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2nd Aug, 2010

This entry is, I suppose, a reaction to a Guardian article a friend linked to on facebook. The original article is here.

This could get long, I don't know, I'm just going to type, so I'm hiding it behind an lj-cut.

If you're viewing this on Facebook (or through some other syndication) and this is stupidly long, I do apologise.

The article concerns one person's experience of Depression, and it got me to thinking about my own history with the same, while the comments got me to thinking about people's attitudes towards it.

With regards to the views of the commentors, I'm not gonna get into the whole "Depression isn't an illness, get over it" versus "Depression is the new pandemic" (and all shades in between) debate...

For the record, my own standpoint is that Depression does exist, it can be horrendously debilitating and is potentially fatal... but I also feel that there is far too much focus on drug-oriented treatment of symptoms rather than a more holistic approach, such as trying to work out what triggered a depressive incident, why it got to the extreme that it did and trying to establish behaviour patterns that reduce the potential for future triggering events to escalate into future depressive incidents... I also feel there is a pre-disposition by the medical profession to medicate rather than treat.

Another commentor's statement rings rather true; there does seem to be a certain one-upmanship when it comes to sufferers; ie, "you call that depression? I had X, Y and Z; that's depression!" I don't think this is helpful (or, indeed healthy) to indulge in; at the end of the day (to borrow some cosmology) a Black Hole is a Black Hole.... it really doesn't matter how far the event horizon extends (ie, how severe the Depression), if you get caught up in it, you are in serious trouble!

This posting is not an attempt to one-up anyone; I'm writing about my own experience. I am very aware that everyone's experience of Depression is different, everyone's experience of Depression is personal and I suspect everyone's experience of Depression is that it feels as though the world is fading away, that your existence has fractured, reality is bleeding out through the cracks and that the Black Hole has you in its grasp and that death would be preferable to a continuing tortured existence...

A few final points I wish to make regarding comments against the original article:

First is simply to state that I believe any and all frank and honest descriptions of people's experiences with Depression are important and useful, regardless of their background and/or circumstances because just about anyone is susceptible. I agree that it would be interesting to hear stories from a wider range of backgrounds, lifestyles, genders, ages, etc than tend to manage to get into the media, but the fact that a national newspaper is publishing an article about Depression at all is a step towards better understanding of an invisible illness, and it might just help alleviate someone's silent suffering.

Second, regarding the taboo nature of Depression, I believe the situation is changing and Depression is becoming better known and better understood by the general public. I suspect that women are far more likely to discuss it with other women, while the greatest taboo is most likely men speaking to other men about it... afterall, men are not well known for discussing their feelings and emotions, and Depression is probably still conceived as a sign of weakness... couple that with someone who is going through their first experience of Depression, who is quite probably thinking that they are weak and pathetic to allow/fail to prevent their brain getting them into the mess that they are spiralling into (as I (and some of the article commentors) still do, despite being very familiar with the illness and this particular feeling), and the likelihood of discussion is further diminished.

And finally, regarding the stigma of Depression... this is still huge. Over the past 10 years, I've spent an awful lot of time unemployed... and, as a consequence of signing on long-term, I've been sent to various "courses" to help in getting a job, so I've had lots of people giving me advice about what to do and not do. Every single person who has given advice to me (not just on these courses) has stated categorically that under no circumstances should you ever mention that you have a history of Depression. Now, this makes my employment history look kind of pathetic because there are gaps when I was unable to work (or even summon up the willpower to get out of bed for that matter), some of which I was claiming Incapacity Benefit for. And yet, when questioned, these advisers (even those in those I've spoken to in the recruiting side of things) believe there are fewer issues with a sparse employment history than an admission of mental health issues. Even the continuation assessment for mental health on Incapacity is (well, the one I was assessed under is defunct, but its no better now by all accounts) badly biased against the patient; from memory, you have 9 assessment questions and have to provide a clinical indicator for 75% of them (this is from memory, no comments about my numbers please!)... I remember getting home and looking over the questions (probably from online; I don't think they gave you a copy of your assessment) and I was hard pressed to get 50%, even if I'd been sat in the DWP doctor's office slashing my wrists open on his desk!! If memory serves, on the day I got less than 25% (my GP was absolutely livid), because I was having a good day, oh, and because under the assessment criteria, long-term insomnia doesn't affect your ability to work!

So, my Depression goes back quite a long time now, to 1995 when my sister died.

OK, just to interject a moment, I did have some contact with mental health services before this; in retrospect, I believe that the stuff prior to my sister's death was related to the whole gender situation and was not a pre-existing minor form of Depression. I have never considered the prior situation to be part of my Depression. If there was any pre-existing depressive stuff, it certainly wasn't to the degree of being Clinical, probably just a combination of normal teen-angst and that continuous nagging uncertainty about who I was coupled with the ongoing certainty that there was something definitely wrong with who I was being... which is probably something every pre-T-Revelation Trans-person goes through.

Now, where was I? Oh yeah, 1995... the year my life ended...

Well, that somewhat over dramatic, I know... but it was the year when everything came unravelled, and the year I started trying to end it.

Oh, and I'm not saying that my sister's death was the only cause... it wasn't, there were various other things going on back then, I just don't want to go into them... I do believe that without that one thing, the others combined wouldn't have been enough to kick me into Depression though, so I tend to count it as being the trigger event.

These days, I'm pretty familiar with the general pattern my Depression takes, but back then I didn't have a clue that there was anything particularly wrong... I just put it down to grief and tried to keep going.

I'm not sure if there are any recognisable stages before what I'm going to try to describe, but the way things usually go when I'm deteriorating into a proper Depressive episode is that to begin with I'll get hypersensitive, not just to criticism (I can be , but to anything and everything; someone doesn't reply to a text message and I'll be convinced they have always hated me, Windows hangs and I'll be sure that I've screwed the machine up beyond rescue, etc. I'll then get ridiculously weepy; the whole hypersensitive thing will reduce my to a weepy mess more and more easily. I'll also totally loose my focus; even if there's something I want to work on, I'll be distracted by the slightest thing. That's not to say that I can't still do stuff, I can, it just takes a lot longer and requires a lot of willpower and concentration, as well as getting rid of as many potential distractions as possible. The hypersensitivity will eventually lead to my brain going into Bad Thoughts; constantly just thoughts about what a fat, ugly, stupid, useless freak (the "FUSUF," I occasionally refer to) I am, about everything my brain can dredge up from the past where I've made a mistake and ended up screwing something up, and of death, of dark pain and anguish...

Somewhere in amongst all that, I'll start comfort eating and put on weight because I'm cooking (for some reason, easy to do) and eating way to much cake, sausage rolls, toad-in-the-hole, etc. as well as gorging on chocolate, etc. These days I make a point of not drink when I'm feeling low because it just amplifies everything and I end up much worse, much quicker. In '95, lets just say I spent most of the Uni term after my sister died very,um, drunk...

Once I'm into Bad Thoughts, its reasonably likely things are going to just get worse, because they tend to end up as a self-reinforcing feedback loop; Bad Thought causes hypersensitive reaction causes weepiness causes further Bad Thoughts and so on... but it doesn't always, and even if it does, its not got a predictable time-frame for further escalation... its a bit like a see-saw at this point; things are just about balanced; I can still just about function when its just Bad Thoughts, although I'll probably be abrasive to the point of rudeness and totally closed off... but its a see-saw with someone adding grains of sand to one end... eventually its going to tip! And when it does, the alarm bells start and I go running to my doctor for medication... Rather than just my focus, my ability to concentrate goes, and I stop being able to do pretty much anything that takes more than a minute or two... even something as simple (and generally perceived as not requiring any brain power) as watching a TV programme becomes incredibly difficult because I'll "phase out" and loose chunks of it, so plots are incredibly difficult to follow. Bizarrely, this is one of the few times in my life when I'm likely to vaguely know what's happening in the world, because (due to the sound-bite-y format) I can (just about) manage a news summary!

Generally once the concentration goes, it'll take a little while (say maybe a couple of weeks) before Bad Thoughts gradually get worse until they've turned into Evil Thoughts... the intensity of the mental-flagellation, self-loathing, etc has ratcheted up, as has the intensity of all the death stuff and my stupid mind will be coming up with inventive (read "ridiculous, over-the-top, often convoluted, and beyond anything that I'm ever likely to actually attempt") ways to kill myself. In the past, this would also be the point where I'd start sticking pins and things into my skin so I'd have an external stimulus to focus on , rather than the internal head-created pain (ie, I'd actually feel something real in amongst my almost entirely divorced-from-reality bubble).

This is the point when I definitely know I'm not in Kansas any more... and these days, having run to the doctor for pills when things started to get properly worrying, its when the first numbing effects of the drugs start.

Having said that, I'm not brave enough to try this bit without drugs, so I don't know if that numbing is just a placebo effect... I know that in the past when I've taken the drugs for long periods, everything has just been numbed-down to near-nothingness... nothing had any edge to it... I didn't get happy, I didn't get sad, I would just get a tiny bit more up or down...

I really don't like feeling like that... so these days I spend the least amount of time possible taking the drugs that I can... I use them as a chemical crutch to help me hobble through the bad bits... and just like with a bad leg, once it stops feeling bad I gradually stop using it.

Anyway, my way seems to be working for me, so this next bit isn't something I've been through since about 2001, but back then, the next step in the downward spiral was that all those Evil Thoughts would kind of gather momentum; I'd end up thinking about little else, I'd stop eating and would loose lots of weight pretty rapidly (far more than my initial comfort eating put on), and I'd loose the ability to do anything... and I mean far more than just not being able to concentrate; the idea of getting out of bed would seem so daunting and difficult; literally terrifying... I'd lie there for ages trying to gather the willpower from somewhere just to go to the loo or something my concentration would be absolutely non-existent... and throughout, my perception of time would be totally out of kilter with reality; the time spent trying to go up to go to the loo would seem like the whole afternoon had passed, the nights I'd spend wide awake with my mind churning over Evil Thoughts at hair-raising speed would feel like days, and yet a week would feel like a day...

Sometimes, some impulse would creep in and I'd go out for a walk at 1 in the morning, and find myself half way to Cheltenham at 3 or 4am... and somehow I'd manage to get back home to Bristol... or I'd find myself by Clifton Suspension Bridge...

Its this Manic Evil Thought phase that is the bit where fatality comes into view... up until now, no matter how bad, unpleasant, appealing, etc all that death stuff has been, its just been thoughts about it... but once I'm at this stage, the rather terrifying prospect of it flaring into thoughts about doing it... these "flare ups" have always been (mercifully) fairly brief, and they don't often coincide with having the means necessary to actually act on them to hand... even when I was pulled down from Clifton Bridge, it didn't start out as an attempt on my life... it started as a stupid impulse to just walk somewhere... I happened to end up on the Bridge, and I happened to have one of these flare ups while I was there... and, as I say, they're brief, although not so brief that I'd have changed my mind before I'd hit the bottom.

In some ways, the flare ups were actually (sort of) a good thing... well, atleast in one way; once one was other, I'd kind of reset to a much lower ebb and things would be better for a while and the Manic Evil Thoughts would recede to being merely Evil!

I still don't have clear, well-sequenced, coherent memories of that period from '95 to '02 when I was firmly under my Depression's thumb; its all topsy-turvy, everything is in this bizarre fluctuating version of time... with coursework deadlines appearing like roadside countdown signs with alarming regularity, and each one would say some time that was weeks ahead, and yet the junction (due date) would spring up a mere moment later! I can't even say for certain how many attempts I made on my own life, although I'm fairly sure that it was more than six, and fewer than ten... and that in itself is a very weird thing to think about..!

I think in a lot of ways, it was Uni that kept me from just giving up and letting it beat me... partly because the coursework deadlines did give me those roadsigns to follow, partly cos it meant that, atleast when I was able, I had something to aim for that was, while not necessarily beyond the Depression, it was beside the Depression (iyswim)... and somehow, that meant that, atleast for a short period, I could manage to pull my head together enough to get something submitted... it didn't always (often) pass, but it atleast was something to show Uni I was still trying... and they seemed to keep the faith... whether my feeble offering helped, I don't know... but they would grant me extenuating circumstances and let my resit marks stand for their full value, rather than being capped at 40%.

I don't think the drugs helped "cure" me (indeed, I don't consider myself to be cured... I expect that my Depression will come back throughout the rest of my life); but they do give me breathing space. I had counselling for most of my time at Uni, but because things were still ongoing at that time, it was generally only about what was going on with me at that particular moment, it certainly didn't have any long-term Therapy-type aspect to it. I have had some psychotherapy... this was a few years ago, back when I was living up in Leeds the last time around, and it ended after I moved down to Dorset (a 500+ mile round trip for a one hour session just isn't viable!). I had an initial assessment by the local Community Mental Health team when I first moved down, but have never heard back from them regarding ongoing therapy (this, despite me being someone undergoing the start of gender transition... atleast, I was atleast until the time I moved back up to Leeds again... at the moment I'm in a kind of limbo with all that).

I don't think I'm doing too badly these days... even though I'm living in my parent's house, which is so far from ideal its unreal (since, due to unknowable paternal reactions (apart from anything) it effectively stops me living as me). The grades I got for the first year of my Masters are proof enough that my concentration is pretty much there, even though the Advanced Databases module had me firmly in to Bad Thoughts... but it hasn't progressed any further. This may be due in part to the fact that I have Glastonbury and Bristol Kite Festival to look forward to, that I know I will both be away from the house for a week or so and will enjoy... and the Masters means I can add in two exam periods, when I will atleast be away, even if they are totally not enjoyable!

And, because I was right, and this is now pretty long, that's where I'm going to leave this.