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A personal account

It came as a bolt out of a clear, blue sky. It did not creep up on me, nudging me with increasing urgency so that I could no longer ignore it. One day I was fine; the next day I evidently was not. Now that it has become a regular visitor, so to speak, I often compare it to a tidal wave or a tsunami, one that shortly will knock me over, spinning me head over heels in the maelstrom, such that I do not know which is upwards to the surface and air and which is downwards to unconsciousness and drowning. But perhaps the simile does not stand up to scrutiny. A tsunami is caused by an earthquake many hundreds of miles offshore. Those in its path speak of a terrible and prolonged shuddering in the ground, a sudden change in the character of the ocean, a distant roaring like the sound of a passing goods train and a noticeable and unusual receding of the tide. Even the wildlife, birds and animals, have disappeared; they can sense something strange is in the air. In the first instance, I had no such warnings. Nobody came on the radio to tell me the forecast for the following day was not so good. In fact, I had my back turned, waving to the family on the beach, when the enormous wave hit me from behind, knocking the wind out of me, very nearly my life.

The ‘it’ that I refer to is chronic, clinical depression. Chronic because it is recurring. More than half of patients ‘relapse’ within one year of treatment. Clinical because it seeks to make a distinction between the layman’s understanding of being depressed - in other words, sad, disheartened, fed- up - with the the medical definition that encapsulates longer-lasting and deeply-rooted feelings of hopelessness, desolation, despair, frequently associated with suicidal thoughts and tendencies. Put like that, it sounds profoundly alarming and indeed it is. Did I ever feel like that. Yes, I’m afraid I did.

What caused it? That is a question I am frequently asked and the simple answer is I don’t know. It has been doing my head in (not the most felicitous phrase under the circumstances) trying to figure out a reason. Sometimes a cause can be attributed: a life-changing event; trauma; bereavement; divorce; redundancy; illness; financial woe. In short, pretty well anything that results in stress and unhappiness, “the slings and arrows of outrageous fortune,” as Hamlet put it. By the way, I truly believe Hamlet is a case study in depression. His father has died (murdered) and his mother has taken as her husband’s replacement Hamlet’s uncle (who turns out to be the murderer) in what is described as an “o’er hasty marriage”. Then Hamlet’s girlfriend, Ophelia, drowns herself. Who can blame the poor young man for questioning the very purpose of his existence? But I can claim no such personal disaster and private angst. To me, the misery had no discernible origin.

What’s it like in the loony bin? To be fair, not everybody put it like that but if they did, I didn’t mind. People with mental problems are not devoid of a sense of humour, an ironic view of the absurdity of their situation. In answer, I can only respond that it isn’t too bad. I was incarcerated for lengthy periods of time in three institutions, in Birmingham, in Bristol and in Bromsgrove. So far I have not reached ‘C’ in the alphabet. On two occasions, I reluctantly agreed to being admitted; on the third I most definitely did not. “It is for your own safety,” I was told, “It’s for the best.” Hmm....I was never convinced. It was unfortunate that this enforced stay coincided with last year’s lockdown. So instead of being encouraged to come out of my room to socialise with other inmates, staff and visitors, I was banged up in isolation, in a single room, all my possessions confiscated, with a guard at the door, just in case I felt the need to explore. I was allowed no visitors - not even my wife - and anyone entering the room - medical staff, cleaners, dinner ladies - was dressed in the full hazmat (short for ‘hazardous materials’ - I never knew that) as if I had Ebola or was a refugee from Chernobyl. Of course, at the height of the pandemic, I sort of understood the reason for the restrictive measures but at the same time I failed to see how being held in isolation was going to help my mood. It made for a lot of introspection and self-analysis - not all of it comfortable. The food....? Reasonable. But there, I lived in a school boarding house for 20 years.

One thing you can be sure of during any hospital stay is that you will meet people worse off than you. When I was recovering from my first knee operation way back in the day before the invention of anaesthetics, the chap in the bed opposite me, with whom I had got on famously, died of a heart attack in the middle of the night. His replacement was clearly very ill. He lasted two nights. When Occupant No. 3 arrived, his neighbour alongside leant across and told him, “If I were you, mate, I’d ask to change beds.” What on earth I, an orthopaedic patient, was doing in a medical ward, I never did discover. But the incongruous fact in a mental institution is that, on the surface at any rate, nobody looks ill. There are no patients with tubes protruding from their body, or shambling figures wheeling respirators around with them, or plastered legs hauled up on a pulley, or ghostly figures with the light in their eyes slowly dimming. But scratch below the surface and you find poor souls who are deeply troubled and severely disturbed. It put my problems into perspective. Or it should have done if only I were thinking straight, which of course I wasn’t. Incidentally, it always brought a wry smile to my face whenever I was escorted along a corridor leading to Mental Health Unit. Clearly, if I was heading in that direction, ‘health’ was a bit of a misnomer. Similarly, anybody turning left for Sexual Health Clinic was rather giving the game away as well.

What treatment was I prescribed? Psychiatry and the treatment of mental illness is a relatively young discipline in the history of medicine. As far as full understanding of the brain and developments of ‘cures’ for its ills, we are still very much at base camp of the ascent. The current school of thought seems to be that no one size fits all, that the enemy needs to be attacked on several different fronts. On the understanding that my disorder might have at its source a chemical imbalance in the brain, I was put on a regime of heavy-duty drugs. This had the effect of dulling the pain but it also deadened my sensibility. According to my wife, I was acting like a zombie, lifeless behind the eyes. Perhaps it acted as a sort of holding pattern but it clearly could not remain as a long-term strategy. The consultant who put me on these drugs that smashed through the ceiling of ‘recommended dosage’ later admitted it was her last throw of the dice. Successive consultants who have read her notes have told me that she was very pessimistic of my chances can I put this..... of not, at some stage, taking my own life. Quite possibly, her decisive intervention saved me.

The cavalry, the spearhead of the offensive - to extend the military metaphor - is Electro- Convulsive Therapy (ECT). It sends an electrical current through the brain causing a brief surge of electrical activity, a seizure in other words. It sounds brutal and bizarre, rather like the brainchild (ha ha!) of somebody who has strayed from the pages of Mary Shelley’s novel Frankenstein but it has been medically proven to alleviate some mental health problems. There were long and detailed discussions with me, most of which I could scarcely remember, before I gave my consent. Quite frankly, by that stage I hardly cared what happened to me. I might as well give it a go was my reasoning; nothing else seems to be working. Accordingly, I underwent two separate courses of six interventions each.

The process, as opposed to the actual procedure, was simple and painless enough. We patients gathered in the waiting room. Some I recognised from my unit;; others were from nearby hospitals. All were grimly silent. There was no conversational exchange, no commonplace observation, no attempt at banter to relieve the tension . Each no doubt had his or her inner demons to battle. When you are called, you cannot help but notice the spaghetti junction of electrodes and wires lying beside your head as you lie down on the bed. We’ve all no doubt been ‘put under’ with anaesthetic before an operation. This was no different. The next thing I remembered was the distant voice of a nurse welcoming me back to the here and now with a cup of tea. I felt no ill effects and as long as you put out of your mind what is actually happening to you when unconscious, it didn’t seem so bad. Possible side-effects are occasional gaps in memory but as I can’t remember them, no great harm seems to have been done. But were there any beneficial effects to this treatment? Once again, it is hard to tell. I’m still here so I cannot categorically claim it was totally ineffective.

The groundwork of the assault is provided by the poor bloody infantry, the talking therapists. Actually, it would be more accurate to call them listening therapists for any such treatment should always be ‘patient-led’, to use the jargon. Talking about myself has never been my strongest suit. In fact, growing up, our generation was discouraged from displaying such self-absorption. “But that’s your problem,” I was continually told, ”You bottle everything up.” Quite possibly but I found

those sessions excruciating, when you all sit in a circle, introduce yourself and tell everybody - at great length - what a grand chap you are and how the rest of the world doesn’t appreciate you. But in the hands of one or two sympathetic and perceptive therapists, who teased out possible personal crises in one-to-one sessions, I felt I was making some progress.

So, am I better? Better, yes, but not best. I have come to the conclusion that the condition can only be managed, rather like diabetes or alcoholism, on a day-by-day basis. Which interventions have worked and which haven’t? I would love to know the answer but Sherlock Holmes’s modus operandi - “when you have eliminated all which is impossible then whatever remains, however improbable, must be the truth” - cannot, in all practicality, be applied in my case. If one part of my medication were withdrawn, and subsequently all of it, I might be fine. But I might not. It is an empirical experiment that is just not worth the candle. So I am stuck with that unhelpful parrot perched on my shoulder offering ugly and unpleasant advice. I know he’s there. I just have to take him on and outmanoeuvre him in the metaphysical debate....every single day. I can’t pretend it’s not a struggle. The only alternative is oblivion and truthfully there are times when oblivion seems like an attractive option.

Andrew Murtagh 16th February 2022

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