Loe raamatut: «Breaking the Bonds»

Preface How to Use This Book

‘I would rather have a physical illness – any physical illness – rather than be depressed. Depression is the worst experience a person can have.’

Anyone who knows what it is to be depressed would agree. It is not just that being depressed means feeling despairing, frightened, guilty, bitter, helpless, tired and ill. It is the most terrible sense of being trapped and alone in some horror-filled prison.

When we have a physical illness or have been injured, we can feel immersed in the pain and discomfort, but, equally, we can separate ourselves from that pain and discomfort. We can talk to other people, share a joke, take an interest in what they are doing, watch television, read a book, plan our future, and when someone shows us love, comfort and support we can feel warmed, cheered and supported, and give back in return our love and gratitude.

When we are depressed we can do none of these things. We are surrounded totally by the prison of depression. We cannot escape, even momentarily. Occasionally we can act normally. We can answer a telephone, or chat briefly to friends. We might feel slightly better in the evening or when we are at work, but all the time we know that the prison has not gone away, just eased its grip on us a little. Even when a course of antidepressant drugs (psychiatric, medical and psychological terms are explained in the section Technical Terms) or a series of ECT (electroconvulsive therapy) has made us feel more able to face life, we know that the prison is still hovering there in the background, waiting. One false word or action, one crisis, and its jaws will snap around us again, and we shall be trapped and helpless.

Inside the prison we are cut off from every other person. We know that we are physically with other people, but what we actually experience is a barrier between them and us. They offer us love, comfort and support, but nothing crosses the barrier to warm, cheer and support us.

Nor do we think it should. We know that we are wicked and do not deserve what people offer us. What we do deserve is this terrible, hateful prison.

Inside that prison our thoughts are not the thoughts that usually accompany pain (usually ‘Ow!’ and ‘Help!’) and discomfort (usually ‘Yuk!’, ‘Groan!’ and ‘Help!’). Our thoughts are concerned with universal moral issues expressed in a personal way, variations of, ‘I ought to have been a better person’: ‘I ought to have done more for other people’, ‘If I had been a better person I would not have been abandoned and betrayed’, ‘I must be wicked, otherwise these disasters would not have happened to me’, ‘I have obligations which I cannot meet’, I have made unforgivable mistakes’, ‘I cannot forgive myself for what I have done’, ‘No one, not even God, could forgive me for what I have done’. With these feelings come the helpless, hopeless feelings of dread.

Inside the prison of depression we cannot escape from the turmoil of these moral issues, for everyone we meet, every newspaper story and television scene, reminds us of our unmet obligations, our unfulfilled duties, our inadequacy and sense of intrinsic evil. We cannot endure this isolation, but we fear other people, and feel that, we must shut ourselves away. We long for death, but fear the aloneness of death and the punishments which could lie beyond it.

Alone though we may feel in the prison of depression, we are not alone in enduring such an experience. Across the planet, many millions of people are trapped in the prison of depression.

If you are reading this book then it is likely to be for one or more of the following reasons:

You are depressed

or

Someone you care about is depressed

or

In your work you have to deal with people who are depressed.

In order to find out about depression you have, perhaps, read articles on depression in newspapers and magazines. You might have read about depression in psychiatric textbooks or in books written for the public by psychiatrists and psychologists. You might have consulted your doctor, or a psychiatrist, or some other professional person. You might have consulted your minister, or perhaps a spiritualist or a faith healer, or tried one of the alternative therapies like homoeopathy or acupuncture. You might have talked to a therapist or counsellor.

You might have been told a great many things about depression, but out of all these sources one message has been given to you loud and clear. ‘Depression is a genetic illness. It cannot be cured, but it can be controlled by drugs.’

This message seems simple, but in fact it leaves you even more confused and frightened.

Somehow, this explanation doesn’t seem right. You can see how bodily diseases like haemophilia and cystic fibrosis could be passed on by a gene, but how could depression – this confusion of feelings, beliefs, passions, fears, wishes, actions and non-actions-be caused by a gene? You have seen how people who have inherited some disease can, provided they care enough about themselves, have friends and family to support them, and get good medical advice, rise above their disease and get on with their lives, whereas it is not possible for you to separate yourself from your depression. It seems to inhabit your very person.

Moreover, depression might seem to be inside a person, but you know that it is also between people. If you are depressed, you know that it has something to do with the people in your life. If someone you love is depressed, you know that that person’s depression has something to do with other people, and you worry about what you might do – or refrain from doing – which would change how your loved one feels. If you are trying to understand why your clients or your colleagues are depressed, you get to know them, and you see the difficulties, losses and disappointments with which they are struggling. You know that depression does not occur, in the way that haemophilia or cystic fibrosis can, to an ordinary person leading a secure and happy life. When you look at all the depressed people you know, you can see that they have, over their lifetime, suffered many difficulties, losses and disappointments, that what success they have achieved has not always brought them happiness, and that when they achieve success and happiness, they cannot enjoy them, for they believe that they do not deserve such happiness and success, that happiness and success will soon be snatched from them, and that pain must follow joy as night the day.

How could a gene create all this?

Moreover, being told that all you are experiencing is nothing but the effect of a gene dismisses all you have experienced and know as being trivial and unimportant. It doesn’t just dismiss your experience and knowledge, it dismisses you. It says that you are nothing but a defective body, carrying a defective gene, passed on to you by an equally defective ancestor, and that you are likely to pass this gene on to your children. You cannot be cleansed of this gene, but must strive to keep it in check by a daily ingestion of drugs which affect the operation of your brain.

If you are depressed, such a diagnosis does nothing to help you, for it simply makes you feel even more intrinsically bad, useless and worthless. Such a diagnosis does nothing to help the relatives of a depressed person, or indeed, any one of us, for we can all worry that at any time we shall produce the depression handed on to us by some ancestor, or that we have already, unwittingly, passed this dread disease on to our children.

However, some of you in your search to learn about depression may have read something which many psychiatrists and psychologists fail to read, namely, the actual research reports by scientists working on the problem of the biological basis of depression. Perhaps you do read the monthly issues of the American Journal of Psychiatry and the British Journal of Psychiatry, or the heavy tomes of the American Psychiatric Review.

If you do, you will know that the sentence ‘Depression is a genetic illness’ is a statement of a wish, not a fact. A hundred years ago the German doctor Kraepelin attributed the behaviour of some of his patients to the illness ‘manic-depression’, and since then psychiatrists have been searching for the cause of this illness. They talk of the ‘gene for depression’ and the ‘gene for mania’, and some of them even say that such genes have been found. They talk, too, of ‘chemical imbalance’, and of physical tests for depression, and some say that the precise chemistry of the imbalance and the tests is known. However, what is described as fact is actually speculation. An enormous amount of research needs to be done before any genetic factor can be shown for certain to play a part in depression, and, from the results of the research, it seems that, if there is a genetic factor, it is one which requires the presence of many other factors – physical, psychological and social – for it to be activated.¹

One of the great difficulties of this research is that, even after a hundred years, psychiatrists still cannot agree on how many kinds of ‘depressive illnesses’ there are.² You will probably have come across terms like ‘clinical depression’, ‘endogenous depression’, ‘reactive depression’, ‘neurotic depression’, ‘bipolar and unipolar depression’, ‘major depressive episode’, and so on. If so, you are certain to be confused, particularly when you discover that different psychiatrists give different diagnoses. One might tell you that you are ‘clinically depressed’, another that you have ‘endogenous depression’, yet another that you have a ‘schizo-affective disorder’. What you are not told is that all these words are just labels used in an attempt to put the people who get depressed into different categories. However, it does seem that, while there are certain things that depressed people do have in common, each of us gets depressed in our own individual way.

If you have read the research literature, you will be saddened and worried to find that what researchers call ‘outcome studies’ show that depressed people treated only with drugs and electroconvulsive therapy do not do well. Most find that the depression recurs. Many remain depressed, but cease to seek any kind of professional help. Many die, not just by their own hand, but through illnesses. Being depressed is physically debilitating.³

This is very troubling, because while psychiatrists talk complacently of ‘managing depression’ by using long-term medication in the way that doctors ‘manage diabetes’ using long-term insulin injections, we know that a person with chronic diabetes can lead an ordinary life, but a person with chronic depression cannot. To be told that you have inherited depression in the way that another person has inherited diabetes is of no help at all. It just makes you more despairing and confused.

If you are a woman and are depressed, no doubt you have been told that it has been caused not just by a chemical imbalance but that this imbalance relates to the functioning of the feminine hormones. This is puzzling, because you can see how the malfunctioning of a hormone could lead you to think, ‘I feel sick’, but how can a hormone, however it functions, cause you to think, ‘I am a bad mother’? Nevertheless, many women discover that from puberty to after the menopause their own real, lived experience is dismissed with the words, ‘It’s your hormones, my dear’.

However, there is a genetic factor in depression. In that double helix of DNA there is a special strand which separates us from all other animals and marks us out as human beings. That special strand of genes not only determines our human shape, it gives us language, and with that the ability to conceive of the past and the future. Using these abilities we can look to the future with hope and courage, or fear and despair; we can remember the past in happiness or mourning, in gratitude or envy, in thankfulness or resentment. Using these abilities we conceive not just of ‘is’ but of ‘ought’, and create for ourselves two worlds of meaning – the world as it is and the world as it ought to be. Now we can trap ourselves in a tangle of ises and oughts. Now we can say to ourselves, ‘I do not accept myself as I am. I ought to be a better person’, and so lay the cornerstone of the prison of depression.

You might, in your search for an understanding of depression, have tried to make sense of it in terms of ises and oughts by reading books by cognitive or behavioural therapists. In many ways these books can be extremely helpful, for they can make you aware of how easy it is to think in extremes (like, ‘Nobody cares about me’, instead of, ‘Some people don’t care about me, but some do’), and they suggest some practical ways of re-organizing your life. But, when they tell you you are thinking and acting ‘irrationally’ or ‘dysfunctionally’, you can hear this as yet another put-down and feel that ever so familiar stab to the heart.⁴

Even if you can put this aside, you soon discover that these cognitive and behavioural therapists slide over, or ignore, the implacable truths and dilemmas of our lives. For instance, one such author chides his client for being so illogical as to say, ‘I’ll never find another friend like that again’, and asks her to estimate just how many people she could meet and how many of these could become friends. He ignores the fact that we do have relationships which are irreplaceable, like those with a parent who gave us unconditional love, or with someone with whom we shared the greatest joys and tragedies of our lives, and when such relationships end we can do nothing but mourn their loss. When we do suffer such losses what we need are not people who tell us to ‘look on the bright side’, but people who can acknowledge and share our pain.

Cognitive and behavioural therapists ignore, too, the major questions which face us all: ‘Why am I here?’, ‘What is the purpose of life?’, ‘What happens when I die?’ They assume that all of us are concerned solely with making the most of our lives, when in fact many of us are chiefly concerned with the question, ‘How can I be a good person?’

In your search for an understanding of depression, and in your concern about the great questions of life, you might have read some of the books on depression which give a religious or spiritual answer to the problem. Some of these books might just heighten your sense of badness and inadequacy, but others do offer consolation. However, most of them advise you to put your trust in God or some spiritual power, and this is precisely what a depressed person cannot do. When we have been repeatedly and deeply hurt by the people we trusted, we learn to be very careful about where we place our trust, and if we cannot trust the people whom we can see and know, how can we trust an unknown, unknowable God? Moreover, if you believe in God, then when you become depressed you find that God, like everyone else, seems far away, and, worse, the more you hate yourself, the more you feel that God will never forgive you.

Whenever we come across an author, or a therapist or counsellor, or a preacher who says to us, ‘Believe as I do and all will be well’, it is very tempting to say, ‘Right, I’ll do that’. However, we cannot change our beliefs about the purpose of life and the nature of death in the way we can our beliefs about the best breakfast cereal. Our beliefs about the purpose of life and the nature of death relate to our own inner truth, and even though we may hide or deny our own inner truth, it never disappears, and it speaks to us clearly. You will know this if ever you have been in analysis and your psychoanalyst has given an interpretation which your inner truth knows is wrong. The respectful, fee-paying part of you can be saying, ‘Yes, I see what you mean’, while your inner truth is saying, ‘No’.

This is where therapists can be dangerous. They can use their position, power and mystique to persuade us that what we know as truth is mere fantasy and that because we are anxious and depressed and having difficulty in coping with our lives we are intrinsically inadequate. If you have read any of the psychoanalytic texts on depression you will have discovered how little respect psychoanalysts have for a person’s own experience and how belittling to the client the psychoanalytic jargon is.

So, whatever you have done to try to discover what depression is and how you might bring it to an end, all that has happened is that you have become more and more confused, and when we are confused we feel powerless and helpless.

The aim of this book is to help you sort out your confusion and regain that which is rightly yours, the power to understand yourself and the society in which you live, so that you can make the best decisions about how you should live your life. With such power we can not only understand the causes and the purposes of depression but, more importantly, free ourselves from its prison and live life joyously, hopefully and freely.

To do this, we begin by understanding our own real, lived experience.

It is our own real, lived experience which leads us into the prison of depression. It is not a gene, or our hormones, or our dysfunctional and illogical thinking, our lack of faith, or our complexes and inadequacies which have brought depression upon us, it is what has happened to us and, most importantly, what we have made of what has happened to us; it is the conclusions we drew from our experience.

That set of conclusions which leads us, finally, into the prison of depression was not drawn illogically, or fantastically, or crazily, but were the correct conclusions to draw, given the information we had at the time.

If, when you were a child, all the adults whom you loved and trusted were telling you that you were bad and that if you didn’t mend your ways terrible things would happen to you, you wisely and correctly drew the conclusion that you were bad and had to work hard to be good. If, when you were a child, all the people you loved and trusted left you or disappointed or betrayed you, you wisely and correctly drew the conclusion that you must be wary of other people and that you should never love anyone completely ever again. You were not to know that if we grow up believing that we are intrinsically bad, and that other people are dangerous, we shall become increasingly isolated, the joy will disappear from our life, and that we shall fall into despair. Even if you did know that, you had to protect yourself. We all have to protect ourselves when we are in danger. The business of life is to live, and this is what we all try to do.

The reason we get into a tangle, be it by becoming depressed, or finding it hard to get on with other people, or any of the multitude of unhappy situations we can get into, is because we fail to go back and check whether the conclusions we drew as children still apply in our lives. We all fail to do this, simply because there is not enough time to be forever checking our conclusions. When we were children we drew the conclusion that we should not put our hand in a fire because fire burns. When we grow up we don’t every day say to ourselves, ‘I’ll just check whether it’s still not safe to touch a fire’. We simply go on acting as if fire will still burn us.

Similarly, many of us when we were children drew the wise and correct conclusion that we should not say what we think because the adults around us will punish us if we do. When we grow up we can fail to check this conclusion, and thus go on acting as if other people will punish us if we dare to say what we think. Never daring to say what you think leads inevitably to missing out on many things which would give you pleasure and confidence, and prevents you from discovering how joyous it is to share your thoughts and feelings with another person. As a child, your conclusion to keep your thoughts to yourself was a wise conclusion. As an adult, all you need to do is to check whether this conclusion still applies, or whether it can be modified – for instance, in conversations with your parents you might still need to be careful about what you say, but with close friends you can speak openly and freely.

What I have put in this book are the conclusions I have drawn from my experience of talking to people about themselves, and I keep checking these conclusions because I go on talking to people about themselves. So much of what people have talked to me about over the years has had to do with the problem of depression.

The problem of depression was first presented to me when I was a baby. I didn’t know it was depression. I just knew that sometimes my mother was loving and caring, sometimes she was silent and unreachable, and sometimes she was wildly, dangerously angry. It was not until I was in my thirties that I realized that my mother had been depressed for most of my childhood. By that time I was involved professionally with people who were depressed, for I was working in a psychiatric hospital in Sheffield, where there were many depressed patients and where the professor of psychiatry, Professor F. A. Jenner and his team were researching into the metabolic basis of depression.

Professor Jenner thought that there might be some interesting, though not important, psychological aspects of those patients whose mood changes seemed to follow some pattern, and suggested that I take this as the basis for my doctoral research.

So I began observing and talking to people who were sunk in depression or, less frequently, fiercely active in mania. I sat in case conferences, and in the staff dining room and lecture rooms, observing and listening to the psychiatrists, all of whom believed most firmly that depression and mania were physical illnesses. I read exhaustively every book and article I could find on depression and mania. Slowly I drew three conclusions from my experiences.

These were

1. From all the possible observations they could make about their patients, the psychiatrists selected a very narrow range of observations.

2. The scientific literature on depression, whether written by psychiatrists or psychoanalysts, described depression only from the point of view of the onlooker. Nowhere was what it feels like to be depressed actually described.

3. When depressed people talked about what it was like to be depressed, they described as central to the experience something which the psychiatrists and psychoanalysts completely ignored, namely, the strange but unmistakable sense of being isolated, of being trapped in some kind of prison whose walls were as strong as they were invisible.

The psychiatrists, I found, spent very little time actually talking to their patients, so there was a great deal about them they did not know. When they did talk to their patients, or about their patients, they were busy turning what the patient said into what the psychiatrists called the symptoms of depressive illness. If the patient said, ‘I no longer enjoy love making’, the psychiatrist marked this down as loss of libido’, and did not enquire as to whether the marriage itself had become flat, stale and unprofitable. If a patient with a deep religious faith said, ‘I feel that God will never forgive me’, the psychiatrist marked this down as ‘irrational guilt’, and did not enquire as to how central to the life of this person a belief in God was. If a patient said, ‘I feel I’m trapped in a sea of mud and the more I try to get out the more I get sucked down’, the psychiatrist marked this down as ‘lowered mood’, and made no attempt to understand just what the person was experiencing.