— Reasons to Stay Alive —
Matt Haig

This book is impossible


THIRTEEN YEARS AGO I knew this couldn’t happen.


I was going to die, you see. Or go mad.


There was no way I would still be here. Sometimes I doubted I would even make the next ten minutes. And the idea that I would be well enough and confident enough to write about it in this way would have been just far too much to believe.


One of the key symptoms of depression is to see no hope. No future. Far from the tunnel having light at the end of it, it seems like it is blocked at both ends, and you are inside it. So if I could have only known the future, that there would be one far brighter than anything I’d experienced, then one end of that tunnel would have been blown to pieces, and I could have faced the light. So the fact that this book exists is proof that depression lies. Depression makes you think things that are wrong.



But depression itself isn’t a lie. It is the most real thing I’ve ever experienced. Of course, it is invisible.


To other people, it sometimes seems like nothing at all. You are walking around with your head on fire and no one can see the flames. And so – as depression is largely unseen and mysterious – it is easy for stigma to survive. Stigma is particularly cruel for depressives, because stigma affects thoughts and depression is a disease of thoughts.


When you are depressed you feel alone, and that no one is going through quite what you are going through. You are so scared of appearing in any way mad you internalise everything, and you are so scared that people will alienate you further you clam up and don’t speak about it, which is a shame, as speaking about it helps. Words – spoken or written – are what connect us to the world, and so speaking about it to people, and writing about this stuff, helps connect us to each other, and to our true selves.


I know, I know, we are humans. We are a clandestine species. Unlike other animals we wear clothes and do our procreating behind closed doors. And we are ashamed when things go wrong with us. But we’ll grow out of this, and the way we’ll do it is by speaking about it. And maybe even through reading and writing about it.



I believe that. Because it was, in part, through reading and writing that I found a kind of salvation from the dark. Ever since I realised that depression lied about the future I have wanted to write a book about my experience, to tackle depression and anxiety head-on. So this book seeks to do two things. To lessen that stigma, and – the possibly more quixotic ambition – to try and actually convince people that the bottom of the valley never provides the clearest view. I wrote this because the oldest clichés remain the truest. Time heals. The tunnel does have light at the end of it, even if we aren’t able to see it. And there’s a two-for-one offer on clouds and silver linings. Words, just sometimes, can set you free.



A note, before we get fully under way


MINDS ARE UNIQUE. They go wrong in unique ways. My mind went wrong in a slightly different way to how other minds go wrong. Our experience overlaps with other people’s, but it is never exactly the same experience. Umbrella labels like ‘depression’ (and ‘anxiety’ and ‘panic disorder’ and ‘OCD’) are useful, but only if we appreciate that people do not all have the same precise experience of such things.


Depression looks different to everyone. Pain is felt in different ways, to different degrees, and provokes different responses. That said, if books had to replicate our exact experience of the world to be useful, the only books worth reading would be written by ourselves.


There is no right or wrong way to have depression, or to have a panic attack, or to feel suicidal. These things just are. Misery, like yoga, is not a competitive sport. But I have found over the years that by reading about other people who have suffered, survived and overcome despair I have felt comforted. It has given me hope. I hope this book can do the same.




1


Falling



‘But in the end one needs more courage to live than to kill himself.’


—Albert Camus, A Happy Death




I CAN REMEMBER the day the old me died.


It started with a thought. Something was going wrong. That was the start. Before I realised what it was. And then, a second or so later, there was a strange sensation inside my head. Some biological activity in the rear of my skull, not far above my neck. The cerebellum. A pulsing or intense flickering, as though a butterfly was trapped inside, combined with a tingling sensation. I did not yet know of the strange physical effects depression and anxiety would create. I just thought I was about to die. And then my heart started to go. And then I started to go. I sank, fast, falling into a new claustrophobic and suffocating reality. And it would be way over a year before I would feel anything like even half-normal again.


Up until that point I’d had no real understanding or awareness of depression, except that I knew my mum had suffered from it for a little while after I was born, and that my great-grandmother on my father’s side had ended up committing suicide. So I suppose there had been a family history, but it hadn’t been a history I’d thought about much.


Anyway, I was twenty-four years old. I was living in Spain – in one of the more sedate and beautiful corners of the island of Ibiza. It was September. Within a fortnight, I would have to return to London, and reality. After six years of student life and summer jobs. I had put off being an adult for as long as I could, and it had loomed like a cloud. A cloud that was now breaking and raining down on me.


The weirdest thing about a mind is that you can have the most intense things going on in there but no one else can see them. The world shrugs. Your pupils might dilate. You may sound incoherent. Your skin might shine with sweat. And there was no way anyone seeing me in that villa could have known what I was feeling, no way they could have appreciated the strange hell I was living through, or why death seemed such a phenomenally good idea.


I stayed in bed for three days. But I didn’t sleep. My girlfriend Andrea came in with water at regular intervals, or fruit, which I could hardly eat.



The window was open to let fresh air in, but the room was still and hot. I can remember being stunned that I was still alive. I know that sounds melodramatic, but depression and panic only give you melodramatic thoughts to play with. Anyway, there was no relief. I wanted to be dead. No. That’s not quite right. I didn’t want to be dead, I just didn’t want to be alive. Death was something that scared me. And death only happens to people who have been living. There were infinitely more people who had never been alive. I wanted to be one of those people. That old classic wish. To never have been born. To have been one of the three hundred million sperm that hadn’t made it.


(What a gift it was to be normal! We’re all walking on these unseen tightropes when really we could slip at any second and come face to face with all the existential horrors that only lie dormant in our minds.)


There was nothing much in this room. There was a bed with a white patternless duvet, and there were white walls. There might have been a picture on the wall but I don’t think so. I certainly can’t remember one. There was a book by the bed. I picked it up once and put it back down. I couldn’t focus for as much as a second. There was no way I could express fully this experience in words, because it was beyond words. Literally, I couldn’t speak about it properly. Words seemed trivial next to this pain.


I remembered worrying about my younger sister, Phoebe. She was in Australia. I worried that she, my closest genetic match, would feel like this. I wanted to speak to her but knew I couldn’t. When we were little, at home in Nottinghamshire, we had developed a bed-time communication system of knocking on the wall between our rooms. I now knocked on the mattress, imagining she could hear me all the way through the world.


Knock. Knock. Knock.


I didn’t have terms like ‘depression’ or ‘panic disorder’ in my head. In my laughable naivety I did not really think that what I was experiencing was something that other people had ever felt. Because it was so alien to me I thought it had to be alien to the species.


‘Andrea, I’m scared.’


‘It’s okay. It’s going to be okay. It’s going to be okay.’


‘What’s happening to me?’


‘I don’t know. But it’s going to be okay.’



‘I don’t understand how this can be happening.’


On the third day, I left the room and I left the villa, and I went outside to kill myself.




IT IS INVISIBLE.


It is not ‘feeling a bit sad’.


It is the wrong word. The word depression makes me think of a flat tyre, something punctured and unmoving. Maybe depression minus anxiety feels like that, but depression laced with terror is not something flat or still. (The poet Melissa Broder once tweeted: ‘what idiot called it “depression” and not “there are bats living in my chest and they take up a lot of room, ps. I see a shadow”?’) At its worst you find yourself wishing, desperately, for any other affliction, any physical pain, because the mind is infinite, and its torments – when they happen – can be equally infinite.


You can be a depressive and be happy, just as you can be a sober alcoholic.



It doesn’t always have an obvious cause.


It can affect people – millionaires, people with good hair, happily married people, people who have just landed a promotion, people who can tap dance and do card tricks and strum a guitar, people who have no noticeable pores, people who exude happiness in their status updates – who seem, from the outside, to have no reason to be miserable.


It is mysterious even to those who suffer from it.




THE SUN WAS beating hard. The air smelt of pine and the sea. The sea was right there, just below the cliff. And the cliff edge was only a few steps away. No more than twenty, I would say. The only plan I had was to take twenty-one steps in that direction.


‘I want to die.’


There was a lizard near my feet. A real lizard. I felt a kind of judgement. The thing with lizards is that they don’t kill themselves. Lizards are survivors. You take off their tail and another grows back. They aren’t mopers. They don’t get depressed. They just get on with it, however harsh and inhospitable the landscape. I wanted, more than anything, to be that lizard.


The villa was behind me. The nicest place I had ever lived. In front of me, the most glorious view I had ever seen. A sparkling Mediterranean, looking like a turquoise tablecloth scattered with tiny diamonds, fringed by a dramatic coastline of limestone cliffs and small, near-white forbidden beaches. It fit almost everyone’s definition of beautiful. And yet, the most beautiful view in the world could not stop me from wanting to kill myself.


A little over a year before I had read a lot of Michel Foucault for my MA. Much of Madness and Civilization. The idea that madness should be allowed to be madness. That a fearful, repressive society brands anyone different as ill. But this was illness. This wasn’t having a crazy thought. This wasn’t being a bit wacky. This wasn’t reading Borges or listening to Captain Beefheart or smoking a pipe or hallucinating a giant Mars bar. This was pain. I had been okay and now, suddenly, I wasn’t. I wasn’t well. So I was ill. It didn’t matter if it was society or science’s fault. I simply did not – could not – feel like this a second longer. I had to end myself.


I was going to do it as well. While my girlfriend was in the villa, oblivious, thinking that I had just needed some air.


I walked, counting my steps, then losing count, my mind all over the place.


‘Don’t chicken out,’ I told myself. Or I think I told myself. ‘Don’t chicken out.’


I made it to the edge of the cliff. I could stop feeling this way simply by taking another step. It was so preposterously easy – a single step – versus the pain of being alive.


Now, listen. If you have ever believed a depressive wants to be happy, you are wrong. They could not care less about the luxury of happiness. They just want to feel an absence of pain. To escape a mind on fire, where thoughts blaze and smoke like old possessions lost to arson. To be normal. Or, as normal is impossible, to be empty. And the only way I could be empty was to stop living. One minus one is zero.


But actually, it wasn’t easy. The weird thing about depression is that, even though you might have more suicidal thoughts, the fear of death remains the same. The only difference is that the pain of life has rapidly increased. So when you hear about someone killing themselves it’s important to know that death wasn’t any less scary for them. It wasn’t a ‘choice’ in the moral sense. To be moralistic about it is to misunderstand.


I stood there for a while. Summoning the courage to die, and then summoning the courage to live. To be. Not to be. Right there, death was so close. An ounce more terror, and the scales would have tipped. There may be a universe in which I took that step, but it isn’t this one.



I had a mother and a father and a sister and a girlfriend. That was four people right there who loved me. I wished like mad, in that moment, that I had no one at all. Not a single soul. Love was trapping me here. And they didn’t know what it was like, what my head was like. Maybe if they were in my head for ten minutes they’d be like, ‘Oh, okay, yes, actually. You should jump. There is no way you should feel this amount of pain. Run and jump and close your eyes and just do it. I mean, if you were on fire I could put a blanket around you, but the flames are invisible. There is nothing we can do. So jump. Or give me a gun and I’ll shoot you. Euthanasia.’


But that was not how it worked. If you are depressed your pain is invisible.


Also, if I’m honest, I was scared. What if I didn’t die? What if I was just paralysed, and I was trapped, motionless, in that state, for ever?


I think life always provides reasons to not die, if we listen hard enough. Those reasons can stem from the past – the people who raised us, maybe, or friends or lovers – or from the future – the possibilities we would be switching off.


And so I kept living. I turned back towards the villa and ended up throwing up from the stress of it all.




THEN ME: I want to die.


NOW ME: Well, you aren’t going to.


THEN ME: That is terrible.


NOW ME: No. It is wonderful. Trust me.


THEN ME: I just can’t cope with the pain.


NOW ME: I know. But you are going to have to. And it will be worth it.


THEN ME: Why? Is everything perfect in the future?


NOW ME: No. Of course not. Life is never perfect. And I still get depressed from time to time. But I’m at a better place. The pain is never as bad. I’ve found out who I am. I’m happy. Right now, I am happy. The storm ends. Believe me.


THEN ME: I can’t believe you.


NOW ME: Why?



THEN ME: You are from the future, and I have no future.


NOW ME: I just told you . . .




I HAD GONE days without proper food. I hadn’t noticed the hunger because of all the other crazy stuff that was happening to my body and brain. Andrea told me I needed to eat. She went to the fridge and got out a carton of Don Simon gazpacho (in Spain they sell it like fruit juice).


‘Drink this,’ she said, unscrewing the cap and handing it over.


I took a sip. The moment I tasted it was the moment I realised how hungry I was so I swallowed some more. I’d probably had half the carton before I had to go outside and throw up again. Admittedly, throwing up from drinking Don Simon gazpacho might not be the surest sign of illness in the world, but Andrea wasn’t taking her chances.


‘Oh God,’ she said. ‘We’re going now.’


‘Where?’ I said.


‘To the medical centre.’


‘They’ll make me take pills,’ I said. ‘I can’t take pills.’



‘Matt. You need pills. You are beyond the point at which not taking pills is an option. We’re going, okay?’


I added a question mark in there, but I don’t really remember it as a question. I don’t know what I answered, but I do know that we went to the medical centre. And that I got pills.


The doctor studied my hands. They were shaking. ‘So how long did the panic last?’


‘It hasn’t really stopped. My heart is beating too fast still. I feel weird.’ Weird nowhere near covered it. I don’t think I added to it, though. Just speaking was an intense effort.


‘It is adrenaline. That is all. How is your breathing. Have you hyperventilated?’


‘No. It is just my heart. I mean, my breathing feels . . . weird . . . but everything feels weird.’


He felt my heart. He felt it with his hand. Two fingers pressed into my chest. He stopped smiling.


‘Are you on drugs?’


‘No!’


‘Have you taken any?’


‘In my life, yes. But not this week. I’d been drinking a lot, though.’



‘Vale, vale, vale,’ he said. ‘You need diazepam. Maximum. The most I am able to give for you.’ For a doctor in a country where you could get diazepam freely over the counter, like it was paracetamol or ibuprofen, this was quite a significant thing to say. ‘This will fix you. I promise.’


I lay there, and imagined the tablets were working. For a moment panic simmered down to a level of heavy anxiety. But that feeling of momentary relaxation actually triggered more panic. And this was a flood. I felt everything pull away from me, like when Brody is sitting on the beach in Jaws and thinks he sees the shark. I was lying there on a sofa but I felt a literal pulling away. As if something was sliding me towards a further distance from reality.




SUICIDE IS NOW – in places including the UK and US – a leading cause of death, accounting for over one in a hundred fatalities. According to figures from the World Health Organization, it kills more people than stomach cancer, cirrhosis of the liver, colon cancer, breast cancer, and Alzheimer’s. As people who kill themselves are, more often than not, depressives, depression is one of the deadliest diseases on the planet. It kills more people than most other forms of violence – warfare, terrorism, domestic abuse, assault, gun crime – put together.


Even more staggeringly, depression is a disease so bad that people are killing themselves because of it in a way they do not kill themselves with any other illness. Yet people still don’t think depression really is that bad. If they did, they wouldn’t say the things they say.




‘COME ON, I know you’ve got tuberculosis, but it could be worse. At least no one’s died.’


‘Why do you think you got cancer of the stomach?’


‘Yes, I know, colon cancer is hard, but you want to try living with someone who has got it. Sheesh. Nightmare.’


‘Oh, Alzheimer’s you say? Oh, tell me about it, I get that all the time.’


‘Ah, meningitis. Come on, mind over matter.’


‘Yes, yes, your leg is on fire, but talking about it all the time isn’t going to help things, is it?’



‘Okay. Yes. Yes. Maybe your parachute has failed. But chin up.’




MEDICATION DIDN’T WORK for me. I think I was partly to blame.


In Bad Science Ben Goldacre points out that ‘You are a placebo responder. Your body plays tricks on your mind. You cannot be trusted.’ This is true, and it can surely work both ways. During that very worst time, when depression co-existed with full-on 24/7 panic disorder, I was scared of everything. I was, quite literally, scared of my shadow. If I looked at an object – shoes, a cushion, a cloud – for long enough then I would see some malevolence inside it, some negative force that, in an earlier and more superstitious century, I might have interpreted as the Devil. But the thing I was most scared of was drugs or anything (alcohol, lack of sleep, sudden news, even a massage) that would change my state of mind.


Later, during lesser bouts of anxiety, I would often find myself enjoying alcohol too much. That soft warm cushioning of existence that is so comforting you end up forgetting the hangover that will ensue. After important meetings I would find myself in bars alone, drinking through the afternoon and nearly missing the last train home. But in 1999 I was years away from being back to this relatively normal level of dysfunction.


It is a strange irony that it was during the period when I most needed my mind to feel better, that I didn’t want to actively interfere with my mind. Not because I didn’t want to be well again, but because I didn’t really believe feeling well again was possible, or far less possible than feeling worse. And worse was terrifying.


So I think part of the problem was that a reverse placebo effect was going on. I would take the diazepam and instantly panic, and the panic increased the moment I felt the drug have any effect at all. Even if it was a good effect.


Months later a similar thing would happen when I started taking St John’s Wort. It would even happen to a degree with ibuprofen. So clearly the diazepam wasn’t entirely to blame. And diazepam is far from being the strongest medication out there. Yet the feeling and level of disconnection I felt on diazepam is something others claim to feel on it too, and so I think that the drug itself (for me) was at least part of the problem.




MEDICATION IS AN incredibly attractive concept. Not just for the person with depression, or the person running a pharmaceutical firm, but for society as a whole. It underlines the idea we have hammered into us by the hundred thousand TV ads we have seen that everything can be fixed by consuming things. It fosters a just-shut-up-and-take-the-pill approach, and creates an ‘us’ and ‘them’ divide, where everyone can relax and feel ‘unreason’ – to borrow Michel Foucault’s favourite word – is being safely neutered in a society which demands we be normal even as it drives us insane.


But anti-depressants and anti-anxiety medication still fill me with fear. It doesn’t help that the names – Fluoxetine, Venlafaxine, Propranolol, Zopiclone – sound like sci-fi villains.


The only drugs I ever took that seemed to make me feel a bit better were sleeping pills. I only had one packet of them because we’d bought them in Spain, where the pharmacists wear reassuring white coats and talk like doctors. Dormidina was the brand name, I think. They didn’t help me sleep but they helped me be awake without feeling total terror. Or distanced me from that terror. But I also knew that they would be very easy to become addicted to, and that the fear of not taking them could rapidly overtake the fear of taking them.


The sleeping tablets enabled me to function enough to go home. I can remember our last day in Spain. I was now sitting at the table, saying nothing as Andrea explained to the people we were working for and technically living with (it was their villa, but they were rarely there) – Andy and Dawn – that we were going home.


Andy and Dawn were good people. I liked them. They were a few years older than me and Andrea, but they were always easy to be around. They ran the largest party in Ibiza, Manumission, which had begun as a small night in Manchester’s gay village a few years before and morphed into a kind of Studio 54 in the Med. By 1999, it was the epicentre of club culture, a magnet for the likes of Kate Moss, Jade Jagger, Irvine Welsh, Jean Paul Gaultier, the Happy Mondays, Fatboy Slim and thousands of European clubbers. It had once seemed like heaven, but now the idea of all that music and all those party people seemed like a nightmare.


But Andy and Dawn didn’t want Andrea to leave.


‘Why don’t you stay here? Matt would be okay. He looks fine.’


‘He’s not fine,’ Andrea answered them. ‘He’s ill.’


I was – by Ibiza standards at least – not a drug person. I was an alcohol person. A Bukowski-worshipping eternal student who had spent my time on the island sitting down in the sun selling tickets at an outside box office while reading airport novels (during my day job selling tickets, I had befriended a magician named Carl who gave me John Grisham novels in exchange for Margaret Atwood and Nietzsche) and drinking booze. But still, I wished madly I’d never taken anything in my life stronger than a coffee. I certainly wished I hadn’t drunk so many bottles of Viña Sol and glasses of vodka and lemon during the last month, or had eaten a few proper breakfasts, or got a bit more sleep.


‘He doesn’t look ill.’ Dawn still had glitter on her face from wherever she had been the night before. The glitter troubled me.



‘I’m sorry,’ I said, weakly, wishing for a more visible illness.


Guilt smashed me like a hammer.


I took another sleeping pill and then my afternoon dose of diazepam and we went to the airport. The party was over.


While on diazepam or the sleeping pills, I never felt any closer to being ‘fixed’. I stayed exactly as ill as ever. The most pills could do, I supposed, was place a distance there. The sleeping pills forced my brain to slow down a bit, but I knew nothing had really changed. Just as, years later, when I was back to drinking alcohol again, I would often cope with lower-level anxiety by getting drunk, all the time knowing that it would be there waiting for me with a hangover on top.


I am reluctant to come out and be anti all pills because I know for some people some pills work. In some cases they seem to numb the pain enough for the good, real work of getting better to happen. In others, they provide a partial long-term solution. Many people can’t do without them. In my case, after my disorientating diazepam panic attacks I had been so scared to take pills that I never actually took anything directly for my depression (as opposed to panic and anxiety).


Personally, for me, I am happy that I largely mended myself without the aid of medication, and feel that having to experience the pain minus any ‘anaesthetic’ meant I got to know my pain very well, and become alert to the subtle upward or downward shifts in my mind. Though I do wonder whether, if I’d had the courage to battle those pill-fearing panic attacks, it could have lessened the pain. It was such relentless, continuous pain that just to think about it now affects my breathing, and my heart can go. I think of being in the passenger seat of a car, as leaden terror swamped me. I had to rise in my seat, my head touching the roof of the car, my body trying to climb out of itself, skin crawling, mind whirring faster than the dark landscape. It would have been good not to have known that kind of terror, and if a pill could have helped, then I should have taken it. If I’d had something to lessen that mental agony (and really that is the word) then maybe it would have been easier to recover from. But by not taking it, I became very in tune with myself. This helped me know what exactly made me feel better (exercise, sunshine, sleep, intense conversation, etc.) and this alertness, an alertness I know from myself and others can be lost via pills, eventually helped me build myself back up from scratch. If I had been dulled or felt that otherness meds can make you feel, things might have been harder.


Here is Professor Jonathan Rottenberg, an evolutionary psychologist and author of The Depths, writing in 2014 words that are strangely comforting:


How will we better contain depression? Expect no magic pill. One lesson learned from treating chronic pain is that it is tough to override responses that are hardwired into the body and mind. Instead, we must follow the economy of mood where it leads, attending to the sources that bring so many into low mood states – think routines that feature too much work and too little sleep. We need broader mood literacy and an awareness of tools that interrupt low mood states before they morph into longer and more severe ones. These tools include altering how we think, the events around us, our relationships, and conditions in our bodies (by exercise, medication, or diet).
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