Golden Linings

Psych wards are busy places. There are hundreds of jobs to do and never enough staff to get them all done. During my brief time in one, I watched the nurses and care assistants charge up and down corridors, muttering to do lists under their breath, and wondered why I – an able-bodied, bored- rigid patient, couldn’t muck in with some of the menial tasks to pass the time. ‘It’s not allowed I’m afraid,’ a nurse told me. She mumbled something about risk assessments and sped on her way.

As a result of this inbalance of labour, the hospital contained two completely inconsistent atmospheres: one of relentless, crushing tedium, and one of relentless, crushing activity. They passed uneasily alongside one another like weather systems. Patients languished in a heavy fog. Staff spun in tornados.

On one particularly dull Tuesday afternoon, I called in on my friend Amelia for a chat. ‘This place is called a ‘Hope and Recovery Centre’,’ she said, lying sulkily on her bed.  ‘How are we supposed to hope and recover with nothing to do?’

‘I read this story once called The Yellow Wallpaper,’ I said, sitting on a chair next to her. ‘It’s about this really anxious woman who is told to get bed rest. She lies there, day after day, with nothing to do or think about, but she’s got this really intricate wallpaper with a yellow flower design running all the way through it and she drives herself insane by analysing it.’

‘At least our walls are white,’ she replied. ‘I don’t know if that’s better or worse.’ There was a bland, inoffensive canvas hanging on Amelia’s wall that broke up the blankness of the paint the way a meaningless platitude breaks a silence.

A nurse swung the door open to do her hourly checks. She placed a tick next to each of our names and turned to leave.

‘Is there anything we can do today?’ Amelia pleaded.

‘Sure.’ The nurse said. ‘Go to the TV room. Doris is watching Oprah Winfrey.’

Doris loved chat shows. She kept the remote control firmly in her hand all day, and put it in her dressing gown pocket when she went to lunch.

‘Or go in the garden. The sun’s out.’

We went outside, squeezed ourselves past the smokers, and paced slowly around the garden to make the walk last longer. We did eight laps and then started to feel silly.

‘It would be nice if they let us plant something,’ Amelia sighed, refusing to go around again. ‘Gardening is harmless, right?’

It was April. The daffodils on the edge of the lawn were blooming, but the soil they were planted in was flecked with cigarette butts. There were hundreds of them, maggot-like, a toxic yellow pattern that spread along the border.

‘I have an idea.’ Amelia said. She took my wrist and dragged me back inside.

‘Do you have any bin bags?’ She asked the first nurse she saw.


‘We want to tidy up the flower beds. They are full of ciggie butts.’

She looked at us incredulously. It was craziness alright, but not as she knew it.

‘We have a gardener for that, girls. Why don’t you go and watch Oprah.’

‘We don’t want to watch Oprah,’ Amelia said, with sudden ponytail-swishing assertiveness that I wanted to cheer. ‘We want to help the flowers grow!’

Another five second stare, and the nurse retrieved a couple of plastic carrier bags from the office. ‘Use these,’ she said. ‘Don’t be out too long.’

We worked, with Girl-Guide focus, till our fingernails were black with earth and our knees dyed green with the grass. Together, we were brave enough to ignore the three nurses who were watching us, baffled, from their office. Eventually, it was all too much for one of them, who came into the garden to make it stop.

‘That’s enough now girls,’ she said, shaking her head. ‘Back inside now.’ We got to our feet and looked down at the patch of earth we had saved.  The daffodils seemed healthier now – golden, rather than sallow.  There was hope for them. They had recovered. I smiled at Amelia, both of us feeling energised at having passed, momentarily, into the nurses’ weather system. And there it was: the first non-chemical high I had felt in a week.

We went back to the TV room, joined Doris on the couch, and listened passively to Oprah talk about wellbeing.

Something Happy

I got engaged last year. My partner proposed in Bournemouth, because he knows I am at my happiest when I’m by the seashore, looking out at the horizon, pondering the future with a vague, gut-born optimism, my hopeful thoughts only intermittently dispersed with worries about rain.

In the evening, he asked me to join him on the hotel room balcony. I looked out to sea, and idly watched the ferry shuttle cars between Swanage and the exclusive village of Sandbanks. When I turned back, he was squeezed awkwardly between the table and the patio door, on one knee, holding a H Samuel ring box and wearing a stiff grin.

I chose to write about this moment for two reasons: firstly, to my own surprise and disappointment, I have morphed into the stereotype of a newly engaged woman: giddy, keen to tell the world, without the slightest regard for the world’s net level of interest.

Also, because this story helps to illustrate the only positive side of depression that I’ve ever been able to identify: any moment of joy that a depression survivor experiences is never, ever taken for granted. Post-depression happiness will only ever be treated with the absolute reverence it deserves. And have no doubt about it – I wrung it dry.

I hurled myself into the joyful news-spreading. I savoured each reply. I sipped champagne and was grateful for the sensation of each tiny, bursting bubble. I forced myself to notice each detail – the flower in the centre of the table, the brisk wind, my bare, cold feet – and planted those details, with brute force, in my long-term memory.

That evening, I felt utterly determined to never sink again. I would be a veg-eating, yoga-doing, positivity-reinforcing, medication-taking because-I’m-worth-it-chanting goddess. This was a new chapter. A new me. Yes it was.

We stayed on the balcony for some time. In the fading light, my attention turned back to the ferry, which had been trundling away in the background all evening, indifferent to our delight. As my excitement settled, my thoughts began to mirror the ferry’s back-and-forth action. I thought about Sandbanks, and the millionaires who lived there. I wondered if we’d ever have a modicum of their wealth. I wondered if we were doing okay, financially. I wondered if we could even afford a wedding. My mind, in its infinite wisdom, handed me the words ‘bailiffs’ and ‘ruin’.

My fiancé frowned. ‘You have your thinky face on,’ he said. ‘Stop it.’

So I did.

Metaphors and meditation

If you’ve ever suffered with depression, chance are, you’ll have your own unique metaphor to describe it. It might be a black dog or a shadow or a giant. The monsters, trolls, beasts, and imps that have invaded and retreated from the minds of the melancholy could populate a seven-volume fantasy saga. (I would read it). This urge to personify mental suffering seems to stem from a natural human desire to make something terrifying and abstract knowable and concrete. In giving it human or animal characteristics, we give it weakness, and limitation, and manageability.

At the moment, I’m picturing my thought stream as an unruly horse that I’m desperate to control. Without any warning, it suddenly bolts from the stable, and rears up in a field of bad memories. It gets spooked, canters into a river of defeatism, and stands there braying uselessly.

I know the only way to control this unhinged beast is with mindfulness practice. I know I shouldn’t have given it up as soon as I started to feel better last time. I wonder what on earth I did with my meditation cushion, then remember it’s being used to hold a load of politics books upright in the living room. I grab it and let them fall like dominoes. I sit on it, close my eyes, lasso the wild horse, calm it with slow breath, and ease it, gently, back into the pen.

There’s no point trying to change the horse’s behaviour. It will pelt for the horizon, churning up the terrain of my mind as it does so, given the slightest chance. This old mare is born to be wild. But there’s another part of my mind, a quieter part, that feels young, pliable, able to grow stronger, and to take charge. This part is dogged, determined, disciplined. It’s this part (the inner stablehand, if we’re running with the metaphor theme) that I’m training when I practice mindfulness.

But it also takes doggedness, determination and dedication to take time out from the wild distracting plain of the world to return to the safe, confined pen of mindfulness, morning after morning, time after time, until the practice itself becomes as ritualistic as breathing. The challenge of making oneself meditate is the challenge of meditation itself, writ large: returning, returning, and returning again.

Perhaps self-love and affirmations and visualisations all those other pleasant-sounding things are not the most important tools in recovery this time, I think, as I settle down to practice. Perhaps self-discipline counts for more.

This time, I’ll commit.

Why talking about mental illness isn’t always the answer

I called the Samaritans for the first time, in the middle of the night, a few years ago. After three rings, a soft female voice, saturated with sympathy, said hello in an almost-whisper.

‘Hello,’ I said.

‘How can I help?’

Feeling awkward, embarrassed, but emboldened by my namelessness, I reeled off my woes. The woman was wonderful. She spoke to me without excessive formality, curtness, or judgement. She showed an interest in me, not just my grievances. I told her my name and where I grew up, which, it turned out, was very near her home, so we stopped that discussion quite abruptly, lest our enshrined anonymity be compromised.

She listened. She told me what she thought. She shared her own redacted experience. I was grateful. But when the ‘sharing’ part was over, I was struck with a sudden sense that the next part should begin. The ‘how do I make this better?’ part. The solution, the treatment, the path to wellness. The bit that is absolutely not the Samaritan’s job.

‘Perhaps your next step would be to go to your doctor to discuss treatment options,’ she said.

‘But I’ve already done this,’ I said. ‘he said there was nothing available for twelve months, and to call you.’ She took a deep breath in and said nothing.

As cathartic as the call was, it was clear that conversations of this nature were not a long-term solution. Offloading my woes was helpful – but only helpful once. Even knowing this, I called again a few weeks later, chasing the sense of blessed relief I felt after the first call, as one chases a hit from an illicit drug, sensing all the while that this was an abuse of the resource they were providing and hating myself a little for it.

When the volunteer asked the inevitable question, ‘Have you spoken to your doctor?’ the truth – that is neither universally nor locally acknowledged – hit home: the NHS in my area at least, is not really in the business of helping those with moderate depression get well. What I am expecting does not exist. I would have no choice but to piece together my own patchwork treatment plan with whatever was at hand. I thanked her and rang off, knowing I would not call again.

This experience has led me shrink a little from the campaigns that urge us to talk more about mental illness, as if words themselves were the antithesis of pain. ‘Talking about it,’ helps in the short term. It helps only if one can maintain the belief that the talking will ultimately lead to some upwards trajectory. Without this belief, therapeutic talking inevitably warps into mere complaining, which only leads to a spiral of negativity, and makes depression worse.

Mental and Physical Disorders: Why They Are Not The Same

After 12 years taking anti-depressants, I decided to approach doctor to ask about withdrawing. She sat back in her chair and put her finger tips together.


I took a deep breath. My motivation had something to do with an earnest, if naïve, desire to take the cushioning off the hard edges of the world. To be able to look at life with cold, unflinching, un-chemically-altered awareness and not sink under the weight of what I saw. But the waiting room was packed with patients, and I decided now wasn’t the time to air my existentialist meanderings. “I just want to see if I can cope,” I told her.

She raised an eyebrow. “Would you tell an epileptic to come off his medication to see if he could cope? Would you tell a diabetic to stop taking insulin? Diabetics don’t produce insulin. You don’t produce serotonin. What you have is no different from a physical illness. It’s that simple.”

I agreed to keep taking them and took my prescription, but our conversation troubled me all day. The idea that depression was in anyway “simple” jarred with my own experience of the condition and the glibness of the statement irritated me. If the past twelve years taught me anything, it’s that with depression, nothing is ever ‘that simple’. It is a complex and contradictory affliction and what is true for one sufferer is not always true for another. For me, the view that mental illness is the equivalent of physical illness will never be satisfactory, no matter how widespread it becomes, and the more I hear it the more I want to push back against the lazy assertion.

Yes, depression and epilepsy both have a biological basis. Yes, they are serious disorders and treatment of both warrants significant public investment. They are comparable in many ways, but there is a big difference between the two and it’s this: depressives, to differing degrees, have an element of choice that epileptics lack. You will never walk into the self-help section of Waterstone’s and find a row of books on ‘overcoming epilepsy’. You will find at least a dozen on freeing yourself from depression. Epileptics are not likely to be prescribed talking therapies which are entirely predicated on the theory that the sufferer has the innate ability to heal himself. Depressives are. Despite all of this, it has become taboo to explicitly state that there is an element of choice in depression, and it’s easy to see why.

On the one hand, choice is empowering. For as long as the depressed person has the power to affect his or her condition, there can be hope for recovery. Choice embodies the inspiring idea of self-determination, of man’s ability to write his own destiny. On the other hand, choice also encapsulates ideas of personal responsibility, self-blame, and guilt, and there are no prizes for guessing which perspective a depressed person prefers. “If I can choose to take steps to leave this horrible place,” one may reason, “I must have chosen to enter it to begin with, and therefore I’m as bad as I thought, and completely responsible.”

Feelings of guilt have long been recognised as core symptoms of the illness, and it is perhaps because of their prevalence that we have become squeamish about mentioning the word ‘choice’ to sufferers. To compare depression to epilepsy is to remove this awkward difference from the picture, and unburden the sufferer from feelings of self-blame. The problem with this is clear: If you whitewash choice, you take a stick from my hand that I could beat myself with, but in doing so, you also take away a tool that I could use to leverage myself to some semblance of wellness.

I did not choose to have depression, but I make thousands of decisions each day and each one has a magnifying or minimising effect on the condition. On a down day, I can choose to cry in a darkened room, or I can choose the harder option: to get up, take a bath and eat breakfast. If I choose the first option, it doesn’t mean I’m bad, or weak, or spineless, or addicted to misery, or wallowing. It doesn’t have to mean anything. But if you come into that room and tell me I’m no more responsible for being bed-ridden than an epileptic would be after having a seizure, you are doing me no favours. You are encouraging an illusion of utter helplessness which could extinguish any sparks of confidence in my ability to make myself well. If, on the other hand, I choose the harder option, this always means something. It means I’m treating my choice as a blessing rather than a curse, and choosing action over inaction is the physical embodiment of hope.


To be a teenager is to have a complicated relationship with control. Some want more of it, fast. Others wanted to lose it completely, and succeed in doing so. My troubles began when I realised I had no control to begin with, and had to fashion a synthetic version of it from whatever was at hand.

My wacky idea that I had any real control over my body was the first thing to go. I had become acquainted with my body’s rebellious streak in the past: when I lost my front teeth, had asthma attacks and succumbed to chickenpox. These moments of powerlessness had been briefly unsettling, but I never stopped believing that ultimately, I was in charge. Now, at age thirteen, my body had launched a full-on mutiny. I was shocked by its sudden subversive behaviour. We had once worked pretty well as a team, but now its lack of balance made gym teachers despair, its spottiness could not be contained with cream or disguised by concealer and its crooked teeth grew so wild that they were dotted with cement and clamped together with metal links, like a dangerous chain gang. My body was agitating for change. My mind was the old order, a reactionary power, digging its heels in in vain.

My world was growing less and less predictable too. It was once quite simple, consisting of little more than a house, a wood, and two grandparents’ dwellings acting as distant outposts. Now it contained an ugly, sprawling high school with a long history it mistook for prestige. Its pupils excelled in maths, science, and organising after-school fights on the driveway leading to Haydock Racecourse. Fights were not spontaneous bursts of aggression, but well organised events with participants, promoters, supporters and a reigning female and male champion of each year group. Bullying was condemned sleepily by teachers in assemblies, but unchallenged in classrooms, and I could neither predict it, nor quash it when I was the target, nor manage my sense of utter fragility in the face of it. Other people, it seemed, could be called a pizza face and not run to the office asking to be sent home. Other people, it seemed, were not total pansies.

At thirteen, I knew two things: one, I was powerless over the world and how I felt within it. Two, such powerlessness could not continue.

If there’s truth in the saying, ‘necessity is the mother of invention’, then in my case, control was the necessity, and Obsessive Compulsive Disorder was the invention. Soon after starting high school, I was no longer quite so concerned about my skin, or my clumsiness, or absent-mindedness, or lack of progress in chemistry. My life had a new, entirely manageable focus: avoiding the number three. If I could do that, I told myself, the rest would fall into place. I would be left alone. Things would go as I planned. I didn’t know exactly how my mind had settled on this particular rule. All I knew was that for me, the number three was heavy with angst, uncertainty and terror. It was like the dense matter at the beginning of the universe, buzzing with terrible potential. Avoiding the number three created a mental short-circuit to a craved sensation: relief from the anxiety of not knowing.

There was one slight problem with this particular rule. The number three is everywhere. In boyband line ups. In traffic lights. It was the number of people I shared a house with. Some of my favourite sentences: ‘I don’t know,’ ‘I don’t care,’ were made up of three little words. I was forced to extend these sentences in order to make them four words, ‘I do not know,’ ‘I do not care.’ Teachers mistook my new linguistic precision as petulance.

Maths lessons were a nightmare. My tutor despaired of my lack of ability to get to grips with cubed numbers. The rule book had to be adapted somehow, so if I had to come into contact with the number, I would touch wood as soon as possible to neutralise the harm done. The net of OCD was tightening around my life, but I didn’t care. My compulsion was a bug, in all three senses of the word: it was a flaw, an illness and a passion. The fact that I seemed to be getting the results I craved only made it stronger. Bullies had eased off, and found a new target in a girl called Tammy. This poor kid was avoided, derided and rejected daily –  the year group’s collective number three. I felt terrible for her, but didn’t intervene. I kept my head down and kept doing what was working.

Did I really believe obeying this rule would make things go my way? Yes and no. My new belief was a leap of faith, and the leap was powered by my survival instinct, not by rational thinking. Because if I didn’t believe it, I was exposed. If I didn’t believe it, I had no armour. So, just as I learned that a2+b2=c2, and that an apostrophe before an ‘S’ indicates possession, I learned that I had to jump over any paving flag in the quad that had shattered into three pieces, or the bullying would start up again. The irrationality of it was itself a kind of teenage rebellion against the plodding logic of my education.

Of course, the rational belief was always there in the sidelines, ready for me to re-access once the nonsense belief had fulfilled its usefulness. The trouble is, beliefs are tyrants. They get high on power. They get a life of their own and they don’t care if they should have retired long ago. As my time at high school drew to a close, and my body’s rebellion eased, OCD made its bid for absolute power. Tackling it was as difficult and dangerous and bloody as a revolution.



I like therapy. I like it for all the reasons you’re not supposed to like it. I like the free, never-ending tissues. I like the neutral walls and the conservatory style wicker chairs that are so soft and pliable that they are almost unsupportive. I even like the awkward bits: at the beginning, when you don’t know where to put your coat or whether there’s a specific chair that the therapist favours; and at the end when you pay them, and it all feels slightly seedy.

I like it when you hear the muffled monotone of the poor chap next door as he recounts his undoubtedly more worthy problems, and how the voice of this stranger makes you feel less alone. I like how rebellious it feels when you pick up the odd phrase through the wall: ‘My mother…’ or ‘When I was a lad…’ and how this unintentional snooping adds to the atmosphere of anonymous intimacy.

I like it when the cleaner barges in with her industrial, clattering hoover and says, ‘Ooh, I’m sorry,’ while the therapist smothers a look of blatant irritation with a smile.

I like therapists, especially when they do things they’re not supposed to do, like agreeing that your work nemesis is an arsehole, or talking about the dark periods of their own lives, whether that involves divorce or drink or binge-eating pop tarts. I like it when they are human.

I like therapy because you don’t know how you really feel until you enter a beige box with a smiling, benevolent stranger who asks you how you are, and in doing so, gives you permission to let that unfathomable, chained up sadness off its leash to run around until it tires itself out.

I like it because it’s human contact, and it’s hope, and it’s borrowed strength.

Therapists like their therapeutic techniques. They like their CBT and their MBCT and their self-compassion Ted talks. They like their cycles and their diagrams. They like making irregular garbed messes of minds into symmetrical flow charts and neat cycles. They are the kind of people who enjoyed simplifying equations in school. They are modern cartographers: they like to draw the landscape of your mind using the words you give them. By the end of session one your mind is less like a bothersome tip and more like a map of a middle earth –  with thin ice and quicksand and ditches and caves and mountains with summits labelled ‘happiness’, ‘stability’, ‘success’ and ‘love’. They like to populate these landscapes with characters: imps and Dreadful Iffies and angry parents and critical school masters. They seem to find your mind fascinating, and to love their jobs.

There are lots of different types of therapy on offer, and I seem to have gone through the lot. I’ve been to CBT and person centred and group. I’ve lay on a couch and sat on a hard-backed chair and mindfully walked across a hospital meeting room.

Perhaps I am ludicrously needy, or perhaps therapy doesn’t really help me at all. After all, if it did, why would I need to keep returning? The truth is, it almost always helps. It’s just that it doesn’t always heal. I’m fine with that, but therapists, usually, aren’t.

They like to be seen as teachers of depression management techniques, rather than shoulders to cry on. The ones I have met do not like it if clients suggest that it is the therapist’s patience or understanding or warmth that brought an improvement in their mood. They like the focus to stay on the diagrams on the whiteboard and the thought-challenging exercises. To credit the therapist rather than the therapy is to demean their professional pride: to imply that they are easers of pain rather than enablers of recovery.

These disparate views of the goals of therapy can lead to the relationship becoming dysfunctional. The therapist pushes their ‘teaching’ agenda, the client is swept along, feeling the need to agree that the skills they are learning are life changing in order to keep hold of the truly helpful thing: contact with an empathetic and knowledgeable other who knows exactly what not to say.

I recently attended a twelve-week group course for the self-management of depression, teaching Cognitive Behavioural therapy techniques. On session two, the teacher nipped out to get more photocopies of a handout. In her absence, a woman in the semi-circle admitted she had not done the homework, which was to list our negative thoughts and challenge them using logical alternatives. One by one, we all admitted to the same thing. Confessions of our non-engagement with the homework we were set became a running joke, and we whispered about it in mock disgrace before the sessions started and during the coffee break. We guarded each others’ secret from the therapist with loyalty, unblinkingly allowing others to lie about their efforts.

Despite our hatred of the exercises we were set, we all kept attending until the end. On the last session, we all told one another that our mood had improved since we started the course, and we said this with sincerity.  It would be difficult to credit CBT techniques as the cause of this improvement, given our minimal engagement with them. Amongst ourselves, we all attributed our improved moods to the support of the course leaders, and one another. In one woman’s words, ‘It’s reassured me that I’m not the only one who can’t do life.’

But it was not easy for me as a service user to make this point. Unfettered honesty was not encouraged through official feedback channels.

At the end of each session, the therapist would go round the circle and ask us, one by one, how we felt it had gone. We were told to answer honestly. Members of the group, who gave mixed reviews in private, only gave positive reviews to the therapist. We could hardly have been blamed for this. It’s unrealistic to expect a bunch of people, suffering from an illness which is characterised by a lack of confidence, self trust and assertiveness, to deliver inconvenient truths to a passionate authority figure to whom a debt of gratitude is owed.

New ways of giving feedback that encourage brutal honesty need to be developed. They should be anonymous, and the acceptability of criticising the service needs to be emphasised and even encouraged. Service Users should be trusted to know what, if anything, has caused their depression to fade, and should be asked about this. And the psychological community should have the guts to accept it, whatever we say. Maybe then it will start to be acknowledged that something as touchy feely and unscientific as human support can be the primary catalyst for recovery.