Shoot the Damn Dog: A Memoir of Depression (10 page)

‘You couldn’t keep still and you couldn’t stop talking. A lot of what you said didn’t make sense. You were up and down like a yo-yo, running down the corridor to the kitchen then coming back, empty-handed, looking bewildered. I couldn’t keep up but, as we know, running is not my best thing.’

‘No,’ I say, feeling faintly ashamed for the self-absorption of my former, mad self. When she was twenty, Betty was in a car accident, smashed up so badly they thought she would not live. She was in hospital for a year, had a leg amputated and now has a prosthetic leg, which makes it awkward for her to walk very far or fast. She never complains. I have never heard her utter a single word of self-pity and she radiates such good humour; you want to warm your hands against her. She is also ceaselessly and transparently grateful to the people who helped her to recover and for, in every sense, her life. It is Betty who taught me about gratitude, a quality I now try to emulate as often as I can. If there is one single mental action that can help a depressive, it is the daily practising of gratitude—but more of that later.

Betty says, ‘Sarah and I hardly recognised you at all. There were glimpses of the person we knew but you, Sally, had gone. It was as if you had put up this huge big wall and disappeared behind it. You were completely unreachable.’

I say nothing. I don’t remember. It is an odd sensation, to be sitting in a warm restaurant lit by fairy lights and listening to stories of a time and a person that I can scarcely recall.

‘Sarah and I didn’t know what to do, so we just sat there. We sat and we sat even though it was obvious you wanted us to go. In the end you almost threw us out. I called Sarah the next day. We both thought we’d lost you completely. We made a pact that one of us would call you every day and try to visit you, if we could get you to let us in. Most of the time you didn’t answer the phone. We always had to leave a message, not knowing if you had got it or, even, if you were still alive.’

I do remember the phone ringing, and the terrible agonising sound of it.

‘And when you did finally call, you always said that you were fine,’ Betty says, ‘even though we knew that you weren’t.’

‘But I’m OK now.’ I choose the word carefully.

Betty will not have it. This is her story, as much as it is mine. She wanted to save me, to make me better, and she couldn’t. All my friends say that, how desperate and helpless they felt, and how terrified. Everyone who loves a depressive feels that terror and impotence. It is a cruel, a desperate illness and not simply for those trapped inside it.

‘Yes, but you weren’t OK, not for a long time. Do you remember that I came to see you in the first hospital you were in?’

I frown. I want to remember. ‘No. Yes. A little.’

‘You had this fixed smile. You kept saying, “This is fine, isn’t it? It’ll be fine now. I’ll be fine.” ’

When she says that, I suddenly want to cry.

‘And I looked around at the barred windows and I thought, “No, this is not fine. She’s in a mental hospital. This is so completely not fine.” Before that, you were always so bright and funny and competent. You could do anything you put your mind to with one hand tied behind your back. With both hands tied behind your back. I was so used to seeing you that way but in the hospital you were sitting on your bed with great black shadows under your eyes, pale as death. You’d obviously been crying for days and all you said was, “I’ll be fine.” ’ She looks sad, momentarily. ‘And I knew you weren’t but because you kept saying it, I couldn’t get past that word to help you.’

‘I’m sorry.’

Betty laughs. ‘It’s fine. Just don’t do it again.’

It was Betty who handed me the words that became my mantra for months, or even years. It is a mantra that I still use, if life ever becomes difficult. And life does sometimes become difficult, whether we are depressed or not.

I was slumped on my sofa, unable to move, unable to do anything or recognise anything of my old life. She was wearing black, as she always does, and smelled of scent and good things. Her hair was bright blonde, her nails lacquered a deep red and there were diamonds on her fingers. I, as usual, was wearing an old cashmere sweater and stained leggings. I felt like we came from two different worlds. She took my hand and held it so tight; I felt the bite of her diamond ring.

‘This too shall pass,’ she said. ‘You’ve got to remember that, Sal. Nothing stays the same, good or bad. It’s the law of the universe. Believe me, I know.’

I looked at her silver-topped walking stick and knew that she knew. And I knew that she was right.

She took off the black sheepskin scarf she was wearing. It smelled of Chanel scent. ‘Please take this,’ she said, ‘it will keep you safe.’

I slept with that scarf around my neck for months. It made me feel safe, even when the demons were right by my side. I still have it, folded away carefully in my cupboard. Sometimes, when I am in need of comfort, I get it out again although, these days, I never wear it to bed.

I don’t use the word ‘fine’ any more, except when I talk about the weather. And I try to let my friends help me. I try to tell the truth.

I remember, vividly, standing in my kitchen during the days I was first battling with depression, and telling nobody how terrible I felt. Sarah was sitting at the table. We had just finished eating. I don’t know what she said but suddenly, something broke in me. I put my hands to my face and I started to cry. Sarah got up and put her arms around me.

‘What is it?’ she asked.

I said, ‘I can’t do this any more.’

‘What can’t you do?’

‘I feel so sad, all of the time.’

‘About what?’

‘Everything.’

‘Try to explain.’

‘I can’t.’

Sarah hugged me. ‘I think we should get you some help.’

I shook my head. ‘No, I’m fine. Really I am. I’m just being stupid.’

She pulled back a little and looked me in the face. ‘Sometimes,’ she said, ‘you are very hard to help.’

I was astonished and hurt. My friends often used to complain about my habit of suddenly disappearing for days on end or my inclination, in those moods, never to answer the phone. It did not occur to me back then that vulnerability is a pleasing or even a necessary part of friendship; that in order to be loved we must also allow the people we love to feel that we need them too.

I am better at it, these days, I hope. And if severe depression broke down that resistance in me, then perhaps it is a breakage for which I should be grateful. My psychiatrist, who I came to like and respect very much once we had got past our initial battles, said to me that he knew what it was that frightened me the most.

‘What’s that?’ I asked. Even I did not know what frightened me the most.

‘Losing your mind.’

‘Well, I did. You were there.’

‘Then perhaps it wasn’t such a bad thing, after all,’ he said.

Madness as advantage. Now there’s a novel idea. ‘In what way?’

He smiled at me. ‘The Buddhists tell us that in order to find yourself, you first have to lose your mind.’

It is one of the most consoling things anybody has ever said to me.

A memoir of depression is, in some sense, the memoir of a life. What made me the way I am? How are the emotional responses I learned unhelpful?

I want to stay free from depression and live my life well. To me, and this may not be the same for everyone (although I have never met a person for whom it is not true), that means looking at my own behaviour and dismantling the parts of it that keep me stuck in negativity. Or even, simply mired in the low-level discontent that stops me from fully engaging with my own life. It is a self-evident truth, so evident that it took me years to learn it, that life is what it is. It is the way we see it that causes us difficulty.

Looking at our own selves is horribly difficult to do, requiring a level of honesty and humility that can at times feel unbearable. Few people are prepared to engage with it fully but without it, I truly believe that we cannot be happy. And happiness, rather than a good-enough life, is what I aim for. It might be a stretch too far, who knows? But in the reaching I shall at least feel that I am taking some sort of action, that what I do matters, if only to myself.

My responses are, of course, all tangled up with family because they so obviously lay the foundations of our characters. Pretty well every expert in behavioural psychology agrees on that. We learn everything by mimicry, from how to tie our shoelaces to what to eat to how we respond to other people. Most of those patterns are unconscious and many are useful but others are downright obstructive.

Those tripwires to happiness need our full attention. It is not how we learned them, or who we learned them from that matters. What matters is that we have enough knowledge and understanding to put them right when they are damaging to our happiness or good relationships.

Some of those characteristics are genetic but quite how many or to what extent, nobody knows. And as we do not know but only understand that some inherent trait in our characters is due to immutable genes, perhaps the best way to deal with that is in the way that we deal with any other trait—through an examination of our own behaviour, seeing them as obstacles that are fixed but in some way passable.

I once read a theory about ‘positive thinking’ that seems to me to be true or, at least, made a sufficient impression on me to remember it. I have always been distrustful of positive thinking, believing it to be as fixed and unyielding as negative thinking. Yet it is the advice most often offered to depressives. That it does not work seems not to occur to those who offer it up like some benevolent panacea. Perhaps it works for them or perhaps they are a product of some positive thinking gene pool. Who knows? Anyway, here is the theory that helped me. I hope that it will help you too.

Imagine that you are driving a car, and that you are heading straight for a brick wall. If you stay in habitual or rigid thinking (the sort of thinking that says, ‘this is the way I always do things’) and do not change the direction in which you are headed, you will drive your car into the brick wall.

Now imagine that you are driving that same car towards that same brick wall. Now use positive thinking to imagine that the wall is, in fact, a tunnel. It is not, of course, you simply hope or wish that it is a tunnel but it is the same old, intractable brick. You still drive your car into the wall.

You are in the same car, facing the same wall except that you use creative or constructive thinking. You see the wall as an obstacle set dead ahead and see that it is solid and immoveable. You use your thinking to change direction and drive your car around it.

Understanding that our thinking is not always helpful sounds so obvious and simple. So does changing our thinking, yet both are formidably difficult to do, perhaps because, most of the time, we never question it. We just go right ahead and do what we have always done, in the same way we have always done it. We crash into relationships, mess up jobs, ruin friendships and all because we believe that our way is the right way.

There is a saying: ‘I’d rather be right than happy.’

And here is another. ‘My way or no way.’

I see that wall as a symbol for an obstacle (or obstacles, there may be many) in our emotional make-up. If we go on behaving in the same way, we will crash. If we pretend that those obstacles in our character don’t exist, or are something else entirely, we will still crash. But if we acknowledge them and behave in a different way, we will come to a better and safer place. Or at least we will, until we meet the next one.

I know that I have dodgy depressive genes as well as certain behavioural brick walls. Those genes are inherited from my family, as are certain of those behavioural traits, although not all. Others are down to environmental events, in other words, childhood, while still more are just the way that I am.

In order to get well, and stay well, I had to examine all of those possibilities: genes, family, childhood, and my own particular nature. I can’t say that I enjoyed it. I doubt that anyone enjoys admitting their own faults and failings or the hurt that they have caused or been caused. I doubt, either, that I would have done so had I not been forced to by the absolute severity of my depression but I like the results of that ruthless self-examination. I feel calmer, easier and happier than I have ever felt, as if I have put down some tiresome burden.

Therapy helped, but it is not magic. It does not change our thoughts or behaviours. It only teaches us what they might be. It does not work unless we take from it what we have learned and put it into action. So it is not, as so many people seem to think, a piece of indulgent navel gazing. Nor is it about blaming the parents. It is, I’d say, quite the opposite. It is about understanding and accepting our parents.

There is a saying, ‘it’s never too late to have a happy childhood’. I’d rephrase that. I’d say, it’s never too late to stop a difficult childhood from turning us into unhappy adults. A difficult childhood may have set up a series of behaviours and responses that leads us to repeat those same patterns in our adult lives. That does not mean that we have to continue those patterns.

Blame is easy and parents are sitting ducks. We can blame them, secure in the knowledge that we have reasons for our behaviour. Or we can understand how those behaviours came to be, and change them. Our parents may have (and most did) done the best they could. They, like us, are stuck in behaviours and patterns that they themselves learned as children. They may go on behaving in those same ways and drive us mad.

So, we can blame and resent them or we can understand that they behave in the way that they do because they are the way that they are. It is not up to us to change them. It is up to us to change ourselves.

The following, in a nutshell is how we might go about doing that, in a therapeutic sense. I understand that I am not responsible for your behaviour, and you are not responsible for mine. I am, however, responsible for the way in which I choose to respond to you. You may, or may not, be responsible for the way you choose to respond to me. I can do nothing about that. The only person I can directly influence or affect is myself.

Good therapy does not leave us stuck in the past. Nor does it allow us to change it. It simply helps us to understand why we do certain things, why they are unhelpful and how we might overcome them. It will not work, though, if we do not use its lessons. The hard work, the lion’s share, is down to us. I have heard people complain about therapy that, ‘It’s all very well learning why I behave in the way that I do. That doesn’t stop me behaving in those ways. I am just more conscious of them.’ Consciousness is where therapy stops and we begin. Therapy can only give us knowledge. It is up to us to use it. It is not easy. Changing a habit of behaviour takes time and endless repetition. We have to, literally, learn to think in a new way. But in order to do that, we have to analyse the old way.

So, in order to understand my depression and to find a possible way out of it, I had to understand the illness, starting with genetics. While we cannot change our biological destiny, an insight into it might help us to be careful, rather than careless, of it. I have two brothers. All three of us have, to varying degrees, suffered from depression. Major depressive disorder is thought to be heritable, although to what extent, nobody appears to know. The verdicts among scientists range from ‘mildly’ to ‘fairly’. New research suggests that women are at greater risk than men. According to a study carried out on 42,000 twins, the heritable rate of depression is forty-two per cent in women and about twenty-nine per cent in men. The study concluded that: ‘Depression is a moderately heritable disorder, suggesting that genetic factors are important, but by no means overwhelming.’

In other words, it is a predisposition as opposed to a predetermination. But if there is depression present in a family, there is also the chance that a parent may be depressed and therefore may not be able to provide the best environment in which to raise a child. So, how much of it is inherited through genes, and how much through environment as a possible result of those genes, is open to debate. As the author of yet another study on genetics and depression cautioned:

I think that’s shorthand for, ‘we don’t really know’, which is hardly surprising as there is no single gene for depression. Like diabetes or cardiovascular disease, depression is a complex genetic disorder, meaning it involves multiple genes. So you can’t go around pointing fingers saying, ‘There’s the culprit.’

It makes sense, too, to think that a certain cocktail of genes may set up an underlying fragility that may make us more susceptible to depression when faced with certain difficulties. Whether we will be faced by those difficulties depends, to an extent, what hardballs life throws at us and also how well we have been taught to deal with them in the first place.

This is what the World Health Organisation says, in rather more scientific language:

Crucially, an episode of depressive illness seems to require a number of stressors (difficult or painful events) to become active. The gene thought to be responsible for the regulation of serotonin, the feelgood neurotransmitter, is known as 5-HTT. It commonly appears as either a short or a long form. It is the presence of the short form that seems to indicate a possibility (rather than an inevitability) of depression. Researchers at King’s College London conducted a study using a control group of 847 people, who they followed over twenty years. It revealed that people who carried one copy of the short form had more depressive symptoms in response to life stresses. Those with two copies of the short form were more than twice as likely to become depressed following stressful situations as those who carry the long form.

But surely, difficult or painful events are a part of everyday life? In which case, anyone with a genetic predisposition to depression is guaranteed to fall ill at some time or other. Well, no. According to biologists, there is only an inherited liability to develop major depression in response to environmental stressors rather than it being an entirely genetically determined condition.

Then there is the nature/nurture debate. Is depression the likely result of a difficult childhood and a dysfunctional family set-up, or is it simply a vulnerability that one is born with? Perhaps both. There is growing evidence that depression has a great deal to do with family patterns, as in learned behaviour. If children are not taught good coping skills or emotional strategies, they may find it difficult, later in life, to deal with problems. And, if depression is actively precipitated by stressful events or problems, those children are perhaps more vulnerable than those who have been taught how to face problems effectively.

I was not taught well. I know how to ignore problems, but not how to face them. My default setting is stoicism, coupled with an extreme self-sufficiency and independence. Now, these are all admirable virtues. They served me brilliantly well in my career and I am grateful for them.

Had it not been for the fact that I also have depression-prone genes, which renders those stoical qualities more destructive than constructive, I might never have become depressed. But I did and, more to the point, so did my two brothers. Three out of three, or one hundred per cent, is a pretty high score for an illness with a genetic liability of, at most, forty-two per cent, and seems to suggest that my particular depression is not simply the result of a mutual biological inheritance but of other, shared influences.

And so I had to look at my family, in more forensic detail that I would normally use. Not simply because I want to know what caused (or may have caused) my depression, but because I would like to see and understand the behavioural patterns that made me vulnerable in the first place. And which, if I am to avoid (or at least, diminish) further episodes, I need to change.

On the surface, we are a happy family. We hug and we kiss. We are pleasant. We can afford to be. We never engage with one another enough to be unpleasant. We do not shout. We do not fight. We do not have rows. We are, in short, like icebergs with only the top on show. The rest is private and it is in that privacy that darkness lies. Or, my darkness, at least. To live on the surface is in its own way fine and perfectly peaceable. Peaceable, at least, until something as catastrophic as mental illness intervenes.