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I wish I could have known at 17 someone like me today
Minette Marrin describes how severe clinical depression drove her father to suicide, her mother to despair and how she has fought her own battle with the illness since childhood
Depression killed my father, it ruined my mother's life and it has consumed a lot of my time and me, one way or another, ever since I can remember. What I wish, looking back, is not only that people had known more about depression, and about brain chemistry; but also that people had been willing to talk about the condition.
Now, it seems to me, people talk about it too much, and too carelessly, and use the word so loosely that it has become almost meaningless; that is almost as bad as not talking about it all. What my parents suffered from, I now know, was severe clinical depression. In my father's case, it drove him to kill himself in 1953 - without any obvious reason - when still a young man, abandoning a wife and young children. In my mother's case, it drove her to despair, made worse by grief and loss. She struggled against it extremely courageously all her life; I saw her death in 1998 as a liberation.
In my case - I cannot speak for my brothers and sister - depression has come mildly and intermittently, by comparison. Sometimes it appears so insidiously and so ambiguously that I feel unsure whether it is just one of the ordinary sadnesses of life, or one of the extraordinary ones, or whether it comes from bad genes and bad brain chemistry. I haven't wanted to believe that there is anything wrong with me; at other times I have been in little doubt.
Either way, depression has been on my mind, so to speak, for many years. At times it has wasted much of my energy, because it is tiring trying to hide it and tiring trying to fight it. It took me a very long time to recognise it; longer still to believe that my mother suffered from it and to convince her of it; and even longer to understand it, in as far as I do, and to acknowledge it in myself, in as far as I do.
Like my mother, I think of it almost as a guilty secret. Even if it is not guilty, it might be better kept secret, even now. But secrets usually make themselves known, and usually to the children in the story. Perhaps that is as it should be.
When I began, as a young child, to wonder about my mother's sadness, most things were denied. We were not told, and I did not discover until I was 17, that my father had killed himself. It was too bad to admit and, besides, it had been in another country. My mother never spoke about it and was desperately upset, particularly for us children, when I found out by chance in the late Sixties.
As a child in the Fifties and early Sixties, I sensed what everybody felt: mental illness was for other people. It was not only a disgrace but also (it seems to me now, looking back) a failure.
It could even be a crime; suicide was still, absurdly enough, illegal in the Fifties. People who were mentally ill - or, as we said then, insane - lived in loony bins; there was an enormous one near us in Dorset, and the inmates used to be let out to walk alone, and in silence, along an old Roman road across the top of the Downs, with their hands always clasped behind their backs, as if they were prisoners. Though not necessarily bad, they were certainly mad and dangerous to know, or so I thought then.
My mother's resistance to the idea that there was something wrong with her was very strong, as was mine. In my admiring eyes, she was all powerful, without weakness. And, after all, she had a great deal to be sad about. She was widowed and lonely and isolated, and her fourth child, delivered early at a time of shock, had been born with brain damage; people's response to my sister in those early years would have been enough to turn anyone into a misanthrope.
Even though I didn't then know about my father's violent death, my mother's deep gloom seemed as justified to me as it did to her; no explanation was needed. Besides, she didn't like to talk about her feelings; people didn't, and wouldn't let others.
Most people didn't hold with "trick-cyclists" anyway, though by a curious irony my mother had (or could have had) a much more sophisticated view: she had read some classic psychiatric and psychoanalytical texts as an undergraduate and young wife, perhaps under the influence of our American father. Our bookshelves at home in Dorset still held volumes of Adler, Freud, Krafft-Ebing and Melanie Klein, and some of my father's medical text books. As a teenager, I came to read them, too.
It is difficult now to remember how powerfully my own thoughts and feelings were influenced by hers, and how hard I found it to see her predicament except as she did. Children can hardly avoid complicity of this kind, and it is difficult for them to disentangle themselves, as I found. But over the years, in the Seventies and early Eighties, various of her children persuaded her to accept various kinds of treatment.
Some of it helped, but the old-fashioned anti-depressants then available had unpleasant side effects, and didn't seem to work well for her. It is true that those early drugs emptied the loony bins of chronic depressives, and set thousands of them free, but the pills did not suit everyone. Depression could sometimes be relieved, it seemed, but not removed.
It was not until many years later, after a long and often comical trawl through psychiatric theory and therapeutic practice, through medical news and fashionable psychobabble, that I read some time in the Eighties of a new American anti-depressant, like no other. I bullied my mother, she bullied her GP and she must have been one of the first people in this country to receive Prozac on the NHS. She took it until the day she died.
Though not as triumphantly liberating from this vale of tears as death was, Prozac did at last free my mother from the worst of her depression. It came too late, perhaps, to undo much lasting harm, but I believe it gave her a new life, and something of her old self back; the last years were probably some of the best.
My own acquaintance with depression was something I never discussed with her; at least, not after I had left university. She knew that at university I was sent to a psychiatrist, like every other girl on my corridor; in progressive circles it was intensely fashionable to be neurotic in the late Sixties. Besides, I had just run my bicycle into the back of a stationary lorry on Magdalene Bridge in Cambridge and knocked myself out. This was considered so stupid that it could only have been a suicide attempt, though the truth is that I was very short-sighted, bicycling with an attractive boy and too vain to wear glasses.
In the psychiatrist's office, wearing my glasses and reading her handwriting upside down, I noticed that she had written only one word, "alienated", on my notes. I despised her immediately: "alienated" was one of the buzz words of the day. You could hardly claim to be an intellectual if you weren't alienated.
She also gave me a large dose of the old-fashioned anti-depressants, which made me so ill that I avoided both drugs and psychiatrists for almost 20 years, despite what I now realise were extended periods of genuine clinical depression. It was only out of desperation that I later pressed both upon my mother.
After that first adolescent episode, I never again spoke to my mother about my own gloom. For a long time, I didn't speak to anyone else very much, either. That is partly because I didn't know what to make of it. For if she had an obvious cause for depression, I certainly did not. It is true that I had had some disorder and early sorrow, suddenly losing our father and our home in America, but it is also true that we had an almost idyllic childhood in England. Since then, I have been exceptionally lucky in many ways, so much so that it is embarrassing, as well as implausible, to admit to depression. Yet this miserable thing always seemed to be lurking, to be lying in wait.
Half the time, I was uncertain of what it was, or of whether there was anything unusual about it, anyway. There is a miserable confusion and ambiguity surrounding this shapeless thing. It was only many years later, to my great relief, that a doctor I trust showed me a textbook list for the diagnosis of depression.
It is quite simple. You have to suffer from so many of the symptoms on the list, persistently, for so many weeks, consecutively, without any other better explanation, and then you know. That is it. You can give it a name. By themselves, the symptoms do not seem remarkable; they could form part of any ordinary life, sometimes - tearfulness, loss of concentration, loss of interest in life, loss of sleep, disturbed appetite, anxiety, overpowering sense of meaninglessness, self-loathing, inability to feel pleasure, or even to seek it, reclusiveness, withdrawal, indecisiveness, thoughts of death and so on. I was in doubt for years.
When in doubt, the adolescent tendency - so long drawn out in our culture - is to find someone else to blame. That was the fashion in my teens and twenties, and therapists of every kind were turning in righteous anger on families, particularly on mothers, in a sub-Freudian frenzy. Like most adolescents, I was tempted to do the same, but it was not long before I began to see that this view of mental illness was merely a theory, and a very ill-founded one at that, picked out of a ragbag of psychoanalytic theory and socialist aspiration.
My enthusiasm for Freud soon gave way to disillusion with the circularity of his argument; as for the exotic woolly-mindedness of post-Freudian theory, it seemed either comical, or shocking, depending on my mood. I will never forget my contempt for the unthinking cruelty of fashionable therapists such as R D Laing, and their followers, who blamed the extreme illness of schizophrenics on their cold, unloving mothers; by the Eighties, it was known that there was an immensely important genetic factor in schizophrenia. Even in the Sixties it seemed obvious to me that nature had a part to play in mental illness, as well as nurture.
The frivolity of talk merchants still angers me. One I consulted in the Eighties, at one of the best-known psychotherapeutic insititutes in London, refused to tell me what discipline he followed, even though I explained that it meant a lot to me to know, as I had read a great deal in the field. In fact, he said hardly anything at all, sitting there impassively in the conventional beard and sandals; but at last, after several sessions, when I said how ashamed I was to feel so bad, and to complain, when I had no real troubles, not like the real miseries of the Vietnamese boat people in the news, he solemnly replied: "You are a boat person."
I can't say that this man singlehandedly turned me into a biological determinist; I had had tendencies that way all along. But he finally made me despair of the talking cure people, good or bad, amateur or famous.
There are some kinds of depression that talking cannot touch, just as there are some kinds of therapist who are impervious to common sense.
I don't mean that talking is worthless; besides, it can be fun. The cartoonist Mel Calman used to say that one of his favourite activities was
sitting in the Patisserie Valerie with a young woman, eating cream cakes and discussing her depression. I used to like it as well, because he was such good company, but I found his approach too Viennese.
He seemed to think that the human condition in general and family life in particular make deep gloom unavoidable, but that talking (and cream cakes) take one's mind off it, or take it off one's mind.
I was very relieved when, at about the same time in the 1980s, it was beginning to be commonly acknowledged that there was almost certainly an important genetic factor in depression, as well as in schizophrenia and many other disorders. It fitted so well with my own impressions. So, too, do the more recent theories about the physiological impact of environment, suggesting that the brain can somehow be engraved with early misery - not just hardwired, but rewired for sorrow, so to speak. Meanwhile, enormous progress in brain science brought forth Prozac and all the other, later SSRI drugs. These drugs do not merely alleviate depression, they stop it. I cannot understand why it is conventional now to decry these drugs and sneer at people for taking "liquid sunshine". They may be relatively crude, and may be abused, but for those who really need them, they are a lifeline. They might have saved my father. I cannot think of them without the most immense gratitude.
Even now, I would rather not admit that I, too, have taken several courses of Prozac, or of similar but more recent drugs. But I think it is worth admitting and talking about. I wish I could have known at 17 someone like me today. It is true that there have already been many other people who have been braver, and who have written eloquently of their own depression, and its treatment. Mostly, though, they have been people who have suffered from very serious, suicidal depression, or manic depression, and have been acutely ill and taken into hospital.
Much less, I think, has been said about the lesser forms of intermittent mild to moderate depression, which I have known. Mild to moderate depression does not tend to drive people to suicide, nor even necessarily to drink. Unlike serious depression, it lacks a dramatic quality that might help to identify it. While it has people in its grip, it does not stop them doing things, but it stops them doing anything well, or with pleasure. It is the enemy of promise, of love, of sex, of fun and of a sense of humour; it makes people stupid and dull and mean, it makes them reclusive, forgetful and slightly paranoid.
Depression does not always depress; sometimes it agitates and overexcites, and makes people painfully anxious. It can make them quick to tears, or to sudden foolish anger, but it can pass almost unrecognised. It can pass for normal, because it is so difficult for anyone, particularly for the sufferer, to see where personality shades into pathology. It sounds like the self-pity of someone obsessed with her own feelings; at best, it seems like the dreariness of someone born, in the wonderful Irish expression, a couple of drinks behind. It invites dislike. It is, in its own dull way, a waste of life and time.
Since the first appearance of Prozac, however, I have been full of hope. However imperfect such drugs are, however little they are understood, and whatever their side effects, they can be little short of miraculous. New, improved versions will certainly follow. Even better is the prospect of genetic engineering; before long, it may be possible to identify and correct genetic tendencies towards depression.
Only someone who has not felt depression could fail to welcome that. Depression has no meaning, no value, no useful connection with talent or intelligence. It is romantic sentimentality to say that depression is the reverse side of creativity. Genetic engineering will take away the fear of passing on bad genes, the fear which made me reluctant to have children of my own, and which makes me watch them anxiously. As a teenager, I was saddened by Philip Larkin's famous verses:
Man hands on misery to man.
It deepens like a coastal shelf.
Get out as early as you can,
And don't have any kids yourself.
Now it seems that science is going to prove Larkin wrong, in this respect at least. The ordinary and extraordinary sadnesses of life cannot be avoided, but I do believe that depression can be destroyed and will in the end be defeated.
The Daily Telegraph | Tuesday, February 20, 2001
