published on 1 November 2013
There is something about this time of year. It is both the best of times and the worst of times. For the many people who struggle with depression in the UK, this time of year can be particularly challenging.
Yes, summer really is now a distant memory. There is a lot of darkness, with the prospect of further diminishing daylight for a long time to come.
We are now starting the manic festive frenzy between Halloween and the New Year, bringing with it multiple levels of stress and anxiety – not least (for many) the sheer financial cost of a ‘normal’ family Christmas.
This is not a moan, it is a mere statement of the reality faced by many as we hurtle into the winter months. One in four of the population may well be thinking this way now, as we adjust this week to the loss of British summer time.
Quite by chance, I have just finished reading the comedian Ruby Wax’s new book, Sane New World. It is a good, inspiring read and I recommend it to anyone who is feeling the seasonal mental squeeze.
In an honest and open way, Ruby shows us what it is like from the inside to face the often overwhelming severity of depression. For anyone who has been anywhere near that experience, it is worth the trouble to read.
For one thing, she does it with great humour – taking something we rarely want to even acknowledge, and turning it into something we can at least laugh about.
Depression, and other forms of mental pain, affects a huge number of us. Just today Andy Burnham, the Labour Shadow Health Secretary, described mental health as the ‘biggest unaddressed health challenge of our age’.
And this includes me too. Like many others, I have had a very difficult two years. I have spent much of this year fighting a fog in my mind, that only seems to allow in the sharp nasty voices of self-criticism.
Like many others, my depression has given me constant heaviness and tiredness, and ongoing mental angst as my mind attempts to ‘sort out’ my problems by thinking them through. This goes together with regular sleeplessness, a lack of interest and motivation, and a perpetual berating of myself for whatever is ‘wrong with me’ being my own fault, and telling myself I could and should be able to do something to fix it.
It comes as a great relief to read of Ruby Wax’s ability to laugh at her own struggles in this same not-so-happy place.
I appreciate in particular the bizarreness of the time when she was checked into the Priory in London during a very difficult period. However, at the same time she was booked to do some TV shows on the effects of mental illness, and she did not want her own struggles to mean she lost out on this work. So:
My husband would pick me up; all the inmates looked at me like I was crazy (high praise from the experts) as I was driven home to interview someone with a mental illness without saying a word about how sick I was. When it was over, my husband would drive me back, I’d get back into my pyjamas and go to bed. (p52)
Later, when she was training at Regents College to become a therapist, she was eventually advised not to continue as a rookie intern. Not because she was doing anything wrong in her role as a therapist, but because London was suddenly full of billboards promoting her in giant sized images for a new TV show on celebrities doing circus stunts, holding a whip and bursting out of a corset. Her supervisor thought some client might find it too strange. As Ruby comments, ‘Perhaps she had a point.’
The book is clearly one of Ruby’s ways of ‘giving something back’ for the support she has been given with her own ongoing struggles. She somehow finds a way to vocalise and express the harsh severity of living with that internal critical voice that causes so much mental pain:
Sadness or unhappiness is perfectly normal… Depression is a whole other beast; it is not situation appropriate. Here’s something you get absolutely free with this illness: a real sense of shame; it comes with the package. And you feel such extreme shame because you think, ‘I’m not being carpet-bombed, I don’t live in a township.’ Your thoughts become so punishing for your selfishness… so loud, so relentless you get not one voice but about 100,000 abusive voices; like if the Devil had Tourettes. (p53)
It was in particular Ruby Wax’s interest in mindfulness as a means of dealing with depression that got me to pick the book up in the first place.
As many followers of the Huffington Post may know already, mindfulness is a meditation technique and philosophy derived largely from Buddhism. Most mindfulness practitioners stress that it is not a religious system, it can be practised as a stand alone approach without reference to any particular religion.
The molecular biologist Jon Kabat-Zinn, of the University of Massachusetts, is largely attributed with the growth of mindfulness in the area of mental health. Through the work of the Center for Mindfulness in Medicine, Health Care, and Society at his university, his writings and talks, and global collaborations with other university centres, Kabat-Zinn has put mindfulness very much on the map as an ‘alternative’ approach to redress many challenges of mental health. A much quoted fact is that NICE (the UK National Institute for Health and Clinical Excellence) has recommended mindfulness based cognitive therapies (MBCT) as a possible treatment for depression, as clinical studies indicate that they can help to prevent the recurrence of severe depression.
I became aware of all this largely from my GP. Like several other NHS trusts through the country, my local health board has introduced a new scheme of ‘books on prescription’. After some discussion with me about this, my GP gave me a prescription for a book (to collect from my local library) jointly written by Professor Mark Williams of Oxford University, Jon Kabat-Zinn, and two others titled The Mindful Way Through Depression.
I have been intrigued by this, not least because of my own interest in the various flows and engagements in the west with spiritualities and religious traditions originating from Asia. I know more about this in the context of Hindu traditions than Buddhism, and must confess I knew little about mindfulness beyond some very basic things.
I have wanted to make this useful to me, and have started a blog on my own experiences of mindfulness meditation for depression – under the pseudonym of Jon Halstead. (I have agonised about this use of a different name in itself, but came to the conclusion that the stigma of mental ill-health is a big one, and not something I want to mess with too much when I am earnestly engaged in the necessities of job hunting.)
For me it is far too early to say whether my initial dabbling in the mindfulness techniques that I have been prescribed have been of any use to the treatment of my depression. I find I want to go further into it, which I take as a positive sign.
Ruby Wax has described it with great clarity in her book, and has talked about the help it has given her in recent years. In particular, she has found the mindfulness practice has helped her to be more aware of herself and what is going on around her, and to recognise much better the early warning signs of depression.
This does not mean you sit there like a lump of tofu with a bindi on your head, listening to the sitar; it means when your mind does what all of our minds do, which is change – change constantly and never stop chattering – you don’t fight it but rather understand and accept it for what it is. (p137)
As all the books on the subject highlight, the main problem seems to be the sheer power of our minds to make ourselves miserable. It appears we are ‘hard wired’ to react to modern life in ways that push us to self destruction.
And to make things worse, the practice of mindfulness is meant to work by cultivating a better awareness of what we are doing inside with our thoughts. Having tried the techniques a few times I have been amazed – like many others – of the wildness of what is going on inside my head. The more I try to still things and concentrate quietly, the more my mind wants to express itself and think.
Apparently this is normal.
And indeed, the more we try to quiet things down and concentrate, the more our minds will run away from this. It is all part of a process of training and development which should lead to a more mindful state, which Kabat-Zinn describes as follows:
mindfulness is the awareness that arises from paying attention on purpose, in the present moment, non-judgementally, to things as they are
I am a long way from that.
I am grateful to my doctor, and to the NHS for putting this initiative into practice. It has the potential to help some of the many people who struggle with depression – and even if it only works for a few, that is perhaps some lives changed for the better.
It is not being presented as an alternative. A lot of hard-nosed scientific clinical trials have been carried out on depression and mindfulness, creating what seems to be a largely positive response within the mental health profession.
It was Winston Churchill who gave us the idiom of depression as a Black Dog. In a context where mental health is largely unacknowledged, stigmatised, and greatly misunderstood, it is good to remember that the ravages of mental pain can and do burden anyone. It is not an affliction of weakness, any more than any other disease.
And thank you also to Ruby Wax and other comedians, who are able to make us laugh even when (and sometimes because) the tears are rolling down our faces.