My childhood went by. I remained anxious. I felt like an outsider, with my left-wing, middle-class parents in a right-wing, working-class town. At sixteen, I got arrested for shoplifting (hair gel, Crunchie bar) and spent an afternoon in a police cell, but that was a symptom of teen idiocy and wanting to fit in, not depression.
I skateboarded badly, got eclectic grades, cultivated asymmetric hair, carried my virginity around like a medieval curse. Normal stuff.
I didn’t totally fit in. I kind of disintegrated around people, and became what they wanted me to be. But paradoxically, I felt an intensity inside me all the time. I didn’t know what it was, but it kept building, like water behind a dam. Later, when I was properly depressed and anxious, I saw the illness as an accumulation of all that thwarted intensity. A kind of breaking through. As though, if you find it hard enough to let your self be free, your self breaks in, flooding your mind in an attempt to drown all those failed half-versions of you.
A visit
PAUL, MY OLD shoplifting partner in crime, was in my parents’ living room. I hadn’t seen him in a few years, since school. To me, it might as well have been millennia. He was looking at me like I was my former self. How could he not see the difference?
‘Do you want to go out on Saturday night? Come on, mate. Old times’ sake.’
The idea was ridiculous. I couldn’t leave the house without feeling an infinite terror. ‘I can’t.’
‘What’s the matter?’
‘I’m just not feeling well. My head’s a bit whacked.’
‘That’s why you need a good night out. If you’re feeling down. Get Andrea to come too. Come on, mate.’
‘Paul, you don’t understand . . .’
I was trapped in a prison. Years before, after spending a few hours in a police cell for that Crunchie bar, I had developed a fear of being locked in places. I never realised how you could be locked inside your own mind.
Act like a man, I told myself. Though I had never really been good at that.
Boys don’t cry
I WANT TO talk about being a man.
A staggeringly higher number of men than women kill themselves. In the UK the ratio is 3:1, in Greece 6:1, in the USA 4:1. This is pretty average. According to the World Health Organization, the only countries in the world where more women than men kill themselves are China and Hong Kong. Everywhere else, many more men than women end their own lives. This is especially strange when you think that, according to every official study, about twice as many women experience depression.
So, clearly, in most places there is something about being a man that makes you more likely to kill yourself. And there is also a paradox. If suicide is a symptom of depression (it is), then why do more women suffer depression than men? Why, in other words, is depression more fatal if you are a man rather than a woman?
The fact that suicide rates vary between eras and countries and genders shows that suicide is not set in stone for anyone.
Consider the UK. In 1981, 2,466 women in the UK took their own lives. Thirty years later that number had almost halved to 1,391. The corresponding figures for men are 4,129 and then 4,590.
So back in 1981, when the Office of National Statistics records began, men were still more likely to kill themselves than women, but only 1.9 times more likely. Now they are 3.5 times more likely.
Why do so many men still kill themselves? What is going wrong?
The common answer is that men, traditionally, see mental illness as a sign of weakness and are reluctant to seek help.
Boys don’t cry. But they do. We do. I do. I weep all the time. (I wept this afternoon, watching Boyhood.) And boys – and men – do commit suicide. In White Noise, Don DeLillo’s anxiety-ridden narrator Jack Gladney is tormented by the concept of masculinity and how he measures up: ‘What could be more useless than a man who couldn’t fix a dripping faucet – fundamentally useless, dead to history, to the messages in his genes?’ And what if, instead of a broken faucet it is a broken mind? Then maybe a man who was worried about his manliness would feel he should be able to fix that on his own too, with nothing but silence amid the ‘white noise’ of modern life, and maybe a few litres of alcohol.
If you are a man or a woman with mental health problems, you are part of a very large and growing group. Many of the greatest and, well, toughest people of all time have suffered from depression. Politicians, astronauts, poets, painters, philosophers, scientists, mathematicians (a hell of a lot of mathematicians), actors, boxers, peace activists, war leaders, and a billion other people fighting their own battles.
You are no less or more of a man or a woman or a human for having depression than you would be for having cancer or cardiovascular disease or a car accident.
So what should we do? Talk. Listen. Encourage talking. Encourage listening. Keep adding to the conversation. Stay on the lookout for those wanting to join in the conversation. Keep reiterating, again and again, that depression is not something you ‘admit to’, it is not something you have to blush about, it is a human experience. A boy-girl-man-woman-young-old-black-white-gay-straight-rich-poor experience. It is not you. It is simply something that happens to you. And something that can often be eased by talking. Words. Comfort. Support. It took me more than a decade to be able to talk openly, properly, to everyone, about my experience. I soon discovered the act of talking is in itself a therapy. Where talk exists, so does hope.
2
Landing
‘ . . . once the storm is over you won’t remember how you made it through, how you managed to survive. You won’t even be sure, in fact, whether the storm is really over. But one thing is certain. When you come out of the storm you won’t be the same person who walked in. That’s what this storm’s all about.’
—Haruki Murakami, Kafka on the Shore
Cherry blossom
A SIDE-EFFECT OF depression is sometimes to become obsessed with the functioning of your brain.
During my breakdown, living back with my parents, I used to imagine reaching into my own skull and taking out the parts of it that were making me feel bad. From having spoken to other people with depression, and having even come across it in other books, this seems to be a common fantasy. But which parts would I have taken out? Would I take out a whole solid chunk, or something small and fluid?
Once, during a dip, I sat on a bench in Park Square in Leeds. It was the sedate part of the city centre. Victorian townhouses now turned into legal offices. I stared at a cherry tree and felt flat. Depression, without anxiety. Just a total, desperate flatness. I could hardly move. Of course, Andrea was with me. I didn’t tell her how bad I was feeling. I just sat there, looking at the pink blossom and the branches. Wishing my thoughts could float away from my head as easily as the blossom floated from the tree. I started to cry. In public. Wishing I was a cherry tree.
The more you research the science of depression, the more you realise it is still more characterised by what we don’t know than what we do. It is 90 per cent mystery.
Unknown unknowns
AS DR DAVID Adam says in his brilliant account of obsessive compulsive disorder, The Man Who Couldn’t Stop: ‘Only a fool or a liar will tell you how the brain works.’
A brain is not a toaster. It is complex. It may only weigh a little over a kilo, but it is a kilo that contains a whole lifetime of memories.
It is worryingly magical, in that it does so much with us still not understanding how or why. It is – like all else – made out of atoms which themselves came into being in stars millions of years ago. Yet more is known about those faraway stars than the processes of our brain, the one item in the whole universe that can think about, well, the whole universe.
A lot of people still believe that depression is about chemical imbalance.
‘Incipient insanity was mainly a matter of chemicals,’ wrote Kurt Vonnegut, in Breakfast of Champions. ‘Dwayne Hoover’s body was manufacturing certain chemicals which unbalanced his mind.’
It is an a
ttractive idea. And one that has, over the years, been supported by numerous scientific studies.
A lot of the research into the scientific causes of depression has focused on chemicals such as dopamine and, more often, serotonin. Serotonin is a neurotransmitter. That is a type of chemical that sends signals from one area of the brain to the other.
The theory goes that an imbalance in serotonin levels – caused by low brain cell production of serotonin – equates to depression. So it is no surprise that some of the most common anti-depressants, from Prozac down, are SSRIs – selective serotonin reuptake inhibitors – which raise the serotonin levels in your brain.
However, the serotonin theory of depression looks a bit wobbly.
The problem has been highlighted by the emergence of anti-depressants that have no effect on serotonin, and some that do the exact opposite of an SSRI (namely, selective serotonin reuptake enhancers, such as tianapetine) which have been shown to be as effective at treating depression. Add to this the fact that serotonin in an active living human brain is a hard thing to measure and you have a very inconclusive picture indeed.
Back in 2008, Ben Goldacre in the Guardian was already questioning the serotonin model. ‘Quacks from the $600 billion pharma industry sell the idea that depression is caused by low serotonin levels in the brain, and so you need drugs which raise the serotonin levels in your brain . . . That’s the serotonin hypothesis. It was always shaky, and the evidence is now hugely contradictory.’
So, annoyingly, scientists aren’t all singing from the same hymn sheet. Some don’t even believe there is a hymn sheet. Others have burnt the hymn sheet and written their own songs.
For instance, a professor of behavioural science at Stanford University called Robert Malenka believes that research needs to be carried out in other areas. Like on the bit of the brain right in the centre, the tiny ‘nucleus accumbens’. As this is already known to be responsible for pleasure and addiction, it makes a kind of sense that if it isn’t working properly we’ll feel the opposite of pleasure – anhedonia. That is the complete inability to feel pleasure, a chief symptom of depression.
It also would mean that the fantasy about reaching into our skulls and taking out the part of our brains that is causing us bother is highly improbable, as we would have to go through the entire frontal cortex to reach this tiny central piece of us.
Maybe looking at a specific part or chemical in the brain is only ever going to give a partial answer. Maybe we should be looking at how we live, and how our minds weren’t made for the lives we lead. Human brains – in terms of cognition and emotion and consciousness – are essentially the same as they were at the time of Shakespeare or Jesus or Cleopatra or the Stone Age. They are not evolving with the pace of change. Neolithic humans never had to face emails or breaking news or pop-up ads or Iggy Azalea videos or a self-service checkout at a strip-lit Tesco Metro on a busy Saturday night. Maybe instead of worrying about upgrading technology and slowly allowing ourselves to be cyborgs we should have a little peek at how we could upgrade our ability to cope with all this change.
One thing can be said for sure: we are nowhere near the end of science – especially a baby science like neuroscience. So most of what we know now will be disproved or reassessed in the future. That is how science works, not through blind faith, but continual doubt.
All we can do, for the moment, is really all we need to do – listen to ourselves. When we are trying to get better, the only truth that matters is what works for us. If something works we don’t necessarily care why. Diazepam didn’t work for me. Sleeping pills and St John’s Wort and homeopathy didn’t fix me either. I have never tried Prozac, because even the idea intensified my panic, so I don’t know about that. But then I have never tried cognitive behavioural therapy either. If pills work for you it doesn’t really matter if this is to do with serotonin or another process or anything else – keep taking them. Hell, if licking wallpaper does it for you, do that. I am not anti pill. I am pro anything that works and I know pills do work for a lot of people. There may well come a time in the future where I take pills again. For now, I do what I know keeps me just about level. Exercise definitely helps me, as does yoga and absorbing myself in something or someone I love, so I keep doing these things. I suppose, in the absence of universal certainties, we are our own best laboratory.
The brain is the body – part one
WE TEND TO see the brain and the body as separate things. While in previous epochs the heart was at the centre of our being, or at least on an equal footing with the mind, now we have this strange separation where the mind is operating the rest of us, like a man inside a JCB digger.
The whole idea of ‘mental health’ as something separate to physical health can be misleading, in some ways. So much of what you feel with anxiety and depression happens elsewhere. The heart palpitations, the aching limbs, the sweaty palms, the tingling sensations that often accompany anxiety, for instance. Or the aching limbs and the total-body fatigue that sometimes becomes part of depression.
Psycho
I SUPPOSE THE first time I really felt my brain was a little bit alien, a bit other, was when I was thirteen. It was a few months after the time I had tried to remove my mole with a toothbrush.
I was in the Peak District, in Derbyshire. School trip. The girls were staying in the hostel. The boys were meant to be staying there too but there had been a double-booking, so eight of us boys stayed in the stables outside, a good distance from the warm hotel.
I hated being away from home. This was another of my big anxieties. I wanted to be back in my own bed looking at my poster of Béatrice Dalle, or reading Stephen King’s Christine.
I lay on a top bunk looking out of the window at the black boggy landscape under a starless sky. I didn’t really have any friends among these boys. They talked only about football, which wasn’t my specialist subject, and wanking, which was slightly more a specialist subject but not one I felt comfortable discussing in public. So I pretended to be asleep.
There was no teacher with us, here in the stables, and there was a kind of Lord of the Flies feeling I didn’t like very much. I was tired. We had walked about ten miles that day, a lot of it through peat bogs. Sleep weighed on me, as thick and dark as the land all around.
I woke, to laughing.
Mad, crazed laughing, as if the funniest thing in the world had just happened.
I had talked in my sleep. Nothing is more hilarious to a thirteen-year-old boy than witnessing an unguarded and embarrassing moment of another thirteen-year-old boy.
I had said something incoherent about cows. And Newark. Newark was my hometown, so that was understandable. The cows thing, well, that was weird. There were no cows in the Peak District. I was told I had said, over and over, ‘Kelham is in Newark.’ (Kelham was a village just outside Newark, where the town council was. My dad worked as an architect there, in the town planning department.) I tried my best to ride the joke. But I was tired, nervous. A school trip was just school, condensed. I had not enjoyed school since I was eleven, when I had been at a village school with a total pupil population of twenty-eight. The school I was at now, Magdalene High School, was a place where I was not very happy. I had spent a lot of the first year faking stomach aches that were rarely believed.
Then I fell asleep again. And when I woke up I was shaking. I was standing up, and I could feel cold air, and there was a considerable amount of blood dripping from my hand. My hand was red and shining with it. There was a shard of glass sticking out of my palm. The window to the stables was smashed in front of me. I felt frightened.
The other boys were all awake, but not laughing now. A teacher was there too. Or was about to be there. My hand had to be bandaged.
I had got out of bed in my sleep. I had shouted out – rather comically – about cows again. (‘The cows are coming! The cows are coming!’) Then I had gone for a piss next to someone’s bed. And then smashed the window. Shortly after, one of the boys shook my arm and I w
oke up.
It wasn’t the first time I had sleepwalked. Over the previous year I had gone into my sister’s bedroom and taken books off her shelves, thinking I was in a library. But my sleepwalking had never gone public. Until now.
I gained a new nickname. Psycho. I felt like a freak. But it could have been worse. I had loving parents and a few friends and a sister I could chat to for hours. My life was pretty comfortable and ordinary, but sometimes a sense of loneliness would creep over me. I felt lonely. Not depression. Just a version of that wallowy, teenage, no-one-understands-me feeling. Of course, I didn’t understand me either.
I worried about things. Nuclear war. Ethiopia. The prospect of going on a ferry. I worried all the time. The only thing that didn’t worry me was the thing that probably should have: worry itself. It would be eleven years before I had to address that one.
Jenga days
ELEVEN YEARS AFTER smashing a window in my sleep, during those ‘breakdown months’ as I’d later call them, there was a lot of empty time to stare worry in the face.
My parents would get up and leave for work and then me and Andrea would have long days in the house. It’s weird to write about this period. I mean, really there is nothing to write about. It was, from the outside, the least eventful phase of my life by quite a way.
From the outside, it was me talking with Andrea, either in my childhood bedroom or downstairs in the kitchen. Occasionally we would venture outside for a short walk in the afternoon. We would go either to the nearest corner shop, only about two or three hundred metres away, or – on more adventurous days – we would go and walk by the river Trent, which was a little further away, on the other side of the town centre, and involved me walking through streets I knew so well from childhood. (How could they stay the same when I felt so different?) Sometimes we bought a newspaper and a tin of soup and some bread, and we would return and read a bit of the paper and make the soup. Later, we might help prepare the evening meal. And that was about it. Talking and sitting and walking. It was hardly Lawrence of Arabia. Life at the lowest possible volume two twenty-four-year-olds could manage.