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.
It also would mean that the fantasy about reaching into our skulls and taking out the part of our brains that is causing us bother is highly improbable, as we would have to go through the entire frontal cortex to reach this tiny central piece of us.
Maybe looking at a specific part or chemical in the brain is only ever going to give a partial answer. Maybe we should be looking at how we live, and how our minds weren’t made for the lives we lead. Human brains – in terms of cognition and emotion and consciousness – are essentially the same as they were at the time of Shakespeare or Jesus or Cleopatra or the Stone Age. They are not evolving with the pace of change. Neolithic humans never had to face emails or breaking news or pop-up ads or Iggy Azalea videos or a self-service checkout at a strip-lit Tesco Metro on a busy Saturday night. Maybe instead of worrying about upgrading technology and slowly allowing ourselves to be cyborgs we should have a little peek at how we could upgrade our ability to cope with all this change.
One thing can be said for sure: we are nowhere near the end of science – especially a baby science like neuroscience. So most of what we know now will be disproved or reassessed in the future. That is how science works, not through blind faith, but continual doubt.
All we can do, for the moment, is really all we need to do – listen to ourselves. When we are trying to get better, the only truth that matters is what works for us. If something works we don’t necessarily care why. Diazepam didn’t work for me. Sleeping pills and St John’s Wort and homeopathy didn’t fix me either. I have never tried Prozac, because even the idea intensified my panic, so I don’t know about that. But then I have never tried cognitive behavioural therapy either. If pills work for you it doesn’t really matter if this is to do with serotonin or another process or anything else – keep taking them. Hell, if licking wallpaper does it for you, do that. I am not anti pill. I am pro anything that works and I know pills do work for a lot of people. There may well come a time in the future where I take pills again. For now, I do what I know keeps me just about level. Exercise definitely helps me, as does yoga and absorbing myself in something or someone I love, so I keep doing these things. I suppose, in the absence of universal certainties, we are our own best laboratory.
The brain is the body – part one
WE TEND TO see the brain and the body as separate things. While in previous epochs the heart was at the centre of our being, or at least on an equal footing with the mind, now we have this strange separation where the mind is operating the rest of us, like a man inside a JCB digger.
The whole idea of ‘mental health’ as something separate to physical health can be misleading, in some ways. So much of what you feel with anxiety and depression happens elsewhere. The heart palpitations, the aching limbs, the sweaty palms, the tingling sensations that often accompany anxiety, for instance. Or the aching limbs and the total-body fatigue that sometimes becomes part of depression.
Psycho
I SUPPOSE THE first time I really felt my brain was a little bit alien, a bit other, was when I was thirteen. It was a few months after the time I had tried to remove my mole with a toothbrush.
I was in the Peak District, in Derbyshire. School trip. The girls were staying in the hostel. The boys were meant to be staying there too but there had been a double-booking, so eight of us boys stayed in the stables outside, a good distance from the warm hotel.
I hated being away from home. This was another of my big anxieties. I wanted to be back in my own bed looking at my poster of Béatrice Dalle, or reading Stephen King’s Christine.
I lay on a top bunk looking out of the window at the black boggy landscape under a starless sky. I didn’t really have any friends among these boys. They talked only about football, which wasn’t my specialist subject, and wanking, which was slightly more a specialist subject but not one I felt comfortable discussing in public. So I pretended to be asleep.
There was no teacher with us, here in the stables, and there was a kind of Lord of the Flies feeling I didn’t like very much. I was tired. We had walked about ten miles that day, a lot of it through peat bogs. Sleep weighed on me, as thick and dark as the land all around.
I woke, to laughing.
Mad, crazed laughing, as if the funniest thing in the world had just happened.
I had talked in my sleep. Nothing is more hilarious to a thirteen-year-old boy than witnessing an unguarded and embarrassing moment of another thirteen-year-old boy.
I had said something incoherent about cows. And Newark. Newark was my hometown, so that was understandable. The cows thing, well, that was weird. There were no cows in the Peak District. I was told I had said, over and over, ‘Kelham is in Newark.’ (Kelham was a village just outside Newark, where the town council was. My dad worked as an architect there, in the town planning department.) I tried my best to ride the joke. But I was tired, nervous. A school trip was just school, condensed. I had not enjoyed school since I was eleven, when I had been at a village school with a total pupil population of twenty-eight. The school I was at now, Magdalene High School, was a place where I was not very happy. I had spent a lot of the first year faking stomach aches that were rarely believed.
Then I fell asleep again. And when I woke up I was shaking. I was standing up, and I could feel cold air, and there was a considerable amount of blood dripping from my hand. My hand was red and shining with it. There was a shard of glass sticking out of my palm. The window to the stables was smashed in front of me. I felt frightened.
The other boys were all awake, but not laughing now. A teacher was there too. Or was about to be there. My hand had to be bandaged.
I had got out of bed in my sleep. I had shouted out – rather comically – about cows again. (‘The cows are coming! The cows are coming!’) Then I had gone for a piss next to someone’s bed. And then smashed the window. Shortly after, one of the boys shook my arm and I woke up.
It wasn’t the first time I had sleepwalked. Over the previous year I had gone into my sister’s bedroom and taken books off her shelves, thinking I was in a library. But my sleepwalking had never gone public. Until now.
I gained a new nickname. Psycho. I felt like a freak. But it could have been worse. I had loving parents and a few friends and a sister I could chat to for hours. My life was pretty comfortable and ordinary, but sometimes a sense of loneliness would creep over me. I felt lonely. Not depression. Just a version of that wallowy, teenage, no-one-understands-me feeling. Of course, I didn’t understand me either.
I worried about things. Nuclear war. Ethiopia. The prospect of going on a ferry. I worried all the time. The only thing that didn’t worry me was the thing that probably should have: worry itself. It would be eleven years before I had to address that one.
Jenga days
ELEVEN YEARS AFTER smashing a window in my sleep, during those ‘breakdown months’ as I’d later call them, there was a lot of empty time to stare worry in the face.
My parents would get up and leave for work and then me and Andrea would have long days in the house. It’s weird to write about this period. I mean, really there is nothing to write about. It was, from the outside, the least eventful phase of my life by quite a way.
From the outside, it was me talking with Andrea, either in my childhood bedroom or downstairs in the kitchen. Occasionally we would venture outside for a short walk in the afternoon. We would go either to the nearest corner shop, only about two or three hundred metres away, or – on more adventurous days – we would go and walk by the river Trent, which was a little further away, on the other side of the town centre, and involved me walking through streets I knew so well from childhood. (How could they stay the same when I felt so different?) Sometimes we bought a newspaper and a tin of soup and some bread, and we would return and read a bit of the paper and make the soup. Later, we might help prepare the evening meal. And that was about it. Talking and sitting and walking. It was hardly Lawrence of Arabia. Life at the lowest possible volume two twenty-four-year-olds could manage.
And yet, those days were the most intense I have lived. Those days contained thousands of tiny battles. They are filled with memories so painful I can only now, with the distance of fourteen and a half years, look at them head-on. I was a nervous wreck. People say ‘take it one day at a time’. But, I used to think to myself, that is all right for them to say. Days were mountains. A week was a trek across the Himalayas. You see, people say that time is relative, but it really bloody is.
Einstein said the way to understand relativity was to imagine the difference between love and pain. ‘When you are courting a nice girl an hour seems like a second. When you sit on a red-hot cinder a second seems like an hour.’ Every moment was red-hot. And the only real thing I wished for, beyond feeling better, was for time to move quicker. I would want 9 a.m. to be 10 a.m. I would want the morning to be the afternoon. I would want the 22nd of September to be the 23rd of September. I would want the light to be dark and the dark to be light. I still had the toy globe I’d had as a boy in my room. I sometimes used to stand there and spin it, wishing I was spinning the world deep into the next millennium.
I was as obsessed with time as some people are about money. It was the only weapon I had. I would build up hours and minutes like pounds and pence. In my head, amid all the raging waters of anxiety, this knowledge buoyed like hope. It is October 3rd, twenty-two days since it happened.
The longer that time went on, and I was still a) alive and b) not mistaking anyone for a hat, the more I felt like there was a chance I could get through this. But it didn’t always work like that. I stacked the days up like Jenga blocks, imagining I was making progress, and then – crash – along would come a five-hour panic attack or a day of total apocalyptic darkness, and those Jenga days would topple back down again.
Warning signs
WARNING SIGNS ARE very hard with depression.
It’s especially hard for people with no direct experience of depression to know them when they see them. Partly this is because some people are confused about what depression actually is. We use ‘depressed’ as a synonym for ‘sad’, which is fine, as we use ‘starving’ as a synonym for ‘hungry’, though the difference between depression and sadness is the difference between genuine starvation and feeling a bit peckish.
Depression is an illness. Yet it doesn’t come with a rash or a cough. It is hard to see, as it is generally invisible. Even though it is a serious illness it is also surprisingly hard for many sufferers to recognise it at first. Not because it doesn’t feel bad – it does – but because that bad feeling seems unrecognisable, or can be confused with other things. For instance, if you feel worthless you might think ‘I feel worthless because I am worthless’. It might be hard to see it as a symptom of an illness. Or even if it is seen as that, it’s possible that low self-worth, combined with fatigue, might mean there is little will or ability to vocalise it.
But in any case, these are some of the most frequently cited signs that someone is depressed.
Fatigue – if someone is tired all the time, for no real reason.
Low self-esteem – a hard one for others to spot, especially in those people who aren’t that comfortable talking about their feelings. And low self-esteem isn’t exactly conducive with getting out there in the world.
‘Psychomotor retardation’ – in certain cases of depression, slow movements and slow speech may happen.
Loss of appetite (though massive increase in appetite can sometimes be a symptom too).
Irritability (though, to be fair, that can be a sign of anything).
Frequent crying episodes.
Anhedonia – I first knew of this word as Woody Allen’s original title for the film Annie Hall. It means, as I’ve said, the inability to experience pleasure in anything. Even the pleasurable things, like sunsets and nice food, and watching dubious Chevy Chase comedies from the eighties. That sort of stuff.
Sudden introversion – if someone seems quieter, or more introverted than normal, it could mean they are depressed. (I can remember there were times when I couldn’t speak. It felt like I couldn’t move my tongue, and talking seemed so utterly pointless. Just as the things other people talked about seemed to belong to another world.)
Demons
THE DEMON SAT next to me in the back of the car.
He was real and false all at once. Not a hallucination exactly, and not transparent like a theme park ghost, but there and not there. There when I closed my eyes. There even when I opened them again, a kind of flickering mind-print transferred over reality, but something imagined rather than seen.
He was short. About three foot. Impish and grey, like a gargoyle on a cathedral, and he was looking up at me, smiling. And then he got up on the seat and started licking my face. He had a long, dry tongue. And he kept on. Lick, lick, lick. He didn’t really scare me. I mean, fear was there, obviously. I was living continually inside fear. But the demon didn’t send me deeper into terror. If anything, he was a comfort. The licks were caring licks, as if I was one big wound and he was trying to make me better.
The car was heading to the Nottingham Theatre Royal. We were off to see Swan Lake. It was the production where all the swans were male. My mother was talking. Andrea was in the front passenger seat, listening with polite patience to my mother. I can’t remember what she was saying but I can remember she was talking, because I kept on thinking This is weird. Mum is talking about Matthew Bourne and her friends who have seen this production and there is a happy demon on the back seat licking my face.
The licking got a bit more annoying. I tried to switch the demon off, or the idea of the demon, but of course that made it worse. Lick, lick, lick, lick. I couldn’t really feel the tongue on my skin, but the idea of the demon licking my face was real enough for my brain to tingle, as if I was being tickled.
The demon laughed. We went into the theatre. Swans danced. I felt my heart speed up. The dark, the confinement, my mother holding my hand, it was all too much. This was it. Everything was over. Except, of course, it wasn’t. I stayed in my seat.
Anxiety and depression, that most common mental health cocktail, fuse together in weird ways. I would often close my eyes and see strange things, but now I feel like sometimes those things were only there because one of the things I was scared of was going mad. And if you are mad, then seeing things that aren’t there is probably a symptom.
If you are scared when there is nothing to be scared of, eventually your brain has to give you things. And so that classic expression – ‘the only thing to fear is fear itself’ – becomes a kind of meaningless taunt. Because fear is enough. It is a monster, in fact.
And, of course –
‘Monsters are real,’ Stephen King said. ‘And ghosts are real too. They live inside us, and sometimes, they win.’
It was dark. The house was silent so we tried to be too.
‘I love you,’ she whispered.
‘I love you,’ I whispered back.
We kissed. I felt demons watching us, gathering around us, as we kissed and held each other. And slowly, in my mind, the demons retreated for a while.
Existence
LIFE IS HARD. It may be beautiful and wonderful but it is also hard. The way people seem to cope is by not thinking about it too much. But some people are not going to be able to do that. And besides, it is the human condition. We think therefore we are. We know we are going to grow old, get ill and die. We know that is going to happen to everyone we know, everyone we love. But also, we have to remember, the only reason we have love in the first place is because of this. Humans might well be the only species to feel depression as we do, but that is simply because we are a remarkable species, one that has created remarkable things – civilisation, language, stories, love songs. Chiaroscuro means a contrast of light and shade. In Renaissance paintings of Jesus, for instance, dark shadow was used to accentuate the light bathing Christ. It is a hard thing to accept, that death and decay and everything bad leads to everything good, but I for one believe it. As Emily Dickinson, eternally great poet and occasionally anxious agoraphobe, said: ‘That it will never come again is what makes life so sweet.’