Shoot the Damn Dog: A Memoir of Depression (4 page)

That’s right, I think. Depression is the great thief.

When I was a child my mother was forever telling me to get my head out of a book and go outside and get some fresh air. Molly is like me. She reads all the time. I never tell her to get her head out of a book. I know the pleasure, the transport, the pure delight that reading brings. Before I was ill, I used to worry that I spent too much of my time with books, living in other people’s lives. I used to think it was, perhaps, because I didn’t much like my own. Perhaps that’s it then. Perhaps depression is simply inhabiting your own life. Or perhaps it’s simply too much reality.

No, this is mad thinking. All my thinking is mad thinking, these days. Round and round it goes, dipping in and out of perspective but always present, never still.

These days I only buy a newspaper because I want to be normal. I want to be a person who reads a newspaper. Besides, it gives me something to do, somewhere to go. Every morning, I go out to get my newspaper and cigarettes. This morning I didn’t. This morning was a bad morning. Or was that yesterday? I try to remember. No, it was this morning. I had a bath. I managed that but then I was shaking so badly with the medication I had to lie down. Or, at least I think it’s the medication. It’s hard to tell.

Why do they call it a ‘mental’ illness? The pain isn’t just in my head; it’s everywhere, but mainly at my throat and in my heart. Perhaps my heart is broken. Is this what this is? My whole chest feels like it’s being crushed. It’s hard to breathe.

I am sitting on the floor, in my bedroom, curled up against the cupboards. I have given up on the bed. I hate the bed and its soft, suffocating embrace. I would like to leave this room, but I can’t. I feel safe in here. Or, as safe as I feel anywhere, which is not very.

How fucking stupid is that? I can’t leave my own bedroom. Me, who used to fly across the world and get on a plane without a moment’s thought. I have been getting on and off aeroplanes on my own since I was ten years old. I am fiercely independent. I am fierce. Or so people tell me. Used to tell me. I never used to be so afraid. When I was one of his editors, I used to stand up against Rupert Murdoch, arguing with him. I used to be so brave. I used to be somebody.

I am still somebody.

Aren’t I?

But who?

I am somebody who can’t leave her bedroom, somebody who can’t walk across a road to buy a newspaper. I start to cry. I hate crying. I hate these tears that come, unbidden, at any time of day.

My cat, Bert, comes and sits next to me and purrs. When I do not respond, he gently bats my wet cheeks with his paw, first one side, and then the other. He keeps the claws sheathed so his paw feels like a velvet powder puff.

Clever cat.

He used to be a hunter, a champion mouser, when we had a garden. Now he follows me around the flat, turning somersaults for my amusement or butting his head against my idle hands, demanding attention. He cries a lot too, his calls echoing through the apartment.

I never used to cry. I hardly ever shed a tear. I spent a whole life not in tears. And that, according to one therapist, is my problem. Is this all it is then? Is this simply forty years of collected tears?

‘Have a good cry. You’ll feel better.’

Stupid, I think, furiously. Stupid.

I remember a nurse, in the psychiatric unit. She was Jamaican, wore her hair in braids fastened with bright glass beads. They hung in a brilliant curtain over the stiff shoulders of her starched white uniform. Her nose was perfect, straight and beautiful, and she had a wide, white smile.

She held my hand at four in the morning, as I cried. They’d given me sleeping pills, enough, they said, to fell an ox. I had to take them sitting in bed because they were so strong. They said I might pass out if I took them standing up. Two hours later, I was still wide awake, walking up and down the empty corridors, up and down, trying to walk away the tears.

The nurse came and got me, led me back to my room and put me in bed, then sat with me, holding my hand.

‘Have a good cry,’ she said, ‘you’ll feel better.’

I shouted at her. Her bright smile dimmed, and went out. I hated myself for shouting, but it seemed so important to be understood.

‘It won’t,’ I shouted. ‘Crying won’t make me feel better. I cry and I cry and I never feel any better. Why does nobody understand that?’

Why does nobody understand that these are tears without a beginning or an end? I thought sadness had a beginning and an end. And a middle. A story, if you like. I was wrong.

She said, ‘Has something happened?’

I ducked my head, plucked at the sheet. ‘No,’ I said. ‘Nothing has happened.’

She patted my hand.

I must stop this, I think. I must stop these tears, stop these thoughts. Perhaps if I stand up, they will stop. Perhaps if I get dressed, perhaps if I try to be me, they will go away.

I take off my nightdress. It is old soft white linen. I have always collected vintage linen. Now it is tattered and stained and sad. I no longer launder and starch it. I am still in my nightie at four in the afternoon.

It is shocking and, shockingly, I don’t care.

I pull on an old cashmere sweater and leggings. They are black. The sweater is large and comforting. The leggings are baggy and comfortable. I have been wearing these same clothes for weeks, months even. I used to work in fashion, to write about it weekly. I love good clothes. My wardrobe was once filled with designer labels. Some of them remain. I look at them and think that if only I could get those clothes on, that I might, once more, become me.

I try, sometimes, but I look awkward, uncomfortable, as if I have put on a stranger’s clothes. So I take them off again.

I feel frightened, suddenly. No, terrified. This is not fear. This is black, consuming terror.

‘Tell me,’ says my therapist, ‘what you look forward to in the day.’

‘Taking my sleeping pills at night,’ I say. ‘Oblivion.’

Not that it lasts very long. I am awake again at three twenty. Always three twenty, never three ten or even three thirty. My eyes snap open and my mind clicks on, as if somebody has pressed a switch. And on it goes, on and on. And it repeats the same thing, over and over.

I want to die. I want, so badly, to die.

I lie on the floor in my bedroom and scream, as if the walls could hear me.

‘Will somebody help me? Will somebody please help me?’

But there is nobody there. I don’t want anybody there. I don’t want anybody to see me like this. I don’t want anybody until the terror gets too much, until I know that I am a danger to myself.

This is one of those times. And so I make a call, to Sarah, my closest friend. We have been friends for more than thirty years. We have seen each other through successes and failures, through damaged romances and unaccountable bliss. She has seen me at my best and at my worst.

And so I call her. Poor Sarah. My poor, sweet Sarah. She gets phone calls from me weekly, sometimes daily. She gets calls when I can no longer contain the pain or the sadness alone.

She must be so bored of me. I am so bored of me.

‘How’s it going?’ she says. She is at work; she is the deputy editor of a magazine. The office is open-plan. It is difficult for her to talk. Sometimes I call her and just cry, because I cannot speak.

I imagine her sitting at her desk, the phone pressed hard to her ear as she searches for words to say to me, words that will betray neither of us in the busy impersonal world of work. I can hear the murmur of voices all around her, the shrill summons of phones, the lovely noise of life going on.

For a moment, I can’t speak. ‘Not good,’ I manage, finally.

Her voice is gentle, concerned. I hate that concern. I hate that it is me who is making her feel that way. ‘How not good?’

I hear my voice, rusty from lack of use. It sounds slow, as if I am talking underwater. ‘Bad,’ I say.

She knows from the sound of my voice how close I am to the edge. ‘I just have to clear something up here. I’ll be with you in an hour, less if I can.’

‘OK,’ I say, because it is all I can manage. I can’t even say thank you.

I lie on the floor in my bedroom and wait. I can’t imagine why she would want to be with me, can’t imagine what she could do for me. She is even more powerless than I am over this thing. Today I can’t honour it by calling it an illness. Today it is just a thing that neither of us knows or understands.

I hope she won’t be long, just the sight of her comforts me. I need her to be with me, even if there is nothing she can say. I am terrified she will give up on me, that this thing will drive her away. Every depressive has that fear. Why would anyone want us? We don’t even want ourselves. Sometimes, we try to drive the people who love us away. Not because we don’t want them with us, but because we cannot bear for them to see what we have become.

She arrives, bringing life with her. I can smell it, sharp and clear, on her coat. Then, just as suddenly, it is gone, absorbed by the dull, dead world of depression. My bedroom smells like a sickroom, stale and sad. I wonder if Sarah can smell it too. Once, there would have been scented candles burning on the mantelpiece, a fire lit, lights shining in every room. Now, one solitary lamp casts a dim pool on the table by the bed. The rest of the flat is in darkness.

Sarah is lovely, her cheeks pink and her eyes alive and sparkling. Her hair is thick and auburn, her coat black, soft leather. ‘Hello, friend,’ she says, crouching down to hug me. I am still on the floor.

Tossing her handbag aside, she sits on my bed. ‘Has something happened?’ she asks. Her voice is gentle with concern.

I duck my head, suddenly conscious that I am wearing the same, stained leggings and sweater, that my hair is matted from sleeping, my face shiny with half-dried tears and that the circles under my eyes look like bruises, purple and violent.

‘Nothing.’ I shake my head, ‘Nothing has happened.’ And it’s true. Nothing at all has happened in my world that day. Just me. I have happened.

‘Just a bad day then,’ she says.

I nod mutely. I have summoned her from her work, brought her all this way to tell her nothing. It is unforgivable. I am unforgivable.

‘I can’t do this, Sarah. I can’t do this any more.’ I mean, stay alive. I can’t stay alive if this is what living is. I start to cry. She lays her hand gently on my head, strokes my hair. She is used to me crying by now. She knows there is nothing she can do.

I wrap my arms around myself, to stop the pain, to stop the tears. My whole body is racked with it; I am shaking with tears. The monster is at my throat.

‘If I was an animal,’ I sob, ‘they’d shoot me, to put me out of my misery.’

‘No, Sal,’ she says, ‘they wouldn’t. Really, they wouldn’t.’

I look up at her face, at the terror and the love in it.

It still makes me cry, to think of it now.

She told me later that she always used to cry, when she left me. She used to drive home, tears pouring down her face, saying the same thing out loud, over and over again. ‘This is not life threatening. She is not going to die. My best friend is not going to die.’

I imagine her driving through the dark streets, crying, chanting aloud to keep the bogeyman away.

Before I became ill, I had no idea that severe depression has definite symptoms just like any other illness. Nor do most people. And that’s where the stigma around mental illness becomes dangerous. Our unwillingness to discuss it openly creates a damaging ignorance. We know the obvious symptoms of physical illness and seek help accordingly but we rarely take our emotional temperatures or check the balance of our mental health.

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.

1. 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.
   
2. 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).
   
3. 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.
   
4. Insomnia or hypersomnia (sleeping excessively) nearly every day.
   
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
   
6. Fatigue or loss of energy nearly every day.
   
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
   
8. A diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
   
9. 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.