Monday, 22 June 2020

Come and tell me some lies

Depression is a liar - a very good liar - but a liar nonetheless. It tries to convince you that certain terrible things are true (or will happen).

Liar, liar

When I was first ill, I was overwhelmed by catastrophic thoughts. Depression bombarded me with terrifying visions about my future. I was quite literally going to end up homeless, penniless, friendless and insane. These thoughts were the most real I have ever experienced - almost as though they were projected onto a huge screen inside my head - with HD and surround sound. Here is a full list of the things that depression said would happen to me:

  • I would become homeless and end up sleeping rough
  • I would never be able to work again
  • I would not have enough money to feed myself
  • I would not be able to live with my partner 
  • My children would disown me
  • I would have to kill myself to end the pain

The images were so convincing that I used to check out shop doorways in Norwich where I could sleep rough. I also researched soups kitchens in the City and considered buying myself a trolley to transport my sleeping bag and gear around on. Despite owning my own home, I was convinced that homelessness was my destiny. At the time, no one could reason with me.

Five years on and none of these things have come true. I'm not saying that life has been easy for me in the last five years because it hasn't - but I wanted to write this post to highlight just how convincing the agitprop of depression can be.  But depression isn't incontrovertible truth. The truth lies elsewhere - quieter and less dramatic.

Friday, 19 June 2020

Had we but world enough and time

One of the very worst things about clinical depression is the fact that, when it strikes, you literally have no idea how long it will last.


It might stick around for a few days or a few weeks or a few months. However, major depressive disorder can last for years. 

This is what makes the pain of depression so hard to bear and explains why depression is such a killer. If you knew that you just had to endure a few weeks or a few months then the whole thing might be doable - but you don't. As you struggle to get through the next ten minutes - with your head literally on fire - you are continually faced with the prospect that this torment could be unending. In fact, the ultimate nightmare of clinical depression is that it could last until you die.

However, in most cases depression does run its course and I think that is a message that needs to be trumpeted. But when you are in the middle of it, you have no way of knowing this - especially if you have no knowledge of the illness. All you can see is what lies directly in front of you: the ultimate death sentence or, rather, life sentence.

Obviously depression is not a competitive sport - so I try not to compare myself to others or indeed minimise the suffering that they have been through. However, in most depression memoirs that I read - the illness only lasts for a year or so; two years max. Mine has now been running since 2015. In fact I spent my 53rd birthday on the ward at Hellesdon Hospital. Next month I will be 58. However, in the last week or so I have been seeing some signs that there could, after five years of intense suffering, be a change happening. 

Thursday, 18 June 2020

Laughing at Depression

Our sense of humour (assuming we had one in the first place) is one of  the first things to go when depression strikes. If you have depression then it can seem like one of the most unfunny things ever. It is remorseless, hideous and painful. It doesn't do one liners, double entendres or puns. But in reality humour can be found literally anywhere - even in depression.


I know for a fact that depression doesn't like you laughing at it. Laughter sends a shudder through its dark heart. Why is that? Well, humour can relieve us - it can liberate us - it can allow us to see things that are ludicrous. It can satirise and make fun of things and it can give us some relief from monsters. And God knows depression is a monster.

Try giving your depression a silly voice: Donald Duck, Homer Simpson, or Boris Johnson on helium. Let it speak in an outrageous French accent; let it do silly walks like John Cleese or wear a funny hat; let it slip on banana skins. 

PS I also collect good jokes about depression. Some of these may be in bad taste but what the hell?

Q: How many depressives does it take to change a lighbulb?

A: (In monotone) It doesn't really matter because the darkness will always win.

If you know of any good ones, please send them to me.

Letting Yourself Go

by Matthew Johnstone
When you're in the grip of the horrors of depression it can be very hard to concentrate on mundane things like personal hygiene. Family and friends may start to notice that your appearance may be deteriorating or that flies are starting to follow you around.

I remember that when I was under the cosh I often forgot to use antiperspirant. I also stopped buying clothes. This was partly due to the thought I wouldn't be around for much longer. What use are underpants to a dead man? In three years, I think, I only bought a pair of trainers, a shirt and a fleece.

I also stopped shaving and grew a beard. This wasn't because I was going all hispster but merely because I didn't have the energy to shave anymore. I did manage to buy a beard trimmer however which, with the guard removed, I would use to hack off as much as possible every month or so. I also struggled (for various reasons) to make it to the hairdresser and the dentist.

In fact, everything becomes a struggle with depression. Even getting into the shower - a normally pleasureable activity - becomes a chore. Fortunately I had a partner and two daughters who tactfully reminded me when I needed to reacquaint myself with some soap.

But depression extends its malaise to all things that need sorting: lawns that need mowing, cars that need MOTing, hedges that need cutting and bins that need putting out. Everything weighs you down.

One of the best ways to deal with this never ending list of requirements is to try and break things down into manageable chunks. Just do one thing a day if you can. (And if you can, congratulate yourself.) Pesonal hygiene is particularly important though and should be a way to boost your self-esteem. It's good to be a sharp dressed man from time to time. While you're at it -  smile at yourself in the mirror too.

CBT

Cognitive Behavioral Therapy or CBT is one of the most popular talking therapies for anxiety and depression. It is predicated on the assumption that our thoughts affect our feelings and our actions and that, in turn, our feelings and actions affect our thoughts.


CBT seeks to challenge, change or modify our thought processes in order to change our feelings and our behaviour. It is often about creating virtuous circles and breaking vicious ones.

This can be a particularly effective treatment for depression because, as we know, depression can lead us into false patterns of negative thinking and trap us in viscious circles.

To give you an example - a person with depression may have lots of negative thoughts about their workplace and, in particular, about times when they think they have failed to perform. These bad thoughts may be impacting on their self-esteem which, in turn, may be making them feel more negative about work and leading to them to become even more ineffective. A CBT therapist might help the person to focus on times when they have been effective at work e.g. times when they have succeeded or where they have received positive feedback from clients or managers. This might then boost the person's self-esteem - so that the next time the person is in the workplace they feel more positive about their work and can be more effective. This in turn promotes more feelings of well being which boosts their self-esteem. In this way the viscious circle is transformed into a virtuous circle.

This is just a simple example - but hopefully demonstrates how CBT can change thoughts, feelings and behaviour. CBT can, sometimes, be available on the NHS.

Things Not to Say to a Depressed Person!

If you're caring for a depressed person, or have a friend who is depressed, it can sometimes be hard to know what to say. Even if you're well-intentioned, it can be easy to say the wrong thing. People with depression often have low self-esteem and profound feelings of guilt and hopelessness and can take, what you consider to be well meaning advice, the wrong way. But obviously, for them it is the wrong way.

Don't Say It!

Sometimes it's easier to list things that you should try to avoid saying - so here goes:

Pull Yourself Together - this is the old classic 'man-up', 'get a grip', 'snap out of it' sort of comment. However, depression is a real illness and has seldom, if ever, been resolved by 'pulling yourself together'. Often, depression is the result of a chemical inbalance in the brain - not of someone who is malingering. You wouldn't say to a diabetic 'man-up' because their body can't produce enough insulin.
It's all in the mind - this is another common thing that people say when they are trying to help. In many ways, depression is 'all in the mind' but that doesn't mean that it isn't a serious and difficult illness to overcome. When a depressed person hears this comment it can come acrosss as very patronising. It can also prompt feelings of guilt because it suggests that it's all their own fault. Or worse that it's purely an imaginary condition in the first place.
Worse things happen at sea - when you feel depressed it can feel truly awful - so to be told that there are many people who are worse off than you is not helpful. Obviously there are many people in the world who endure terrible illness and suffering - but it doesn't lessen someone's depression to hear that. In fact, it is likely to increase someone's depression to realise that the world is full of suffering. There is also an implied suggestion here that the depressed person may be over-acting or milking the situation
Count your blessings - as I have mentioned before depression can affect anyone. It can affect those who, on the surface, are very lucky. It can affect the rich, the happily married, the successful. But that doesn't mean that their suffering is any the less because of these things. As Matthew Johnstone says depression is an 'equal opportunity mutt'.

Other unhelpful comments include:
  • Look on the bright side
    • Just get off the sofa and go and do some exercise
    • You don't look depressed
    • It's a lovely day outside
    • Cheer up
      • You're just looking for attention
      • Have you taken your tablets today?

      Instead, try being thoughtful and empathetic. Sometimes just being there is probably the most important thing that you can do - because having depression can feel very lonely. You may have heard it all before - but listening is very important too. Try to be encouraging if the depressed person is thinking of seeking support via their GP or is about to try counselling or medication etc. Helping them to do practical things for them like cooking a meal can be good - but try not to do too much for them as this can take away their sense of self reliance. Asking if they would like to go for a walk or a coffee can be good. Bringing them useful books can be thoughtful - but try not to force them to read them. (Just leave them in the bag for later.) Talking about people who have been through the same thing they are going through can be good. Unconditional love goes a long way too.

      Psychomotor Retardation or Agitation

      This is another symptom of depression as identified in The Diagnostic and Statistical Manual of Mental Disorders - first published in the 1860s.

      Psychomotor retardation is a condition where both thinking and physical responses slow down. It is a symptom of major depression and can manifest itself in both movements and speech patterns. Many symptoms of depression are invisible but psychomotor retardation can actually be observed. Those affected can start to move, speak and react slowly. The amount of speech that sufferers engage in can also diminsh. PR can affect coordination too.

      However, as we know by now, depression is always contrary so in some sufferers - instead of a slowing down there is a speeding up and this is known as psychomotor agitation. This is characterised by unecessary, fast movements such as pacing or toe-tapping. In these sufferers, talking can also be accelerated. I suffered from agitated depression and I used to pace the house - completely unable to settle in a chair; I wasn't a great talker though.