Packing the Rucksack

Although I did not realise it, I had been packing for depression for most of my life. Nothing especially terrible happened to me during childhood but I remember that anxious little girl who found the early years of school difficult. One of my older sisters told me recently that she had looked forward to my coming to school but that her memories of me at that time were of a miserable child who became her usual, happier self once she arrived home. Until recently, I had forgotten about most of this. It was not inevitable that I ended up with depression but it happened, many years after that anxious and melancholy four year old started school.

Packed into the rucksack were plenty of unhelpful items that I had worn (and worn out!), such as perfectionism, seeing things in ‘all or nothing’ terms, a harsh, inner critic and many of the other things that those who have experienced depression will know all about because, although their rucksack contents are not identical, they are fellow travellers.

It’s hard to say which items fitted most snugly into that rucksack. All I know is, I shouldered the rucksack and kept going, often without realising just how heavy it was. And I certainly did not ask anyone else to carry it for me for a while, to ease the load! I was happy enough to offer to carry others’ rucksacks but mine and its largely unaffirming contents were my responsibility. I might have blisters on my feet and sore shoulders but I would manage. So, of course, when I reached the border crossing into Depression, I was let straight through without a search.

Arrival

Again, I only realised with hindsight that I had experienced short bouts of depression for most of my life. At that point, it didn’t really have a name because I had no map and could not identify it. Once I’d arrived, I must have missed the big sign saying “Welcome to Depression” because I still did not realise where I was. It was acute, swift and I thought I was dying. No. I was sure I was dying. I’d been physically ill on and off and I decided that my illness was terminal. Sluggish to the point of immobility, I was not eating, doing almost nothing: the full Depression tourist experience, souvenirs available in the gift shop to your right after the third circle of Hell. A friend thousands of miles away sent me a card: “Are you okay?”. Even at that distance she had spotted a problem.

It became so unbearable I went to the GP and gave him my diagnosis: terminal illness, these symptoms, I am dying. Knowing me relatively well and being a sensitive and understanding professional, he did not laugh but asked questions, many questions and he gave my illness a name: depression. Just like that. I wasn’t dying. I left the surgery, met my husband, sat on a bench with him and wept. And wept and wept. No more dying then. There were options and decisions to make and all would be well. Or so I thought. What could go wrong now I had a proper map?

I began taking medication and was on a waiting list to see someone at the local mental health partnership. Not being a health professional, I cannot advise anyone else on medication. I don’t take medication any longer but the GP said to me when we discussed it: “It’s your body. It’s your decision.” That’s worth bearing in mind. That, and asking lots of questions about the implications and consequences of taking medication.

Although I am going to call it therapy here, that’s a broad term for any number of options when it comes to seeing a mental health professional. Using the travel analogy, these hard-working and dedicated folk are guides, helping you to plan your journey beyond depression, gently teasing out what your needs are and how best to help you. It is a collaborative process, not one where you arrive at the hotel and your room is booked, fresh sheets are on the bed and a complementary fruit basket awaits you. You have to help make the bed, work out how to turn on the shower and find out how to call reception yourself. You also have to decide which tour company will best suit you. While I was waiting to see someone at the local NHS mental health clinic, I had the option of using a counselling service that was available via another route. I chose or was allocated, the wrong guide. Vulnerable as I was (so perhaps not a balanced judge at this point), I felt that the counsellor did not like me. I saw this as more or less confirmed when I attended the second session with her and she told me I was “All right” now and need not return: “Here’s your rucksack. I’ll walk you out of town!”

If at first you don’t succeed, try someone else and keep trying. It’s worth it. I was not deterred from therapy by this experience. I had friends who had suffered from depression and who had gained real benefit from therapy. If I could find rapport with someone, I’d feel safe.

Turning point

Eventually, after some months, it was my turn to attend the mental health clinic. I saw a clinical psychiatric nurse. She was warm, friendly and reassuring. Unfortunately, I was unable to see her again due to a change in personnel but I was sent some Cognitive Behaviour Therapy worksheets that were quite helpful. 

After a while, I asked to see someone else. A clinical psychologist telephoned and arranged an appointment for me. He was the person who not only took me out of the third circle of hell but showed me that, all things considered, the journey itself was not without benefit. And he made me laugh. I felt rapport and I felt safe. All of that did not happen overnight. It took some time. A lot of time, as it happens. And of course, I wanted the whistlestop tour through Depression, the instant result. How on earth could someone (me) who gardens, who nurtures food through the seasons, not see that, as the therapist said to me, “These things take time”? But of course they do! The best food is grown slowly and nurtured. The best self-awareness and well-being takes lots and lots of practice. Small gains can make a big difference.

As I see it (and this is my take, based on personal experience, so not the definitive guide) the therapeutic relationship is unique. It is not a friendship but ideally, a good, working relationship. The clinical psychologist I saw was like a very good teacher: nurturing, affirming, collaborative, inviting me to join in on the journey, setting boundaries but never coercing me. He was always very professional but approachable. I felt safe and was able to be open with him as I had never been with anyone in my life. My seeing him also helped other people. For the first time I was able to tell those close to me how I was feeling and also to give them some hope about the future.

But I was still hanging about Depression, never quite making it to the edge of town. I also decided, early in the course of therapy, that I had to be the star patient, the perfect patient. It did not immediately occur to me that if I were so perfect as a patient, I would not be there! From this distance, I guess this was inevitable, given that I wanted the five star accommodation for a fraction of the price: to be recovering and well in as short a time as possible. Thank goodness for a patient, tolerant, clever and skilled therapist.

And thank goodness for family and friends who were patient and understanding, helpful and kind. Nobody ever told me to pull my socks up, to ‘get over’ it, to stop my nonsense and snap out of it. I have to admit that I sort of guessed who would respond like that and did not tell them.

My husband put up with a lot. People who live with you bear the brunt. That doesn’t mean one has to be constantly apologising for being ‘pathetic’. People with depression are unwell. How would you help someone who was physically ill? A friend who had suffered from chronic depression sent me a book that had been recommended to her: Sunbathing in the Rain: A Cheerful Book About Depression by Gwyneth Lewis. This wonderful book, read in small chunks (concentration and good memory were not a feature of my travels through Depression and things were best read over a few times) made me realise that my inertia or what I called depression paralysis, where I would sit, unable to move for a long time, was not uncommon. Several other things chimed with me, such as poor concentration and difficulty remembering some things (such as putting a cucumber in the freezer instead of the fridge). The author had also experienced what it was like to live with a depressed person, and she was able to offer advice from both sides of the border, to those caring for others with depression. 

I also read two books by Sue Bender. One, an old favourite, Plain and Simple is about her time with Amish communities and the second, Everyday Sacred is more personal, about her quest for equilibrium in a busy life. With short passages that were easy to digest, these books were helpful. I also read things that were like a warm bath and undemanding. I found that a household hints book was soothing. Reading about removing chewing gum from carpet (weird but true) washed over me and sent me to sleep. 

What I did on my holiday

As my concentration improved, I began to read and read about depression, having realised that I knew very little about the condition. And, yes, a little like travellers who obsessively read every guide to their intended destination, I read widely and in depth (intense, moi?). I also began to make changes to my way of living, some small, some greater and requiring more patience. I fell in and out of depression but it was no longer acute. This happened over a few years, rather than months, with many stumbles in between but I was learning to be less harsh with myself, more positively assertive and more confident about the choices I could make.

I was on the road out of Depression and heading towards Recovery, a place I’d heard about. I liked the sound of it but first, I had to earn the fare. That took some time and effort but the process was enriching. We are often sold the idea that happiness is the pot of gold at the end of the rainbow but I am not convinced that happiness without depth, without finer shades of emotion, is the only show in town. Excitement, contentment, deeper awareness of self and others, sadness, spiritual enlightenment, grief, pride, satisfaction and a desire for justice are just some of the aspects of a rich emotional life. My mother has dementia and can no longer read, finds it difficult to remember what day it is or what she had for lunch but she also has a strongly emotional life. She is loving, very funny, has likes and dislikes, remembers and grieves for my father, reflects on her childhood and her life as a mother and wife, laughs, flirts with my husband and loves listening to music. She also experiences fear and worries about things but mostly she enjoys her life and loves her children as much as ever she did. The dementia may worsen and she may lose some of this richness but for now, the finer shades are still there. I have learned a lot from her about richness and depth and patience.

I needed patience. It was incredibly frustrating not being able to concentrate, not to hear music and not being able to write. I had written since I was a child and had been, prior to depression, writing well and with enjoyment. Some people discover that creativity helps them out of depression and turning to art, craft, writing and other creative activities is their passage out of town. Others, like me, dry up. Listening to audio books had been a great pleasure for me until I had depression. I could not pay attention or concentrate at all. Nor did I feel motivated to do this. I could not listen to music at all until gradually, I began to listen to music designed for relaxation – not much light and shade in this music but it did the trick and helped me to relax. I was grateful for this because music was incredibly important to me and it was good eventually to return to being able to listen. I slowly found the patience to understand that small gains were important, such as being able to listen to a bit of music every so often, to write (without feeling that what I was writing was rubbish) for a short time and to get back to other craft work or at least to read books about it. As a well-known book editor tells aspiring writers: persist, persist, persist. With the help of a good therapist, sympathetic family and friends, it is possible to claw back some enjoyment in enriching activities. The one thing that I realised (very slowly) was that I did things differently, with more awareness, less haste and with gratitude for each small gain. Instead of rushing about like the White Rabbit in Alice in Wonderland, I did things more slowly. It had to be slow as I could not do anything very fast in those early days.

I had loved gardening, growing food, being out and about with the hens, enjoying almost all weathers but once I had depression, I was overwhelmed by the thought of all of that work and the garden became more and more neglected. Apart from the inertia of depression, the ‘to do’ list was simply too daunting. I went on and on at one time about being late planting seed potatoes. In the end, I planted them late, they came up and we had a good crop. I am still a bit overwhelmed during the summer about that ‘to do’ list but now I make sure I enjoy my time out in the garden, relish the small gains and think how lucky I am to be out there with the hens pottering about alongside me, hearing their deeply contented noises when they find a worm, enjoying their pleasure as I used to. If other people think the garden is a bit of a tip that’s their problem and not mine, as it once was.

I was also directed to this website by my therapist, who recommended the relaxation audio material. I was incredibly grateful for this as it helped me to sleep when, at four each morning I was lying awake, training for the day’s panic attacks and several bouts of hopelessness. I still listen to the quick relaxation and use it when I feel stressed or unable to sleep for some reason.

The road to Recovery

… is paved with trial and error. ‘All or nothing’ has no place on this road. What follows is not definitive advice. This website can advise better than I can. Below is what I learned, what worked for me. It’s different for everyone even though there are aspects that may chime with others. 

First, I have to remind myself sometimes that I left the heavy rucksack behind somewhere in Depression. I now travel much lighter than I once did. Second, I have to remember that the life journey is a process and that if you fix your eyes firmly on the ground and keep marching straight ahead, you miss the trees, the animals, the sunsets and the conversations of your travelling companions. I went out for a run this morning and stopped (puffing!) at the top of the hill that looks out over the hills and down to Glasgow. There was very little to be heard beyond the cows pulling at the grass and it was a beautiful frosty, clear and sunny autumn morning. I made the choice to stop, look, listen and enjoy rather than worry like the White Rabbit, “oh my ears and whiskers, I’ll be late, so much to do…” you can fill in the rest, I think. Before, I may not even have recognised that I had a choice. I was able to stop and enjoy just being there even devoting a few seconds ( a huge gain for me) to the present and not the future and what needed to be done.

Below are some of the ways in which I now travel much more lightly than I used:

1. Stop and think! I now make choices about how I react to things, even when the old, anxious or depressive reactions bubble up first. 
2. I value myself, my time and my thoughts much more than I used to. Before I thought that what everyone else thought was probably better than my own ideas and opinions. I also thought that their time was more valuable than mine. I don’t automatically put my interests on the back burner all the time now. Balance is the key. Being totally focussed on self is not helpful but nor is devaluing yourself to the point where others always come first. I don’t automatically agree to do something that others want me to do. I reflect first and act second.
3. If I feel that I have to assert myself, I try to think it through and act with an awareness that relationships may change due my assertiveness. I am no shrinking violet but I now see that a balanced relationship of any kind is one which has light and shade and one in which both parties have to accommodate and in which they should expect, from time to time, to be accommodated also. People’s opinion of me may change because I assert myself but that may not necessarily be a negative outcome. None of this means shouting at people or berating them but learning to stand one’s ground firmly and calmly and it takes practice – lots of it! 
4. Trying hard not to become a bore, I say what I think and feel more often. Not in a me, me, me way but calmly and clearly, when possible without heat. I recently told someone close to me about the way I reacted to a particular situation. It was the first time I had ever been open about it. It wasn’t even a big deal, really, nothing that a little assertiveness couldn’t have sorted out. I realised how much I had hidden it away, even from myself. This, too, takes practice and perseverance. 
5. Moderation might sound dull but it works. Trying not to do everything and be perfect all of the time is good for a start. The website will tell you all about moderation, about sensible diet and other helpful things. Going overboard was one of my party tricks: overworking and trying to fit in everything else, including relationships in the tiny amount of time left over. And I thought I was coping…
6. I wake each day and try to think about something pleasurable that I am looking forward to in the day, be it small or large. When you have depression, nothing seems pleasurable but as you recover, hang on to those moments of joy, interest and excitement and savour them. At night before I sleep, I think about three or four good things that happened during the day. On not so good days, this requires effort.
7. On my pc and also on small cards that I carry with me are some important messages to myself. I read them every single day often more than once. In those messages are reminders to stop, think and choose, a list of what keeps me well, what I enjoy doing and how to keep the demons at bay. I also keep a lovely photo of my dog as wallpaper on the computer to keep me positive. She is one of the happiest living things I know and a great joy. In the hardest days, when she was a puppy, she forced me out of my chair and outside. I would sometimes walk her with tears pouring down my face but she got me up and doing and was always a friendly face, ready to greet me with a wagging tail and a play bow (she’s a black dog, incidentally). There’s a lovely New Yorker cartoon that shows a human ‘patient’ lying on a couch, crying, while the dog ‘therapist’ says from the chair, “But I think you’re wonderful!” It is pinned to my office wall.
8. Exercise. This can be really hard, especially for people with limited mobility but exercise for me is like a strong painkiller for the spirits. After a good walk or a run, I feel ready to get on with things. Research shows it is beneficial which is why just about everybody recommends it. I can endorse that view from personal experience. For me, this is one thing I will insist on making time for. It’s one of the first things I plan each day. At first, it might have been only ten minutes or so. Ten minutes is better than nothing. Having a seemingly ingrained attitude that exercise was something to be fitted in around the needs of others, I realised I would not get real benefit unless I turned the table and saw just how good exercise was for me and how I was more effective as a person when I had regular exercise. Other people gained the benefit of my exercise too.
9. Being with people who accepted me and who cared for me was and is important. With the people who dragged me down or made me feel worthless, I tried to minimise contact without hurting their feelings. It also led me to examine my relationship with these people. Sometimes, one has no choice. Colleagues, family members or people who belong to groups and activities of which you are a member can be very trying. I found my tolerance levels extremely low sometimes. So what could I do about it? I examined my reactions to these people and tried to develop strategies for managing it. Working through some of the problems with a therapist helped enormously and took some of the sting out of the anxiety caused by others’ unhelpful attitudes. There were harder things, however. A friend who had been incredibly supportive when I was at my worst, turned to me eighteen months later when we were discussing depression and said, “It seems sort of self-indulgent”. Having had to exorcise that particular demon myself, I was very disappointed to hear her saying this. I felt it to be a real judgement on me: that I had been wallowing in self-pity instead of pulling my socks up. I talked about this with a discreet friend and thought about the remark. Perhaps this was the speaker’s concern about her own mental state. She had certainly hovered on the outskirts of Depression, so perhaps she was not judging me but herself.
10. A rich life. Having a rich life is as close as the nearest public library, choir, ceilidh, charity, museum, interest group, club, writing course or walking track. If it is difficult to get out and about for some reason, it is possible to join groups online that are positive and active in their interests. For me the problem was that I had a rich life and did not make it a priority, so I would suggest that it is a good idea to look at the resources already to hand. A rich life can mean doing things that cost nothing or as little as a bus fare. If you would like to learn about gardening or growing your own food, ask about a local community garden or allotment scheme. There can be long waiting lists for allotments but in the meantime you can volunteer your labour for some training and spare produce. Be prepared to learn the art of weeding and digging! Joining groups and clubs might be hit and miss until you find the right place, so check things out before committing to paying your subscription or volunteering your time. If it does not feel right, it might take a bit more time or it might not be the place for you.
11. A spiritual life. This does not mean joining a religious group necessarily but for some people, that can be life-changing too. Spiritual activities are those that make you feel uplifted in some way. It might be bagging a Munro, praying, reading inspirational or reflective works by religious writers or philosophers, singing with a choir, learning to meditate, a particular form of creative endeavour or working as a volunteer with elderly people. Learning to meditate can be hard at first and requires concentration but it can be done in short bursts. Some of the material on the practice of Mindfulness can be helpful. 
12. Don’t give up on yourself. That’s something I try to remember every day to remind myself that I am not worthless and hopeless. There are setbacks. A few months ago I was confronted by real hostility and aggression in a work context. It came out of the blue and was unfortunately complicated by the fact that the balance of power was tipped in favour of the other person. It was incredibly difficult to put the whole episode into perspective but I managed to do this, despite being pretty wobbly on and off. It took time, perseverance and the support of a couple of people who went in to bat for me and although the experience has left me shaken, I am blowed if I am going to let it stop me getting on with my life. There is too much to enjoy, much to be thankful for and years of rich life ahead.

A problem solving strategy

When I come up against difficulties, especially those that induce incredibly low spirits, I use this analogy to help myself to move on and to be proactive in making choices.

Imagine you are out walking and you come across an incredibly boggy piece of ground. There is no way across but via the bog. You are wearing wellies that leak or walking boots that are not waterproof. The most likely outcome is that your feet will get sodden and muddy and since you will be walking for some time after that and you have no dry socks, your feet will be wet and cold. You hate having wet, muddy feet feet. What can you do? Here are the choices:

1. You can turn around and go home.
2. You can turn back and decide that you will return another day wearing fully waterproof boots.
3. You can walk through the bog and put up with wet, muddy feet.
4. You can look around the edges for a less damp route, finding stepping stones.
5. You stand at the edge of the bog, hyperventilate and burst into tears.
6. You can think about why wet, muddy feet are such a problem for you.
7. You can take your boots and socks off, walk barefoot across the bog, wash your feet in the nearest burn and then put your socks and boots back on.
8. ?
9. ?
10. ?

The last three choices are for other lateral thinking type solutions. The point of this exercise for me is to remind myself that there are a number of options, ways of thinking around and through difficulty. Some of them are helpful, others less so. In the earlier dilemma, when I was confronted by hostility, I thought through the choices I had about my reaction to it. It took a lot of thinking but eventually I decided that I needed to get on with things rather than letting the hurt permeate my life and that of those close to me. That certainly did not happen overnight. Dear old George Herbert said that living well is the best revenge. I am not looking for revenge but living a rich and varied life helps put things in perspective.

So here is my survival kit for the journey through Depression and onwards to Recovery:

• Travel light;
• Make space in your (very light) rucksack for the things that give you pleasure and or/fulfilment;
• Don’t let anyone else try to pack your bag for you and don’t allow them to put anything in there that would add too much extra weight, no matter how much they insist;
• Be patient when the transport is delayed. It will probably come eventually and in the meantime, you can chat with the other passengers about the interesting journey ahead;
• Consult only intelligent, sympathetic and helpful guides;
• En route, start making your own map;
• Try not to travel alone but invite interesting and loving people to join the adventure. If you are stumbling then ask them to help you;
• Thank your fellow travellers and affirm them when they are good company or help you to hold the map up the right way;
• Affirm yourself for your own map-reading skills;
• Don’t be afraid to take a side road if it looks interesting or if it looks like an easier way over difficult terrain;
• Be responsible for choosing your route;
• Make sure that along the way you listen to your own footsteps and those of others;
• Stop and enjoy the sunsets, write a poem or paint a picture of them;
• Be a sympathetic fellow traveller to others in your situation;
• Quietly and gently part company with those who constantly criticise your pace or your map-reading skills;
• Laugh out loud as you walk along, even if you are on your own;
• At day’s end, kick your boots off, sit by the fire, sigh with satisfaction and give yourself a round of applause for the distance you’ve come that day, no matter how short;
• Be thankful;
• Be at peace;
• Just be and enjoy the journey.

Some resources that helped

• This website;
• The Black Dog by Matthew Johnstone (Constable & Robinson);
• Sunbathing in the Rain: A Cheerful Book about Depression by Gwyneth Lewis (Harper Perennial);
• Plain and Simple by Sue Bender (Harper Collins);
• Everyday Sacred by Sue Bender (Harper Collins);
• Malignant Sadness by Lewis Wolpert (Faber & Faber);
• The Rough Guide to Happiness by Nick Baylis (has an excellent section at the back, too on choosing a therapist) (Rough Guides);
• The Noonday Demon by Andrew Solomon (Vintage);
• Wherever You Go, There You Are: Mindfulness Meditation for Everyday Life by John Kabat-Zinn (Piatkus Books);
• Depression: The Way Out of your Prison by Dorothy Rowe (Routledge);
• The Beck Diet Solution Workbook by Judith Beck (Oxmoor House) – uses Cognitive Behaviour Therapy techniques to change eating behaviour;