Yes, I was traumatised for many years. The abuse was merely emotional, but it hurt. Like it or not memories of those days dogged me for years. They simmered just below the surface and distorted my thinking and my behaviour. They made it far harder to learn how to cope with my own depression. They made it less likely I’d make a good parent myself.

I was exceedingly fortunate. Over the years I made a number of friends who listened attentively as I rambled on about how bad things had been. Some experiences I recounted again and again. Gradually I got used to them and they lost their power.

We all have painful memories. By and large they can be left alone because we’ve grown beyond them, but sometimes there’s one worth dealing with because it’s having a damaging effect now. In a previous post I described some NLP work I did with a student which enabled him to recreate an alternate version of a true memory. In the alternate version he handled an embarrassing situation as he would now with his increased maturity and understanding. If the bad memory surfaces he has the option of switching to the modified version. Which version is true? In a sense neither. The actual events happened, but they do not describe who he is now. He is able to relax and shrug off the embarrassment because he knows he has now used that experience, he has grown up.

Some memories are like feuds between families or nations. What triggered things happened long ago and we should move on, but somehow we can’t. Someone, perhaps a parent, treated us in some unfair way which has crippled us, and we continue to resent what they did and suffer the after effects. This is frighteningly normal, but hardly rational and certainly not helpful.

The trouble is that we may need more than friends loving enough to listen to our memories. We may need the skills and expertise of a counsellor trained and experienced in working with destructive memories.

Psychodynamic counselling does far more than just deal with memories, but it is one approach that might prove useful. I suspect Post-Trauma counselling could also be useful, though I’ve not experienced that kind. A competent NLP practitioner should also be able to help.

A triplet of warnings:

• You need to let go of destructive memories, yet if you’ve been hanging on to them grimly for decades that will not be easy. Approach this with your eyes open: it will be hard work, and it may prove very painful for a short time. It is worth it.
• There is evidence that some hidden memories which are affecting you now may best be left alone. Dragging them to the surface and experiencing them again can make matters worse. I suspect whether or not this happens has a lot to do with the relationship you and your counsellor have with each other.
• There are examples of counsellors looking for repressed memories, and phrasing their questions so badly that false memories are created in the client. Beware of a counsellor who asks closed questions such as “did your father abuse you” when they should be asking open questions like “thinking back, do you think any part of your childhood might have been worse than it should have been?”. Police are increasingly being trained to interview witnesses using only open questions and non emotive words because otherwise they run a high risk of altering the witness’s memories just by how they phrase the question. Loftus and Palmer did a neat experiment on this in 1974. Google ‘Loftus and Palmer 1974′ or check out this site which describes the research.

If you know of any other types of counselling which includes constructive reprocessing of bad memories please let me know. Thank you.

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There’s a well-known saying about how to help people in poor countries: give a man a fish and you feed him for today, give him a fishing rod and he’s set for life. 

Of course if he’s too weak with hunger to fish for himself then a fish to eat first makes sense, but after that it’s wise to show him how you use the fishing rod to catch more fish, and then give him the rod.

In the previous post I described how I was helped after my first breakdown. I was referred to a doctor who specialised in student mental health problems. He first of all established a suitable relationship. Then he prescribed something to help with the immediate symptoms. After that he told me to try one possible strategy which should help, and it did. Since then I’ve been learning how to resolve many subsequent problems, and sometimes I’ve had guidance from counsellors – some of them doctors – on how to set about doing this.

The long-term target has been that I become someone who knows how to set about solving his own problems.

Arguably this should be a part of any type of counselling. It may not be an obvious part; if it’s there it may be hidden. Sometimes I’ve only realised afterwards that I’ve learned something by simply paying attention, observing the counsellor at work. This facet of their work might have been more effective if it had been conscious.

Everyone has problems; they’re a part of life. We start by passively letting someone else solve each problem for us. As we grow up we begin to understand how they have helped us. We begin to listen and to try things out for ourselves. Gradually we develop a stock of possible strategies to look through and experiment with. At this point we’re still immature. We need to learn how to deal with a fresh problem for which we currently have no solution: we need to learn how to solve problems ourselves. We need to move from being entirely dependent on other people like a baby to being independent.

Warning: independence is not the final goal. Adolescence is about becoming independent of our parents, finding out who we are. Full maturity requires us to move even further and to recognise the need to be interdependent, a member of society who helps and is helped by other people, a member of the family.

If you suffer the crippling effects of depression, or are human in any other way and face problems which appear insoluble, look for people who can help you. But don’t be passive. Do not look just for help with the most obvious current problem. Look beyond today and find out more about how you may be able to help yourself. Gradually begin to accept some responsibility for your own treatment. And if you are receiving counselling from someone who wants to do it all for you …

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I was 21 when I had my first breakdown. I’d been suffering teenage depression on and off for six years but not known what it was, never questioned it. Suddenly I was too ill to go to lectures. In those days there was no specialist student health care, but a local GP (family doctor) had become increasingly concerned by the mental health problems he saw in his student patients. A year or two earlier he had decided to specialise in treating this epidemic. I was lucky enough to be referred to him by my own GP.

I don’t know what he prescribed me. Almost certainly a tricyclic antidepressant (this was autumn of 1970). I’ve just looked them up on the net and I certainly gained several recognised side effects: increased heart rate, drowsiness, blurred vision, dizziness, confusion. Mind you I was pretty confused when he first saw me.

The first consultation was weird. Okay so he sat behind a large desk and I had a traditional upright surgery chair. But he offered me a coffee, which was shrewd. It worked in much the same way as being given a drink when you arrive at a party. I had something to hold on to, something to take sips from as if I felt confident and purposeful.

His overall approach was way ahead of its time, perhaps because he had not been trained as a psychiatrist so came at the problem with fresh eyes. The starting point was medication, but he made it clear that the antidepressant was only to give me the opportunity to work hard at learning to cope with depression. So that’s what this was. Depression. Hmmm.

“The trouble is that when you feel down you have only the one escape route: running.”

I was a keen member of the university cross-country and athletics teams, and hell I enjoyed running. Best of all was ten or fifteen miles at relaxed pace through the beautiful countryside around Durham. That’s Durham England. If I felt a bit rough I went for a run. But if I felt seriously rough any attempt to run would be frustrating because the energy was gone. Clinical depression affects you physically. I would try to train and fail. The harder I worked at it the worse I got, which was absurd. Races were a waste of time.

“You try to escape by running and find that route is closed to you. What do you do? Nothing. You do nothing because you have no other escape routes set up apart from friends who are usually not available because they’re working or having a life of their own.”

I must have looked blank.

“When I get home from work I’m often feeling pretty rough. What do I do? I knock hell out of the garden. Do I like gardening? Sometimes. Not always. But I do it anyway, and it helps me feel better even when I don’t think I’m enjoying it. But some evenings it’s too dark or it’s raining heavily.”

What did he do then? Sorry, I can’t remember.

“Now you’re too depressed to run what other hobbies do you have?”

- I write.

“When was the last time you wrote?”

- well, er, I wrote a novel two years ago …

“Are you well enough to write?”

- er … well … I read a lot. I listen to music.

“You just told me you’re picking up books, trying to read them, and giving up after just a page or two. You said music isn’t doing anything for you anymore. In fact you have nothing but friends to fall back on when you’re this ill.”

I doubt I nodded, but he was right.

He told me I must find at least one new hobby. How? Well I could try browsing the local bookshop to see if anything caught my eye.

“This is your homework. You find one new activity to try. I don’t care what it is so long as you try it. No matter whether you find a new hobby first time off, the key thing is to try something. And then something else. And we keep going till you have a battery of escape routes to fall back on when you’re depressed. See you next week. Good luck.” He smiled and shook my hand firmly.

I went to the local bookshop (these days a Waterstones but not then). It was an Aladdin’s cave, but cold and dark and grey with the air like treacle. I kept wanting to cry but I made myself work through every single shelf of non-fiction. I read every title. I took some books off the shelf for a browse.

I have no idea what activity I picked, but I do remember the faint glimmer of light that doing something, anything, left me feeling ever so slightly better. No, I didn’t feel happy. No, I still couldn’t think straight. No, the future was still black. But something eased just a tiny bit, barely enough to notice. I had made a crucial discovery: when you’re depressed doing anything is better than just sitting around thinking about how bad you feel.

Actually there were two other long-term results: a lifelong love of browsing bookshops (which fortunately my wife shares, though it’s cost a lot of money over the years), and a tremendous variety of interests. To focus enough on writing to produce the next book for my agent to try and sell I’ve had to be brutal in sidelining many hobbies.

The doctor cum counsellor I saw in Durham from 1970 through 1972 used a range of techniques. The one I’ve described above would probably now be called solution-focused therapy. It was exactly what I needed at the time, and has benefited me ever since. I’ve sometimes used it with people I’ve tried to help, but rarely as forcefully as it was used on me: once I had a really bad weekend and made an appointment to see this doctor. What was I supposed to do when I realised I was getting worse? Anything but sit around moping. What had I done over the weekend? Sat around moping. There’s your answer so next weekend have stuff planned and do it no matter how you feel. Just do it. He then warned me that if I ever came back complaining of being worse yet had not followed this strategy then he’d not see me again. Hard words, but spoken forcefully at exactly the right time. The next weekend I had planned in detail, and I stuck with the plan. I didn’t feel okay. But I didn’t feel worse. Success! Often success for a depressive is entering a bad situation and simply not feeling worse than before.

If your counsellor proposes some action on your part then you have only two rational choices: you can give it a go, or you can stop seeing that therapist. And what harm is it going to do trying out their suggestion? After all, it might work. You’ll be sure it won’t, but give it a go. Give it a serious go, and in so far as you can when ill be open minded. Not every suggestion will work, but you can be almost certain that when you first hear of something that can help you’ll try to reject it; that is part of depression.

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The rawest form of this approach is often referred to as person-centred counselling. The guy who started it was Carl Rogers, a remarkably able therapist. He believed that we each already have the resources to solve our personal problems, and the counsellor shouldn’t interfere by telling the client what to do. In his book ‘On Becoming A Person’ he says this (I rephrase slightly) :

If the counsellor works at our relationship in such a way that I experience his genuineness, transparency, and warm acceptance of me as an individual, and in such a way that I realise he is sensitively seeing my world as I see it then I will become more of a person, understand myself better, function more effectively, gain confidence, be more understanding and accepting of myself and others, be more able to cope with life, and move closer to being who I want to be.

(The book was first published in 1961 and is still readily available.)

Rogers’ theory is: that’s all the counsellor does, although it has to be genuine. If it is then in my experience this really does make a difference. One problem is that even given this rare type of support I still may not be able to sort out the mess my head is in. Another problem is that many counsellors find they are unable to accept clients as they are. I’ve tried working with at least one student who I simply could not accept or prize as he was – and I failed to be of any real help.

Some counsellors confuse the need to be ‘professional’ with the need to show none of these feelings, and as a result their work is far less effective.

The founders of NLP (Richard Bandler and John Grinder) included Carl Rogers in a small group of highly effective counsellors they chose to study. They were ignoring how each therapist claimed to be achieving their results and instead observed with great care what each person was actually doing. Apparently Rogers was seen to be doing more than he said. For instance when clarifying for someone what their options were his body language indicated a preference – even though he was not aware of it.

Rogers’ basic approach, his underpinning attitude to each client, is incredibly powerful on its own. My own feeling, though, is that it should be the background against which other techniques can be used as and when appropriate.

On the other hand I’ve worked with two psycho-dynamic counsellors, and by far the most effective was the one showing very little emotion but having by far the greater training and experience in the method. She came across as caring but professional. Not cold. The other was warm and accepting but not all that helpful.

Conclusions

I aim to be genuine with everyone I meet. For instance if I have nothing good to say I keep quiet, and only when I identify something I believe is worth complimenting do I comment. I try to accept everyone warmly – we each have a hard battle to fight, we each make mistakes. This can be difficult, so I work at seeing the other person’s world through their eyes. I seem to enjoy life much more as a result.

I would prefer a counsellor to be able to communicate at least some of this to the client. But sometimes the nature of the problem requires an expert in some particular approach, and you may have to take what you can get.

An anecdote

Some time back I heard of an experienced senior medical doctor who was taken ill and admitted to hospital for tests. He describes his feelings and thoughts when his consultant surgeon sat down beside the bed and told him he had terminal cancer. I quote his approximate words from memory:

“At that moment the one thing I wanted more than anything else was human contact. I looked at him wishing he would grip my shoulder or hold my hand, but he just sat there. He was behaving in the professional way Doctors are trained to behave: don’t get emotionally involved, never touch the patient except for clear professional purposes.

“But I longed for him to reach out and make human contact. And in that instant I looked back at my entire career behaving professionally and knew that sometimes I should have stretched the boundaries.”

It means a lot to a homeless person when someone pauses, smiles, says hello, and makes even the faintest attempt to understand what it feels like to be homeless.

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It's time to talk to someone, but who?

What types of counselling are there?

Here’s a list of what I’ve come across.

My questions are: How does the counsellor expect to achieve results, what do they see as the source of my problems, and what approach do they believe is likely to help? Most formal methods of counselling will include two or more of these facets.

1. The Relationship: you already have the resources within you to sort things out. All that is needed is that I create the right relationship between us.
2. The Solutions: your problems have practical solutions which I will teach you. Some of this will include you learning new skills.
3. Finding solutions: you need to develop problem-solving skills of your own.
4. Memories: it’s all in your memories, especially the ones of your childhood.
5. Repressed feelings: you’re lying to yourself about how you really feel.
6. Consciously controlling thoughts: your natural way of creating and processing thoughts is damaging, so lets help you make some changes.
7. Mental reprogramming: there’s a range of mental tricks other people just use naturally to modify how they think and react. You can learn their tricks.
8. Mindfulness: the problem is your attitude to experiencing life from moment to moment.
9. Hypnotherapy.
10. Classic conditioning.

We’ll take these one at a time – which I guess will take nine ten posts, but you never know.

(A tenth facet added 4 April 2010 as a result of working on facet 4.)

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Bad memories can be tough to live with. Alcohol and other drugs feel like a solution but they are oh so temporary, and the side effects can be worse than the memories.

Have you ever watched a film in which a character has repeated flashbacks to some traumatic event in their past? Part of the story line is that the past is controlling their present. Believe me, it happens.

Fortunately bad memories can be controlled. Some interesting new research on this has recently been published and the BBC have reported on it here. (I think the researchers’ web site is here, although I’ve yet to track down the original research paper. Let me know if you find a link to it. Meanwhile I’ll be studying some of their other research papers with interest )

We all have memories we’d prefer to be rid of. Sometimes these are powerful forces distorting lives. For years my own memories of things that happened in my childhood (actually fairly mild emotional abuse) tortured me. They kept returning. They kept hurting. They kept telling me I’d never recover, never be normal, never achieve what I was capable of. Okay, so I still haven’t achieved that, but now I can relive those memories without pain, and without them manipulating me. They’re just part of who I am, and I’ve moved on from the bad effects.

Often it’s not the experience itself that damages us, but how we react to reliving it inside our head.

Some therapists believe in getting clients to relive trauma. I guess repeated exposure is supposed to dull the pain. That strikes me as a pretty hit or miss approach without clear objectives, although I believe it can work. My understanding is that this process on its own sometimes makes the memory even more damaging. Another danger is that incompetent (presumably uninformed) counsellors or interrogators can guide the process in such a way as to change the memories into what the questioner thinks they might have been. In fact it’s frighteningly easy to create false memories. Arthur Miller’s play ‘The Crucible’ contains some great examples of this, but on a lesser scale we all do this all the time with our own memories. Usually it doesn’t matter. Sometimes it does. If we witness a crime our memories may well be not quite right, and careless questionning can distort them further.

A couple of thoughts here, based on study, training, and experience:

Firstly I believe it is important we retain the original, factual memory as something we can recall at will. The trick is to no longer be controlled by the mental images, but to be able to view them calmly, with hindsight. Probably the only experience we cannot learn something of value for this life from is death. I’m guessing that in the (Phelps Lab) research mentioned above the subjects were able to recall having been frightened by the chosen colour.

Secondly, it is relatively easy to create a second version of a memory. For instance I have helped a student make an alternate memory of a time when he behaved stupidly. In the new version he behaves as the older, more experienced him would have reacted. He has both memories, and is clear which is the historic truth. The other is a psychological truth.

Of course, in creating a second version we are not just reliving the original but reprocessing it in controlled ways within minutes, which is well within the six hour window Dr Elizabeth Phelps’ team identified.

By the way, if you need help with a memory and so far no one has been able to help, consider seeking out a qualified NLP practitioner. They’re not all good, but they should at least have been trained in effective skills and techniques. Make sure he or she understands you wish to retain the original version undamaged and clearly identifiable.

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I lived with a chronically depressed dad, and reading this helps me make sense of my childhood and understand both my parents better.

Jenny, my wife, has severe attacks of depression which have no obvious cause. I cope using a range of strategies I’m still learning, and because I love her very much. Anne Sheffield’s book has rejuvenated my efforts to help and support Jenny, and has provided a wealth of useful information. Despite forty years of study I found this book a revelation. Thank you Anne.

During the eighties Jenny became frighteningly depressed with occasional manic phases and a brief period of mild catatonia. Over six years she spent two and a quarter years in psychiatric hospital making no progress. Most of the doctors either ignored me or treated me as an irrelevant annoyance. After a couple of years I was at my wits end trying to support Jenny, cope with my own depression, and look after our two sons. Someone at the hospital arranged for me to see a psychiatric social worker who came across as tired and distracted – certainly over worked. I asked if there was any way we could be helped as a family. “Are you asking to have the children taken into council care?” he asked. “Hell no!” I said. “In that case there’s nothing we can do to help. Good bye.”

A nuclear bomb doesn’t just affect where it explodes. When I’m badly depressed there is fallout. Other people suffer and have to cope. I’m very fortunate to have known so many people prepared to live with my mood swings – not least Jenny and the boys (sorry guys, we know you’ve been men for a long time but we can’t help thinking of you as our ‘boys’).

If you live with someone who is depressed you know exactly what I’m talking about. The trouble is that most people around you do not understand, and this includes a frightening number of medics. The situation is improving. Medics are better trained now. People are beginning to understand. But having someone close to you depressed will never be easy.

Anne writes with knowledge based on experience of being depressed and living with depressed people. She includes many true examples from people she knows and has interviewed. I think every aspect of the situation is covered, and the result is an eminently readable book full of useful information, great coping strategies, and hope.

If you live outside the USA then you do need to allow for a natural bias towards the situation and culture in the States, but that should be no problem. Inevitably there are sections which are incomplete or slightly biased, but that doesn’t matter. My experiences living with Jenny when she is depressed bear little relation to the scenario described by Anne, which makes me feel extremely fortunate and blessed. There are forms of talking therapy Anne is not familiar with. But her writing has expanded my understanding and clarified a lot of stuff that was scattered and confused in my head. The book was first published in 1998 so a few parts are now slightly out of date.

The book is aimed at anyone who lives with a depressive or manic depressive (bipolar) person. It has sections specific to you if the depressed person is a parent or a child. It looks at the differences between male and female depression, between child (up to about 25) and adult depression, and between different types of depression. It looks at the range of treatments available, both chemical and non chemical. It does all this using simple language and considerable human warmth.

Anne has not just based the book on her own experiences and those of people she helps at the Mood Disorders Support Group in New York City. She’s also gone to a great deal of trouble researching the facts, and has had her writing checked by medical professionals.

If you live with a depressed person buy and read this book, and keep it to hand for reference and encouragement.

If you are depressed then get this book for the person closest to you, and when you’re feeling well enough try reading it yourself.

Anne Sheffield’s related web site is here.

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How can you treat depression?

This depends on the person, the type of depression, its severity, and its cause. Do not try to treat yourself. See someone who is medically trained and experienced. If you have clinical depression and they do not specialise in psychiatry they should refer you for treatment to someone who does.

The world is grey and it's always raining, but there's hope.

Treatment with medication

Severe depression needs medication first before the patient is likely to be able to cope with or respond to any kind of talking therapy. Some cases which feel like the end of the world but are less severe (such as atypical depression and the early stages of reactive depression) may well respond to the right talking therapy.

There is plenty of advice on the net about what medication to use. Be very, very wary of this. If it helps you understand the problems and how anti-depressants work that’s great. But you need someone medically qualified to diagnose the problem and identify the most likely medication to work. Even then you have to wait weeks, maybe a couple of months, to experience any effect. The dose may need to be adjusted. It may turn out the obvious treatment doesn’t actually work for you and something else needs to be tried. And then of course there are usually side effects. Almost all side effects are worth living with! Do not buy medicine over the net.

Since I was first diagnosed with depression in 1970 I’ve been prescribed a range of different medicines. Some had little or no effect and needed to be changed. One mood stabiliser made food taste like cardboard. Since throughout most of the five years I took it I was stabilised at a fairly depressed state I finally persuaded a psychiatrist I should come off it.

Warning: once you are taking any medicine for depression only reduce or stop taking it under competent medical supervision. Stopping too fast or at the wrong time can have devastating effects.

A previous article on medication for mental illness is here.

Treatment with talking

I’ve had a range of talking therapies (counselling, psychotherapy). Cognitive Behavioural Therapy (CBT) and Mindfulness Therapy have been very helpful. I also use some related stuff from Neuro-Linguistic Programming (NLP). At one stage eighteen months of psycho-dynamic therapy was highly effective. Don’t expect the therapist to do all the work, and don’t expect quick results. And by the way (note especially to Jeremy Laurance of The Independent) the old Freudian style psychoanalyst might ask you to lie down on a couch, but I doubt any other counsellor would. Also psychoanalysis seems to be unhelpful with depression.

Once clinically depressed talking therapies are unlikely to be of any help until the depression has been eased at least a bit with the right medication. If your therapist tells you medication is never needed for depression you need to find another therapist. They may be very good at what they do and mean well, but in this one statement they are dangerously wrong. Mild forms of depression can often be helped a lot by the right therapist using the right talking therapy well, but not so severe biological depression.

Two previous articles on counselling/psychotherapy for mental illness are here and here.

Treatment by other methods

I find it helpful to use light therapy. We noticed my depressive cycle is often related to time of year so bought a light box (the psychiatrist was cynical), and it works for me as part of an overall treatment plan. It should be used only in the mornings to avoid it causing sleep disturbances. I start using it on dull days well before autumn (fall) kicks in. My own light box uses fluorescent tubes. These need to be of the right type because ordinary fluorescenrt light does not contain the part of visible light I most need. Also after a year or two of use the specialist tubes wear out; they still provide plenty of light, but have lost the bit I need and I have to replace them. I haven’t tried the newer type of ‘blue’ light available. Light therapy is intended to help boost serotonin levels in people who from Seasonal Afferctive Disorder (SAD). A good introductory Wikipedia article is here. Skip the irrelevent bits.

In extreme cases of depression which do not appear to respond to medication a course of ECT may work. This involves the painless electrical stimulation of parts of the brain. I had it many years ago, and found it a perfectly acceptable form of treatment. I recovered from that depression fast as a result but later relapsed. For me a longer term treatment involving both medication and counselling was needed.

There are many ‘alternative therapies’ on offer. These include acupuncture, homeopathy, feng shui and aromatherapy. My own feeling is that these include a mixture of total junk with some stuff of value. I haven’t read up thoroughly on most of them. If you want to know more a Wikipedia article to start with is here.

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The article is informative and well written, but misses out in two areas. I’ll look at one today, the other tomorrow. This is by no means a complete analysis, but hopefully it will be of help.

All colour has been washed out of the world. It's raining all the time. Real life is just a blur.

What is depression?

Jeremy’s answer is a good introduction given the necessary brevity – it’s just a minor aside in an article focussed elsewhere.  Here are some additional thoughts from the point of view of a long-term sufferer married to a long-term sufferer:

Depression is not just feeling down for a few days. It is an illness, a change in brain chemistry which can have devastating effects on both the sufferer and on friends and relatives.

Phrases like ‘loss of pleasure in things that were once enjoyable’ is correct but misleading because it gives no sense of the seriousness of the problem. My own depression is controlled to some extent by Prozac, but I can still be knocked out of useful activity for days at a time.

It’s not just a matter of getting less enjoyment from watching my favourite TV programme. I feel weak, like you do the first day of recovery from flu. Often my body hurts, I get headaches and sinus pain. I sleep more hours a day, and on occasion have slept all day and all night.

If I can push myself to do anything I soon feel tired physically and mentally - no stamina. And it’s so hard to start an activity however simple because I can’t imagine enjoying doing anything but sleeping. Usually, with Prozac’s help, once I’m started on something I actually do enjoy it. The trouble is that in the motivation phase I have to take it on trust this will happen.

Taking photos on the North York Moors last weekend was enjoyable even though I was depressed. Some of the photos are here (or two posts down if you’re on the blog home page). Writing this article is hard because my mind is fuzzy and resists being made to think clearly. It’s the mental equivalent of trying to run through knee-deep porridge. And I’m not experiencing much pleasure in the process.

I also can become severely withdrawn and uncommunicative, snapping at Jenny if she tries to help. I can become over-critical of other people, and very short-tempered, very angry. Sometimes I’ll go for hours fighting the desire to cry without knowing exactly why. Anything that involves getting dressed, or leaving the house, or worst of all going out in the evening, feels almost intolerable. Something that works for me at my worst is to withdraw into playing computer games for several days. Sometimes I need to increase the dose of Prozac.

I’m not a typical depressive. I’m not sure anyone is. There are different types of depression and people are affected differently, but real clinical depression of any type can be catastrophic. At least until it is adequately treated. It has altered the course of my own life, although perhaps for the better. It has ruled out many career options, and made what I can do often much harder and less productive.

The first time I was hit with major adult depression I went almost overnight from being a high-flying Maths student to barely understanding anything the lecturers said. I was lucky. Results in the part one finals the year before were good enough to get me a degree, but other people have to drop out of university with no qualification.

A factor often overlooked, especially by medical professionals, is depression fallout. My sister and I were affected in a major way by our Dad’s repeated depression. Mum was affected far more. When depressed he could become demanding, extremely sensitive to anything out of place in the house, bad tempered, unpredictable. He often blamed Mum for everything that was wrong in his life. I was around sometimes when he’d have a knife at her throat and be threatening to kill her. The amazing thing is that she loved him and stuck with him till he died aged 85.

He’d also make sudden changes of mind which hurt other people; for instance one September he suddenly announced that ‘they’ had no right to know the details of his finances so there was no way he’d fill in my annual student grant application form. I started my teacher-training year severely depressed with no money.

That’s a brief and highly subjective summary. I’m working on an objective and rather more thorough description of what depression is, but you’ll have to wait for that.

* The Independent article is a response to a couple of recent publications in the UK:
Research has shown that although the number of people suffering depression has stayed more or less constant, prescriptions for anti-depressant drugs has doubled in 14 years. The original BMJ article is aimed at medics but may be found here.
Also our National Institute for Clinical Excellence (NICE) has just published updated guidelines for the treatment of depression in adults. The full report is 580 pages. Even the quick reference guide is 28 pages. This is not for the faint-hearted. Some degree of training and knowledge is needed before trying to apply the guidance. If you’re really interested you’ll find it here.

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