Saturday 26 March 2016

Depression without sadness

A few weeks ago I was sitting at my desk at the end of the working day, sorting CVs for a job opening. I had just returned from the classroom - cover for an absent tutor - but it had otherwise been a very normal day. A few minutes into this routine task, I noticed that something was wrong. No matter how hard I focused on the paper copies, I could not find any of the required information, nor at times could I even remember what it was that I should be looking for. As I flicked backwards and forwards through the pages, it was as if I was not in my own head looking out, but looking in and seeing only my own inevitable failure to carry out this routine task. I persisted, redoubling my efforts to attend to what was in front of my eyes, refusing to acknowledge the growing realisation that something was very wrong. But my awareness of the outside world only grew thinner and thinner, as more and more I turned inward.

It was then that the blackness came. A literal blackness swallowed up my vision. There was a sense too of numbness across my forehead and crown as if my head was being smothered and bound in bandages. I leaned forward and stooped over the desk, making myself hunched and smaller. If a colleague had entered my office at that moment, they may well have mistook my posture as a need to protect myself. But in reality, I was being folded up and inward, drawn down into a void.

I have suffered from bouts of depression for years. Hitherto they have always been characterised by a sense of worthlessness. They have almost without exception lasted no longer than a week and there has always been a trigger - a broken heart, a regret, or a series of setbacks that had brought me to question my identity and sense of efficacy. But now it seems my symptoms have evolved. In fact, this nightmare episode at my desk was preceded by at least a month of other symptoms, so unprecedented, that I had a great deal of difficulty recognising that I was sliding into a major depressive episode.

Four weeks previously I noticed that I was having difficulty concentrating and was uncharacteristically forgetful. Frequently I would move around the house on chores and forget what it was that I was supposed to be doing. I had difficulty taking in information while reading, and then one evening in the pub while in the middle of an anecdote, I could not recall the name of the colleague with whom I have shared an office for a year, and who was sitting opposite me at the time. At the same time I became aware that my head was extremely foggy. The kind of sensation that plagues you when you wake up stale and drowsy after a dissatisfying daytime nap, only ever-present, from the moment I got up, till the instant I closed my eyes. By this time I was also physically very tired, and sleeping ten, sometimes twelve hours a night to compensate. But no matter how much I slept, I could not feel refreshed. All this caused me to worry of course, and I feared I might have a serious neurological problem. And who wouldn't? Not only were these symptoms physical and cognitive, there was absolutely no emotional dimension. No sadness. No sense of worthlessness. No trigger. Nothing that would mark this out as the depression with which I had long been familiar.

I made a doctor's appointment, but the earliest they could see me was late in the following week. I accepted this, since, despite my symptoms, I could still function. That weekend while out for a walk in a local park, I began to feel dissociation. If you have never experienced this, it is difficult to explain but it was as if a connection between my mind and my body had been severed. When my body moved off, I often had the sensation that I was leaving my mind somewhere behind, which made me feel slightly dizzy and disorientated. My limbs too felt as if they had been clumsily stitched on to my torso and seemed somehow to ring with an unpleasant nervous sensation, as if butterflies were flying around inside them. The more I attended to these sensations to scrutinise and control them, the worse they seemed to get, until at times I felt that I was going to have a seizure, collapse and lose control completely right there in the park. I walked slowly home, choosing to feel numb rather than the anxiety of attending to these desperate symptoms. The prospect of losing control of my body completely and doing who knows what right there in the street seemed very real. Only by sleeping could I find some respite.

The next day I awoke with this realisation: if I were to continue to monitor my symptoms in detail, to fear for their origin in terms of a serious neurological condition, I would, in all likelihood, get caught in a vicious spiral of anxiety and dissociation until I lost touch with reality completely. However frightening these symptoms were, more unacceptable to me was the thought that fear itself could take me over. Such are the insights you gain when you are stripped of all that is adventitious by the vicissitudes of extreme adversity. And how quickly we tend to forget this hard won knowledge; for I had been here before. Once in my twenties when an eating disorder halted progress on my PhD, and once again a decade later when my marriage failed. Both times I was brought low by the sense of loss, only to realise that the only truth that endures is the reality of your own self, and the environment of which you are now a part. All other actors, goals, beliefs, assets and achievements are transient, and to cleave to them is like trying to grasp water as it flows through your hand. 

This was a Monday morning three weeks after I first noticed something was wrong. My usual routine would have seen me filling the half hour before leaving the house, drinking coffee, eating breakfast, listening to the news, reading the news and responding to work emails and private messages, all at the same time. Instead I lay on my sofa, gazed out of the window and tried simply to be mindful of the only truth that endures, the reality of my own self pressing into the sofa, filling a space inside the four walls as sounds from the surrounding streets, telephone wires bouncing in the breeze, and birds winging and swooping across the sky marked the progress of the present through time.

I had short-circuited my anxiety for now, and at my desk, I was calmer. My symptoms were still in evidence, but I no longer made them my focus. Instead, I simply accepted that I was operating at a deficit, and focused on getting that morning's tasks done as best I could. Also, mid-morning, I decided that I would message a list of my symptoms to a friend who suffers from major depressive episodes. I had spent some time researching my symptoms on line and knew that there was at least a chance that they were a modified expression of my existing depression, however incredible this felt to me. 

She responded almost immediately. Almost all the symptoms I listed she confirmed as characteristic of major depressive episodes as she experiences them. It is odd to hear this, but I felt, if not joyful, then certainly relieved to hear this. The brain fog, dissociation, fatigue and momentary disorientation continued throughout the week, but for the most part, I was stable and coping. 

Mornings that week always began the same way, by greeting the brain fog with a sense of disappointment that there had been no overnight change, by getting ready for work, then settling down on the sofa for half an hour of mindfulness before I left the house. I also began to notice a new and particularly debilitating symptom. Perhaps one of the cruellest symptoms of depression, as I experience it, is the dissociation, not from your own self, but from others. If you have never experienced this then you need to imagine an utter inability to connect. You find yourself in the company of others, watching them laugh or listening to them tell a story, you are aware of their facial expressions, their mood, you are aware that you should be responding in some way, and you do. You smile, you laugh, you add another comment. But all this is mechanical. As if scripted in a language that you can speak but not understand. There is no depth, no meaning no involvement with any of these behaviours with the result that your are utterly alone together. Most times you can just about bear this by ignoring it and inserting as much artificial energy between you and the world of others as you can muster. But sometimes your energy collapses, or you simply run out of motivation. Or again, the conversation disintegrates into a series of contingent stills, which, like a film advanced frame by frame, may reveal a hideous grimace in the midst of an unguarded fit of laughter. It is at these times that company becomes a form of torture. You lose your place in the script completely, and are left exposed with no way of concealing the shame of your own anxiety, despair and loneliness.

Elsewhere in this blog I have written of the joy I experience when connecting with another mind, and of the role creative language use plays in revitalising our jaded perspective of the world. For me the simplest yet greatest of pleasures is finding just the right language and mode of delivery to drop curiosities, insights and startling moments of beauty into the ears of others. This is doubtless why I became a teacher. But all throughout that week, my time in the classroom was a real source of anxiety. I had to take great care to build up enough energy before entering to last me through the 90 mins. And even though I delivered all my lesson aims, and the students enjoyed their lessons, for me it was a disappointing and exhausting performance.

Somehow the week passed, and I made it late on Friday evening to the doctor's. In the UK, a standard appointment lasts 10 minutes - precious little time for you to explain the complexities of your mental health problem, let alone for the GP to listen, explore and diagnose your complaint. But by this point in the week, I was already 90 percent sure I was suffering from depression. The doctor's confirmation again came as a relief, as was his recommendation that I deal with it through therapy alone. Now that I knew what it was, I felt sure that I could beat this depression, or more precisely, that I only had to hunker down long enough and my mood would suddenly lift, as it had so many times before. Before leaving his office, and already when he had warned me twice that we would have to bring the consultation to a close, I asked him: how was it possible to have depression without sadness? He could not answer.

The weekend passed in close company, which helped to calm me. I spoke about my mood often and felt no pressure to follow the empty ritual of normal relations. Sunday evening, however, was much worse, since I became aware of another disturbing deficit which undid many of my gains.

I have played the guitar on and off for decades, and in the early part of this year, I had taken it up again with renewed conviction. More specifically, I had spent most evenings in January learning classic blues solos, playing them over and over again until the phrasing was fast and smooth. At the same time, I was meeting every week or so with a group of friends who also sing and play guitar to develop a set list of songs. On Sunday evening, my friends arrived for a rehearsal, and I noticed that I was feeling very anxious. We began to play, but my concentration was so poor I could not remember the chords or the changes. And even when I had them written in front of me, I could barely process them quick enough to keep up with the song. Also, like the social ritual of conversation, the structure of the music seemed arbitrary. Whereas I would normally lose myself in the flow of the music, now I was locked out, spasmodically adding staccato and forced notes to a sequence of steps that refused to cohere together into a whole. But most worryingly, my fingers, which just a few weeks previous had moved so fast and with such control over the fretboard, were now clumsy, cold and weak. Again, my body felt as if it no longer belonged to me, as if some vital internal connection had been severed.

I went to bed that evening slightly embarrassed and utterly dejected, and woke up with extremely thick brain fog, which lasted all day. Looking back on my motor problems of the previous evening, I once again could not shake the sensation that there was something neurologically wrong with me. This gloom-laden thought came back to me again and again. After all, how is it possible to have depression without sadness?

In the afternoon, I was called upon to teach a class unexpectedly, which evidently used up all my resources, because it was when I returned to my desk to sort come CVs for a job opening that I was suddenly swallowed up by darkness.

Hunched over my desk, I fought against it the only way I could, by focusing on the reality of my own self, and the environment of which I was then a part - the only truth that endures. Going under, I forced myself to attend to my body, my breath, the sensation of my elbows resting on the table, the strands of hair beneath my fingertips, and soon enough I saw again the light from the window opposite.


To be continued.










1 comment:

Unknown said...

Beautiful. Thank you