Understanding the Depressions. Wyn Bramley
those external demands on you. You might have got depressed at losing your family long before you were ready, grieved over abandoning your lovely dad. You might have been pushed into a career and failed at it, the stress of it all making you ill with those rituals you seem to find so funny. Your contentment isn’t just happenstance: you were enabled to shape your own life and you seized the chance.”
“Codswallop!” declared Mira, all the same looking a bit shaken. I banged the table and demanded a truce. We all laughed, helping ourselves to another slice of Mira’s excellent lemon drizzle cake.
This is a clear case of Nurture winning out over Nature (assuming that the family trait was a genetic predisposition and not behaviours learned via unconscious imitation). Despite a pronounced family history, sound relationships in Mira’s home appeared to operate as an antidote. Mira’s denial of the seriousness of the family members’ symptoms helped her normalise her family’s traits so she didn’t have to worry about them until she was old enough to shape her own future and deal with them in herself; but the denial was only partial, as her self-preserving decisions about her future confirms.
Whatever you make of your childhood and the key relationships that followed, however valiantly you fought, Nature sometimes wins out anyway. You will have met people who seem mature, fulfilled, get on very well with themselves and others, show all signs of being well-adjusted, even happy. Still the axe of Depressive illness falls, sometimes repeatedly, and apparently unrelated to especial life events. They shouldn’t be blamed or blame themselves, nor subject themselves or be subjected to interminable therapy as if there is some elusive mystery to be dug up that will solve everything. This happens all too often however and only makes matters worse. Geneticists, neurobiologists and chemists are all working assiduously to relieve cases like this, but our knowledge remains patchy and inconclusive. Even if there were a mystery to be exhumed, some kinds of personality (Mira’s, for example) are fundamentally and resolutely opposed to looking inward and backwards. As the saying goes, they can be taken to the water (of therapy) but they can’t be made to drink!
Benevolent, enlightened childrearing doesn’t automatically guarantee you a Depression-free life in the future, though the odds may be weighted in your favour. Neither does a background of Depressions in the family, an unhappy childhood, and some awful memories lurking about in your store, necessarily prevent you from enjoying a happy life in the present. Indeed, strong loving attachments to others in the present can go a long way to reducing, neutralising or even countermanding negative past experiences while preventing the burgeoning of genetic leanings into Depression proper.
However, reliance on just one onion layer (say a contented present life) is risky. Should current secure ties be broken, due to divorce, say, or a loved one’s death, an extramarital affair or a business failure, then that protective Present Life layer can collapse, leaving the underlying layers exposed. If these are in a sufficiently robust condition they will hold firm and even temporarily take over the function of showing a reasonably okay “face” to the world until that layer can regenerate (till new affirming relationships are made in other words). But if a crammed memory store is now laid open, the delicacy of your relations with your Self uncovered, your questionable personal history laid bare such that all signs now point to a repetition of old mistakes, what chance is there of you staying well, especially if there are no replacement options on the horizon?
An individual’s apparent toleration of stress and misfortune is not proof of moral fibre, or even mental health. Neither is the temporary inability to bear it a sign of weakness: you can be strong and resilient on the inside and not on the outside, and vice versa. These are purely psychodynamic (literally “mind movement”) matters, as I hope this chapter has shown. All our onions have the same layers but are configured in endless combinations.
Chapter 3
Two Stories, Big ‘D’ and Little ‘d’
In this chapter I will discuss two Depressions: a very serious mid-life one which came apparently out of the blue, and another where an otherwise happy man failed to keep his childhood trauma locked away. In both cases I illustrate the significance of family involvement, both in causation and in healing.
Penny’s story
Back in the sixties, barely out of our teens, my best friend Val and I were training as mental nurses (as they were called then) in a massive Victorian hospital on the Eastern edges of London. We were keen students, in our second year now, and we arrogantly assumed that we’d seen it all. Penny was to teach us some humility.
Val had recently met Brian at a jazz club and regaled me endlessly with his wonderful qualities. Soon she was invited to meet his family and afterwards told me every detail. Brian had a married brother in BBC radio. A first baby was on the way. Dad was in insurance, “a bit of an old woman but a sweetie”. Mum, mid-fifties, was “warm and cuddly”, taught ballet and tap to children. Her name was Penny and she had been married to Harry for thirty allegedly contented years.
The relationship with Brian progressed smoothly; we were able to talk about other things for a change. Then one day Val reported that Penny was unwell, couldn’t even manage her usual slap-up Sunday roast that Val always looked forward to (Val and I were daily subjected to terrible hospital food). Penny’s hands had developed an intermittent but distinct tremor, her lower lip wobbled when she spoke, and her feet were unsteady. She “rested” on the settee all day, while Harry brought endless cups of tea she didn’t want, puffing and patting her cushions, constantly urging her to take it easy. This of course had the opposite effect, made her more agitated (much to Val’s disgust – she bullied him into phoning the GP, amazed he’d been too reluctant to “bother” him before now).
That same day the young doctor arrived after his surgery (yes, they could in those days), gave her a thorough examination and took some blood samples. Val and I mused about diagnosis, clearly something neurological. Could it be Parkinson’s, one of the epilepsies, some sort of wasting disease? Later on she was bundled into taxis for X-rays and neurological tests at the local hospital, but nothing was found. The poor doctor was at a loss, muttered about viruses and tropical diseases, talked to his superiors, but got nowhere.
The symptoms got worse and worse, the doctor increasing his visits, clearly frightened and out of control. On her and Brian’s weekend visits, Val now spent more time at Penny’s bedside, the settee having been abandoned. Dad kept proffering food from which she turned away, though Val managed to get her to sip some fluids. She seemed increasingly vague and tottery, always wanting sleep though she only dozed. There was a bedpan for weekdays, but Penny let Val escort her to the toilet at weekends, leaning heavily on her arm. She would sit on the toilet a-tremble and incoherently muttering for a long time, pale, thin, exhausted yet agitated, before she could summon the strength to return to bed. With “old fusspot” out of the way, Val took the lavatorial opportunity to do what she had never so far dreamt of doing – asking nosy questions.
As Penny’s facial muscles fought to get out “b-b-b-” and “c-c-c-” from between her slackened, drooping lips, it struck a rather desperate Val that there might be some clue here. “Penny, are you trying to say something?” Penny sat staring at the frosted toilet window, apparently lost to her own world. The gibberish seemed a conversation – if it was a conversation – with herself rather than any attempt to communicate. Dreading she might do damage (we had had it drilled into us: if you can’t do any good for heaven’s sake do no harm), Val urged: “Penny, look at me, look at me”. And she did. “B-b-b- baby” she said, perfectly clearly. Val saw on Penny’s waxen face what she had never seen before – tears.
Frail and shaking, Penny finally got out her story, a single word at a time. The “c-c-c” turned out to be “k-k-k-kill”. She had killed her first baby and wanted to die. She was evil. Nowadays we would refer to it as a cot death, but a sleepless young Penny had taken the crying infant to her bed and in the night it had suffocated. The doctors said she must have rolled over on top of the child and killed it. She was a murderer.
Val was shocked. How could she have missed it all these weeks and months? This was some kind of massive Depression. Bodily, Penny was almost at the point of stupor. If she slowed down any more she would die, her suicidal