An article in the February 2005 issue of the Harvard Mental Health Letter, a newsletter issued by Harvard Medical School describes dysthymia thus:
The Greek word dysthymia means ‘bad state of mind’ or ‘ill humour’. As one of the two chief forms of clinical depression, it usually has fewer or less serious symptoms than major depression but lasts longer. Dysthymia is a serious disorder. It is not ‘minor’ depression, and it is not a condition intermediate between severe clinical depression and depression in the casual colloquial sense. In some cases it is more disabling than major depression.
Like major depression, dysthymia has roots in genetic susceptibility, neurochemical imbalances, childhood and adult stress and trauma, and social circumstances, especially isolation and the unavailability of help.
Dysthymia runs in families and probably has a hereditary component. The rate of depression in the families of people with dysthymia is as high as fifty per cent for the early onset form of the disorder. There are few twin or adoption studies, so it’s uncertain how much of this family connection is genetic.
As the Harvard Mental Health description suggests, it is difficult to see whether my mother’s depression is an inherited predisposition, the result of a lonely and disrupted childhood or of a troublesome marriage exacerbated by social isolation in the many (often difficult) countries in which my parents lived. Perhaps, as in the case of most depressive disorders, it is all of the above.
My mother was an only child whose parents worked in the theatre so were travelling for much of the time and living in digs. It was unsuitable for a small child so she was packed off to live with her aunts, who ran a nursing home for the elderly, in which she spent most of her young life. My mother, who rarely even mentions her childhood, once said, in a rare moment of candour, that she didn’t have a mother until she was eleven, or at least not a mother who was in any sense present.
Of the two maiden aunts, the elder was a dominant character, the younger a weak, almost childlike figure who was often bullied by her older sister. The younger confided in my mother, herself only a child, seeking her out for comfort and a place to unload her troubles. It must have been a lonely, not to say alarming, existence for a small child, deprived of her parents and under the care of two adults, neither of whom had any experience of children and one of whom was scarcely an adult herself.
Then there were the war years, evacuation and a boarding school. Her parents adored her, but they adored each other too, often to the exclusion of anyone else. I had seen this first hand, having spent a great deal of time with them during holidays from my boarding school. While they were always welcoming, they also seemed faintly surprised to find somebody else in their midst. It must have been doubly difficult to be their child, conscious of their intense focus on each other but never quite included and often sent away for long periods of time. Perhaps this is why my mother has always demanded singular amounts of love and attention from those around her.
Then there was her married life, trailing around the world after my father, living in alien and often difficult cultures, particularly for women, her children sent away to school in another country. My mother’s lively intelligence never suited the coffee mornings that dominate ex-patriots’ wives days.
My mother was also, and I think this is particularly important for a woman of her independent nature and intelligence, unable to work because there was no work for women in the countries to which my father was posted. She was part of that generation of women who were expected to be entirely dependent on their husbands; their confidence so diminished that they often became frightened by the demands of the wider world and hid that fear behind a stubborn and defensive domesticity. I know I would have hated it and I am so like my mother, I cannot believe it did not do her harm.
Neither did my mother find the solace and comfort she needed in marriage. My parents have endured a troubled and sometimes frankly unhappy relationship, but are still together after fifty-two years. In that they are no different from many other couples of their generation who stayed together despite an obvious incompatibility. Age has mellowed them and they are perhaps happier than they have ever been. Whether that is an argument for staying in a difficult marriage, I really don’t know.
I do know that their unhappiness had a profound impact on me and on my younger brother, Tony, who spent the early part of his adult life convinced that he would never marry or have children because he could not tolerate the possibility of the misery that would inevitably follow.
Happily, he did marry and have children. He has, in effect, broken the treaty although it has not always been easy for him. So has Michael. Then again, they were less connected to my mother who used me as her confidante and, too often, as the dumping ground for her disappointment and bitterness with my father. Perhaps she mistook me for an adult, not understanding that in the presence of our parents, we are always children. I listened, for hours, to her dislike of him and her desire, never actually carried out, to leave him. If ever I suggested that she should leave, she would either tell me that I didn’t understand, or find some reason why it would be impossible.
I love my father very much, and found it increasingly difficult to listen to my mother’s litany of his failings. I love my mother too, and felt sorry for and sad about her unhappiness. I was torn, and the only resolution I could see was to walk away from both of them but I could not do that either. For better, or for worse, they are my parents.
It is not, I fully believe, my mother’s fault. She has never had any help with her emotions or her depression and lived through a period of history when any analysis of feelings was not considered useful. She is aware that she gets depressed, but does not know how to deal with it or, even, how severe depression can become. When I telephoned her to say that I had just been diagnosed with severe clinical depression and was to be admitted to a mental hospital, her first response was to say, ‘I’m so depressed, I need the bed next to you.’
When I recounted that remark to a therapist, she shivered in protest, as she did when I said that my mother came to visit me only once, and briefly, in three psychiatric units. My father did not come at all. This might seem astonishing, and when I look at it dispassionately, I feel quite astonished myself, but I know it was not out of indifference, it was because they would have thought it better to leave me to the experts.
Some people say, ‘Oh, it’s just their generation,’ but there were plenty of elderly people visiting their sons and daughters. I said nothing to them at the time because it seemed to me that there was nothing to say; it was merely symptomatic of the emotional distance that exists in my family as well as the stigma that creates an impenetrable barrier around those who suffer from mental illness.
My family’s apparent lack of concern as well as the fear and secrecy surrounding a stay in a mental hospital made me feel inexpressibly lonely and, of course, only made my condition worse. And it was not just family. One of my closest friends, closer than a brother, failed to send even a card, let alone visit. This is a man who, when I had flu, sent fleets of cars carrying orange juice, magazines, flowers and grapes to my bedside because he could not be there himself. Yet, after I left the psychiatric unit, he was bewildered to be met by tears and anger at his absence. ‘But I thought that was what I was supposed to do,’ he said, himself in tears. ‘I thought I was supposed to leave you alone.’
Why? In which other illness are we supposed to leave people alone? This is an aside, I know, but it may be important for anyone who does not know what to do when a friend or loved one is in a mental hospital. Go and visit them, unless they are too ill to see people or have expressly said that they don’t want visitors. The nursing staff will tell you if that is the case. Send them something, whether it is love, flowers or a card. Let them know that you care, and that they matter. Don’t wait to be asked. The depressive is in no state to make that sort of demand. They scarcely know their own mind.
As for my mother, her inability to express her true feelin
gs has, over the years, caused her great unhappiness, resulting in a constant, simmering frustration and an irritation that she tends to vent on my father. It is extraordinarily painful to watch. My father, as many men before him have done, simply withdraws and becomes yet more silent. It is not in his emotional make-up to take such things personally, which, of course, manifests in indifference and only makes my mother’s behaviour worse. She wants a reaction, even a negative one, and the frustrated need to get a response blinds her to her own escalating and sometimes cruel behaviour.
Similar wars of attrition are being fought, even now, in countless houses across the land. My parents are far from unusual. As a child who loves both their parents, it is heartbreaking to watch but it is the fate of many children, whatever their age, caught up in an unhappy marriage. Loyalties are torn to breaking point and children, for whatever reason—and there are many theories about this—will always feel responsibility for their parents’ happiness. It is, in brutally biological terms, in their best interests. A child must depend on its parents—it has no choice—so it will deny and internalise any difficulties by withdrawing and shutting down. Either that or it will become difficult, or wayward or actively aggressive. Anything to get the attention of its parents, to distract them from the hostility, overt or otherwise, that they are waging on each other.
If a parent is too absorbed in their own problems or misery, they have little time for their child’s demands. Their own needs come first. Their own emotions are paramount so their tensions and arguments are played out in full view of their children. Self-absorption is a powerful thing; it blinds us to all manner of destructive behaviour—even towards those we love the most.
The worst, and most profound impact of my parent’s unhappiness with each other was on my understanding of relationships. If you are raised in an atmosphere of tense and sometimes poisonous silence, or witness a relationship in which two adults rarely touch or kiss, you are unlikely to learn how to have a good relationship yourself. Or, even, to know what a good, intimate relationship might look like. As a result, I have always felt it is better to be alone and at the same time, I long for connection. It is not a happy place to be and if depression is precipitated by stressors, then one of the greatest we can endure is the breakdown of our intimate relationships. Most research into the effect of unhappy marriages on children focuses on the impact of divorce, assuming, somewhat precipitously, that all marital unhappiness ends in divorce. There are fewer studies of the effect on children of long-term, chronic and often unspoken marital misery that continues over decades, but those that do exist are pretty conclusive.
A study by E. Mark Cummings, a professor of psychology at the University of Notre Dame, Indiana, examined the impact of parental conflict on children’s future behaviour. It found that the manner in which parents handle everyday marital conflicts has a significant effect on how secure their children feel, and, in turn, significantly affects their future emotional adjustment. Destructive forms of marital conflict—such as personal insults, defensiveness, marital withdrawal, sadness or fear—set in motion events that later led to emotional insecurity and maladjustment in children, including depression, anxiety and behavioural problems.
According to research done by Alan Booth and Paul Amato at Penn State University, marital conflict among continuously married parents was associated with less contact and greater emotional distance between parents and their adult children, irrespective of whether the parents’ marriage had ended in divorce. Although not previously studied, this finding suggests that even children with continuously married, rather than divorced, parents can feel caught between the two. Moreover, growing up with discordant parents is linked with elevated levels of psychological distress, even after children have left the parental home.
We can leave the last word on this to Freud. Who else?
If there are quarrels between the parents or if their marriage is unhappy, the ground will be prepared in their children for the severest predisposition to a disturbance of sexual development or to neurotic illness
My mother’s irritation with and disappointment in my father has a source, even if it is not one that we understood as we were growing up. Although he has never been officially diagnosed, it seems almost certain that he has Asperger’s syndrome. This condition, also known as high-functioning autism, was not officially recognised until the early nineties, although it was described in medical literature in 1944 by Hans Asperger. It has become yet more public since the publication of the best-selling novel, The Curious Incident of the Dog in the Night-Time by Mark Haddon, in which the main character, a young boy, suffers from Asperger’s. Its sufferers are predominantly male and the spectrum of the condition ranges from very mild to severe in its manifestation.
The recentness of its discovery explains why my father, who is now in his eighties, was oblivious to the condition. He only became aware of it when my nephew, Michael’s son, was diagnosed and, in order to better understand the condition affecting his grandson, read a textbook on the syndrome. He pointed out that he recognised himself on every page. And we recognised him. Michael, himself aware that he also has distinct characteristics of Asperger’s, is convinced that my father is affected.
It has always been apparent that there was something very different about my dad. It was just that until recently, we did not know what. The most pronounced characteristics of the syndrome are social discomfort to the point of avoidance of any situation involving unfamiliar people or places, repetitive behaviour patterns and extreme difficulty in looking somebody in the eye. As children, we used to put my father’s odd manner down to an almost pathological shyness. Even normal interactions, which the rest of us take for granted, are difficult.
There is also a possible link between Asperger’s and depression. According to the Autism Research Institute, researchers believe that Asperger’s syndrome is, ‘probably hereditary because many families report having an “odd” relative or two. In addition, depression and bipolar disorder are often reported in those with Asperger’s syndrome as well as in family members.’
The other, and most difficult characteristic of Asperger’s syndrome is the distinct absence of what we call normal emotions or attitudes. Among its described behaviours are,
Difficulty understanding others’ feelings. Pedantic, formal style of speaking; often called ‘little professor’, verbose. Extreme difficulty reading and/or interpreting social cues. Socially and emotionally inappropriate responses. Literal interpretation of language. Difficulty comprehending implied meanings.
While I always felt valued for my ability and loved in every practical way, I never felt in any way understood by my father. And I never felt that I understood him and, to extrapolate from there I never felt that I understood men or male behaviour. This is what, according to every piece of research, little girls use their fathers for; as a sort of test case.
My brothers weren’t much help either in that they both disappeared to school when I was very young. Perhaps it’s no wonder that I didn’t understand relationships either, or how to have them, as two failed marriages bear testimony. I am still astonished when men behave kindly towards me, in an emotional rather than a practical sense, and find it difficult to reveal any emotional fears or weaknesses, not out of any fear of ridicule but because I always feel that it will be met with either blank incomprehension or indifference. I have no such difficulties with my female friends.
That is my father’s legacy to me. Or, rather, the legacy of the condition from which he suffers. I’m sure, too, that it is the legacy of every child growing up with an Asperger’s parent although there has been very little documented or written about this. Modern research seems almost exclusively concerned with theories about dealing with an Asperger’s child but as the research around the condition is still, in every sense, in its infancy, this is perhaps not surprising.
I love my father, very much. He is a kind man, supremely well intentioned in every respect. His nature is, in every way,
good. But I would despair, sometimes, of his behaviour. And so I would watch him with a mixture of love and hopelessness, wanting him to be in charge, to take control or to show some empathy and understanding. I also, in my mother’s footsteps, felt blind irritation. Why could he not behave like normal men?
This, of course, was at its worst when I was a teenager, wanting some lead or direction and wanting, more importantly, some emotional support and understanding. There is not, in my father, an inability to love. On the contrary. There is, instead, an inability to empathise. That might seem like a small distinction but in my emotional terrain, it is huge. I am aware of a constant sense of frustration, a nagging undertow of feeling perpetually misunderstood and the belief that my deeper and most important feelings will always be rejected or ignored. As my mother has a similar emotional blindness to my father, through her own undiagnosed depression, this was doubly enforced.
In a wider context, a child who feels ignored or misunderstood turns that message against themselves. It becomes, I have no right to feel the way that I do. And an analyst will, inevitably, take that to yet another level. A child whose deeper feelings are constantly minimised, challenged or simply ignored, ends up believing, I have no right to be the way that I am. I reject myself.
Depression, some thinkers believe, is a rejection of the self.
John Bowlby, psychotherapist and the originator of attachment theory, puts it this way, ‘Whether a child or adult is in a state of insecurity, anxiety or distress is determined in large part by the accessibility or responsiveness of his principal attachment figure.’
This responsiveness or what, these days, we might call unconditional positive regard is the quality that children actively need in order to flourish. Certainly, it’s the quality that lays the blueprint for an emotionally healthy adult. A lack of it or a skewed weakness is known as attachment disorder and all sorts of emotional conditions from depression to addiction are ascribed to its presence.
Shoot the Damn Dog: A Memoir of Depression Page 16
