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.

‘Sorry?’

‘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.

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.

“Why?”

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.

Dissociative Disorder

To discover the name of an affliction is to be slightly reassured. If a problem can be bound and encased in words, it is not bigger than words. If it can be described, it is, by extension, not beyond our understanding, and can in theory be managed.

In 2000, I typed my new and unnerving symptoms into the new and unnerving internet. ‘Sense of distance’, I wrote. ‘Things aren’t real’. ‘Senses dulled’. The web, which, from its early days, excelled in diagnosis, gave me the title I was looking for: Dissociative Disorder.

If discovering the name of a problem can be comforting, capturing the essence of it in a decent metaphor can bring further solace, a further sense of mastery. For this reason, I’ve tried, over the years, to capture the essence of the disorder in less clinical language.

I have thought of it as a mist, a burqa worn on the inside, a veil covering all the senses. It is doubt made palpable. When I explain the disorder to a non-sufferer using one of these descriptions, they seem to garner a loose impression of what I mean. They hold a fragile, vague, incomplete understanding, patched up with guess work.  This description can also be used to explain how the sufferer experiences the entire world.

One morning, I woke up, and my surroundings had taken two steps back. I had had dreams more vivid and convincing than this. I got dressed and went into the living room. Intellectually, I knew that my sister was in the arm chair, nibbling a piece of toast with jam and watching The New Adventures of Superman, but I felt as if she was galaxies away. I knew I was as ‘present’ as I had ever been, but it was as if my skin and eyes and taste buds were no longer tools for experiencing the world but thick, downy duvets that I had retreated behind.

I must just be tired, I thought. I drank Red Bull on my way into school the next day, and got an early night. The following morning, I felt the same. In school, I stared at the graffiti on my desk. I tensed every muscle in my skull and tried to shatter the screen with force. It bent but did not break. I felt frightened, but at the same time, anesthetised. The emotions that were so intense a few weeks ago were now blunted.

This anesthetised feeling is the entire raison d’etre of the disorder. It does not begin life as a problem, but as a solution to the problem of overwhelming emotion. Faced with the tidal wave of unpleasant feelings that were part and parcel of adolescence, my mind built a sea wall. It rejected the sources of these emotions, but it lacked the precision to single them out, and so issued a blanket ban on everything.

Vladimir Nabokov wrote: ‘Unless a film of flesh envelopes us, we die. Man exists only in so far as he is separated from his surroundings… Stay inside or you perish. Death is divestment. Death is communion.’ Dissociative disorder is a mind’s an admission that the film of flesh is insufficient. It is another layer of separation to prevent the peril of communion.

The significance of the change hit me one weekend. My family and I went on an outing to Rivington Pike. This is a Lancashire landmark, and we loved to fill empty Sundays by climbing it. Hundreds of other local people did the same. As a kid, I decided that it was distinctly less boring than most other hills. Half way up, there was a hidden Japanese-style garden with fountains and a pond. The garden and the rugged woodland which surrounded it created a pleasing contrast between wildness and gentility. At the hill’s base, motorcycle gangs in leather sipped Earl Grey inside a tea shop, echoing this contrast.

My family and I would reach the top and sit on the side of the hill just below the summit to dodge the wind, which was usually strong enough to lift a greyhound off its paws.  We would eat our sandwiches stoically, silently, in formation, pointing out landmarks across the county: The Reebok stadium, Blackpool tower, the sprawling, curling housing estates of Bolton. That particular Sunday, I came to a disturbing realisation: my mind hadn’t just shrunk away from the boring bits, but the beautiful bits, the awe-inspiring bits: the height, depth and breadth of the entire world. This familiar, beloved view was now as moving and engaging as a sound stage.

When the panic receded, I realised it wasn’t quite as bad as all that. It was not the disorder itself that caused the most distress, but my belief in is power. That day on Rivington Pike I believed I had lost my chance to experience any of life’s riches. I had not. I have had the disorder for half my lifetime, and it has not prevented me from making lifelong friends, from falling in love, from learning or growing. It is not bullet proof glass, as I first feared, but a ‘semi permeable membrane’. Love can get through. Joy can get through.

A few months ago, my friend Laura called me from London. After swapping news, she sheepishly asked me, ‘Do you ever feel like the world is a million miles away? Like… you’re not really here?’

She was expecting blank incomprehension followed by a weak attempt to empathise. What she got was an abridged version of this post.

That day on Rivington Pike, I would never have believed the disorder could bring me closer to anyone or anything. But fifteen years later, a friend had found herself lost within the mist and I was able to reassure her that there was nothing, really, to fear. It was a peculiar paradox: we were three hundred miles from one another, and had been brought closer by our shared sense of isolation. It was comforting to learn that friendship, and the desire to connect, can outsmart anything the mind can produce to prevent connection.

The fog of Dissociative Disorder may disappear one day, it may not. Even if it never shifts, it will not have had the final word. The mist can be isolating. It can be terrifying. But I merely had to look around to see that I wasn’t alone within it.