Shoot the Damn Dog: A Memoir of Depression (27 page)

Over sixty per cent of the human brain consists of fat, which insulates nerve cells to support proper electrical signalling. More than one third of the brain’s fat is composed of omega-3 fatty acids such as those found in fish oil. Neuroscientists believe that deficiencies of essential fatty acids may upset the fatty make-up of the brain and contribute to mood disorders.

The crucial ingredient seems to be EPA (eicosapentaenoic acid; an omega-3 fatty acid), and research seems to indicate that to have an effect on depression you need to take 1,000 mg (1 gram) of EPA a day. You could, of course, get that amount from eating fish if you were prepared to stomach more than half a kilo of wild salmon daily. Farmed salmon is thought to contain less beneficial fats and is also implicated in high levels of toxins.

EPA supplementation is also particularly good for people with depression that is resistant to treatment with SSRI medication. It appears to improve the accessibility of the brain to the antidepressant and allow it to do its work. It is important, though, to take pharmaceutical-grade oil with a high content of EPA, so it’s worth searching around. The Internet is a good source. As EPA is only one constituent of omega-3, you need to work out the number of capsules or the amount of pure oil you need to take in order to get the therapeutic dose of one gram of pure EPA. You should allow three months for it to have any effect and it does not work for everyone.

I also take complex B vitamins daily. I had not considered taking vitamins until I had a blood test for a quite unrelated condition, last year. The doctor asked me if I was eating well because my vitamin B12 levels were abnormally low. I have always eaten well but, since my illness, I am particularly careful about my diet since poor nutrition seems to me an obvious link to poor mood.

So I was somewhat surprised until I discovered that low levels of vitamin B12 are often linked to higher incidences of depression. A report, published in
BMC Psychiatry
and the result of a study undertaken by researchers at Kuopio University Hospital, Finland, suggests that there is a link between vitamin B12 levels and the probability of recovery from major depression. A further report maintained that B12 makes antidepressants work more effectively although researchers are still puzzling over why some depressed people have lower B12 levels and recommend further investigation.

All I know is that taking B12 works for me. On a couple of occasions I have run out of vitamins and omega-3 or grown bored of taking my daily dose of pills and oils. On both occasions, within a couple of weeks, my mood plummeted. Sometimes, we are our own best evidence.

I have learned to calm my mind in other ways too. One of those is meditation.

There are many different forms but I practise Transcendental Meditation (or TM), which I took up in order to counteract the early morning waking, which I did not at the time realise was the first symptom of my illness. I thought it would calm my frantic mind but I think now that it had other, less enjoyable effects.

My teacher warned me that meditation is not entirely benign and that it has the power to disturb long-repressed feelings so I was not to be too concerned if I experienced sudden flashes of anger or grief. In me, it seemed to uncover much more than that but whether it simply foreshadowed the depressive storms that were already gathering on the horizon, I do not know.

I do know that when I was very ill, I was unable to meditate. Simply closing my eyes set off such storms of grief and terrible imaginings that I became frightened of doing it at all. This, apparently, is quite common in severe depression and many meditation and yoga teachers advise students not to close their eyes if they experience it.

I simply abandoned meditation altogether and I would say to anyone in the middle of a depressive episode that it would be best not even to attempt it. If you do want to practise some form of self-soothing then gentle breathing exercises performed with your eyes open are far kinder.

As a part of recovery, however, meditation has proved invaluable. Once the worst of my illness had passed, I began to meditate again, at first tentatively and now, regularly for twenty minutes every morning. If I find the time, I meditate in the evening too, as twenty minutes, morning and evening, are described as having the most powerful benefit. The effect appears to be cumulative but for me the most obvious benefit has been a deep-seated feeling of calm. It is, fanciful as it sounds, as if somebody has turned the volume down a little. There are acres of research on this but I simply feel that as depression is precipitated by stress, it makes sense to do anything that one can to reduce that.

As to which form of meditation, it is best to go to a class or a teacher and learn the discipline properly. As a group practice, it is formidably powerful and, once again, a connection to other people is profoundly helpful to the depressive.

The last, persistent symptom of my depression was the throat monster, good old
Globus hystericus
.

One morning, when I was meditating, it was particularly bad. It had been, for weeks. I thought, I can’t go on like this.

A little while later Maggie, a friend, telephoned.

‘How are you?’ she said.

‘Really low. It’s this thing at my throat. It’s dragging me down. Every time I feel it, which is every day, it reminds me of the way that I used to feel when I was really sick with depression. It makes me believe that I’ll never be right again.’

‘Go and see my pin man,’ she said. ‘He’s brilliant at stuff like that.’

‘What? Mad people?’

She laughed. ‘And the rest.’

I went to see the pin man. His name is Robert.

‘I can get rid of that for you,’ he said. ‘The Chinese call it plum stone.’

‘You can?’ I said, wondering if a few acupuncture needles would succeed where one psychiatrist, five therapists, three psychiatric units, two tons of antidepressants, Xanax, Valium, and five vats of pure alcohol had failed.

‘Sure, although it may take two or three sessions.’

It took two.

I go and see Robert every two weeks, without fail. I have no idea what he does or how acupuncture works, although he did try to explain it to me.

Actually, I don’t care. I just know that his needles work, that they keep me, in some mysterious way, in balance. But, like any other treatment, consistency is crucial. One session is not enough. It is a commitment to health and, like any other commitment, requires steadiness of purpose.

Acupuncture is one of the few alternative therapies to have found some sanction from science. In the first study of its kind in the West, reported in the
Psychiatric Times
in 2000, Dr John Allen, associate professor of psychology, cognitive science and neuroscience at the University of Arizona, got together with acupuncturist Rosa Schyner to compare the reduction of major depression in three groups of women. For eight weeks the first group of women received specific acupuncture therapy for depression. The second group received acupuncture treatment for symptoms not associated with depression. The final group was put on a wait-list. The women in the first two groups were not told which treatment they were getting.

At the end of eight weeks, the women who received specific acupuncture treatment for depression were significantly less depressed (sixty-four per cent experienced full remission according to
DSM-IV
criteria) than the women who received acupuncture treatment for symptoms not related to depression.

There are now many more trials under way. They look promising. It seems that acupuncture may well be able to deliver a release from severe depression at least as good as antidepressants. There are, though, two other variables; the acupuncture practitioner and the patient. It is worth searching out a good acupuncturist and it is sensible to understand that it may not work at first. Try, try and try again. It is the mantra of recovery, in all things.

If there is any lesson I have learned from depression, it is this.

We have to let go—of self-pity, anger and blame. We are what we are. Life is what it is. It will be what it is, however we are, and the best way to deal with it is gently. It took me a long time to learn that. In every psychiatric hospital all the psychiatrists, therapists and nurses kept saying the same thing.

‘You must let go, Sally.’

The trouble was, I did not understand what they meant and nor could they tell me how to do it. Whenever my mind wrapped in coils so black and tight and knotted that I thought they could never be undone, I tried to do as they suggested.

The harder I tried, the more my mind seemed to hold on.

And then I came across the writings of a Buddhist teacher, Jack Kornfield, an American who went to Tibet as an adolescent and became a monk, in part to calm the agonised tangle of his mind. He went on silent retreats, spent long hours in meditation, learned humility, acceptance and non-judgement. He was happy. And then he returned to New York, and discovered all that he had learned sitting peaceably halfway up a mountainside in Tibet was no match for the tense speed and aggression of Manhattan. He retrained, as a psychologist, and began to match the teachings of the East to the knowledge of the West.

Here is something he wrote:

When I read that I felt one of those rare moments of clear, lucid understanding. It was a moment of light.

Years of clenched meaninglessness slipped into place. The coils loosened and fell away. It did not last, of course. Nothing does. But it gave me a sufficient understanding to know that when I get into difficulty, the best way for me is not to try to let go, but to let it be.

And so it is with my illness. I know that I am fragile in some way. People often say, ‘Are you frightened it will come back?’

Of course.

Do I worry about it?

No. Worrying is a holding on to, a tightening of the coils. I take action to avoid a relapse. That’s different from worrying about it. Worrying is inaction, a paralysis of fear. It is an agitation about a future that has not happened, and a past that cannot be changed. It can be understood, explained, even apologised for. But it cannot be changed.

Here is another story I find useful.

It is about a young Buddhist novice who was learning meditation with his master. It was a hot day so the windows were wide open. Across the way, a car engine was being persistently revved. The young novice squirmed and shifted on his cushion. He peeked at his master who was motionless, his eyes closed in beatific peace. Finally, the novice could stand it no longer. He approached his master.

‘How can you meditate with such a noise?’

The master did not open his eyes. ‘What noise?’ he said.

‘That car!’ exclaimed the novice. ‘Isn’t it bothering you?’

‘Is it the car that’s bothering you?’ said his master. ‘Or is it you that’s bothering the car?’

The novice thought about this for a while, then walked silently back to his cushion and sat down and closed his eyes.

I often think of that story when some detail of life (sometimes an event but more usually a person, as in the spirit of Sartre; ‘hell is other people’) irritates me. Are they bothering me? Or have I fixed on something about them in some part of my mind and it is, in fact, me who is bothering them?

Even the thought is usually sufficient to stop the bother.

The last method I practise regularly is gratitude.

I know, it sounds too cute for words.

It works.

Other than this book, I write regular columns for newspapers and magazines.

Sometimes, the deadlines get crazy. Sometimes, I want to pay attention to the rest of my life. Sometimes, I do not want to write at all.

When that feeling of stress—trapped by work; cut off from pleasure—becomes too overwhelming, I let loose the gratitude theory.

It goes something like this.

I am grateful for the talent to write.

I am grateful that people pay me to write.

I am grateful that I have the ability to write, after losing it in depression.

I am grateful that something that gives me so much pleasure also gives me the ability to earn a living.

I am grateful that people are sufficiently interested in what I have to say to publish it.

I am grateful that I can take my work anywhere and do it everywhere; up a mountain, in the middle of the night.

By the time I have finished, I am generally able to settle down happily to work. I use it in other ways too. Every night, before I sleep, I run through a gratitude list in my head. The trick is to stay with the details; otherwise the great temptation is to scurry past the more obvious objects of gratitude. For example, I am always, eternally, grateful for my daughter so it’s curious how easily she can get passed by in my head. But if I concentrate on some detail of Molly and focus on the fact that she had a happy day at school that day or remember that she and a friend had made up a quarrel, I see and appreciate her presence in my life with greater clarity.

Nor do we need to be solely grateful to the people we are most intimate with. I often find myself grateful for the comfort of strangers; a man who gave up his seat for me on the bus, a woman who helped me out with a heavy shopping bag. Remembering small acts of kindness puts the world in a finer, sweeter order.

Some people write a daily gratitude list, but however you do it the consistency of habit has undeniably positive results. It teaches you to see life as a blessing rather than a trial, or a punishment, which is where the depressed mind is inclined to go. Obviously, gratitude as a daily practice is not new. It has been used by every spiritual discipline from Buddhism through Islam to Christianity. However, the scientific study of it is new, most prominently spearheaded by Martin Seligman, a professor of psychology (with a string of other degrees to his name) at the University of Pennsylvania and author of
Authentic Happiness
. According to Seligman, ‘Empirically the amount of gratitude is related to baseline levels of happiness. The less gratitude you have in life the more unhappy you are, interestingly.’

It was Seligman who first defined the term ‘learned helplessness’ when he was working in animal-behaviour labs. Dogs were given electric shocks. When they learned that no matter what they did, they couldn’t avoid the shocks, they simply gave up trying. Later, even when they could easily escape, they passively endured the electric shocks. Seligman went on to apply this finding to humans and developed the theory of learned helplessness as a model for depression.

In an interview published on
Edge
, a website devoted to an interplay of science, society and culture, he explained that:

The wondering why became the Positive Psychology movement, which teaches people what Seligman calls, ‘learned optimism’.

Those interventions consist, in brief, of expressing gratitude, knowing your strengths and crafting everything you do to use them as much as possible and discovering an activity that consistently challenges and entertains you. For some people that might be studying nuclear fission, for others it could be doing a jigsaw puzzle. It doesn’t much matter. What matters is that it is sufficiently absorbing to lose yourself in and sufficiently challenging to keep you eagerly anticipating the next moment. Mine is gardening. When I am in the garden, I forget everything but the task in hand. Seligman also discovered that a single act of kindness makes people feel far better about themselves (for a full day) than any transient act of pleasure, such as buying a new pair of shoes or going to the movies. He calls the feeling it inspires, elevation. An act of kindness might be helping an elderly neighbour to do their shopping or standing aside to let somebody pass instead of barging past them and making them feel they don’t matter or exist.

When we think about how other people are feeling, we stop concentrating so hard on ourselves. We expand rather than contract, and so the world expands along with us. We can change our whole day (and other people’s) with a single kind word, or ruin it by an angry exchange. By thinking outside ourselves, we also stop thinking about how life isn’t giving us happiness and how we might give a little happiness to life.

There is, though, a final route to optimism. Here’s Seligman again:

Whether we feel that way through a spiritual practice, a walk in the park or (as in my case) sitting around with a bunch of depressives or alcoholics doesn’t much matter. What matters is to feel that we are not alone.

Every story deserves a happy ending. Here is mine.

Tom and I met again, three years after we parted. We had not seen each other at all during those years but he was never far from my mind—or from my heart. We met in a pub. He bought me a drink, lime and soda. Then he bought me a cup of tea.

‘You’re a cheap date these days,’ he laughed, but I noticed his hands were shaking. So were mine.

He said, ‘How’s your love life?’

I felt as if I was about thirteen. Was he asking me as an old friend, or because he wanted to know if I was available? I searched for a right answer and then, because I could find no right answer except the truth, I said, ‘Non-existent. We were too much of a hard act to follow. How’s yours?’

He was silent for a while, and then he smiled at me. ‘The same.’

Two years later, we were married. It is, in its own particular way, bliss.