It’s been a while since I have spoken about my mental health issues publicly. And I think it’s time to talk because I’m trying to stop taking antidepressants…and I don’t know yet whether I’ll succeed.
I stopped taking my antidepressants in the first week of December 2014. Not suddenly…I went on a proper action plan for slowly weaning myself off them.
My current bout of depression started in September 2012, which makes it just over two years now. For over a year, I had been on the highest dose of my antidepressant medication – citalapram, 40mg / day – as my course of treatment. Additionally, I am still currently on pregabalin – a drug more commonly used to treat nerve pain in chronic cases – to control my Generalised Anxiety Disorder (GAD).
Seven months ago, I started feeling better…and that depression was no longer my problem. I felt a modicum of control in my life, through the consistent treatment that I was getting from my psychiatrist and my therapist. Sure, I still had “issues”…but the world didn’t feel permanently dull and dim, like it did in my earlier phases of full-blown depression. So, I told them that I was feeling better and would like to begin proceeding with ceasing antidepressants. I began this process in June 2014.
I had good reason to be worried about “doing this the right way” because antidepressant discontinuation syndrome is a very real thing. In the alphabet soup of mental health disorders, this one’s bad because sudden or quick cessation of SSRI antidepressants (like citalopram) can cause electric shocks in your brain (“brain zaps”; which I’ve had to deal with earlier), sensory disturbances, insomnia and a whole lot more. The cause for this, like many other mental health problems, remains unknown.
It’s the possibility of insomnia that I was most worried about. I knew that worsening insomnia would flare up my anxiety disorder, because it usually does. I wanted this badly. There was a part of me which wanted to know that I had won. And I wanted this from a medical professional because I worship objective feedback.
I desperately wanted closure on this chapter of my life that had gone on for the past two years.
I needed this.
The road to the end of the tunnel wasn’t easy. Technically, it’s possible to taper off in a couple of months. It dragged out to six months for me because dose adjustments sometimes took longer to get used to. I also had to pause on cutting back dosage during weeks when I had to readjust the dosage of my anti-anxiety medication upwards to counteract issues are they cropped up. But, by mid-November 2014, I was on the lowest “starter” dose of citalopram and I got the go-ahead from my psychiatrist to stop once I finished with my last batch.
At first, everything seemed to be going okay. I stopped taking citalopram and felt fine. While it was too early to celebrate, I was secretly doing victory laps on the inside.
And then, a few days after I stopped taking it, everything went spectacularly shit.
The worst part was the first week or so. I found myself hitting random brick walls of grief which came out of nowhere. I found myself crying uncontrollably, something which always wrecks me because I hate crying. What shook me to my core was that all of this was happening without any reason: not a bad day at work, not fights with people, not a sad song or a book or a film or a TV show. I always look for rational explanations for life events, and especially when it comes to emotional matters I find that I can’t deal when emotions come out of nowhere due to the loss of a sense of control that evokes.
It scared me because after six months of slow progress, I was suddenly facing what happened at the height of my depression. A sudden and unexpected regression that seemed like an unravelling of everything that I worked towards to make go away.
The answer, of course, was that I needed to stick to the path of staying off my medication a tad longer to see if the situation improved.
I always talk about the importance of seeking professional medical help. When I detect things going wrong, when I notice the early-warning signs, I make an active effort to set up an appointment with a doctor as soon as possible. I exercise, practise meditation, eat right, ensure that I have an active social calendar so that I don’t stew in my own thoughts, stick to my medication religiously.
What bothered me is that I did everything right. What bothered me is that I have ended courses of antidepressant treatment in the past when my depression went away without any of these problems.
Faced with this supposed regression, I started questioning whether things really have gotten so bad that I need to stay on them longer. And how much longer I needed to stay on them. And whether there is any light at the end of the tunnel for me. Whether this will affect me for the rest of my life.
At this point, I found myself blaming one person: me. I was the one who thought that I was better. I was the one who asked to be taken off antidepressants. I have been the one pushing myself all these months saying “just a few more days / weeks / months until this is over”. I am the one who asked the training wheels to be taken off. Sure, my doctors agreed with me but they did so on my insistence. I did so because I genuinely thought that I was better off and by all indications things did seem to be going that way. Now, I was on the verge of being proven wrong.
I know better. I know that it’s not “my fault” that I have depression and the right way to go about it is to look at it like any other disease. But that’s not really true, is it?
It’s easy to find strength to fight depression when you know there’s an end. It might be a few months, a year, two years but if you believe this is something that you can get over then it makes it easier to handle the shit cards life has dealt you. That if you fall down, you just need to pick yourself up again and try again.
Maybe this was my depression-like symptoms talking, but through that week of hell I felt that if these symptoms weren’t a passing phenomenon, that if I needed to go back on antidepressants…I’d lost. I felt that I couldn’t pick myself up again – not even “just one more time”. I may have misjudged where the finish line was, but I felt that knowing that, I couldn’t find that last ounce of energy to push myself even a little longer. I felt like I’d reached my limit. As a friend said, I didn’t have the strength to let the loss gut me and carry on.
I had another scare during that period. I was still pushing myself to keep my social life active, and like anyone else, I enjoy drinks with company. Except…on one occasion I blacked out after four glasses of wine.
Now, the interaction between alcohol and antidepressants is a common one – albeit one I’ve never faced. It’s also an interaction with my anti-anxiety medication – pregabalin – but I’d never seriously considered this affected me until that point. I’ve had moments in the past six months when I’ve blacked out – which I discussed with my psychiatrist as well – but the consensus we both reached, and what I believed as well, was that was probably just due to the amount I’d drunk on those occasions (a lot) and the rate at which I had drunk (very quickly).
Blackout after four glasses of wine was new and worrying, because it’s well below my normal tolerance. So I looked into it, and discussed it, and what I found was worrying: it probably wasn’t just a “normal” drunken blackout, but central nervous system (CNS) depression (no relation to normal depression). CNS depression can result in decreased breathing, decreased heart rate, and loss of consciousness with very serious implications leading right up to coma or death. And I wouldn’t even know what was happening because I’d written it off as bog-standard drunkenness. Some people face this side-effect when taking my particular anti-anxiety pills and alcohol. Apparently I was one of those “some people”.
It also made me realise that through that period, I was drinking quite consistently. Never excessively, just a couple of bottles of beer every day and well within the recommended daily intake limit – but I was still doing it. Beer doesn’t affect me the same way wine does (I’ve entirely stayed away from spirits and liqueurs during the weaning-off period; and I don’t drink whiskey) and hasn’t caused CNS depression-like blackouts. I was swapping out juices, colas, milk for bottles of beer in my fridge. And while by no means what I was doing could be classified as alcoholism (I think; it’s not like I was polishing off bottles of wine daily), I still needed to – and did – put an end to it.
All of that was 3-4 weeks ago, which brings me to now, in 2015. During these weeks, I’ve continued to have major issues with insomnia. On most days, I find it unable to sleep until 4am, 5am, 6am, or 7am. My sleep cycle is completely disrupted, which obviously affects my general mood as well.
I’ve faced wildly oscillating moods: grief, euphoria, rage, calmness, happiness, anxiety – all which seem to come and go on their own without any external factors. I’m facing an increasing disconnect between my internal emotions and the brave face that I want to project outside. As I mentioned, what bothers me is the lack of control when I don’t know what’s causing these fluctuations.
Life goes on, work goes on. It’s helped that this happened over the holiday season, when I’ve had time off from work to deal with it. But during the weeks when I was at work, I found myself staving off panic attacks by rushing out of the building for fresh air or for a smoke or crying in toilets that I know are usually deserted. I’ve broken down many times – including during a hackathon event that I helped organise. And then back, as if nothing happened.
More worryingly, I’ve had recurring thoughts of self-harm. Like I’ve written about earlier, I’ve never been suicidal; pain, for me, has always been a way of dealing with distress, a sense of release. Not being able to sleep drives me up the wall. Even though I haven’t had thoughts of self-harm in the past months, I’ve worked with my therapist on coping strategies, just in case. For instance, I’ve thrown away bandages and antiseptic wash because knowing they would be there was an enabler for me in “safely” cutting myself. But I’ve found myself berating for being stupid when I’ve had thoughts of self-harm, because I would do it “just this once” and I shouldn’t have thrown those items away.
I’ve had the urge to binge eat then force vomit. Not that it matters, because I often feel nauseous anyway.
I’ve had the urge to burn myself with cigarette stubs; as I get more desperate, I’ve imagined doing in increasingly painful ways: moving on from my limbs to my face to inside my mouth. Or my eyes. Whatever makes this go away, even temporarily.
I’ve had hallucinations – or perhaps that’s the wrong word. Half-awake dreams? Visions? While I’ve still been able to distinguish between reality and imagination, I’ve felt strongly that as if my coffee machine or my phone or my desk are part of my body and oh god it’s itching so bad and that I need to scratch it until it bleeds. I’ve felt that my bedroom walls are actually just dirt that I can dig out through. I’ve found myself obsessively and laboriously cleaning every surface in my home with cleaning spray and single portions of toilet paper, just to keep myself occupied. Or watching myself into a Netflix coma of endlessly-loading TV shows. Or obsessively gnawing on headphone wires. Anything and everything to regain control.
My employer offers a 24-hour employee assistance hotline that’s operated by a third-party provider. Even though I’ve wanted to, and even though I’ve used it in the past when things were way better, I haven’t been able to bring myself to lean on this avenue for support. People on the outside, with no knowledge of who you are as a person necessarily err towards the side of caution – and they should – but rationally or irrationally I’ve stayed away from it, in case they call in the emergency services or tell my workplace. I don’t want that escalation, just someone to talk to in that mental state, and personally I’m not comfortable with telling them these thoughts when there’s even the slightest possibility of getting formally escalated. Because that would only worsen my sense of control over the situation.
“No matter how bad things are, you can always make things worse.”
All of this sounds scary and bad and alarming, I know. I haven’t done any of things – no matter how strong the urge has been – because even in my worst moments I know that actually doing it would be a slippery slope that leads to much, much worse.
But I’m also trying to finally be honest, brutally so, because facing what I was going through publicly helped me the last time I was in such a bad place. I haven’t spoken this openly – not in its entirety – even to my friends, because in a way I must have realised that admitting to them would first involve admitting to myself that things were bad. Invoking one of my personal idols, Paul Carr, (once again) who decided to quit drinking publicly…
When I decided to stop, I wrote an open letter on my blog, explaining that I had a serious problem with alcohol and asking for the support of those around me. Posting on Facebook or Twitter for just your friends would work just as well. If you’re worried about your professional reputation if you “come out” as an addict, you might want to consider sending a group email to a dozen or so people you trust. Believe me, word will get around. The key is for people you encounter on a day-to-day basis to be aware that you have a problem and are trying to fix it. Those people are the ones who will be your greatest allies in quitting.
I’m scared shitless and I have been for the past month. I want to put an end to that by taking the step of writing about this because, once again, I’m tired of hiding. I feel the element of having to tell my friends that I lost was playing on my head. So I’m throwing that out of the window by telling everyone. I’ve come to terms with the fact that if do have to get back on antidepressants, I will be able to do it. That I’ll not see it as “losing”. That it will be the right thing to do. Or at least, that’s what I believe I can bring myself to do.
While it’s certainly unusual to get antidepressant discontinuation syndrome with a slow taper off (like the one I’ve gone through) and specifically with the medication I was on (citalopram), there is still a chance that it explains everything that I have been going over the past month. I’m hoping that is the answer.
Maybe it’s too early to declare victory…on my plan to ultimately get better. But I’ll take that. I’m resuming appointments with my psychiatrist and therapist, now that the holiday season is over and they’re back. I can’t call this a New Years’ “resolution” but I hope and wish that going off antidepressants this year will be first step towards a final resolution of my mental health issues. At least for this time.
I did, ultimately, get a degree in September 2013 (without having an official graduation ceremony). Having a degree at hand and all my work experience would have been of little consolation if my terrible university results (a final degree classification of 2:2) precluded me from finding a permanent job. I’d been progressing with multiple conditional job offers at that point – conditional on my degree results, for which every employer needed a minimum of 2:1 – without a final contract in place.
My student visa in the UK expired last year October 14, the day I left the country. On October 16th the same week, I had a confirmed contract from Accenture on the table.
A lot happened between then and this year in February 2014, when I finally accepted that offer and joined Accenture – my current job. I had another job, took time off, got to meet friends I hadn’t seen for years…but coming back to the narrative I started with, I was still on the highest dose of antidepressants possible. By this point I was also battling with major anxiety disorder issues and insomnia.
Depression is a bastard that doesn’t particularly care about how well your life is going on paper, as it was for me. A consistent lack of sleep was affecting my anxiety issues was affecting my sleep was affecting my depression was affecting my depression. My biggest worry was that all jobs that I’d had so far were either at startups, universities, or small businesses. I didn’t know how or whether I’d be able to work in a large consulting company (Accenture is as close as it gets to how large a corporation can be) while still being able to deal with my personal issues effectively.
I’d never disclosed my mental health issues in a workplace context, ever. By nature all the teams that I had worked until that point were small and tightly-knit – 3-10 people – and even though I’d never told them my issues, the sense of bonding was enough to tide any issues over. How would it turn out when I was part of The Machine? (I say that in the nicest terms, because I was apprehensive about the workplace culture change.)
As hard as it was for me to do, I knew that I needed support…so I decided to “come out” to my company. Not to everyone, but at least to HR and my line managers so that I got the support that I needed with flexible working times and time-off while getting treatment. I got a little courage from the fact that Accenture seemed to have well-defined processes in place to handle these situations – and that there were protections that I had under UK’s Equality Act.
And I have to say, I’ve been completely blown away by the level of understanding and empathy that I’ve received. I’ve had occupational health counselling to determine what adjustments could be made, monthly catchups with my HR advisor on how I was doing, the ability to be a part of the company’s flexible working programme.
I attended a workshop for the launch of an initiative within the company called “Mental Health Allies” a couple of months ago, which is a step Accenture is taking for helping employees with mental health problems. There’s one comment that stood out to me, from someone within the leadership team: that 8-10 years ago, when companies talked about such issues, the question they were asking themselves is “Are we liable for this?”; now, the conversation has moved to “How can we help our people?”
I’m genuinely thankful that I’m part of the generation where social norms around depression and other disorders may finally be moving on from outright stigma. (Who know, even this might be too early to celebrate.) I also feel glad and comforted by the fact that at least at Accenture, I’m part of company that takes the wellbeing of its employees very seriously.
This support that I got at work was instrumental in helping me feel better. That I had support structures that I can count on, including taking time-off should I feel the need to.
Work…gives me a sense of purpose. It helped me battle my depression because it gives me a reason to get out of bed. It motivates me to get better by doing the best job I can.
I wanted to end this blog post on a happy note. I did, finally, get to attend a graduation ceremony this year. Without my invites being pulled at the last-minute, or not getting the awards for exceptional performance that I got at university that I was supposed to get.
Graduation is obviously an emotional moment in every university student’s life. But the vindication that I felt from proving to myself, and proving to all those who said I was in too bad shape to graduate and maybe actually I should try again later, wrong.
Looking back, I now know that my university lecturers did try to do the right thing and weren’t just out to get me. And I can also finally acknowledge that I did find a lot of support through the exceptional people at Surrey University’s Centre for Wellbeing, all of which was critical in helping me get better. And of course, my friends, who in their own ways – even without directly talking about my problems – helped me get over my problems.
That was the moment that I finally felt that I’d gotten over my depression, because I could close the university chapter of my life, the time during which I was at the height of my depression. I’m not going to be in denial if I need to get help again, on this occasion. But it was also a reminder to myself that I want to get better…and I can.
My university released its results for this academic year and I’ve just found out that I’m not graduating this year. I need to resit two modules in August as part of the late summer resits the university offers, which means that the exam board will not be able to ratify my results in time for the graduation ceremony in July.
In June, I was called by the department to discuss “my case”. I was told in that meeting that I had the following options:
Take a leave of absence from university on medical grounds, take exams later, and defer my graduation until next year.
Sit for the June exams as normal, but in doing so acknowledge that I was going against the department’s advice.
I do accept my personal responsibility for why this is happening. I chose the latter option, and the gamble didn’t pay off.
The problem I faced was that I’d gone into a freefall for the period from February to May. I had a pile of work to chew through and not enough time.
I felt paralysed. I felt claustrophobic. My primary concern was my dissertation. I’d sunk a lot of effort into it at the start of the academic year, and it was a project that I was proud to be doing because it was innovative, it was an idea that I came up with myself, and something that I felt passionate about. I planned to use the Easter break to catch up on my project, and I emailed my dissertation supervisor for guidance at the time. I never heard back.
I looked up to my dissertation supervisor as role model in academic research, almost as a father-figure for how he guided me through the year. (And my counsellor was someone that I looked up to as a mother-figure too.) It wasn’t until that blog post I published on depression that I felt comfortable to talk to him about what I was going through. I was ashamed to admit it, and I was scared whether he’d consider me less capable for it. In fact, he was quite understanding and supportive. It reassured me the tiniest bit to know that he had my back.
So when I didn’t get an email response back during Easter break from him, paranoia kicked in. I thought my supervisor was mad or disappointed with me, for letting him down. I felt shame and guilt for not performing to what I thought was the best of my abilities. Faced with technical challenges, I just plain gave up on working on the project for weeks.
The truth was for more mundane: the email that I sent simply got buried in the flood of emails that academics usually get. I could have resolved the situation simply by pinging him again. When I finally felt stable, I tried to get on track with getting in touch with people in my department. I’d been regularly attending counselling sessions and having medical reviews of my case, and I went with this evidence to them.
The university does have procedures in place for considering extenuating circumstances. Unfortunately, the process of applying for one and the evidence being considered is a long-winded process, and decisions can take weeks – if not months – to be reached. By the time I applied I started getting decisions back on coursework and dissertation deadline extensions, it was already a week to go for my exams. It literally came down to the wire. I remember frantically panicking in the library because I’d supplied all the evidence, and yet only found out half an hour before the normal dissertation deadline whether my circumstances would be considered. I almost had a panic attack.
And then…I just got a week extra, when I was finally getting back on track but felt I needed more time to catch up during all those lost weeks. I didn’t realistically think I’d get an extra three months, but what I wanted was to have my dissertation deadline stretch into the summer before the exam board met so that I could focus on preparing for my exams. That, apparently, wasn’t possible because of logistical reasons.
I could have appealed the decision my department took directly with the university. However, due to the procedure laid down for this, it would have meant waiting for 3-4 months before I found out the outcome. And if I lost the appeal, well, I’d be up shit creek without a paddle for having failed my dissertation. So I decided not to, and rushed through with wrapping up my project.
I redirected all my efforts into getting the project, and did have a working demo in time. My project was to create a real-time gaze tracking system that worked with standard webcam video on mobile phones. (Kinda like what the Samsung Galaxy S4 has, but more advanced because they aren’t doing “true” gaze tracking.) Admittedly, partly due to the time schedule I was on I didn’t have time to sort out bugs in upstream open source projects that I was using, so I didn’t hit all of the targets that I set out to achieve…but it was at least the best of a worst case effort.
During the same time, I was asked to attend a review by the department. Based on the evidence that I had provided so far to them, all of the mental health concerns that were raised during my medical reviews, their recommendation was I take a leave of absence. It was quite a frank and friendly chat, actually. I remember sitting in that room and my overpowering urge was that I just wanted this whole episode of university to be done and over with. Taking deferred assessment would mean I would be paying tuition fees for another year where I would have jack to do except for kick tyres until (possibly) June 2014, as I would have to wait until then to take exams. And most of all, I just wanted to graduate with my friends. I decided to take the decision to plunge ahead with exams this year. Honestly, I didn’t even care what degree classification I would get. I just wanted to get this done with.
In retrospect, it’s easy to say that I should have taken the “out” when it was offered to me. It’s also easy to be bitter and start blaming external factors. Yes, I wish there was better communication between different arms of the university. Yes, I would have fucking loved it if they made an exception to the rules to suit my schedule. Yes, I wish some of the communication and the decision-making process was quicker, so that I could make informed decisions faster without needing to go through long spells of anxiety.
But the truth is that, at the end of the day, it was my decision to ignore the advice and go ahead. I may not have been in the best state of mind when I made the decision, but it is something that I need to live with. Similarly, I was the one who let go and effectively went AWOL from my course. I can’t “take responsibility” for my depression because I didn’t choose to be this way, but ultimately that’s what happened and affected my performance.
I’m actually quite impressed and glad with all the support that I have received from my university. Throughout the process, the people whom I have spoken to have been understanding; constrained by what they could do according to the rules, but understanding nonetheless – and to me, while I was going through a hard time, that meant a lot. I also have to thank the Students’ Union for excellent advice and support throughout the process. Every step of the way when I faltered, it was reassuring to know that it just wasn’t my friends but the university too which had my back.
As things stand now, I’m taking resits in August. Resits are capped at pass-mark cutoff under our university’s regulations, which means my overall degree classification will probably suffer in the process since it’s weighted heavily towards performance in the final year. I will have a transcript by September, when the final exam board meets to ratify results, but I won’t be awarded a degree scroll until next year’s graduation ceremony in June.
What next? Honestly, I have no idea. I guess I need to focus on the resits for now. I probably need to do a second degree to make up for what I know will be shit result on this one, whenever I find that out three months later. Which will be made harder by the fact that I have a shit result, so my options may be limited, unless my extenuating circumstances are taken into consideration. And the PhD offer that I could have had is definitely off the cards now.
A big confidence boost in the recent weeks has been that I have been making good progress with job applications. I have made it to the final round for every single application I have made, with only two of them giving a final decision so far; rejecting my application, but with valuable feedback nonetheless. And I’m currently awaiting outcomes from multiple companies, with more confirmed interviews lined up in the future. The first thing that I did after I finally felt I was in control of things was to get on with the job hunt, and finding approval from such external agencies feels good. I have my fingers crossed that through the interview process and/or in case I get offer, my extenuating circumstances would be something they are willing to consider – and that I can move on from higher education.
Failing which…I have no idea what degree to study next or where to study it. It kinda excites and scares me.
Academic stress has not been my only concern over the past few months. I’ve had my own problems to deal with, with getting better and more often than not it has felt like gasping for breath. Times when I feel better, times when I feel worse. Besides that, I’ve had friends going through personal problems too during the period which I was helping them deal with. I won’t go into details because it concerns the private lives of other people, but it was something that added to the stress and anxiety nevertheless. I absolutely don’t regret it though; I would be there for them if I had to do it again. What I have realised this year is that I’ve finally learnt not be a selfish little piece of shit and sometimes put others’ concerns before my own, because that’s just what friends do. And in return, I’ve had friends who’ve stuck with me through some pretty dark times. I’m glad for that.
Throughout the months when I battled worsening depression, I never wanted my friends to know the true extent of how shit I was feeling on a day-to-day basis. I’d tell them what was bothering me, but almost in a flippant, nonchalant way. I like to present an image of “yes, I’ve got my shit together” because the alternative of actually showing how bad I was a rabbit hole that I didn’t want to go down. Despite their best intentions and what people say, the truth is that nobody likes being around a depressive at their worst – especially if they have never been through anything like it. Like I said in my earlier blog post on depression, healing is a long-term process and if you don’t make efforts to achieve that goal, you’re well and truly fucked. I like to think “I’m not bothered by what’s happening, I’ll just focus on the moment” because if I do think it should bother me, then it does actually bother me and I feel worse. It’s a vicious feedback loop.
Looking back at the past few months, I’d say that the support that I’ve had from friends has massively helped me recover. Because I’ve seen other people dealing with similar issues, I’m glad I was able to push myself to remain socially active and not give up on daily life. It’s given me something to wake up to every day.
I recently acted as an extra in a film shot by the university’s alumni department about the university’s graduation ceremony. I got to wear a robe and a hat, and I made a mental note to amend my robe hire order because I found out through that shoot that I got my hat measurements wrong. I’d only just made my graduation ceremony bookings earlier this week. And now, I won’t have to bother with that at least until next year.
This is a video that is intended to be played at every graduation ceremony for the next two years.
Irony, thou art a cruel bitch.
“Life was so much simpler ten years ago when I knew everything.” – Paul Carr
It’s 3am as I write this blog post. Yet, I can still hear birds chirping outside my window. I’ve been stuck in a rut for the past few weeks and honestly, I don’t know what quite to do with my life at the moment. There are times when my mind is racing along at a thousand miles an hour with too many thoughts than I can humanly handle; times when every thought seems to be coated in a thick dollop of honey and crawling along. I either starve myself or binge eat on most days. My sleep cycle is off the charts, either sleeping for less than half an hour a day (or not at all), or spending sixteen hours a day “napping”. Smoking, which helps with stress release, is something that I’m indulging in like a chimney stack right now.
There’s simply too much going on in my head and I truly wish I could talk about all of those things here. I can’t, I simply can’t bring myself to do it though – partly because it involves not just me but other people close to me too, but mostly because I’m usually not comfortable talking about my mental health issues.
I wrote a blog post a couple of months ago – Depression, Zen, and barber shops – the first time that I ever publicly talked about the fact that I’m affected by depression. It felt cathartic to, in a sense, shed a skin I’d been hiding inside. But I still didn’t go too far with talking about what it’s like to actually deal with depression on a daily basis. That’s what I hope to do now, in the hope that it helps me clear my head. Helps me get out of this rut.
The popular conception of treatment of mental health issues is that of an ornate leather couch where you lie down on, get shown some ink splatter, and then a distinguished and bespectacled gentleman with a beard nods sadly and tells you that you want to have sex with your mom because of underlying trauma.
I wish I had a fucking couch to lie on the first time I sought help for depression. Freudian psychoanalysis – to which the whole shebang of inkblot tests and lying on couches belongs – is fairly discredited in the modern mental health community. This is primarily due to advancements in the understanding of how mental illnesses actually affect people. The first point of contact when seeking help, as is with most people these days, is usually through a recommendation from a counsellor to a general practician – yes, the same doctor you see for common cold and chlamydia – where you’re evaluated for how seriously depression is affecting you.
My first appointment ever with a doctor regarding depression lasted less than ten minutes. Evaluation is done using a standard nine-question questionnaire that checks for statistically objective indicators of behaviour that have been shown to show a strong positive correlation with the occurrence of depression. I was considered a serious enough case to need medical intervention (as opposed to just counselling) and sent away with a prescription.
The truth is that modern mental health treatment is firmly based in the usage and prescription of antidepressant drugs. The whole operation runs with the ruthless efficiency of a battery chicken farm.
To this day, nobody really knows the precise mechanism of how antidepressants work.
Well, the doctors have their theories. The fundamental idea is that when a person suffers from depression, their brain chemistry is physically altered due to reduced levels of certain neurotransmitters such as serotonin and norepinephrine, chemicals that help transfer messages within the brain. From this correlation, it was found that certain substances that alter brain chemistry by increasing the levels of these select neurotransmitters over time help patients recover.
Therein lies the crux of why modern medical science places so much faith in pharmaceuticals: they have been proven time after time to be incredibly effective at solving the problems they are intended to solve. Even though the mechanism of how the drugs work may not be fully understood, in comparison to placebos, antidepressants on the market have been shown to work. But while antidepressants do work in helping a person feel better, most of them come with a host of unintended side effects. It’s just something that you learn to live with.
The first time I had depression, ages ago in high school, was a mild episode that was solved through talking therapy. I was so glad to have the support of my teachers back then. Then a second wave hit me: the first antidepressant that I was ever prescribed was one that a lay reader would probably be familiar with – fluoxetine, better known as Prozac. The infamous blue pill – although you’d be hard-pressed to find it in its original form as developed by Eli Lilly due to the rise of generic versions – is the line of first resort for any doctor. I went through two courses of fluoxetine for different episodes, and it worked well. I got better. I got happier. It felt good, it felt like a dark and sad chapter in my life had finally ended and I’d beaten something that I never hoped would enter my life again.
Something changed two years ago. I started my industrial placement year…and after a few months I started to hate the routine. It was this time that I came to the realisation that perhaps depression was a thing in my life that I had to deal with in the long term. I don’t attribute my work itself to causing triggering the episode, just that as a person I have issues and the onset can happen any time. This time I was diagnosed with a mild episode again and after a couple of weeks on a newer medication I was prescribed a low dosage course of fluoxetine again, since it had been so effective earlier.
For many months, it helped me maintain a modicum of normalcy and allowed me to remain productive. I impressed my academic tutor and my supervisor at work with my work and it made me feel better about myself. I enjoyed my work, I enjoyed the fact that I had money and the freedom that it gave me to travel around – just like I had done during my study exchange year in Singapore. For a short while, I wished and hoped that I would finish this course of treatment soon too and get on with final year at university when the time came.
I remember the exact moment when I felt that things started going downhill again. I was backpacking in Turkey, in the town of Pamukkale – with its stunning travertine cliffs – and I was a restaurant with a friendly owner. The food was delicious and my company amazing. The owner had these cats that went around crawling around the legs of the patrons. I started petting one of them, and wave of nausea hit me. I felt like I had run head-on into a wall of sadness, and in that moment, as I was stroking that cat’s neck, I wanted to squeeze my hand around it and choke it to death. I just wanted to hurt something really, really bad. I wanted to know what it felt like to take another living being’s life. The only reason why I didn’t do it is because it was a public place and my present company wouldn’t appreciate it. (People wouldn’t appreciate me murdering a cat in the middle of a busy restaurant is what I’m trying to say.)
When I went back to the hotel room, I found that for the first time in months, I simply couldn’t sleep. I sat shivering in the balcony for hours, naked, chain-smoking, reading Michael Crichton’sSphere on my newly-gifted Kindle through faint tubelight streaming from the room. I simply lost track of time. At some point, I went into the bathroom and sat under a broken shower soaking myself in freezing cold water, crying. I rarely cry. Except this time, I did.
The rest of the trip, I went through a phase of maniacal happiness. I fucked like a rabbit; on one occasion in a dormitory, which was…weird. I got high as fuck and missed buses for cities further down my itinerary. My return to Istanbul (for my flight back) was a blur of parties every day – including making out with a guy, full-on. I met up with a member of Travel.SE, a travel site where I am a moderator and I enjoyed meeting someone on there in real life, a lot. That whole last week was just a string of unbelievably high euphoria.
And then, I came back to university, and everything came crashing down. I felt isolated and friendless: I’d been away from university for two years by then, and it felt like I didn’t really know anyone, even my old friends, that well any more. There seemed to be this huge barrier between them and me of what experiences we’d been through – and how we hadn’t been in proper touch for years – that I couldn’t seem to get over. Every conversation I had appeared to be the same. “Oh, how nice to see you after ages! Same here! How have you been? We should catch up some day.” Etcetera. I realise it’s neither my fault nor theirs – well, the onus probably was on me to make the effort to reintegrate – but the effect was still that I felt claustrophobic, socially. I plunged deeper into depression, my worst episode yet far, and I was put on an even higher dose of fluoxetine.
Antidepressants, on their own, are not habit-forming substances – such as sleeping pills or anti-anxiety drugs such as diazepam (Valium, yet another drug I’d expect readers to have heard of). They simply take a long time to work since treatment of depression takes months, if not years. But what every depressive fears is if/when they stop responding to a treatment that works for them, which is what happened with me on fluoxetine. On this higher dosage, side effects started kicking in. One of the classic side effects of fluoxetine is insomnia, and this hit me hard. Weeks into my higher dose course, I found myself unable to sleep until I reached a point where I went three days without absolutely any sleep at all. I was highly strung out and I was a group assessment exercise organised by our department for “professional development” when I had requested a callback from the medical centre. I got the call during the assessment exercise briefing and I ran out into the hallway to take the call, and just sat there crying to the nurse on the phone telling her that I hadn’t slept for days. There were no appointments – not even an emergency one – available until two days away. I spent what felt like ages crying while she told me a recipe for soothing tea – and then I composed myself and went back into the room with my coursemates. The one thing I fucking hated is publicly acknowledging that I had a defect in me. I saw it as a sign of weakness.
When a patient stops responding to a treatment they are prescribed, a whack-a-mole game of finding the next drug that works begins. That’s the path I have been on for the past six months, and it isn’t getting any better.
Insomnia is but one of the few common side effects of modern day antidepressants. The very first class of antidepressants that were wildly successful, discovered in the 1950s, and with which the whole pharmacological response school of treating mental illnesses began, were tricyclic antidepressants. They have mostly gone out of fashion these days since they tend to make patients mildly to violently sick, but more importantly, most of them can be fatal if overdosed on – a risk that medical professionals try to avoid.
Most widely-prescribed antidepressants, including Prozac among many others, these days belong to a class called Selective Serotonin Reuptake Inhibitor (SSRI). SSRIs work along the principle that I described earlier in this blog post, i.e., by preventing the serotonin neurotransmitter from being recaptured by neurons (a process called ‘reuptake’) which thus boosts the levels of free serotonin in the brain. The reason SSRIs are so in fashion is because they also have a positive effect on a wider range of associated disorders often affecting depressives, such as anxiety disorders, as well as the fact that many SSRIs are safer than tricyclic antidepressants when overdosed on.
Yet, as awesome as they sound, SSRIs aren’t without their fault. Every person undergoing treatment with SSRIs has to come to terms with the fact that they also need to inevitably deal with the side effects that they come with. Some of these are fairly mundane: such as dry mouth, nausea, diarrhoea, headaches, weight loss, et al – it depends on the specific antidepressant, really, and also varies from person-to-person. Yet another common drawback is that alcohol, which is a depressant, can cause rapid sedation when drunk in conjunction with antidepressants; hence, on most antidepressants or anti-anxiety pills it is strongly advised not to drink alcohol at all. The job that doctors try to achieve is to find the specific one that has the most positive effects without adversely affecting the life of the patient.
One of the weirder side effects of SSRIs, which discourages a patient from abruptly stopping a course, are “brain zaps“. Because of the mechanism in which SSRIs work, and the fact that a drug dose only lasts in the body for so long, sudden cessation of drug intake causes a sharp drop-off in serotonin levels and this manifests itself in the form of what feels like jolts of electricity in your brain. (I just had one of these a couple of days ago when I ran out of my meds and didn’t take my prescription for a couple of days.) It’s the reason why even when depression is considered to be treated, prescription of drugs isn’t stopped immediately but slowly tapered off through increasingly lower doses.
The biggest elephant in the room though for anyone using SSRIs – and this is by far one of the most common side effects – is sexual dysfunction. SSRI antidepressants commonly cause a drop-off in libido or any sort of interest in sexual activity. It only gets worse once you can get over the first step of not feeling like having sex to the actual process of having sex. Without being sexist, sexual dysfunction is something that women can deal with better since the physical manifestation of female sexual dysfunction is less apparent. Statistically, women are far likelier to suffer from depression; which leaves guys suffering from depression – like me – in an awkward position since there’s less awareness within the medical community of how to deal with such situations.
The worst that can happen to a guy on SSRIs is total or partial erectile dysfunction – and when it does happen, it can be incredibly humiliating and damaging to self-esteem, probably the last thing someone with depression needs or can deal with. Some drugs are far more susceptible to cause this and I try to stay the fuck away from them at the length of a bargepole, requesting to be switched out of them as soon as I can.
But that’s just the worst case scenario. What I’ve found to be more common with me – including my current medication, citalopram (another SSRI) – is that it causes sexual anhedonia; basically, a complete lack of any pleasure during sex. Physically, the time to orgasm varies; often I find that I can go on longer simply because I feel less sensation. That is, if I orgasm at all – which in itself can be a sexually-laden bombshell if the other person is not aware of the fact that I’m on antidepressants or what side effects they have, as it can make them feel inadequate if you just stay fucking erect feeling nothing at all. Either way – whether it’s the worst case scenario or the slightly-less-worse scenario – the point is that being on antidepressants completely sucks the pleasure out of sex and that itself is something that I’ve found to be incredibly damaging. All this when you get in the mood to have sex in the first place.
I’ve been on yet another class of antidepressants known as NaSSAs which do not typically exhibit the same sexual dysfunction side effects that SSRIs manifest. Not having to worry about whether I’d have fun during sex was incredibly liberating for my self-esteem when I was on them, but NaSSAs come with their own suite of problems which made them untenable for me. The drug I was on is mirtazapine, which was prescribed to me specifically because it causes sedation, to help with my insomnia. And for a while it did: mirtazapine knocked me out cold within half an hour of taking my dose. The problem was that at the dose that I needed for it to be effective as an antidepressant, it caused me to oversleep massively. Regardless of what time I took my medication, mirtazapine knocked me out for twelve hours or more at a time. It got to the point where I started dreading any appointments before 2pm in the afternoon. It even affected me during a job interview which was in the morning where I was just too groggy to think straight. Eventually, I stopped taking my medication altogether without consulting my doctor because I had a string of appointments one week when I really needed to get up in the morning.
My second major issue with mirtazapine is that caused me to get insanely hungry. Now, this is usually considered to be a positive side effect as depression often causes patients to drop in weight due to a loss of appetite. Yet, in my case, the complication was I have a tetchy relationship with how I perceive my body image. I used to be a skinny kid in high school, but after a bout of typhoid I went through a phase where I couldn’t do any physical activity for months on end. My weight almost doubled, an increase of 40 kg. I hated it for a couple of years, and I felt helpless to do anything about it as it felt those months with typhoid had significantly changed my daily routine. Then, over time, through a combination of better eating and partly through loss of appetite caused by depression, I shed a lot of that extra weight I had gained. I’m at a stage now where I’m comfortably within the healthy BMI range yet I’m so insecure that I want to lose 8 kg further to drop to the lower end of the BMI scale.
I have another reason for wanting to lose a lot more weight even now. I’ve gone through phases earlier – and even now – of binge-eating and purging, or as you may otherwise know it, bulimia. I typically consume 1000-1200 calories a day; then on some other days, I consume 5000-6000 calories in one sitting (the guideline daily recommendation is around 2000-2500 calories). I just stuff myself silly until I’m bursting, and then I force myself to puke it out. I spend ages hunched over the toilet bowl in our house and I lie there puking and feeling miserable. Sometimes, I eat my own vomit again as a way of punishing myself for binge-eating.
On mirtazapine, I felt hungry all the time despite how much I ate. Keeping in control of the number of calories I eat and overall either keeping my weight constant or reducing gives me a tiny sense of control in my life, and I found on this medication my anxiety levels went through the roof because I inevitably found my weight increasing due to overeating.
Despite the fact that it was actually making me feel better than ever during my waking hours, despite the fact that it didn’t have the typical sexual dysfunction side effects, mirtazapine was affecting my sense of happiness and control over my life in other ways which affected me to the extent that I stopped taking the medication without consultation. And that’s the most dangerous place a depressive can be in. I did get in touch with a doctor eventually and then started a course of treatment on another drug (a variant that belonged to the SSNRI class) – which didn’t work because it triggered an allergic reaction, so I had to be switched yet another one.
And so the whack-a-mole goes on. The thing about antidepressants is that they take time to kick in. Positive or negative effects can take at least two weeks, and more commonly, up to a month to start showing up properly so when switching around antidepressants, I go through this phase when I feel much, much worse. I might have painted a bleak picture, but without the support of antidepressants it feels much worse. Not having any control over your emotions, not being interested in the lives of your friends, not being interested in doing any work…day in and day out, day after day sucker punches you in the gut. When even you can’t think straight to get the things done that you want to do, it feels like life has no purpose. The meds become a necessary evil.
Say everything goes okay with your medication. You find that one drug that works for you. You might think that would be that, but the sad reality is that it’s often not. SSRI antidepressants have another common side effect: that they tend to make patients feel that their emotions are “flatlined”. They lift you out from feeling dark and gloomy all the time, they help you get up on your own feet and start functioning as normal member of society…but at the same time, for some people, it just substitutes that with a consistent sense of feeling “meh“. And although “meh” is a state one can tolerably exist in, for patients undergoing treatment for depression long-term – e.g., those whose onset factors are more complicated than something with a clear-cut trigger such as the death of someone close – dealing with this state becomes an issue too.
My life, whenever I’ve been on antidepressants, seems to have Every Day Is Exactly The Same from the Nine Inch Nails as its fucking soundtrack. On SSRIs, my typical drug response has usually resulted in this flatlining of emotions. This makes me perplexed and lost. At first, when the meds start working, I find that I can finally go ahead with my life, start meeting up with friends again and do the things that I need to get done. Yet over many months, this dulling of emotional response makes doubt creep in. “Why am I not enjoying the things that I used to any more? Why don’t I feel happy when hanging out with friends any more?” And so on. Lowering the dosage of the medication could help reduce the dulling of emotions, but it’s simply not that easy as that since a reduced dosage could mean that the medication is no longer effective at helping fight depression.
Thus continues the vicious cycle.
The hot water will open up your capillaries. The aspirin you just took will thin your blood…Oh and if you do decide to take the coward’s way out, make sure you cut along the tracks not across them – that’s a rookie mistake.
Humour and pain are two emotions that I find rise above this baseline of meh-ness. I tend to find random things funny; when hilarity ensues, I feel like I’m actually feeling something. Humour and pain, I think, tap into something so fundamentally basic in the human psyche that it can break through any other mental barriers.
I’m typically not suicidal, as I think of it as cop out to just quit on life. When I do have suicidal thoughts, they tend not to go beyond the ideation phase. My relationship with self-harm, on the other hand, is complicated. At times when I feel better, I can think rationally and I don’t indulge in self-harm; it’s something that I haven’t done for years now. Recently though, when I stopped taking my antidepressants and then was switched around on a couple of different ones, I found it hard to keep a grip on reality. My motivation for self-harm doesn’t stem from typical reasons why people do it – mostly, due to self-loathing – but because there are times when I feel so empty and emotionless that I’m desperate to do something – anything – to have any kind of feeling at all, even if it be pain. Within the past year, I have used various methods to achieve this: cutting myself (multiple times), scraping my tongue with a razor (this was when I started overeating and it induced guilt in me for succumbing), bleached my hair to the point that my scalp started bleeding, burnt myself with cigarettes (multiple times; it’s much harder than you see in films because the cigarette stub usually goes out on contact with flesh). Cutting myself is an act I have down to a ritual now, laying down plastic sheets so that I don’t mess my room’s carpet (I don’t want to lose my deposit).
The draw of self-harm for me is that when the pain sears through my head, it’s an immediate and noticeable emotion. There are memories I have from childhood that are too traumatic and when they do pop into my head, in high-definition, I would just about do absolutely anything to push them out of my head. Or to forget a particularly violent or traumatic dream I may have had. Or, if I go through a day when I feel particularly emotionless. Pain, of the kind caused by the things I’ve done, dials it up to eleven – and keeps it there. After a session of self-harm, I can actually move on and concentrate on work.
Not all pain has to be self-destructive. Self-harm is a method of release I’m driven to in my darkest times. What I usually do otherwise is sit outside in the cold; if it’s rainy or snowy, without warm clothing and bracing cold helps me have a physical reaction, an emotion. Or, walking barefoot in the middle of the night – in the snow or otherwise – to an underpass (that leads to Tesco) near my house, and then just screaming or crying until my lungs give out. I mean, the number of times that I’ve snuck out of the house and spent it outside, shivering in the cold is a count that I have lost track of by now. It helps me deal with things.
My moments of self-harm and pain are intensely private to me. I don’t like reaching out to friends because I don’t do it as a way of attention-seeking, I do it as a measure of stress-relief. The decision to harm myself at any point, I see that as a fully-formed, final decision rather than an opportunity to talk to a friend so that they can reason me out of it. I would see a friend who did try to talk to me at such a time as an intrusion on my privacy. Most importantly, I hate to put my friends through a period of worrying for me because trying to deal with someone on the verge of self-harm is incredibly taxing, as I have experienced time and again when dealing with people I know who do the same. I would still happily talk to any of my friends who wants support at such a time, but only if they want it to be so.
Although someone’s intention in helping me (or anyone else for that matter) about to inflict self-harm are inarguably well-intentioned, unless it is something that you have experienced yourself it’s probably an act you won’t understand. It cannot be rationalised. It cannot be reasoned away, nor can an attempt at reverse psychology work in such a situation. This can be hard to understand and accept, especially when it’s someone you care about, but the best anyone can do is to listen to the underlying reason that is driving a person to self-harm on that occasion, rather than discuss the act itself.
The reason for why the way I process things the way I do can vary but one of the common ones is there’s an element of feeling neglected by parents that leads to a child seek validation elsewhere instead. I do feel that way about the relationship I feel with my parents. I don’t think I had their approval growing up as a child – and I still think I don’t have their approval. Actually, it’s more complicated than that. Rightly or wrongly, I see indifference bordering on apathy when I think about their relationship with me in my childhood. In a way, this had a positive effect inasmuch as making me more independent in my later years in life, although in a sense that independence is probably an illusion since I still enjoy the safety net of their financial support. I also get the feeling that even though my parents never valued me directly, they did use my achievements when around other people as a means of regulating their own self-esteem. That may or may not have been the case, but regardless, that is how I perceive it and that’s what affects me now. Because I feel that I’ve never had their approval, my sense of self-esteem is closely tied to how my peers and superiors (academic, mostly so far; or work superiors) perceive me. (I touched upon this aspect in my previous blog post on depression when I talked about a need for seeking attention.) The mechanism of how this works and how uneven attention from parents can affect children is largely held by the psychological community these days to be explained by “attachment theory“, that a child needs to feel attached to a caregiver for social and emotional development to happen.
I was made to realise this by my counsellor, that due to how I grew up, I have a fundamentally broken mental model of what love (not necessarily romantic), empathy, caring about others et al is all about. I consistently face pressure that I need to stand out in some way – whether it be by being good at something (or believing that I’m good at something) or being otherwise outrageous. At its very basic, it’s attention-seeking. The clash between the private and public egos results in behaviours such as defense mechanisms for anything that I see as an attack on me; it’s a question of whether I perceive it as an attack on me rather than whether it was intended that way. What I didn’t even realise is that I was often hurting people close to me because of my behaviour. I am positively obsessed with power and being in control. I get jealous of any perceived shifts in attention incredibly quickly, almost as knee-jerk reaction – and my instinctive response is tit-for-tat, albeit passive-aggressively. And – as much as pains me now to admit this, or how hurtful this may come across as to my friends, because now I know better – I often looked people around me as “toys” who only had my interest as long as I found them interesting or exciting; as interchangeable units for my narcissistic supply. (This was a two-way street, however, as I also considered that other people saw me as an interchangeable unit; basically, that no human being was truly interested in anyone else.) I derived pleasure out of tearing other people down because it made me feel better about myself and I thought that’s how the world works. When I had conversations – and I sometimes feel this way, still – I got the sense that I often wasn’t really listening, just using it as means to an end to get myself heard.
I carried on the emotional responses that I built up as a child who felt his sense of self-esteem and ego so horribly mangled later into life. Intellectually, understand what the concepts of “empathy” or “listening” or “friendship” or “love”, for instance, are; intuitively, I don’t. It’s the difference between being nice and wearing a nice sweater that I once spoke about. I’m not socially inept, because I can grasp how I should act or what I should say in social situations. I would go so far as to say that since I saw I friends as my source of narcissistic supply, since I was power-hungry, since I was emotionally disengaged, and I understood this socially, I could be deliberately manipulative. I’m not saying every interaction was motivated by that or that I didn’t genuinely feel the way I acted in all situations, but I may have done so on specific occasions, and frequently as a habit.
What I’m left dealing with is the fallout of those feelings and the realisation, now, that I am that person. Guilt. Guilt about the fact that is the person who I was, and perhaps, still am because maybe I don’t even recognise when I behave in such a manner. Soul-crushing guilt and self-loathing when I catch myself these days doing any of the things that I mentioned above and how horrible a person that makes me. Paranoia. Paranoia, partly due to depression and partly due to my underlying insecure self-esteem, that people don’t really like me. Aside from anything else, I’m an incredibly needy person and when I get an impression that I’m not getting someone’s attention, it makes me think that they don’t really like me. Fundamentally, I have massive trust issues with allowing myself to get close to people. I build a wall around my emotions and I (unfairly?) expect other people to trust me before I reciprocate. (Perhaps similar to what many people would feel like, except in my case this in conjunction with other behavioural responses that I have built up.) Doubt. Doubt about whether I actually, truly care about others. How do I know whether I truly care for or like someone when I don’t know whether I’m actually feeling something or whether I’m simply intellectualising it, when I have no baseline to compare it to? What do I do on being told that the core of my self-identity, my understanding of myself and the people around me is flawed? My brain simply goes into fritz-mode trying to figure out where I and my interpersonal relationships stand in this regard.
The goal of modern medical science is to stabilise a patient in the short-term using drugs, and to use talking therapy in conjunction with that for longer term stability. Talking therapy can come in many forms – some still stick to the older school of psychoanalysis – but the consensus these days is to stick a technique called cognitive behavioural therapy (CBT). The basic aim of CBT is to identify specific problems – perhaps more importantly to help the patient independently be aware of them, not just in the setting of a counselling session – and then formulating actionable strategies to change that behaviour. I made a comparison to mental health treatment being run akin to a battery chicken farm. The demand for psychological help these days is so high that CBT for depression has been standardised for recurring themes among depressives that it can be administered in through software.
In my case, I feel CBT both helps me and holds me back in tackling my issues. My behavioural and emotional responses, instinctively, are so warped that I need to run it through the filter of CBT to consciously check whether what I’m doing is right, and if not, correct my response. Yet, at the same time, when a core part of my self-doubt is whether I’m actually experiencing those emotions as opposed to just rationalising them, it adds to that sense of unease. Running everything through a filter makes me die a little on the inside as I wonder whether I’m better off being less spontaneous than earlier; a constant reminder of the guilt about the person I was / am. Every time the filter of CBT catches something, I tell myself that I do indeed need this and that I’m probably better off for it. Probably…
Part of therapy for me is to reconcile the concept of private and public self-image into a single consistent identity. I’m well on-board with accepting I need to do this. What I am still trying to come to terms with is how in the short-term it has made me far more insecure. Since I’m trying to actively restrain myself from avenues to feed my ego, it amplifies my underlying low self-esteem. What’s more, evaluating positive feedback through CBT makes me wary of accepting it, as it may feed my ego, I find myself increasingly paranoid about whether anyone cares for me or loves me. I’m now scared to take any signs of people taking an interest in me as them liking me.
Here’s where I have found Zen to be liberating. I know I bang on about it like an evangelical Christian, but it’s true that it has had a positive effect on me. I loved the idea of loving Zen before I actually loved Zen. It gives me the strength to believe that I cannot intellectualise, I cannot rationalise, I cannot read it in a book or hear it in a sermon…all without imposing a set of commandments or (what I consider, as an atheist) ridiculous artificial constructs of a judgemental old bearded guy sitting on a cloud. Concepts such as mindfulness and deep listening – how to truly let go and just listen to another person, and do it selflessly – are teaching me what empathy is about. It’s made me comfortable with the fact that I cannot change myself by wanting to change myself, for that in itself is being slave to a desire. Zen places supreme importance on effortlessness and instinct – which is what I feel I need to truly grasp solutions to my issues.
When people say that mental illnesses such as depression are “#firstworldproblems“, that, say, there are so many “disadvantaged people in Africa” and that I should be thankful for what I have (or anything along those lines), it really pisses me off. I see it as an apples-to-oranges comparison. The first issue is that having grown up in India, I am acutely aware of the fact that how low the awareness is about mental health issues and how terrible the support systems are. Even during my study exchange year in Singapore – a supposedly modern, “Westernised” Asian country – I found that the attitude of many people was shockingly backwards. (For what it’s worth, medical facilities and insurance coverage for them in Singapore is incredibly good.)
There’s a theory in psychology known as Maslow’s hierarchy of needs. While it has now been superseded by other theories of explaining the human psyche, it still bears worth noting. What Maslow proposed is that humans have a pyramidal hierarchy of needs that need to be fulfilled for happy life. Lower down the ladder come basic needs such as food, water, shelter – and only once basic needs are satisfied does it free people to think about more cerebral topics such as sociological factors, the “meaning of life”, so to speak. The criticism surrounding this theory mostly stems from the ranking of these factors, and whether these would vary depending on the kind of society a person is raised in.
Nevertheless, in my opinion, I do feel that people have an internal model of what their priorities are and some needs are more important than others. Modern-day societies in developed countries (and the well-off in developing countries) make it relatively easy for the tangible, physical human needs to be fulfilled, which frees up time to think about other, intangible things. The sociological factors that contribute to stress are vastly different, even though in comparison to “disadvantaged” populations these stress factors may sound like whining. Regardless of whether you feel this a problem or not, the fact is that for people suffering from mental illnesses, the issues that prevent them from living a happy and enjoyable life – however trivial they may seem to an external viewer – are very real to them. I’m reminded of a curiously specific psychological disorder that has been observed by sociologists only in Africa known as “penis snatching“, where a patient believes their penis has been stolen. You may wonder how a person can ignore visual evidence to the contrary of a physical part of their body missing but the only thing that matters is that it feels real to a patient.
There’s a tremendous importance attached to individualistic achievement in modern society (as opposed to collectivist societies in the past), to the point this is closely tied to the sense of self-worth for many people. No wonder that incidences of mental illnesses is on the rise – both because the factors contributing to it are higher and also because there is greater recognition this is a valid ailment that can affect people. Reminiscing about the “good ol’ days” isn’t going to help, realistically; this is what our society is now and we have to find the best way to handle issues arising out of it.
This brings me back to the why I wrote this blog post. The things that I have written about here are facts that precious few of my friends know about – indeed, some will come as a surprise even to them. And for the friends whom I don’t talk to about my issues, it will perhaps come as a surprise, say, that I have mental health issues or inflict self-harm because I’m wary of outwardly displaying the fact that I have these problems. I don’t have much sympathy for people who simply give up; part of getting better has to be a desire to want to get better. Social contact is very helpful: I need to constantly remind myself to get out of the house and meet friends, not necessarily to drone on about my problems but just to be in the company of those closest to me. Even then, say, after deciding to meet up with someone, I may be too washed over by soul-crushing hopelessness to summon up the strength to get out of bed to go meet them – the temptation to just bail on them is often great – but I have to remind myself that unless I do this, I won’t be getting better or doing myself any favours.
To talk about this publicly was hard, incredibly hard for me. As I said earlier, I have massive issues with trust, paranoia, and doubt – especially when I’m not clear about them in my own head. Do I think that someone who has read this will be paranoid themselves that I may be faking caring for them or being manipulative, or generally, whether I’m just faking being happy when going through depression? I don’t know the answer to that. I genuinely don’t want to be that person and I’m try my best not to be. But I’m also aware that my instinctive emotional responses are not going to change overnight – although by this point it has been months since I’ve working away at changing this. I count myself incredibly lucky to have friends who’ve stuck with me and care for me despite everything. I’ve also been blown away by the amount of support I have received from my university in helping me deal with my issues, it makes me feel that there’s at least some people in a position of authority who do care about my well-being.
I’m taking a page out of Paul Carr‘s book – literally – as he’s one my favourite authors and role models in life, who had an alcoholism problem that he dealt with by quitting publicly through the website ispauldrinkingagain.com. To quote:
When I decided to stop, I wrote an open letter on my blog, explaining that I had a serious problem with alcohol and asking for the support of those around me. Posting on Facebook or Twitter for just your friends would work just as well. If you’re worried about your professional reputation if you “come out” as an addict, you might want to consider sending a group email to a dozen or so people you trust. Believe me, word will get around. The key is for people you encounter on a day-to-day basis to be aware that you have a problem and are trying to fix it. Those people are the ones who will be your greatest allies in quitting.
By doing this, I hope to hold myself responsible publicly, in case I ever slip-up. I know my private / public egos aren’t going to vanish into thin air, but I can use those very traits to constantly remind myself that people are possibly aware of the problems I have and I cannot hide in the anonymity of knowing I can get away with it. I’ve had this duality of friends who knew / friends who didn’t, and that itself, I think – maintaining a public self-image and a more private, closed-off self-image was hurting me. While I have been relatively successful from letting my problems affect me in work or academic life, I get the feeling that when it comes to friendships and relationships I have let my struggle come to define me – and I don’t want it be that way.
What I have also realised over the past year or so is that there’s an immense amount of stigma surrounding mental illnesses. Friends that I know who also suffer from various mental disorders feel ashamed or paranoid of discussing what they are going through because they are worried about people being judgemental. And you know what? I’m tired of hiding. I’m tired of feeling ashamed, feeling that there’s a defect in me. I’ve gradually gotten more comfortable with talking about the issues that I’m going through, and I feel that the more openly that people talk about such issues – even potentially embarrassing ones – the better off everyone will be. I enjoy writing and instead of letting all these thoughts stew in my head, the process of writing all this down has helped me think clearer about where I stand on my dealing with the issues I have.
I get the sense that friends who haven’t faced mental health issues or not known anyone who’s had one also find it hard, understandably, to wrap their heads around what it is like to go through it. Depression is far more common than you’d think; within my friend circle, I’ve been surprised by the number who have somehow been affected in their lives by it. It’s hard for people to get how it can be difficult to find the motivation to get out of bed, to eat, to socialise. Talking through the process of how depression, self-harm, and my personality disorder issues affect me on a day-to-day basis – if you’ve stuck with reading it this far! – will perhaps give people reading this an insight into what it’s like.
And if you have a friend or someone close to you who’s facing mental health issues, here’s my advice: don’t give them advice. You don’t have to nor should you need to feel compelled to. That is a job for certified medical professionals to determine what their issues are and how to best deal with them. Mental health issues are unlike everyday problems that you may discuss with others about, since depressives have a fundamentally different way of processing the world around them. What you can do is just listen to them and make them feel comfortable enough to do so since it can be incredibly tough for someone to open up. That itself can be unimaginably therapeutic, for someone with depression to know that they have friends willing to listen to them. Depression makes you feel so hopeless that they may not even make the effort to talk to you about it, so you often have to draw them out.
Sometimes, a throwaway “How are you doing?” comment reminds depressives that they have people who care for them and that they have things in life to live for. Emotional support can be as simple as that.
The last time I had a haircut was back in February. Since then I have cycled through various iterations of dyed hair: ginger, blonde, grey, blackish-blonde, reddish-black. I simply love the attention that I get from dyeing my hair after each episode – and from the general perception that people who know me get from it that I do “crazy, spontaneous things”. The truth is that it helps my self-image a lot to be perceived as outré.
I have a weird relationship with my self-image. I meticulously cultivate a persona that ensures that I get attention from others. I do genuinely like having a different taste in culture, although I do wonder whether at some point this has become a self-fulfilling prophecy. (I like different things because I like being different?) I go through intense phases of self-loathing despite outwardly denying this ever happens. There are times when I feel intense hatred towards my parents for what I feel was a lackadaisical attitude in parenting in my childhood, sometimes I feel indifferent towards them, and yet other times I feel a needy yearning for their approval. My relationship with my parents is another one of those things I am incredibly uncomfortable with because I don’t know myself where I stand. When I said in my last post that I could not decide whether to fly to India or not, this was partly the reason: I wasn’t sure whether I was ready to face my internal demons on where I really stand with respect to my parents. (I took the decision to solider on.)
Thus far I have shied away from ever mentioning this publicly, but you know what, fuck it: I suffer from depression. It’s become a fact-of-life that I have struggled with for years, along with associated problems such as behavioural and eating disorders. I consider cognitive behavioural therapy to be “for losers”, even though I rely on it – and medication – massively as a crutch to remain a functioning individual. I loathe how being on medication appears to make my emotions ‘flatline’ while generally keeping my mood stable in a way that I cannot without their help. Most of all, I hate the side effects that come with taking antidepressants – which have been various depending on the specific antidepressant that I’m on at any given time.
What has been hardest is that I’ve never let on that I suffer from depression, except to a handful of friends; although of late I’ve let more and more friends in on this ‘secret’. Acknowledging what I see as a ‘defect’ in myself simply did not sit well with my curated ‘public’ persona. My biggest worry with telling anyone about this has been that I don’t want to be pitied and, well, when I do tell friends what are they going to do about it anyway? Depression is, ultimately, a problem that I need to deal with myself. Still, I’m grateful for friends who over the years have lent an ear to me in my darkest hours.
The past few months have been incredibly harsh as I went through a major depressive episode. What really freaked me out is during this time I had thoughts of self-harm – and I usually haven’t been that ‘bad’ to have thoughts of harming myself or others. This was driven less by self-loathing and more by a lack of any kind of feeling during this phase, to the extent that I wanted to hurt myself just to experience ‘something’. One of the reasons why I started letting more friends know what I was going through is because I was incredibly scared of losing grip and actually doing something stupid. I put on a brave face regardless because I didn’t want my friends worrying about me, but it was nice to know that there were people who went out of their way to simply meet up with me and chat about what I was going through (and what was going on in their life).
Part of this self-image cultivation is my online identity. It crept up in a way that I didn’t even notice. I was timing posts on Twitter or Facebook so that I knew they got maximum exposure: craving for retweets, likes, and shares consumed me and I when I got them, I genuinely got a kick out of it (no matter how much I denied it). That’s what I was on about when I wanted to disconnect during my trip to Turkey.
Thus the cycle continues. I feel smug about how self-aware I am, feel smug about recognising my own feeling-smugness-of-my-self-awareness and so on as I take one step forward two steps backward on what I keep thinking is a path towards self-actualisation and personal epiphany. For all the noise that I make about changing as a person, I don’t know how much of it is just that – noise – and how much I’ve really changed.
My takeaway from being more open about what I’m going through has taught me one thing: that a lot more people than you think suffer from mental illnesses, from personal experiences that I found out when I told my own experiences. Am I wrong to feel somewhat comforted by this fact? I don’t know. What I do know is that mental illnesses are still an awkward topic, and there are people who look at you weirdly for it…but equally there are also a lot of people who are very supportive about. Still, the anxiety of not know which of these two camps someone falls in and the ‘shame’ of admitting a ‘defect’ in yourself are what makes it hard to be forthcoming about this.
When I started writing this blog post, I didn’t mean to be this candid. My initial draft was vague – my usual bullshit – but the more I thought of it, the less I was arsed about gently skirting around the issue. It feels cathartic to get this out – for better or worse.
I have considered myself to be a radical atheist for a long time. I started off with wishy-washy agnosticism because much of the worship done in my Hindu family didn’t make sense to me. What took me over the edge is the example of people such as Douglas Adams, Richard Dawkins, and Christopher Hitchens whom I look up to as idols. (The irony of using the word ‘idols’ in a discussion about atheism is not lost on me.) Dawkins’ The God Delusion truly cemented my belief – or should I say the lack thereof – in a higher deity.
Around the time I read The God Delusion, I read many religious texts and books on religion. Despite my then firmly cemented ‘belief’ in atheism, Zen Buddhism stood out for me because it appeared to me to be more of a philosophy rather than a religion. My appreciation of Zen in the beginning was primary from a literary standpoint (much like my appreciation of other Japanese literary forms). I loved how esoteric Zen koans were. How quaint!
Yet, I held back from seriously looking into Buddhism because my impression of it was spoiled by whatever little exposure I had to it within India or at school. The school of Buddhism that I was exposed to is known as Hinayana, which is rigidly structured as an old-school religion with rituals, idol worship, saints, et al – everything that I despise about religion in general. This impression was not improved during my travels around South-East Asia either, as the countries there primarily practice schools of Buddhism descended from Hinayana. While I acknowledged there were certain aspects of even this form of Buddhism that I found appealing, the negatives far outweighed the positives.
I took a closer look at religion during this year’s major depressive episode. (Yes, I really was that desperate.) What I discovered is that there is another major school of Buddhism called Mahayana that has significantly different attitudes towards ritual, i.e., many sects within this school do not indulge in the very things that had previously turned me off from Buddhism. Through a colleague I knew at my industrial placement year, I had heard of Sokka Gakai – a school that practices Nichiren Buddhism. I had misgivings about this because their Wikipedia entry painted them as a particularly radical sect which believed every other sect of Buddhism was wrong, a stand that I found laughable for a ‘compassionate’ religion like Buddhism to take.
The fundamental belief of Nichiren Buddhism is that every Buddhist text other than the Lotus Sutra is invalid. They express this faith in the Lotus Sutra by chanting a phrase – “Nam myoho renge kyo“ (which roughly translates to “I dedicate my life to the Lotus Sutra”) – over and over.
I planned to simply walk away from Sokka Gakai, because it just wasn’t for me. But the person who introduced me to the group – a lecturer at my university, actually – was such a nice person that I wanted to meet with him in person to tell him that it wasn’t for me. That was all I planned to say, but in that meeting I found myself being far more candid about how the rational part of me simply didn’t accept a practice such as theirs.
He advised me read a book which had helped him overcome his own doubts when he started chanting: The Buddha In Daily Life by Richard Causton. Again, I was sceptical whether this would help at all due to reservations I had against Nichiren Buddhism’s basic premise. I gave the book a try anyway, expecting that I would quickly find it to be something that I wouldn’t want to waste time on.
I was surprised to find that I quite enjoyed the book. Yes, it’s primarily about Nichiren Buddhism; yes, it is peppered throughout with references to nam myoho renge kyo; yes, I still did not agree with that part. What really stood out for me though is the first section of the book which is about Buddhist philosophy in general – and to date I haven’t read any book or come across any resource which explains this in a no-nonsense, pragmatic way like it does. The book first dispels commonly held impressions that people have about Buddhist concepts such as karma, reincarnation, nirvana et al are ‘supernatural’ in any way. Causton acknowledges that much of the core message of Buddhism has been lost into rituals and supernatural stories, because early forms of Buddhism used these as a method to ‘ease’ followers of Hinduism and other stricter religions into the concepts of Buddhism. He also reconciled scientific beliefs with concepts of Buddhism. Stripped down to its core concepts, Buddhism is a philosophy and a way of understanding the human psyche.
I still didn’t agree with the latter half of the book, which then goes on in a repetitive drone about how chanting their mantra is The One and The Only Way. However, the core concepts of Buddhism are so lucidly explained by Causton that when I revisited books on Zen (such as Zen Mind, Beginner’s Mind by Shunryu Suzuki and The Heart of Buddha’s Teaching by Thich Nhat Hanh; I’m also currently reading The Way of Zen by Alan Watts) everything made so much more sense. The problem with these books on Zen – and Zen in general – is that they either throw a lot of righteous-sounding terms at you and/or are written in an obscure manner which can be quite daunting for a beginner. In a way this is to be expected, as Zen places a huge emphasis on direct teacher-to-student transmission, eschewing the written word. Still, once I had read the interpretation from Causton’s book, everything made so much sense. You know that moment when things just click and everything falls into place in your head? I had one of those moments.
I’ve started reading a lot more about Zen, and reading it more seriously. Zen Buddhism has helped me make an uneasy peace with this internal strife I have with my self-image. What I like about Zen is that it is so pure and abstract to the point that it’s just a philosophy and not a religion – a point that many Zen masters take an effort to stress. Much of its focus is on zazen (mindful sitting meditation) as a way of getting in touch with your “inner self”. Zen is very much about finding answers within yourself, living in the moment, and being comfortable with who you are.
I won’t lie: zazen is hard. Very hard. Sitting meditation – “just sit” – without doing anything else is such an anathema for anyone brought up with Western cultural values of rationalism that it feels like a waste of time. At first. I found myself saying that “Oh, I don’t have time for this” even to meditate for a couple of minutes a day.
Slowly, though, it has started making sense. I joined a meditation group that meets in our university called New Buddha Way. While this group doesn’t subscribe to any particular school of Buddhism, roughly it is aligned with Mahayana concepts. Getting into a weekly schedule by going for these meetings helped into getting on with a routine for meditating.
The deeper that I study Zen, the more convinced I am about this as a philosophy for life – primarily because it’s so open-ended and abstract. It’s hard to get a hang of but once you ‘get’ it, Zen feels incredibly refreshing. More importantly, it co-exists happily with my belief as a ‘radical atheist’. My advice to anyone to wants to take the plunge? Read Causton’s The Buddha In Daily Life first, but ignore the bits about Nichiren Buddhism. Then, read a book from any of the Zen masters mentioned in this list of beginners’ Zen books.
When my mom asked me to get a haircut when I came back to Delhi, my first reaction was that I didn’t want to do it. I didn’t want to do it because much of my reddish-dyed hair were the tips / fringes, which had previously been blonde and thus retained the dye the most. Getting a haircut would mean much of what would be left behind would be my natural hair colour (black). I hated the prospect of losing a talking point among friends whom I’d inevitably meet on this trip.
I stumbled upon that barber shop quite serendipitously while on a quick trip to one of the local markets for some stationery. It was one of those old-school barber shops you find all across India. A slim, gaudily-painted door proclaimed they served “ladies and gentlemen” customers.
It looked just like my memories from childhood. The floor was littered with yet-unswept swathes of cut hair. There was a tattered cushioned bench on which a guy was waiting – probably for his turn – next to a stack of well-thumbed and newspapers and dog-eared magazines. The newspapers are invariably one of the Hindi language dailies – Hindustan, or Navbharat Times, or Dainik Jagran – and the magazines are invariably one of the Bollywood gossip mags – Filmfare, or Stardust. There was a small CRT television on a stand in near the ceiling in a corner playing a C-grade Bollywood film…the barbers in presence had one eye on the TV, and another on the task at hand. The air smelled of cheap shaving cream and talcum powder. And the walls were a weird hue of blue (just like in the picture below!).
Much of the upper-and-middle-class clientèle – in which I should count myself – migrated away to ‘classier’ barber shops that sprung up as vast sections of Indian economy moved up the ladder in the late 90s. I took a snap decision to get a haircut at this particular shop I was in. I wanted to relive that experience from childhood, self-image considerations be damned. And, just as I’d expected, I got a head massage when my barber was done. (It’s not as dirty as it sounds. Honestly. Look, just watch this ad…about 1:30 in.) You simply won’t find the same experience anywhere else other than India. That was 50 rupees well-spent – and I didn’t mind losing my dyed hair.
I realise that the link between this section and the previous ones is tenuous at best. My point is that I’m typically a person who obsesses about my personality and body image, how others perceive me, and what impact that has on my self-esteem. Through Zen, I have slowly – albeit tetchily – learned to let myself go and ‘be’. I am usually one ‘persona’ in public, and an almost-different person in private. Over time, I found these two identities to be increasingly at odds with each other as I tried to cope with depression and other behavioural / mental health issues. Perhaps because of what I see as a neglect towards my state-of-affairs from my parents I crave for attention from my peers instead. Perhaps my ‘issues’ are something else altogether and I don’t realise that.
This state of ‘being’ is something incredibly alien to me…that I still find myself fighting it. There are times when I find Zen incredibly stupid…and yet I’ve found myself grasping back at it as a way out of my cycle of medication and therapy. What I’ve realised is that change doesn’t come from wanting to change. As Zen teaches, it is less about seeking something and more about being more comfortable with who you are, understanding yourself better.
I don’t know whether Zen is finally this something that will help me long-term in being a more emotionally stable person – but I sure fucking hope it does.