comfort somebody who is distressed. It is hard not to obey it.

  After a long while, the therapist looks at the rest of us. ‘Would anybody like to say anything to Susie?’

  I look at Susie, her hands clenched across her face, knuckles white, as she fights the urge not to hit herself. I used to do the same thing, slap myself to stop my own tears.

  ‘If I was crying,’ I say, ‘would you tell me to shut up?’

  She lifts her face from her fists in astonishment. ‘No, of course not.’

  ‘Then why are you doing it to yourself?’

  ‘Because I hate myself when I’m like this. I want me to stop.’

  I understand that. I wanted me to stop too.

  So, we’ve heard it all. We’ve heard it from friends, from family, from meaningless strangers. But, most of all, we’ve heard it from ourselves.

  Pull yourself together.

  There are lots of people worse off.

  It’s not that bad.

  Get over yourself.

  Get a life.

  I did not, could not, blame anybody who offered me such advice. It was no more than I told myself daily, even hourly. I developed terrible pains in my face. It took me a long time (and a dentist) to realise it was because I kept my jaw clamped tight. I was gritting my teeth to get through the days.

  Only once did I answer back. It was a bloke on a building site, just trying to be cheery, just being normal.

  He called out: ‘Cheer up love, it might never happen.’

  I turned on him and I said: ‘Well, it fucking well has happened. And what are you going to do about it?’

  I might just as well have hit him. He was shaven-headed and built like a brick shit house but he spread his hands beseechingly and blushed. He said nothing. Nor did I. I was trying too hard not to cry.

  There were men like him in the hospital. One was a cab driver, huge and burly. He looked like a hard man but his expression told another story. He was terrified his mates would discover he was in a loony bin. He did not want to share his feelings or tell us how he felt, which was bad. Very, very bad. He thought about dying, about hanging himself by the neck. ‘I don’t understand,’ was all he said.

  The group murmured in assent. Nor did we.

  None of us understood why we had been singled out for depression. None of us knew how we came to be shut away in a psychiatric hospital, compelled to spill out our emotional guts to strangers. It was not the way we saw ourselves. I
t was not the way that we wanted others to see us.

  Losing My Balance

  The greatest danger, that of losing one’s own self, may pass off quietly as if it were nothing; every other loss, that of an arm, a leg, five dollars etc., is sure to be noticed.

  Søren Kierkegaard

  If there is one fact about depression on which all the experts agree, it is that there is no single cause but rather a number of contributory factors that come together and may trigger a depressive episode in people who are vulnerable.

  I say, may, because nobody knows which combination of triggers is liable to be explosive nor why one person should be affected when another, given the exact same set of factors, should remain untouched.

  But it is generally agreed that major depression is the result of a number of difficult events (known as stressors) that, coming in quick succession, affect the chemical balance of the brain. Depression, literally, changes your mind.

  Those stressors may include a relationship breakdown, the loss of a job, the death of a loved one or financial problems. Loss of any kind seems to be a significant trigger. Depression often runs in families so there may also be a genetic susceptibility—but it is a predisposition rather than a predetermination. It does not mean that everyone with depression in the family is destined to develop the illness. Nor is everyone who experiences difficult events destined to become seriously depressed.

  My descent into depression was steady, textbook, even. I began to wake, every morning, at twenty minutes past three. My head was an alarm clock, set to the minute; to the not-so-sweet spot.

  Early morning waking is one of the classic symptoms of depression, but I had no idea so I paid it little attention. I had a lot on my mind and anyway, I have suffered from insomnia since I was a child, although it used to be of the not being able to get off to sleep variety.