‘It is this acute awareness of transience and limitation that constitutes mild depression,’ says Andrew Solomon in The Noonday Demon. Is that true? Is that what depression really is? Think, to be bogged down by a fear of impermanence in a world that isn’t a permanent place to begin with. Then how does my place in the world matter? Why agonize over my purpose in life when both life and purpose are fleeting?
Maybe all I possess is a big-picture vantage point that I’m unable to clamber down from. The world around me is being put into constant, unfiltered perspective, and while others can push it away and forget about it, I can’t.
Maybe my only problem is that I’m one of those who can’t forget.
Spoonful of Sugar
Through all the silent and occasionally not-so-silent struggles in my teenage years, my mother had been hard-pressed trying to help me in spite of not knowing what the problem was. And all I did was shut her out and pretend I was fine. She’d nudge me gently, suggest I see a psychiatrist or psychotherapist often enough, but I’d aggressively shoot down her advice each and every time. She could see I was struggling but I had expertly concealed the worst of it from her and she didn’t really realize the full extent of what I was grappling with. But, in the aftermath of swallowing those pills, I knew that had to change.
A few days after the Tylenol incident I sat down with my mother and slowly and shakily attempted to unburden myself of the mountainous load I had been carrying all on my own.
‘Something’s wrong, Mama, I feel empty,’ I remember mumbling to her.
It was a glaring summer afternoon and she was in the living room, busy paying bills.
I had been sitting across from her, wrestling with my thoughts in silence for almost fifteen minutes before I finally got the words out.
‘Hmmm, what darling?’ she asked absentmindedly.
‘I feel empty. I feel so empty that it hurts.’
She looked up at me, bills forgotten. ‘Okay, in what way exactly?’ she asked slowly, looking concerned.
‘I don’t know,’ I said, still not properly meeting her gaze. ‘I just feel . . . wrong.’
A tear trickled down my face, uninvited. This was the first time I had ever tried to articulate what it was that I had been feeling for all this time. For six years the Feeling had slowly taken root in me and mounted and escalated and finally led me to this moment. It was the first time I had ever really acknowledged, even to myself, that something was wrong . . . and I had no way of describing it.
‘I’m not happy. I can’t remember the last time I was happy. I can’t remember the last time I wasn’t this sad. Everything hurts. It hurts all the time and I’m scared I’ll never stop feeling like this. I’m really scared.’
I didn’t exactly tell her what had prompted this long, overdue confession—I was too afraid that she would never let me out of her sight again if I told her—but I said everything I could to make her aware of the gravity of the situation I had found myself in.
She listened quietly as I continued talking, her face growing from concerned to resolute. When I was done she held me in her arms and reassured me in the way that only mothers can. ‘Don’t worry. I love you and we’re going to figure out what’s going on and deal with it together,’ she said.
If you’re anything like me, you’ll scoff at the idea that a stranger can teach you things about yourself that you don’t already know. But as human beings we’re full of unconscious motivations and historical explanations for our current patterns of behaviour. Psychotherapy, or talk therapy, is the first line of defence against mental illness, and it provides a non-judgemental environment in which you can share your thoughts and feelings and feel supported and understood. Some forms of therapy are insight-oriented and help increase your self-awareness, while other forms offer specific, research-based techniques to help you challenge your negative thinking, manage stress, improve your mood and enhance the quality of your relationships. Psychotherapists are usually able to provide you with guidance and help you ascertain whether or not you’re in need of further medical intervention and are required to progress to the second line of defence—meeting with a psychiatrist.
The difference between psychotherapists, psychologists and psychiatrists is often a source of confusion for people.
To put it simply, a psychologist is someone who has a PhD in psychology, while psychotherapist is an umbrella term used to describe a professional who treats emotional issues—psychotherapists can include psychologists but they can also include trained therapists who do not hold a doctorate and are equipped to provide counselling and guidance at a graduate level. Both focus on treatment involving psychotherapy and behavioural interventions.
Neither psychologists nor psychotherapists are able to prescribe medication, however—this is a qualification possessed by psychiatrists who are trained medical doctors, and who focus primarily on treatment through medication.
For me, given the precarious mental place I was in at the time, meeting a psychiatrist was no longer an option, it was the only option. My mother had understood the pain I was in, and while she recognized whatever I was grappling with was not to be taken lightly, she knew it was not for her to decide what was going on with me. The very next day I was in the waiting room, nervously readying myself for my first therapy session.
The road to a diagnosis began there. I was ordered to do a series of blood tests which revealed that among other things, I had extremely low levels of serotonin, a neurotransmitter considered one of the primary contributors to feelings of well-being and happiness. Further sessions of psychoanalysis, therapy and psychological testing confirmed I was dealing with major depressive disorder and soon enough, I started on medication to help alleviate the severity of my symptoms.
There is still a lot of debate, controversy and conjecture about the diagnostic tools and treatments available for depression and other mental health illnesses. There are a lot of studies that link low levels of serotonin to depression but there are an equal number of studies that suggest that serotonin’s role in depression has been, at the very least, largely exaggerated.
There are a lot of people who claim that medication has helped cure them of depressive and other symptoms, but, there are just as many who claim it hasn’t helped them, or, in some cases, has made them worse. While modern psychiatry is perhaps a lot further along than it was twenty years ago, the fact remains that there is still a whole lot we simply don’t know.
To begin with, we still lack a complete and exhaustive understanding of the brain—the alleged birthplace of all mental illness. We don’t even understand where consciousness—the source of every existential idea—comes from.
We struggle with the very basics—what qualifies as depression in the first place? All our treatments are based on the idea that there exists a fundamental imbalance in the mind, but, in order to define the parameters of what constitutes an imbalance, you must first understand what balance is. In order to pinpoint what abnormal is, you must first define normal. If there is such a thing as ideal brain chemistry we are yet to define it. If there is such a thing as ideal emotional state we are also yet to define that.
To this day, despite the many purported causes for mental illness, there has been no way to conclusively link depression to any one cause. According to a piece published by Harvard Medical School, ‘It’s often said that depression results from a chemical imbalance, but that . . . doesn’t capture how complex the disease is.’ It goes on to say that ‘depression doesn’t spring from simply having too much or too little of certain brain chemicals. Rather, there are many possible causes of depression, including faulty mood regulation by the brain, genetic vulnerability, stressful life events, medications, and medical problems . . .
‘To be sure, chemicals are involved in this process, but it is not a simple matter of one chemical being too low and another too high. Rather, many chemicals are involved, working both inside and outside nerve cells.’†
Given that there is no conc
rete or absolute cause for depression yet, there is also no one, foolproof way to diagnose it. There is no simple blood test or X-Ray to pinpoint the causes of depression or mental illness, instead as psychiatrist Allen Frances puts it ‘psychiatric diagnosis still relies exclusively on fallible subjective judgements rather than objective biological tests’. As a result of all this diagnostic ambiguity there is no one treatment for mental illness either, and psychiatrists can’t always predict which treatments will work and for whom. Does that mean treatments don’t work? No, it doesn’t. It just means that what constitutes ‘treatment’ looks different for everyone.
While there have been a lot of advancements in what we’ve learned about the biology of depression we’re still a long way from seeing the whole picture. We are in the early days still, the middle ages of psychiatric science, in the sense that there are numerous treatment options available to choose from but figuring out what works still involves a lot of hunches and guesswork. Psychiatrists and psychotherapists have to play the part of both medical professionals as well as detectives. They have to work to untangle and ascertain not only the possible biological causes of a mental illness but also the unique psychological causes of one. As a result, individual treatment plans take work and patience to find and perfect. It means a willingness to accept that what worked for someone else may not necessarily work for you, and vice versa. It means that no one treatment is a magic cure-all.
Keeping in mind that that information we have is still somewhat incomplete, we must educate ourselves to the best of our ability and use whatever tools we have available to us to begin to form a clearer picture.
I can’t say I took to therapy easily or that I was thrilled about being branded mentally ill and needing anti-depressants, but I had finally understood what I was going through was much bigger than me, and that I had to try everything I could to feel like ‘myself’ again. For me, I found that both talk therapy and specific medication did work to improve my state of mind, but, even then my depression was not miraculously cured and some of my worst years were still to come. But within a year of that frightened attempt at suicide I had gotten to a place where all active desire to end my life left me, and so far, it hasn’t come back.
As a teenager, I hadn’t yet learned I could help myself with the right tools like talk therapy, medication and exercise and, most importantly, had the realization that relief could be achieved at all. I also didn’t realize the effect being a teenager was having on my depression. Our bodies experience an extraordinary number of chemical changes through puberty. We’re flooded with hormones that affect our moods, which have a marked effect on our neurochemistry. Whether you’re depressed or not and whether you’re prone to mental illness or not, being a teenager involves developmental turmoil. It took the settling down of all these chemical reactions in my body to finally allow me the chance to accurately assess my situation for the first time.
By the time I was in my early twenties, therapists and psychiatrists had become a regular fixture in my life. I learned early on in the experience that finding the right therapist, like finding the right relationship, can take a great deal of patience and willingness to occasionally be disappointed. We’re all built differently, and we all respond uniquely to various forms of care. All psychotherapists and psychiatrists have their own personalities and varied approaches to healing, and therapy is most successful when you find someone you can communicate well with. I’ll be honest, the first therapist I went to was not a good fit for me at all. She was a psychiatrist who also offered counselling, and talk therapy was obviously not her field of expertise. She also always had a waiting room full of people making the process both long and extremely rushed, so she wasn’t able to give me the care or the attention I needed at the time. I went to several before I settled on one who suited me, and once I found a rhythm and established a good relationship with my therapist, I found the experience to be invaluable. I believe that for me, depression started out as something that had a chemical trigger, but because I lived with it for so many years at such a sensitive time in my life—my teenage years—it progressively became more and more psychological. Therapy taught me so much about myself and my psychological triggers and defences. It helped me delve deep into my fears and insecurities and gave me a deeper understanding of where they came from. I learned to spot and identify all the ways in which I unknowingly hampered my own progress. Years of living with depression had given rise to a number of unconscious behaviours that acted as defence mechanisms and they, as much as the illness itself, were also holding me back. It was through therapy that I realized how much shame and self-loathing I had cultivated over the years. I didn’t just not like myself, I hated myself. And there was no pill to pop for that.
Therapy is nothing but an education in yourself; an opportunity to elevate the way you live your life. I’d recommend therapy to anyone, not just someone who lives with mental illness.
I faced a similar struggle with accepting medication. I was afraid of the implications, but in retrospect I realize that my personal aversion to medication was a pre-conditioned response that came from ignorance and misinformation about anti-depressants. It took a lot of experimentation with medication for me to find the ones that suited me. Some made me feel dull or sleepy or tired, others made me feel bloated and uncomfortable and hungry, still others made me feel no different at all. With trial and error, I found the medication and doses that worked for me and still allowed me to feel like myself. I learned that my moods could be regulated and I didn’t have to go through the rest of my life feeling so bleak and devoid of hope. It wasn’t a miraculous solution that fixed me overnight. Anti-depressants don’t make you giddy with joy and happiness, and they definitely don’t cause a ‘high’ like numerous people believe. Anti-depressants simply make you . . . less sad. They make your moods and your pain manageable, getting you to a steady enough emotional state to allow you to start implementing treatments and working on the things that need work. It helps make depression feel like a controllable challenge rather than something dark and unbeatable.
However, in dealing with depression, further cures are necessary. I had taken the first steps towards healing myself, but I still struggled with being labelled ‘depressed’, and in particular its characterization as a mental illness.
I grappled with what it meant for me and for my identity to be branded as someone who had a mental illness. It was already incredibly difficult to confess to the magnitude of my sadness, but once the tag was added to the mix, it seemed to get even harder. Being diagnosed wasn’t as straightforward as just accepting the label.
On one hand, there was a huge sense of relief in finally having a name for the thing I had been battling with for so long. There was also relief in being able to look at my mum and my friends and go, ‘Aha! SEE. I wasn’t just being lazy and spoiled and difficult. How stupid do you feel now?’
But, on the other hand, there was also a ton of denial.
The negative voices of depression that lived in my head for so long had done a very thorough job with me and they had convinced me that I was just crazy and no good.
‘Depressed’ just sounded like far too convenient an answer—it almost felt like a way out—a nice way to convince myself that I wasn’t as worthless as I felt.
There was also a marked difference in the way I thought I was perceived when I told people I was clinically depressed. When I was sad, I was just sad—I was someone who was struggling under the weight of difficulties life was throwing at me. But when I was depressed, I was either damaged or a drama queen—there was something fundamentally wrong with my make-up as a person.
While people’s reactions were varied, for the most part they contained nuggets of either fear or scepticism. They were either unwilling to believe I was depressed, preferring to look at me as someone who was lazy and melodramatic, and if they did believe me, they saw me as someone who wasn’t entirely stable. Even then I knew that caution and apprehension were natural reactions
to things that are not fully understood, but it was difficult not to take these reactions at least a little personally, especially when they came from ‘adults’.
It was my father who taught me a long time ago that no one can disrespect you or shame you without your permission. When I was eight years old I came home crying from school one day because a classmate had called me stupid after I failed a maths test.
‘First, there’s nothing wrong with being stupid. I’m stupid,’ I remember my father saying, talking loudly and patiently to be heard over the sound of my furious, rather theatrical sobs. ‘Only stupid people can learn things, beta. Smart people think they already know everything.’
‘But I’m not stupid, Papa,’ I moaned, tears streaming down my face.
‘Then what’s the problem?’ he shot back. ‘If someone calls you stupid and you are stupid, then it shouldn’t bother you because what they’re saying is true, and if someone calls you stupid and you aren’t stupid, then also it shouldn’t bother you because what they’re saying is not true. Neither the truth nor lies should trouble you.’
That lesson has stayed with me my entire life and it’s what came back to me during those days when I was first learning to cope with people’s reactions to my condition. People labelling me depressed needn’t have bothered me because it was the truth, and people construing there was something wrong with me as a result of my being depressed or calling me crazy or a drama queen needn’t have bothered me either because that wasn’t the truth—and deep down inside I already knew that. I had to take the power out of the words people were using and put more power into what I was telling myself.
The reactions I got weren’t all negative, however. I also received an overwhelming amount of love and patience from those close to me. Even if they didn’t understand what I was going through they made every effort so I would feel safe and loved. And in the midst of their care and understanding, I began to notice the effect my depression was, in turn, having on them. I had spent years gazing intently inwards; I hadn’t stopped to consider how my ups and downs impacted other people.
I've Never Been (Un) Happier Page 7
