Gradually and then suddenly

As I think about World Suicide Prevention Day, it’s in a fortnight, I can’t help but wonder how effective that initiative will or won’t be, and I’m drawn to recall Elizabeth Wurtzel’s dark and compelling work, her experience of depression. The World suicide Prevention Day site is rudely smiley and brightly coloured, it almost chuckles at me. The site irks me, as does the notion of a prevention day. Why link something that can’t always be conquered in weeks, months or even years with ‘a day’. Isn’t that a bit of whack for those who can be gripped with depression for endless periods? The notion of WSPD is all out of kilter, to prevent suicide wouldn’t we need to address depression first? I do acknowledge that depression is not the only cause of suicide but the major one.

Elizabeth Wurtzel doesn’t pin down a cause of depression, what she does is describe the burden, it’s overarching breadth and seemingly bottomless depth of the affliction. I believe understanding depression and people afflicted by depression, people Wurtzel describes as the walking waking dead, a greater priority than suicide prevention. To me, prevention is not a position to start from, it sets up an adversarial (helping?) relationship between preventer and the suicidal. Ready for battle? Building understanding is my preference.

This is one of Elizabeth Wurtzel’s descriptions of what depression can look like from the inside:

“… Depression is a lot like that: Slowly, over the years, the data will accumulate in your heart and mind, a computer program for total negativity will build into your system, making life feel more and more unbearable. But you won’t even notice it coming on, thinking that it is somehow normal, something about getting older, about turning eight or turning twelve or turning fifteen, and then one day you realize that your entire life is just awful, not worth living, a horror and a black blot on the white terrain of human existence. One morning you wake up afraid you are going to live.

In my case, I was not frightened in the least bit at the thought that I might live because I was certain, quite certain, that I was already dead. The actual dying part, the withering away of my physical body, was a mere formality. My spirit, my emotional being, whatever you want to call all that inner turmoil that has nothing to do with physical existence, were long gone, dead and gone, and only a mass of the most fucking god-awful excruciating pain like a pair of boiling hot tongs clamped tight around my spine and pressing on all my nerves was left in its wake.

That’s the thing I want to make clear about depression: It’s got nothing at all to do with life. In the course of life, there is sadness and pain and sorrow, all of which, in their right time and season, are normal — unpleasant, but normal. Depression is an altogether different zone because it involves a complete absence: absence of affect, absence of feeling, absence of response, absence of interest. The pain you feel in the course of a major clinical depression is an attempt on nature’s part (nature, after all, abhors a vacuum) to fill up the empty space. But for all intents and purposes, the deeply depressed are just the walking, waking dead.

And the scariest part is that if you ask anyone in the throes of depression how he got there, to pin down the turning point, he’ll never know. There is a classic moment in The Sun Also Rises when someone asks Mike Campbell how he went bankrupt, and all he can say in response is, ‘Gradually and then suddenly.’ When someone asks how I lost my mind, that is all I can say too.”

Prozac Nation: Young and Depressed in America: A Memoir, Elizabeth Wurtzel

A dear friend told me the same thing, gradually and then suddenly, that was her experience. In retrospect I can see the same in Mottsu and how he lived and left, it helps me to know that. That simple statement does more to encourage understanding and support depression than any number of world-wide prevention days.

Vale Charlie Haddon

Charlie Haddon, 22, lead vocalist of the band Ou Est Le Swimming Pool, died by suicide after playing at a music festival in Belgium.

His family are reported to be heartbroken, understandably. Charlie Haddon’s dramatic death is distressing and tragic.

I am a little (but obviously not completely) lost for words, suicide is a complex issue and I stand more for suicide understanding than suicide prevention. It all makes me sad. I don’t know how in the world to make a difference, although I think about suicide in terms of cause and effect a lot. To draw a simple casual link for a complex social problem isn’t possible. There is not one or even a few things to do differently.

I think we are all a little more depressed than we ought to be and we’re all suicidal in degrees. What helps? After almost a year of blogging I can only think of;
– Heart – talking, caring, sharing, empathising
– Hand – holding hands and being there in simple and undemanding way
– Hope – if hope and resilience can be learned by rats we might learn it too

My emerging view is that rather than curing any one depressed person we need to support and accept what sits within ourselves, before anything starts to change it seems important to sit with what is. I don’t have the words yet and I do know that I’m slowly getting closer. A year is hardly any time at all.

Talking about the taboo topic of depression

Mark Rice Oxley writes, in the UK Guardian this month, that you can recover from depression, he says that he’s made it and that you can make it too.

In the article (link above) Mark Rice-Oxley says “I wouldn’t wish this illness on my worst enemy; it’s the most terrifying thing that has ever happened to me. But, in a strange way, I am glad of the lessons it taught me.”

Tim Cantopher, a psychiatrist and author of Depressive Illness: Curse of the Strong is quoted as agreeing, he says, “A lot of patients are grateful. They say that without the illness they wouldn’t have been able to make the changes they made to become happy.”

I had a conversation with a dear friend on the weekend and she said something similar after coming through a debilitating depression over a year ago. She says she wouldn’t change a minute of her experience for all it has helped her know about herself, for all she is still discovering and appreciating about her life.

Mark Rice-Oxley quotes four things as helping “meditation, love, time and therapy.” Even if she were to put them in a different order, I think my friend would attribute her well-being to same four things.

Depression is a horrible affliction and it’s possible to live through it, not easy but possible.

Tough Choice: Smoke and die v. Quit and die

I have admitted to the guilty pleasure of being a sometimes smoker, although I happily identify as a non-smoker. I am well aware of the negative consequences of smoking and I choose not to indulge.

I’m not an addictive or automatic smoker, fortunately for me I can take ‘em or leave ‘em. Even so I struggle to watch an episode of Mad Men, where even the doctors have ashtrays on their desks, without longing for a cigarette.

Whatever additive tendencies I may have, smoking is not one of them. I enjoy every cigarette and contentedly go without a puff for years at a time. It’s not the same for others. Many, who know the risks and health affects of smoking and including some who disapprove of it, are also dependent on being able to light up another cigarette. Addicted.

There is a wonder drug, Champix, that blocks nicotine receptors in the brain and supports even the most addicted smokers to ‘give up’. Most will understand giving up to mean the cessation of smoking, and for some taking the drug giving up is more sinister, as some will die by suicide.

Now an argument rages about the greater harm cigarettes, which 16,000 deaths a year in Australia are attributed to, or Champix (the nicotine inhibiting wonder drug) the use of which was linked to 55 deaths by suicide in a week, in the US last November.

The US Food and Drug Administration now requires warnings on the medication “…highlighting the risk of serious neuropsychiatric symptoms in patients using these products. These symptoms include changes in behavior, hostility, agitation, depressed mood, suicidal thoughts and behavior, and attempted suicide. The added warnings are based on the continued review of postmarketing adverse event reports for varenicline and bupropion received by the FDA. These reports included those with a temporal relationship between the use of varenicline or bupropion and suicidal events and the occurrence of suicidal ideation and suicidal behavior in patients with no history of psychiatric disease.”
http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm170090.htm 1 July 2009

Apparently Pfizer, who market Chapix, have said a causal link between the drug and suicidal ideation has yet to be established. Now they sound a bit a tobacco company…

Established causal link or not I wanted to mention that Champix has been linked to insomnia, aggression, depression, suicide and quitting cigarettes.

Hope and resilience in photographs

The Black Dog Institute is a not-for-profit, educational, research, clinical and community-oriented facility offering specialist expertise in depression and bipolar disorder.

The entries have been judged for Snapping the Black Dog: A Photographic Competition about Hope and Resilience in the Fight against Depression.

Wonderful poignant images that capture the essence of both hope and resilience. Apart from the photography competition the site provides information, explanations and links to support resources.

Its a fabulous resource where more can be learned about depression and bi-polar disorder, including fact and information sheets that can be downloaded.

Huddled like a sick ape in the back of my mind

Since reading this passage I can’t shake the image of the sick ape…

“It was absolutely uncanny, gave me the creeps. That woman actually thought I’d been thinking of suicide.

I had been thinking of it right enough, often do, always have the idea of it huddled like a sick ape in the back of my mind. But I’d never do it. Well, that’s not true either. I can imagine the state of mind, I’ve been in it often enough. no place for the self to sit down and catch its breath. Just being hurried, hurried out of existence. When I feel like that even such a thing as posting a letter or going to the laundrette wears me out. The mind moves ahead of every action making me tired in advance of what I do. Even a thing as simple as changing trains in the Underground becomes terribly heavy…”

Hoban, R. (1975) Turtle Diary p. 75. London: Bloomsbury Publishing

Oh, thanks Russell Hoban, finally I can feel how suicidal thoughts reside in one’s head, quietly omnipresent and huddled. Oh my, Hoban’s description of ‘it’ is haunting.

I am reminded of Mottsu’s lethargy, how he was weighed down by his depression and how he barely plodded through his last days. I didn’t quite see it then but now, with 20/20 hindsight; I can see how he struggled and he did not (could not) find the space to sit down and catch his breath.

Having said that I will also say that help is at hand. Around the world there are services dedicated to supporting people keep living. In Australia those seeking support and information about suicide prevention can contact Lifeline on 13 11 14

Depression is…

For a lucky some of us, depression is difficult to fathom as a potentially fatal affliction. For others is an omnipresent shadow, that is difficult to explain and impossible to share.

“For me, depression is kind of like the Jimi Hendrix experience without the Jimi Hendrix. It’s the big black hole at the end of the universe, and it’s sucking all the colour and majesty out of life like a late-night ShamWow commercial. All the happiness there ever was and all the joy that will ever be; all the smiles you ever saw and all the light you’ll ever see – flushed like a dead goldfish down a rusty drain pipe.”

Richard Parker writes with eloquence about depression from the inside.
http://www.abc.net.au/unleashed/stories/s2942107.htm

When you see the rest of your life coming towards you

“My father did, I think. Commit suicide.

Although they called it an accident.

His car went over a cliff into the sea.

On to some rocks that you can see at low tide but not high water.

No collision, no skid marks or anything.

My mother kept the newspaper cutting, I still have it somewhere.

Who knows what might have appeared in the road coming towards him.

The rest of his life maybe.”

Hoban, R. (1975) Turtle Diary p. 76. London: Bloomsbury Publishing

Read Russell Hoban, he is an author to read. His words are touching, at times he tells the story from right inside your head. His words grab me, I sit on the tram with Turtle Diary on my lap and eyes moist, early in the morning. I try not to glimpse my life down the road, and can imagine my reaction if I were to see it. What are we living for?

“My despair has long since been ground up fine and is no more than the daily salt and pepper of my life.” same book, same tram journey, same moist eyes and me sighing.

With his words Hoban reaches into my chest grips my heart, twists and squeezes. I gasp for air, relieved. That’s what I live for, the experience of breathing.

Living and breathing.

Un-slumping yourself is not easily done

“I’m sorry to say so but, sadly, it’s true that Bang-ups and Hang-ups can happen to you.

You can get all hung up in a prickle-ly perch.

And your gang will fly on.

You’ll be left in a Lurch.

You’ll come down from the Lurch with an unpleasant bump.

And the chances are, then, that you’ll be in a Slump.

And when you’re in a Slump, you’re not in for much fun. Un-slumping yourself is not easily done.”

Oh! The Places You’ll Go!
Dr. Seuss

Smoking

Research published this month in the British Journal of Psychiatry found that there is a cause and effect relationship between smoking and depression.

Cigarette smoking, like depression, is not readily explicable. It is not straight forward. When the police came to tell me that Mottsu’s body was found I asked a friend to buy me cigarettes. There’s not research on cigarettes and consolation – not that I was consoled. Smoking then was almost in defiance. I have smoked a lot of cigarettes since then and then stopped as readily as I started.

I enjoy cigarettes, and I don’t smoke, that is I don’t identify as a smoker. I remember enjoying being a smoker way back a long time ago. I breathe deeply as I run the gauntlet of people who stand on the city streets smoking. I can’t watch an episode of Mad Men without longing for a cigarette. It’s deplorable and delicious.

Breathing, consciously inhaling and subsequently expelling air is one secret to surviving emotional distress. I remember waking and reminding myself to breathe. To thoughtfully produce each breath, a sign of living even when almost asphyxiated by grief.

Smoking didn’t foster depression, I enjoyed it too much for that.