Switching off Jeremy Kyle was probably as decisive a statement as anything I had managed thus far. More to the point, it was a tacit recognition that his sanctimonious custodianship of this toxic cockpit of raw emotion was not where I wanted to be.
But I’m thankful – truly I am – for Mr Kyle’s show in one respect. It defined one end of the scale. Rock bottom. Absolute zero. Nobody will ever make a television programme worse than this. But how do you leave rock bottom? How do you climb back into the light? When apathy has, for months, been in the ascendant, how do you break its malign grip?
Lewis Wolpert, emeritus professor of biology at University College London, wrote one of the best tracts on depression I know. Malignant sadness: the anatomy of depression, published in 1999, talks in depth about the complex emotional landscape of depression. Perhaps the defining leitmotif of his book is the sense of shame, the sense that somehow one is weak, lacking in some vital component of one’s psyche. And he lays bare the shame when he talks of his grief at his wife’s death going on to say that depression was worse.
Let me say immediately that my depression was nowhere near that of his malignant sadness. I call it depression because, on self-diagnosis, it met the clinical criteria with a MADRS of 19 and a Ham-D score of 14. Depression is a range of depth, from mild apathy and anhedonia through to an all-consuming sense of worthlessness. I was very much in the shallows of depression rather than its black depths, where the wild things are. But it gave me a glimpse of what kind of place that was, and where that whirlpool of my darkest imaginings could take me.
There are of course different ways of looking at things. And I won’t insult your intelligence with the trite glass-half-full-half-empty metaphor. But the way in which we recognise depression has significant bearing on how we choose to address it. If we ascribe greater intensity to our experience than is the case, we medicalise the experience immediately – it calls for drugs. If on the other hand we play down what our bodies are telling us, we may underestimate its consequences.
My background is in neuropharmacology, the action of drugs on the brain. For many years I headed a team looking at neuropsychopharmacological aspects of brain function. I can even remember some of it!
I should nail my colours to the mast right here. There are plenty of people who see antidepressants as part of a grand conspiracy theory by the drug companies to sell us medicines at whatever cost. I do not see it that way. My view is much more simplistic. I see depression as a neurochemical imbalance, in the same way that diabetes is a neurohormonal imbalance. It is only our stigmatisation of the one but not the other that allows people to draw such fanciful conclusions. If we stigmatise depression and further stigmatise antidepressants, we do a great disservice to those who experience depression and struggle with the choices they make.
Don’t get me wrong. I am as critical of the pharmaceutical industry and its motivations as anyone. And that is probably a subject for another day.
So my first decision – well, second after switching off Jeremy Kyle – was to decide whether I needed medication. And you may be surprised to hear, especially after the above, that I chose not to seek medication. And that decision was taken not because of any inherent reticence over drugs but simply a desire to see what could be achieved without.
So, no drugs. Where do we go from here?
[to be continued]