Look at how a single candle can both defy and define the darkness.
– Anne Frank
When I was nineteen years old, I was a sworn police officer in the New South Wales Police Force. Early one morning in 1990, I went with other officers to Newtown Railway Station as part of my duties. It was peak hour. A man in his early twenties had committed suicide. He had been suffering from depression.
Almost two years later, Daniel Pollock did the same thing, taking his own life in the same way, by walking in front of a train, at the same railway station. This time, I was not there. Daniel was an Australian actor playing the character of Davey in the 1992 Australian drama film Romper Stomper, starring alongside Russell Crowe. He was also in his early twenties. Daniel died before the release of the movie and was posthumously awarded Best Supporting Actor at the 1992 Australian Film Industry Awards. He was famous and had a bright future, but depression did not care. It did not discriminate.
These were the first times in my life that I had even heard the word ‘depression’. I do not recall thinking any more about it for some time. When I did, it was twenty-five years later. I had no choice.
I was sitting in the waiting room of my doctor’s surgery. I knew that something was not right. It had taken a lot of time and effort even to get there. I was always tired, extraordinarily lazy, and lacked the energy for even the most basic of everyday tasks. I could not focus, retain new information or recall detail that I had been proficient in eliciting only several weeks before. Concentrating on work was impossible. Even the rudimentary aspects of my work as a lawyer and business advisor became untenable.
I was not motivated and lost interest in hobbies, exercise, friends, family and all other aspects of my life. I could not explain why I always felt so deeply and profoundly sad, worthless, angry, and irritable all at the same time. Nor why, suddenly, I considered myself a failure and life to be hopeless. I felt guilty and remonstrated with myself persistently over past events or minor personal shortcomings, seemingly incapable of letting them go. I felt so alone, helpless, and not worthy of love or attention from anyone. I often cried and for no apparent reason. I just wanted to sleep. At least when I did, the pain of these unsolicited and uninvited new feelings would subside. I was starting to eat more. I drank alcohol to excess to try to ease the pain. It would not go away.
I had never felt this way before. Each day was the same, each one a struggle under mounting pressure fuelled by the way that I was feeling physically and mentally. I felt utterly lost, out of control and isolated from my own body and mind. I wanted to be left alone. I wanted to die.
It was late September 2016.
After a few more visits to the doctor and some tests, I discovered that I had depression. At the time of my diagnosis, I had just turned forty-seven. It was at this point that my journey with this illness began. The black dog had bitten me. The bite marks would take a long time to heal.
Doctor, I have a few questions
After my initial diagnosis, I had a few unanswered questions.
How will I explain depression to my friends, colleagues, and family?
What is causing me to be depressed?
How long will it last?
What treatments are available?
These seem like logical questions, right? I thought so but finding the answers would turn out to be an intensive, time-consuming and (at times) frustrating process.
It does not take long to discover that there is a plethora of information available from an equally diverse array of sources. Often, these references are highly technical, overly scientific, and not practical. Most of it is written by scientific researchers, academics, and health care clinicians, each in the pursuit of advancing the body of knowledge in their respective fields of expertise.
In my work, I had been accustomed to reading and understanding complex issues and concepts. However, I quickly learned that it would take years to read and try to digest it all sufficiently to respond to my fundamental questions. If you have ever read academic research papers, you will understand my point. It was surprising to find that research and medical science did not have all the answers, particularly regarding the causes for depression, frequency of misdiagnosis, and practical strategies to adopt when seeking treatment and to respond to treatment barriers in a meaningful way.
That is not to say that these resources were not helpful. Quite the contrary—they were. It is just that searching for answers to these questions while you are still suffering is arduous. Compiling relevant information and deciphering the good from the bad (and sometimes, the ugly) is a chore. I will save you some of the pain here because I will refer to several information sources that I found useful. I discovered the most helpful resources were written by people that had suffered or were still suffering from depression themselves. Personal sufferers tended to be more direct, practical, and less fascinated by technical terminology, lists of symptoms and diagnostic tools or guidelines.
Most of the self-help books and other publications dealing with mental illness tend to focus on the well-documented and traditional forms of treatment and recovery. I will talk about these and other methods in Chapter Four. Depending on my progress or even how my day was going, I learned these methods were not always practical.
Also, a lot of writers in this area talk about ‘steps’ to recovery, akin to the types of recovery platforms known to addiction (drugs, alcohol, and gambling, as examples). Under these systems, you pass through one ‘step’ (or stage) before progressing to the next in the same way before completing the final step to recovery. My experience with depression is that it is better to refer to ‘pathways’ that you take rather than individual ‘steps’. There are a couple of reasons for this.
First, there is no one initial step, or successive steps, that you must satisfy before you move onto the next within your system of recovery. Second, it is possible (and highly probable) that you will take different directions at varying stages of your illness without necessarily starting at one point or another. I liken recovery to a maze with several possible routes to the exit. You might try one, find that it is not for you and then select another. You might then decide that the first one you tried was the better of the two options. Ultimately your sole objective is to get to the end. There just might be many different pathways to arrive at the destination. You get to choose which route to try first and last. There is no order to it. Hence, no steps required.
You may be surprised to learn the best source of information about how to respond to most of these questions is not the articles, books, blogs, and posts at your disposal. The only person that knows what you are feeling and what recovery program will work best for you is YOU. All you need are the tools to make it happen. In responding to my illness over several years and continually seeking answers, I have discovered a range of tools and additional techniques that have assisted me in my battle with depression and anxiety. I will share these with you later in this book.
The shadow boxer
I think it is critical to have at least a basic understanding of the disease and its prevalence around the world. Without that context, it is easy to misunderstand it or, worse still, underestimate its potential impact. It is also important to highlight a vital message for you to keep in the back of your mind throughout your journey, particularly in the dark times.
Most people will have had some experience with depression and anxiety, whether it is personal or through their family, friends, or work colleagues. In 2017, more than two hundred and sixty-four million people of all ages were affected by depression, equating to approximately 3.5 per cent of the global population. In some countries, the proportionate rate was higher than the world figure, highlighting to varying degrees the prevalence of depression in all societies around the globe.
Research suggests that the share of the population with depression ranges between 2 per cent and 6 per cent around the world today. It has become a leading cause of disability worldwide and is a significant contributor to the overall global burden of disease. This burden is on the rise globally.
Here is the crucial message. Depression is common. A lot of people experience it and will continue to do so. That means that people with depression are not alone. They are never alone.
In the same way that people are unique, the severity and impact of depression are different in each case. Still, there are also some universal experiences that can be shared to benefit your recovery. It also follows that people before you have learned to survive and recover from the illness, and go on to lead healthy, productive, and happy lives. You can do that too.
Outside the well-documented symptoms, psychiatric criteria, and technical guidelines, very few people have conveyed what it is like to have depression. Some have tried. The ‘black hole that there is no way to climb out of (nor point in doing so)’. The black dog. The ‘darkness’, which ‘alienates you from your work, your passions, and the people around you. That, in turn, pulls you further into the darkness and allows it to do further damage. Things that once brought you joy – like “rainbows” and “views” – come to seem like they do not matter. You would previously have turned to them to restore your happiness, but they no longer have that effect. Hence, you wind up, stuck there, in the darkness.’
In the beginning, one of the most challenging things is that it is not easy to explain to those around you what it is like to have depression, particularly those people that have never suffered or had experience with it. I still struggle to come to grips with some sort of explanation.
Depression is a remorselessly corrosive agent of the soul. It takes you to a dark, unpredictable, and morbid place that makes you question your existence almost every moment of nearly every day and, at times, pray for it to end. If you let it, it will destroy everything about you and your life. Before it does so, it tortures you, day by day, night by night, until you have nothing left but relentless pain and misery.
More than likely, depression will also make you feel like the worst person in the world. It can make you feel responsible for events and situations for which you are not even remotely responsible but feel compelled to assume a burden of guilt for them, nevertheless. The illness can make you feel sinister, dirty, and melancholy all at the same time. In your own mind, you become the bad guy, the villain, the archenemy of everything that is good. But depression is a liar, a cheat, and a thief. It deliberately misleads, steals everything from you and yields nothing in return but prolonged anguish.
Ultimately, the mission (should you choose to accept it) is to convince yourself that, like the performance of a magician, depression is a clever act of illusion designed to deceive and deprive your mind of the reality. Hope is the panacea to recovery but finding it while you are afflicted can be elusive. It can also be both challenging and confronting. To rediscover hope requires hard work, genuine self-discovery, a commitment to change and acceptance that you are unlikely to discover your pathways to recovery on your own and without support from your Recovery Team.
Battling this illness is like boxing at shadows. If you want out, you must keep swinging. Ultimately, you will land a punch. If you are to knock it out, you must give it your best shot.
Another way of arriving at some explanation is to relate depression to what it is not.
Depression is different from usual mood fluctuations and short-lived emotional responses to challenges in everyday life. While everyone has felt sad, depression is different. It is essential to understand that depression is a mental condition. A lot of people confuse depression with sadness. One may be a symptom of the other, but it does not necessarily mean they are the same.
Depression is unique and characterised by well recognised and documented life-cycle risk factors, symptoms, types and diagnostic guidelines. Symptoms are prevalent nearly every day, persist for extended periods and result in a significant change in a person’s ‘normal’ mood. Depressive disorders occur with varying severity, ranging from mild to moderate (or persistent depression, dysthymia) to severe (or major depressive disorder).
An individual with a mild depressive episode is usually distressed by the symptoms and has some difficulty in continuing with everyday work and social activities but will probably not cease to function altogether. During a severe depressive episode, it is improbable that the sufferer will be able to continue with social, work, or domestic activities, except to a minimal extent.
Periods of low mood or difficulty are typical for humans, however, these feelings usually pass for most people. The difference between a low mood and depression is observed when an individual’s feelings consistently interfere with their daily life over a minimum period of two weeks.
The severity and duration of depressive episodes that lead to depression overtaking your life and becoming your life’s focus distinguishes it from the everyday low mood, which may conversely come and go periodically without any substantive impact on your day-to-day life. The other notable point of distinction is that, with depression, thoughts of death (as opposed to dying, which we all think about from time to time) are pervasive. They remain with you throughout your journey with the illness.
What caused me to be depressed?
You should not expect a complete answer to this question from academic research or medical science. While you may never know the exact cause of your depression, it is highly likely that you will at least be introduced to some possibilities at various stages of your treatment, whether from therapy, self-help, or other remedy options.
Depression is a complex condition. Its causes are not fully understood, remain mostly unknown, and vary according to individual circumstances. Research suggests that depression may result from a complex interaction of social, psychological, environmental, and biological factors (including genetics). These factors influence the prevalence of depression, evidencing the existence of some common trends among countries globally.
Although the exact reasons why depression manifests are unclear, risk factors are well- known. For example, people who have gone through adverse life events (unemployment, bereavement, psychological trauma) are more likely to develop depression.
While the reasons for people experiencing depression and its incidence vary, it does not discriminate. It does not matter how old you are. A woman or a man. Married or single. An adult or a child. Nor does it care where you live, what you do for work, where you went to school, college or university, where you come from, or whether you are rich, poor, famous or infamous (or a combination of these).
It follows that we should not be at all surprised that depression will make an appearance in our lives, or the life of someone we know, at some time during our existence on the planet.
We are all vulnerable.
How long will it last?
If you broke your arm, a doctor could advise how many weeks you were likely to need a cast before recovering from this type of injury. Unfortunately, depression is not like that.
Episodes of depression can vary in duration from weeks to years but typically last for a minimum of several weeks. For some people, depression is a long-term illness.
The duration of the illness depends on your diagnosis. Your diagnosis stems from the duration and severity of your symptoms, any responses to treatment or recurring risk factors.
Depression is often chronic and recurrent. One study found that fewer than one-third of patients recovered and remained well in the eighteen months after an episode of depression. According to the American Psychiatric Association, at least 50 per cent of people who have experienced an episode of major depression will go on to have a second. About 80 per cent of people who have two events will have a third. These figures highlight the importance of treatment and the need for it to focus on maintaining wellness and preventing relapse.
The simple, practical answer is that it lasts until you recover. Getting the right treatment is vital. I will talk about treatment options and coping strategies later in the book.
What treatments are available?
Untreated, depression can cause the affected person to suffer greatly and function poorly at work, at school, college or university, and in the family.
At its worst, depression can lead to suicide, which has a devastating impact on families, friends, and whole communities. Globally, close to eight hundred thousand people die due to suicide each year, which is about one person every forty seconds. According to research, depression plays a role in more than one-half of all suicide attempts, and individuals with depression are twenty times more likely to die from suicide than someone without it. Importantly, this does not mean that most people with depression will suicide or attempt it. Most will not do so.
In Chapter Three, I talk about some barriers you are likely to experience before and during your treatment. This information will get you prepared to confront some common obstacles and avoid the negative impact these can have on your active treatment. In Chapter Four, I outline standard treatment options and provide some practical assistance, based on my experience, to assist you with the development of your recovery plan.
One critical message in this context is that it is possible to recover from depression and, regardless of the treatment options, the most effective recovery will also be directed by you because the pathway chosen by you is always the right one.