Sneaky

Depression is a stealthy beast. Anyone who knows it will tell you how it can creep up, silent and subtle. It slinks along behind you, beside you, gathers over you and whispers dark secrets in your ear. And still you may not see it, even as it slowly weighs you down. You know all the signs. You know this creature well. But so devious it is by nature, it slips by in secret every time.

One of depression's self defense mechanisms is the intense self doubt which it fosters. I am aware that I suffer with depression. It is in my medical records. It is acknowledged by every doctor I meet. I am prescribed medication for it. I am vocal about stigma around mental health issues; I am open about my illness. I refer to it as an illness. But I don't believe it, at a deeper level. I am not sure that it is an illness. I am not sure that I am suffering enough to warrant compassion. When I am depressed, I don't believe I deserve sympathy. I feel like a fraud. I cannot really be 'depressed'! (I hear the word as spat by a dispassionate judge). Sometimes I wonder why 'depression' is named as an illness by medical professionals, when their behaviour and every piece of evidence seems to say otherwise, that you are simply living incorrectly, that your attitude is wrong, or that you are emotionally lazy. The line between 'illness' and a less clinical unhappiness or dissatisfaction, and the question of culpability, is a matter of contention, and I am not sure on which side I stand - but I am profoundly confused by this dichotomy. I do tend to think in 'black and white', it is hard to choose a point in the middle. I see all of the points on the spectrum equally clearly, but my mind recoils in horror at the notion of choosing a conceit; which equally, seems imperative and necessary. I am one or other other - nothing in between - but which one?

I know that I am feeling very bad, that I am struggling, and that's all that really matters, and that means depression (with the telltale symptoms of lack of interest, shame, guilt, loneliness, tearfulness, numb, and so on).  I 'know' that I am depressed, but the alternative explanation looms - the idea that I am simply weak, a hypochondriac, a lazy, self obsessed brat. I talk as if I am certain that I am ill, that my issues are clinical, that I am deserving of treatment - as if I am certain that I am not lazy of mind, self indulgent, melodramatic.

I know the depth of my depression when it is on me, I am aware of how low I am on the scale. Or I think I know - I am sure I know. I see the signs.

However, depression is deceitful. Only when relief comes, only when some light and air comes back into the world and your mood lifts for a while - do you truly see how low you were, how tightly the black dog had its jaws around your neck. It is an impressive trick - to have you deny yourself and not know it, to know your suffering and yet be blinded from it. To starve yourself of kindness.

You sense the shadow that crouches over you, but... the name of the beast, the true knowledge of it is somewhere at the back of your mind, the tip of your tongue. You cannot quite recall it. You might know it, know it by name, the thing blocking out the sun; if only you would raise your head and look up. And yet you never look up.

Derealisation

I experienced some pretty profound depression around the age of 15. My dad recently mentioned a letter that my counsellor apparently sent to my headteacher, because at the time I had been put on 'daily report' because I wasn't performing as I should have been. I don't really remember this at all, but my memory in general is very patchy, especially around painful experiences, or even happy experiences. I certainly didn't realise that correspondence of this type had gone on between my counsellor and my school, and felt pretty embarrassed about it when I heard.  I don't remember being on report, either. Apparently the letter said that I was experiencing 'morbid thoughts and derealisation'. The word 'derealisation' had never been mentioned to me before my dad brought this up on the phone a few weeks ago - at least not in my memory, which doesn't mean that it didn't happen. But when I looked it up, I recognised the description. I think generally my experience of it was pretty subtle - I know some people will feel more literally that the world is not real. I think I had experiences like this in a limited way, from time to time, but generally speaking I related more to the secondary description on Wikipedia: 'feeling as though one's environment is lacking in spontaneity, emotional coloring and depth'.  I had always characterised what I experienced as being part of depression, as being depression itself - what happens when depression gets that deep and low - I didn't realise that it is a symptom in its own right. I always compare my experiences since then to this time, and no matter how I've felt since then, it can never be as bad as those few years. 

Often, the world seemed colourless and grey, bald and white, devoid of meaning. Other people seemed empty to me. Sometimes I felt completely empty, flat and without emotion or real feeling, with no reaction to the outside world, and I could see absolutely no worth in anybody or anything. I was untouchable, nothing could move or sway me. I was a mannequin, muffled and shrink-wrapped, absolutely starved of real emotional content or personal connection. 

My moods were very changeable, and I remember comparing the movement between this depressive state and a more normal state to somebody turning the light on and off; I imagined a table with many objects laid out before me. The objects were the people and things in my life. When the light was on, they had colour, depth and meaning - I could see them and interact with them, they had an effect on me. But when the light was off - nothing changed, really, everybody and everything was still there - but they were grey, entirely grey. I could see their outlines, but they had no meaning, I did not care about them at all. They could not reach me emotionally, they were ghosts, they were of no interest, they were far away, they were in shadow. 

My English teacher lent me a book of poems called 'Ariel' by Sylvia Plath, and it spoke directly to me. 


'The nights snapped out of sight like a lizard's eyelid:
A world of bald white days in a shadeless socket.
A vulturous boredom pinned me in this tree. 
If he were I, he would do what I did. '

- The Hanging Man, Sylvia Plath

I saw the world as white, clinical. I/the world was a terrible void of emotion, meaning or interest. I loathed myself; how could anyone be so flat, so unreactive? Where did my soul go? Where was my emotional core? I loathed everybody else - where was their pain, their despair, their emotion? I could not see that the people around me had an inner life. For all I knew, there was nothing inside them, nothing in their hearts or minds. Everything was worthless, flat, grey. 

Other times, - rare times - colour and light and pain would flood in and fill me with sensation, with what I termed to be 'meaning'. I felt things; I was alive, I was moved, I was filled with sorrow or melancholy as I listened to music late at night in my room - better than the terrible numbness. I would constantly search inside myself in vain for this authentic emotion, for this real experience, and the more I searched the more it eluded me. Or I was excited, manic, filled with nervous energy - loud, impulsive, jovial - but always on the edge, hating myself and my behaviour, terrified of when I would crash.

This only served to make the numbness, the grey, all the more terrible when it came. This greyness made me believe that I felt nothing, that I was empty, that the world was utterly cold, plain and white, that there was nothing in it that meant anything. These profound changes in my perception - like turning off and on a light - made no sense to me. I could not understand why one day I would wake up in one world, and the next another entirely. There was no rhyme or reason for the change in temperature, in the quality of the light, when nothing externally had changed at all. Why did I sometimes not give a damn about the people around me, about what they said or did or whether they were there or not? Was I completely evil, empty, blackened, dried out, hollow, unreal? I could not understand. I wanted to die. 
This led me to almost fetishize emotion and feeling and experience itself - I called it 'meaning', and for many years painful honesty and emotional over-sharing has been a big problem for me, as I attempt to force this genuine experience of the world. I have idolised the experience of emotion, the sharing of innermost thoughts and secrets, the deep soulsearching and digging up of important feelings, because I desperately needed to be reassured that I had an inner life, and that other people did, too. I would test them - trying to find out if there was anything behind the mask. 

Antidepressant medication and stigma

I read this today, which I've read before but found really useful to read again. 

Ten Supportive Things I'm Glad Somebody Said To Me

The previous post, 'Ten things not to say to a depressed person', is great too, but I'm glad there is a positive version as well. So many people have been incredibly supportive and accepting lately - members of my sports club who don't necessarily have knowledge about these things who have treated me as someone who is ill, rather than as someone alien or self obsessed or lazy or all the negative things I imagine that other people see in me. This is especially wonderful when you are unable to see past this image of yourself.

But out in the real world there's a lot of belittling and invalidating and blaming behavior which can be really insidious and is easy to internalise (although the situation is definitely improving, attitudes have transformed even in my lifetime and organisations like Rethink and Mind are doing exciting work). One of my bug bears recently is the stigma around antidepressants, that they make you 'numb' and the idea that taking them is somehow cowardly or avoiding the issue - the 'prozac nation' view. Antidepressants do sometimes make you feel numb - I certainly don't deny that - but depression can have exactly the same effect. I do object to relatively throwaway comments around the idea that people are numbing themselves against the cruelty of the modern world, or that we are coddled and cosseted so much we create the problems for ourselves. Beyond whether this is in some way true or not, it is irrelevant - if you can make life less painful for yourself then you do. 

A feeling of total emotional flatness is not the desired response to antidepressants and is also a depressive symptom in itself. Medication that helps to make negative symptoms less overwhelming is not a cowardly or cheat's way out. (There are other psychiatric medications which may attack symptoms with more of a sedative/sledgehammer effect, but that's for another blogger).

  Thankfully it's been a long time since I've experienced an extreme degree of emotional flatness, which is an awful thing to go through - and at the moment I would welcome some respite from overwhelming and quite deeply felt negative emotions and reactions to everyday life. 'Fully experiencing' those negative symptoms without any intervention is not particularly helpful either - although catharsis certainly has a place in recovery, it can be a very small and specific part depending on your particular issues, and chemical intervention can also play a part. Often there's a choice between functioning in everyday life and catharsis; you can't do both, and its hard to say whether your current suffering is a helpful part of your journey or whether you are just stuck. Most of the time we need to choose 'functioning' over 'pain that might be healing in the long run', if at all possible - that's what society demands of us - so society cannot also demand that we both function in our jobs and daily lives AND magically fix ourselves, pull our socks up, think positive - all completely without drugs or help - using some spectacular strength of will - when strength of will is precisely what is lacking in the case of a depressive episode. 

May be worth mentioning I am not feeling nearly as sure of myself as I was when I wrote that diatribe; it's never really clear whether that's because I feel particularly low now, or that I felt unusually sure of myself then. I suppose in reality I am looking for objectivity where none can be.

I wanted to talk about a metaphor which occurred to me as I was walking in the park the other day. It felt strangely liberating to walk in the park, as if I had never realised before that I could leave my desk and go outside and go wherever I wanted. I thought about depression as being like this transparent jar that you are trapped underneath, suffocating, cut off from everybody and everything. Only if the jar is taken away - you will never know. As far as you know, you are always trapped, there is no way out.
As far as everybody else is concerned, there is no jar at all and never was. Why doesn't she just come out, they think. Why doesn't she just come out into the sun?

Here's a message I sent to a friend recently outlining how I'd been feeling since losing my job last year, trying to start a home business but still experiencing a lot of anxiety and depression.

After our brief chat earlier I felt the need to share some of my recent ruminations & experiences.

I said 'I am allowing myself to have a breakdown' - I'm giving myself the space to be broken for the first time ever. I'm okay right now -I started a new antidepressant (another one) about a week ago after having 2-3 periods of the worst depression I've experienced probably since I was around 15, and that's saying something. The few months prior have been incredibly painful and scary, dealing with my life situation and having to face losing my job, and being alone a lot, being a parasite in someone else's home, and wondering why I find everything so incredibly difficult. At times I felt I was making progress, but realisations would be punctuated with horrible fear and depression. The new medication has made me feel very ill for a week but I am starting to feel much better, and I think the agony of catharsis was necessary before I took the antidepressant to make this sort of progress, which I hope will prove to be more permanent than anything previously.

Anyway, I 'realised' a few months ago that I have spent my entire adult life trying to convince other people that I am ill and need help, when really the only person who needed to realise that was me. It's been helpful to me over the last few days to regard the last 12+ years as one big breakdown. I've always wondered - what exactly is a breakdown? Have I had one? What constitutes one? I did some googling and the answer is it's not a real term, but it usually involves large amounts of depression and anxiety building up until you can't cope anymore. Well! That describes my entire life! And a breakdown is, I guess, about other people noticing that you can't cope, and reaching a crisis where you either let out a massive cry for help or just visibly break somehow (it's always seemed that you're not allowed to say you can't take it anymore, you have to break in some visible way). I've had depressive breakdown after breakdown, but always got out of the job/house/situation just before I could lose anything, until now, or managed to carry on somehow. I am horrifically high functioning - it's weird. I don't know why I am still here, how I have carried on like this, how I have tolerated life.

Last week I was crying my eyes out, I'd been taking my new medication for a few days, I was really sad about something, I was in terrible pain, and I thought, 'I don't deserve to feel this way.' And then i stopped and thought - I haven't had that particular thought since I was maybe 11. I've never thought 'I don't deserve to be miserable'. It felt like a big thing - the result of many months of pain and thinking and working on self compassion. I still felt awful, but it was a different flavour of awful.

Obviously at some point, I thought that being sad and being in pain was such a constant that I must deserve it, and completely internalised that idea. I've been thinking a lot about my life, and trying to make sense of a lot of painful memories, a lot of shame - but regarding it as one big breakdown really vindicates me; I can have compassion for myself, I was in pain, I was broken and never took the time to fix myself.

Since then, I've noticed my obsession with 'deserving' things, that to 'deserve' to have anything, I have to work, that there is some objective judgement that can be made of your soul that means you 'deserve' to be healthy and happy and calm. And I've decided that deserving is utterly irrelevant - I am an organism, and my purpose is to fight for my own survival - to take what I can get from life, because nobody else can do that for me. Only I can say when I've had enough, when I can't take it anymore, when i need a break. I can carry on forever struggling up mountains with two broken legs (which is what I've been doing!) waiting for someone to say - that's enough now, it's okay. But if I do that - all that is going to happen is that I will die young, because I'm not fighting for my own wellbeing. I thought I could never rest because I need to move forwards, I don't deserve to rest, to take anything free from the anyone or to rely on anyone, to take advantage of anyone or anything. But that's how healthy people survive, they take anything free they can get and they rest whenever they can and they do the least work possible - it's efficiency, it's sane. Most people do it on a smaller and more approved scale - they manage to get through their whole life working and functioning every day, but they take their solace from life in other little ways, in the way they think - I don't know how, so I have to break and rebuild myself, to learn how to give myself a break.

I've recently been active on a mental health social networking site, and it's lovely - but I notice in everybody what I have found in myself: we all think we need to be rescued from this life, because we can't judge for ourselves what we need, what we deserve, whether we are suffering enough, whether we are trying enough, whether we deserve to be saved.

I think I am learning to be more compassionate towards myself. It's hard to explain it here - and sadly I don't think it's something that you can put into words and share with others and have it fix them (not that that's what I'm trying to do here at all, I just wanted to share my thoughts), everyone has to make their own journey - this is all only stuff people have been telling me and that I've 'known' forever, and never really believed.

My task for now is to learn to do nothing, to be lazy, to not be in pain, and then I can learn to be moderate and to live life like a normal person, and then maybe I can think about being a functioning member of society again. For now I am just trying to be aware of how broken I am and how much I've struggled, and how much I am just going to keep struggling id something doesn't change. I'm going to take as much as I can from the world to aid my rest and recovery, to become figuratively fat and strong and grow some skin to give me an actual chance in life, a chance to actually live and compete in this world - as an organism in a finite universe, competing with other organisms, and there's no god to judge who most deserves that crust of bread you're fighting for. So you better be well rested and well fed.

Disciplinary: Dismissed for anxiety/depression

I found this post in the 'notes' section of my facebook account & read through it. it's something I wrote after my disciplinary (they dismissed me). I still can't really make any sense of what happened.
4 weeks before, I had a glowing review and a payrise.
And then things just got worse and worse, they took my keys off me, they started monitoring me very closely, which triggered an anxiety attack where I had difficulty breathing and I left work at lunchtime and went home, saying I was having an anxiety attack. They sent me a text message late at night saying they had sent me an email and I must read it - it was a letter saying I was suspended and must come in for a disciplinary meeting that Friday. (I think it was Tuesday or Wednesday).

 Friday, 27 July 2012 at 13:29

Am waiting for the 'verdict' now. Feel extremely sick. Went with my mum and she prompted me a bit.

Lots of talk about my recent conduct, my capacity to work, my inability to do what I'm asked, etc.

Mum thought they were really kind and accommodating. I feel differently, but I get the impression that is because I am insane. We seemed to have different interpretations of events and situations.

My mum asked if they would consider giving me some unpaid leave until I feel I am able to go back. They said I am obviously in a bad place with my illness. They asked if I was still taking my medication. They said they cannot make any other accommodations for me because it would be unfair to other staff. They asked if I felt I would get better and my mum kept prompting me to say what I could do to improve the way I work. I just felt sick and humiliated. They said they are concerned that I can't take criticism and that is part of the job of being a graphic designer.

They are thinking about things now and will get in touch with my mum.

My mum and her partner suggested getting in touch with a housing office as I am losing my flat soon and that I would be put in a hostel... I really don't want to do that. They also said I am welcome to stay with them though.

They kept asking about what 'triggered' my recent downfall. They thought all sorts of things, like the fact they were taking on new staff. I don't feel that is it. I was devastated by a relationship earlier in the year and a few weeks ago I got drunk and had an unpleasant encounter and those haven't helped. I resent the implication that I felt bitter somehow about them taking on new staff. I had actually looked forward to it, thinking that things would be a lot better. And I didn't really want to say but this is a cycle for me that happens over and over. This time I didn't walk out and stayed and faced it, to some extent. I am still running away a bit, but it's a bti different this time.

But other people think they can see the causes of my behavior a lot better than me and they are probably right.

I feel humiliated, ashamed and still terrified, and I am scared that people will stop loving me because I am a coward and have been having horribly, angry thoughts about all sorts of people, including my employers.

I tried to follow up a referral to the NHS mental health team earlier in the week but they seemed to have lost my details and said they would put me in the system and call me back, which they didn't, so I called again today and they said exactly the same thing again.

I would really like to try for support allowance/incapacity at least for a while. I don't think many people in my life would approve and would think I am a coward and can do better - provided of course that I would actually be able to get any sort of support like that.