Shoot the Damn Dog: A Memoir of Depression

by Sally Brampton

  Good therapy does not leave us stuck in the past. Nor does it allow us to change it. It simply helps us to understand why we do certain things, why they are unhelpful and how we might overcome them. It will not work, though, if we do not use its lessons. The hard work, the lion’s share, is down to us. I have heard people complain about therapy that, ‘It’s all very well learning why I behave in the way that I do. That doesn’t stop me behaving in those ways. I am just more conscious of them.’ Consciousness is where therapy stops and we begin. Therapy can only give us knowledge. It is up to us to use it. It is not easy. Changing a habit of behaviour takes time and endless repetition. We have to, literally, learn to think in a new way. But in order to do that, we have to analyse the old way.

  So, in order to understand my depression and to find a possible way out of it, I had to understand the illness, starting with genetics. While we cannot change our biological destiny, an insight into it might help us to be careful, rather than careless, of it. I have two brothers. All three of us have, to varying degrees, suffered from depression. Major depressive disorder is thought to be heritable, although to what extent, nobody appears to know. The verdicts among scientists range from ‘mildly’ to ‘fairly’. New research suggests that women are at greater risk than men. According to a study carried out on 42,000 twins, the heritable rate of depression is forty-two per cent in women and about twenty-nine per cent in men. The study concluded that: ‘Depression is a moderately heritable disorder, suggesting that genetic factors are important, but by no means overwhelming.’

  In other words, it is a predisposition as opposed to a predetermination. But if there is depression present in a family, there is also the chance that a parent may be depressed and therefore may not be able to provide the best environment in which to raise a child. So, how much of it is inherited through genes, and how much through environment as a possible result of those genes, is open to debate. As the author of yet another study on genetics and depression cautioned:

  Because parents may provide both high-risk genes and a high-risk rearing environment, disentangling psychosocial and biological factors mediating the transmission of risk across generations is a challenge.

  I think that’s shorthand for, ‘we don’t really know’, which is hardly surprising as there is no single gene for depression. Like diabetes or cardiovascular disease, depression is a complex genetic disorder, meaning it involves multiple genes. So you can’t go around pointing fingers saying, ‘There’s the culprit.’

  It makes sense, too, to think that a certain cocktail of genes may set up an underlying fragility that may make us more susceptible to depression when faced with certain difficulties. Whether we will be faced by those difficulties depends, to an extent, what hardballs life throws at us and also how well we have been taught to deal with them in the first place.

  This is what the World Health Organisation says, in rather more scientific language:

  Depression is a complex disorder which can manifest itself under a variety of circumstances and due to a multiplicity of factors. The biopsychosocial model is useful to understand the causation of depression where biological (genetic and biochemical), sociological (stressors) and psychological (development and life experiences) factors interact to produce a picture of depression. Research during the last fifty years indicates that there is no single factor which can explain the cause for depression.

  Crucially, an episode of depressive illness seems to require a number of stressors (difficult or painful events) to become active. The gene thought to be responsible for the regulation of serotonin, the feelgood neurotransmitter, is known as 5-HTT. It commonly appears as either a short or a long form. It is the presence of the short form that seems to indicate a possibility (rather than an inevitability) of depression. Researchers at King’s College London conducted a study using a control group of 847 people, who they followed over twenty years. It revealed that people who carried one copy of the short form had more depressive symptoms in response to life stresses. Those with two copies of the short form were more than twice as likely to become depressed following stressful situations as those who carry the long form.

  But surely, difficult or painful events are a part of everyday life? In which case, anyone with a genetic predisposition to depression is guaranteed to fall ill at some time or other. Well, no. According to biologists, there is only an inherited liability to develop major depression in response to environmental stressors rather than it being an entirely genetically determined condition.

  Then there is the nature/nurture debate. Is depression the likely result of a difficult childhood and a dysfunctional family set-up, or is it simply a vulnerability that one is born with? Perhaps both. There is growing evidence that depression has a great deal to do with family patterns, as in learned behaviour. If children are not taught good coping skills or emotional strategies, they may find it difficult, later in life, to deal with problems. And, if depression is actively precipitated by stressful events or problems, those children are perhaps more vulnerable than those who have been taught how to face problems effectively.

  I was not taught well. I know how to ignore problems, but not how to face them. My default setting is stoicism, coupled with an extreme self-sufficiency and independence. Now, these are all admirable virtues. They served me brilliantly well in my career and I am grateful for them.

  Had it not been for the fact that I also have depression-prone genes, which renders those stoical qualities more destructive than constructive, I might never have become depressed. But I did and, more to the point, so did my two brothers. Three out of three, or one hundred per cent, is a pretty high score for an illness with a genetic liability of, at most, forty-two per cent, and seems to suggest that my particular depression is not simply the result of a mutual biological inheritance but of other, shared influences.

  And so I had to look at my family, in more forensic detail that I would normally use. Not simply because I want to know what caused (or may have caused) my depression, but because I would like to see and understand the behavioural patterns that made me vulnerable in the first place. And which, if I am to avoid (or at least, diminish) further episodes, I need to change.

  On the surface, we are a happy family. We hug and we kiss. We are pleasant. We can afford to be. We never engage with one another enough to be unpleasant. We do not shout. We do not fight. We do not have rows. We are, in short, like icebergs with only the top on show. The rest is private and it is in that privacy that darkness lies. Or, my darkness, at least. To live on the surface is in its own way fine and perfectly peaceable. Peaceable, at least, until something as catastrophic as mental illness intervenes.

  Our childhood was spent moving. We were brought up in six different countries, in Brunei, Brazil, Aden, Oman and Angola—and England too—following my father wherever his work took him. All three of us were sent to boarding schools, which were not the benign, liberal institutions that most are today. If we were ever made unhappy by our disrupted, peripatetic childhood, we did not say so. Not to each other and rarely to our parents although I was the most vocal of us three. But I am the most volatile too although that volatility, when I look at what goes on in other families, seems a very tepid thing. We do not, as a family, ever say how we really feel. We just get on with things and if ever we did express distress, there was always our mother to say, ‘Don’t upset yourself.’

  I am, these days, amused by that phrase; it is so beautifully English. It tells us two things. It says that the initial upset is not important enough to be taken seriously and that it is anyway, you who is upsetting yourself. It’s a lose-lose situation so better to put up and shut up. It was not intended unkindly. It just shows, I think, how the details of family lore can, quite innocently, weave their way into an impenetrable emotional deadlock.

  I saw this clearly, perhaps for the first time, when I was driving my younger brother, Tony, to the airport. At the time, I was still struggling with my depression and deep in therapy, so I
was perhaps more conscious than usual of odd behaviour. I was also very conscious of the depression that seems to haunt our family or, at least, us children. When he was young, between the ages of about fifteen to twenty-five, my older brother, Michael, suffered badly from depression. He got no help. We do not, like most families, have any dealings with psychiatrists or therapists and this was thirty years ago, long before such things were commonplace or acceptable.

  At the time I drove Tony to the airport, he was also depressed. He had lost a startling amount of weight, was deathly pale and had great black rings circling his eyes. The medication he was taking did not appear to be working. Tony’s self-prescribed remedy for depression was to go off around the world, alone. He left his wife and three children behind and arranged a three-month sabbatical from his City job. The company for which he works is very formal so is not in the habit of handing out leave to senior employees but when he explained he had severe depression, they were sympathetic.

  As we drove I said, ‘Have Mum and Dad asked you why you are going away?’

  Tony shrugged. ‘No.’

  ‘Have they asked you why you look so dreadful?’

  He smiled faintly. ‘Thanks and no, they haven’t.’

  ‘They’ve said nothing to you at all?’

  ‘No.’

  ‘So you’ve told your boss that you’re depressed, but not Mum and Dad?’

  ‘That’s right.’

  ‘Have they asked you how you are emotionally?’

  He grinned, a familiar cheeky smile that held echoes of our childhood. ‘Of course not.’

  My parents are not uncaring. They love their children very much. It is just they do not express emotion well because it was never expressed to them. We do not knit our behaviour into patterns on our own. We learn them from our parents. And they learn them from their parents before them. We are all following a pattern that was laid down years before we were even born.

  Those childhood patterns are hard to break. I still, after years of therapy, dislike saying how I really feel. The effort of it chokes me, literally, with a constriction at my throat. And there, obviously, are the origins of the throat monster. I don’t need to be an amateur psychologist to know that. I’ve had plenty of experts to tell me. I swallow down my feelings and choke on my true instincts. I have no idea, in the classic therapeutic phrase, ‘how to get my needs met’.

  Why? Because, as one therapist told me, I have been beautifully trained to have no needs or, when I had them, to deny them. I needed, as a child, to feel safe, to be secure, to form lasting attachments and not only to people but also to places and things. Living between six countries over a period of eighteen years, leaving schools, houses, friends and cultures was not the best way to feel secure.

  As human beings we all have to learn to adapt, it is part of our condition. As children we have to learn to adapt in order to survive because we are so wholly dependent on adults. So I adapted. Impermanence was so much a part of my childhood that to my childish mind, I became the only fixed point in my landscape. I was powerless to change the way things were and it seemed to me that my parents were powerless too. No point making a fuss, no point wishing life was otherwise.

  I remember, when I was nine and we left Aden for the last time, the sight of Bimbo, our dog, snuffling happily in the garbage heaps piled on the sandy pavements outside our house.

  He was the only dog we had ever owned, or would ever own. We moved too much to have pets. It was not fair to leave them behind, on us or on them. Bimbo was being sent to live with another family. I knew that I would never see him again. I knew, too, that Aden was becoming a dangerous place. There had been a bomb at the airport some weeks before. A friend of mine, a child, had been hospitalised after a piece of shrapnel was blown into her stomach. As far as my nine-year-old self was concerned, we were abandoning our dog to danger. I lay in my bunk on the boat back to England and cried. But I knew that there was nothing to be done and nothing would come of crying about it, just as I had discovered that nothing could be done about leaving my friends in Aden, my school, my house and all the other familiar things that bring comfort.

  And so, as I understand it, I adjusted to constant loss as well as the inability to articulate any distress on, as one therapist described it, an ‘adapted’ level. The term, ‘adapted child’ was originally used by Eric Berne, the father of Transactional Analysis in the 1950s. Essentially it means the compliant, orderly side of us that hides anger, pleases others and generally acts the good girl or boy. The more that behaviour is rewarded (and the more that any other behaviour is punished or, more usually, ignored) the more we adapt ourselves to keeping quiet and not making a fuss. Put in another way, we adopt the position known in therapeutic terms as ‘abandonment or withdrawal’.

  It is not, either, only the still, pale, silent child who has withdrawn. Withdrawal takes place at a far deeper level and may be disguised by a bright, lively and social exterior—the sort of exterior that indicates compliance because compliance brings its own rewards.

  Alice Miller, psychoanalyst and author of The Drama of Being a Child, describes the ways in which children recognise their parents’ needs at a very young age and then repress their own, often very intense, feelings and needs, because he or she believes they are unacceptable to the parents. Miller writes,

  Depression is the price the adult pays for this early self-abandonment. These are people who have always asked themselves what others need from them, thus not only neglecting their own feelings and needs, but never even making contact with them.

  I remember, clearly, the first obvious sign of my brother Michael’s depression. We were living in Oman, a slice of land just above Saudi Arabia, and had planned to go on a fishing trip with another family. When we were about to leave, everybody gathered together except Michael, who had disappeared. We searched the house, which was quickly done, and the area immediately outside the house. We lived in the desert, but a desert made of steep ravines and gorges. The temperatures there were unbearable, sometimes reaching 130 degrees Fahrenheit in the shade. After a brief search, we asked our houseboy, Mohammed, to go out and look. Mohammed knew the terrain intimately and could run up and down the ravines barefoot, dodging the scorpions and snakes that lived there. It was not a place for a fourteen-year-old schoolboy, fresh off the plane from England, to be wandering. Mohammed came back empty-handed.

  We sat and waited. The silence seemed endless.

  Two hours later, Michael appeared. He looked startled to find us in the house. He obviously thought that we would all have gone on the boat trip, as planned. He said simply, ‘I didn’t want to go on the boat, so I went for a walk.’

  My mother, who was understandably frightened and angry, asked him furiously why he had not said anything or told anyone.

  Michael simply shrugged. ‘I thought that nobody would notice.’

  Nobody would notice. That remark has haunted me for years.

  ‘Stop abandoning yourself,’ a therapist, Elizabeth, once said to me.

  ‘What?’ I didn’t understand.

  She explained it like this.

  Every time you feel sad and swallow down your tears, you abandon yourself.

  If somebody hurts you and you pretend that you are fine, you abandon yourself.

  Every time you don’t eat, or fail to feed yourself, you abandon yourself.

  If you are tired, but refuse to rest, you abandon yourself.

  If you drink too much and poison yourself with alcohol, you abandon yourself.

  If you don’t ask for what you need from somebody with whom you are intimate, you abandon yourself.

  The times when you resent putting somebody else’s needs before your own are the times when you are abandoning yourself.

  If you don’t ask for help when you need it, you abandon yourself.

  ‘You suffer,’ Elizabeth said, ‘from a failure of care.’

  From who?

  ‘From yourself,’ she says. ‘And before that, from your
parents. They are the ones who should have taught you how to take care of yourself.’

  A failure of care. It sounds so harsh. And at the same time so childlike. Both things are true. An inability to take care of oneself or soothe oneself is a sign of immaturity. It is a failure of understanding, or of teaching. If you are not taught as a child how to take care of yourself, you do not know as an adult. The pattern becomes ingrained. You are now an adult inhabited by a child. The child pleads, the adult overrules. You deny yourself proper care.

  There are, of course, many theories about the effects of childhood on later, adult depression but this particular idea rings true about my own. If nothing was constant, it was better not to become attached and better not to need. If you are bullied as a child, as I was, often, at the various schools I attended, it is better to make yourself smaller or disappear entirely. Either that or pretend that you are impervious.

  None of this, of course, occurred to me at the time. It did not even occur to me in my twenties and thirties when my mantra was: ‘It is better to be alone.’ I learned very early that anything I loved—people, dogs, schools, houses—was taken away from me. So I decided, although not consciously, never to become too attached to anything.

  To put that in therapeutic language, this state of detachment is best described as becoming ‘wantless and needless’. If you adopt the position of not wanting or needing anything emotionally, you are unlikely to get hurt. To sustain that entirely, you withdraw emotionally and even physically from others, although you may show a perfectly sociable exterior when you are out in the world. It is the interior that is fiercely defended. Some people (as I did) adopt this as a solution to emotional pain, forgetting that we are communal animals, biologically and genetically determined to interact with others. The solution then becomes the problem. We not only need emotional comfort, we are programmed to seek it out, which is perhaps why I married twice. It is also, perhaps, why both marriages failed—a sort of self-fulfilling prophecy. Like the adapted child, we become the adapted adult. We engage on the exterior but remain withdrawn on the interior.