The black dog

Sometimes people talk about the "black dog" in relation to depression, but what do they mean? This video explains it brilliantly and gives a real flavour of what depression feels like.

WHO black dog video

When the black dog comes to call it's difficult to do anything - just getting out of bed requires superhuman strength. I know of someone who had to leave home because their partner would constantly moan that if they were home all day, then why couldn't they do something useful while they were there - put the washing on, mow the lawn - anything. I don't suppose the partner meant to be hurtful but they were actually making them worse - made them feel even more of a failure than they already felt. If you were ill in bed with the flu, you wouldn't be expected to do anything. Just because you can't see the illness doesn't mean it doesn't exist.

Another good example of what depression feels like is in this excerpt of Marian Keyes book This charming man. Theres a few things in this that are classic depression symptoms - putting on a face, not being able to do the simplest of tasks, overthinking everything, feeling anxious, looking for quick solutions, sucidial thoughts. When I first read this book, it was like reading about my own mind. 

This Time to Change advert also gives some good insights into what depression feels like. For example - feeling so fragile that you feel you may disappear into dust if someone says "boo" or wanting to hide in the smallest, darkest hole you can find (I wanted to hide in the wardrobe although other people have said they wanted to hide under the duvet). Some other examples in this video are what people think depression is - ie a form of "madness" (but its not). And, the end shows what happens when you're feeling a bit better - absolutely nothing, you are exactly the same as everyone else.

What is depression like?

Depression is not about being sad or a bit fed up, indeed, there's nothing much worse you can say to a depressed person than using the word "depressed" in an insignificant way eg "Yeah I'm so depressed Eastenders isn't on tonight".

You can be depressed when you have everything you could want - Hollywood stars like Catherine Zeta Jones can have depression. Just as someone living on the street with nothing can be entirely depression-free. 

Depression isn't something you can control - you cant "pull yourself together". Just as friends and family cant fix it by giving you a gift, or taking you on holiday or talking through your problems. 

Depression isn't constant - the phrase "good days and bad days" is used in connection with depression and it is very relevant. Just because someone seems happy or has managed to get through a challenge doesn't mean they are "fixed". One therapist I saw suggested marking the days on a calendar - a smiley face for a good day and a sad face for a bad day. In the beginning the calendar may consist entirely of sad faces. You know you are getting better when the good days outnumber the bad days. But both will still exist. 

I know of someone whose work colleagues got frustrated with her because she was always posting on Facebook about the things she'd done, places she'd been and photos of her smiling and happy (and yet she was off work with depression). But that's typical of depression - you do have moments of "happy" but you are also very concerned about how you appear to the outside world - you want to appear "normal" so you will only venture out with your face (and often smile) on, you willing only show the world your happy face, even if you're not feeling happy - you pretend, which makes going out difficult and hence you'd rather stay in (which makes you even more proud of yourself when you do go out).

Another symptom of depression is self medication - in my case, its alcohol and shopping; but it can be drugs, exercise, food, energy drinks, over the counter medication like st johns wort or vitamins. Anything to make you feel in control or that bring on the happy hormones even for a short time. Unfortunately that is why depression and addiction often go hand in hand. 

So how can you help? I went to a conference about how to deal with mental health in the workplace, and the answer was simple - ask the person, as each case, each person, is different. Some things are universal though - keep lines of communication open. Just because someone doesn't want to talk today, that doesn't mean they'll never want to talk. Depressed people often have phobias of phones. I have one friend who will arrange to meet up and then not turn up and not answer the phone or respond to text messages. We just write it off as a bad day and try again next week. Of course "asking the person" isn't always helpful since you can never be sure you are asking the person or the "face". At my worst, whenever anyone asked me how I was, I'd smile and say "fine". Depressed people will often miss doctors appointments - either because they didn't have the energy to get there or because they didn't want a light shined on what feels to them as the black, disgusting side of themselves. Of course that makes everyone think they are faking or better which means every more work the person and even harder to seek help next time. The system doesn't work well for mental health - its designed for physical health where the person hurts and wants help, mentally ill people feel abnormal and ashamed and will do everything to avoid "help" until its too late or they are so low it is a very difficult (and long journey) to get back from.  Anti depressants (and talking therapies) are not quick fixes - you should probably allocate at least a year to them.

That's why I am writing these blogs and supporting the Time to Change campaign. We need to be able to talk about mental health more openly so you can recognise symptoms in yourself, or others, quicker which will allow you to stop the illness before it gets too strong. if you find a lump - you go to the doctor straight away or it may be difficult or impossible to remove, the same is true for depression. Go and talk to someone!

Marian Keyes "This Charming Man"

This is an excerpt from Marian Keyes "This Charming Man" (2008) p243-263. It gives a good idea of someone going through depression. 

On the in breath, “I’m. ” On the out breath, “dying”.

That was the wrong mantra. It should be: On the in breath, “All”. On the out breath, “is well”. All is well. All is well. All is well. I’m dying. I’m dying. I’m dying. I’mdyingI’mdyingI’mdyingI’mdying.

But she wasn’t dying. She just wished she was.

…

Her soul? It felt like a tomato which had been left at the bottom of the fridge for four months. Black, reeking, rotting. One touch and it would collapse. It sat at her centre, infecting her entire being with filth.

…

Yes, yes, and remember to smile.

…

She shouldn’t have gone to Dublin. Over the weekend, putting on a cheery show in front of her family had depleted her, leaving her lower than ever.

…

There was no way of enduring it while Dr Kay found Prozac in the book, showed her the contraindications, then found the other drug.  It would probably take less than a minute, but she didn’t have a minute in her.

…

There was something a little shameful about having a short drive to work. Twenty minute commutes were for losers. Real people endured a macho hour and a quarter; it was important to have something to complain about. While she was stopped at the traffic lights on Wimbledon High Street, a bus passed in front of her, the huge letters on its side – an ad for a DVD – streaming down the street like a banner. FEARLESS. It hit like a stamp to her heart. It was a message.

Fearless. Today I will be fearless. Today I will be fearless. Today I was fearless.

But even after repeating it several times, she remained doubtful. It didn’t feel right. No, this wasn’t meant to be her message. The ad on the next bus would be the one.

But what if a bus didn’t come by the time the lights changed. Then she would have to go without a message today. She was anxious. She wanted her instructions.

Don’t change, don’t change, don’t change, she pleaded with her traffic lights.

…

As she waited for the barrier to the underground car park to lift, she noticed that she was ten minutes late. She couldn’t understand it. Shed had spare time this morning. But time played tricks on her: it jumped, stretched, swallowed itself. It wanted her to know that she couldn’t control it and this frightened her.

…

It was time for her to open her car door and join the world; instead she slumped back against her headrest. Eight hours. Of other people. Of having to talk. Of having to make decisions.

Get out. Get out. Get out.

She was as powerless to move as a butterfly pinned to a card, but her paralysis mixed unpleasantly with the knowledge that she was late again and getting later with every second.

She was moving. She was outside the car and on her feet. The lump of lead in place of her stomach was so dense, she could hardly stand for the weight of it. She felt as if she was staggering as she walked towards the life, as if her knees couldn’t support the burden of herself.

Kill me kill me kill me.

She looked at the lift call button. Her hand was supposed to press it. Nothing happened.

Press it press it press it.

Rico was the first person she saw when she opened the door. He’d been watching for her. His dark eyes kindled with warmth. ‘How are you?’

I’m dead. I’m dead. I’m dead. “Fine. You?”

…

Everyone laughed. Marnie managed a wobbly smile.

…

She just couldn’t talk to people anymore. She certainly couldn’t hustle for business and she couldn’t articulate precisely why. The only explanation she could find was that it shamed her. She didn’t want to bother people; she didn’t want to draw attention to herself; she didn’t want to ask for anything because she couldn’t endure the rejection.

Because she had no other choice, she forced herself to try. But she couldn’t strike the right note of breezy fun (usually with men) or trustworthy calm (women). Her true voice was buried beneath a mountain of rocks, her treacherous mouth wouldn’t say the right words, and when she tried to smile, she found that she twitched instead. She came across as pushy, strange and desperate; she was embarrassing people.

She’d thought returning to work would fix her but it had made everything worse.

…

Then Bea, the office manager, had left and Guy had suggested Marnie step into the breach. It was both a relief – at least now she had a regular salary – and a humiliation. She was a failure. Again.

…

A file was waiting – like an accusation – on her desk. One of Wen-Yi’s. It was the Mr Less sale. Her heart dropped like a rock off a cliff.

This file was cursed.  So many things had gone wrong. She had mailed the original documents to the wrong address, one of Mr Lee’s many rental properties, where they had gathered dust on an unoccupied mat for two and a half weeks.  She had sent photocopies rather than the originals to the building society: a heinous offence. She had lost – no other explanation – the direct debit form authorizing the building society to recoup their monthly payments; it should have been in Mr Lee’s file and it simply wasn’t and she had no idea, no idea all, where it should have got to. Worse, she remembered having seen it, so it wasn’t as though she could blame Mr Lee by saying he had never filled it in.

Her glitches and omissions had slowed down this sale by several weeks; she couldn't bear to let herself know exactly how many, but sometimes her brain broke free of her control and ran off, taunting her by totting up the different delays while she desperately tried to recapture and silence it.

…

Satisfied that she really had the correct piece of paper, she began to fill it in, paying such attention to the details that she began to sweat. What had happened to her? When had she bruised her confidence so badly that she couldn’t trust herself to do this simple task?

…

Guy trumped Wen-Li; she had to do the post. She moved Mr Lee’s form to the safety of her in-tray and began tearing at the envelopes with her nails.

Guy frowned at her. “Use your letter knife”.

“Of course.” She couldn’t even open the post properly. She reached for her desk-tidy and drew out a letter knife. She had a sudden flash of plunging it into her heart.

…

While she was at the photocopier, she decided to copy all the other signed documents which had come in the post. She forced herself to concentrate hard – on not mixing up the forms and on ensuring that it was the photocopies which went into the files and the originals which were put aside to be sent to the banks. It wasn’t rocket science, she was well aware of that, but so much of the time she seemed unable to get it right.

…

A coincidence, a happy one, she hadn’t counted out how many envelopes shed need, she had just happened to accidentally select the exact number.

I feel better, she thought. It must be the Prozac.

Even though she hadn’t started actually taking it yet. Simply carrying the prescription in her handbag seemed to be having a positive effect.

Then her gaze fell on Mr Lee’s form – still waiting patiently in her in tray to be enveloped and mailed – and all the light went out. She didn’t have an envelope for him. The stationary cupboard was no more than four or five yards away, but she was unable to get her legs to stand up and walk. She couldn’t understand it. It wasn’t physical exhaustion, as if her legs were tired. It was like there was a force field around her, pressing down on her with irresistible weight. She could have jokingly asked one of the others to help – Rico would do it – but it was an odd thing to request. And by now, she couldn’t even speak. Shed used herself all up.

It’s urgent. It’s urgent. It’s urgent.

But that was why she couldn’t do it: it was too frightening.

I’ll do it soon. I’ll do it soon. I’ll do it soon.

But whenever she caught a glimpse of the form out of the corner of her eye, she felt as though she were being flayed alive, so she took it from the in-tray and shoved it in her drawer, beneath a jar of vitamin B5 – ‘the happy vitamin’ and a packet of St John’s Wort.

…

She hadn’t taken any vitamin B5 all day – no wonder she felt so wretched – but when she opened her drawer she saw, lurking beneath the vitamin jar, Mr Lee’s form. Still there. Still unsent. The floor tilted beneath her. How could she not have done this? When it was so important?

And it was too late now, she had missed todays post.

She vowed, with fierce promise, that she would mail it first thing the following morning. But what if Wen-Yi found it? What if he decided to check up on her and look through her stuff when she had left for the day?

Seized with terror, she slid the piece of paper from the drawer and shoved it into her handbag in a quick jerky movement.

…

Words spoke in her head: In some place in the world, right now, someone is being tortured. Make it stop. Make it stop. Make it stop.

Whoever they are, wherever they are, give them some relief.

This was her own fault. There had been an item on last night news about two teenage girls who’d been kidnapped by four men.

…

And why did no one else seem to obsess as she did?

…

She was Verity’s mother, it had to be her fault.

CBT

I've done CBT (Cognitive Behavioural Therapy) three times but lots of other people (counsellors, well meaning friends and family etc) have talked to me about aspects of it.

For those not aware of it, it basically involves identifying negative thoughts and addressing them with the aim of taking the power out of the thought and encouraging positive and more logical thinking.

For example, I often think I'm totally useless. CBT has taught me that when this thought comes to mind, I should say "STOP" (the therapist suggested saying it out loud as it gives it more power) and remind myself that:
1. I'm not "totally" anything - we all have shades of light and dark in everything
2. I'm not useless - I can do lots of useful things like looking after children, talking to people, learning new things, making jewellery
3. Who determines "usefulness"? - there are no rules to life, no "should be", no "have to" we're all different and what I consider useful is not the rule of life

The idea is that if you practice this skill often enough it will become automatic to think positively rather than negatively. During the therapy course we were told to write down any negative thoughts and this rethinking action to give it more weight and to reread it when you need encouragement. It is also a helpful tactic I've learnt to write down all the positive things that have happened during the day - however small, to encourage positive thinking to drown out the negative thoughts.

The problem with CBT I found is it is pretty impossible to do when you have full blown depression when the negative thoughts are at their strongest. (During my last bout of depression, I couldn't even write down the negative thoughts because I couldn't identify them as negative - they were just thoughts and writing them down seemed to validate them even more). And when you're "up" the negative thoughts are fewer and have less power and therefore don't feel like they warrant this re-wiring procedure.

However, the last couple of days, I have been thinking about my CBT training. Specifically with my tendency to fall into the "all or nothing" (which is one of the recognised negative thinking patterns) trap.

(Im a victim of all the different types of negative thoughts (of course - i wouldn't expect anything else from my "all or nothing" persona!). For your information, here is a rundown on them: Negative thoughts)

For example, I can't go running, I have to run a marathon; I can't write a blog, I have to write an award winning, salary earning blog.

The trouble with this thinking is that when the "all" doesn't happen then I feel like a failure, which is magnified because once I decide I want to do it, I feel I should be at the "all" point and therefore I have failed.
Looking back, I can see this happen in lots of places - i decided I wanted to be promoted and when I wasn't as soon as the thought entered my head, I was a failure.

But the one that sticks out and is perhaps what defines me today is that I always wanted a big family (and when I say "always" I'm fairly confident in the use of the word - I remember wanting babies as soon as I knew where they came from) but because I didn't have one, then I was miserable, I thought about it constantly and what a failure I was for not having children (I can remember this thought at least age 18) - I was unhappy when I had no children and when I had one I felt worse because it wasn't the dream I thought it would be and I ONLY had one. 'Normal' people would say "but you've got a big family now" but it doesn't work like that in my head - in my head I failed for 30-odd years and that's a lot of failing to make up for. :(

Logically, we can say a thought isn't valid - but logic and emotions are two different things. When I would "present" my thought journal to the therapy group, the therapist would ask "and do you believe the rational answer to your negative thought?" And I'd be puzzled - absolutely not: it's crazy talk, I AM totally useless, no amount of rationalising is going to change that. And that's the problem with CBT - it's good in theory but it's another solution dreamt up by non-depressed people. There is a lot of research done to back the benefits of CBT (for example see this BBC Science report) but its not the quick fix, the government want it to be.

They are funny things - thoughts. Where do they come from that can make us so miserable? Maybe we should identify the root cause and address that rather than the symptoms of how we feel when we think them. Where do these "should" rules come from? (A woman "should" be able to work and have children, A man "should" provide for his family) and how can we diffuse their power over us?

Mental health, or depression in my case, is something that needs to be opened up to discussion so we can reduce its stigma so we people can talk about it more and allow more positive thoughts circulate. Locked inside my own head I feel like a failure for having depression - if we talked about it more, I (and others less able to divulge their feelings) wouldnt feel like failures and negative thoughts would get less.

I've had GPs tell me anti-depressants aren't addictive (obviously said by someone who hasn't tried to come off them), family members tell me to "pull myself together" and co-workers ask me "but you're alright now though aren't you?" All scenarios that could be resolved (and make me feel a little less repulsive) by a little bit more education. That's why Im supporting Time to Change Wales to get us talking more about mental health - don't worry, its not catching (and anyway, you've probably already had it at one time and in some format)

About me

My name is Nic Danson and I have depression. It's taken me a long time to be able to say that in the same way as I would say "and I have green eyes" but that's how I feel about it. It's part of me, like it or lump it, you accept me, you accept that part of me. 

I first tried to kill myself when I was 17. I had failed my driving test for the third time and having never failed at anything before I didn't know how to cope. I took a knife and went to the field across the road from my house. Luckily (or unluckily) the knife was blunt and I only succeeded in making a hole in my jumper and so here I am still. (And I passed my test on the fourth attempt). Since then, when doctors have asked me if I think about suicide I look at them strangely "doesn't everyone?". It's only since I stopped thinking about it in the same way as what shoes to wear that I realise it's NOT normal to think like that. 

I hated university and the depression reared again. People think depression means being sad but it's not that at all. I could laugh and joke with my friends and I got through each day. I call it putting one foot in front of the other, because that's what it feels like - you get through, you exist. But I had a shopping addiction - I'd buy things that didn't even fit and put them at the back of the wardrobe and pretend they weren't there. I also spent a lot of time on my own. I developed what I called "the outside Nic" - she's happy and confident and talks a lot to everyone. But she's exhausting and after putting on the act for a while, I'd need a rest and that meant being by myself. 

Things got better and I carried on my merry way until I had my first baby. I'd gone from being busy and useful in work to being at home with only a baby for company and feeling useless. I managed to keep going until I went back to work and things got back to normal. Then I had my second child and this time the post natal depression was worse. Doctors offered me anti depressants but I didn't want to stop breast feeding because that would make me a failure as a mum (I now know you can breastfeed on anti depressants) so I tried the technique I know best - hiding it and putting on a show. I went back to work earlier - when the baby was 4 months old. 

I had to find new coping strategies - I couldn't spend much time on my own (with my own thoughts) so I'd take the train to meetings in Birmingham rather than drive. When I was in the car, I'd play inspirational songs to psych up to putting on "outside Nic". I just kept going, ignoring and hiding.

I then had a miscarriage. That was tough. I tried going back to work straight away to do what I knew best - acting. But I managed an hour before I had to go back to the doctors and get signed off sick. After a couple of weeks off. I went back and carried on. 

Ironically (as will become clear), my third baby is the only one I think I didn't have post natal depression with. I used to lie on the sofa with him and relish the feeling of the happy hormones flooding me. I can still remember it. It was bliss. 

Unfortunately, 2 years later was when the big blow came. In old fashioned terms I had a "nervous breakdown". I'd drive to work wishing I could lose control of the car so it would all be over. The inspirational car songs got louder and on constant repeat. My manager started to notice a change in the tone of my emails "it has been decided", instead of "I'm happy to announce" and called me into his office. I know I started crying. I can't remember what I said but I remember his face when I said I got post viral depression and hangover depression. To me - that was and still is, entirely normal. Everyone has up and down moods - mine are just more pronounced. And one of the benefits of depression is that I am more conscious of my own emotions. 

I put it down to stress - three children and a full time job. I'll be ok after a holiday. I looked into hypnotherapy to improve my confidence. I just needed to "pull myself together". People told me I should go part time - but I couldn't do my job part time and I had to be good at my job, that was what defined me. But then I couldn't eat. I slept all the time. Eventually I couldn't bring myself to drive to work anymore and I went to the doctors. 

That doctors appointment was awful. I felt like I was having to prove myself. She was obviously going through a checklist of depression - eating, sleeping, suicide, blah blah blah. But to me she didn't seem compassionate at all. At the end of her test, I must have passed because she said "I think you've got depression, I'll give you some anti depressants". I felt relieved but also a failure. Only people who can't cope take anti depressants. 

After a week or so on the anti depressants I felt worse. I had to grip the steering wheel of the car to stop myself from driving through the level crossing where I live. I'd drive to the shops and I had to force myself to turn left to go home instead of turning right to run away to "Home and Away" (the tv programme where everyone is happy and the sun always shines) (I still tell my kids I'm running away to Home and Away when they wind me up!) 

I went back to the doctors and she increased my dosage which seemed totally bizarre to me - surely if they were making me feel worse, they were no good? But she was right, I did start to feel better. 

I was off work for 3 months. The company did everything they were supposed to do. I was referred to occupational health and had to see a doctor. I sat outside the office psyching myself up for ages. But doctors do what doctors do in these situations - he basically asked me what I wanted him to write. I said I was fine and I was ready to go back to work. So he did. And I did. 

The company wanted something or someone to blame. I said I was finding it hard working with one particular manager so they decided I was being bullied by him and moved me to a different area. (They didn't think maybe I was finding it hard because I was ill?) I was given a job where I was away from everyone and worked on my own. I found it more and more hard to pick up the phone to ring people. Simple things felt like climbing Mount Everest. Eventually I was called in and started on a performance improvement plan. I felt sick. The only thing I'd ever been good at was working. Now I failed at that as well. I was useless. Eventually we (the company and I) agreed that I would leave with best wishes all round. I still miss that job. I still yearn for that person I was before (the breakdown). I still think Ill go back one day but in my heart I know I've changed, work has changed. And, if I'm honest, I can feel the anxiety ramp up as soon as I look at a job specification. If I go back to work (and I truly hope I do one day) it'll be somewhere different, somewhere less stressful. 

Since leaving work I've had my ups and downs but the "outside Nic" is more an exaggeration of myself rather than a totally different person. I still find her tiring but I can counter that by having less to do and planning quiet times. There's a theory about "spoons" (Spoon theory) which strikes a chord with me. My "to do" list may seem a bit pathetic to some people but I get by. 

Since leaving work I spend the majority of my time with the other mums in the school playground. When I tell them my story, they most often say "I've had depression" or "I take anti depressants". I think I've so far met 2 women who have had no experience of mental health problems (at least until now). So the 1 in 4 ratio (1 in 4 people have a mental health problem. (Office for National Statistics, Psychiatric Morbidity (2007) makes total sense to me (or is perhaps even a bit conservative). 

I'm a member of a couple of jewellery making groups and the number of women who also have depression or other mental health issues is incredible. And the symptoms are similar - a dislike of phones, an avoidance of leaving the house, putting on "outside people", lack of confidence often showing as aggression or over confidence, constantly over analysing what people said or mean. 

Now I read a status of Facebook or talk to a mum in the playgroup  and I can hear the depression symptoms emanating from them. It's so sad. I try to tell them - maybe you need to go and get some happy pills. They say "ill be ok after this week is over", "I just need a holiday", "I just wish my husband would help more". They are all excuses. They put their heads in the sand. Just the same as I used to. 

That's why I want to do this - talk about my own experience and take the stigma out of it. We all have mental health, just as we all have physical health. A cold = feeling blue, a broken leg = a bad marriage break up, diabetes = long term clinical depression. It shouldn't be shied away from. 

I'm a well educated woman. I have a degree in computer science and a post graduate diploma in human resources. I can turn my hand to most things and yet when an employer finds out about my mental health, it's "thanks but no thanks". The system isn't set up for people like me. I've known a number of women who have been de-listed from the post natal depression support because they haven't turned up for their appointments. Why? Because they couldn't bring themselves to get out of the car in the hospital car park, which is surely a symptom of the depression and they shouldn't be penalised for it. 

I can be a useful member of society. I'm a governor for both my children's schools - I'm currently vice chair of the primary school. I used to be the secretary of the PTA. I'm admin of a Facebook group. My opinion is asked for. I read current affairs and I'm interested in social policy and inclusion. I could run for government (if only I could face phoning about the application process and the stress of reading what is required!) 

Every 6 months or so the doctors want to "review" my anti-depressant prescription. They ask me "do you want to come off them yet?" I tell them, "I never ever want to be without them again". I feel normal on them. I feel abnormal without them. Don't judge me because I take them. 

Disclaimer

I am a champion for Time to change wales the first project aimed at reducing the stigma and discrimination relating to mental health.

I am not an expert in mental health and all opinions are mine.

If you require assistance try mind or your own gp.