Shoot the Damn Dog: A Memoir of Depression (22 page)

Not all at once, but slowly, you will catch glimpses of the self you used to know and the life you used to have. It is important, though, to try to believe in life even at a time when belief seems impossible, even, when death seems preferable. It is important, too, to accept that severe depression is an illness of body as well as mind and that both have a profound capacity for healing. I can say that because I know, because I’ve been there. My irritation with Margaret was that she was speaking intellectually, not from the heart—or the soul—of experience.

What I do know, from my own experience and that of other depressives, is that severe depression and suicidal preoccupation are absolute intimates. They are inseparable. I like the way psychiatrist John Greden, at the University of Michigan puts it: ‘Suicidal thoughts are to depression what fever is to pneumonia.’

It is important that depressives understand that suicidal preoccupation is not a matter for shame or guilt. It is simply a clinical symptom of an illness. It may feel like a reality but as John Greden says, it is only a passing manifestation, like a high fever, that will, with time, abate. I knew, when my preoccupation with suicide began to diminish, that I was getting well again.

Suicide is so much a part of the illness that twenty per cent of people with severe depression will make a suicide attempt while half of those with bipolar depression may do so. Someone in a first depressive episode is particularly likely to attempt suicide while those who have been though a few episodes are less likely to do so, presumably because they have learned to live with their illness and to believe that, eventually, it will pass.

These days, I rarely think about suicide, unless I happen to be passing through one of my infrequent black holes. On days like that I cannot think, cannot feel but, above all, I cannot connect. I remember standing in my garden, a place that I love, and looking at a flower, blooming on a plant that I had grown from seed. Ordinarily, I take intense pleasure in plants and, being naturally selfish, in plants that I personally have grown, but on that particular day I looked at the flower and felt nothing, not even interest. It was a flower, an object, a thing with no power to rouse admiration or pleasure or wonder.

And I thought, this is depression, this absolute and complete lack of connection to life. At times like that suicide, or death, presses heavy on my mind. If I cannot live, cannot connect with life but am doomed, for ever, to have my face pressed against the window watching it pass me by, then why not die? What is that already, if not a living death?

I used to think that I was alone in those thoughts until I heard a man say, in group therapy, that he had spent the past week considering all the ways in which he might kill himself.

‘But I know now,’ he said, ‘not to take my mind too seriously. It is simply AST, or Automatic Suicidal Thinking.’ He paused comically. ‘Doesn’t everyone have that?’

These days, whenever Nigel or I are focused too much on death, we say to each other, ‘Oh, that’s just AST. Doesn’t everyone have that?’ It reduces the terror (and taboo) of our thoughts to a commonplace, a shared symptom that will pass.

If we can bring our most unmanageable thoughts into the open, we can reduce their terror. Fear grows in the dark. I used to tell nobody about my suicidal thoughts. I thought that they were too appalling, too unmentionable to be allowed. When I felt like that, I used to go to bed and stay there, unable to face the horribly changed world, waiting for my focus to shift back to normality.

Now, I do two things.

First, I tell somebody how I feel. Obviously, I choose that person carefully. Some people panic at the very word, suicide, and panic is the last thing that I need. It makes me feel ashamed of my thoughts, and shame makes me feel wretched. It makes me feel so wretched, that my preoccupation with suicide grows worse.

Secondly, I force myself to go through the ordinary, domestic motions of life. Even small achievements help, washing up a mug, throwing out a pile of newspapers. So does going for a walk, particularly first thing in the morning, which is when my depression is always at its worst. It is my black dog hour.

The effort, to get into my car and drive to a park (in London any contact with nature requires effort) can be monumental. I have driven through rush-hour traffic and early morning school runs with tears pouring down my face. I have walked every inch of three London parks, crying. I have cried in the rain and cried in sunshine; I have worn dark glasses to hide my tears and I have worn no disguise, have felt past caring. But one thing I know is true; after an hour of fast walking, I always feel better.

Research bears this out. A pilot clinical trial at the University of Texas Southwestern Medical Center, Dallas, found that adding exercise to antidepressant medications significantly reduces depressive symptoms in patients with major depressive disorders. The study involved seventeen patients with major depression. All were taking antidepressants but were still experiencing residual symptoms of depression, such as insomnia, lack of concentration, irritability, sleep problems, lack of motivation, and sadness. Participants in the study were prescribed a twelve-week aerobic exercise programme (walking, treadmill, or cycling) of at least thirty minutes daily. Each week the severity of depressive symptoms was evaluated using both clinician and patient-rated instruments. Exercise had a marked effect on reducing symptoms suggesting that exercise along with antidepressants could prove an effective strategy for the treatment of major depression.

Another study at the University of Texas Southwestern Medical Center found that thirty-minute aerobic workouts done three to five times a week cut depressive symptoms by fifty per cent in young adults while research at Duke University, North Carolina, found exercise as effective a treatment for depression as antidepressants, with fewer relapses and a higher recovery rate.

Walking has yet another benefit for me. It is as if, by going through the motion of walking, I can convince myself that I am still a part of the motion of life. When my mood is particularly low, I tell myself that the black hole, the abrupt and horrible disconnection with life will pass (‘this too shall pass, this too shall pass’ is my mantra as I walk). I know my despair is not real and nor is my sudden and intimate attachment to suicide real. It is a manifestation of my mind, or my illness, and it will pass.

For some, it does not pass. The overall fatality rate for depressive illness is thought to be anywhere between ten and twenty per cent, although the figure most mentioned is fifteen per cent. The fight becomes too hard and we let go. This should not be a matter for shame or stigma, nor for reproach and guilt among those we leave behind. For the depressive it is the abandoning of a long and terrifying struggle and a struggle that we feel we can never win. It is not a matter for shame, just great sorrow. It is the bitter end to a terrible illness, desperately fought.

In the months immediately following my suicide attempt, I felt that it was over. I had given up. Nobody and nothing could help me. No drug, no shrink, no hospital, no therapist, no lover, no friend. Not even death could help me.

I was on my own and the only way through I could see was to take one halting step at a time.

And so it began, the long, slow and painful road to recovery.

It took three years.

Curiously, I see suicide as the turning point, although it didn’t feel like it at the time. By giving up on any expectation that anyone could help me, I took absolute responsibility for my illness and began to look for ways in which I might help myself. Here are some of the things that I did. I offer them up in the hope that they might help somebody else.

I took up yoga.

I walked for at least half an hour a day.

I tried not to isolate myself and began to see my friends, but only for a cup of tea or a quiet meal. I particularly saw my friends who are depressives both because it was soothing to be among other people who understood and also because I learned that in helping other people, I began to help myself.

I avoided any social situation that put me under pressure to perform, dress up or pretend that I was fully functional.

I accepted that I could not read or write (at least not in a way that was in any sense effective, bearing in mind that this is the way that I earn a living) and began instead to focus on the things that I could do. Most were mechanical tasks such as doing the washing up, cleaning my flat, painting a wall, restoring an old vintage chair or gardening.

I stopped trying to use energy that I did not have and accepted that going to bed in the afternoon did not mean that I was worthless. It meant that I was tired.

I watched old movies and comedies and avoided news programmes, current affairs, highly charged emotional drama, or anything that might trigger distress.

I understood that I had an illness, not a weakness.

I stopped feeling ashamed.

It was not easy. There were bad times and worse times and there were also times when, as Nigel is quick to point out, ‘You were quite mad.’

As, indeed, I was.

If insanity means having no judgement or intuition, I was honestly mad. There were times when I put my faith in people in whom it was so plainly mad to have faith in they may as well have had warnings stamped on their foreheads. My usually good intuition seemed to have gone astray but when your mind is in that much disarray, all sense has fled. You are, literally, at the mercy of others. I felt, at times, that I was as innocent as a child and often seemed to find myself washed up, beached in the company of fantasists and charlatans but, somehow, I was always rescued. I will say this: there is enough goodness in this world to prevail. Or perhaps I was just lucky.

But in among the bad and the worse times, there were also moments when I felt, if not hope, then at least the glimmerings of possibility. I began to believe that, one day, I might be well again and would re-inhabit the person I call myself. But, first, I had to understand myself. I had to learn how to live again, just as somebody with a physical illness might have to learn to walk again.

It was like starting from the beginning. It took me a long time, for example, to understand, or to re-understand, why people do things. Why, in fact, they do anything at all. What is it that occupies their time? What is the point of doing?

During my long morning walks I watched people hurrying along in suits and trainers. Where was it they were going, and why were they in such haste? I simply couldn’t imagine feeling such urgency. I watched others throwing a ball for a dog, picking it up, and throwing it again. Why? Where was the sense in such pointless repetition?

Finally, I accepted that essentially there is no point—the doing
is
the point, that and that life is made up of a series of actions that, repeated often enough, begin to assume a shape and a meaning all of their own. They become meaningful to us only because we attach meaning to them or because they give us an outcome that serves us in some way.

Immediately after my suicide attempt, those were the thoughts and ideas that occupied my mind. Life had ceased to have meaning but so, as well, had death. If nothing has meaning, how do you go on? In what do you trust? The defining character of severe depression was, for me, that absolute loss of trust. The healthy mind does not question every single, tiny little action. It accepts. It trusts in the process.

I started in small ways. There was meaning to the washing-up inasmuch as it meant that Molly and I had plates and knives and forks to eat with. There was meaning to walking up the road to the shops because it was there I bought the food to feed my child. There was meaning to cooking because it made food that gave my body the energy to do the washing up and go to the shops and do the cooking and eat the food that gave me the energy to…

I understood that it was a process and either you took part or you opted out. I had tried opting out and there I found no solution. So I took part in the process and in the taking part, I began to find meaning.

I took up yoga, at the suggestion of a friend. It had helped her through some bad times and she thought it might help me. It was also the exercise recommended by every psychiatric unit I had been in, where classes were held every morning. One of the nurses told me she had seen good results with yoga in some cases of severe depression.

So I found a class and in that simple act began to find meaning inasmuch as it got me out of the house, among people, and it made me move my body in ways that, afterwards, made it feel easier and freer. Gradually, I began to realise that it made me feel stronger, calmer and more expansive. And so I began to look forward to my yoga sessions until, gradually, I realised that when I woke up, it was something that I wanted to do every day. Slowly, I began to build up a practice. I trusted in the process, and in the outcome.

It taught me, too, about acceptance, in that in order to do yoga well, you have to accept the body just as it is with all its kinks and pains and strains and awkward bits. It taught me to be gentler with myself (something, I believe, that every depressive needs to learn) and to encourage, rather than push, my body to perform in new and unexpected ways. It taught me that it was fear, or rigid and habitual thinking, that made me believe that I would never achieve a headstand or be able to do a handstand. If our minds can hold us back, then they can push us forwards too.

Now, I can do both a headstand and a handstand with ease. Those achievements may be small in the greater scheme of things but to me they are huge. They mean something.

Yoga also helped me to understand that comparing myself to others is pointless. They can do what I cannot and I can do what they cannot, because we are all different, and unique. I cannot, for example, squat or sit back on my heels, at least, not yet, but I can sit cross-legged or in lotus position with relative ease. The person next to me may catch their heel and bring it to their head in a way that seems to me impossible, but I can turn upside down in a position that seems to them unattainable.

Yoga helped, too, to ease the pain that I was in. I had by this time understood that the throat monster was a purely somatic condition. In other words, it is emotional pain masquerading as physical distress. That did not stop it being real (it was so painful that, at times, I was in tears, and could not eat or drink) but it did mean that no amount of neck massage or soothing throat medicines had any effect. People who suffer from it tend to think that they must have advanced throat cancer, despite a battery of medical tests showing there is nothing physically wrong with them.

Yoga has the double benefit of being a gentle intervention tailored to the individual (no two yoga practices are ever the same, because no two bodies are the same) as well as a set of exercises that calm the nervous system and alleviate stress. There is a wonderful, comic American phrase, ‘our issues are in our tissues’. In other words, emotions or old, unresolved feelings can cause neck pain or back ache, a nervous stomach, stiff hips or a throat monster.

I was astonished by how physically painful my depression was. Everything hurt, but in particular my throat, neck and chest while my arms and legs were often stiff and aching. I had always assumed, like most people, that depression is a neck-up condition and that my mind is somehow a completely separate entity to my body. I paid lip service to the view, ‘healthy body, healthy mind’, but until I became depressed, I had no idea that it worked the other way around too, ‘healthy mind, healthy body’.

Experts now accept that the physical pain and suffering experienced in severe depression is real. It is not a figment of imagination or a deluded mind. A study carried out by researchers at the University of Alberta, shows that depression is a major risk factor for the onset of severe neck and lower back pain. People who suffer from depression are four times more likely to develop intense or disabling neck and lower back pain than those who are not depressed.

In a study of over 25,000 patients at fifteen primary care centres on five continents, Seattle researchers found that fifty per cent of all depressed patients worldwide report multiple unexplained physical symptoms and concluded that ‘somatic symptoms are a core component of the depressive syndrome.’

In truth, the mental and physical are inseparable and it is this holistic fusion that yogis have long understood. Yoga helped to ease the pain and stiffness in my body, but it did more than that; it began to disentangle the black knots in my mind. As to why this should be, there is very little hard evidence. This is because a singular control group is impossible in yoga as there are so many variants within the 3,000-year-old discipline that it cannot be subjected to the rigid rules that Western science demands. Timothy B. McCall, medical editor of
Yoga Journal
puts it this way:

The most persuasive evidence of the benefits of hatha yoga (the physical practice of postures that also includes deep breathing exercises and meditation), and in particular pranayama (a series of deep breathing exercises), comes from the National Institute of Mental Health and Neuroscience in India. Studies have shown a high success rate (up to seventy-three per cent) for treating depression with sudharshan kriya, a pranayama technique that involves breathing naturally through the nose and mouth in three distinct rhythms. Stephen Cope, a psychotherapist and author of
Yoga and the Quest for the True Self
, maintains that hatha yoga postures improve mood by moving energy through places in the body where feelings of grief or anger are stored. He calls hatha yoga, ‘an accessible form of learning self-soothing.’

Together with walking, if there is an exercise that is helpful to someone suffering from depression, I believe it is yoga. It must, though, be done properly and with some persistence. That may seem horribly difficult when you’re very ill, but yoga is such a forgiving discipline that even lying on a yoga mat and practising deep, rhythmical breathing is helpful. From there you can build up to five minutes of gentle poses and from there to ten, to twenty and so on.

Amy Weintraub is a yoga teacher who once suffered from severe depression and took up yoga in order to soothe her depression. In her book,
Yoga For Depression
, she writes passionately and convincingly (using numerous case studies) about the benefits of yoga and breathing practices. She also, like many yogis before her, stresses the importance of regular practice.

It is, though, worth seeking out a yoga teacher with whom you have an affinity, just as it is better to find a small class. The larger classes tend to be filled with people in search of that elusive ‘yoga butt’ or in pursuit of the body beautiful. For those of us who are in pursuit of the mind beautiful, one to one attention from a yoga teacher is crucial as is doing the postures slowly and correctly. So is abandoning the prevailing cultural belief that exercise is about competition or perfection.

There is no such thing as a perfect yoga pose; we aim for progress rather than perfection. We try to do the best that we can and it is in the trying that we discover that the best is always good enough—a useful lesson for anyone who battles depression.