The Great Below

living the feeling life


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Depression

What is depression? A recent BBC programme with Alastair Campbell, a longtime sufferer, delved into possible reasons and new treatments for this very human condition, though it was rather inconclusive. What the programme showed very well, however, was what it was like when the ‘black dog’ suddenly hit – seemingly irrespective of what was outwardly happening in Campbell’s life.  There was a window in the stairwell at his home looking out over the garden, by which he gauged his state of mind – on bad days, he felt unable to raise the blind and face the world, let alone shave and exercise.

If you have never experienced depression – and many people don’t – it must be hard to imagine what it feels like. Even when you have been depressed and are now feeling better, the two states seem to have almost nothing in common; it’s a bit like trying to recall the pain of childbirth – you know that it really hurt but you can no longer quite imagine it. Campbell described his depression as being ‘unplugged from life’: unable to experience joy, love, or comfort even at the heart of his loving family. It’s clear that depression can affect anyone, no matter how much they seem to have in their lives from the outside.

I chose the above image – and all such illustrations have an inevitable whiff of cliche about them – because when I am depressed the principle feeling is of extreme existential loneliness. I continue to function, and might even seem outwardly to be having a busy and social time; I understand objectively that I am loved and have many good things my life, but it’s as though I can’t feel or touch them. It often seems that I have discovered, or remembered, the bitter truth of life – that there is no point to anything and we are all ultimately on our own. One way I have found to endure is to be extra kind to myself and try to remind myself that ‘this too will pass.’ And, usually within a few weeks, it does.

I’m lucky. I’ve know many people who suffer far more extreme depression than me – my mother for a start, who struggled with severe suicidal bouts throughout her life. Other friends have had varying encounters with depression – bi-polar swings, reactive depression brought on through grief and trauma, drug and alcohol addiction in an effort to cope, or having to live with persisent dysthymia or ‘low mood’. Some have chosen to take their lives when, like Virginia Woolf, they simply could not face going into the darkness again.

For me, these relatively short periods of depression come and go in my life with no obvious pattern – although having just come through such a spell, I recall that I have often experienced springtime depression in the past. It feels so ironic, when nature is bursting into life and people are taking advantage of the warmer weather to enjoy themselves, that I can go into a kind of mental and physical shut-down. The wind goes out of my sails, I can’t find motivation to do anything except lie on the sofa, or see any point to life apart from just getting through it. There’s a grim sense of injustice, too, and incomprehension, that other people are able to feel so differently to me – from where do they get their energy, their joy in life, their goddam happiness? Why can’t I find some of that in myself?

Where depression is concerned, although there are certain common manifestations,  there are probably as many causes as there are people. This article explains that it is most likely a combination of genetic susceptibility,  brain chemistry, life experiences and who knows what other factors such as insufficient gut bacteria or systemic inflammation – the latest suspects in the search for an answer. Different things work – or don’t work – for different people. I have never chosen to take anti-depressants, on the basis that by the time they start to be effective – often a few weeks or months – I will probably have started to feel better anyway. Perhaps taking them could protect me from the tendency to periodically ‘crash’, but I’m not sure the side effects are worth it. My mother had electric shock therapy, a popular treatment in the 1960s which is still in use today, and although it temporarily helped her mood, it left her with post-traumatic stress. There’s no perfect answer.

Fortunately we are much better now at talking openly about mental health and emotions, and there’s no longer so much shame in ‘not coping’, or seeking help. The mere fact of telling someone (or in the case of television, everyone!) how bad you feel can be an enormous relief, and for me is often the beginning of turning things around.

 


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Post-natal

This week I watched a TV programme where Louis Theroux spoke to women in a mother- and-baby psychiatric unit about their varying experiences of post-natal psychosis and depression. These women were on the most severe end of the spectrum, hence their being admitted to full-time care, often under section. I found the programme upsetting to watch because it chimed with what I know of my mother’s experience, although at the time her condition was largely unrecognised and almost never treated.

Though even less understood, there are as many women who suffer from depression during pregnancy as post-natally, and frequently both. My mother was first officially diagnosed with clinical depression in 1958, when she was pregnant with me. She was in her early thirties and had been married to my father for six years, during which time she had been trying not to get pregnant, always insisting that she did not want to be a mother. But my father’s persistence, along with the vagaries of the ‘rhythm method’ contraception they used, meant that she had already conceived once, losing the baby at three months. I don’t know how she felt about that miscarriage – perhaps because of her ambivalence it was a a relief, though she was very angry with my father for abandoning her in hospital to go off on a business trip the next day.

My mother always blamed the hormonal changes of pregnancy for triggering severe depression, as she experienced it every time she became pregnant, but I doubt it was purely a physical or chemical process. Being effectively co-erced into motherhood against her will, with the underlying social expectation that being a mother was the most, if not only, fulfilling life choice for a woman, must have been a grim experience. Of course if she’d had her way I would not have been born, which I can’t wish for, but it’s clear that our whole relationship and the course of my life has been marked by the fallout from this unhappy time.

What is it like to be a baby in the womb of a depressed mother? There is some evidence* that such babies are more likely to experience depression themselves in later life, though it’s not clear whether this is genetic, environmental, or due to changes in foetal development from the mother’s depression. I also got very depressed for a time during pregnancy, even though I had spent five years being treated for infertility, so my son’s conception (through IVF) was much longed-for.  Perhaps my brain chemistry was triggered in a similar way to my mother’s, or perhaps external events – my relationship with my husband was very difficult and distant at this stage, which meant I felt very alone – contributed to feeling low when I might have been expecting to feel very happy.

Things didn’t get any better for my mother after I was born: the birth was very traumatic as I came out three weeks’ late, very large and she had to be cut in order for me to be born. The gas and air she was given for pain relief made her hallucinate and this, combined with her own anxiety and terror, convinced her that there was something seriously wrong with me and she refused to see me for the first twenty-four hours. Even when my father persuaded her that all was well and I was a healthy and beautiful baby, she still believed that I was somehow damaged. She later described it – to me – as ‘the worst day of my life’.

When I watched some women in the programme say that they were able to feel nothing for their babies, even though they seemed to be caring for them perfectly adequately, I understood that I had probably been on the receiving end of this maternal indifference. How terrible must it feel not to love your own baby? Luckily for me I bonded instantly with my son and loved him to distraction. As a small baby I at least had my father and grandmother, who we lived with, both doting on me, and I look perfectly cheerful in all the photographs. My mother was obsessive about my physical care, especially cleanliness – apparently she bathed me and washed my long hair every day. However I never felt that I had bonded properly with her until towards the very end of her life, when she became like a child herself. It’s not her fault, or mine, but there’s a loneliness inside me, a sense of never having been properly received on earth, that I have never managed to assuage.

*https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710585/

 

 


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Heredity

Does mental illness run in families? In the past, people were prevented from marrying – and thus procreating – if they were considered to come from a ‘tainted’ line. In the 20th century, theories of the heritability of mental illness fed the development of eugenics and the horrors of Nazi ‘experimentation’. Latterly, scientists have found that there is indeed a genetic element in the predisposition to certain mental illnesses, albeit influenced equally by the social and emotional conditions of a person’s life.

On my mother’s side several generations have suffered from psychiatric illnesses. My great-grandmother was diagnosed with ‘religious melancholia’ and was in and out of hospital, until ultimately dying in an asylum at the age of 61. She would prostrate herself in prayer for days at a time, refusing to eat until she began to hallucinate and hear voices. In past eras she might have been considered a visionary, or joined a strict religious order: think of the ‘anchorites’ of the Middle Ages, a majority of whom were women, who were literally walled up in small cells for a lifetime of prayer. But my great-grandmother had three children, a husband – she could only withdraw through madness.

Her condition might today be called ‘scrupulosity’, a form of obsessive compulsive disorder characterised by pathological guilt and the fear of divine judgement for perceived sins. But the word ‘melancholia’ also suggests depression and the hallucinations and voices something more. Recent research has found a significant genetic link between depression, bipolar disorder and schizophrenia*. My mother suffered from severe lifelong depression, and a young male cousin of hers hanged himself at sixteen in what was at the time passed off as an ‘accident’, suicide being illegal at the time, as well as a source of shame and opprobrium. Alzheimers disease, which also has strong links to depression, has affected three generations of my mother’s family, including her mother and her sister.

In my generation, one of my cousins has schizophrenia. She is the youngest daughter of the youngest daughter of the youngest daughter of my great-grandmother, who was herself a youngest daughter – it’s as though the illness has trickled down the female line to land in her lap, which sounds rather like a bad fairy-tale. Our understanding and labelling of mental illnesses keeps changing, as well as the degree of openness with which they are discussed, so I may well have other family members whose conditions remained secret or who I simply do not know about.

The recent science of epigenetics has begun exploring how what we experience can alter how our genes work, leading to changes in the brain and how we manage stress hormones. It’s not yet conclusive whether or how that alteration is actually passed on to future generations through the DNA. What seems certain, however, is that trauma can be and often is passed on through the generations by psychological means, especially trauma that is unresolved or unacknowledged. How a parent responds to their child, how they respond to events, how they teach their child to respond – either deliberately or by unconscious example – all shape that child’s psychological development and how, in turn, they will parent their own offspring. Even trying to parent differently, as most of us attempt in one way or another, does not always alter the underlying pattern – as a friend once commented: ‘180 degrees from wrong is not necessarily right.’

You could argue that there is barely a family without trauma in its background: poverty, displacement, early death, loss of children, sexual or physical abuse – these are the stuff of human history and you don’t have to look very far to find them. Above all, in the past century, there is war, on a scale and of a magnitude unprecedented in history, and wars encompass all of the other kinds of trauma imaginable, and add plenty of their own. We are all children of war, in one way or another, whether or not our families were directly involved, and it is the cumulative effects of this trauma in my family and society that is the main subject of my book.

 

*https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2962129-1/fulltext