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.