January 27, 2006

The Elephant on My Seesaw

Poised solemnly on the front porch Peter stared across at the silent Australian bush knowing that the early dawn stillness would soon be shattered by the raucous laughter of Kookaburras defending their domain. This would be the last time he would hear them. The crackling noise from the exhaust breaks of a large semi descending the nearby Billabong range seemed to be an irony to him; the final reminder of his long term successful career in the motor industry. “No more stalling,” he thought, ”choices have been made, everything is in place, the time had come.”

Moving inside he glanced through the door into his office. Everything Wendy would need was in place. Dizziness from his first batch of benzodiazepine and codeine tablets were making movement difficult as he walked through to the double garage, closing the door behind him. He checked to ensure the two inch plastic hose was still wedged into the top of the passenger window of his Commodore and glanced at it disappearing on it’s dire journey to the rear exhaust pipe. The remainder of the tablets and a bottle of water were still on the dash where he left them the night before. Sitting in the driver’s seat, he closed the door, washed down the remainder of the tablets, waited for a short while, then started the engine. He was unconsciousness before the carbon monoxide filled the cabin.

Peter at the time of his death was my good friend of twenty years. I mourned him then, I mourn him now. Rarely speaking of it, he carried a huge burden of severe depression. His life was a dichotomy; one side presenting as a wholesome well integrated male, the other an experience of the unseen emotional turmoil of depression. He was a well known as a responsible family man; lovely home, wonderful wife, great kids, active Christian, yet his internal life was totally off balance. It was like having an elephant on the other end of his seesaw. His life long personal struggle to get his emotional feet on the ground kept failing till he finally gave up. The elephant was too heavy.

Most who knew Peter could not fathom the ‘why’ of his actions. But for those who like myself, suffer the same affliction, understand his action with a frightening clarity. We too have entertained similar action unawares. Although this phenomenon has at last become recognized as a legitimate human experience to be treated with respect, the severity and horror of it still leaves many sufferers wallowing in their own personal and lonely hell. Today it exists in proportions so epidemic that virtually almost no-one is unaware of it’s insidious influence.

My personal introduction to ‘Jumbo’ began 33 years ago when I was a second year student studying theology.I was hospitalised after contracting Meningitis (bad experience). During convalescence I began to experience an unrelenting malaise of negativity and despair that caused a tightness across my chest and the pit of my stomach. In this state I returned to college in absolute confusion. As Senior Student I applied myself to being a good example and displayed I think a reasonable front, but inside I was falling apart, doubting the very basis of my faith.

I remember seeking counsel from the College Principal and was told to “ Buck up, even the great Christians I know struggle!“ He meant well, but his comment in a sense mirrored many future encounters with well-intentioned friends as I struggled to balance my life with a confusing burden. The stigma and negative stereotype impacted on my confidence and ability to perform in every area of my life. I cannot begin to describe the complexity of subsequent attempts to live normally. The Christian life as I understood it just would not work, notwithstanding a lot of effort. ( oddly enough it was to those I was ministering to).

For the next 25 years or so I struggled believing I was a deficient, hypocritical Christian leader. It was a nightmare; ordained minister to a number of Churches in Australia, pioneer missionary work in Borneo, plus some business activity. I tried every source of help I could think of: healing of the memories, charismatic experience, counselling, demonic exorcism etc. resulting only with occasional slight relief. Eventually a good friend, a medical professional, while visiting with us, looked at me and suggested, “John, I think you suffer with a depressive illness”.

“Well this is an interesting idea”, I pondered, but because of the then cultural negative stereotyping of the illness and my distorted holiness paradigms, I was beyond any appeciation of her insight.

However her comment did begin a seven-year torrid battle with a range if GPs, Psychiatrists and Psychologists all of whom diagnosed me as a sufferer of Severe Endogenous Depression with an accompanying Anxiety Disorder. I was convinced for a long time that the source of the problem lay in the dark caverns of my own heart and treated their opinions with suspicion including the prescribed medications. My own wife a competent Registered Nurse counselled me endlessly to listen to their advice. With my arrogance and polarising mood swings I am amazed that she has stayed with me let alone love me as she has.

Eventually a practitioner at the Seventh Day Hospital in Sydney, whom I had frustrated immensely for at least eighteen months, looked me firmly and said , “John, from all the people I have counselled for depression, and there are many, there is only one person I know, who genuinely suffers with endogenous depression. Do you know who it is?”

Not wanting to listen, I replied, “ No, who are you talking about ?“

“You! “ He said, ” I have told you it is a result of meningitis. Now stop messing me around and take the medication! “ He had shown an aptitude for accuracy in other areas of my degenerating anatomy, giving his words distinct advantages over my pride, so albeit reluctantly I surrendered to wisdom and accepted a psychiatric label.

Unfortunately my predicament became more complicated. About this time we had to relocate to the South Coast when my back was severely injured. I began treatment with benzodiazepines, codeine then oxicontine to curb the pain (Sadly with no advice as to the addictive dangers of such medicines – seriously! ) I became a mess; addicted to prescription barbiturates and at the same time being encouraged to continue with the anti-depressants. One batch of medication was in conflict with the other making life intolerable. Every activity small or large was a major emotional crisis, not only effecting me but having a terrible impact on my family. The small business I was running was struggling to stay afloat. After preaching on a Sunday morning I would come home and collapse on the bed sobbing with overwhelming emotions of absolute failure and hypocrisy.
I resigned from my Pastorate, closed my business, then admitted myself into a drug rehabilitation programme (Sherwood Cliffs – great place, great staff) to become free of the barbiturates. Detoxification and the following 4 months was unbearable (vallium addiction is much harder to get free of than heroin – more about that later).

Back home again I worked with my current Doctor (great bloke) determined to find the appropriate anti-depressant and build up to a suitable dosage. One morning ten / twelve weeks later, I woke sobbing on my wife’s lap with Jumbo smiling like a Cheshire cat at the other end of my see-saw. Then strangely, between 11am and 12pm midday gradual relief began; It was like walking out of a refrigerated cold room into the warm air. Jumbo was dismounting and I was able to place both feet firmly on tera firma. I began to live responsibly and I think normally for the first time in thirty odd years. Each day I was able to achieve activities etc with an unusual sense of balance with my feet firmly on the ground.
(More stuff re medications and pro-active / responsible behaviour)

These medications that I am still taking are no doubt significant in my healing yet I have to own the fact that there are other presenting issues that I also have to address. That turning point occurred some time ago and since then I have become aware that my elephant is a predator and I often sense him poised near the other end of the plank which he sometimes mounts successfully, I find myself more now proactively equipped to unseat him, but it is never easy. The issue of medication for someone suffering with depression is a complicated one and for some people I think not necessary. The health industry, driven by pharmaceutical companies is an issue that depressed people need to understand. We need to sit in our doctor’s surgery and take some control of what is happening. (This is a sensitive topic of which I would like to write more of later. Suffice it to say now that my own experience in some doctor’s surgeries leaves a lot to be desired.) One continually mounts guard. Every day the possibility of attrition is terrifying. I am convinced that maintaining normality for someone with this illness is as difficult a challenge that life can offer. The balance is always precarious.

Understanding Depression.

Depression for me is the experience of a chronic malaise and dread that permeates all facets of my emotional life. Chronologically it is unpredictable. A sense of hopelessness and negative beliefs result in distorted paradigms and dysfunctional behaviour; in it’s extreme state I entertain suicide. It is the product of having contracted both meningitis and malaria. Existentially it is the result of a number of behavioural deficiencies. As the adult child of an alcoholic father I have inherited habits that I still struggle with that can become stressors triggering depression.(eg Many male adult children of alcoholics demonstrate strong messianic behaviour and spend an inordinate amount of time trying to resolve the damage created by their unrealistic commitments.) It has been professionally diagnosed as, ‘Severe Endogenous’, ‘ Panic Attacks / Anxiety Disorder’ and sometimes’ Bi-Polar’ Depression (not Manic). When ‘ill’ it is extremely difficult to ‘exist’, let alone be productive. Behaviour presents as a performance, and if my efforts are life changing in others; a definite act of pure ‘grace’. (The best response from my sermons have occurred whilst wrestling with Jumbo in the pulpit.)

About Depressive Symptoms

There is available a large range of lists that define the basic symptoms that depressed people experience. Such lists are used by professionals and are printed out in many publications to help people understand themselves and their illness. The websites of Black Dog Institute and Beyond Blue have good lists.
( blackdoginstitute.org.au beyondblue.org.au )

My Personal Experience of ‘Depressive Symptoms

§ I feel intensely miserable and sad
§ I feel exhausted a lot of the time with no energy. I procrastinate and can’t complete tasks and keep promises
§ I feel as if the smallest tasks are sometimes impossible. Often exhausted.
§ I seldom enjoy things that I once did. Libido is low and my appetite is affected
§ I often feel extremely anxious
§ I become agoraphobic and social experiences create a sense of panic and agitation.
§ I am convinced my life is a failure, there is no future, and heaven will be a ‘slap on the hand’ experience. Guilt and failure predominate.
§ Anger is a strong emotion.
§ I have a poor sense of self worth and no confidence in company.
§ Everything is interpreted through a negative lens
§ I have a preoccupation with the failures of the past.
§ I cry a lot.
§ My sleep patterns are disruptive.
§ I entertain thoughts of suicide

The Different Types of Depression

I have noticed over the years that there has been a disparity among professionals in defining depression resulting in a plethora of opinions in an industry that is more dynamic than static with its terms. Therefore understanding the differing levels of depression can be confusing. The most helpful current one I have encountered is that of The Black Dog Institute attached to the Prince of Wales Hospital and affiliated with the University of New South Wales.

Non-melancholic Depression – the most common form of depression – it means a depressed mood state lasting more than 2 weeks and affecting functioning at home or at work. There is no psychomotor disturbance and no psychotic features

Melancholia, Melancholic Depression – The quintessential ‘biological’ sub-type of depression; it has been variously described as: likely to emerge without any immediately preceding stressor; having certain clinical features (such as observable psychomotor disturbance) and having over-represented features (for example, non-reactive mood, loss of pleasure, mood worse in the morning); having genetic and biological causes; being unlikely to respond to placebo medication and being highly likely to respond to physical treatments.
( This is often referred to as clinical or endogenous depression )

Psychotic Depression – a type of depression whose clinical features are similar to, although generally more severe than, those associated with melancholic depression, including observable psychomotor disturbance, with the added presence of psychotic symptoms (delusions and/or hallucinations)

Postnatal Depression – any type of depression in the first nine to twelve months following the birth of a baby. (I personally would add to this one the event of depression after some severe illnesses or surgery).

Personally I think diagnosing depression is not all that difficult for someone trained in any of the healing industries;curing it is the big challenge. Having access to lists like these by pastors and staff workers I believe could equip them better in helping people with depression understand what is happening. Today every Pastor / Counsellor should know when to recommend someone to seek help from a Medical Professional and preferably to which one. I have found the above breakdown from Black Dog very helpful. Discerning the difference between re-active ( non-melancholic ) and clinical ( melancholic ) may well become a common experience for Pastors in the future.
Stuff for those who are close to depressed people.

I have felt some disappointment with the material I have come across directed at giving advise to those who are closely related, family or otherwise to people with this illness.
I have been highly impressed with the high level of affection and tolerance displayed by these people as the role of helping a depressive is a tough call. Personally I consider them to be of exceptional character and patience, my own wife being one of them. (More on this later) Yet sadly I have also observed that not all of them demonstrate a clear appreciation of the ‘ world or reality’ of depressed people. Their commitment to help in any way they can is often challenged by not being able to really understand the nature or the world that their suffering friend /mate lives in.

This I believe is one of the main reasons that we who are afflicted with this malady, become very lonely. Our world is not accurately understood and by default we tend to repel people rather than attract them. Everyone I have spoken with who has this illness, admit they have lost even good friends. One man I know, who has graduated in theology, been a good elder in his church for some time, has raised his family well, held a high office in Quantas, shared with me that he lost most of his close friends since he came down with this illness. Another close friend of my wife, who has been ill for many years, has developed a fortress lifestyle around her home largely due to mistreatment and misunderstanding even from her immediate family. Several years ago a friend of mine lamented to someone that, even though I was a gifted communicator, I was lacking in character because of depression (What was particularly hurtful was that as a health professional I believed she understood my illness). My close friend Peter, who took his life, did not share with his friends the extent of his struggle including myself. I often wonder if any early attempts to do so may have been a bad experience for him. A huge amount of further anecdotal evidence exists demonstrating that this issue of misunderstanding causes sufferers to increasingly retreat into their own world of loneliness due to inappropriate responses they receive from others. This is very sad because many of those I have met who struggle deeply with this malady, are gifted and mature people who have so much to offer, yet live their lives in relative isolation.

Some people I have met, who themselves have never experienced depression, when confronted by someone who is depressed often assume that their problem can be solved by simply adopting a different attitude. This thinking is quite common. Several years ago, I was the proprietor of a small growing business struggling with ‘Jumbo’, I found myself in the midst of a stressful conflict which was intensified because it was with someone I considered a close friend. I sat in the office belonging to his accountant fighting back tears, endeavouring to solve some difficult issues. Eventually an agreement was reached after which the accountant looked at me across his desk and stated bluntly, ”You looked depressed – pull your shoulders back, lift your head up, and get over it!” I looked at him silently and then calmly left the office for fear of what I might say. One could give more examples add infinitum / add nauseum of similar irresponsible and hurtful language. Equally painful is the body language ; eg.’an inaudible intolerant sigh with a turning away of the head accompanied with a raising of the eyebrows’ or a subtle condescending look before walking silently away’. Or ‘just the simple silent slight shaking of the head’. To some these comments may seem to be melodromatic but be assured to someone in the mode of real depression these responses are very, very painful. They tend to reinforce the state of depression, intensify the emotional malady, and reinforce the sense of dreadful anticipation of the next encounter.

Without doubt their has been immense progress in recent years regarding the increasing acceptance in our community that depression can be an illness. Our health industries have taken great pains to communicate this through a range of channels with immense success. The evidence that it can be an illness relating to the imbalance of the chemicals in the brain is beyond question. Owning and recognising this by helpers of people with depression is a first step, and a very important one in providing support. But it needs to be understood that it is an illness as severe and real as a broken leg or even cancer. My observation has been that most helpers are more than aware of this but don’t understand that this has to be translated into language and behaviour that is helpful, not disparaging or condescending. For example if you overheard someone in a hospital saying to a patient in traction with broken limbs, ‘ Don’t worry Tom, if you just stop being sorry for yourself you will be out of bed tomorrow’, or ‘ If you started reading your Bible more enthusiastically and prayed more fervently your broken limbs will be healed’, you would not be impressed. Naturally such things would not normally be said and anybody doing so would have to be considered dangerous to have around. What is most helpful to the person in traction are words or behaviour that acknowledges with some empathy the pain and difficulty being experienced. Eg, “Wow, you must be in a lot of pain, is there anything I can do for you?’, or “Tom, you look like you have been in a real scrap. Tell me all about it. How did it happen?” Tom, feeling that his illness is appreciated and acknowledged will indulge himself with a luxurious commentary detailing his calamity resulting with the affirmation that his humanness is secure. What is important is that he not be left with the idea that he is sub-normal. This opportunity of being able to tell one’s story is recognized as highly therapeutic in all levels of healing. Yet many sufferers of depression can rarely do it outside of the counsellor’s room.

I have come to see after much observation, that not many people realise that the world a depressed person lives in, is also part of the illness. The thinking, the emotions and the paradigms of a person suffering severe depression is their real world – it is not a fantasy! True, this world of their’s may not in reality be commensurate with their actual world, but their conception of it, albeit a denial of reality is very, very real. A young mother suffering with severe post-natal depression may, while sobbing uncontrollably on the shoulders of her neighbour declare, “Helen I am an absolute failure as a mother. My children don’t love me, I am no use to them or my baby, my life is useless. And I know Tom doesn’t love me anymore; I know he’s lying when he says he does. Oh, how I wish I could die; they would all be better off without me!” Her reality is part of her illness.

Now the truth is that she is an attractive well put together young woman, whose children are a credit to her, and is adored by Tom. Nevertheless her perceptions are her reality, and nothing will convince her otherwise as long as she remains in the mode of depression. The fact that Helen in response says, “That just isn’t true.” Will be interpreted by the mother that Helen does not understand. In a few months time, no longer depressed her real world will be the actual world and the depressed world of her recent past, will seem like a bad dream. The world’s most famous explorer/missionary would have to be David Livingston, whose success of trail blazing in Africa is legendary if not unequalled. It’s surprising to know that he suffered deeply with depression towards the end of his life on the shores of Lake Tanganyika, after his greatest achievement of reaching the upper Nile. He was convinced that his life was a complete failure. The truth was, he wasn’t only London Geographic’s greatest asset, but front-page material around the word for much of his life, yet his real world when ill with depression, was a denial of his every success.

Moreover this same concept applies to individuals with a bi-polar illness. If the swing moves toward the manic side then the reality can consist of a world of dangerous expectations, sometimes psychotic and hallucinating. Eric, who was an alcoholic came to me for help some years ago with an obvious bi-polar disorder, for which he also began to receive professional help. His perceived real world was sometimes that of an exceptionally bright businessman. In 1985 when the mobile phone industry began to move from the bulky installed models on cars, the new smaller handheld phones were unavailable in retail shops, and were marketed by direct sales. During a bi-polar high, Eric unwisely invested heavily in this opportunity convinced that he was on the way to great wealth. His decision was based on an unrealistic emotional high, not on sound business opportunity. When it shortly collapsed around him, his despondency was leveraged due to the heights from which he had fallen. The cruel nightmare of bi-polar sufferers is due to emotional turmoil of ‘real worlds’ at extreme opposites of the pendulum.

Health Professionals working in the geriatric industry understand this. They are involved with people who have a range of deteriorating psychomotor disorders generally labelled as Dementia. At the home where my wife, a Registered Nurse works, there is this delightful resident who was a bus driver earlier in his life. Suffering with Dementia he revels in his perceived role of driving his bus around the home stoping at various ‘bus stops’ offering rides to other residents and getting annoyed with them for choosing to walk rather that travelling in luxury. This is his real world and the staff are trained to enter into his world rather than demean it. For example, at bed time asking him to drive them to the “bus stop” at the foot of his bed. At another home nearby one of the residents was convinced that the medications storeroom with a vertical meshed window in the centre of it was a lift and when passing it asks, “Is the life working today?” One of the Nurses ( providing some light humour to the staff ) stood behind the window one morning and slowly lowered herself down, provided a great moment for the deluded resident. This analogy may seem too extreme but I think it is helpful in understanding depressed people. We need to formulate conversation and behaviour that not only recognises their real world but respects it as well. Appropriate responses communicate a recognition of the geniuses of the illness and affirms their sense of self-worth and humanness. If we can do this and encourage the sufferer to talk freely in a safe environment about their world we provide I believe the best of all therapy’s, the opportunity for someone to tell their story to a good friend.

Let me make a few suggestions:-

“Hi Mary, you look you might be a bit depressed. I hear that can be quite horrible. How long have you felt like this?”

“David, you mentioned on the phone last night that you were depressed. I’d like to hear about it”.

“You may not feel like talking about it, but I have nothing to do this afternoon and I’m not leaving till you tell me what’s going on”.

“I hear you have been retrenched Natalie. You were so good at your job, what happened?”

What do you mean depressed? I don’t understand, tell me about it”.

Other topics I would like to write about:-
The sins of the pharmaceutical industry
Depression cannot be solved by medication alone. The problems of a pharmaceutical dependant culture. Over prescription by doctors.
Depression and Doctors.
The need to take responsibility in the Doctor’s surgery; ask questions about medication, alternative treatments etc. Doctor’s today are under immense pressure – but it is your body/mind.
Adult pain from childhood & adolescence.
Adult children of dysfunctional families. Etc
Appreciating the dignity of being a child of God.
The thoroughness of our healing through the Death & Resurrection of Jesus. Progress = growing where you are at. Maturity = living in our world as Jesus did in His. Living life inside out ie happiness is a product not a goal. Paul Barnett speaks about ‘The Great Reversal’.
Depression and Sinfulness
Pro-active lifestyle. Practical behavioural issues. The importance of living in an organised world. Achieving goals.
Supplementary / Necessary healing issues. Exercise. Diet. Light – the daily cycle.
John Callaghan