16 August 2013

♫...It all keeps adding up, I think I'm cracking up...♫

I hate talking about my mental health. I mention the fact that I am depressed when I'm listing all my medical conditions or whatever. But I only talk about it in that detached, factual way. I don't usually go into the details of the thoughts in my head. I've learned from experience that nothing loses you friends faster than freaking them out by telling them that you don't know what the point of you remaining alive is.

At the weekend Giles Fraser wrote a Guardian article about how we shouldn't medicate having "a shit job or a shit home life". It's all stuff I've heard before when I've answered the question "why do you take anti-depressants?" with "because my life is terrible."

Would these people prefer it if I were dead rather than pathologising normal life events?

I've had depression on and off since I was about 8. And it was something that happened 5 years ago that really, truly, made me understand the difference between sadness and depression.

When my mum died I cried for days. I was grief-stricken, heart-broken, and sadder than I've ever been in my whole life. But, interestingly, I didn't feel depressed at all.

Although I've used the Black Dog metaphor once before because it fit what I was feeling at the time, I usually tend to think of depression as an unending night.

At night you can't go to the bank, because the bank is closed. At night you can't return phone calls because businesses are closed. There's no point in opening mail in the middle of the night because you can't make any phone calls the letter might require you to make until morning. You can't do housework in the middle of the night because the hoover or washing machine will wake your neighbours. In the middle of the night you can't phone a friend and say "hey, fancy meeting up for a cuppa?" Because A) They'll have work tomorrow. And B) Unless you want petrol station dispenser tea served through the night window: There's nowhere to go for a cuppa. At night all there really is to do is stare at the ceiling.

Depression to me feels like a night that never ends. Except the sun still rises and sets, the never ending darkness is inside my head. I can't go to the bank, or make a phone call, or open my mail, or do the housework, or ask a friend out for a cuppa because I feel too dark for such things. I just sit and stare at the wall.

When my mum died I cried and cried. But the sun still rose and set, even in my head. I was able to ring around funeral directors. I was able to phone the Peugeot garage repeatedly to harass them into fixing my fucking car because I really needed it. I was able to go to the bank to deal with mum's money. I was able to phone friends who'd also lost a parent because I wanted to talk to people who'd gone through what I was going through.

I was beyond sad, but I never felt that clinical depression darkness that I'm so familiar with. And I think the main reason for that was the amount of support I got. I spent most of the month following mum's death at my dad's house. There were always family members around helping out with stuff. When I came home for things like hospital appointments or to pick up my eventually repaired car there were always friends at my flat who'd come and bring food. I swear I didn't make myself a cup of tea for about a fortnight because there was always someone around to hand me a freshly-brewed cuppa.

That's such a sharp contrast to my normal life. Ordinarily the only human beings I ever speak to are the receptionists at my GP's surgery, my GP, the local pharmacist, and the doctors, nurses and receptionists at any of the 5 hospitals where I'm currently a registered patient. I'm such a frequent visitor to the gastroenterology clinic at my local hospital, and the rhinology clinic at the Royal National Throat, Nose and Ear hospital that I don't need to give my name at reception any more; they know who I am. I have no local friends to lean on for real life support, the only socialising I ever do is on social networks like Twitter where I engage with people who are scattered across the whole planet.

I can't be sure that such an unusual level of social support was the reason I didn't become clinically depressed in the immediate aftermath of my mum's death, but it certainly seems like the most obvious reason. In fact, it's the only thing I can think of.

But the things that do make me clinically depressed are exactly the kinds of things that Fraser believes people shouldn't receive medication for. I have a shit home life, no partner, and no job at all; never mind a shit one.

I don't take anti-depressants because they're forced upon me by pharmaceutical companies trying to enforce happiness. I went to my GP out of desperation because I couldn't carry on living feeling as awful as I did.

Yes, a great many of the things that make me feel low are down to social pressures. I don't feel a social pressure to have a compulsory smile on my face but we do live in a society in which people are pressured to have a job. Which is a huge problem for someone like me who is too ill to work. LBC (which is basically just a phone-in version of the Daily Mail) on in the Doctor's waiting room reminds you of the sheer number of people who think you're a scrounger and resent paying their taxes to keep you alive. You can't even go to the emergency dentist to get a broken filling fixed without being made to feel small when she asks you "what do you do for a living?" And this is just the social pressure angle, other issues with being too ill to work include: Never having any money, not having career satisfaction, and, of course, being ill all the time.

The fact that I live in a flat that's not accessible enough for my impaired mobility depresses me. Moving depresses me even more. In fact, it was living in the property before this one - the one that was a rodent infested hole the size of a cupboard - that prompted me to seek pharmacological help because I couldn't bear my living situation any more.

My absence of family depresses me. I have no partner, no children, no siblings and no mother. When my dad dies I will be absolutely and truly alone in this world. And don't bother suggesting that I might have found a partner by then: We all know that's never going to happen.

Being ill depresses me. The mobility impairment I've had all my life doesn't depress me in itself, but I can't count the number of times I've been reduced to darkness by people treating me cruelly because they're disablist bastards. Some of my physical health problems cause me to be depressed directly. There's a phase after a migraine called "postdrome" which can cause depression. You'd think I'd be happy that my pain had cleared up. But instead, after a migraine, all I can think about is how much I'd be better off dead. I try to remind myself that it's just the postdrome and I'll be fine in the morning; but it's hard to keep telling yourself that when the rest of your life is a fucking disaster.

I've failed at doing everything I loved. I failed at swimming. I failed at comedy. I tried doing an awesome Masters degree but never got to finish it because of my health. There is literally nothing in my life I can look back upon that I've succeeded at.

According to Giles Fraser, none of this list of misery warrants medication because it's normal to be sad when your life is terrible. And pathologising this normal response is just making Big Pharma rich. It doesn't matter that without drugs to boost my mood that I might not last long. Even just looking at this list of things in black and white makes me wonder what the point is of carrying on.

There are plenty of physical conditions that are a perfectly normal response to life's ups and downs that we medicate. Catching a cold is a perfectly normal response to sitting next to someone with a cold on the bus. We medicate colds with paracetamol and decongestants. Breaking your ankle is a perfectly normal response to slipping on an icy pavement. Should we not medicate that with painkillers? Or are the painkillers just pathologising a normal response to winter?

If it's OK to medicate physical responses to life's normalities that make you ill or cause you pain, why should mental illness or pain of social origin be treated any differently?

3 comments:

  1. I'll admit to being slightly freaked out, I'll take issue with you on whether you failed, or society failed the Social Model test, but I think this is one of the most illuminating pieces of writing on depression I've read. People talk about the bio-chemical nature of depression in order to distinguish it from 'simple' sadness, or grief, but this piece has made me realise, or remember, that the brain is not just chemistry and cell-structure, but also thought, and if we focus only on one aspect of it when we talk about depression, then we fail to consider the entire condition, and if we actively refuse to consider both aspects, and that thoughts flow out of the life we experience, not just the chemistry and structures of our brain, then we fail the person, not just the condition.

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  2. What an awesome post. I agree you have got to the crux of the relationship between physical disability and depression. The causal link is not so much the actual physical limitations but the crippling social exclusion. But it breaks my heart when you call yourself a failure. No-one who writes as powerfully and as truthfully as you do should be able to think of themselves as a failure.

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  3. When I studied psychology, this was the great irony we came up against. There are lots of problems you can help folks to manage, and lots of bad experiences (and unfortunate programming) you can help folks to recover from. But sometimes people have problems because they are currently in really bad circumstances.

    I do think it's a public health scandal. You can't actually save everyone from life events which might make them mentally unwell, but we shouldn't have systems that almost guarantee it. This government in particular has done the equivalent of polishing the pavements on the poorest streets of the country so folk can be slipping and sliding all year round.

    It must be reiterated that you're not a failure. Consider the other disabled people you know - including folks who have never had a job, never finished an undergraduate degree, have never exhibited any creative or sporting talents or aren't particularly good at social media. I bet if we ran through your friends, you'd find reasons why each individual is not a failure. There are as many reasons why you're not. Your past adventures with swimming, comedy and academia shouldn't be put down as ways you've failed, but things you achieved. The fact none of them (as yet) have lead to glittering prizes isn't entirely beside the point - they feel lost (and certain aspects may be gone for good), that really sucks. But you still did them; those achievements, rather than the absence of greater things, are part of who you are.

    It's entirely legitimate to argue that your life is crap. But you aren't. This is very important because while hardship, discrimination and loneliness can be endured, self-loathing cannot. You're great - you write things like this.

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