A few months back, I got depressed. Not blue or a little bit sad, but throw-myself-on-the-floor, weeping, screaming, bathroom-wall-punching-until-my-knuckles-bleed, jump-in-front-of-a-bus depressed. I would wake up in the morning (from not sleeping) and feel as if I was underwater, the weight of it crushing down on me. My words coming out like bubbling murmurs. An incessant ringing in my ears. I couldn’t think straight; sometimes I couldn’t even think. I had no logic or capacity to control my emotions. Everything was open and raw, like a massive septic sore. Yet at the same time I felt desolate, unresponsive and completely and utterly empty. As if a negative of a person, as Sylvia Plath once described, almost as if I didn’t exist.
Depression is nothing new in my world, having experienced bouts of it since my teen years. As such, I’ve become fairly adept at recognising the appearance of this looming threat and managing its cyclical visits, mostly without much intervention. When it begins to shroud my brain in darkness and I become tired and listless, I force myself to take long walks, write, eat properly, do the occasional yoga stretch and when I’m really pressed, imagine having conversations with my make-believe therapist who I’ve decided looks like David Thewlis. The sense of abject despair and hollowness eventually subsides, but it would be disingenuous of me to say it ever fully disappears. It’s a fact in my life and I’ve learnt to live with it.
This time around however, was different as my usual arsenal of coping strategies was no longer as accessible. Unlike with one small child, having two meant that the day was totally sculptured around their needs and temperaments. There was no room for long walks or the plugging in of headphones; my world had become inexorably child-centric. Despite profound exhaustion, I was unable to sleep; my mind whirred throughout the night, each thought in my head part of an infinite digression. When I got out of bed, my body ached so intensely I felt as if it were being held together by rusting wire. I went through the day like an automaton, with nothing to offer my children except irritability interspersed with floods of tears.
I expected all of this and so trudged on, safe in the knowledge that at some point the marathon would end and life with the two of them would become easier.
Then one morning, at around 4am, I realised I needed help. The baby was crying and I got up to attend to him. Neither asleep nor awake, I went through the motions of giving him his milk but he refused to settle. He was emitting that horrific shrill newborn cry, the sound of it reverberating in my bones, infiltrating my skull and making my stomach pinch. The need for it to stop was so intense that for a blindingly rage-filled moment, I wanted to throw him across the room. So ferocious was the sensation that I immediately panicked and handed the baby to my partner. I need help, I said to him, I’m worried I’m going to hurt him.
A few days later, my GP prescribed me some sleeping pills, recommended some relaxation apps, and referred me to the local talking therapies service – a self-referral service. The immediate recommendations my doctor provided me with proved very helpful in the short term, however the referral process for mental healthcare I found frustrating and totally inadequate.
After a series of phone consultations and completing of the same set of questionnaires at least three times over, it was decided that the ‘appropriate’ course of therapy for me would be a CBT (cognitive behavioural therapy) workshop. My eyes rolled as the consultant said this to me. I didn’t blame her – she was nice enough. But I resented a) the suggestion that this was part of an informed and considered case-specific ‘decision’ when in fact CBT is essentially the only form of therapy initially on offer through the NHS; b) that I couldn’t even speak to a counsellor directly, but instead had to be filtered through a workshop and c) as someone who has been living with depression for over fifteen years, the suggestion that CBT was somehow revelatory, as opposed to a therapy I had been exposed to on numerous occasions in the past.
I felt myself getting increasingly frustrated as I spoke to the consultant. It was not the response I had hoped for when asking for help. I understood the logic: the workshops were almost a form of triage, weeding out those who may benefit from brief instructive discussion in a safe environment, and separating them from those who may need further assistance. The flip side of this is that one might feel – as I did – that the acuteness and particularities of one’s mental state are being overlooked, that one is being thrown onto the production line of mental healthcare with a one-size-fits-all approach.
If I attended the two hour introduction (in three weeks time from the phone call the consultant and I were having), then the eight hour workshop (a week after that), then the two hour follow up (a month afterward) then I would be asked if I still felt I needed help and then I would be scheduled for a one-off consultation with a mental health professional. I found the whole situation abhorrent and patronising, but I tried to remain a good sport. After all, what choice did I have? Fine, I said to the woman on the phone, I’ll give it a try. To maintain the pretense that this was somehow a tailored response to my case, the consultant then said “Now is it depression or anxiety you think you suffer from more? I just want to make sure we put you in the right workshop?” I explained that I didn’t really feel I could separate the two as both conditions seemed to inform the other – surely that diagnosis was something for a professional to help flesh out, rather than me having to self diagnose over the phone?
Equipped with this sense of deflation and low expectation, I went along to the introduction, where my stance was immediately confirmed. The woman running the workshop was so alarmingly bereft of basic communication skills that it seemed more fitting that she cluster around the group table with the rest of us than attempt to lead the discussion. As I sat there, I felt my anxiety shoot through the roof and considered asking her to list her credentials. Painfully, I weathered the two hours, allowing her the benefit of the doubt (a waste of time) after which I left feeling no more informed nor assisted. The upshot was that I resigned myself to managing my own condition as help was looking increasingly unlikely. Which, somewhat perversely, is probably what the workshop hopes to encourage.
Plastered at the bottom of all written correspondence with the talking therapies service is the disclaimer that they are not a crisis service. If people are in crisis, then they are directed to contact the Samaritans. This is all fair and well, but one of the problems I’ve encountered with mental health provision is that there is considerable onus on the individual to not only understand their own condition but to be able to assess how acute it is. Fortunately for me, the length of time I’ve had depression and the various treatments I’ve undergone over the years have enabled me to recognise most of its permutations, but there are many people who aren’t as familiar with their condition and are suffering far more intensely than I ever have. If people are reaching for help, the last thing they should be forced to do is participate in a drawn out, tedious process which ultimately seems to trivialise their experiences. What if there hadn’t been that small part of my brain which prevented me from acting on some of these extreme impulses? What if I acted on those moments of desperate need? My children may very well be without a mother. Or, more disconcertingly, I may be without a baby.