Depression

© Martin Rowson

Blackness ever blackening: my lifetime of depression

How do I explain an existence dominated by the bleakest, darkest moods? And do I even want to? By Jenny Diski.

I was such a moody child. That’s what my parents said.

“She’s such a moody child.”

“Why are you such a moody child?”

I don’t remember ever being called a happy-go-lucky or sunny-natured child, or feeling like one, although I certainly experienced varieties of happiness sometimes. I have a clear memory of somersaulting out of bed one morning when I was six or seven for the pleasure of getting up and going to school. Yet I’m suspicious of that moment as having more to do with me trying to manipulate the family mood than a genuine expression of joie de vivre. It looks, in retrospect, too theatrical. It’s the only really energetic recollection I have of myself, but I’m sure there were others.

My most pervasive memory of young childhood, however, is of being in ‘a mood’, which really consisted of just the one mood in several shades of monochrome: a spectrum that ranged from a comforting solitary dreaminess inside a softly enclosing gentle shadow at one end to, at the far side of the continuum, the grimmest darkness in a hard-frozen, fractured icescape. Always it was me on the inside, them out there, beyond my enclosure, unable to reach in. And me, sometimes not wanting, sometimes not able, to reach out.

“She’s having one of her moods,” my mother would say about me when my father returned from work. The words could be declined to suit the situation: I had moods; I was in a mood; I was a moody child. Being ‘a moody child’ described a permanent condition, while being ‘in a mood’ usually referred to the bleakest moods, which could last for hours, actually days sometimes. I don’t think either sort only happened as a result of being in trouble (which happened easily and often), when my first response was usually anger and a sense of overwhelming unfairness, a welling-up of outrage – probably a common experience of all children – that only later might evolve into a mood and withdrawal.

Sometimes a mood arrived when my parents were arguing or fighting and began with misery or fear – and withdrawal. Sometimes a mood just fell over me for no reason I could see at all. It would rain down on me, saturating me with its bleak, dank, darkness – and withdrawal. Once it had begun it was a very specific event, and although each episode must have started at some moment or other, it always seemed to me, and possibly to them, as if it had already been in progress for ages. Always already – as if I had been born in a mood as some are born in a caul. My parents recognised it, I recognised it. I can’t remember a moment or an incident when it first happened, nor, no matter how young an age I think back to, when I wasn’t aware of being in danger of sinking into one of my fearful moods.

My parents stood over me as I huddled in a corner or sat cross-legged on the floor with my eyes focused on the patterned carpet. They stood and questioned me, always the same questions, and I couldn’t reply. What’s the matter with you? What’s wrong? Has something happened? Why are you like this? Why don’t you answer me when I’m talking to you? Pull yourself together and tell me what the matter is. What’s wrong? Why are you behaving like this? Answer me! The mood, as we called it, created a space and a blockade around me that deflected the questions, like an all-encompassing shield; it muffled them, saved me from them, but, equally, kept me apart from them and any possibility of answering them or of reaching out with my voice or body.

I can explain it up to an extent now. With hindsight. Using narrative for an experience that is, I think, entirely without narrative. (To me, then, explaining wasn’t the point, any more than a train is the point once you’ve arrived at your destination.) It is reaching some place deep inside, a physically experienced cavernous place enclosed by the barrier, as it seems, of my skeleton and skin, and something in addition that forces out the air of the room a little way beyond my physical self. It is a place where I can’t be, and where I can’t not be.

I know that this place that I enter, the inner-space surrounding me – in which I can’t be, can’t breathe, can’t exist, but can’t not exist – also itself can’t be. A room for which there is no room. A place that makes no sense, that no sense can be made of, but which is all there is when I am in it. It is negative upon negative. Blackness ever blackening. Obscurity and obstacle always increasing, arriving at a point where nothing can be retrieved, mended – and then more and further, beyond my capacity to imagine more. A struggle that only and always resolves itself into a further impossibility, to infinity, eternity; a terrifying forever, in the most inexplicably inhuman sense of the word. And this place, this condition that has me in it, while the world mouths at me on the outside, is where I am, is what has happened, is why; and makes everything, inside and out, life itself, simply, really simply, impossible. I am islanded in the impossible, and unreachable. Yet, always the impossibility gets worse. There is no end to the worseness, the tumbling of can’tness down and down, in and in, to can’tnesses that I have never before imagined, or at any rate have forgotten, that imply further depths or intensities of can’tness that I haven’t dared to fear, but I can see coming, or me moving towards. That, roughly, is what it is like being at the blackest end of the continuum. It is like living inside this paragraph, which in its speed and insistence, melodrama and bumbling words fails to convey how awful and how physical it is, and how much I don’t want to be in it.

That is the worst, as far as I know, but it is part of the spectrum we all live with. Between the contrasting blues of deep despair and dreamy oceanic bliss, there is an entire flicker-book of moods. We think of ‘moods’ as accompanying our lives, colouring them, shading them, and of events and external stimuli creating moods that tint and alter our daily existence. Something happens – we read about a political crisis, see a cat being cute on the internet, have a dream, good or bad – and our being in the world is overlain by a (usually) appropriate mood. Mood is a colour wash over that something we think of as ‘our lives’: the working out and progress in the world of our particular underlying self.

We all have a more or less deep sense of ‘what we really are’, which is buffeted and put at risk temporarily or permanently by moods, as a boat is by the turmoil of the Bay of Biscay or the dying of the winds in the doldrums. I’ve been on both of those boats and know the power the swell or stillness has over the conveyance, that sense of being a small object in the storm or the lull as it progresses. It is possible, though, that the essential self we perceive is a mirage. It might be no more fundamental, no more unitary, than the moods we want to say affect ‘us’ and change our feelings at any moment. What if our moods are our lives, if our selves are the flicker-book: that what we really are is a continuous fluxing of emotional shades created and conditioned by our biological and experiential environments – body, mind, world – and there is no more a single self, impinged on by fleeting moods, than there is that single mood my parents defined as interrupting my real self?

Nobody would have said so in the 1950s, but clearly I was a child who had depressive episodes of some sort. When they took me to the doctor, he told them what they already knew: that I was moody, that I suffered from emotional growing-pains, and he cheered them up by explaining that I’d grow out of it and by prescribing a bottle of some sweet syrup that was called a ‘tonic’.

I didn’t grow out of it.

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Diagnosis is at the mercy of time and fashion (call it scientific progress, if you like). Today children are diagnosed in their cradles with this or that ‘mental’ disorder, so defined because it can’t be clearly seen like a fractured limb or a fevered infection. The mind, after all, is invisible, actually non-existent to some, and although there is now the possibility of looking at brain activity through fMRI scans, neuroimaging remains little more at present than a pin-the-tail-on-the-donkey activity in many cases. Something happens in the hippocampus or the amygdala when you feel up or down that can be seen in brightly coloured splodges, but how or why it happens and what this tells us is hardly known. The present state of neuroimaging has been compared to phrenology. If we were sure of what happened in the brain and why and how its underlying biochemistry worked, we would have no reason to classify illness as ‘mental’ or ‘physical’.Words used to diagnose depression don’t reflect reality

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, has been regularly revised since it was first released in 1952. Using an expert panel to reach a consensus, each edition alters and refines some existing definitions, and confirms for clinical psychologists and psychiatrists what is to be considered a disorder of the mind and how to test for it, based on symptoms presented by a patient. In May 2013 DSM-V arrived. The severest form of depression I experience is known as a major depressive disorder, while the matrix of low affect into which this comes and goes has variously been described by the DSM in the past under the diagnoses of chronic depressive disorder and dysthymic disorder. The new DSM-V now subsumes these under the diagnosis of persistent depressive disorder (PDD).

PDD has a cluster of symptoms (such as feelings of hopelessness, trouble sleeping, low self-esteem), of which two must be present for two years or more in order for an individual to qualify for the diagnosis. It has melancholic features of sadness and feeling down in the dumps, an early onset (childhood or adolescence), and it isn’t, as major depression is, generally temporary and self-limiting. DSM-V estimates that 0.5 per cent of the US population have PDD/dysthymia, but other sources state figures that are considerably higher. Its cause is not obvious, but possible factors include genetics, childhood loss or family dysfunction and isolation. It is characterised by patients saying something like “I’ve always been this way”. So far no revision of the DSM has given PDD/dysthymia the name of miserabilism. But in the world of truism, which we mostly inhabit and so often is true enough but not helpful, the idea of glass-half-full-or-half-empty optimism or pessimism covers what DSM-V describes, and is recognisable enough to those of us who think of ourselves as just plain born down-in-the-mouth miserabilists.

Tonio Kröger, a novella by Thomas Mann, pitches the withdrawn, dark, clumsy Tonio, condemned always to partner the girl “falling in the dance”, against the fair, smiling, graceful beings around him. It’s a description of the darkness of an artistic temperament, but to me, when I read it as an adolescent, it was a description of my clumsy, perturbed life in a world that seemed to manage to get on with it so much better than I did. Reference to the familiar dysthymic type or mood can be found easily in literature. In Henry James’s The Ambassadors, Miss Gostrey explains to Lambert Strether: “Your failure’s general… The failure to enjoy…is what I mean.” In the first paragraph of Moby-Dick, Ishmael introduces himself: “Whenever I find myself growing grim about the mouth; whenever it is a damp, drizzly November in my soul; whenever I find myself involuntarily pausing before coffin warehouses, and bringing up the rear of every funeral I meet…then, I account it high time to get to sea as soon as I can.” Melville’s other great creation, Bartleby, the Scrivener, is surely the patron saint of the dysthymic: enigmatic, standing numb but implacable, repeating quietly and firmly, “I would prefer not to”. Perhaps a better test than the DSM for the presence of PDD is your childhood response to the character of Eeyore in A A Milne’s Winnie-the-Pooh books.

“Good morning, Pooh Bear,” said Eeyore gloomily. “If it is a good morning,” he said. “Which I doubt,” said he.

“Why, what’s the matter?”

“Nothing, Pooh Bear, nothing. We can’t all, and some of us don’t. That’s all there is to it.”

“Can’t all what?” said Pooh, rubbing his nose.

“Gaiety. Song-and-dance. Here we go round the mulberry bush.”   

I was always Eeyore. I expected things to go wrong, to break, to spoil. I saw the wrongness where other people found contentment. I was a sitting-on-my-own force of negativity, who both understood and couldn’t comprehend why I spent so much time on my own when other children spent so much time playing together. At five or ten, it wasn’t a style choice as it had been for fashionable young men in Elizabethan times, their clothes carefully awry, listening head-in-hand to Dowland’s melodious misery, the Morrissey of his day, or as it would be later for the 20th-century goths. It was the box in which I lived. And yet it wasn’t a box I really wanted to escape from. I looked out, sort of enviously, but really knowing I was where I belonged and wanted to be. It felt like me. I’ve always been this way.

Just a couple of decades later, the psychologists and psychiatrists could have checked their DSMs and called me dysthymic (DSM-IV) or suffering from PDD (DSM-V). By the time I was in my late teens I had received a diagnosis of clinical depression, now major depressive disorder, but although that justified various sorts of medication and interventions, it didn’t really tell me what it was I was, apart from me, the grumpy child who never looked on the bright side, and who fell from time to time into chasms of despair.

I wonder if it would have felt different to have had a diagnosis of dysthymia or PDD when I was stuck inside myself. It would have served as a sort of explanation to both me and my parents, and there is something to be said for labels when you are adrift in a baffling frame of mind. The word disorder is not as comforting or legitimising as something ending in ‘itis’ or ‘osis’, but at least it tells you that something about you is not working according to plan. It also tells your doctor that you might not grow out of it.

“People with dysthymia also are at increased risk for more severe episodes of depression. In fact, as many as 80 to 90 percent will get major depression,” states a report by the PsychCentral website, while rates of suicidal behaviour for dysthymia (PDD) are similar to those for major depression. Ian Goodyer, Professor of Child and Adolescent Psychiatry at the University of Cambridge and a practising child psychiatrist, told me he thought the diagnosis of PDD was a useful one in treating children, and that it provided “a nuanced way to think about children who are miserable”.

Professor Goodyer sees children whose social and educational lives are impaired and who are something other than unhappily angry (a different sort of disorder). They are sad children who lack social and emotional interest in the world around them. He doesn’t treat these patients with antidepressants, but uses the diagnosis to talk with the children, and most importantly to intervene and manage risks to such children within a family. He finds these patients have a lack of resilience, as if they are lacking a layer of skin. When I asked whether these children were born or made by their environment, he said there is evidence of family predisposition, as there is in major depression, and that it’s perfectly clear to any new parent that, even at birth, a baby is already ‘somebody’. The word personality is frowned on at a diagnostic level, but he quoted a clarifying sentence to me: “Genes propose, environments dispose” (a paraphrase of Peter and Jean Medawar’s “Genetics proposes, epigenetics disposes”).

Trevor Turner, a retired consultant psychiatrist in east London and a former vice-president of the Royal College of Psychiatrists, also recognised the diagnosis, though as a hospital psychiatrist he more often saw patients at the more severe end of the depression continuum. He comes from a working life in which more pressing and extreme forms of mental illness demanded urgent attention and strained the limited resources of the NHS. He sees the diagnostic world of the DSM, and the American Psychiatric Association which supports it, as remote from his always embattled NHS experience: “The ‘thymias’ which the DSMs discover – cyclothymia, dysthymia – are helpful for private practitioners in the States. They provide another disorder to be diagnosed, treated and billed for.”

Turner does not deny the existence of chronic misery, but inclines towards a cultural definition. There are people who chronically feel not quite right. They are tired and depressed, they brood and complain. They just don’t function as well as they’d like to or think they ought to. They feel they aren’t right in the world. Such people have a negative effect on others and are difficult to live with. They don’t add value to the lives of others, and this increases their sense of isolation. Although he believes that to some extent we all have our “emotional throttle set at birth”, the need for subtle refinements of diagnosis for depression stems largely, he thinks, from the relatively recent demand and expectation that we should be happy. We’ve reached a point where if you are not actively experiencing ‘happiness’ then you feel you are ill. And if your friends and family think you aren’t happy enough or making them happy enough, they advise a trip to the doctor. Although Turner, as a practising psychiatrist, used all the psychotropic medications at his disposal to treat very ill people, he reminds me about Freud’s notion of ‘ordinary human unhappiness’, which in those days, at least, was not a pathology. It isn’t that something isn’t wrong, but it might be that medical diagnosis and doctors are not the remedy for our troubled spirits.

I find myself increasingly thinking about the ancient system of the humours – black bile, yellow bile, phlegm and blood – expressed by Hippocrates and expanded by Galen. Then, as now, it was supposed that there was a perfect balance of physical chemistry, almost never achieved, which set the guidelines for deficiencies and excesses of the four humours. These ‘juices’ flowed through everybody in variable proportions. They were responsible for an individual’s personality or temperament, and when out of kilter caused all our physical and mental ills.

Given the debate that continues to rage about the action of the most famous neurotransmitters – serotonin, dopamine, norepinephrine – on our moods and mental wellbeing, we might as well be talking about the four humours. The magical idea of chemical balance has been with us for millennia – even if we feel our current discourse is backed by ‘proper’ science while early modern medicine was laughably speculative. It is attractive and plausible, and the idea of something measurable that can be adjusted by re-uptake inhibitors or enhancers is so much more seductive than considering the possibility that negative emotions, a darker vision, might have a proper place in the world.

With all the confidence of Hildegard of Bingen discussing the balance of humours in the 12th century, the Daily Mail, quoting Dr Cosmo Hallström of the Royal College of Psychiatrists and Professor Craig Jackson of Birmingham City University, told us in 2013 that you may not just be grumpy, cynical or antisocial – you might have an honest-to-goodness disorder:

“Dysthymia is linked to a lack of serotonin – a brain chemical that governs mood… Recent studies have found it may be caused by an imbalance of dopamine, another brain chemical. ‘We need a certain level of brain chemicals such as dopamine and serotonin to function well, and people that produce too little – or, in some cases, too much, thus upsetting this delicate balance – may experience symptoms of dysthymia,’ says Professor Jackson.”

Yet while all the diagnostic criteria for dysthymia/PDD seem to fit me to a T, there is a powerful voice in the back of my mind that demands something other than a diagnostic label for my understanding that I’ve always been this way. Many people, especially young people, resist medication, giving as their reason the fear that it will stop them being themselves, who they are. Doctors, friends and family (and now the Daily Mail) reply that they are unwell, that they don’t have to view the world and their existence in the way they do.

For a long time I refused to take antidepressants, although by the time I was in my early 20s I was self-medicating with barbiturates to achieve what I most dearly wanted: oblivion – a period of relief from my unbearable feelings. The ‘me’ that I was so keen on retaining was intolerable to myself; I really couldn’t bear to be without the buffers of strong hypnotics around me, yet I had a conviction that I should only numb the intolerable on a daily basis, not permanently alter it. In my mind it had to do with maintaining a line of truth to myself, so that it was always there, telling me how things really were. What I felt most urgently was that during episodes of depression, as well as in my generally low mood, I had to see reality face-to-face, and that those who were generally contented enough in themselves and with the world saw reality through a distorted, comforting glass that smoothed away the viciousness and horror.

I gave myself breaks with barbiturates, but most of the time I lived with the veil lifted. I lacked a screen that kept the awful alienness of the world, the nature of being in a causeless, pitiless universe, at a distance, and I saw with agonising (I’m using the word carefully) accuracy how things really were. I had no doubt about this. In fact, I have no doubt about it now. Even when the veil is present, something in the making of me means I know, as I knew then, that there is an intolerable reality lurking behind it, a bleak, inhuman emptiness, and that this is the truth behind the web of stories we tell ourselves about ourselves and the world.

At my best, I tell myself that accepting ‘pointlessness’ is simply to be grown up. All thinking, honest people who are not succoured by religion must know this. But the truth is I find it unendurable; I have never got to the point where I can live with the idea that there is no point. Nor do I really feel that human community or connectedness makes up for it. It is a great immaturity in me, a thin-skinnedness, and what keeps me depressed, as well I suppose as providing an underlying motif in my writing. Telling the truth – and that always seemed to me to mean the dark, unappetising truth – was essential, an absolute, conscious and compelling imperative of my life. I’ve never liked the rather pompous morality of this insistence, but it has always been there, not really a belief, but a necessity accompanying my existence. It was the theoretical core of my depression, if not my childhood moodiness. It was the outward expression of my despair.

I very much dislike the idea that writing (or ‘creativity’, a word I find idiotic and embarrassing) has a therapeutic function. I can’t ever recall feeling better after having written something – apart from the satisfaction of having got something done. Nevertheless, it is a great good fortune that I have been able to be a writer. It has, perhaps in a literal way, saved my life; at any rate it’s given me a way of passing my time that lets me engage in a controlled way with what I can’t avoid about myself. The sadness and anger I feel about myself and the way of the world is sometimes reflected back at me by certain other people who are fortunate enough to be able to write or make art as a way of life.

Martin Rowson draws ferocious political cartoons for the Guardian. I spoke to him about his experience of living with an affect that produces such workDrawing depression. He regarded the diagnosis of PDD in a similar way to Trevor Turner: “Special interest groups pathologise everything they can.” The basis of his work is humour, he says, and humour is about unhappiness. Happiness is “the big lie of neoliberalism”, the pretence that we can have “whatever we want, whenever we want it, for ever. That not to be happy is to be a social failure. It’s all nonsense.” Happiness and contentment is merely the quiescence that allows everything that is wrong in politics and economics to continue. It is his job to laugh at power.

“Making raspberries, the sound that children use to take down pomposity, is one of the first noises infants make. We must laugh at the unbearable,” he said. “Things are horrible, so I portray the horrible.” But he channels his sense of despair, and that of his readers, into mockery of the rich and powerful. “My job is to afflict the comfortable by making people laugh at them.”

He puts his fury at the world down on paper every day, and yet, in doing so, he works in a medium that satisfies him. Four hours a day working in watercolour, he feels, is a meditative, calming activity in itself. He sees himself as a genial, affable person, not morose at all. I can’t experience writing like this, and I could never be described as affable, but speaking to Rowson, I experience a conviviality that I often have with individuals who have what others might see as a dark or negative view of the world.

Laughter is where I connect with people and how I know who I can connect with. I’m not sure that there has been a study of the relationship between humour and despair in academic psychiatry, but read Samuel Beckett, Thomas Bernhard, look at the work of Martin Rowson or Steve Bell, listen to the jokes of persecuted or oppressed communities and it is clearly an essential component in the survival of the gloomiest. Our depression might be persistent, our affect low, we might have started life getting out of the wrong side of the bed and be incapable of looking on the bright side, we may dismiss happiness as a plot against reality, but my word, how we miserabilists laugh when we share our gloomy view of the world.