Shoot the Damn Dog: A Memoir of Depression (2 page)

When finally I ended up in front of a psychiatrist, unable to stop crying, unable to function, wanting only to be dead, he said, ‘If you had pneumonia, would you try to cure yourself?’

No.

He shrugged. ‘So why do you think you can cure your own depression?’

Why? Because I thought I could manage my own mind. It never occurred to me that I was suffering from an illness over which, by that time, I had little or no control. I knew nothing about depression. All I knew was that I had fought my head for a year, and I had lost.

‘You are ill,’ he said. ‘You are very, very ill.’

At the time, it felt like the nicest thing anybody had ever said to me. I wasn’t mad. I was simply sick.

When I say this, later, to a fellow depressive, he smiles in recognition and says that when his psychiatrist told him that if he refused to go into hospital voluntarily, she would have to consider sectioning him—putting him there by force—he was not frightened or angry. He was relieved. ‘I was ill. I needed to go into hospital. I could stop pretending that I was coping.’

Sometimes I think depression should be called the coping illness. So many of us struggle on, not daring or knowing how to ask for help. More of us, terribly, go undiagnosed.

This, of course, is my story. Everyone’s experience of depression is unique. I can only say what happened to me in the hope that it might throw some light on somebody else’s suffering and help them too. It might, too, help those who love somebody suffering from depression better to understand what it is they are going through. If it has helped me in any way it is towards a better understanding of myself as well as my inherent vulnerabilities. Otherwise, I’d leave them well alone. Contemplating one’s own navel has a limited appeal. I’d sooner get on with living, which is the antithesis of depression.

But I can’t, and there’s the truth, just as nobody who lives with a severe, recurrent illness can afford to ignore themselves or their symptoms. I keep an eye on myself, a benign objective focus that, I hope, takes my illness—rather than myself—seriously. Neither am I (nor do I ever want to be) a professional depressive, always defining myself by the melancholia that seems to dog my heels; the black dog as it is sometimes known. Frankly, I’d happily shoot the damn dog and be done with it; but I have come to accept that it is both unkillable and, in some sense, unknowable. Certainly, it often takes me by surprise.

The part of myself that I prefer (of course) is the part Molly calls my, ‘usual happy self’, just as real as the depressive part of my nature, which I think of as my shadow self. I am, inherently, an optimist. I love life. I enjoy people. I have many good friends. I value friendship above all else and it was my friends who sustained me through the long dark days of depression. While my inability to reach out and communicate with them drove me almost mad with grief, I knew they were there even when I was incapable of speaking to them. And they were still there when I emerged and for that I am indescribably grateful.

So I am not an expert but simply somebody who suffers from depressive illness who is writing a book. My path through depression is neither right nor wrong, it is simply mine.

Nor can my account, in all honesty, be complete. Depression, as my psychiatrist told me when first we met and I complained at my inability to think myself out of it, depresses every single cognitive process. Concentration, memory, logic, reason, even the interpretation of facts and actual events are all interrupted.

‘If we did a test on you now,’ he said, ‘I can guarantee that your IQ would be down by at least thirty points.’

It is as if the mind draws a veil across itself. There are parts of my memory of that time that are still missing, including books that I supposedly read. When I came to look at them again I discovered that they were almost entirely unfamiliar. It is the same with films. Parts of them are eerily familiar, so much so that I get an immediate sense of déjà vu, but I have no recollection of the beginning or the end or even the middle of the story. There are conversations I have had, or that people have told me I have had, that are quite blank to me and I am apt to grow confused about the chronology of months, or even years. Mercifully, some might say, for depression is not a place to linger.

By contrast, other parts of my memory of that time are still acute enough to mean that I have only to pass certain places or smell certain scents to feel intense pain. It returns at an almost cellular level. It is as if both my body and my mind remember, and I believe that depressive illness is both physical and mental, that the body is capable of holding on to memories and experiences that the mind wishes to forget.

I doubt I am alone in being haunted by my illness. All depressives remember how sick they were, how sick some of us still are.

Before I tell you about my depression, I should tell you something about my life so far. Or perhaps that should be myself so far.

I was born in Brunei, but I am English. I grew up in many different countries. After Brunei, we moved to Brazil and from there to Aden, Oman and Angola. We spent about three years in each country, with brief intervals in England. My father took a job with Shell after the war and was posted abroad. We followed wherever his work took him.

I went to a boarding school in England from the age of eleven, but saw nothing of this country other than the school. It was not home. Home was in whatever country my parents were living at the time. I came to live here fully when I was eighteen. I have two brothers, one on either side of me in age. The eldest is Michael and the youngest is Tony. They, too, were away at school for most of our childhood.

Dad comes from South London and is the eldest of four. His father, Reg, was a Cockney, born, as he was proud to say, within the sound of Bow bells. Reg worked as a handyman; then moved to the country to run a petrol station. Or, at least, it was my grandad’s version of the country: a small bungalow set in front of a set of petrol pumps in the middle of a lorry park on a busy roundabout outside Norwich. This was long before self-service so Reg was out all hours in his flat cap and his brown cotton coat. It seemed to us that he was always happy, a practical joker, teaching his budgie to talk nonsense, chasing us kids around his bungalow with his false teeth out, his gummy grin reducing us to helpless giggles.

My grandmother Maisie was pint-sized, barely reaching five feet tall, with red hair and blue eyes. She kept everything, her house, Reg, their four kids in apple-pie order. And she made a mean lemon curd.

My mother is also a Londoner, but posher, born in Richmond. Her father, Phil Ray, was an actor, working in music hall and on the stage. Later, he found work in films and television, playing mostly bit parts in over forty films from
Sons and Lovers
to
Dracula: Prince of Darkness
and
Frankenstein Created Woman
. He always turned out a good priest and was a regular on
Dr Who, Z Cars
and even, fleetingly, in
Hancock’s Half Hour
. A shy, quiet man, with a melancholic streak, he loved to act because, as he said, it allowed him to be somebody else.

His greatest passion was my grandmother Dorothy whose stage name was Jackie, and who was a dancer and a model. Hugely elegant, despite never having any money, she made all her own clothes, including her hats and coats, and taught me to sew. I spent a great deal of time with her, every weekend that I was allowed out of boarding school in England, while my parents were abroad. When she died, my grandfather made a shrine of photographs of her in one corner of their flat. And then he just quietly faded away.

My daughter, Molly, is also a Londoner. And so am I, if only by adoption.

I am blonde with blue eyes, stand five feet seven tall and weigh 140 pounds, more or less. I would prefer it to be less.

I love fashion, perhaps influenced by my grandmother, and studied it at Central Saint Martin’s, where, having taught for many years, I am now a visiting professor. I still love good clothes.

After college, I wrote about fashion for
Vogue
, where I started my career, having won the
Vogue
Talent Contest. I then worked for the
Observer
newspaper, where I was fashion editor for four years.

I am a mother, to Molly, whom I love very much, and who loves me. ‘This much,’ as she says, her arms open wide.

I love words. And books.

I am a successful journalist. Successful in that people pay me to write for them, for which I am always grateful. As a child, it never occurred to me that people would give me money to do what I love best.

I am a successful novelist. Successful inasmuch as I have written four novels, all of which sold modestly but well. Or, at least, well enough for a publisher always to ask me to write another.

I was a successful magazine editor. In the mid-1980s, I launched
Elle
, which I edited for four years. It was a gratifying and immediate hit and established a blueprint, or so it is said, for a new attitude in women’s magazines. Ten years later, I edited another magazine,
Red
, for a brief year and with far less success. Some people loved it, others loathed it. I console myself that nobody seemed indifferent.

I am less successful at relationships. I have been married twice, which is not something I am pleased about. At least, I am not pleased about the failures, rather than the marriages both of which, at the time, I liked very much. I remain close friends with both my ex-husbands.

I am in love with and loved by somebody, and hope that I am better at loving him than I was at loving my husbands. I suspect that he hopes so too.

Gardening is my passion. So is good food. I love to cook. There are few things I like more than to feed my friends.

I am, in all these ways, blessed.

I am also a depressive.

It doesn’t quite fit, does it?

A little while ago, I was driving a close friend, Nigel, to have a scan. He had suspected tumours in his lungs and his liver.

‘Obstacles’ they called them, and marked the request
URGENT
. He puts on a funny voice as he reports this to me, camping up the word. We both know what it means, obstacles to life, but have a silent pact not to say it.

We arrive at the clinic. Nigel disappears through double doors marked with a big red
STOP
sign. I watch him go. I am in pieces but I smile, foolishly, for he cannot see me. We have been in a clinic together before, a psychiatric clinic. It is where we first met. We are both childishly fond of telling the story at parties. ‘We met in a loony bin.’ People never know whether to believe us. But when we laugh, they laugh too. It is only funny because it seems unbelievable. We don’t look like the sort of people who suffer from depression. But I’ve been in three psychiatric units. Nobody in there looked like the sort of person who suffers from depression. It is no respecter of type. Or gender. Or class. Or money. Or success.

Nigel has been a huge education for my daughter, Molly. She knows that I met him in a mental hospital. She met him there herself, when she visited. And she loves him.

‘If he’s mad,’ she says, ‘then I love mad people.’

‘Not mad, darling, just depressed.’

‘Whatever.’

When Nigel and I first met, we were both madly, and I use that word advisedly, suicidal. Nigel’s preferred method of killing himself, or planning to kill himself, was to drive his car fast into a wall. He had all the bends and speeds around his house worked out in his head. He knew all the best corners.

I was in the hospital because I was a danger to myself. I was as capable of killing myself as I was of making a cup of tea. At the time, I could not say which I would prefer.

We got to know each other unusually well, bound together by our illness and by an abrupt, if not altogether welcome, vulnerability. If there is a faster way to intimacy than depression’s catastrophic disintegration or the absolute honesty demanded by group therapy, then I have never met it. Not all friendships made in psychiatric units survive, of course. Why should they? We are people first, depressives second. There are other, more important, ties that bind than a mutual mental illness.

After we left the hospital, we remained friends as much for our devotion to books and gardens or the latest reality TV show as our intimate understanding of suicide. These days, we rarely discuss our illness. We are not, as Nigel is quick to point out, ‘a pair of neurotic ambulance chasers’.

Nonetheless, it is the bleak, unwelcome shadows that depression sometimes throws at us that keep us stuck so fast. We can talk to each other at times when we can talk to nobody else. We can say things we could say to nobody else.

One day, soon after we left hospital, Nigel telephoned. I was down in the black pit and I was crying. He listened to me for a while in silence. That silence was unutterably consoling. He will never, as others do, try to persuade me out of my own reality. He won’t tell me I feel something that I don’t.

When I was very ill, I became so tired of people telling me that things would get better. I felt, always, that I must try to comfort them by agreeing. Either that, or stay silent. There were no words to explain the depths of my despair. I didn’t understand it myself.

When I had stopped crying Nigel said, ‘I think what you need is a nice drive in the country.’ Remembering his chosen method of suicide, I asked him how he was feeling that particular day. He laughed.

Nigel walks back through the red stop sign doors. He smiles at me, despite the circumstances in which we find ourselves, and says that we have to return in an hour, to pick up the results and take them to his GP. We smile at each other almost all of the time. We are usually cheerful in each other’s company. It is as if we have taken an unspoken pact of reassurance. We also both know that each of us is capable of smiling and talking cheerfully while at the same time planning our own deaths. Even so, we depend on each other not to die, at least not on purpose.

It is a beautiful day, sunny and warm. We go to a café, sit outside. He eats carrot cake; I have a lemon muffin. My dog begs for crumbs. Halfway through his carrot cake, I ask him if he is frightened. They’d done more tests the week before, scans on his bones. His ribs have been hurting badly. We both know what that means but we have never before said it out loud.

‘No,’ he says, ‘I’m not frightened of cancer or dying. You know me, and dying.’

Yes, I know him and dying. Suicide is his default setting. It’s never too far from his mind. He uses it, he thinks, as a release mechanism. It is an escape hatch, if not in fact, then at least in thought. ‘Dying,’ he says, ‘feels like nothing against the fear of going through another episode of severe depression. I don’t think I could do it again.’

Nor do I. I don’t think I could cope with the severity of the depression that claimed and destroyed four years of my life. Four years. It seems so little in the scheme of things.

So there you have it. My life in two choices. To be happy or to die.

I choose happy.

It sounds flippant. It’s not. If I choose to look up and not down, it’s because I know what waits below. I am a depressive. It took me a long time to say those words out loud. Just as it took me a long time to come to terms with my illness.

All illnesses need to be managed and in that, depression is no different. It is a complex treatment, just as wellness is a complex and fluctuating state of being. Both need managing. Both need constant awareness. I mean by wellness, not just a physical robustness but also an emotional wholeness; a complete engagement and connection with life.

While there has been a shift in attitude, there is still a common belief that depression is simply a chemical imbalance of the mind that requires chemical intervention. I don’t dispute that. In its acute phase, depression certainly needs medication. At that stage, nothing else can touch it. Once out of the acute phase it needs a great deal more.

I am not against antidepressants—far from it. Drugs can and do save lives. They can and do transform lives. But depression is not a singular illness and it requires more than a singular approach to alleviate it and keep it at bay. Most psychiatrists admit that antidepressants are a palliative, not a cure.

Listen to Martin Seligman, Professor of Psychology at the University of Pennsylvania; ‘The dirty little secret of biological psychiatry is that every single drug in the psychopharmacopoeia is palliative. That is, all of them are symptom suppressors, and when you stop taking them you’re back at square one.’

Antidepressants are not the miracle workers or the ‘happy pills’ our culture suggests. They did not, for example, work for me.

I thought that if I went into hospital, I would become well. I thought a pill could make me better. The failure of both to do either was almost more catastrophic for me than the illness itself. Far from making me better, it sent me into a despair from which I thought I would never emerge. If the great panacea of the twenty-first century could not help me, what could?

After months of medication and two stays in psychiatric units, my psychiatrist admitted that he was stumped. I have something known as treatment-resistant depression. In other words, it resists all chemical attempts to alleviate it. It was only when I was better that he told me that, in his experience, antidepressants are effective on only thirty per cent of the people to whom he prescribes them. Later, I discovered that opinions vary on this, as they do on almost every area of depressive illness, but that most experts agree that for a significant number of people, antidepressants are completely ineffective.

Far from being a panacea, psychopharmacology is a ludicrously inexact science. Its reputation as a modern miracle is based on the thirty per cent for whom antidepressants effect an almost magical cure of near remission. For the next thirty to forty per cent of people suffering from depression, it is touch and go. They may need to try two or three or even four antidepressants to discover the one that works for them. Then, for the last thirty per cent, for people like me, antidepressants have no effect at all.

‘Why,’ I asked my psychiatrist, ‘don’t you tell us that?’

He shrugged. ‘Because I am in the business of bringing hope to my patients.’

I applaud his sentiment, but I also know that there is nothing more hopeless than the depressive who believes they are beyond all help and who does not know or understand why.

When I first became depressed, all my trust was in modern medicine. Like most people, I believed the myth of happy pills. You get depression, you take drugs, you get better.

When that remedy failed, I thought, in some obscure way, that it was my fault—that it was me who was failing modern medicine and not the other way around.

Sadly, I am not alone in this. According to research published by the Clinical Neuroscience Research Centre in Dartford:

I recall a day in my psychiatrist’s office. I am slumped on the sofa, shaking and crying. My psychiatrist’s expression is severe. More than that, he seems uneasy. The prognosis, he says, is bad. I have been severely depressed for an unusually long time, around eighteen months, which is long enough for my condition to be regarded as ‘chronic’.

He suggests that we try ECT (Electro Convulsive Therapy) but I saw a friend I made in the first psychiatric unit I was in suffer its consequences with apparently little benefit. Her memory, she complained, was shot to pieces. I am set against it, and say so. I want my memories, good and bad. He frowns, a tiny jolt of impatience framing his eyes. He is a scientist. He wants to make me well, not whole. At least, that is my interpretation and I wonder, for a moment, what the whole of me is. If depression is a part of me, perhaps I must simply accept it as it is. Except that I know that I cannot go on like this. He knows it too. He is trying to help.

‘How does ECT work?’ I ask.

‘We don’t know. We just know that, usually, it does and that the memory loss, usually, is short term and short-lived.’

I sigh. There are far too many ‘usually’s in his sentence. ‘But there are no guarantees?’

‘No,’ he says, avoiding my gaze.

Then he tells me a story, about being on a train journey with a friend with whom he attended medical school. The friend is a heart surgeon. My psychiatrist is trying to explain his work, and some of the difficulties he daily encounters. I suspect that I am one of those difficulties. After a while, his friend the heart surgeon exclaims, ‘It must be like being in an operating theatre, preparing to make the first incision and somebody shouts, “No, make the cut over here.” Then another calls, “No, over here.” Then a third voice joins in, “Over here!”

‘In cases like this,’ my psychiatrist says, ‘it is trial and error.’

I am a case. I am a trial. And I am an error.

‘Poor you,’ I say, when what I really mean is, poor me.

There is, he says, another treatment for the chronic, a lobotomy. Not the ancient hacksaw version of Hollywood myth but a modern refinement, involving needle-fine wires. These days it goes by the more reassuring title of psychosurgery. But the success rate, among the chronic, is only twenty per cent.

I say nothing. I think he must be joking. I hope he is joking even though I can see that he is not. We return to the subject of my medication. So far we have tried five different varieties and two combinations of others. I feel like I am in a sweet shop. Let’s try some of the blue ones. No good? Well, how about some blue with some pink? Or how about a few of the yellow?

My psychiatrist, in a desperate attempt to break the pattern of resistance, loads me with more and more drugs. He is nothing, if not an optimist. I think that all psychiatrists must be optimists. They could not stay in their profession if they were not.

At one time, I am taking the top dose of the SSRI antidepressant Venlafaxine which is often given to treatment-resistant patients. On top of that I take 1,000 mgs of lithium daily. Lithium is usually prescribed for bipolar depression (manic depression) from which I do not suffer. The reason I am taking it is because a body of research from the States suggests that loading lithium on top of a mega dose of an SSRI might, in some cases, break the resistance.

It does nothing for me, other than make me so physically ill I think I might die. I shake so badly I can scarcely stand. My mouth is filled with a sour taste so repulsive I cannot eat. Even water tastes foul. The depression does not shift.

I am sicker than ever and it is two years since I took my first antidepressant, prescribed by my GP. She stuck a pin in a book. ‘Let’s try this one,’ she said. Ten months later, I was hospitalised with severe clinical depression. In the hospital, the doctor took one look at the level of antidepressant I was taking and laughed out loud.

It was not my GP’s fault. She was doing, in a limited time and with a limited knowledge of the new drugs that constantly appear on the market, the best that she could. The hard-pressed GP will be confronted with one new case of depression at every surgery session. One in every three people attending a GP’s surgery has significant psychological symptoms. Even so, our understanding of major depressive disorder is so limited that only sixty per cent of those presenting with it will be detected and only ten per cent of those diagnosed are referred on to specialist services.

It is not that science is failing us. It is simply that the solution is as complex and multifaceted as the illness itself. For every theory of its causes, there is another to contradict it; for every new treatment, there is another that dismisses it as ineffective. This is not deliberate obstruction. Depressive illness, as well as being complex, is highly individual. What works for one person does not work for another. And often there is no explanation why this is so. Scientists do not know why one method or drug might work, where another does not. They know that, for some people, SSRI antidepressants work, but they have no real idea how. Or what the long-term effects might be.