Pete went on answering the questions and found that for a majority of them he was rating himself at two or three. He then reached the final question and hesitated while muttering to himself, ‘I felt that life was meaningless.’ Pete felt pressure build up behind his eyes as he recalled the incident on the balcony just two nights ago. His hand trembled a little as he made a scratchy circle around the number three. Pete then exhaled through his nose to release the pressure behind his eyes before handing the clipboard back to the secretary with a forced smile. She smiled warmly and then stood up to knock on the door of the treatment room. Doctor Ong appeared in the doorway and gestured towards Pete. ‘Please come in,’ he said in a soft and welcoming voice.
Doctor Ong had a kind, youthful face. His youth was accentuated by a head of thick black hair with not one strand of grey. His presence was peaceful, which made Pete feel as though he was someone he could talk to.
As Pete stepped into the office, he noticed that the lighting was the same as that in the waiting room to ease the transition between the rooms. Doctor Ong’s office was about twice the size of the waiting room and was modestly furnished with a coffee table at its centre, which had a small plant on it alongside a box of tissues, and a regular couch along the wall opposite the doorway. There was also a single office chair, which Pete surmised was where Doctor Ong would sit.
Glancing around the room Pete thought, No chaise longue. Guess that piece of conventional wisdom about shrinks is wrong. I hope the conventional wisdom that they ask endless open-ended questions is also wrong.
‘Hi, I’m Gabriel. Good to meet you, Peter,’ Doctor Ong said, holding out his hand.
Pete turned from surveying the room and shook Gabriel’s hand. ‘Hi Gabriel, I go by Pete,’ he volunteered.
‘Thanks. Good to know,’ Gabriel said and gestured towards the couch, ‘Please take a seat, Pete.’
Pete sat down and nervously smoothed his jeans along his thighs.
‘You look nervous, is this your first time in therapy?’ Gabriel asked.
Wow, a simple question to start with, that’s a good sign, Pete thought. ‘Yes,’ he said.
‘Why do you feel nervous?’ Gabriel asked.
Knew it was too good to last, Pete thought. ‘Well, for one thing, if anyone at my work found out I was in therapy, I could lose my job.’
‘Why do you say that?’ Gabriel asked curiously.
‘I work in investment banking and in my industry, no one’s going to employ someone who they think’s mentally unstable.’
‘That sounds like an unforgiving workplace. I understand your concerns completely, but please be assured that things discussed in this office will be kept private unless there are very exceptional circumstances,’ Gabriel said reassuringly.
Pete decided to test Gabriel’s definition of exceptional and asked, ‘Like, that I’m going to kill myself?’
Gabriel was not fazed. ‘Yes, or harm others,’ he answered.
Gabriel let those words hang in the air for a few seconds, perhaps to see if Pete was just trying to be verbally combative or was signalling that he wanted to talk more about why he was there. The silence lengthened, so Gabriel moved on.
‘If I may, can I look through your questionnaire answers for a minute?’ Gabriel asked politely.
‘Please go ahead,’ Pete answered. He could see Gabriel’s eyes tracking down the questionnaire and tried to glean his reaction to each answer. But Gabriel’s face remained impassive. He looked back up at Pete. ‘So, let’s go back to your work environment. It sounds stressful. You must be doing some pretty important things to warrant such stress,’ Gabriel offered.
Pete let out a contemptuous huff and leaned forward as if he were about to let Gabriel in on a secret. ‘I work in the world’s biggest casino. It’s not as if I’m a surgeon or anything.’
‘I thought you said you were an investment banker. How’s that like a casino?’
Pete smiled. ‘I’m a foreign-exchange trader, which means I’m like a house poker player in a casino. I play poker against the whales such as hedge funds and pension funds as well as the minnows that do business with the bank.’
‘So, what type of house player are you? A proposition or stakes player?’ Gabriel inquired.
Pete was surprised by the knowledge behind Gabriel’s question. ‘Ah, I’m a stakes player. The bank backs me and while it pays me a salary, my bonuses depend on how much money I make. But I have to exceed a certain amount of winnings before I start getting a share of that money. It’s called making budget.’
‘So, how’s that budget determined and what happens if you don’t make it?’ Gabriel asked curiously.
‘It’s usually an increment of your budget from last year and if you don’t make budget, most of the time you find yourself without a job,’ Pete replied.
‘So, let me see if I understand this correctly,’ Gabriel said. ‘Not only are you encouraged to gamble, you’re threatened with losing your job if you don’t gamble enough. And then, as if that wasn’t enough, they ramp up the amount you have to gamble each year?’
Pete nodded and smiled. ‘That about sums it up.’
‘No wonder we had the Global Financial Crisis,’ Gabriel said, shaking his head.
‘Well, I’m exaggerating a little,’ Pete admitted. ‘Since the Crisis, the regulators have clamped down a lot on the banks.’
‘In what way?’ Gabriel asked.
‘Well, they’ve greatly reduced the stakes banks can use to back traders, which has made making money very difficult. The Crisis also reduced the number of players coming in the casino door, which has also made things a lot harder. And then there’s the rise of the machines,’ Pete said sighing.
‘What are the machines?’ Gabriel queried.
‘They’re electronic trading platforms. A lot of the players that are left prefer trading with them rather than with actual traders,’ Pete answered.
‘But playing the machines would be the equivalent of playing a shill. Most poker players hate playing shills because they’ve no skin in the game,’ Gabriel said, sounding a little confused.
Pete was again impressed by Gabriel’s knowledge of poker. ‘Yeah, but they make tighter spreads, which makes trading cheaper.’
‘Spreads? What are they?’ Gabriel asked.
‘It’s the difference between what I will buy and sell a currency for,’ Pete explained.
‘Like a money changer,’ Gabriel said, beginning to understand.
Pete chuckled. ‘Yeah, but my spreads are a lot tighter than any money changer’s I can assure you. And they’re changing every few minutes or even seconds if the market’s busy. Money changers change their spreads only every few hours. So, on top of playing poker, I also have to make tight-enough spreads to make sure that people come to our money changers, otherwise Sales will complain.’
‘And what do Sales do?’ Gabriel said.
‘I often ask that question myself,’ Pete replied half-jokingly. ‘But they’re like the casino hosts that try to make sure the whales play at our bank.’
Gabriel nodded. ‘Wow, I think the casino analogy is appropriate, and I can see how it makes your job very stressful.’
Pete looked at Gabriel curiously. ‘How do you know so much about poker and casinos anyway?’
‘I studied in Queensland and you Aussies love to gamble, so the psychiatry students had a poker ring going,’ Gabriel explained. He paused as a sly smile came across his face. ‘We also needed somewhere to practise our bluffing before we tried it out on patients.’
Pete smiled back. I’m really starting to like this guy, he mused. ‘How do you know I’m Australian?’ he said.
‘Your accent.’
‘I could be Kiwi,’ Pete insisted.
‘I don’t think so. I haven’t heard one eh and your “I”s sound like “e”s not “uh”s,’ Gabriel observed.
Pete nodded, impressed, and asked curiously, ‘So, how did you do in those poker games?’
A wolf-like
grin came across Gabriel’s face as he answered, ‘I had a small and crappy second-hand car. Other students didn’t.’ Gabriel allowed a brief pause and then continued, ‘But, that’s enough about me. Your work sounds hectic.’
‘Yes, it is, and I’m impressed with your grasp of what it’s like,’ Pete said with respect.
‘You sound surprised,’ Gabriel offered.
‘To be honest, I came in here with a misconception,’ Pete confessed.
‘And that was?’ Gabriel probed.
‘That you’d just ask me a series of open-ended questions and not really hear what I had to say,’ Pete explained.
‘Well, I’m glad to have dispelled that misconception. How does that make you feel?’ Gabriel asked with a grin on his face.
Pete let out a laugh and sat back on the couch, then he sighed. ‘You know, that’s the first time I’ve more than chuckled in weeks.’
‘Well let’s talk about that then. You obviously have a very stressful job, but I’m guessing you’re here to talk about more than just that.’
Pete let out a bigger sigh. The niceties were done with and it was time to cross the Rubicon.
6
Crossing the Rubicon
Pete had rehearsed this moment several times in his mind, but still had trouble starting. ‘You see the thing with me is, I’ve…I’ve always had times when I’ve felt down, but most of the time I could wait it out and my mood would lift in a day or so. But this time…’ Pete’s jaw tightened up as he worked to hold back tears, his gaze drifting to the floor.
Gabriel allowed a few seconds for Pete to continue, but when he didn’t Gabriel asked gently, ‘Is there a particular reason why your mood hasn’t lifted this time around?’
Pete took a breath and continued, still not making eye contact with Gabriel. ‘I’ve been more stressed out at work than normal, but I can usually handle it. It’s just that…’
Gabriel leaned forward. ‘Pete, how bad has it been this time?’ he asked sympathetically.
Pete began to tear up again. ‘I’ve…I’ve been down longer and deeper than usual.’
‘What do you mean by deeper?’
‘A couple of nights back I was on my balcony and…’ Pete began to cry. He tried to speak, but his throat and stomach muscles ached with the emotions that were buckling his body.
After a few seconds, Pete swiped at the tears and wiped his hands on his jeans. Gabriel ripped a tissue from the box on the coffee table and placed it gently in Pete’s hand. After Pete regained his composure he said, ‘What stopped you?’
‘I slipped.’
‘You slipped? On which side of the balcony?’
Gabriel’s question caused Pete’s head to jerk up and Gabriel realised his mistake immediately. ‘Sorry, silly question.’
‘I slipped and fell trying to get my leg over the balcony rails,’ Pete explained irritably. He felt like a fool.
Gabriel quickly asked, ‘So why not get back up and try again?’
Pete was now holding Gabriel’s gaze, but was slow to answer. ‘I started thinking about my son, Bobby,’ he said, and the tears started again, but this time they were tears of love rather than despair. ‘I couldn’t bear the thought of leaving him without a father.’
‘You clearly care very much for your son and I think that can be a good driving force going forward,’ Gabriel said.
Pete nodded, and Gabriel continued, ‘Pete, have you ever talked to anybody about this before? Your wife or your parents?’
Pete let out of huff. ‘In my family, we don’t talk about our feelings. But my mum seemed to understand anyway. Whenever I was feeling down, she shielded me from my father. I even overheard her once, whispering to him, “You ought to know what it’s like”.’ Pete then paused as he thought about his father. He recalled the many times he had seen his father come into the house from a day’s work appearing physically and mentally exhausted. Or his father poring over the farm’s accounts with his mother and regularly sighing and needing encouragement from her. And while Pete’s father tried never to take his bad moods out on the rest of the family, he could not help but be impatient and short-tempered with Pete and Tom. Pete then continued, ‘My dad likely suffers from depression and so probably doesn’t want to hear about how other people are feeling.’
‘I understand,’ Gabriel said gently before asking, ‘How about your wife, have you discussed this with her?’
‘Liz is how I ended up here. She said, “I can’t handle it by myself anymore”.’
‘Is Liz the only reason you’re here?’ Gabriel probed.
‘Is this like rehab and I have to check myself in or I’m not allowed in the program?’ Pete asked, bridling.
Gabriel back-pedalled a little. ‘I’m sorry I didn’t mean it that way. I’m just trying to understand why you sought help. Along with the questionnaire you answered, it’s important for me in assessing your condition.’
‘OK,’ Pete nodded, ‘it’s not just Liz or the balcony thing, I also blew up really badly at this guy at work, which really hurt my chances of getting a promotion; and if it happens again I could get fired. I was even forced to take leave for the rest of the week. So, I guess I agree with Liz. I just can’t handle it anymore.’
‘I think Liz is right, Pete. I’m not sure if it’s genetics or the environment or a combination of the two, but you’re very likely suffering from depression,’ Gabriel offered.
‘I’m sorry Gabriel, but that’s hardly news to me,’ Pete replied.
‘Yes, but it’s clearly got a lot worse,’ Gabriel offered.
‘So, what do we do about it?’
‘Well, my recommendation is a course of antidepressants along with cognitive mindfulness behavioural therapy.’
Pete sucked in his lips. ‘Are the antidepressants really necessary?’
‘To be honest, Pete, I think you need them. You said yourself your depression’s worse than ever and that you’re having trouble handling it,’ Gabriel replied. Pete still did not look convinced and so Gabriel continued, ‘Look at it this way. I’m Teochew, which means that I have a genetic predisposition to high cholesterol. So, no matter how much I diet and exercise, I’m still going to have high cholesterol and be at risk of a heart attack as I get older. So, like my father, I’m probably going to have to start taking statins in a few years.’
Pete was surprised, but before he could say anything, Gabriel continued, ‘It seems to me that you could have a genetic predisposition to depression and for whatever reason – age or environment – you need a bit of help handling it at the moment. It doesn’t have to be permanent, just long enough for the cognitive therapy to work.’
Pete’s curiosity was piqued. ‘OK then. So, what does cognitive mindfulness behavioural therapy involve?’
‘It teaches you ways to relax, such as meditation…’
Pete smiled and let out another huff.
‘You seem sceptical,’ Gabriel observed.
‘I’m not sceptical, but it doesn’t take a doctor to work out that stressed people become depressed, so being taught how to de-stress seems a little too obvious to be labelled therapy and cost hundreds of dollars an hour. Wouldn’t yoga classes be cheaper?’
Gabriel smiled. ‘Well I can assure you that it’s more than just meditation. While optimists are said to view the world through rose-coloured glasses, depressed people look at it through cracked glasses. Cognitive therapy tries to teach you a different way of looking at the world. There have even been studies that show taking antidepressants while going through cognitive therapy can rewire the brain and allow people to permanently come off antidepressants.’
‘I don’t like the sound of being rewired – makes me sound like a kitchen light,’ Pete said.
‘True, but you’re hardly burning bright.’
Pete let out a sigh as he considered the path he was about to embark on. ‘So how do we start?’
‘I’ll start you on a small dose of a selective serotonin reuptake inhibitor or SSRI, which
should stabilise your moods.’
‘I could use something to help manage my anger as well as my down days.’
‘The SSRI that I’m going to prescribe will help with that, but one of its side effects is anxiety. So, I’m going to also give you some Xanax,’ Gabriel added.
Pete sat forward. ‘So, let me get this straight, you’re going to treat my depression by giving me anxiety?’ he asked, incredulous.
Gabriel suppressed a smile. ‘The anxiety is only temporary. And you don’t have to take the Xanax if you don’t feel that you need to.’
‘It all sounds a little too convenient to me. Does the drug company that makes the SSRI also make Xanax?’ Pete asked suspiciously.
‘They’re rival companies and I strongly suggest you take the Xanax if you need it.’
‘OK,’ Pete agreed reluctantly and then asked, ‘So how do we start cognitive therapy?’
‘Well, to start with, I need you to acknowledge that there are many reasons for living. So, at the end of every day, I would like you to write down at least three things that were good about the day and that you should be thankful for. And when we meet next, I would like you to share some of them with me.’
Pete looked at Gabriel quizzically. ‘You mean these sessions come with homework?’
‘Yes, they do. Cognitive therapy only works if you work it,’ Gabriel quipped.
Pete chuckled. ‘OK, so what else do I have to do? Make a pledge not to kill myself?’
Gabriel leaned forward to add gravity to what he was about to say. ‘I need you to let me know that you’re OK. And that you are not going to harm yourself .’
Pete took a breath and avoided Gabriel’s gaze while he checked in on himself emotionally. ‘Well, I can tell you that, right now, I’m all right. But I’m not sure how I’ll feel tomorrow, or the next day or the day after that. I guess if I’m writing down happy thoughts every day even when I’m feeling crap, I won’t be thinking of killing myself will I?’ he added grumpily.
Learning to Fly: A story about overcoming depression Page 3