August 2014

This was written in August to be translated for my column in the Swedish Goteborgs-Posten.

Some things are best met with silence. If I were to proceed with this month’s column in an honest way, it would be a blank page, without words. The imaginary blankness of the page represents the other blanknesses I have already created in my life, these past few weeks. A friend just phoned to talk to me about a mutual friend who sadly is very ill. We talk about how she will manage, what we can do, how although we know her and she is our friend, there are thousands, millions of others, also struck down with severe illness. We must bear them in mind, but our friend is our friend and her experience concerns us directly. When that conversation is done, my friend on the phone says, ‘I’m sure we don’t have to talk about…how awful…the dreadful…Do we?’
‘No,’ I say, cutting off his hesitations. ‘We don’t have to. I can’t.’
‘Yes, the same with me. Well, you know…’
‘Yes, I know.’
That blankness. Once again the desire to look away has taken hold of me. The hole in our conversation is the equivalent of the imagined blankness of this page, and the swerving of my mind away from my responses, sad, angry, disbelieving, violent even, as I come across reports.
I no longer watch the news. The Channel 4 News with John Snow as an anchor has been my first place of detailed information about what is going on in the world. It is thorough and serious, it doesn’t have an agenda of the shorter, more popular news broadcasts on other channels, which cut the sadness or cruelty of the world news with upbeat human interest stories, or at least not so much. It does ask you to face what is going on, whatever it is, and it often enough isn’t good, often enough very bad. There are no other news programmes on television that have such a good daily, hour-long analysis of world events. After that, I read the Guardian, online these days, and then weekly and monthly news magazines, in print and on the screen, that fill in the political background of the news or present facets of situations that I haven’t thought of. I listen to some of the hourly bulletins on the radio as well as longer analysis programmes. Of course, there is Twitter, which has now become a kind of infinite curator of daily thought and writing about what is happening; tweets from various journalists or interested people linking to readings and videos on obvious and not so obvious topics, that I would never have found by myself. Keeping up.
I haven’t been my happiest self in the last few months, for no particular reason, at least to start with, just because I am made to have periods of not being my happiest self. But still, while my low spirits continued, I tried to watch the Channel 4 News regularly, to attempt to keep up with the world whose doings I’ve rather lost interest in, as my mood begins to circle its wagons and to look intently and pointlessly at interior reflections of myself mirrored in time and space, rather than out at the world. I know it’s important to know what’s going on. It’s important to witness, not to look away. But I really feel as if I’ve had some inner resolve taken from me, or that I’m missing some protective coating that enabled me to do that.
It has been like that since I saw the news several weeks ago that the three missing Israeli teenagers had been found dead. Of course, the news seeps in, and I find myself with all the emotions welling up. The shelling of schools, the claim that the opposition are using civilians as hostages, the reversal of the reality of who is weak and who is strong to make the aggressors victims and the victims aggressors. Of course, both are aggressors, but the two sides are radically unequal. The one side rich and with American and European weapons, the other deliberately impoverished with a population of 50% children. Not being young, I have nowhere to put the anger I feel, or any excuse for my disbelief. ‘How can they do that? How can they?’ I hear myself saying. And then stop because it’s a naive and foolish question. One that cannot be answered in any way that would be satisfactory to me. I would be on the street, marching with the thousands if I could. But although I have good reasons why I can’t, I also know that I am sure that all the marching by all the decent people in the world will not effect a real change. I know that change comes about in economic and diplomatic ways. If it comes about at all. Still, I am pleased that there is a presence on the street expressing their dismay at the absence of humanity.
I am living such a secluded life. There isn’t a single person I know, or who I correspond with who would take the other side, or disagree with me on more than minor points. No one who doesn’t believe that the motives are not really defence, but land-grabbing and ethnic cleansing. The death of the three students was known about by the government, but not the population, a month before the ‘retaliatory’ aggression. The population is, of course, being used, in the same way that the opposition is sidelined. There must be many who side with the stronger force. I do not put myself in the way of them, any more than I can tolerate seeing the news, except out of the corner of my eyes, or as links pointing to the horror of it on Twitter. I know I’m not alone in not wanting to look. The columnist Suzanne Moore, in the Guardian, wrote how she didn’t need to see those awful pictures of dead and wounded children to know that what was happening was wrong. Words are enough, even the word ‘civilian’ is enough. It isn’t only cowardice, it is also that we’ve seen it before, we don’t need it to show us other people’s pain, or to invade the privacy of those whose privacy has most terribly already been invaded by being killed. If I don’t look at the news or the pictures being put up everywhere on the Internet, it is only because I’ve paid attention to them for decades now. And all that time, I haven’t felt anything I might do could help. Marching, signing petitions, boycotting, of course, all those things, but finally all there is is helpless anger and shame that human beings behave in such a way.

4.8.14

Blackness Ever Blackening

Yet another piece on depression by me. Always something new to say. Always another angle to look at pointlessness from. Until there isn’t. This time in Mosaic. With marvellous illustrations (yes, that is me as a vile murderous young woman) by Martin Rowson.  http://mosaicscience.com/story/blackness-ever-blackening-my-lifetime-depression 

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Me and Her

Here’s a piece from my before translation Swedish column in the Goteborgs-Posten in the early spring.

It’s spring again. I know that because the frogs are furiously at it in the pond and the faintest of greens is appearing on the birch tree. There’s even a hint of sun after the Cambridge morning mist has passed. Why am I sunk in gloom, barely able to get out of bed? Certainly not before morning has almost passed into afternoon. Why am I dreading the passing of the week because it means there’s another one in store? Waking in the morning with a concrete block of dread inside my chest weighing me down? Looking forward only to the moment in the evening, much too early, when I turn off the light and that brief startling relief that I am in the dark and can let myself, with chemical assistance, fall asleep – until I wake every couple of hours during the night?

Well, chemistry might answer those questions. I’ve been here often enough before, both with and without real life events to trigger the condition. It’s my character, my type, my destiny, the way the molecules fell and the cookie crumbled at the fertilization of the egg that became me. The blackness falls over me regularly, although, in the last twenty years during which I’ve been medicated, usually better controlled and for shorter periods than at present. It lurks in the ingredients of my brain recipe. There’s also what they call environmental factors. A weird childhood that caused one psychiatrist to say I was lucky I haven’t turned out psychotic. I’d be crazy not to be a depressive, another said to me. In addition, there’s the death of four people, three who I’d known since my teenage years, one my oldest friend, two of them and the arrangement of their funerals within the last four months. And still the deaths continue and the past is chipped away.

You can mix and match the chemical and environmental reasons every which way, or take just the one or the other. It doesn’t matter, there are very few choices in the management of this thing, even if you include alternative therapies, whatever the cause. I’m too self-aware and armoured, apparently, for talk therapy to be much use. CBT, even if I had the energy for list-making, box-ticking, and contract writing, doesn’t inspire me with any confidence. So only sitting through it and medication remain. I’ve gone for medication – new and different anti-depressants – because I know that sitting through it is not only agony, but dangerous, as well as very difficult for other people to deal with. Actually, the medication option includes sitting through it, because of the way that antidepressants famously don’t start to work for a month or so, and often make you feel worse, with mind numbing side effects. And then, of course, it might turn out that they are not the right pills for you. So start again, another month of sitting through it. At some point, one is too old for the wait to seem worth it.

Another question is how does it come about that I am writing this, and have written a couple of long articles since the dark settled over me? That’s two questions really. First, I seem to have a ‘writing head’ that clicks on when I set my hands on a keyboard. Writing has nothing to do with the daily living me, even if it uses the daily living me as a conduit. It’s a mystery to me, really strange as I watch myself do it, but the psychiatrist I saw said that she thought I’d probably always been ‘disassociated’ and wasn’t surprised that I could write while I could hardly talk or move. I didn’t go into it any deeper than that. It rang true to me, but I don’t want to think about it too much. I don’t like mystery and magic about writing and ignorance easily settles for mysterious.

The second part of the question is why on earth would I write such intimate stuff about myself when I could be writing about the state of the world, the latest must-see US TV series or whether street fashion echoes the fractured structure of the government coalition. Why take such an unwarrented interest in myself? And why expose myself? One answer is simple narcissism. People who write, especially people who write novels and memoiristic non-fiction must by definition be narcissistic. Another answer, which might be the same one, is that everything I write is writing about me. The state of the world as I write it, is happening through my eyes, inevitably; filtered by my mind, turned into opinion and sentences by my fingers. I don’t have a sense of me in here and it out there as a writer. The writer and the state of the world are both in here and out there together. For the non-writer me, part of the darkness is a refusal to turn on the TV news. To refuse to acknowledge the world. Yet at the same time I’m unable to stop myself reading intently online about mean and vicious world events, which are as bleak and warlike as myself at the moment. The world perhaps always reflects one’s state of mind, although it’s hard for me to imagine observing the events in the Ukraine and Crimea in a happy, cheerful mood and coming away optimistic. The world always looks bleak to me, and always has. I understand that this is not the case with everyone, although I can’t imagine it. It might be that my lurking darkness exists in that way all the time, even when I’m perfectly ‘well’. Most importantly, if writing matters, it matters that writers write about the world, and that there is always and only their view that you are at any given time reading. My writing for publication of any sort, is not the beginning of a dialogue. The round-up piece of everyone’s views is useful, but it’s not writing as I mean it and do it. In whatever mood, (though unfortunately I don’t have many so my work is hardly kaleidoscopic) I reject the idea that I should not be included and include myself in whatever I write about. How could I uninclude myself?

But what about privacy? Don’t I mind about exposing my inner state to anonymous readers anywhere in the world, whom I don’t know and who don’t know me? The answer is, I’m not. I’m sitting here in bed writing this on my screen in silence in an empty house (the Poet is having a break, giving a paper in Oxford). No one is reading this except me. That I know some people will read this (those that don’t turn to other less narcissistic matters) doesn’t matter. Forgive me, I know you are each an individual with a live mind and a beating heart, but to me as I write you simply don’t exist. I am talking to myself. The ‘you’ I address right now is me-as-reader. Nothing gets beyond these four walls. Sometimes, to my surprise, I get messages from readers talking about a piece I’ve written or books of mine they’ve read, and it really does shock me, for all that I understand the reality. Someone read that, and is talking to me! Or they think they are. They are, of course, really talking to the me that goes about in the world. The one who reads the emails. The writer-me isn’t available, all she does is write. Sometimes though she hears the faint sound of world out there, and it’s a shock when the fraction of the world that reads me makes itself known. When I started writing and people came up to me to say they’d read something of mine, I had to stop myself reacting as if they’d stolen my private diary and remember that I sent the writing out into the world. Very inconsistent. But there it is. I don’t mind being that. We are, all of us, difficult, inconsistent creatures.

I’ve chosen not to look up ‘dissociation’ in the psychiatric diagnostic books, but the word does make some sense to me. As a handhold on reality, I think I should be grateful for it. There have certainly been times when I’ve been in this condition, when I have been silent and unmoving for months on end, taking most of the day to get the energy even to have a pee. As black and bleak as I can ever imagine it being. But since I’ve been ‘a writer’, I’ve been able for short periods to keep my hands moving on the keyboard and focus through some small hole in my mind on the words appearing on the screen. Dissociation works for me. I wonder if integration is the opposite of dissociation. I imagine so. I also imagine that an integrated me would be silent. In writerly terms it would be an absence of words, a full stop. I think the silence of an integrated self must be akin to the perfection of the terminal point without a word before or after it.

 

My Melancholia

 This is a piece I wrote for the Goteborgs Posten, a Swedish paper for which I write a monthly column (which is translated into Swedish).

 

I’ve spent a good deal of time lately reading up on the set of historical, medical and philosophical conditions known for centuries as melancholia and more recently as depression. My interest is that I’ve been commissioned to write a book about melancholia, but I’ll be writing it because it’s a subject I’ve lived with and thought around most of my life. I wonder what took me so long — and then again, I don’t. As far as I can understand it, I’ve had bouts of depression since I was a child. When I was little, it was called being ‘in a mood’ or ‘sulking’, and no one, including me, thought to query that definition. Looking back, the sense of hopelessness, despair, of seeing no way out of the dark place in which I suddenly or gradually found myself completely trapped, was just as present when I was ‘in a mood’ at the age of eight or nine, as it was when I was first diagnosed as clinically depressed and hospitalised at the age of fifteen, and then at twenty, and then at thirty-four, with non-hospitalised episodes lasting weeks or months plentifully in-between. 

I came to think of myself as chemically prone to depression. Not that I reject the idea that the circumstances of my very messy family had been a perfectly reasonable cause, but undoubtedly, given the many possibilities of psychological responses, depression was how it took me. I’ve never had the slightest tendency towards symptoms that might define a schizophrenic illness (aside from taking drugs). Never heard voices, seen things that were apparently not there, felt impelled  to act by something alien, outside or inside myself. I was perhaps tipped into a lifelong depressive illness by my experiences as a child, but never into psychosis. 

Life and chemistry makes good sense to me as a pairing, and though chemistry might cause the problem on its own, I doubt that how you respond psychologically to life is unconnected to the balance of your physiology. Chemistry affects how you respond to experience and experience affects the chemistry of mood. That doesn’t mean that one’s psychology is absolutely determined and unalterable: talking therapy and medication can change what might be an impossible life into one that functions quite well. Freud spoke of returning people to ‘ordinary unhappiness’. Sadness and mood variation are not illnesses but part of life unless they become overwhelming. No one sloughs their life experience off like a lizard its skin, but with assistance it’s possible to use experience rather than let it use you. At any rate, up to a point.

Nevertheless, the history of the idea of melancholia and depression is as vivid and fascinating as any other subject that turns out to be so broad that you are unlikely to come to the end of learning about it. The actual writing of my book is still in progress – there is so much to read on such a range of topics that I have forcibly to stop myself reading and making notes, and get to grips with actually writing a book that is intended to take in as many aspects of melancholia (including a whole spectrum of my own experiences) as it’s possible to grasp or speculate about. But then that’s probably true of any book one ever wants to read or write. 

I started, of course, with the key text: Robert Burton’s Anatomy of Melancholy, written in the early seventeenth century. In well over 1000 pages, Burton informs, infuriates, amuses, terrifies and delights the reader with everything that was or might be known on the subject of melancholy. Like the French essayist, Montaigne, no possible digression is left unexplored, and also like Montaigne, Burton claims to be writing his vast book in order to keep his own melancholic condition under control. Unlike Montaigne, he isn’t explicitly exploring himself or using his own experience as an example of both the particularities and generalities of humankind. He wants to establish an order for the subject (melancholia as an Elizabethan fashion, as an incredibly varied medical diagnosis, as religious excess, as a love disorder) and show everything that can be known about it, as well as to suggest ways in which afflicted people might be cured. But like many humanist texts at the time of the Renaissance, and maybe all good books, it is even bigger (in more than just its brick-like size) than the subject it claims to be about.

At the same time, I read that watershed text in thinking about mood disorders, Freud’s Mourning and Melancholia, as well as more recent commentaries and reports of neurological findings. What strikes me most at the moment is the language which Burton (and, for example, Hidegard of Bingen, or Saint Theresa of Avila) uses to describe the medical and moral condition. It goes back to the humoural theory of the Greeks: the four ‘humours’ that coursed through the body and in various combinations caused one of four main personality types: phlegmatic, choleric, sanguine and melancholic. Galen, Burton, Hildegard and St Theresa describe a very specific physiology – the places in the body and activity of the humours. They discuss the intricate circulation of the humours that had their source in bodily organs and affected the heart and the brain – when the brain was overheated with the fumes of too much ‘burnt bile’, the eyes spilled out liquid tears to relieve the pressure which were believed to be of a different kind to those tears that were the result of physical hurt.  No one was in perfect balance, and medicine’s job was to adjust the proportions. Too much black bile from the spleen was the main cause of melancholia, but it was much more complicated than that. It is a plausible system in its world, but by the time that Burton had finished writing his Anatomy, the new experimentalists, like Francis Bacon, were doing away with humoural theory and insisting on the visible evidence discovered by cutting up bodies and describing what was found.

Jump ahead four hundred years and I am struck by the similarity between the somewhat haphazard theories of depression then and now. For years now, I have taken a maintenance dose of a serotonin-reuptake-inhibitor (SSRI). I decided after sitting through many of my depressions, that it was only a matter of time before the suicidal thoughts beat the natural tendency of depression eventually to lift. I figured I’d been there and done that, and so took and continue to take an anti-depressant which, even if it doesn’t make me giggly and happy-go-lucky, at least seems to stop me becoming immobilised for months by despair. The pill is said to work by increasing the amount of serotonin in my brain, a neurotransmitter thought to be involved in mood disorders. The idea would be that for reasons of physiology or life experience I was not producing enough of it. Anti-depressants are said to work on a monoamine imbalance, though no one I’ve spoken to has explained exactly why. The pills are supposed to be rebalancing my unbalanced brain chemistry.

But recent research in the United States has shown that there is not very much statistical difference between the effectiveness on depression of SSRIs (50% positive) and of placebos (30-35% positive). One serotonin enhancer (tianeptine) has been found to decrease serotonin but it does not induce depression – which makes the theory of monoamine imbalance look doubtful. There is something that professionals call ‘treatment resistant depression’. It means, I suppose, that they don’t know why some depressed people stay depressed, which suggests a less certain understanding of the nature of depression than we might expect with all our medical and technological science. The longer I look into modern theories of mood disorders, the more they start to look strangely similar to the old humoural theories and remedies. Too little of this, increase that. If that doesn’t work, try some hellebore. Neither Robert Burton nor a medical psychiatrist can explain exactly what happens physiologically when a person becomes depressed, nor why precisely this or that remedy does or doesn’t make a difference. And I know even less, for all that I have spent much of my life thinking and reading about the issue. What looks like an airy-fairy made-up description of complicated channels of unknowable humours in Burton’s physiology of melancholia means no less to me than the serotonin I so easily talk about and take a remedy to enhance. I might as well be following Galen’s prescriptions as my doctor’s for all I really know of my brain chemistry. Just as the old physicians had suggested, in the early 20th century a physiologist discovered that tears of grief and sadness were indeed chemically different from tears of pain. Remembering his time living with the Azande people of north central Africa, the anthropologist E. E. Evans-Pritchard said after he returned to England that he thought their habit of studying of chicken entrails was as good a way as any he had come across in his life of making decisions. I have a feeling that Galen’s and Hippocrates’s humoural imbalance theories are in much the same relationship with modern monoamine imbalance depression theory. And perhaps that’s even a bit of a relief.