Reasons to Stay Alive (HC) (5 page)

To pull myself together.

No one did. From the outside a person sees your physical form, sees that you are a unified mass of atoms and cells. Yet inside you feel like a Big Bang has happened. You feel lost, disintegrated, spread across the universe amid infinite dark space.

‘I’ll try, Dad, I’ll try.’

They were the words he wanted to hear so I gave him them. And I returned to staring out at those ghosts of my childhood.

Pretty normal childhood

DOES MENTAL ILLNESS
just happen, or is it there all along? According to the World Health Organization nearly half of all mental disorders are present in some form before the age of fourteen.

When I became ill at twenty-four it felt like something terribly new and sudden. I had a pretty normal, ordinary childhood. But I never really felt very normal. (Does anyone?) I usually felt anxious.

A typical memory would be me as a ten-year-old, standing on the stairs and asking the babysitter if I could stay with her until my parents came back. I was crying.

She was kind. She let me sit with her. I liked her a lot. She smelt of vanilla and wore baggy t-shirts. She was called Jenny. Jenny the Babysitter Who Lived Up the Street. A decade or so later she would have transformed into Jenny Saville, the Britart star famed for her large-scale painted depictions of naked women.

‘Do you think they’ll be home soon?’

‘Yes,’ said Jenny, patiently. ‘Of course they will. They’re only a mile away. That’s not very far, you know?’

I knew.

But I also knew they could have got mugged or killed or eaten by dogs. They weren’t, of course. Very few Newark-on-Trent residents ended their Saturday night being eaten by dogs. They came home. But all my childhood, over and over again, I carried on this way. Always inadvertently teaching myself how to be anxious. In a world where possibility is endless, the possibilities for pain and loss and permanent separation are also endless. So fear breeds imagination, and vice versa, on and on and on, until there is nothing left to do except go mad.

Then something else. A bit less ordinary, but still in the ballpark. I was thirteen. Me and a friend went over to some girls in our year on the school field. Sat down. One of the girls – one I fancied more than anything – looked at me and then made a disgusted face to her friends. Then she spoke words that I would remember twenty-six years later when I came to write them down in a book. She said: ‘Ugh. I don’t want
that
sitting next to me. With
his spider legs on his face.’ She went on to explain, as the ground kept refusing to swallow me up, what she meant. ‘The hair growing out of his moles. It looks like spiders.’

At about five that afternoon I went into the bathroom at home and used my dad’s razor to shave the hairs off my moles. I looked at my face and hated it. I looked at the two most prominent moles on my face.

I picked up my toothbrush and pressed it into my left cheek, right over my largest mole. I clenched my eyes shut and rubbed hard. I brushed and brushed, until there was blood dripping into the sink, until my face was throbbing with heat and pain from the friction.

My mum came in that day and saw me bleeding.

‘Matthew, what on earth has happened to your face?’

I held a tissue over the fresh, bleeding scar and mumbled the truth.

That night I couldn’t sleep. My left cheek throbbed beneath a giant plaster, but that wasn’t the reason. I was thinking of school, of explaining away the plaster. I was thinking of that other universe where I was dead. And where the girl would hear I was dead and the guilt
would make her cry. A suicidal thought, I suppose. But a comforting one.

My childhood went by. I remained anxious. I felt like an outsider, with my left-wing, middle-class parents in a right-wing, working-class town. At sixteen, I got arrested for shoplifting (hair gel, Crunchie bar) and spent an afternoon in a police cell, but that was a symptom of teen idiocy and wanting to fit in, not depression.

I skateboarded badly, got eclectic grades, cultivated asymmetric hair, carried my virginity around like a medieval curse. Normal stuff.

I didn’t totally fit in. I kind of disintegrated around people, and became what they wanted me to be. But paradoxically, I felt an intensity inside me all the time. I didn’t know what it was, but it kept building, like water behind a dam. Later, when I was properly depressed and anxious, I saw the illness as an accumulation of all that thwarted intensity. A kind of breaking through. As though, if you find it hard enough to let your self be free, your self breaks in, flooding your mind in an attempt to drown all those failed half-versions of you.

A visit

PAUL, MY OLD
shoplifting partner in crime, was in my parents’ living room. I hadn’t seen him in a few years, since school. To me, it might as well have been millennia. He was looking at me like I was my former self. How could he not see the difference?

‘Do you want to go out on Saturday night? Come on, mate. Old times’ sake.’

The idea was ridiculous. I couldn’t leave the house without feeling an infinite terror. ‘I can’t.’

‘What’s the matter?’

‘I’m just not feeling well. My head’s a bit whacked.’

‘That’s why you need a good night out. If you’re feeling down. Get Andrea to come too. Come on, mate.’

‘Paul, you don’t understand . . .’

I was trapped in a prison. Years before, after spending a few hours in a police cell for that Crunchie bar, I had
developed a fear of being locked in places. I never realised how you could be locked inside your own mind.

Act like a man
, I told myself. Though I had never really been good at that.

Boys don’t cry

I WANT TO
talk about being a man.

A staggeringly higher number of men than women kill themselves. In the UK the ratio is 3:1, in Greece 6:1, in the USA 4:1. This is pretty average. According to the World Health Organization, the only countries in the world where more women than men kill themselves are China and Hong Kong. Everywhere else, many more men than women end their own lives. This is especially strange when you think that, according to every official study, about twice as many women experience depression.

So, clearly, in most places there is something about being a man that makes you more likely to kill yourself. And there is also a paradox. If suicide is a symptom of depression (it is), then why do more women suffer depression than men? Why, in other words, is depression more fatal if you are a man rather than a woman?

The fact that suicide rates vary between eras and
countries and genders shows that suicide is not set in stone for anyone.

Consider the UK. In 1981, 2,466 women in the UK took their own lives. Thirty years later that number had almost halved to 1,391. The corresponding figures for men are 4,129 and then 4,590.

So back in 1981, when the Office of National Statistics records began, men were still more likely to kill themselves than women, but only 1.9 times more likely. Now they are 3.5 times more likely.

Why do so many men still kill themselves? What is going wrong?

The common answer is that men, traditionally, see mental illness as a sign of weakness and are reluctant to seek help.

Boys don’t cry
. But they do. We do. I do. I weep all the time. (I wept this afternoon, watching
Boyhood.
) And boys – and men – do commit suicide. In
White Noise
, Don DeLillo’s anxiety-ridden narrator Jack Gladney is tormented by the concept of masculinity and how he measures up: ‘What could be more useless than a man who couldn’t fix a dripping faucet – fundamentally useless, dead to history, to the messages in his genes?’ And what
if, instead of a broken faucet it is a broken mind? Then maybe a man who was worried about his manliness would feel he should be able to fix that on his own too, with nothing but silence amid the ‘white noise’ of modern life, and maybe a few litres of alcohol.

If you are a man or a woman with mental health problems, you are part of a very large and growing group. Many of the greatest and, well, toughest people of all time have suffered from depression. Politicians, astronauts, poets, painters, philosophers, scientists, mathematicians (a hell of a lot of mathematicians), actors, boxers, peace activists, war leaders, and a billion other people fighting their own battles.

You are no less or more of a man or a woman or a human for having depression than you would be for having cancer or cardiovascular disease or a car accident.

So what should we do? Talk. Listen. Encourage talking. Encourage listening. Keep adding to the conversation. Stay on the lookout for those wanting to join in the conversation. Keep reiterating, again and again, that depression is not something you ‘admit to’, it is not something you have to blush about, it is a human experience. A boy-girl-man-woman-young-old-black-white-gay-straight-rich-poor
experience. It is not
you
. It is simply something that happens
to
you. And something that can often be eased by talking. Words. Comfort. Support. It took me more than a decade to be able to talk openly, properly, to everyone, about my experience. I soon discovered the act of talking is in itself a therapy. Where talk exists, so does hope.

2

Landing

‘ . . . once the storm is over you won’t remember how you made it through, how you managed to survive. You won’t even be sure, in fact, whether the storm is really over. But one thing is certain. When you come out of the storm you won’t be the same person who walked in. That’s what this storm’s all about.’

—Haruki Murakami,
Kafka on the Shore

Cherry blossom

A SIDE-EFFECT OF
depression is sometimes to become obsessed with the functioning of your brain.

During my breakdown, living back with my parents, I used to imagine reaching into my own skull and taking out the parts of it that were making me feel bad. From having spoken to other people with depression, and having even come across it in other books, this seems to be a common fantasy. But which parts would I have taken out? Would I take out a whole solid chunk, or something small and fluid?

Once, during a dip, I sat on a bench in Park Square in Leeds. It was the sedate part of the city centre. Victorian townhouses now turned into legal offices. I stared at a cherry tree and felt flat. Depression, without anxiety. Just a total, desperate flatness. I could hardly move. Of course, Andrea was with me. I didn’t tell her how bad I was feeling. I just sat there, looking at the pink blossom and
the branches. Wishing my thoughts could float away from my head as easily as the blossom floated from the tree. I started to cry. In public. Wishing I was a cherry tree.

The more you research the science of depression, the more you realise it is still more characterised by what we don’t know than what we do. It is 90 per cent mystery.

Unknown unknowns

AS DR DAVID
Adam says in his brilliant account of obsessive compulsive disorder,
The Man Who Couldn’t Stop
: ‘Only a fool or a liar will tell you how the brain works.’

A brain is not a toaster. It is complex. It may only weigh a little over a kilo, but it is a kilo that contains a whole lifetime of memories.

It is worryingly magical, in that it does so much with us still not understanding how or why. It is – like all else – made out of atoms which themselves came into being in stars millions of years ago. Yet more is known about those faraway stars than the processes of our brain, the one item in the whole universe that can think about, well, the whole universe.

A lot of people still believe that depression is about chemical imbalance.

‘Incipient insanity was mainly a matter of chemicals,’ wrote Kurt Vonnegut, in
Breakfast of Champions
. ‘Dwayne
Hoover’s body was manufacturing certain chemicals which unbalanced his mind.’

It is an attractive idea. And one that has, over the years, been supported by numerous scientific studies.

A lot of the research into the scientific causes of depression has focused on chemicals such as dopamine and, more often, serotonin. Serotonin is a neurotransmitter. That is a type of chemical that sends signals from one area of the brain to the other.

The theory goes that an imbalance in serotonin levels – caused by low brain cell production of serotonin – equates to depression. So it is no surprise that some of the most common anti-depressants, from Prozac down, are SSRIs – selective serotonin reuptake inhibitors – which raise the serotonin levels in your brain.

However, the serotonin theory of depression looks a bit wobbly.

The problem has been highlighted by the emergence of anti-depressants that have no effect on serotonin, and some that do the exact opposite of an SSRI (namely, selective serotonin reuptake
enhancers
, such as tianapetine) which have been shown to be as effective at treating depression. Add to this the fact that serotonin in an active living
human brain is a hard thing to measure and you have a very inconclusive picture indeed.

Back in 2008, Ben Goldacre in the
Guardian
was already questioning the serotonin model. ‘Quacks from the $600 billion pharma industry sell the idea that depression is caused by low serotonin levels in the brain, and so you need drugs which raise the serotonin levels in your brain . . . That’s the serotonin hypothesis. It was always shaky, and the evidence is now hugely contradictory.’

So, annoyingly, scientists aren’t all singing from the same hymn sheet. Some don’t even believe there
is
a hymn sheet. Others have burnt the hymn sheet and written their own songs.

For instance, a professor of behavioural science at Stanford University called Robert Malenka believes that research needs to be carried out in other areas. Like on the bit of the brain right in the centre, the tiny ‘nucleus accumbens’. As this is already known to be responsible for pleasure and addiction, it makes a kind of sense that if it isn’t working properly we’ll feel the opposite of pleasure – anhedonia. That is the complete inability to feel pleasure, a chief symptom of depression.