The Black Dog, the Blue Period: My Experience of Clinical Depression (Part 1)

Image: 1902–03, Femme assise (Melancholy Woman), by Pablo Picasso from his blue period, so called as he sunk into a deep depression and only produced monochromatic works, primarily in the color blue during this time. To me, they are a brilliant representation of life in depression.


Ever since I can remember, I have felt different, out of place, and at odds with my surroundings. This feeling was most acute when I was a child. I don’t have many memories of childhood, and the ones I do have are happy. But there is a sepia quality to them, as if I’m watching my memories from the eyes of an outside observer.

Time and again, I have reflected on that feeling of “out-of-placeness” but never more so than when I was depressed. For whatever reason, how I felt during my long and brutal depression is tethered to how I felt as a child. It makes me believe that, perhaps, the depression was inevitable; that I had started walking down that tight-rope not in my late teenage years, as I had previously assumed, but much, much earlier.

I had always had low self-esteem and various anxieties growing up, but the naivete and innocence of adolescence meant I never questioned the legitimacy of my feelings, accepting them as true and real. Overtime, the common perils of puberty and junior high magnified those feelings. I remember stumbling from day to day, attempting to navigate the obstacle course of school, parents, friends, hormones, etc. I thought I was like everyone else, that I was doing an okay job playing at being a regular girl. But, I didn’t realize that I was constantly repressing my fears, anxieties and emotions, and keeping silent when I should have stood up for myself when I felt bullied for my otherness.

If I can describe my junior high and high school years in one word, it would be “desperation”. From the age of 10, when I immigrated to Canada from the Middle East (by way of India where I was born), I was desperate for acceptance from my peers. I wanted to understand Canadian culture and belong. I remember people exclaiming because only six months after arriving in Canada I had already lost my accent. I was so proud.

I was desperate to be like the other girls who were so effortlessly cool–shiny, straight hair glistening in the sun as I wrestled daily with my thick, black curls. They wore the right clothes, had the right bodies, and sported the right attitude. It seemed like life came so easy to them. I was wrong, of course. They all had their own struggles, some very similar to my own, I’m sure.

High school was a blur of the same: a rocky road of trying to find my place while maintaining a facade of stubborn self-assurance (as is requisite to being a high-schooler). I don’t think I was a very good person, either. Clawing at the rungs of the popularity ladder meant ascribing to the rules and politics of high-school life. So, anyone who was anyone was supposed to shun “the losers” (speak to them at your own peril), and worship those who were at the top. If this sounds like the plot of “Mean Girls” that’s because it was, much of the time. Plus, add in a dash of drugs, alcohol, sex, fights, pregnancies, abortions, a suicide attempt by a drug-addicted student, and you have something that is closer to the plot of modern-day Degrassi.

Luckily, I was not involved directly in any of the above, but sometimes I wished I was–so strong was my desire to belong. However, my actual personality was much different than what I modelled it into every day to become someone else. I liked art and comic books, style and creativity, reading and writing. I had thoughts and ideas on important issues that often differed from those of others. But attempting to belong in my peer group meant I had to diminish those aspects of my personality which weren’t cool and didn’t conform to popular opinion. Expressing my true self would mean risking losing all social connections at this fragile time, and I was not about to do that.

When I look back, I don’t remember being happy whatsoever. Body image was always a source of extreme anxiety for me, which didn’t help when confronting juvenile attractions. Unlike junior high where I flourished in my classes, I hated my high school classes which taught me nothing and left me ill prepared for life after graduation. My medical career path was pre-seclected for me by cultural and familial expectations. These same expectations were often at odds with my identity. I experienced no personal growth and felt like a plant left in the dark, unwatered and unwanted. All these little things were starting to add up.  And, something else was stirring beneath the surface. The seeds of depression were already there and they were given the appropriate ingredients to proliferate like weeds with the help of Accutane* and University.

Picture
The Old Guitarist by Pablo Picasso (1903)

My early University experience was incredibly isolating. I remember a lot of walking in those first years. I walked daily from lab to class to lab to library to the washroom to cry then back to class, all across dusty, dishwater-brown linoleum floors. I had friends, but I was too busy drowning in my own skin. Forget making plans or “going to parties”, most days I couldn’t get out of bed. My depression crept on me so slowly that by the time I was skipping an entire semester of classes, exams and all, it all felt normal. I accepted it as a part of my life. Decreasing contact with friends and acquaintances graduated to complete self-imposed isolation. I blamed myself for everything. I cried every single day and night. I ate my pain. I swallowed my grief. Not having a “legitimate reason” to be depressed only made me feel worse about my “incompetence”. The greatest irony of this situation was that despite being a Psychology major, I had no idea what was wrong with me.

This went on for two years. I was an A+ student who purposely missed exams. But in my mind I had no capability and there was also no point. This was the worst of it. It wasn’t the sadness–people often tend to confuse depression for a single note of sadness. Depression is not sadness. It is a multitude of soul-sucking emotional and physical symptoms which chisel away at a person, culminating in the eventual hollowing out of their being. In my experience, the worst part was the utter lack of hope, and the belief that the future would continue to be as bleak as it was or even worse. I could only describe my depression in my diaries as “a black abyss”. I could not see anything beyond darkness. My future was colored by this same lens. Thus, my future was also non-existent. This nihilism and hopelessness was all there was. In time, I became addicted to the grief and fed it. I began to look for ways to validate my beliefs by comparing myself to other, more accomplished people. Like a masochist, I found whatever evidence I could to confirm my perceived incompetencies so I could revel in the cycle of negativity; I could settle in and get cosy in the dark, heavy blanket that was my depression.


Picture
The Black Dog by Katrina Miller, the black dog is a symbol of depression and suicide

I chastised myself for my rapid weight gain due to depression. I began to loathe myself. I could no longer think clearly and life was a dense fog that I couldn’t move through. I took no pleasure in anything anymore. I would sit and watch TV or browse the Internet for hours, numbing myself to the outside world. I would go days without talking to anyone outside of my family, and that too was just so I could keep up appearances. One thing you may not know about depressive persons: we are very, very good at acting normal. I still went to work twice a week, still volunteered, went to school most days but didn’t go to class. I, and others like me, deserve all the acting awards for the ruses we pull off daily. But we justify them. The last thing I wanted to do was worry my parents; besides, what would I tell them? That “I’m a stupid child, a bad daughter, a failure, an embarrassment”….and so went the lament that never ends. And when I say never ends, I mean it. Imagine listening to a playlist of your worst enemy cruelly whispering, hissing and taunting you with your worst fears, insecurities, negative beliefs and insults. But this voice does not belong to your enemy, it belongs to you, and the playlist is endless, and no matter what you do you can’t take off the headphones and the volume only gets louder and the cord wraps itself around your neck like a vice growing tighter and tighter. This is depression.

I often thought about suicide but never about going through with it. I could never do that to my family. In a strange twisting of the knife, I felt like I deserved to suffer and live in pain everyday. For what? I still don’t know. This was the rationale of a very ill mind. Besides, I felt like I was dead already because I certainly wasn’t living. Another thing that is not well-known about depression: it is as much physical as it is mental. My body would ache from the fatigue. My reflexes were slower. My head felt heavy, or it would hurt from hours of crying. The cycle of insomnia and oversleeping made me feel like a zombie.

The first time I realized that there might be something really wrong with me was when I took online quizzes on depression symptoms online, and read articles on the same. I referred to my textbooks, too. My depression score on every test was off the charts. Granted these were just online tests but it was something. Finally, there was some validation! But validation for what? That I was crazy? That I had a sick mind? That I am abnormal? I echoed society’s worst views on mental illness to myself. I repeated the stigma which stopped me from seeking help (also known as self-stigma). Despite recognizing that there might be something wrong with me,  I still did nothing about it because by this time I had internalized the dialogue of hopelessness and failure I had repeated to myself for three years. This was my normal, it was all I knew anymore.


Then things started to get really bad. My memory was being affected. I couldn’t remember events from the previous day, let alone the previous week. If I couldn’t pay attention in class before, now it was virtually impossible. Eventually, I needed to get a letter for a potential exam deferral. At this point, still, I did not think I deserved any such help. I though I was just a weak student who was pretending to be sick. Again, the irony of being a psychology student is not lost on me. I met with a counsellor at the University and she said something that impacted me deeply. She said, “You are not stupid. Your self, the smart, capable person you are, is still in there.” I can’t describe how powerful these words were for me. They made me tear up then as they do now. For the first time someone recognized the great tragedy of my depression – the death of my former life and self. I had been mourning the person who was full of life, humour, happiness, hope and promise for so long that I didn’t believe I could ever get her back.

And I didn’t get her back, I believe I became someone better.

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Blue Nude 1902, by Pablo Picasso

After seeing my first counsellor that one time, I didn’t go back. I was still in the throes of depression, but my thoughts had shifted a little due to seeking help and taking some control back. My counsellor had lent me two books which had also helped validate my feelings. These were: The Mindful Way Through Depression and Feeling Good, a cornerstone of CBT, which were both helpful during this time. I can’t remember exactly why I did it, I assume it was because I just couldn’t take it anymore and hiding the pain had become harder than just telling the truth, so I decided to talk to my family about what I had been going through for so long.

I first told my sister who then talked to my parents. Through finally communicating openly, I realized that my parents had been worried about me. At last, the pieces fit together for them too. The lack of spirit or interest, the fatigue, the oversleeping, the not-sleeping-at-all, the random bursts of anger, the lack of communication or contact, the missed classes, everything made sense. I also realized how blessed I was to have a family that not only supported me but tried to learn as much as possible so they too could understand what I was going through.

I began long-term therapy. Terrified of psychopharmaceutical drugs, I chose to work with a CBT specialist, only. But, strangely enough, I didn’t really take away much from the CBT techniques. Having read Feeling Good, I didn’t find the therapies in these sessions to be very helpful again. However, just the act of taking back control through seeking help was the switch I needed to light the bulb of optimism. I began to talk more. I began to do things for my future. I started undoing the damage my depression had wrought. Lest you think that I was now cured, this could not be farther from the truth. While I started on the path to happiness, or at least normalcy, I was still suffering everyday. I had to defer the exam for the single course I was taking because I still couldn’t get myself to class to face other people, or to do anything productive. But I could go to the therapy, and that was a great start.

Therapy, family support, sunlight (we forget how important this is sometimes), and combating the negative thoughts that had flooded my mind for years, were all instrumental in helping me change. The following semester, Fall 2010, after summer break, I did something slightly inadvisable for someone in my condition and took 4 courses. This was because I had charted a new path for my life and I went in head first. I was hopeful for the first time in a long time. The semester could have ended very poorly but, because the clouds of depression were clearing and I was able to think clearly for the first time in years, I worked hard and got straight A+s, like I used to. I was ecstatic, but I was also cautiously optimistic and I have been ever since.

Depression, in my opinion, never really goes away. Like a debilitating physical illness or injury, it leaves scars. During my recovery, I feared that any unexpected event could trigger those same thoughts and feelings again. It had been 5 years since the onset of my major depression and I had finally begun feeling better, but little did I know that something else was in store in the coming years and my fears regarding recurrence and relapse would be realized, but in a way I could never have expected.

To be continued…

*Isotretinoin has been linked to depression and suicide in a number of studies: http://www.nejm.org/doi/full/10.1056/NEJM200102083440616
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463189/
http://www.drugwatch.com/accutane/recall.php

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