Shoot the Damn Dog: A Memoir of Depression

by Sally Brampton

  ‘Hello,’ he said, in a tone so knowingly familiar that I stopped in my tracks.

  ‘Hello,’ I said.

  He peered down at me. He was very tall, with black curly hair hiding most of his face.

  ‘I know you.’

  This is always a tricky situation in a mental hospital, particularly when the person in question is skeletally thin and wearing full black leathers and multiple piercings. I had no recollection of him but my memory, at that time, was not at its best. Did he know me or was I part of some virtual reality playing in his head?

  ‘Of course,’ I said, because it seemed simpler to agree.

  ‘What are you in for?’

  ‘Depression. You?’

  ‘Drugs,’ he said, as if I would have guessed for sure. ‘You know. The old days.’

  I tried to place him. Fashion? Magazines? Fleet Street? Nothing about him was familiar. I shrugged. ‘Well, they got us both, in one way or another.’

  ‘They sure did.’ He raised a benevolent hand. ‘Be well,’ he said and faded away.

  ‘Who was that?’ Nigel asked.

  ‘I have no idea.’

  ‘Consorting with the druggies already,’ he teased.

  ‘No, I mean I really have no idea. Absolutely none. But he knows me. Or, he thinks he does.’

  ‘He’s Thin Lizzy,’ said Nigel. ‘Or he thinks he is.’

  We are standing on a cobbled mews street in London. It is ten thirty at night and a faint drizzle makes the pavements shine. I am wearing a nightdress and a pair of flip-flops. According to Nigel, I wore flip-flops all the time, mostly unsuitably he says, but I don’t remember. They were jewelled, and my toenails were painted red. I remember the painted toenails. I had developed a fixation with my hands and feet, believing that if they were perfectly manicured and painted, then I still had some semblance of control. I chose to ignore the fact that I couldn’t manage the parts in between. I had worked in or around fashion for twenty years but had so lost any connection to or understanding of myself, that I no longer knew how to get dressed. Getting dressed requires an identity I seemed to have lost or, at any rate, mislaid.

  Standing in the mews in flip-flops in the rain, I realise that most of us are out of our heads on drugs. Or, rather, more out of our heads than usual. Our medication is always handed out at nine thirty precisely, so we are an hour into our dose. There’s a faint buzzing in my ears from the sleeping pills I have taken. Max dosage, or so the nurse who gave them to me said.

  ‘Now you’ll sleep,’ she pronounced cheerfully.

  That was before the fire alarm sounded and the entire intake of the hospital spilled out into the back street. Some, the most serious cases, had to be carried, bundled in blankets.

  One man is propped in a wheelchair, head lolling, spittle dribbling across his cheek.

  Around him, people talk excitedly, voices high-pitched and hyperactive. Most smoke furiously. It looks like some mad rave, a warehouse pyjama party. A phalanx of nurses stands further up the street, arms crossed like bouncers, although they are there to keep us penned into the mews, not to keep us out.

  A woman is shouting. She is bone thin, with transparently white skin and wild red hair and is wearing a ripped lace negligee under a battered old leather jacket.

  ‘My fucking psychiatrist fucking sectioned me,’ she yells, at no one in particular. ‘I said to him, “What the fuck are you doing, fucker?” I’m not mad. How dare you section me? Don’t you fucking know who I fucking am? I’m fucking Janis Joplin, you fucker!’

  And she starts to sing, her voice rising over the wail of sirens as the fire brigade arrive. As Joplin imitations go, it’s not bad but everyone ignores her.

  A voice says, ‘Sally?’

  I turn around. A sweet-faced woman is staring at me. She is young and pretty although the bloat of alcohol is in her face. She must only be in her thirties, and is hugging a Gap hooded top over striped men’s pyjamas. For a moment, I can’t place her.

  ‘It’s me,’ she says. ‘Lily.’

  I do know her. She’s a fellow writer.

  ‘Hello,’ I say. I don’t ask her how she is. In the loony bin, you learn not to ask questions like that.

  ‘What are you in for?’ she says.

  ‘Depression. You?’

  ‘I’m with the alkies, top floor. They put me in here, occasionally, to dry out. Then I go and do it all over again.’ She pulls a face. ‘I drive everyone mad. Have you got any money?’

  I look down at my nightdress and flip-flops and my empty, bare hands. They look half dead under the neon of the street lights. ‘No.’

  ‘Pity. The pub up the road’s still open. We could get a swift one in before closing time.’

  A man behind us takes off, starts running up the road, whooping loudly. The great escape. The phalanx of nurses edge together nervously.

  ‘He’s got the right idea,’ Lily says, watching his progress towards the pub.

  Halfway up the road the man stops, his arms held wide, then swoops back towards us like a deranged bird.

  ‘Got any money?’ Lily says to him.

  ‘It’s a blast,’ he says, panting. ‘You should try it. It’s like freedom!’

  ‘Have you got any money?’ Lily says.

  ‘Silly bitch,’ he says, then all energy seems to leave his wire-thin body and he flops down on to the wet pavement. ‘Do you think they’ll let us back in soon?’ he whines plaintively. ‘I’m tired.’

  Lily turns abruptly and disappears into the crowd. I hear her voice, trailing high above the noise. ‘Anybody got any money?’

  It is the last time I see her. Two years later, I hear from some mutual friends that she is dead from an accidental overdose, complicated by excessive alcohol. I am sad, but not surprised.

  A nurse appears, framed in the lit doorway. ‘Back to bed, everyone,’ he says. ‘Excitement’s over.’

  We shuffle back in to the building like obedient children. Apparently some madman set fire to his bed. Or a pile of magazines. Or a letter he took exception to. The stories vary.

  There are two more fire drills that week. Neither are false alarms.

  Tom comes to see me every night, after the six o’clock meal. We lie on the hard single bed, arms around each other. I kiss him and he kisses me back, and then he pulls away.

  ‘Too weird,’ he says. We lie together, not talking much. I don’t know what he’s thinking. I don’t ask and he doesn’t say. I try to tell him something about my day, the routine that we slip into as easily as a warm bath. It is comforting to be told where to go and what to do, and even what to think, when you haven’t the strength to decide for yourself. It is hard, though, to explain that to somebody who still carries the smell of the outside world, sharp and clear and tearingly familiar, so I don’t.

  Tom never stays long. I feel his eagerness to be gone, even as he arrives. I don’t blame him. It’s not a place to linger, unless you have to.

  I have begun to make friends among my fellow patients. There are around thirty of us depressives but, even though I listen to their stories in group, most of them remain as opaque to me as they, presumably, do to themselves.

  One of the friends I make is Andy, who is suicidal. He was admitted after stabbing himself six times in the stomach, with a kitchen knife. He was discovered, early in the morning, lying under a bush on an empty stretch of common ground, quietly bleeding to death. He cannot remember how he got there or, even, really why. They took him to hospital and stitched together his innards and then sent him here, to have his head examined. His head is shaved, or perhaps it is bald, and he has a bullish neck and a belly on him that must, or so one can only hope, have cushioned some of the severity of the blows.

  ‘Did it hurt?’ I say.

  He rolls his eyes. ‘Of course it fucking well hurt. And only a loony would ask that question.’

  Despite his appearance, he is a gentle man and a graphic designer by trade. Business is bad. It’s an unforgiving profession and Andy feels, m
ore than anything, unforgiven. Not just by his work, but by everything.

  He is inquisitive and makes friends easily, almost too determined to be liked, and is not in the least disconcerted by his surroundings. He seems, more than that, to enjoy them. Some people do. After the lonely hell of mental illness, a hospital with all its rules and regulations can seem like a safe haven.

  He’s not one of the smokers, although he hangs out with them. They gather outside my room, which is right at the end of the corridor, tucked away on its own. There is a table, a cluster of chairs and two overflowing ashtrays and, at any given time, three or four people smoking furiously. I don’t know why we need a smoking area, as we’re allowed to smoke in our rooms. I encounter the smokers every time I step out of my room to go and make a cup of tea in the small kitchen up the corridor.

  ‘Sorry, sorry.’ Kate flaps her arms furiously to dispel the smoke, but only manages to shoo it straight through the open door into my room. Not that it will make much difference. My room is already thick with smoke.

  Kate is big and loud and glamorous with dark hair, streaked with tawny blonde, and hazel, cat’s eyes. She wears hoodies and track pants ‘the only thing that’ll fit my fat ass’ and white trainers with fluorescent stripes. And false nails, ‘these are perfect, the best, I’ll tell you where to get them done, if you like’ and lots of jewellery. She works in advertising. It seems the wrong job for somebody with a crippling anxiety disorder. Not that you’d credit it now.

  ‘You wouldn’t recognise her as the same person who arrived here,’ Nigel says later. ‘She hardly spoke, and kept her arms wrapped tightly around herself and her head right down. And she wore these spooky glasses, very narrow and severe. We were all completely terrified of her.’

  Kate is laughing at something that Susie has said. ‘Silly cow.’ The two are inseparable, bound together by their mutual diagnosis of a severe anxiety disorder. ‘Sorry about the smoking,’ she says again, flapping her arms inconsequentially in the air.

  ‘It’s fine,’ I say. ‘No problem.’

  Andy says, ‘We’re having a party. Would you like some birthday cake?’

  I shake my head. I’ve been crying for hours. I’m not in the mood to face people.

  ‘Bad day?’ Kate says.

  I shake my head again, not trusting myself to speak, and start walking up the corridor.

  ‘Catch you later,’ Kate calls.

  We meet again in group therapy and bond in Negative Automatic Thoughts. This is one of the strands of Cognitive Behavioural Therapy (CBT), the form of therapy used most often in psychiatric units and by the NHS. This is partly a financial decision as CBT is thought to be effective after ten sessions, rather than the ten years, or more, usually devoted to Freudian-based analysis.

  Unlike analysis, CBT pays only a nodding reference to the past and concentrates instead on solving present problems. One of those, or so it is thought, is that depressives hold to a rigid pattern of negative thinking which leads us to act in self-defeating ways. The central tenet of CBT is that thoughts beget behaviour—hence its name, cognitive, as in thoughts, and behavioural, as in actions.

  In essence, it consists of a number of repetitive exercises designed to identify and then challenge those negative thought patterns and put fresh ways of thinking and behaviour in their place. It is designed as a course of exercises; it has a beginning, a middle and an end, so by its particular nature it is possible to assess results empirically, a virtue that no other form of therapy (which is by nature, unstructured; wandering through childhood, stopping off at adolescence, coming into adulthood and meandering back to childhood again) can lay claim to. And, because hospitals and health services like to see results, or evidence-based programmes and because it is time-limited, it has become the most highly regarded and therefore most popular form of therapy on offer. In many local health services, it is the only form of therapy available.

  Its greatest virtue is in the treatment of anxiety disorders, which are more susceptible than many other emotional disorders to the sort of logic that CBT proposes. Most anxiety is based on faulty thinking, or misplaced fears, and CBT exercises can both challenge and then dislodge those fears if used consistently. It is also magnificently good at addressing phobias, which, as one psychiatrist put it, ‘have to be bored into submission.’

  It is less effective, and this is simply a personal view, in the treatment of severe depression or, at least, a depression that has no obvious, single cause. In the case of a reactive depression, which, as the name suggests, is a depression caused by a reaction to an event, it tends to be more effective. But in depression as pathology, it seems only capable of chipping away at the solid block of frozen feelings, or lack of feelings characterised by the black hole of which so many sufferers speak.

  Part of the strategy of CBT is in investing, absolutely, in the belief that emotions are simply thoughts in action. A thought begets an emotion, and not the other way around. I’m not sure that I entirely believe that. Some emotions are inarticulate, they are without words or language. They seem to come from some primitive, pre-verbal base. Memories rely on language to exist, they form a narrative, a continuous loop running in our heads. Without words, memories cannot exist. Or, at least, we cannot access them through our minds. We may, however, be able to access them with our bodies, which perhaps explains the remarkable physicality of emotions—a knot in the stomach, a pain in the neck.

  Or it may be that these physical emotions are memories lodged at a time when we were infants and pre-verbal, when words did not exist. This is some of the thinking that goes into analytical therapy, and why it concentrates so emphatically on the first two years of life in an attempt to try to access the subconscious, or unconscious. Now neuroscientists are beginning to discover that perhaps those early thinkers were not as misguided as modern opinion tends to believe. The brain is not, as had been previously thought, fixed, but subtly plastic; so abuse in the early years, or even a failure of mother—child bonding, can cause certain areas of the brain to fail to develop, or to develop abnormally. Inarticulate emotions also go some way towards explaining post-traumatic disorder. When events are too horrific to verbalise or too terrifying to stitch into the verbal narrative of memories, they become lodged in the body and manifest in shaking, sweating and flashbacks.

  I don’t know if that’s true, although it makes a sort of sense. It seems to me that nobody understands the genesis of emotions, ungovernable or not, although neuroscientists are beginning to take ever greater strides in understanding the workings of the human mind. Perhaps before too long we shall see the emergence of new forms of therapy.

  Right now, we’re stuck within the limits of our understanding, which is how I come to be sitting in a group of people examining my Negative Automatic Thoughts.

  First, the therapist says, we must banish imperatives from our heads. No ‘musts’ or ‘oughts’ or ‘shoulds’ are allowed. Words such as these keep us stuck in negative thinking. So we are instructed to replace, ‘I must get better’ with, ‘I am going to try to get better’.

  Or, how about, ‘I should love my mother’ with, ‘I am going to try to get along better with my mother’.

  I put up my hand.

  The therapist smiles encouragingly. ‘Yes, Sally?’

  ‘Isn’t banning the use of imperatives in itself an imperative? We must not use imperatives. We must not say should.’

  ‘No, not really, not in the way that we use it.’

  I catch sight of Kate. A broad grin has settled on her face. She senses trouble.

  I say, ‘In what way do we not use it?’

  A tiny frown of irritation knits itself above the therapist’s eyes. ‘Shall we deal with this later, Sally?’

  I shrug. I am not being contrary. I prefer to fully understand a method before I can engage with it. Kate’s eyes roll expressively and I catch, just for a moment, a glimpse of who she is. She’s the bad girl who always sits at the back of the class. And I’m the annoyin
g one who likes to challenge authority. Both of which, as it turns out later, are true.

  A little later, the therapist assigns us a task. CBT is filled with tasks, or exercises. There’s homework too, or written work, none of which I do. Not because I think that CBT is a waste of time. For some people, it works and it works well. People like Kate and Susie, for example, for whom it worked magnificently. At the time, I was unable to read or write so it was of little use to me. Nor could I engage with it, in part because of the logic it prescribes, which seems to me too limited and prosaic. It assumes that life is logical, when all my evidence shows that it is not. It also assumes that my thoughts, or my mind, are logical, which is assuredly not the case.

  The therapist asks us to imagine something, an activity, which we hate most to do. I have two. They are driving (about which I had a full-blooded phobia for ten years) and public speaking. Both of them seem to me to be eminently sensible things to be afraid of. One may kill you or somebody else, which seems a good enough reason to dislike it, and the other forces you into full sight of crowds of people, a situation I have never enjoyed.

  ‘Sally, what’s the thing you most hate doing?’ asks the therapist.

  ‘Public speaking. I’d as soon have tacks put through my eyes.’

  She winces slightly. ‘An interesting choice of words.’

  ‘But descriptive.’

  ‘What would happen if I made you do it now?’

  ‘I would shake. My voice would tremble. The palms of my hands would grow clammy. I might feel as if I was going to faint.’

  ‘And that would frighten you?’

  ‘Yes, of course. Those are all physical symptoms of fear.’

  ‘What frightens you exactly?’

  ‘That those things would happen.’

  ‘And what would people think of you?’

  ‘That I’m afraid.’

  ‘And why is that bad?’

  ‘We all avoid fear. None of us like it.’

  ‘Would people thinking you are afraid make you feel like less of a person, like a bad person?’