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- Herausgeber: Hammersmith Health Books
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2020
Depression affects more than 300 million people worldwide from all walks of life, and can be a completely debilitating and isolating mental illness. Lynn Crilly speaks from personal and professional experience, having suffered depression herself, and provides much needed positive, practical answers, illustrated with observations and anecdotes from carers and sufferers themselves, Hope with Depression explains the many varieties of depression, how to spot them and the possible causes and drivers, and gives a balanced guide to available treatments – both mainstream and 'alternative' – in the context of what has worked in Lynn's experience. This is a practical, supportive guide for anyone with this condition or helping someone with depression, be they a family member, teacher, sports coach, workplace colleague or friend. It recognises that each person's illness and recovery will differ and having detailed knowledge and a full toolkit of treatment options is the way to empower each individual with hope for recovery.
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Hope with Depression
a self-help guide for those affected and their families, friends and carers
Lynn Crilly
With a Foreword by Stephen Mallen
iv
To Kevin, Charlotte and Samantha and to all my family and friends, thank you for loving me.
Contents
About the Author
Lynn Crilly is an award-winning counsellor and mother of twin girls. When one of her twin daughters, Samantha, struggled with OCD and anorexia nervosa, having followed the conventional therapy routes to no avail, Lynn took the decision to follow her gut instincts and rehabilitate Samantha herself. She subsequently developed her unique form of counselling to support sufferers and their families going through similar experiences. Lynn continues to work with families every day, battling mental health issues at her clinics in Surrey and West Sussex, UK. She uses the knowledge and experience she has gained to write self-help books covering an array of mental health issues, with the aim of helping combat stigma and destructive myths whilst also providing a positive and constructive way forward for sufferers and the families and carers affected. She is admired for her passion and understanding – something she attributes to the strength and loyalty of her family and friends, with whom she spends as much time as possible. www.lynncrilly.com
Acknowledgements
First and foremost, I would like to say a BIG thank you to my wonderful husband Kevin, who has always given me his unconditional love and support. His unquestioning belief in me has given me the strength to achieve all I have so far… I love you more with every new day.
To our beautiful twin daughters, Charlotte and Samantha; I am so proud of the gorgeous young ladies you have become and love you both very much.
A big thank you to Callum and Jay for loving our girls unconditionally and making my family complete; love you both loads.
Much love to my mum and dad, who have always been there for me with the kettle on and ready to listen, with their constant love and support.
My brother Steve and sister-in-law Sue, thank you for being there.
A special thank you to Kate, Wendy, Gill, Gerry, Leanne, Hannah, Dionne, Kyra, Michelle, Shauna, Neil and all my friends who continue to love me unconditionally, your friendship is a rare and valued gift.
A warm thank you to our wonderful GPs, past and present, John Dalzell and Sarah Benney, who over the years have given us as a family and me as a professional their unreserved support.
Thank you to all my clients both past and present who have put their trust and belief in me and my work, which has enabled me to help and support them to make the positive changes viiineeded in their lives and, in doing so, changed mine.
A huge thank you to Mel Hunter, who has been my writing hand to help create Hope with Depression.
And special thanks to Stephen Mallen for all his support throughout the writing of this book and for honouring the pledge he made to his son, to bring about lasting change for all those affected by mental illness.
I have been incredibly privileged to have been supported by so many wonderful people from all walks of life, who have all trusted and believed in me enough to make a contribution to this book; for that I thank you all.
Lastly, and by no means least, thank you to my lovely publisher Georgina Bentliff (Hammersmith Health Books) for being so supportive, open minded and a total pleasure to work with.
Once again, a big thank you to all the mentioned above and the many others who have championed, helped and supported me over the years; without each and every one of you, I know I would not be who and where I am today, both personally and professionally; for this I will always be grateful.
Foreword
Depression is one of mankind’s most prevalent and most pernicious diseases. According to the World Health Organization (WHO), approximately 300 million people, representing 4.4% of the world’s population, are suffering from depressive illness.1 Depression is a leading factor in suicide, which accounts for more than 800,000 deaths worldwide and more than 6000 in the UK every year.
WHO data in 2015 also showed that depression is the single largest cause of global disability, accounting for 7.5% of all years lived with a disability or illness. Depression is quite simply one of humanity’s greatest burdens, impacting on the lives of untold millions who endure profound misery and despair on a daily basis.
Perversely, however, depression – like many other psychological disorders – remains poorly appreciated and mired in stigma and misunderstanding. This is intensely problematic. Millions of people suffer in silence, afraid to reach out for the care and support they so desperately need. Policy makers and economists struggle to formulate plans and investments which might start to address the problem. Employers remain unsure how to properly address mental health in the workplace and the school system has become the unwitting crucible of a crisis in adolescent mental illness.
We also remain largely illiterate as a society with regard to depression and mental illness. This leaves vast numbers xof parents, spouses, relatives, colleagues and friends unable to provide care and support for those they love. Our attitudes towards and understanding of mental illness are decades behind our knowledge of physical illness. In the UK, ‘Parity of Esteem’ between mental and physical health was enshrined in the Health & Social Care Act (2012).2 For the vast majority of those suffering from depression, however, parity remains little more than empty rhetoric and a distant dream.
Parity will only be achieved via structural reform. Within the UK, less than 6% of the total medical research budget is spent on mental illness.3 Each year, we spend approximately £8 per capita on mental health research. This compares with £110 on dementia and £178 on cancer.4 In recent years, society, celebrities, the media, employers and multiple organisations have worked together to destroy stigma and raise awareness. And we have come a long way. The persistent and profound imbalances in spending and resource allocation for those afflicted by mental illness nevertheless remind us of the enormity of the challenge still before us.
Within this context, Hope with Depression provides an invaluable resource which greatly improves our understanding of this terrible condition. Drawing upon scientific reference, expert advice and the poignant and powerful lived experience of both suffers and carers, this comprehensive, accessible and honest book is designed to not only assist anyone with an interest in the subject, but to also provide crucial and detailed advice to those either living with or affected by depression.
The selfless and dedicated work of the Crilly family in this field is nothing short of exemplary, turning adversity and tragedy into informed analysis and positive action. When I lost my dear son to depression four years ago, I dedicated myself to improving the mental health system. Much progress xihas been made, but there is a long journey ahead. This publication represents another significant step on that journey.
Stephen Mallen
Bereaved father
Co-founder, Zero Suicide Alliance
National Suicide Prevention Action Group, Department of Health & Social Care
Chair, The MindEd Trust
June 2019
References
1. World Health Organization. Depression and other Common Mental Disorders.: Global Health Estimates. 2017. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf (accessed 18/06/2019)
2. Mental Health Foundation. Parity of esteem. www.mentalhealth.org.uk/a-to-z/p/parity-esteem (accessed 18/06/2019)
3. Centre for Mental Health. The NHS Mandate and mental health. 09 April 2018. www.centreformentalhealth.org.uk/nhs-mandate-and-mental-health (accessed 18/06/2019)
4. www.theguardian.com/mental-health-research-matters/2017/jan/20/12-statistics-to-get-you-thinking-about-mental-health-in-young-people (accessed 18/06/2019 – no longer available)
To cut a long story short…
Anyone looking at us 15 years ago would have assumed from the outside that we were a perfectly ‘normal’ family: my husband Kevin and I and our beautiful twin daughters Charlotte and Samantha seemed to have everything anyone could possibly wish for, and more. We were in a really good place in our lives, glued together by the strong foundations of our marriage and two happy, healthy girls. Of course, we had our ups and downs, like most couples, and life threw challenges our way, but we always worked together to overcome them and move forward, trying carefully to balance our scaffolding business and family life, just like any other working parents. We were doing okay… Or so we thought.
Our picture-perfect little world fell apart when Samantha was diagnosed with the early stages of anorexia nervosa at the start of her teenage years. Her battle with this particular mental illness tested our family to its limits and, just when we thought we had come through the worst, she was then diagnosed with obsessive compulsive disorder (OCD). We had no knowledge at all of eating disorders or OCD when the girls were young and tackling these two illnesses, one following the other, was akin to climbing a mountain without a map, a guide or any of the right equipment.
As a fellow sufferer of mental illness, the main thing as a mother I was armed with was love and empathy. I had faced my own struggle in the years before Samantha’s problems became xiiiapparent. For me, the diagnosis was depression, and for three years I tried to shift the black cloud that permanently overshadowed my life. With the unconditional love of my family and close friends, and a supportive GP who prescribed antidepressants, I was finally able to pull myself free, but I can now see that I too am predisposed to mental ill health and I have since had to be alert to and act on the tell-tale signs that those dark and threatening clouds could once again be gathering. I now realise it is something I will probably have to be aware of for the rest of my life.
Along with my personal experience of depression, it is also the battle we faced with Samantha that ultimately led me to where I am now, writing this book… Hope with Depression.
Like any parent, I wanted to do the best I could to help my daughter to recover. We tried everything we could to get her the help she so desperately needed, from our local (very supportive) GP to both NHS and private clinics and therapists, but sadly nothing appeared to be working for Samantha. I read many books and scoured the internet for as much information and guidance as I could get my hands on but could not find anything that I or my family could truly relate to or which gave me any real hope that there was a light at the end of the tunnel, for Samantha and for us as a family.
Every website, book or support group I found seemed to focus mainly on the actual person experiencing the illness and not the family, friends or carers, who I felt needed help and support just as much as the sufferer. I desperately needed answers and was keen to reach out to others, anybody with a genuine understanding of what was happening to us, to help us stop Samantha’s condition in its tracks, but there was nothing available.
In a moment of desperation, with my family falling apart, I let my intuition guide me and took the decision to rehabilitate her myself. Thankfully, with the full support of our GP, the girls’ school and our family and friends, I was able to dedicate myself xivcompletely to Samantha, injecting positive thinking, love and hope, whilst trying to show her a life outside of the eating disorder, and later the OCD, never giving up on my belief that she would get better no matter how difficult the situation became.
I slowly encouraged her to start communicating with me. She began sharing her distorted, and at times very irrational, views of her world and her innermost thoughts, her head engaged in a constant battle with itself. Patience, love and open-mindedness were paramount, not just with Samantha but for the family as a unit. It was the steepest learning curve I could have ever imagined, but, step by step, Samantha slowly found her way back to us.
Despite Sam’s illnesses and my own experience of depression, Kevin, my husband, has never really understood mental illness, and has never pretended to. At the height of Samantha’s illness the pressure and enormity of it all took its toll on us briefly, to the point that I once asked him to leave. Thankfully, he ignored my request and stayed, continuing to provide his powerful and unconditional love and support, without which we could never have survived. He used to think Samantha was intentionally behaving as she did for attention but now he readily accepts things for what they are, supporting Samantha unconditionally, even though, sometimes, he struggles to get his head around her quirky ways of thinking.
Samantha’s twin sister Charlotte has also been pivotal in her recovery and now works alongside me at my practice, with an empathy that can only come from first-hand experience. She has forfeited pieces of her own life so that Samantha could be given the full-on care that she needed and the bond between my two girls is now unbelievably strong. Their mutual respect for one another, as a result of the journey they have shared, is testament to that.
I have learnt through all of this the importance of constant communication, patience, non-judgement, unconditional love xvand most of all HOPE and that in fact there is no such thing as the ‘perfect’ family. Trying to be perfect is not only unrealistic, but can be dangerous.
Some time into Samantha’s recovery, I was contacted by the mother of a 17-year-old girl who was suffering from an eating disorder. She asked me if I could help them as they were finding, as we had, that none of the conventional routes was making any difference. Encouraged by my husband, I approached their situation just as I had approached Samantha’s, looking beyond her illness to the person within and giving her the unconditional and non-judgemental support that I realised from our experience had been so beneficial. Having been able to help her, and her family, successfully, I made the decision to build my own counselling practice based on everything I had read, learnt and experienced from our own journey with Samantha. I then went on to do some studying of my own, including training as a Master of NLP (Neuro-linguistic Programming) and as a Psy-Tap practitioner. I was keen to work with other sufferers and their families, giving them the unreserved support and complete lack of judgement that my own experience had taught me were both vital and necessary. I tentatively opened my doors to people from all walks of life, struggling to deal with mental illness, be it the sufferer or a supportive loved one. My little successes were never shouted from the rooftops but from then on people seemed to find me through recommendation and word-of-mouth. I am now contacted on a daily basis by frantic and frightened parents, carers and siblings from all over the world, all of whom have concerns about loved ones, some as young as eight years old, most just wanting to talk to me, desperate for a glimmer of hope. I now help people suffering from eating disorders, OCD, depression anxiety, self-harm and low self-esteem. The way I interact with my clients may seem a little unorthodox to some; however, I feel it is important to get to know the person as a whole rather than just seeing them through the lens of their illness, and xviworking alongside the family rather than just the sufferer helps to build a united front against the illness. No two people who enter my office are ever the same and they all experience the issues in a way that is unique to them; hence, the way I approach their treatment is similarly unique to each client. I am learning about each individual case as it naturally unfolds so I can give as much time and attention as we need both in and outside our sessions to build a mutual trust within our relationship which enables me to be one step ahead of the illness, in turn facilitating a quicker and more effective recovery for all concerned; we may do puzzles together while we chat, or make jewellery or other arts and crafts projects. The atmosphere tends to be much less intense than the traditional image of the patient-therapist relationship, and can at times even be fun! I have certainly learnt a lot from working with people in this way, and I focus on maintaining a positive environment, so from the minute they walk in they feel comfortable and at ease and from the very start they know they can get better and that they are in control of their own recovery.
I also respond on an emotional level rather than a clinical one to the things they tell me. I do not always get it right, and I do not pretend to; sometimes, on the odd occasion, there may be the need for additional assistance and input from other avenues but my practical and down-to-earth approach has earned me the endearing handle of ‘Fairy Godmother’!
So here I am, many years later. If you had told me over 10 years ago that I would be doing what I am doing today I would not have believed you! Nor could I have foreseen that our future as a family would be so much healthier and happier; our dynamics have changed in a way I did not think possible. During these rewarding years I have had the privilege of working with some wonderful people and their families, each and every one of them unique. Whilst I have been able to support and guide them through their journeys, I too have learnt from them. My clients have said that they find my practical and down-to-earth xviiapproach really refreshing and have even compared me to the therapist in the film The King’s Speech on more than one occasion. His methods were unconventional and unorthodox – but they got results. I never expected my practice to expand to the scale it has but through this I have been able to share my ever-growing knowledge of all kinds of mental illness and help clients to find the best route towards recovery, not just for the sufferer but for those close to them.
My ever-increasing client list highlighted just how little emotional support or real empathy there was available for the carers, friends and families of those suffering from mental illness, and having had first-hand experience of the destruction it can cause within the family unit I felt compelled to write my first book (Hope with Eating Disorders, published in 2012). I was keen to share what I had learnt from our journey with Samantha in the hope that it would bring some guidance, comfort, strength and hope to others. Outwardly it was impossible to identify families who were going through similar experiences, yet when I spoke openly about what we had experienced within our family, I learnt that most people I knew were struggling with something behind closed doors. They had been too afraid to talk about it for fear of the stigma or judgement which sadly still surrounds mental health issues, even in today’s society when a staggering one in four of us will experience or suffer from some form of mental illness at any one time. It was then I realised how widespread issues like self-harm, anxiety, depression, OCD and eating disorders are and how confusing the wealth of information available on these subjects can be to the reader. Despite many high-profile initiatives by the Government and various celebrities making mental health awareness a target, there are still countless people of all ages suffering in silence, in need of help and support, and many loved ones, friends and carers confused and unsure of how to help them.
Looking back, although Samantha had left most of her issues xviiibehind, she never truly felt comfortable in her own skin until the last few years, when she reignited her love for drama and the arts. Consequently, we have watched her grow into a beautiful, confident and vibrant young lady, pursuing a passion that allows her to express herself. Her passion and desire for life have been strengthened by the encouragement of her supportive and loving fiancé, Jay. Charlotte also has a wonderful, understanding husband, Callum, who has been on this journey with us since the beginning, so I am hugely relieved – being happy and healthy is all I have ever wanted for both of my girls.
This brings us to Hope with Depression…
My main aim in writing this new book is to help you understand depression and identify the symptoms of this destructive mental illness as early as you possibly can, allowing you to intervene swiftly and with more insight into the different treatments available (mainstream and alternative), all of which are paramount for a quicker and more effective long-term recovery.
After the first edition of Hope with Eating Disorders was published in 2012, which I am proud to say was very well received by sufferers, carers and those who work in the eating disorder world, I went on to write more books: Fundamentals, A Guide For Parents, Teachers and Carers on Mental Health and Self-Esteem, with co-author Natasha Devon; Hope with OCD with the publisher of this edition, Hammersmith Health Books; and then the second edition of Hope with Eating Disorders, again published by Hammersmith Health Books, in 2019.
In the eight years since I wrote my first book, the first edition of Hope with Eating Disorders, many things have moved on and changed in the way mental illness is portrayed and understood. The wider public’s understanding of these complex conditions has in many ways grown but at the same time the pressures that society faces are evolving at such a pace that it can be difficult to xixkeep up. The media landscape has altered, with the internet and social media exerting a stronger influence than ever before – and this is something we do our best to influence positively with our YouTube channel, Hope with Mental Health.
In the chapters that follow, I will try to answer some of the questions that I am asked frequently, and my objective is to give you, the reader, the hope and belief that you have the strength and courage not only to support and guide your child/friend/loved-one through these turbulent waters but to be able to see them safely to the other side, where they and, indeed, everyone closely involved with them will be able to move forward with their lives. I would like this book to act as a road map not only for those who simply do not know where to turn for help, but also for those who would like to have a clearer understanding of depression in general.
I hope to relieve you of some of the burden, confusion and pain you may be feeling, as you enter the unknown, and to arm you with as much knowledge, guidance and strength as I can, to enable you to continue your journey with courage, trusting in your own personal skills and instinct, just as I did, remembering always that communication is the key, along with unconditional love, perseverance, non-judgement, patience and hope.
This book emphasises that there is no ‘right’ or ‘wrong’ path to recovery. My own experience demonstrates that each family or support network must take whatever action is right for them: if one option proves ineffective, try another – never buy into the myth that people with depression cannot recover. Never give up hope and never give up trying.
With hope, perseverance, love and a lot of effort from us all, my family has reached a very positive place. Samantha has recently graduated with a 2:1 in performing arts, and is now writing her own book, Hope Through Poetry (some poems from which are in this book) due to be published May 2020. She has become engaged to Jay, who I know will continue to love and xxsupport her through any difficult times that may lie ahead. And above all she is happy and healthy – bubbly, funny and waking with a smile on her face. Her sister, Charlotte, is forging her own path with a loving partner, Callum, and a bright future ahead, and my husband and I can look forward to the next phase in our lives, finally content that our girls are happy and surrounded by love. Our experiences of mental illness have brought us to where we are now: wiser, more appreciative of each other, and with more understanding of others. I never stopped hoping we would one day reach this point, and now we have, I am able to hand that hope on to you. Anything is possible… my family is living proof of that.
Please note:
Over the pages that follow you will share the experiences of other carers and sufferers, and realise that some of the emotions you may be experiencing are natural and normal. You will be given an insight into how your loved one is thinking and feeling, with the aim of providing you with a genuine understanding of their condition. I have also included an unbiased guide to some different types of treatment available, both mainstream and alternative. All the contributors and therapists are real people, but some have changed their names to protect their identity.
Behind the maskBy Samantha Crilly
People sometimes ask me why I feel this way And for the life of me I can never think of what to say It can be mistaken for a feeling of sadness, but this couldn’t be less true Although don’t get me wrong, I can feel sad too I can even feel streaks of happiness run through my mind But it’s always the clarity I can never seem to find Like an emotionless fog running through my head space Always keeping me in exactly the same place An intense crippling timeless dimension Where everything I do requires constant attention It sounds crazy, but the biggest struggle for me is getting out of bed It’s never out of laziness, it’s pure dread for the day ahead An on-going battle which continuously waits at my feet The same one as yesterday I crawled my way through to defeat The only escape I encounter is when I’m sleeping Yet so often I still feel the depression creep in I can occasionally be persuaded to venture out for a walk But I pray I don’t bump into anyone and have to talk Sometimes I catch familiar faces I haven’t seen in a while But I never set loose the truth, I just stand there and smile I do wonder if they can ever tell, Then again I know my mask hides me well My home is now my safe place, I feel somewhat secure Nowadays I never really feel curious as to what’s outside the door I don’t seem to hold a connection to the world anymore When I am in my moments of darkness I always remember that time moves on regardless I know this present moment won’t last after today And maybe, just maybe, one day I will feel okay
Chapter 1
What is depression?
Depression, in its clinical sense, is defined as a ‘low mood disorder’; however, in reality it is much more than that. It is a deeprooted, debilitating and destructive mental illness that affects both the sufferers and their carers alike. Once well established, the severity of this dreadful illness and the tormented misery it rains down on the sufferer can destroy relationships and ruin the lives of not only the person suffering but also everyone around them. Some may describe depression as ‘feeling like they are stuck under water’; others as though they are ‘looking at their life through a frosty window’. For me, it was like having a black cloud following me around wherever I went from the minute I woke up to the minute I went to sleep.
Depression changes a person’s way of thinking, their feelings and/or their behaviour. This can cause the person distress, and can make it difficult to function on a psychological and sometimes on a physical level too. Individuals with depression may not always look ill, particularly if their symptoms are mild. However, some sufferers may show more obvious and explicit physical signs.
Together, anxiety and depression are two of the most common mental illnesses and are thought to affect around one in five of the British population at some point in their lifetime.1 Like all mental illnesses, depression does not discriminate and can affect 2anyone, regardless of age, gender, sexuality, ethnicity or social background. However, evidence also shows that certain groups in society may be more vulnerable to depression than others.
Everyone’s experience and journey with depression is unique to them. It can present itself in many different guises and can be an illness of extremes. For some, its control can deprive them of sleep, while others may find themselves sleeping for days at a time. Similarly, some may find themselves emotionally eating to excess, while others may find their appetite has been totally demolished. Equally, some sufferers may find themselves frantic with excess energy, while others may struggle just to get out of bed. For me, the depression caused extreme fatigue. I felt constantly exhausted, making it a struggle to function on a daily basis.
Depression is a serious mental illness and deserves the same attention and respect as any physical illness, yet sadly, as it is essentially invisible, it is still often woefully misunderstood, feared and trivialised. If we were to break one of our arms or legs, not only would a doctor know exactly how to fix it, but we would probably receive a lot of sympathy and support from the people around us.
With depression, there is no such obvious response. Fearing what they cannot see, people around the sufferer may draw away or worry that they will say or do the wrong thing. This can be frustrating for someone experiencing depression, as they might feel that their condition has not been recognised, or that the people close to them do not care.
Emma, who suffers from depression, says:
I don’t think that people fully understand how I feel. My husband certainly doesn’t. No one talks to me about it and sometimes I feel that I want to talk about it but that it’s pointless.3
To be brutally honest I didn’t understand mental health issues before I was diagnosed with depression. I feel I was very dismissive of it, like it didn’t exist. Like people made it up. And I wonder if that’s how other people feel about me.
For someone suffering in silence it can take an act of great courage and strength to admit to a loved one or a medical professional that there could potentially be something wrong. Once it is all out in the open, it can be such a relief for the sufferer to know they are not going mad and that what they are experiencing is, in fact, a very common mental health issue suffered by millions of people across the globe.
The duration for which someone can suffer from depression differs from person to person; in some cases, as it was for me, it can take root and manifest itself for months or even years at a time; in other cases, it can pass through like a succession of rainstorms.
You may turn to the internet hoping it may help you to understand a bit more, or you may scour articles in the press on the condition, but this could leave you even more confused and frustrated. As there is so much varied information available through different channels, it is very difficult to know what applies to you and your own situation.
Clare O gives us her advice from her own experience as a carer:
The internet has good advice on what not to say to someone who has depression and how to support someone, but it’s not as connected as sitting across from someone who is completely neutral. Hearing someone talk back to you instead of just reading off a screen seems more connected to the situation, more human.
Within this book I aim to provide the information that I think really matters, with no agenda other than helping you to 4understand some of the different types of depression, the signs to look for, and some of the various options going forward that are available to you, the sufferer or carer.
How is depression different from feeling low?
One of the most common misconceptions surrounding depression is that it is comparable to feeling a little sad or down. Many people who suffer from depression do feel sadness, but true depression is very different from just feeling low.
Bernice explains how depression is more than just having the blues:
I became aware of my depression when I suddenly lost my job. I knew it was more than just a case of feeling down. It persisted for a long period of time, weeks turning into months. After realising a year had gone by and i still felt no different, I knew something had to be done.
Sadness and low feelings generally resolve themselves after a relatively short period of time, usually a matter of weeks. Feeling this way is a normal reaction to things that happen in life, and when hard times hit, it is absolutely natural to be plunged into a bleak mood. Similarly, it is normal to be anxious about challenges in life and feeling worried or nervous is a sign that our body’s natural stress response is working properly.
Depression, on the other hand, extends beyond sadness. It persists and deepens, seeping into many, if not all, areas of life and may leave those with this debilitating and draining mental illness struggling to cope on both a mental and a physical level, often losing interest in the world around them.
Claire, who is in recovery from clinical depression and anxiety, describes how her depression was more than feeling low:5
Completely empty and numb. It is the only way I can describe it. The lack of reasoning, interest in your surroundings and family, kids, jobs etc. The feeling of hopelessness, that you are a failure, that you are no good at anything. A waste of space, ugly, like a big black cloud is constantly sitting with you, holding you tightly and not letting you escape.
Depression is a serious mental illness, which you cannot simply ‘snap out of’, or ‘cheer up’ by trying to think positively. The feelings of despair, lethargy, anxiety and emptiness that may characterise someone’s depression are very real and should be acknowledged as such rather than dismissed or glossed over.
How does it feel?
A pervasive feeling of unhappiness coupled with a loss of interest in the things they used to love doing is fairly common to many sufferers. They may feel anxious or tearful, hopeless or wracked with guilt. Things they used to love doing may no longer bring them pleasure, and they may feel removed from other people, isolated and trapped within their own thoughts. For me, I constantly felt sad, drained and distant. Everything was all too much effort – all of which was very out of character for me.
There are also likely to be some physical symptoms. Those with depression may struggle to sleep or sleep too much. They may feel constantly lethargic, suffer with aches and pains, lose their sex drive and/or have issues with food. They may find it hard to concentrate, battle with making decisions and/or be weighed down by poor self-esteem and self-worth.
Pete, who is in recovery from major depressive disorder, shares how he felt:
The guilt and shame can be unbearable – partly because of the stigma that we associate with mental health problems. I lose all energy and can struggle to get up and do even the most basic 6day-to-day tasks. I struggle to concentrate and can become forgetful and unreliable, causing myself more guilt. I’ve had periods when I’ve felt so ashamed of myself and how I have looked that I’ve been unable to look at myself in a mirror for even a fraction of a second. I’ve also had physical symptoms, such as mystery aches and pains, tingling in my arms and hands, and headaches. All of these feelings have led to me having significant periods where I’ve had consistent suicidal thoughts.
In severe cases, these feelings of worthlessness and hopelessness may be so acute that sufferers may struggle to see the meaning of their existence, to the point where they may consider taking their own life.
I have briefly mentioned the black cloud that constantly followed me around, as that is how my depression felt to me, but it will vary from person to person. Many are familiar with the phrase ‘The Black Dog’, which, it is said, is how Winston Churchill described his own depressive spells. The idea of a dark companion who stays bleakly by your side, snarling and growling, will be familiar to many people with depression. To others it can feel different, perhaps causing a feeling of numbness or detachment from everyday life. Some will say they feel like they are suffocating and struggling for breath; others, that they have a heavy weight pressing down on them. They may even say it as if life is a rollercoaster with the fall approaching but the sufferer powerless to stop it. Each individual with depression will have their own interpretation
Jamie Day, who is in recovery from severe depression, says:
At its worst, it was like wearing blinkers. All I could see was a dark tunnel with immense, frenzied noise attacking me as I tried to make my way through. There was no clarity to my thinking, just sadness, panic and loss of hope, which always resulted in suicidal thoughts. Dark thoughts became my norm and were like a (very dangerous) coping strategy, knowing I’d be ending it soon. Thankfully, I didn’t.
7Katie says of how her depression makes her feel:
Depression made me feel like I was in a bubble. I could see normality around me but I couldn’t feel it and I couldn’t pop that bubble. I would watch my family and friends smiling and interacting but I couldn’t pop the bubble and come out of it and be the real Kate. I would often remind myself of the real Kate and couldn’t understand why I couldn’t be that person again. I felt like a shell of my former self, almost like an out-of-body experience.
Sheila describes how she puts on a mask when she is out and how it makes her feel:
When I do go out, I put on an act, with a smile, and pretend all is okay with me. Which in itself I find totally exhausting! As soon as I get back home I feel a sense of relief, I can take the mask off and go back to how I really feel – depressed!
What depression is not
In the hope of arming you with as much knowledge and understanding of this dark and destructive mental illness as I can, I thought it might be helpful to cover a few points on what I think depressions is not.
Depression is NOT:
Something you can just ‘snap out of’
For most people, it is not possible to ‘out-think’ depression. A sufferer cannot simply paint a smile on their face and forget how they are feeling. I know this from my own experience and, believe me, I tried. However much I ‘put on a brave face’ and pretended everything was okay, the black cloud continued to follow me around and was constantly present.
For carers and loved ones who have never suffered from or 8had any personal experience with depression, it can be hard not to tell someone to just ‘look on the bright side’ or ‘count your blessings’. But it is much more helpful to try to acknowledge their feelings and to understand what they are going through as this could be the validation they need that will encourage them to seek help.
Howard says of how people around him thought it was a phase he would snap out of:
When I was at my lowest and I couldn’t hide the depression any longer, my friends just really did not understand. They kept saying I would just wake up and not feel like this anymore. Every day I woke up and felt the exact same, if not worse. It is definitely something I could not just snap out of.
A sign of weakness
Depression is not a sign that someone simply cannot cope, that they should ‘man up’ and be strong enough to resist the negative thoughts. However, it is misconceptions like this that can actually prevent people from getting help because they fear that society (including family, friends and work colleagues) could judge them.
In fact, the opposite is true. Fighting through the turmoil of depressive illness is truly a testament to someone’s strength. Like a powerful storm, depression can mentally batter a sufferer. To be strong enough to face that onslaught, while at the same time making efforts to gain an understanding of the illness they are suffering from, shows a person should be respected and admired.
Janet, whose husband is now recovered from depression, says:
It took a good year or so for my husband to start feeling like himself again after struggling with depression for quite a long 9time. Honestly, I think it took more courage and strength for him to start the recovery journey and get himself on track than it did for him to stay with the depression. I am so proud of where he is now and he has said that he is so happy that he took that difficult journey.
Something everyone goes through
Most people experience extreme sadness at some point in their life, perhaps through a traumatic event, such as the death of a loved one, or a major upheaval, such as redundancy, divorce or illness. This may even make them ‘feel depressed’, but that sadness is often a feeling, whereas depression itself is an illness.
The difference is that people who ‘feel depressed’ will find that their sadness is temporary and is generally linked to something that has happened to them. Depression, on the other hand, which according to the charity Mind around 3% of the population are experiencing at any one time, can be exacerbated or even triggered by life events.
For those who do not suffer from depression, their black clouds can be chased away by sunshine. For those who battle through this mental illness, the cloud stubbornly lingers, no matter how bright the world outside is looking.
Something that lasts forever
The idea that depression could last forever, that it could plague someone for the rest of their life, can make the illness seem even more overwhelming and distressing. It may even prevent sufferers from seeking help as they believe and worry that there is no way out of it. In fact, for around half of those who suffer a depressive episode, it will be a one-off. Though the other half will suffer from depression more than once, they may also have many long periods when they are well. They can often find ways 10other than medication to manage the illness, and those tools they learn may also benefit other areas of their life. Furthermore, they will come to recognise when they might be vulnerable or susceptible to another period of depression, which will enable them to get the right help and support more quickly and recover faster.
Arun inspires us when he says:
Recovery is like being born again. Another opportunity within life, to be able to be yourself and no longer fear what others may think of you and not to fear that you are a monster. You are entitled to be you.
Causes of depression
It is clear that depression can have a range of complex factors at its root, including biological and psychological causes, as well as issues linked to society and the knocks and challenges that life can throw at us.
Although there are various theories surrounding its development, it is currently thought to be a combination of biological, genetic, cognitive and environmental factors acting together, or individually, as a trigger.
Genetics and family history
While depression can often be linked to someone’s experiences in life, it is also now known that genetics can play a part and if you have a close family member with depression, you are more likely to develop it yourself. Research is ongoing to identify the genes that make people more susceptible to certain types of depression, although it is worth bearing in mind that the link may also be due to the fact that we learn behaviour from those closest to us as we are growing up.11
Ella shares her experience:
Both of my parents have suffered with mental illness at one point in their life. I definitely think I was ‘born’ with it in my blood. No matter how much I try to fight it sometimes it just still comes at me. I am able to live my life, but just know it is part of me and my family and we all have to stay strong for each other.
Personality type
The way someone views the world and how they react to the things that happen to them in their life can also influence their chance of developing depression. Our perspective is shaped early by events in our childhood and the models we are shown by those closest to us, leading us to develop certain personality types. Some of these personalities place us more at risk of developing depression. For example, those who are prone to worrying or are easily rattled may have a higher risk, while those who fear social situations or who are wary of getting too close to others can be more sensitive and less resilient when faced with stressful life events.
Elaine shares her experience of how her depression emerged:
I believe it was my internalisation of things and feeling that everything was my fault and that I was not good enough. I never put myself first. Low self-worth and low self-esteem. My parents were very strict and always said you can do better so now I am a perfectionist and try to strive for perfection which is unattainable, so everything I do is never up to the standards I have so this leads to feeling a failure.
Brain chemistry
For the non-scientists among us, brain chemistry can remain pretty mystifying. Even the experts are not entirely sure what happens in the brain that causes depression. The most likely 12answer is thought to lie with neurotransmitters, the chemicals that carry signals from one part of the brain to another. In people with depression, the signals that relate to happiness are thought to weaken or become disrupted as they move between nerve cells, with the movement of serotonin – a chemical in the body that helps regulate mood – most likely to be affected.
Childhood experiences
It is now thought that going through difficult experiences in childhood may leave a person more susceptible to depression later in life. Abuse, neglect, an unstable family life, bereavement or another traumatic event can have an impact that lasts a lifetime. It is possible that a succession of challenges may have a bigger impact than one single traumatic event.
Battling through painful emotions and situations as a child can lead to low self-esteem, and this could impact someone’s chances of developing depression.
Charliee, who suffers from bipolar disorder, shares her experience:
I had quite a challenging childhood with my family. My father also has a bipolar diagnosis and would self-medicate with alcohol. Sadly, this made him physically violent to me, my mum and my eight siblings. I’ve had no contact with him for 12 years so I’m guessing that probably had something to do with causing depression!
Stressful life events
Often a stressful event can be the precursor to depression developing. This may be because self-esteem, which when strong can be an important defence against mental illness, is compromised. Without support to help someone cope with the 13emotional fallout caused by stressful chapters in their life, it is all too easy for a low mood to spiral into depression.
People who have experienced a relationship breaking down, redundancy, bereavement, or even a stressful ‘positive’ event such as moving to a new house or getting married, may also find their depression is triggered.
Mary shares her experience of when she feels her depression started:
I think it was the stressful life event of someone you are very close to, who has always been there for you, being ill and not knowing if they are going to get better. Even when my mum got better, I was still unable to lift myself back out of depression for a long time, which made me feel guilty and I didn’t understand it. I should have been happy she had recovered. In the last few years my dad has suffered ill health and when he is in hospital etc I get the feelings of panic and anxiety back again that I had before and I can almost feel it creeping up on me.
Another stressful life event is something known as ‘empty nest syndrome’, affecting parents. This can be described as feelings of grief and/or loneliness when a child leaves home for the first time, either to attend university, live on their own or move away. A parent can be left feeling bereft and with a lack of purpose or of being needed. As this life stage is a very normal and common event, the emotional and mental repercussions could go unrecognised or even just be taken as the norm. However, these could progress into something deeper if left unspoken about or not addressed.
Tania, whose empty nest syndrome escalated into severe depression, tells us more below:
I was very much looking forward to my son moving out. I wanted more time to myself and quality time with my husband. Once my son moved out I suddenly felt a massive void in my life; I was completely not expecting it. I did speak to a few 14friends who just said it would pass and it was normal to feel that way, but for some reason the void just wouldn’t shift; it got bigger and bigger until I found myself deep into depression. My husband got really worried about me and took me to the doctors; from that point I found ways to bring myself back up. It was a very dangerous time in my life and I am so grateful that my husband looked after me.
Life stages
If we consider the path of life, there are certain times and stages that may make people more vulnerable to depression, either because of changes in their bodies that may alter the way their brain processes things, or because of external factors which are more likely to cause stress in their lives.
Biological changes can occur throughout life but are most recognised during the teenage years and pregnancy. It is also recognised that in older age, changes can occur to brain function which may be related to physical illness, which could make these people more vulnerable to depression. Coupled with social isolation and loneliness that is often experienced by older members of society, depression may take hold.
Frances says:
For many years I so looked forward to the day I retired, having lots of dreams and ambitions to cover when I finally had the time. I came from quite a stressful job, and then just one day I stopped. It was actually very difficult for me, and having been around lots of people daily, and being busy, to then being pretty much on my own or with my husband caused me to sink into depression for a while. Thankfully now I am enjoying retirement and am volunteering part time.
Physical illness
Physical illness can play a part in depression in different ways. Depression (or low mood) can be triggered by illness in another 15part of the body, while someone with depression is also more prone to developing another illness.
Someone who has an illness may experience anxiety or depression linked to their feelings and fears about their condition, especially if the illness is a long-term one and is compromising a person’s quality of life. Depression can also be a symptom of a particular illness. For example, people who have Parkinson’s disease, stroke, cancer or thyroid disorders may be at higher risk of developing depression (for more information see Chapter 6).
If it is the depression that came first, the risk of developing certain illnesses is thought to be higher for those who have the mental illness. For example, research suggests that adults who have experienced depression may be at a higher risk of heart disease than those who have not.2 Furthermore, depression can affect the life-choices that people make. It may lead to a less healthy lifestyle and it is well documented that obesity, smoking and/or heavy drinking, for example, can have a huge impact on a person’s health.
Natalie shares her experience:
When I was a teenager, I had numerous spontaneous pneumothoraxes and seven surgeries in two years. It’s a lot to deal with. A lot physically and emotionally. I missed school and had to try and catch up on homework and things. I just felt really down all the time and was struggling so my parents took me to the doctor, and he said I had clinical depression. I don’t think I fully realised what was going on with me, just that I felt ‘different’.
Caring for someone else
Being a carer increases the risk of depression significantly. It is thought that nearly three-quarters (72%) of carers in England have suffered mental ill health, such as stress and depression.3 This is due to a number of factors. There is the understandable 16stress and anxiety of looking after a loved one, the financial worries that may be connected with that, often coupled with fears about the future. By the nature of their role, carers also have little time for themselves, with their own health and well-being often put on the back-burner. They may also feel isolated and alone, which has a knock-on effect on their self-esteem and resilience. These are all factors that can make someone more vulnerable to depression.
Clare O, who now suffers from situational depression as a result of caring for her partner with depression, tells us more of her experience:
I think being around someone you love, you can’t help but to go through the motions with them.
For me, although I understood that someone with depression can become a different person, at times it still was hard not to take it personally. I felt like I was a sponge to my partner’s depression. There’s only so many times you can listen to someone say they no longer wish to live before it puts you yourself at risk mentally, which is why I sought support in therapy, for my own well-being, without feeling guilty about putting my family and friends in the middle of the negative emotions. I never realised how little help there was for partners of people with depression; a good group would have been ideal.
Other mental illnesses
There is a very strong link between depression and other mental illnesses. For example, people with an eating disorder or obsessive-compulsive disorder may find their illness interlinks with depression. This can be something of a chicken and egg situation; it can be really difficult to determine which illness originated first, the depression or the other illness. Research clearly shows that those who suffer with one of these mental illnesses can be very vulnerable to another.417
For example, with eating disorders, there is evidence that a significant number of those diagnosed also have a history of depression, with persistent low mood contributing to the onset of an eating disorder. However, that connection can also work in reverse, with the undernourished brain and body of an eating disorder sufferer having a negative and debilitating effect on their mood and outlook.
For sufferers themselves and those close to them, it is therefore important to come to terms with this reality, to be vigilant to persistent changes in their mood and outlook and to understand that they need to be fore-armed against mental illness in all its guises.
Having that knowledge will give them power. It will allow them to prioritise looking after their physical and mental health and building their self-esteem and self-worth to help them deal with the mental health challenges that may come their way (for more information see Chapter 6).
Hope with depression
I know the above paints a pretty bleak picture, but I cannot reiterate enough that, from my own experience, both personally and professionally, and contrary to popular belief, full and lasting recovery from depression is possible, remembering always that, as every individual sufferer is unique, so is their experience and in turn their recovery.
The most common question I am asked by concerned friends and relatives of sufferers of depression is simply ‘What can I do?’ The most crucial step is to develop a better understanding of depression – not just the physical symptoms, but the state of mind which infuses them. Furthermore, the earlier you can both recognise the signs for concern and in turn act on them, the quicker your loved one may be able to receive help, stopping the illness from becoming hard-wired and taking over their life. 18If you notice something is amiss, try not to adopt a ‘wait and see’ approach, remembering that early intervention can be key to a quicker and more effective recovery. Even if they are not ready to seek help, acknowledging your loved one’s struggle and showing that you are there for them can be the first crucial step on their journey to recovery.
One thing I do not want carers to do is feel guilty. It is all too easy for the people around sufferers of depression to blame themselves. Not only is this blame often misplaced, it can actually delay recovery, potentially placing an obstacle in the way of your loved one’s journey back to health. Guilt is a destructive and ultimately pointless emotion, and one I hope to rid you of.
All carers – whether they be family, friends, colleagues or professionals – if possible, need to work together as a team, not only to support the sufferer but each other, too.
Carol, whose friend is in recovery from severe depression, says of how her group of friends worked together to help Paula into recovery:
