Was I Sick?
I remember the experience well; the heavy fogginess in my head, the almost impossibility of making decisions, the sense of overwhelm when I gazed, almost unseeing, around my distressingly messy house,
the tape of negative thoughts about everything running constantly in my mind, bashing my head against the bathroom tiles to dislodge the fuzziness, the inability to sleep, the all-pervading sense of hopelessness when I thought about the future.
I was profoundly unhappy and at a complete loss as to how to help myself.
But was I ill?
I think I might have been emotionally unsteady, out of whack, not thinking straight…but I don’t think I was sick.
Sickness implies a biological basis.
Of course, I had wondered, many times, if there wasn’t actually something very, very wrong with me. I certainly didn’t feel normal. I knew what I was feeling was not normal because it was not always that bad.
For much of my life, from around my teens, I have felt a bit low.
What form did this ‘low feeling’ take?
I cried a fair bit, especially in my teens, a time known for angst. I remember spending a great deal of time on the floor with the dog, bawling into her furry neck and my mother, hands wringing, saying, ‘If I only knew how to help you!’
Self-consciousness and lack of confidence were features that marred university life.
Worry about what other people thought of me, my introverted and rather sensitive nature and thoughtful personality created a broodiness that coloured my experience of life.
None of these characteristics – self-consciousness, introversion, sensitivity or being reflective – meant that I was profoundly unhappy, but they may have created my way of being in the world, a way which made me aware of what I believed were my personal shortcomings, led me to require time alone away from others, heightened sensitivity towards sorrows and miseries and cruelties of the world, and contributed to the underlying sense of melancholy and uncertainty that coloured my young adult life.
But I wasn’t ill.
In fact, I was often filled with a sense of excitement about life and the world. I longed to travel and when I first went overseas in my early 20s, I thought I was coming home to myself. Finally, overseas, I felt alive, confident, adventurous, optimistic, joyful.
During the years when I felt at my lowest were those years with significant levels of stress. A failed romance followed by 5 tough PhD years at the end of my 20s, the loss of a loved, but potentially unlikely career, two job losses in my early 30s, an unsuccessful business in my mid-30s.
These were years typified by heart-felt sorrow, regret, attempts to remake myself again and again, a fear that I would never settle into a normal life, make money, buy a house or apartment and feel strong and optimistic.
These were years typified by frequent weeping, very poor sleep and a tendency to isolate, bursts of energy between periods of being barely able to move, moments of clear-headedness which dissolved into days of inability to think through situations or make decisions, flashes of knowing I was headed in the right direction which disappeared into the fog of deep uncertainty.
I was Profoundly Unhappy
I don’t think I was ill, but I know I was profoundly, overwhelmingly, intensely unhappy and my thinking didn’t help.
I couldn’t apply my logical brain to the situation. This brain, which had got me around Syria alone as a 24 year old, through a PhD, through training in immigration law, and whose analytical abilities had kept me resilient and empowered, suddenly seemed to abandon me.
It seemed obsessed with how terrible my life was, how I’d ‘always been’ weak and useless, how grim the future looked, how it was all hopeless and nothing would ever change.
These thoughts were not a reflection of reality, of course. I was very fortunate in many, many ways, I was a strong, intelligent, sensible woman, the future wasn’t bleak and there were lots of ways it could and would improve.
I just found that hard to believe at the time.
I don’t think I was ill.
But my thinking was definitely disordered.
Is a disordered mind an illness? Or just out of working order? Needing a tune-up?
But aren’t all illnesses symptoms of something that is out of whack?
Illnesses that begin with the infiltration of a foreign body – a germ, say – such as a stomach upset, a bite or sting, an infection, make one physically sick. Something that doesn’t belong in the body gets into the body and wreaks havoc. Physical illnesses or sicknesses are biological in origin.
Such illnesses are treated with antibiotic medication and often clear up. They may clear up even without medication, though they may take longer and be more uncomfortable.
But what about cancer, Alzheimer’s, Parkinson’s, diabetes, MS, arthritis…what should we call those?
What about blindness, deafness, Down’s Syndrome…what should we call those? Are they disorders? Malfunctions?
What about birth defects, like the one I was born with, a hole-in-the-heart or atrial septal defect? How should we label them?
What about developmental or growth disorders like the one I experienced, scoliosis of the spine? What should they be called?
Surely they are not sicknesses because they are not caused by the infiltration of a foreign body or germ. They are not biological and are not treated with medication.
They are caused by the body’s own systems malfunctioning or wearing out. They are not bacterial diseases, but rather changes or even failures in the way the body works. Organs, glands, systems not working as they are expected to or simply breaking down.
They are medical conditions. They are treated in the operating theatre. I had surgery for my heart and back conditions.
They are also treated pharmacologically, with drugs developed to mimic the body’s own processes, like taking thyroxine for an underactive thyroid.
What about the range of problems referred to as mental illnesses? There are many and they have different manifestations.
Are they biological diseases, caused by a foreign body, or bacteria? Are they medical conditions, physical malfunctions of some system in the body?
The short answer is, we just don’t know.
All we have are ‘symptoms’. I have little knowledge of psychotic conditions, but I do have experience with depression, because this is what the GP called my unrelenting sadness.
A bunch of symptoms.
My depression was diagnosed on the basis of what I told her about what I was feeling emotionally and how this manifest physically.
Most doctors’ appointments go like this. You feel sick. You go to the doctor and explain how you’re feeling. Depending on what you’ve said, the doctor may look at your body, feel around the uncomfortable or painful area, listen to your heart, take your blood pressure, ask for tests to be done, order x-rays or scans. The doctor gathers information and having reviewed the facts before her, makes a diagnosis.
When the doctor diagnosed my sadness as depression, the GP didn’t do any tests; no blood samples were taken, she didn’t listen to my heart, check my pulse, order a scan or x-ray.
There’s no biological basis to depression, not that we know of.
You can’t stick a needle into your head and test whatever comes out. There’s no test for how many neurotransmitters you have in your brain. You can’t scan for or test for an ‘imbalance of chemicals’. Even if there is something ‘malfunctioning’ in the brain of a person with depression, this is not proof that there is a biological basis to the condition.
Yet, chemicals (drugs) are prescribed in ever-increasing numbers to people who present at the GP with overwhelming sadness.
So perhaps it’s a medical condition of the brain, like Alzheimer’s or MS, a malfunction of a brain system. You can scan for that. The brain can be scanned and the cause of the condition can be pinpointed. Some malfunctions of the brain cannot be cured, yet. They can be improved with drugs, the inevitable end delayed, but not, unfortunately, ultimately avoided.
No one has yet come up with a scan for depression.
But sadness is different to depression. They feel different. They last for different lengths of time. They are different. The experts say so.
I went to the doctor when my profound feelings of sadness were beginning to frighten me.
I was already hurting myself, banging my head against doorframes or the hard white tiles of the shower. I made fists and pummelled my head. I wanted the fuzziness out of there.
People cut themselves to rid themselves of the pain. Teenagers who cut are taken to doctors because clearly hurting yourself in this way is not normal. People who are found semi-conscience or worse and have put themselves in this condition are often hospitalised because damaging yourself in this way is not normal.
So perhaps there is a sliding scale of deep and profound unhappiness. Perhaps it can lead to such a deep malaise that death is the only way out and perhaps this is the moment that deep and profound unhappiness turns into a disease.
But I don’t know that I believe that.
Isn’t it just part of being human to have unpleasant and unwanted feelings?
Antidepressants or Placebos?
People who are at the cusp of (or are actually attempting to) hurting themselves may not present at the family doctor. They may present at the emergency room of a hospital, either conscious or unconscious. Something very disordered has caused them to decide to die. Pharmacological assistance (antidepressant drugs) seem to be effective in treating the deep and profound sadness that leads to that decision.
Perhaps people who believe death is the only answer are ill, because their behaviour is not normal. It’s not normal to wish yourself out of the world. The normal prerogative for human beings is preservation of life.
When people present at the GP with a deep and profound sadness, pharmacological assistance is not so effective. But they feel bad so they go to the doctor, just like I did. They are not sure where else to go. They are wondering if they are ill. They are frightened. They want to the doctor to tell them what’s wrong and to put it right. They understand that doctors deal in medication and that medication makes pain go away. They want the pain to go away and expect that medical treatment will be offered.
And sometimes it works. I felt instantly better. Merely a few hours after taking my first antidepressant tablet I felt the fog beginning to lift. I knew it was going to be OK.
But how is this possible? Antidepressants are famed for their long lead time. Effects are often not felt for at least 4 weeks, so the manufacturers say.
I now believe that what I felt was not the antidepressant taking effect, but a placebo effect.
I have been brought up in the western medical system in which doctors treat diseases with drugs and medical conditions with surgery. I have received plenty of both in my lifetime. I fully expected to leave the surgery with a prescription for an antidepressant medication. I wanted it. I felt really, really bad and wanted to feel better. So I had a high expectation that the medication would have a positive effect.
Now I was what Rutherford and Roose describe as a ‘treatment-naïve’ patient.
I had no idea how antidepressants worked nor of side-effects.
I was hungry for help, desperate for the seemingly endless sadness to go away. I had wondered for a long time whether I was actually unwell, but never quite certain as I thought my feelings might be something to do with my personality. I had some kind of defective character. I don’t think that is true either, but it was part of the reason that it took so long to seek help. I just thought I had to pull up my socks and be more positive. Or something. Rutherford and Roose report that the placebo effect is noticeable even in treatment-naïve individuals.
I think what I was actually feeling was tremendous relief that I was finally getting help. What is relief? Relief cuts the fight-or-flight response and allows calm to be restored.
I felt calmer because I had taken action. Sharing a secret fear, confiding in a sympathetic human being was a therapeutic relationship which made me feel less like it was my fault, and more as though I could actually be unwell and that medication was the answer. It was a relief to put a name to my feelings and a solution I could understand.
Simply deciding to visit the doctor, revealing my deep and profound sadness to her and taking away an antidepressant prescription was enough to raise my mood through the production of neurotransmitters involved in good feelings and gave me a sense of control, and that made me feel better.
This was not the antidepressant being effective, I don’t think. I had gone to the doctor expecting to be listened to and given a solution. I was. I took the pill and felt better, because that was what I anticipated would happen.
So is a positive response to antidepressants all in the mind?
No, I think it’s in the brain.
My actions had led to my feeling calmer and more in control, which released my brain’s own healing chemicals: opioids, which slow breathing, block pain and have a natural antidepressant effect.
I had no side-effects. I didn’t know what the side-effects were, with the exception of lower libido, the only side-effect my second (male) GP asked me about. There may have been other side-effects, but if there were, I either didn’t experience them or experienced them as part of the illness which I knew I must have, the illness of depression.
I wonder whether antidepressants work for some people because they believe they will.
Having been to the doctor and obtained a packet of antidepressants, I took them faithfully for 6 months and then went off them, because I thought they had cured my depression. I felt pretty good, at least much better than I had for years, and I had no negative experiences going cold turkey.
But the horrid feelings came back. Suddenly I was back where I was; weeping, confused, frightened and angry with myself for going off the antidepressants.
Obviously they were working and I had foolishly thought I was cured. Clearly the cure takes a bit longer.
I decided I needed to take control again and returned to the doctor who frowned and said I needed to stick with the antidepressants. She handed over another prescription and relieved and determined I went to the chemist, now convinced they were making me better, fighting this illness.
I went back home, back to my usual life. Nothing changed significantly. Oh yes, my intense, profound sadness became just plain old sadness, and sometimes dipped again into profound sadness, but nothing in my life changed. My business was stressful, I took little exercise, I isolated from my friends, my home was still a mess, I ate and slept poorly.
But at least I didn’t have side-effects. Others take the prescriptions from their doctors and enter the vicious world of antidepressants: doses, side-effects, more drugs to counter the side-effects, deciding that putting up with some side-effects are not as bad as the profound and intense sadness that drove them to the doctor in the first place.
Nothing changes. Work stays boring or stressful, relationships are still battle zones, lives are spent on couches, in cars or cubicles, fast food, convenience food, food devoid of nutrition appears on dinner plates every evening. Life has little meaning; people are buffeted about by its dramas and challenges.
When I took myself off the antidepressants, the depth of my sadness lowered again. Does this mean they were working? Not really. I just didn’t feel particularly empowered to change anything in my life.
Because I didn’t know that my deep and profound sadness was caused by my reaction to what I was experiencing in life and possibly because the antidepressants were numbing my emotions so that I was bereft of any motivation or desire to change anything about my life.
There was no biological basis to my deep and profound sadness.
The second time I went off antidepressants the same thing happened; the symptoms returned in a flood. The GP sighed and made me promise I wouldn’t go off them again without his assistance.
I promised and I kept my promise.
Things improved dramatically after I closed my incredibly stressful business, retrained as an English teacher and went off to live and teach in China. I had new experiences doing something I loved, travel. I joined a gym. I mostly ate home cooked food. I felt my job had purpose and meaning and my students were grateful for my help.
My brain wasn’t out of whack; my life was and nobody, not the GP, nor the psychologist, had the insight to ask me about how my life was going.
Why should they? To the doctor, deep and profound sadness is biological and needs to be treated with chemicals. To the psychologist, it is a disorder of thinking, possibly caused by childhood traumas which need to be analysed and healed with ‘closure’.
There is some truth in the psychological basis for deep and profound sadness. But psychoanalysing the past doesn’t necessarily lead to meaningful change in the present.
Some people call antidepressants ‘life-rings’ you throw to someone while they are drowning. Drowning in the normal deep deep sadness of life. They say that if you want to get back in the water, sooner or later you’re going to have to learn how to swim. In other words, take the antidepressants, but if you want a less sad, less dissatisfying life, you’re going to have to create it.
Reduction in stress and a meaningful life will eliminate deep and profound sadness. Exercise, nutrition, good sleep and close friends will eliminate deep and profound sadness.
Some degree of symptomatic reduction may be achieved through the use of antidepressant medication. But studies have shown that symptomatic reduction can also be achieved through exercise, nutrition, good sleep and close friends. Exercise, nutrition, good sleep and a close friends change the brain in the same way that antidepressants are claimed – but not proven – to do.
And without all the side-effects.
A healthy body. Good friends. Meaningful work. Strong relationships:
You don’t get those in a pill.