r we ok?

What surprises me every time I go through this is that I didn’t see it coming.

There were physical signs. Since Easter I’ve had a feeling in my ribs - a sinking in my sternum and dull pain in the centre that can’t be relieved, or stretched out. It feels like I’m walking around with a boot pressing on my chest. My joints have been hurting, my hips and back, my shoulders, my feet. I was waking up at night, and started catching every bug that came along.

There were other signs too: last week I sat down to write a list, and ten minutes later realised I had been sitting motionless at the table, trying to think clearly. I sat down to edit a perfectly good paper that I’d written for work, decided I hated it, tried to fix it, made it more confusing, and then undid all my edits. I’m struggling to dress because I hate everything I own. I wear a lot of black to work right now, not because it represents my mood but because it’s so much easier to only have to choose earrings.

Cleaning up is impossible. Every day I felt like I was being shot with an epi-pen at random intervals, feeling adrenaline rise through my chest, down my arms, spinning my brain. Sometimes there's a trigger, sometimes none. 

In the past, if I’ve let this go too far, I would start coming off my bike. It’s because I’m riding around trying to deal with the very shouty critical voice in my mind, cranked to eleven. Riding requires constant engagement with strangers, which is fodder for a hypercritical mind. This time I hadn’t been riding because I've been a bit unwell, and maybe that’s a good thing.

So last week I finally admitted that I’m not ok.

There are some commonalities in depression, but it’s also the case that everyone reacts differently. I don’t tend to go steadily down, I get more fragile and chaotic inside, and simultaneously more desperate to keep the façade in place and not let anyone notice there’s a problem. I go through the usual ups and downs of life but the floor of the downs gets lower. I’ll wake up feeling crushed, then a friend might drop round with a cake (yes, that does still happen), and I’m fine again. But afterwards the sinking happens and it’s been getting lower.

I can look for causes, and I can identify a few. The world is a scary place right now. My skin’s a bit thin, always has been, and that’s not always a bad thing. I’ve just pulled out of a period of being hit with more than my fair share of slings and arrows. And I’m on my own, keeping a roof overhead, bills paid, and food in tummies.

I don’t like to admit that I’m not ok, and that unwillingness intensifies as I slide. I am  blessed with good friendships with some wonderful people, and I have loving family members. And, perversely, that can mean that telling them is the least likely thing I will do. Because underpinning depression is a whole lot of things, and the associated collapse in self-esteem is grounded in fear. I have been learning a lot about fear lately, and the guises it comes in. Fear can be found in perceptible thoughts, but also lurks in paralysis, anger and confusion. And with that knowledge in mind, the layers can be named.

The outer fear is: my friends would be worried, and I don’t want to worry them.

And the fear under that is: it will be too hard for them.

And the fear under that is: they will not want to be around.

And the fear under that is: I will be alone.

And thus, in a self-fulfilling prophecy, when I start sinking, I feel ashamed of reaching out, and I make myself alone, and my deepest fear comes true.

We all have fears in like this. I have a friend who was chronically ill as a child, which caused her parents a lot of stress. As an adult, she struggles to admit it when she is sick. In trying to work out why, she realised part of her is still afraid of her illness making people angry. For me, it’s being emotionally in need that scares me. But there come times when those irrational fears get really loud, and the fight is exhausting. 

In many ways withdrawal is a sensible reaction: having a collapsing self-esteem puts a load on your friendships, and my internal fight to keep up appearances makes me intense to be around. It’s hard to like someone who you can see is struggling to believe that they are worthy of your care. It’s even harder to care for someone who rejects care because they don’t feel that they are worth it.

Perhaps it’s easier if, when we go through this, we’re transparent about it: I’m not ok, and I’m a bit hard to connect with, and it’s not your fault, and yes your friendship really matters. Friends who are steel and Teflon are the best – the ones who are resolutely there, but who can separate their care for you from the mood you're in. That process is easier if we all understand how this works a bit better.

*****

Last week, two local superheroes launched a book. It’s called “Mental” and it’s by writer and all-round top bird Catherine Deveny and the delightfully affable radio psychiatrist Steve Ellen.

Steve Ellen has been one of the doctors on the RRR radio show Radio Therapy since puss was a kitten (or at least since I was a law student). These doctors and allied health professionals are a delight to anyone with slightly hypochondriacal tendencies (I’m not saying anything) but have also been a way for me to see the practice of mental health as rewarding and unfolding and endlessly interesting for professionals. At a time when I struggled to tell anyone that I needed care and I was at times narrowly avoiding hospitalisation, these bubbly doctors and psychologists were talking about their compassion for their patients, allowing me to let all stigma fly out the window like a fart in a stuffy room and let in some fresh air.

Dev runs writing workshops where she joyfully kicks your arse into believing in your own voice. I first went to one three years ago when I had just broken up with the father of my kids. My memories of that day are of great food and great optimism, including Dev's cheerful views on my situation: “you won’t know yourself in twelve months”, “you have a magnificent arse”, and “there are men in the world who like fat-arsed mouthy brunettes, just find yourself one of those”. Whether she likes it or not, I’ve loved her ever since. Catherine is bossy and wicked and baldly working-class Melburnian. If any voice in my head is telling me to get my shit together it’s a voice like this, but previously I would have experienced this as critical. To have her so openly talk about depression and love and vulnerability over the past few years has been a godsend.

So this time, that voice started saying “you can get your shit together, and ask for help, and get on the meds, without needing to apologise to anyone.”

*****

There is a Buddhist parable (or koan) about “the second arrow”. In short, the parable says that if a person is shot with an arrow, there is no point shooting a second one. The teaching is that sometimes in life you will get hit with an arrow. But many of us then shoot one at ourselves in response.

Buddhist teacher Tara Brach uses this parable to explain the phenomenon of blame – the human tendency to react to painful events by blaming others, or blaming ourselves. I remember when I first heard this parable (not from Tara but another teacher, Gil Fronsdal), I was struck by the idea that we could separate feeling awful, burdened or weary from being angry with ourselves for feeling those things. Perhaps it would be easier if we could just feel them.

This is what often happens with depression: we feel like crap, and then feel ashamed of feeling like crap, partly because we see the impact of it on those who love us. Sometimes shame is useful, and there is room for looking for answers, but if you are already wounded, injuring yourself further doesn’t help. It makes it doubly hard to put the pieces back together.

The other word for this process of shooting arrows is, of course, stigma. Like so many words it’s become a bit threadbare with overuse, but I suppose it is what I’m getting at here.

The harm that comes from stigma, apart from the shame it brings, is that it is a massive drag on getting help. Stigma can come from external sources - people around you might blame you for your illness, sometimes through a misguided sense of care. But worse is internal stigma, when the person who is depressed blames themselves and refuses assistance.

A lot was done in the 1990s and 2000s about destigmatising depression. New, much safer antidepressant medications (SSRIs and SNRIs) were available, heavily marketed and quite effective. Depression was as unshameful as a broken leg, we were told, a “chemical imbalance”, an illness of the mind that could be quite simply cured with medication. Jeff Kennett, former ad exec who became the Victorian Premier, started Beyond Blue, an organisation designed to promote health assistance for those who were depressed and anxious. My workplace started a peer support network. It was ok to talk about depression.

From 1997 to 2008, suicide rates in Australia dropped substantially, mostly for men, and mostly in the younger age brackets, and largely stabilised over the following decade (with a slight climb). Gen X is doing a bit better than the baby boomers, and Millennials are doing better than their older cousins. There are no doubt many factors – including gun control laws - but I wonder if it is partly because we are growing up more literate in mental health, less ashamed of seeking assistance, and more able to get it.

At the same time, cracks began to show in the purely medical model of depression. Revolutions in trauma research over the past twenty years have shown clear correlations between mood and personality disorders and childhood adversity, and long-term improvements come with talking in a safe environment. Research into SSRIs shows that there are limits to their value – they are relatively crude and work best in tandem with a good relationship with a well-qualified talking therapist who has a range of tools available to rehabilitate a suffering mind.

This is one thing I really like about Dev and Dr Doolittle’s book. They talk about the range of tools available, and they talk about their own quite different experiences of feeling like this, and different responses. There is no black and white. For me, just reading that two people who seem so effortlessly confident have had times when they have felt the world turn grey and heavy reminded me that I do not have to feel ashamed.

So on Wednesday, I walked into the doctor’s rooms and said “I reckon I need medication”. 

Her face said “I thought you’d never ask”.

And while I still walked in there wishing I didn’t have to even ask for help in the first place, I was not so ashamed. I can more easily separate the arrows these days. 

I don’t have to “battle” mental illness: I experience it, in episodes. There are many ingredients that have gone into my experiences of depression, many well out of my  control. My biggest battle is my own mind’s unwillingness to acknowledge it. If that battle could stop, it would be helpful.

Sometimes depression is a rational response to a scary and challenging environment, inside and/or out. To be honest, sometimes it brings me considerable insights. It’s not the enemy. It just is what it is. Some of us live with this, it's not easy, and it's a good idea to have help on hand.

*****

Writing this, I’m of course thinking all the usual things that I do when I’m down: that this is oversharing and loading everyone with something I should deal with, that I should get over myself. To some extent, it is a bit narcissistic to make a piece of writing about your own experience. So I ask myself: why write all this?

And when I ask, the answer comes quickly: because there are others who I care about a whole lot who I know suffer too, and probably many more who I do not know about.

So I’m writing this, because I know (and it breaks my heart) that I have friends who are going through this. I have some who go through it regularly and are used to the ride, I have friends who are recovering and shocked by where they dropped to, some who are lost and refusing help. Of course I wouldn’t name anyone, but if you see yourself here, I am telling you that it’s ok. You’re all really beautiful people, and I know you can’t hold onto that thought easily, just like I can’t. So let’s keep holding it for each other, passing it around.

*****

Tonight, I talked to my daughters briefly about medications over dinner. I said that I know I’ve been a bit teary lately, and I’ve been really tired, and I realised that, while talking to someone is helping me a lot, I’m a bit stuck and I need some help to enjoy things again, and I’ve started taking medication.

My big kid looked at me and pointed her fork. “So no more teary fits?”

“Not since I started, no”

Her face softened. “Oh thank God.”

My little kid looked at me and shrugged. “Yeah, I could have told you that.”

She finished her plate.

“Now can we please read Harry Potter?”