Month: October 2022

What does it feel like to be depressed?

What to does it actually feel like to be severely depressed? To be very anxious? To suffer from OCD?

People who don’t suffer from mental illness often think that being depressed is a bit like being sad, that being anxious is like having a touch of nerves before an exam, and that having a compulsion is simply an urge to do something. They’re all much worse.

Depression is very different from feeling a bit down, or having a moment of passing sadness. It’s an extraordinary “pain in the mind”. Imagine feeling sad, but much, much sadder than you’ve ever felt before. Imagine all the lights being turned off in your head. Imagine your mind turning black; black is the colour of depression. You’re living in a monochrome world where all feelings except pain have been turned right down. Imagine a dark ball at the centre of your being that is so cold it hurts. It’s like an icy knife in your soul; it’s worse than any physical pain. You just want to go to bed and cry, to fall asleep, or even die. Death would be a relief, because death is an end to the misery. In any case, who cares: alive or dead, what’s the difference in the end? And who would miss you anyway? You hate yourself and your life. The idea of doing anything is impossible to contemplate. There’s nothing to look forward to, and nothing gives you pleasure, not even the things that in better mental states you can rely upon to excite you. Your despair is utter. Everything is hopeless; and you are sure you’re never going to get better. You feel a terrible sense of doom, foreboding, and fear, not just that you’re never going to get better, but that the universe is a threatening, mysterious, evil place. And everything is such a fight; everyday life is exhausting. You can’t concentrate long enough to be able to complete simple tasks, and in any case you forget what you were going to do nearly as soon as you form the intention to do it.

Managing to do the little things can wipe you out after you’ve used up so much energy making yourself do them. You feel exhausted all the time; deep fatigue goes with severe depression. You make mistakes in the simplest tasks. You have no motivation do to do anything anyway, and no interest in anything. You feel nothing other than total despair, and feeling amazingly, incredibly guilty about everything, as though you’re lazy, incompetent and everything wrong with the world is your fault. So you deserve to suffer so much. Everything is overwhelming, and you are paralysed. You don’t just have very low self-esteem, you are also full of self-hatred. You are the lowest of the low and completely worthless; the world would be a better place without you. If you‘re depressed for any period of time self care tends to go out of the window: what is the point of shaving? Can you really be bothered to wash your face? Who cares if the kitchen sink is filthy? You overeat and overeat convenience food, because that’s all you can be bothered to cook. You sit, finding yourself in tears, and you’re not sure why. You feel completely alone; no one can possibly understand how you feel just now. You can’t bring yourself to speak to other people anyway. And in one final little trick of the mind, time slows down to prolong the agony. Every second is torture. So you try to sleep for as much of the day as possible, and you drink wine and take pills to try to ensure that you can sleep. You feel physically ill as well, with aches and pains exaggerated to distraction. There’s a tickle and lump in your throat. You perpetually tug at your eyebrows, and occasionally pull them out so that they contain strange bald patches. And the ear-worms – those annoying tunes stuck in your head – drive you even madder. You also worry that you’re a black hole of misery, sucking in joy around you, ruining the lives of others – so it’s fortunate that you prefer to suffer in isolation. It is paradoxical that you are lonely and yet want to be alone at the same time, but depression is full of paradoxes. When you’re severely depressed you can’t do anything. You just want to sit still and let the pain wash over you. Some people kill themselves because they can’t take the pain any more; and some people are so ill they can’t even initiate the act of suicide. You have contemplated suicide many times because everyday life hurts too much, and often you really don’t care if you wake up tomorrow morning or not.

That’s what it’s like for me at its worse, but fortunately therapy and medication has helped me enormously. It’s been a while since I’ve felt that bad, but I still get occasional relapses, occasional inklings of those feelings.

I find severe anxiety more difficult to describe. It is a bit like being anxious before an exam, or giving an important presentation or wedding speech, but much more intense and persistent. It is also highly visceral; it gets to your gut. You can’t concentrate on anything, but instead worry about everything. You’re completely on autopilot.

Anxiety often goes with depression, giving a condition imaginatively known as “anxious depression”. There is also agitated depression, which is similar but with more activity – of a bad sort.

It is my misfortune to suffer from obsessive-compulsive disorder (OCD) as well (which is occasionally co-morbid with depression). An obsession is not just like a pre-occupation; it is all-consuming, and you can think of nothing else. A compulsion isn’t simply an urge to do something, or check that you really did lock the door; you must do it, usually many times. My OCD started when I was about 11. I would repeatedly get up in the night to check that my bus pass was in my jacket pocket, and go downstairs to check that the front door was shut. I think it was about fifty times a night, possibly more. Why didn’t anybody notice? Then when a passenger in the back seat of my uncles’ cars I would worry that passing drivers would be able to read my thoughts (even though I knew that was impossible), and might be insulted by them, so I had to apologise to them by saying “sorry” mentally – in powers of three. Occasionally I would reach 243 sub-vocalisations. I suffered greatly performing these compulsions, but the prospect of not doing them filled me with even greater pain. Performing these compulsions also releases the mental pressure somewhat, perhaps in a similar way that self-harm makes some people feel a little better. Eventually the compulsions faded away, to be placed with slightly less compulsive compulsions, such as hand-washing (but much less excessively). I still tend to do things in multiples of three (such as checking the front door is locked behind me nine times), and I am still a very obsessive person, with curious obsessions like having to have complete sets of things such as books all in the same format.
That’s what it’s like when it’s bad, but even then perhaps I have failed to capture the full horror. I am sure that for some people it is even worse.

I am Emeritus Professor of Psychology at the University of Dundee. There is much more information on mental health and other things on my website, www.trevorharley.com. Please pass details of this blog on to anyone who might find it useful. There is no need for anyone to suffer in silence. If you are depressed, anxious, or suffer from OCD, contact your GP, or NHS 111, or a psychology or medical practitioner, or call Samaritans or Samaritans USA.

Sing if you’re glad to be mad, sing if you’re happy that way

As I write it’s World Mental Health Day. Should we take pride in being mad? Is it indeed something to celebrate? How do remove the stigma surrounding mental health problems?

As I start writing this entry, today, Monday 10 October, is World Mental Health Day, so I thought I’d write an entry to celebrate it.

“Mad Pride” is a movement of people who argue that individuals with mental health issues should be proud of their “mad” identity. According to its Wikipedia entry, the movement started in 1993 in Toronto in response to local prejudice towards people with a psychiatric history, and grew from there. Mad Pride seeks to educate people about mental illness, and also to “reclaim” terms of abuse such as “nutter”. I have mixed feelings about this idea. On the one hand educating people is obviously good, as is identifying and preventing psychiatric abuse. We also need to be wary about what is labelled as “ill” or “mad”. In 1860 Elizabeth Packard was committed by her husband to Jacksonville Insane asylum for three years by her husband because she disagreed with her his religious and political beliefs and with the way he treated her. Most people have heard of the misuse of psychiatry in the USSR, with the hospitalisation and enforced treatment of people with anti-state and anti-communist views, a “disorder” that was charmingly called “delusion of reformism”. There was also Walter Freeman’s use of lobotomy, performing several thousand lobotomies across the USA spanning decades, including one on a child of just four. Virtually everyone would agree that these sorts of things are wrong, but on the other hand, being anxious or depressed is utterly miserable. Would anyone say they’re glad to have cancer? I doubt it very much. We can have pride in coping, pride in surviving, definitely, but pride and joy in being mad?

Perhaps I’m misinterpreting the idea of the movement. Of course some mental health conditions have positives as well as negatives, such as the bursts of energy and creativity that go with bipolar disorder, but whether people think the ups are worth the downs is highly debatable, and the suicide rate in this group suggests many don’t. I don’t also mind – indeed I quite enjoy – being neurodivergent. There is nothing “wrong” with me just because I’m very introverted, and don’t much care for social activity, or am “on the spectrum”, but these things don’t cause me suffering, apart from when other people tell me I shouldn’t be this way, and in that respect I am right behind “difference pride” movement. There is also some vagueness associated with the term “mad”; people say so-and-so is mad because of their unusual behaviour, but they don’t really mean that person is suffering from a mental illness. The key word here is “suffering”: the suffering mental illness can cause is horrible, and definitely not to be celebrated.

It is extremely important to be able to say that you have mental health difficulties without feeling shame or with there being any stigma attached. The situation used to be much worse, and still many people feel embarrassed about being mentally unwell. They shouldn’t. To take my favourite analogy, people don’t feel stigmatised and ashamed because they have cancer (although admittedly once there was some stigma attached to it, because it was so poorly understood and usually a death sentence; my mother would never refer to it by name, simply calling it “tthe c-word”””, which was often confusing for the young me just learning a few swear words). The brain is an organ like any others, and mental illness is a brain disorder (albeit a complex one, involving genes and upbringing). You wouldn’t feel embarrassed to say you had a pancreatic disorder; so why should you feel shame about your brain going wrong? My mother, yet again, though often very ill with depression and OCD, would refuse to do anything about it, because, she thought, she should be able to control it; if only she were strong enough the depression would go. I am not saying that attitude and taking some responsibility aren’t important, simply that we should accept mental illness has some physical basis and that we should not feel shame because we are ill. Neither am I saying that there are not psychological influences on physical health and illness, when there clearly are, but there are limits to what we can do.

If I could excise mental illness from my health, would I? It is so difficult to imagine life with just the bad bits cut out, and the bad bits influence the good too. Would I be able to write and be a scientist without any OCD, for example? It makes me think of that episode of Dr Who, The genesis of the Daleks, when the Doctor decides against killing all the Daleks at their inception because he concludes they have done more good in uniting the universe than they did harm. I wouldn’t be me without my mental health problems. It has shaped my personality, and given me a degree of resilience I probably wouldn’t otherwise have. “That which does not kill us makes us stronger”, as Nietzsche said in his Twilight of the Idols.

Finally some explanation. I let my subscription to WordPress lapse because it costs money and like most others I am trying to cut back. I tried hosting this blog on my website, but it’s clear that many people prefer this way of reading the material, and I can see why, so I have renewed my subscription. Please do check out my website though because there is a lot of material there:

www.trevorharley.com.

Anyway, stay healthy, stay proud, don’t feel shame or embarrassment about mental health, and seek help if you need it. There is no point in suffering in silence. And the best of luck to Mad Pride; the only way we will overcome stigma about mental health issues is by being honest.