Читать книгу Breaking the Bonds - Paula Nicolson, Dorothy Rowe, Dorothy Rowe - Страница 7

‘I would rather have a physical illness – any physical illness – rather than be depressed. Depression is the worst experience a person can have.’

Anyone who knows what it is to be depressed would agree. It is not just that being depressed means feeling despairing, frightened, guilty, bitter, helpless, tired and ill. It is the most terrible sense of being trapped and alone in some horror-filled prison.

When we have a physical illness or have been injured, we can feel immersed in the pain and discomfort, but, equally, we can separate ourselves from that pain and discomfort. We can talk to other people, share a joke, take an interest in what they are doing, watch television, read a book, plan our future, and when someone shows us love, comfort and support we can feel warmed, cheered and supported, and give back in return our love and gratitude.

When we are depressed we can do none of these things. We are surrounded totally by the prison of depression. We cannot escape, even momentarily. Occasionally we can act normally. We can answer a telephone, or chat briefly to friends. We might feel slightly better in the evening or when we are at work, but all the time we know that the prison has not gone away, just eased its grip on us a little. Even when a course of antidepressant drugs (psychiatric, medical and psychological terms are explained in the section Technical Terms) or a series of ECT (electroconvulsive therapy) has made us feel more able to face life, we know that the prison is still hovering there in the background, waiting. One false word or action, one crisis, and its jaws will snap around us again, and we shall be trapped and helpless.

Inside the prison we are cut off from every other person. We know that we are physically with other people, but what we actually experience is a barrier between them and us. They offer us love, comfort and support, but nothing crosses the barrier to warm, cheer and support us.

Nor do we think it should. We know that we are wicked and do not deserve what people offer us. What we do deserve is this terrible, hateful prison.

Inside that prison our thoughts are not the thoughts that usually accompany pain (usually ‘Ow!’ and ‘Help!’) and discomfort (usually ‘Yuk!’, ‘Groan!’ and ‘Help!’). Our thoughts are concerned with universal moral issues expressed in a personal way, variations of, ‘I ought to have been a better person’: ‘I ought to have done more for other people’, ‘If I had been a better person I would not have been abandoned and betrayed’, ‘I must be wicked, otherwise these disasters would not have happened to me’, ‘I have obligations which I cannot meet’, I have made unforgivable mistakes’, ‘I cannot forgive myself for what I have done’, ‘No one, not even God, could forgive me for what I have done’. With these feelings come the helpless, hopeless feelings of dread.

Inside the prison of depression we cannot escape from the turmoil of these moral issues, for everyone we meet, every newspaper story and television scene, reminds us of our unmet obligations, our unfulfilled duties, our inadequacy and sense of intrinsic evil. We cannot endure this isolation, but we fear other people, and feel that, we must shut ourselves away. We long for death, but fear the aloneness of death and the punishments which could lie beyond it.

Alone though we may feel in the prison of depression, we are not alone in enduring such an experience. Across the planet, many millions of people are trapped in the prison of depression.

If you are reading this book then it is likely to be for one or more of the following reasons:

You are depressed

or

Someone you care about is depressed

or

In your work you have to deal with people who are depressed.

In order to find out about depression you have, perhaps, read articles on depression in newspapers and magazines. You might have read about depression in psychiatric textbooks or in books written for the public by psychiatrists and psychologists. You might have consulted your doctor, or a psychiatrist, or some other professional person. You might have consulted your minister, or perhaps a spiritualist or a faith healer, or tried one of the alternative therapies like homoeopathy or acupuncture. You might have talked to a therapist or counsellor.

You might have been told a great many things about depression, but out of all these sources one message has been given to you loud and clear. ‘Depression is a genetic illness. It cannot be cured, but it can be controlled by drugs.’

This message seems simple, but in fact it leaves you even more confused and frightened.

Somehow, this explanation doesn’t seem right. You can see how bodily diseases like haemophilia and cystic fibrosis could be passed on by a gene, but how could depression – this confusion of feelings, beliefs, passions, fears, wishes, actions and non-actions-be caused by a gene? You have seen how people who have inherited some disease can, provided they care enough about themselves, have friends and family to support them, and get good medical advice, rise above their disease and get on with their lives, whereas it is not possible for you to separate yourself from your depression. It seems to inhabit your very person.

Moreover, depression might seem to be inside a person, but you know that it is also between people. If you are depressed, you know that it has something to do with the people in your life. If someone you love is depressed, you know that that person’s depression has something to do with other people, and you worry about what you might do – or refrain from doing – which would change how your loved one feels. If you are trying to understand why your clients or your colleagues are depressed, you get to know them, and you see the difficulties, losses and disappointments with which they are struggling. You know that depression does not occur, in the way that haemophilia or cystic fibrosis can, to an ordinary person leading a secure and happy life. When you look at all the depressed people you know, you can see that they have, over their lifetime, suffered many difficulties, losses and disappointments, that what success they have achieved has not always brought them happiness, and that when they achieve success and happiness, they cannot enjoy them, for they believe that they do not deserve such happiness and success, that happiness and success will soon be snatched from them, and that pain must follow joy as night the day.

How could a gene create all this?

Moreover, being told that all you are experiencing is nothing but the effect of a gene dismisses all you have experienced and know as being trivial and unimportant. It doesn’t just dismiss your experience and knowledge, it dismisses you. It says that you are nothing but a defective body, carrying a defective gene, passed on to you by an equally defective ancestor, and that you are likely to pass this gene on to your children. You cannot be cleansed of this gene, but must strive to keep it in check by a daily ingestion of drugs which affect the operation of your brain.

If you are depressed, such a diagnosis does nothing to help you, for it simply makes you feel even more intrinsically bad, useless and worthless. Such a diagnosis does nothing to help the relatives of a depressed person, or indeed, any one of us, for we can all worry that at any time we shall produce the depression handed on to us by some ancestor, or that we have already, unwittingly, passed this dread disease on to our children.

However, some of you in your search to learn about depression may have read something which many psychiatrists and psychologists fail to read, namely, the actual research reports by scientists working on the problem of the biological basis of depression. Perhaps you do read the monthly issues of the American Journal of Psychiatry and the British Journal of Psychiatry, or the heavy tomes of the American Psychiatric Review.

If you do, you will know that the sentence ‘Depression is a genetic illness’ is a statement of a wish, not a fact. A hundred years ago the German doctor Kraepelin attributed the behaviour of some of his patients to the illness ‘manic-depression’, and since then psychiatrists have been searching for the cause of this illness. They talk of the ‘gene for depression’ and the ‘gene for mania’, and some of them even say that such genes have been found. They talk, too, of ‘chemical imbalance’, and of physical tests for depression, and some say that the precise chemistry of the imbalance and the tests is known. However, what is described as fact is actually speculation. An enormous amount of research needs to be done before any genetic factor can be shown for certain to play a part in depression, and, from the results of the research, it seems that, if there is a genetic factor, it is one which requires the presence of many other factors – physical, psychological and social – for it to be activated.¹

One of the great difficulties of this research is that, even after a hundred years, psychiatrists still cannot agree on how many kinds of ‘depressive illnesses’ there are.² You will probably have come across terms like ‘clinical depression’, ‘endogenous depression’, ‘reactive depression’, ‘neurotic depression’, ‘bipolar and unipolar depression’, ‘major depressive episode’, and so on. If so, you are certain to be confused, particularly when you discover that different psychiatrists give different diagnoses. One might tell you that you are ‘clinically depressed’, another that you have ‘endogenous depression’, yet another that you have a ‘schizo-affective disorder’. What you are not told is that all these words are just labels used in an attempt to put the people who get depressed into different categories. However, it does seem that, while there are certain things that depressed people do have in common, each of us gets depressed in our own individual way.

If you have read the research literature, you will be saddened and worried to find that what researchers call ‘outcome studies’ show that depressed people treated only with drugs and electroconvulsive therapy do not do well. Most find that the depression recurs. Many remain depressed, but cease to seek any kind of professional help. Many die, not just by their own hand, but through illnesses. Being depressed is physically debilitating.³

This is very troubling, because while psychiatrists talk complacently of ‘managing depression’ by using long-term medication in the way that doctors ‘manage diabetes’ using long-term insulin injections, we know that a person with chronic diabetes can lead an ordinary life, but a person with chronic depression cannot. To be told that you have inherited depression in the way that another person has inherited diabetes is of no help at all. It just makes you more despairing and confused.

If you are a woman and are depressed, no doubt you have been told that it has been caused not just by a chemical imbalance but that this imbalance relates to the functioning of the feminine hormones. This is puzzling, because you can see how the malfunctioning of a hormone could lead you to think, ‘I feel sick’, but how can a hormone, however it functions, cause you to think, ‘I am a bad mother’? Nevertheless, many women discover that from puberty to after the menopause their own real, lived experience is dismissed with the words, ‘It’s your hormones, my dear’.

However, there is a genetic factor in depression. In that double helix of DNA there is a special strand which separates us from all other animals and marks us out as human beings. That special strand of genes not only determines our human shape, it gives us language, and with that the ability to conceive of the past and the future. Using these abilities we can look to the future with hope and courage, or fear and despair; we can remember the past in happiness or mourning, in gratitude or envy, in thankfulness or resentment. Using these abilities we conceive not just of ‘is’ but of ‘ought’, and create for ourselves two worlds of meaning – the world as it is and the world as it ought to be. Now we can trap ourselves in a tangle of ises and oughts. Now we can say to ourselves, ‘I do not accept myself as I am. I ought to be a better person’, and so lay the cornerstone of the prison of depression.

You might, in your search for an understanding of depression, have tried to make sense of it in terms of ises and oughts by reading books by cognitive or behavioural therapists. In many ways these books can be extremely helpful, for they can make you aware of how easy it is to think in extremes (like, ‘Nobody cares about me’, instead of, ‘Some people don’t care about me, but some do’), and they suggest some practical ways of re-organizing your life. But, when they tell you you are thinking and acting ‘irrationally’ or ‘dysfunctionally’, you can hear this as yet another put-down and feel that ever so familiar stab to the heart.⁴

Even if you can put this aside, you soon discover that these cognitive and behavioural therapists slide over, or ignore, the implacable truths and dilemmas of our lives. For instance, one such author chides his client for being so illogical as to say, ‘I’ll never find another friend like that again’, and asks her to estimate just how many people she could meet and how many of these could become friends. He ignores the fact that we do have relationships which are irreplaceable, like those with a parent who gave us unconditional love, or with someone with whom we shared the greatest joys and tragedies of our lives, and when such relationships end we can do nothing but mourn their loss. When we do suffer such losses what we need are not people who tell us to ‘look on the bright side’, but people who can acknowledge and share our pain.

Cognitive and behavioural therapists ignore, too, the major questions which face us all: ‘Why am I here?’, ‘What is the purpose of life?’, ‘What happens when I die?’ They assume that all of us are concerned solely with making the most of our lives, when in fact many of us are chiefly concerned with the question, ‘How can I be a good person?’

In your search for an understanding of depression, and in your concern about the great questions of life, you might have read some of the books on depression which give a religious or spiritual answer to the problem. Some of these books might just heighten your sense of badness and inadequacy, but others do offer consolation. However, most of them advise you to put your trust in God or some spiritual power, and this is precisely what a depressed person cannot do. When we have been repeatedly and deeply hurt by the people we trusted, we learn to be very careful about where we place our trust, and if we cannot trust the people whom we can see and know, how can we trust an unknown, unknowable God? Moreover, if you believe in God, then when you become depressed you find that God, like everyone else, seems far away, and, worse, the more you hate yourself, the more you feel that God will never forgive you.

Whenever we come across an author, or a therapist or counsellor, or a preacher who says to us, ‘Believe as I do and all will be well’, it is very tempting to say, ‘Right, I’ll do that’. However, we cannot change our beliefs about the purpose of life and the nature of death in the way we can our beliefs about the best breakfast cereal. Our beliefs about the purpose of life and the nature of death relate to our own inner truth, and even though we may hide or deny our own inner truth, it never disappears, and it speaks to us clearly. You will know this if ever you have been in analysis and your psychoanalyst has given an interpretation which your inner truth knows is wrong. The respectful, fee-paying part of you can be saying, ‘Yes, I see what you mean’, while your inner truth is saying, ‘No’.

This is where therapists can be dangerous. They can use their position, power and mystique to persuade us that what we know as truth is mere fantasy and that because we are anxious and depressed and having difficulty in coping with our lives we are intrinsically inadequate. If you have read any of the psychoanalytic texts on depression you will have discovered how little respect psychoanalysts have for a person’s own experience and how belittling to the client the psychoanalytic jargon is.

So, whatever you have done to try to discover what depression is and how you might bring it to an end, all that has happened is that you have become more and more confused, and when we are confused we feel powerless and helpless.

The aim of this book is to help you sort out your confusion and regain that which is rightly yours, the power to understand yourself and the society in which you live, so that you can make the best decisions about how you should live your life. With such power we can not only understand the causes and the purposes of depression but, more importantly, free ourselves from its prison and live life joyously, hopefully and freely.

To do this, we begin by understanding our own real, lived experience.

It is our own real, lived experience which leads us into the prison of depression. It is not a gene, or our hormones, or our dysfunctional and illogical thinking, our lack of faith, or our complexes and inadequacies which have brought depression upon us, it is what has happened to us and, most importantly, what we have made of what has happened to us; it is the conclusions we drew from our experience.

That set of conclusions which leads us, finally, into the prison of depression was not drawn illogically, or fantastically, or crazily, but were the correct conclusions to draw, given the information we had at the time.

If, when you were a child, all the adults whom you loved and trusted were telling you that you were bad and that if you didn’t mend your ways terrible things would happen to you, you wisely and correctly drew the conclusion that you were bad and had to work hard to be good. If, when you were a child, all the people you loved and trusted left you or disappointed or betrayed you, you wisely and correctly drew the conclusion that you must be wary of other people and that you should never love anyone completely ever again. You were not to know that if we grow up believing that we are intrinsically bad, and that other people are dangerous, we shall become increasingly isolated, the joy will disappear from our life, and that we shall fall into despair. Even if you did know that, you had to protect yourself. We all have to protect ourselves when we are in danger. The business of life is to live, and this is what we all try to do.

The reason we get into a tangle, be it by becoming depressed, or finding it hard to get on with other people, or any of the multitude of unhappy situations we can get into, is because we fail to go back and check whether the conclusions we drew as children still apply in our lives. We all fail to do this, simply because there is not enough time to be forever checking our conclusions. When we were children we drew the conclusion that we should not put our hand in a fire because fire burns. When we grow up we don’t every day say to ourselves, ‘I’ll just check whether it’s still not safe to touch a fire’. We simply go on acting as if fire will still burn us.

Similarly, many of us when we were children drew the wise and correct conclusion that we should not say what we think because the adults around us will punish us if we do. When we grow up we can fail to check this conclusion, and thus go on acting as if other people will punish us if we dare to say what we think. Never daring to say what you think leads inevitably to missing out on many things which would give you pleasure and confidence, and prevents you from discovering how joyous it is to share your thoughts and feelings with another person. As a child, your conclusion to keep your thoughts to yourself was a wise conclusion. As an adult, all you need to do is to check whether this conclusion still applies, or whether it can be modified – for instance, in conversations with your parents you might still need to be careful about what you say, but with close friends you can speak openly and freely.

What I have put in this book are the conclusions I have drawn from my experience of talking to people about themselves, and I keep checking these conclusions because I go on talking to people about themselves. So much of what people have talked to me about over the years has had to do with the problem of depression.

The problem of depression was first presented to me when I was a baby. I didn’t know it was depression. I just knew that sometimes my mother was loving and caring, sometimes she was silent and unreachable, and sometimes she was wildly, dangerously angry. It was not until I was in my thirties that I realized that my mother had been depressed for most of my childhood. By that time I was involved professionally with people who were depressed, for I was working in a psychiatric hospital in Sheffield, where there were many depressed patients and where the professor of psychiatry, Professor F. A. Jenner and his team were researching into the metabolic basis of depression.

Professor Jenner thought that there might be some interesting, though not important, psychological aspects of those patients whose mood changes seemed to follow some pattern, and suggested that I take this as the basis for my doctoral research.

So I began observing and talking to people who were sunk in depression or, less frequently, fiercely active in mania. I sat in case conferences, and in the staff dining room and lecture rooms, observing and listening to the psychiatrists, all of whom believed most firmly that depression and mania were physical illnesses. I read exhaustively every book and article I could find on depression and mania. Slowly I drew three conclusions from my experiences.

These were

1. From all the possible observations they could make about their patients, the psychiatrists selected a very narrow range of observations.

2. The scientific literature on depression, whether written by psychiatrists or psychoanalysts, described depression only from the point of view of the onlooker. Nowhere was what it feels like to be depressed actually described.

3. When depressed people talked about what it was like to be depressed, they described as central to the experience something which the psychiatrists and psychoanalysts completely ignored, namely, the strange but unmistakable sense of being isolated, of being trapped in some kind of prison whose walls were as strong as they were invisible.

The psychiatrists, I found, spent very little time actually talking to their patients, so there was a great deal about them they did not know. When they did talk to their patients, or about their patients, they were busy turning what the patient said into what the psychiatrists called the symptoms of depressive illness. If the patient said, ‘I no longer enjoy love making’, the psychiatrist marked this down as loss of libido’, and did not enquire as to whether the marriage itself had become flat, stale and unprofitable. If a patient with a deep religious faith said, ‘I feel that God will never forgive me’, the psychiatrist marked this down as ‘irrational guilt’, and did not enquire as to how central to the life of this person a belief in God was. If a patient said, ‘I feel I’m trapped in a sea of mud and the more I try to get out the more I get sucked down’, the psychiatrist marked this down as ‘lowered mood’, and made no attempt to understand just what the person was experiencing.

There is a good reason why psychiatrists, both then and now, do not enquire too carefully into what their patients think and feel. The reason is that people ruin theories. Psychiatrists and psychologists go to a great deal of trouble to create their theories about why people behave as they do and they want all people to fit these theories. We can make up all kinds of theories about people simply by making a few observations of what a few people do, and our theory can seem very good, but as soon as we make a few more observations, or, worse, ask people what they think, we find that our theory is ruined. People are so diverse they just don’t fit into theories.

Every time I run a workshop where I talk about my theories about why we behave as we do, people in the workshop are sure to say, ‘I’m not like that’, and ‘I don’t see it that way’. So I can understand why psychiatrists prefer not to put themselves into situations where their patients can challenge their theories.

It is not just that people are so individual that they don’t fit theories, it is also that each of us is so complex that no single label can ever describe us accurately. We are complex because we can always think, feel and believe two opposite things at one and the same time. Recently, one of my clients, a man in his thirties who had told me frequently and at some length how he was so timid and shy, how bad he was at his job, how he had got his qualifications only by the sheerest of chance, said to me, ‘I’m really very arrogant. I always believe I could do the job much better than the people I work for’. And so he is, both humble and arrogant.

I have found, as you must have too, that no matter how well you know a person, there is always something more to be discovered about that person. No one ever tells his life history completely; no one ever reveals all of his thoughts, feelings and desires; no one behaves in exactly the same way with each person he meets. No category can ever encapsulate an entire person, no theory can ever explain completely why any one of us behaves as we do.

Thus, to maintain their theories, psychiatrists have always had to avoid talking to their patients. This is why in psychiatric hospitals patients and staff are kept so separate. It is not simply, as so many patients have been led to believe, that patients are inferior creatures who could contaminate the sane and superior doctors and nurses.

However, by not talking to their patients psychiatrists have failed to learn from them just what the experience of depression actually is.

What the patients in Sheffield told me, and what depressed people have gone on telling me, is that being depressed is very different from being unhappy. When we are unhappy we still feel a connection to the rest of the world, but when we are depressed we are cut off, enclosed in a strange isolation. People describe this experience in vivid images: ‘I’m in a dark tunnel, and beyond the tunnel is another tunnel’, ‘I’m at the bottom of a black pit and no one can reach me’, ‘I’m stumbling lost in grey, swirling mist’, ‘I’m trapped beneath a dome of glass and the people outside appear like shadows’.

As the people in Sheffield and later in Lincolnshire were telling me this, they were also describing how their experiences had led them to draw conclusions which served to cut them off from other people, conclusions like, ‘I am bad and unacceptable’, ‘I must not forgive’, ‘I must not trust other people’. I described this research in my first book, The Experience of Depression.⁵

In my conversations with people who were depressed, we frequently talked of death, of the losses they had suffered and the fears they had about their own death. Talking about death meant talking about religious beliefs. I realized how important all this was, and I knew how psychiatrists and psychologists ignore the whole question of belief. So I wrote my next book. The Construction of Life and Death,⁶ where I described how the people who coped with their lives held beliefs which gave them courage and optimism, while those who did not cope held beliefs which made them frightened and pessimistic. For instance, among those people who believed in God, those who coped believed in a loving and benevolent God, while those who did not cope believed in a God who noticed them only to punish them and who did not forgive.

By then I had come to see that the beliefs which cut us off from ourselves, from others, and from our past and future can be summarized in six basic beliefs. If you have never been depressed and want to try it out, you will find the recipe for depression in my book, Depression: The Way Out of Your Prison.⁷

Depression is not a state of passive misery. It is an experience of tremendous fear. Just what this fear is and how we try to deal with it was the subject of my next book, Beyond Fear.⁸ How we can use our understanding of this fear to develop ourselves and become the person that we want to be was the theme of my following book, The Successful Self.⁹

Because I have been talking to depressed people now for over twenty years and have kept in touch with many of them, I have been able to follow how these people changed themselves and their lives. In the second edition of my first book, now called Choosing Not Losing,¹⁰ I added postscripts to the chapters about my depressed clients, describing how, ten years later, they were living their lives. In this present book I have brought together what I have discovered about how people can take charge of their lives and so change.

With all that I have written about depression in my earlier books, I do not feel that I have said everything that could be said or ought to be said about depression, because depression is not a problem which strikes just a few unlucky people. Depression is a problem from which no one is exempt.

It is impossible to estimate in any way accurately just how many people are depressed. It has been estimated that in the USA some four per cent of the population is depressed at any one time, and for around the world, an estimate of a hundred million has been given, but these are likely, for a number of reasons, to be underestimates.

Many people, when they consult a doctor, feel that they should speak only of physical complaints. It is very easy for the doctor to give just physical treatments and overlook the unspoken misery of depression. Julia West, an American psychologist working in Saudi Arabia, found that her women clients would describe their aches and pains, tiredness and illness, but not their personal misery of depression. This may have been because they experienced their depression only in physical terms, or it may have been because, in their discussions with Julia, they were always accompanied by their menfolk.¹¹ There are many of us who feel that our relatives, even when they are present only in spirit, prevent us from speaking freely about our misery.

Many depressed people do not seek any kind of medical help. It may be that they do not wish to reveal their misery to a doctor, or it may be that they do not realize that their dull, grey, lonely, cramped, trapped way of living can be called depression.

Amongst those people who lead apparently happy and successful lives, there are many who would say, ‘I’m not depressed’, but who know that depression, like a great black bird, hovers above them, ready to settle with a heavy, smothering weight upon their shoulders should they act, or speak, or even think without due care. Such people often ask me, ‘Doesn’t being with a depressed person make you depressed?’, and they look disbelieving when I answer, ‘No’. They are convinced that depressed people are dangerous because their depression can magically and malignly call forth the depression lurking in themselves. Rather than confront their own depression, they spurn all contact with depressed people, or strive to isolate and confine them. If you are depressed you might have had experience of such people, perhaps even your own doctor, treating you as if you had the plague.

This fear of depression can prevent us from realizing that no matter how fortunate and far-sighted we may be, not one of us can be certain that the circumstances of our life will not change and all that supports our way of life vanish. Neither by hard work nor by goodness can we control every aspect of our life and ward off all tragedies. It may be that at some time all the people we love and need abandon us or reject us, or that the projects which gave our life meaning and purpose crumble or fail. When such disasters befall us, we feel great fear, and if we do not understand the nature of this fear we can defend ourselves against it by turning against ourselves, despairing, and locking ourselves in the prison of depression. On the other hand, if we do understand this fear and ourselves, we can, when disaster strikes, become appropriately unhappy but not depressed, courageous and not defeated.

Generally in the following chapters I use the pronoun ‘we’ when referring to something we all do, and, when I want to speak of the things which depressed people do, I use the pronoun ‘you’. There is a difference between the way we think, feel and act when we are laying down the foundations of the prison of depression or living in the prison, and the way we think, feel and act when depression plays no part in our lives. However, I could have used ‘we’ throughout, for we are all capable of doing all that I describe if we are not wise.

By ‘wise’ I mean knowing what we fear most, and why; knowing what we need most, and why; and knowing how to defend ourselves in ways inexpensive of time and strength, and how to get and hold what we need in ways that enrich our life and our relationships.

Thus this book is for all of us.

The book is divided into five sections.

Section One, The Meaning of Depression, describes how we create the world of meaning (that is, our beliefs, attitudes, conclusions, opinions, expectations, wishes and fears) in which each of us lives. We live in meaning like a fish lives in water. Creating meaning is what each of us does all the time, but while we are very good at doing this, we often have difficulty in understanding just how we do it. As the ancient Chinese philosophers said, ‘The fish is the last to discover the water’. Yet an understanding of how we create meaning is essential to an understanding of ourselves.

The world of meaning we each create is like a landscape in which we live. The landscape has limits, so in a sense we all build ourselves a prison, a prison made up of ‘This is where and how I live, this is the kind of person I am, these are my obligations, duties, attachments and responsibilities, these are the rules I must follow’. However, some of us create landscapes which are vast and open, full of interesting and exciting possibilities, while others build landscapes which are cramped, monotonous and confined. The most cramped and confined of these is the prison of depression. In Section One I show just how we create such a prison.

Section Two, Why Is It So Hard to Change?, is concerned with why we so often do not want to leave our cramped prison, or re-structure it into something open and various. Depression is such a horrible experience that at first it seems that no one would want to remain in it, yet if you are depressed you know that being depressed does have advantages. As a university student said to me recently, ‘My depression is like an old sweater. It’s comfortable, so I keep it on. I think it’s risky to change it for something new.’

The fear of change keeps many of us from changing; so does our pride, and the way we take things personally and hang on to hopes. Then there are the people who do not want us to change. Our loved ones do not want us to be unhappy, but, equally, they do not always want us to change the way we live our lives. What would happen to them if their depressed wife or mother gave up being depressed and went to college instead, or their depressed husband or father gave up being depressed and instead of battling on as a captain of industry became an opera singer? Even if, in giving up being depressed, you do not change your way of life, you do behave differently, and that means that your loved ones have to respond to you differently. They might not want to make the effort of thinking about you differently, and they may not be all that pleased when you no longer play the role of the martyr, sacrificing yourself for them, and instead insist that there are times when your needs must take priority. So it can happen that while you are making valiant efforts to unlock your prison of depression your nearest and dearest are resolutely barring the door.

You have to face these issues before you begin what is the subject matter of Section Three, The Journey Out of the Prison of Depression.

Here I tell you what the Expert’s Secret is, and what preparations you need to make for the journey. Since at some time when you are depressed you will think of suicide, I have presented my argument that suicide is not a solution. I list some of the things you will need to find on your journey, and, since loneliness is such a problem, I give some suggestions as to how you might leave it behind. Before reaching journey’s end, I show how some people have helped one another and tried out something new.

The key to the prison of depression is the discovery that you are not the bad, worthless, unacceptable person you thought you were, but that you, with all your strengths and weaknesses and peculiarities, are a person you can love and accept wholeheartedly. This discovery sometimes comes like a flash of blinding light, but more frequently it comes slowly, through a process of understanding which we can undertake like a journey, preparing for it beforehand, and then making sure that we visit certain places along the way. As with all such journeys in search of wisdom and understanding, we realize when we reach our goal that what we sought was in our possession all the time.

As you read this book you might at different points exclaim, ‘Aha!’, or think, ‘I wonder how that applies to me?’ It is a good idea to make a note of the Aha! experiences in case you forget. Sometimes, underlining the passages in the book is not enough, especially if you want to comment and the margins are not wide enough. So you might like to use a separate notebook where you can put your Ahas!, as well as do any of the Discovery exercises I suggest as ways of answering the question, ‘I wonder how that applies to me?’

These exercises I have put in Section Four, Discoveries. Whenever in the first three sections it might be useful to do a relevant Discovery exercise I have marked this with the letter D and the number of the exercise.

The Discovery exercises are NOT compulsory, and there are no right answers except those which are right for you.

Occasionally, in the first three sections, I refer to what might be called technical matters, things which you might like to know more about. So, in Section Five, there is a series of Technical Footnotes. You might want to dip into these while reading the main part of the book.

Thus, if you want to know more about the research and arguments about the biology of depression, this is presented in Section Five under ‘Is Depression a Physical Illnees?’ Whether or not to use antidepressant or tranquillizing drugs is discussed in Drags – Friend or Foe?’ Since, try as I might to write only in ordinary, everyday language, I sometimes have to use the jargon of psychiatry and psychology, the glossary, Technical Terms – Keys to the Jargon’, gives the definitions of these words. Whether or not to seek the help of a therapist and, if so, how can you tell if someone is a good therapist are questions which I have attempted to answer in ‘Choosing a Therapist’.

All too often in life we neglect to take proper account of the stuff of our heart, our own inner truth. All too often other people tell us that our own inner truth is wrong, crazy, unacceptable. If you are depressed, perhaps some people have silenced you by saying, That’s not you speaking. It’s your illness’. To be silenced in this way is the utmost cruelty. Jill Tweedie, novelist and journalist, once wrote:

Ex-depressive as I am, with only the occasional lapse, I cannot dismiss the idea that the vision of life seen in depression has the truth in it, the bare-boned skeletal truth, and an intrinsic part of depression is knowing this and being told that it is not so. Reality, however terrible, is bearable if others allow its reality. When they refuse you that, when they skip around you pretending you’ve got it wrong, that’s rock-bottom time.¹²

Somehow, if we can face ‘the bare-boned, skeletal truth’ we can find the courage to go on with our lives. We can find that courage because, as the ordinary people that we are, we are brave. We know that life is full of uncertainty, not just the uncertainty we all face in terms of nuclear war, or of the destruction of the ecological balance of the planet, or of huge national debts, or of terrorism, or of Aids, but the uncertainties we each face in our own way: ‘Will the firm I work for go bust?’ ‘Will my child get to school safely?’ ‘Is the lump in my groin cancer?’ ‘How will I manage if my husband dies?’ We each have to live with our own uncertainties.

We are brave in the way we keep on going. We get up and go to work, no matter that our work is dull and unrewarding or demanding and stressful. We go on cleaning, cooking and looking after our children, knowing that many of the things we would like for ourselves and our children are not going to come our way. We go on trying to make our children brave by telling them that they are wonderful and that the future is opening up before them full of promise. We try not to tell them that their future might be tough and miserable, even though we fear it may be so. We go on loving one another, even though we know that out of that love will come the terrible pain of separation and loss.

Sometimes we lose our nerve. Sometimes our courage falters, and then we feel great fear. This happens when we lose confidence in ourselves and we find that there is an unacceptable discrepancy between what we thought our life would be and what it actually is.

Such a discovery is made by just about all of us at some point in our lives. When it does, we feel an immense fear which threatens to overwhelm and annihilate us. One way of dealing with this fear is by locking ourselves in the prison of depression. In there we can shut out other disturbances and give ourselves time to think things through and so come to terms with the discrepancy between what our life is and what we want it to be.

For some of us, coming to terms with the discrepancy and building another life is not too difficult, and so our period of depression is brief. However, for others of us the task is much more difficult. So much more has been staked and lost, so much time and effort has been wasted, and so few alternatives for the future are on offer. Most of all, if you have grown up believing that you are bad and unacceptable and that you have to work hard to be good, then in the prison of depression you can doubt that you have the right to change your life and to claim something for yourself. Thus your sojourn in the prison of depression goes on, until you can discover in yourself that sense of intrinsic acceptance and worth with which you were born.

This is not an easy thing to do because you have been told so many confusing things, not just by psychiatrists, but in the past by your parents and teachers, and in the present by people who want you to be the sort of person they want you to be.

Many people, not just psychiatrists, want to believe that depression is a physical illness.

If you are depressed and believe that it is a physical illness you may be holding this belief because it allows you to be irresponsible – no matter what you do, you can say, ‘I cannot help what I do, I am ill’. Or perhaps you believe depression is a physical illness because you are trapped in an impossible situation and being depressed is the only form of escape that you can find. Or perhaps you have been brought up to believe that you must never question what anyone in a position of authority says, and so if psychiatrists, backed by the whole medical profession, say that depression is a physical illness, you believe them without question.

Many people want to believe that depression is a physical illness because that allows them to ignore the suffering of other people and the complexities of life. It requires very little mental effort to think, ‘Depression is a physical illness’. Whereas to understand how we think, feel and act, how we affect and are affected by the people around us, how we respond to and are affected by the customs and beliefs attached to our gender, dass, race, religion and nationality, and how we respond to and are affected by the propaganda that we are subjected to and the political, economic and ecological changes in the world we live in requires considerable mental effort and a tolerance of uncertainty. To say, ‘Depression is a physical illness’ requires one sentence. To describe the multitude of matters which are relevant to our experience of depression requires many sentences, indeed, a large book.

The aim of this book is to help you sort out this confusion and to be a signpost for your journey out of the prison of depression. Depression is not an illness. It is an experience out of which we can gain greater understanding of ourselves and other people.

My friend Pat Wakeling, a psychiatrist who, having found that the treatment his colleagues gave him for his depression did not work, had to find his own way out of the prison, wrote:

Depression is not – as I have eventually and painfully learned – something to sweep under the carpet: to deny, to forget. It is an experience that brings great misery and causes a great waste of time, but it can be, if one is fortunate, a source of personal wisdom and worth more than a hundred philosophies.¹³

This book is a distillation of my work not just on depression but on all the suffering which we can encounter. In it you will hear the voices of some of the people who have talked to me over the last twenty years, people living in the United States, Britain and Australia. To them I give my gratitude and love.