DOROTHY ROWE

BREAKING THE BONDS

Understanding Depression, Finding Freedom

Copyright

HarperCollinsPublishers Ltd. 1 London Bridge Street London SE1 9GF

www.harpercollins.co.uk

Published by HarperPress 2006

Previously published in paperback by HarperCollins 1994

Reprinted eleven times

Previously published in paperback by Fontana 1991

Reprinted two times

First published in Great Britain as The Depression Handbook by HarperCollinsPublishers 1991

Copyright © Dorothy Rowe 1991

The Author asserts the moral right to be identified as the author of this work

A catalogue record for this book is available from the British Library

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Source ISBN: 9780006375654

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Praise

Praise for Dorothy Rowe:

‘Dr Dorothy Rowe, seer, has qualities which to my mind place her somewhere between sainthood and genius’

FAY WELDON

‘Dorothy Rowe’s books are exceptional. Rowe has not just got common sense but wisdom and real writing gifts. It’s pleasurable to read her blend of quoted poetry, proper and powerful prose and good jokes’

Observer

‘You can’t go to a party without meeting at least two people whose lives have been changed by Dorothy Rowe’

LINDA GRANT

‘Dorothy Rowe stands out among psychologists for her clear insight into human experience: her writing is refreshingly free from dubious theoretical constructs and jargon’

Independent

Dedication

To Diana, Ron and Ed

Contents

Cover

Title Page

Copyright

Praise

Dedication

Preface: How to Use This Book

I The Meaning of Depression

1 An Ordinary Story

2 Depression – the Painful Isolation

3 Our Greatest Fear

Finding the Source of Our Greatest Fear

Extraverts and Introverts

Why We Need to Know Ourselves

4 Believing That We Are Not Good Enough

Drawing the Conclusion ‘I Am Bad’

Saving Our Self

Becoming An Expert in Feeling Guilty

Compensations for Believing ‘I Am Bad’

Living Our Story

5 Constructing Our Prison of Depression

How Thoughts and Images Create a Prison

How Pat Built her Prison of Depression

The Recipe for Depression

How the Six Beliefs Fit Together

II Why Is It So Hard To Change?

6 Fearing Change

7 Wanting Certainty

8 Pride

9 Taking Things Personally

10 Hanging On to Hopes

11 Other People

Ourselves and Society

Families Against Change

Partners and Power

III The Journey Out of the Prison of Depression

12 The Expert’s Secret

13 Fitting Yourself for the Journey

14 Suicide Is Not a Solution

15 What You Need to Find Along the Way

Labelling Emotions Correctly

Finding Forgiveness

The Consequences of Striving to Be Good

The World Is Neither Just Nor Unjust

Our Helplessness Is the Source of Our Strength

Changing Our Relationships with Other People

16 Leaving Loneliness Behind

Our Rules about Our Relationships

Our Beliefs about Relationships

Our Skills in Our Relationships

Our Emotions in Our Relationships

Dismantling the Barrier

Twelve Decisions

17 Helping One Another

18 Trying Something New

19 Journey’s End

IV Discoveries

20 Discoveries

Discoveries

V Technical Footnotes

21 Is Depression a Physical Illness?

The History of Depression

The Classification of Depression

What Psychiatrists Say Publicly

What Psychiatrists Say Privately

Why Psychiatrists Insist that Depression Is a Physical Illness

Why Psychologists Insist that Depression Is a Physical Illness

The Cause and Outcome of Cancer and Heart Disease

How Important Is Thinking?

What it Means to Be Told That You Have a Genetic Illness

Understanding Why

22 Drugs – Friend or Foe?

23 Choosing a Therapist

Different Kinds of Therapy

Kinds of Therapists

24 Technical Terms – Keys to the Jargon

Keep Reading

References

Index

Acknowledgements

About the Author

Also by the Author

About the Publisher

Preface How to Use This Book

‘I would rather have a physical illness – any physical illness – rather than be depressed. Depression is the worst experience a person can have.’

Anyone who knows what it is to be depressed would agree. It is not just that being depressed means feeling despairing, frightened, guilty, bitter, helpless, tired and ill. It is the most terrible sense of being trapped and alone in some horror-filled prison.

When we have a physical illness or have been injured, we can feel immersed in the pain and discomfort, but, equally, we can separate ourselves from that pain and discomfort. We can talk to other people, share a joke, take an interest in what they are doing, watch television, read a book, plan our future, and when someone shows us love, comfort and support we can feel warmed, cheered and supported, and give back in return our love and gratitude.

When we are depressed we can do none of these things. We are surrounded totally by the prison of depression. We cannot escape, even momentarily. Occasionally we can act normally. We can answer a telephone, or chat briefly to friends. We might feel slightly better in the evening or when we are at work, but all the time we know that the prison has not gone away, just eased its grip on us a little. Even when a course of antidepressant drugs (psychiatric, medical and psychological terms are explained in the section Technical Terms) or a series of ECT (electroconvulsive therapy) has made us feel more able to face life, we know that the prison is still hovering there in the background, waiting. One false word or action, one crisis, and its jaws will snap around us again, and we shall be trapped and helpless.

Inside the prison we are cut off from every other person. We know that we are physically with other people, but what we actually experience is a barrier between them and us. They offer us love, comfort and support, but nothing crosses the barrier to warm, cheer and support us.

Nor do we think it should. We know that we are wicked and do not deserve what people offer us. What we do deserve is this terrible, hateful prison.

Inside that prison our thoughts are not the thoughts that usually accompany pain (usually ‘Ow!’ and ‘Help!’) and discomfort (usually ‘Yuk!’, ‘Groan!’ and ‘Help!’). Our thoughts are concerned with universal moral issues expressed in a personal way, variations of, ‘I ought to have been a better person’: ‘I ought to have done more for other people’, ‘If I had been a better person I would not have been abandoned and betrayed’, ‘I must be wicked, otherwise these disasters would not have happened to me’, ‘I have obligations which I cannot meet’, I have made unforgivable mistakes’, ‘I cannot forgive myself for what I have done’, ‘No one, not even God, could forgive me for what I have done’. With these feelings come the helpless, hopeless feelings of dread.

Inside the prison of depression we cannot escape from the turmoil of these moral issues, for everyone we meet, every newspaper story and television scene, reminds us of our unmet obligations, our unfulfilled duties, our inadequacy and sense of intrinsic evil. We cannot endure this isolation, but we fear other people, and feel that, we must shut ourselves away. We long for death, but fear the aloneness of death and the punishments which could lie beyond it.

Alone though we may feel in the prison of depression, we are not alone in enduring such an experience. Across the planet, many millions of people are trapped in the prison of depression.

If you are reading this book then it is likely to be for one or more of the following reasons:

You are depressed

or

Someone you care about is depressed

or

In your work you have to deal with people who are depressed.

In order to find out about depression you have, perhaps, read articles on depression in newspapers and magazines. You might have read about depression in psychiatric textbooks or in books written for the public by psychiatrists and psychologists. You might have consulted your doctor, or a psychiatrist, or some other professional person. You might have consulted your minister, or perhaps a spiritualist or a faith healer, or tried one of the alternative therapies like homoeopathy or acupuncture. You might have talked to a therapist or counsellor.

You might have been told a great many things about depression, but out of all these sources one message has been given to you loud and clear. ‘Depression is a genetic illness. It cannot be cured, but it can be controlled by drugs.’

This message seems simple, but in fact it leaves you even more confused and frightened.

Somehow, this explanation doesn’t seem right. You can see how bodily diseases like haemophilia and cystic fibrosis could be passed on by a gene, but how could depression – this confusion of feelings, beliefs, passions, fears, wishes, actions and non-actions-be caused by a gene? You have seen how people who have inherited some disease can, provided they care enough about themselves, have friends and family to support them, and get good medical advice, rise above their disease and get on with their lives, whereas it is not possible for you to separate yourself from your depression. It seems to inhabit your very person.

Moreover, depression might seem to be inside a person, but you know that it is also between people. If you are depressed, you know that it has something to do with the people in your life. If someone you love is depressed, you know that that person’s depression has something to do with other people, and you worry about what you might do – or refrain from doing – which would change how your loved one feels. If you are trying to understand why your clients or your colleagues are depressed, you get to know them, and you see the difficulties, losses and disappointments with which they are struggling. You know that depression does not occur, in the way that haemophilia or cystic fibrosis can, to an ordinary person leading a secure and happy life. When you look at all the depressed people you know, you can see that they have, over their lifetime, suffered many difficulties, losses and disappointments, that what success they have achieved has not always brought them happiness, and that when they achieve success and happiness, they cannot enjoy them, for they believe that they do not deserve such happiness and success, that happiness and success will soon be snatched from them, and that pain must follow joy as night the day.

How could a gene create all this?

Moreover, being told that all you are experiencing is nothing but the effect of a gene dismisses all you have experienced and know as being trivial and unimportant. It doesn’t just dismiss your experience and knowledge, it dismisses you. It says that you are nothing but a defective body, carrying a defective gene, passed on to you by an equally defective ancestor, and that you are likely to pass this gene on to your children. You cannot be cleansed of this gene, but must strive to keep it in check by a daily ingestion of drugs which affect the operation of your brain.

If you are depressed, such a diagnosis does nothing to help you, for it simply makes you feel even more intrinsically bad, useless and worthless. Such a diagnosis does nothing to help the relatives of a depressed person, or indeed, any one of us, for we can all worry that at any time we shall produce the depression handed on to us by some ancestor, or that we have already, unwittingly, passed this dread disease on to our children.

However, some of you in your search to learn about depression may have read something which many psychiatrists and psychologists fail to read, namely, the actual research reports by scientists working on the problem of the biological basis of depression. Perhaps you do read the monthly issues of the American Journal of Psychiatry and the British Journal of Psychiatry, or the heavy tomes of the American Psychiatric Review.

If you do, you will know that the sentence ‘Depression is a genetic illness’ is a statement of a wish, not a fact. A hundred years ago the German doctor Kraepelin attributed the behaviour of some of his patients to the illness ‘manic-depression’, and since then psychiatrists have been searching for the cause of this illness. They talk of the ‘gene for depression’ and the ‘gene for mania’, and some of them even say that such genes have been found. They talk, too, of ‘chemical imbalance’, and of physical tests for depression, and some say that the precise chemistry of the imbalance and the tests is known. However, what is described as fact is actually speculation. An enormous amount of research needs to be done before any genetic factor can be shown for certain to play a part in depression, and, from the results of the research, it seems that, if there is a genetic factor, it is one which requires the presence of many other factors – physical, psychological and social – for it to be activated.¹

One of the great difficulties of this research is that, even after a hundred years, psychiatrists still cannot agree on how many kinds of ‘depressive illnesses’ there are.² You will probably have come across terms like ‘clinical depression’, ‘endogenous depression’, ‘reactive depression’, ‘neurotic depression’, ‘bipolar and unipolar depression’, ‘major depressive episode’, and so on. If so, you are certain to be confused, particularly when you discover that different psychiatrists give different diagnoses. One might tell you that you are ‘clinically depressed’, another that you have ‘endogenous depression’, yet another that you have a ‘schizo-affective disorder’. What you are not told is that all these words are just labels used in an attempt to put the people who get depressed into different categories. However, it does seem that, while there are certain things that depressed people do have in common, each of us gets depressed in our own individual way.

If you have read the research literature, you will be saddened and worried to find that what researchers call ‘outcome studies’ show that depressed people treated only with drugs and electroconvulsive therapy do not do well. Most find that the depression recurs. Many remain depressed, but cease to seek any kind of professional help. Many die, not just by their own hand, but through illnesses. Being depressed is physically debilitating.³

This is very troubling, because while psychiatrists talk complacently of ‘managing depression’ by using long-term medication in the way that doctors ‘manage diabetes’ using long-term insulin injections, we know that a person with chronic diabetes can lead an ordinary life, but a person with chronic depression cannot. To be told that you have inherited depression in the way that another person has inherited diabetes is of no help at all. It just makes you more despairing and confused.

If you are a woman and are depressed, no doubt you have been told that it has been caused not just by a chemical imbalance but that this imbalance relates to the functioning of the feminine hormones. This is puzzling, because you can see how the malfunctioning of a hormone could lead you to think, ‘I feel sick’, but how can a hormone, however it functions, cause you to think, ‘I am a bad mother’? Nevertheless, many women discover that from puberty to after the menopause their own real, lived experience is dismissed with the words, ‘It’s your hormones, my dear’.

However, there is a genetic factor in depression. In that double helix of DNA there is a special strand which separates us from all other animals and marks us out as human beings. That special strand of genes not only determines our human shape, it gives us language, and with that the ability to conceive of the past and the future. Using these abilities we can look to the future with hope and courage, or fear and despair; we can remember the past in happiness or mourning, in gratitude or envy, in thankfulness or resentment. Using these abilities we conceive not just of ‘is’ but of ‘ought’, and create for ourselves two worlds of meaning – the world as it is and the world as it ought to be. Now we can trap ourselves in a tangle of ises and oughts. Now we can say to ourselves, ‘I do not accept myself as I am. I ought to be a better person’, and so lay the cornerstone of the prison of depression.

You might, in your search for an understanding of depression, have tried to make sense of it in terms of ises and oughts by reading books by cognitive or behavioural therapists. In many ways these books can be extremely helpful, for they can make you aware of how easy it is to think in extremes (like, ‘Nobody cares about me’, instead of, ‘Some people don’t care about me, but some do’), and they suggest some practical ways of re-organizing your life. But, when they tell you you are thinking and acting ‘irrationally’ or ‘dysfunctionally’, you can hear this as yet another put-down and feel that ever so familiar stab to the heart.⁴

Even if you can put this aside, you soon discover that these cognitive and behavioural therapists slide over, or ignore, the implacable truths and dilemmas of our lives. For instance, one such author chides his client for being so illogical as to say, ‘I’ll never find another friend like that again’, and asks her to estimate just how many people she could meet and how many of these could become friends. He ignores the fact that we do have relationships which are irreplaceable, like those with a parent who gave us unconditional love, or with someone with whom we shared the greatest joys and tragedies of our lives, and when such relationships end we can do nothing but mourn their loss. When we do suffer such losses what we need are not people who tell us to ‘look on the bright side’, but people who can acknowledge and share our pain.

Cognitive and behavioural therapists ignore, too, the major questions which face us all: ‘Why am I here?’, ‘What is the purpose of life?’, ‘What happens when I die?’ They assume that all of us are concerned solely with making the most of our lives, when in fact many of us are chiefly concerned with the question, ‘How can I be a good person?’

In your search for an understanding of depression, and in your concern about the great questions of life, you might have read some of the books on depression which give a religious or spiritual answer to the problem. Some of these books might just heighten your sense of badness and inadequacy, but others do offer consolation. However, most of them advise you to put your trust in God or some spiritual power, and this is precisely what a depressed person cannot do. When we have been repeatedly and deeply hurt by the people we trusted, we learn to be very careful about where we place our trust, and if we cannot trust the people whom we can see and know, how can we trust an unknown, unknowable God? Moreover, if you believe in God, then when you become depressed you find that God, like everyone else, seems far away, and, worse, the more you hate yourself, the more you feel that God will never forgive you.

Whenever we come across an author, or a therapist or counsellor, or a preacher who says to us, ‘Believe as I do and all will be well’, it is very tempting to say, ‘Right, I’ll do that’. However, we cannot change our beliefs about the purpose of life and the nature of death in the way we can our beliefs about the best breakfast cereal. Our beliefs about the purpose of life and the nature of death relate to our own inner truth, and even though we may hide or deny our own inner truth, it never disappears, and it speaks to us clearly. You will know this if ever you have been in analysis and your psychoanalyst has given an interpretation which your inner truth knows is wrong. The respectful, fee-paying part of you can be saying, ‘Yes, I see what you mean’, while your inner truth is saying, ‘No’.

This is where therapists can be dangerous. They can use their position, power and mystique to persuade us that what we know as truth is mere fantasy and that because we are anxious and depressed and having difficulty in coping with our lives we are intrinsically inadequate. If you have read any of the psychoanalytic texts on depression you will have discovered how little respect psychoanalysts have for a person’s own experience and how belittling to the client the psychoanalytic jargon is.

So, whatever you have done to try to discover what depression is and how you might bring it to an end, all that has happened is that you have become more and more confused, and when we are confused we feel powerless and helpless.

The aim of this book is to help you sort out your confusion and regain that which is rightly yours, the power to understand yourself and the society in which you live, so that you can make the best decisions about how you should live your life. With such power we can not only understand the causes and the purposes of depression but, more importantly, free ourselves from its prison and live life joyously, hopefully and freely.

To do this, we begin by understanding our own real, lived experience.

It is our own real, lived experience which leads us into the prison of depression. It is not a gene, or our hormones, or our dysfunctional and illogical thinking, our lack of faith, or our complexes and inadequacies which have brought depression upon us, it is what has happened to us and, most importantly, what we have made of what has happened to us; it is the conclusions we drew from our experience.

That set of conclusions which leads us, finally, into the prison of depression was not drawn illogically, or fantastically, or crazily, but were the correct conclusions to draw, given the information we had at the time.

If, when you were a child, all the adults whom you loved and trusted were telling you that you were bad and that if you didn’t mend your ways terrible things would happen to you, you wisely and correctly drew the conclusion that you were bad and had to work hard to be good. If, when you were a child, all the people you loved and trusted left you or disappointed or betrayed you, you wisely and correctly drew the conclusion that you must be wary of other people and that you should never love anyone completely ever again. You were not to know that if we grow up believing that we are intrinsically bad, and that other people are dangerous, we shall become increasingly isolated, the joy will disappear from our life, and that we shall fall into despair. Even if you did know that, you had to protect yourself. We all have to protect ourselves when we are in danger. The business of life is to live, and this is what we all try to do.

The reason we get into a tangle, be it by becoming depressed, or finding it hard to get on with other people, or any of the multitude of unhappy situations we can get into, is because we fail to go back and check whether the conclusions we drew as children still apply in our lives. We all fail to do this, simply because there is not enough time to be forever checking our conclusions. When we were children we drew the conclusion that we should not put our hand in a fire because fire burns. When we grow up we don’t every day say to ourselves, ‘I’ll just check whether it’s still not safe to touch a fire’. We simply go on acting as if fire will still burn us.

Similarly, many of us when we were children drew the wise and correct conclusion that we should not say what we think because the adults around us will punish us if we do. When we grow up we can fail to check this conclusion, and thus go on acting as if other people will punish us if we dare to say what we think. Never daring to say what you think leads inevitably to missing out on many things which would give you pleasure and confidence, and prevents you from discovering how joyous it is to share your thoughts and feelings with another person. As a child, your conclusion to keep your thoughts to yourself was a wise conclusion. As an adult, all you need to do is to check whether this conclusion still applies, or whether it can be modified – for instance, in conversations with your parents you might still need to be careful about what you say, but with close friends you can speak openly and freely.

What I have put in this book are the conclusions I have drawn from my experience of talking to people about themselves, and I keep checking these conclusions because I go on talking to people about themselves. So much of what people have talked to me about over the years has had to do with the problem of depression.

The problem of depression was first presented to me when I was a baby. I didn’t know it was depression. I just knew that sometimes my mother was loving and caring, sometimes she was silent and unreachable, and sometimes she was wildly, dangerously angry. It was not until I was in my thirties that I realized that my mother had been depressed for most of my childhood. By that time I was involved professionally with people who were depressed, for I was working in a psychiatric hospital in Sheffield, where there were many depressed patients and where the professor of psychiatry, Professor F. A. Jenner and his team were researching into the metabolic basis of depression.

Professor Jenner thought that there might be some interesting, though not important, psychological aspects of those patients whose mood changes seemed to follow some pattern, and suggested that I take this as the basis for my doctoral research.

So I began observing and talking to people who were sunk in depression or, less frequently, fiercely active in mania. I sat in case conferences, and in the staff dining room and lecture rooms, observing and listening to the psychiatrists, all of whom believed most firmly that depression and mania were physical illnesses. I read exhaustively every book and article I could find on depression and mania. Slowly I drew three conclusions from my experiences.

These were

1. From all the possible observations they could make about their patients, the psychiatrists selected a very narrow range of observations.

2. The scientific literature on depression, whether written by psychiatrists or psychoanalysts, described depression only from the point of view of the onlooker. Nowhere was what it feels like to be depressed actually described.

3. When depressed people talked about what it was like to be depressed, they described as central to the experience something which the psychiatrists and psychoanalysts completely ignored, namely, the strange but unmistakable sense of being isolated, of being trapped in some kind of prison whose walls were as strong as they were invisible.

The psychiatrists, I found, spent very little time actually talking to their patients, so there was a great deal about them they did not know. When they did talk to their patients, or about their patients, they were busy turning what the patient said into what the psychiatrists called the symptoms of depressive illness. If the patient said, ‘I no longer enjoy love making’, the psychiatrist marked this down as loss of libido’, and did not enquire as to whether the marriage itself had become flat, stale and unprofitable. If a patient with a deep religious faith said, ‘I feel that God will never forgive me’, the psychiatrist marked this down as ‘irrational guilt’, and did not enquire as to how central to the life of this person a belief in God was. If a patient said, ‘I feel I’m trapped in a sea of mud and the more I try to get out the more I get sucked down’, the psychiatrist marked this down as ‘lowered mood’, and made no attempt to understand just what the person was experiencing.

There is a good reason why psychiatrists, both then and now, do not enquire too carefully into what their patients think and feel. The reason is that people ruin theories. Psychiatrists and psychologists go to a great deal of trouble to create their theories about why people behave as they do and they want all people to fit these theories. We can make up all kinds of theories about people simply by making a few observations of what a few people do, and our theory can seem very good, but as soon as we make a few more observations, or, worse, ask people what they think, we find that our theory is ruined. People are so diverse they just don’t fit into theories.

Every time I run a workshop where I talk about my theories about why we behave as we do, people in the workshop are sure to say, ‘I’m not like that’, and ‘I don’t see it that way’. So I can understand why psychiatrists prefer not to put themselves into situations where their patients can challenge their theories.

It is not just that people are so individual that they don’t fit theories, it is also that each of us is so complex that no single label can ever describe us accurately. We are complex because we can always think, feel and believe two opposite things at one and the same time. Recently, one of my clients, a man in his thirties who had told me frequently and at some length how he was so timid and shy, how bad he was at his job, how he had got his qualifications only by the sheerest of chance, said to me, ‘I’m really very arrogant. I always believe I could do the job much better than the people I work for’. And so he is, both humble and arrogant.

I have found, as you must have too, that no matter how well you know a person, there is always something more to be discovered about that person. No one ever tells his life history completely; no one ever reveals all of his thoughts, feelings and desires; no one behaves in exactly the same way with each person he meets. No category can ever encapsulate an entire person, no theory can ever explain completely why any one of us behaves as we do.

Thus, to maintain their theories, psychiatrists have always had to avoid talking to their patients. This is why in psychiatric hospitals patients and staff are kept so separate. It is not simply, as so many patients have been led to believe, that patients are inferior creatures who could contaminate the sane and superior doctors and nurses.

However, by not talking to their patients psychiatrists have failed to learn from them just what the experience of depression actually is.

What the patients in Sheffield told me, and what depressed people have gone on telling me, is that being depressed is very different from being unhappy. When we are unhappy we still feel a connection to the rest of the world, but when we are depressed we are cut off, enclosed in a strange isolation. People describe this experience in vivid images: ‘I’m in a dark tunnel, and beyond the tunnel is another tunnel’, ‘I’m at the bottom of a black pit and no one can reach me’, ‘I’m stumbling lost in grey, swirling mist’, ‘I’m trapped beneath a dome of glass and the people outside appear like shadows’.

As the people in Sheffield and later in Lincolnshire were telling me this, they were also describing how their experiences had led them to draw conclusions which served to cut them off from other people, conclusions like, ‘I am bad and unacceptable’, ‘I must not forgive’, ‘I must not trust other people’. I described this research in my first book, The Experience of Depression.⁵

In my conversations with people who were depressed, we frequently talked of death, of the losses they had suffered and the fears they had about their own death. Talking about death meant talking about religious beliefs. I realized how important all this was, and I knew how psychiatrists and psychologists ignore the whole question of belief. So I wrote my next book. The Construction of Life and Death,⁶ where I described how the people who coped with their lives held beliefs which gave them courage and optimism, while those who did not cope held beliefs which made them frightened and pessimistic. For instance, among those people who believed in God, those who coped believed in a loving and benevolent God, while those who did not cope believed in a God who noticed them only to punish them and who did not forgive.

By then I had come to see that the beliefs which cut us off from ourselves, from others, and from our past and future can be summarized in six basic beliefs. If you have never been depressed and want to try it out, you will find the recipe for depression in my book, Depression: The Way Out of Your Prison.⁷

Depression is not a state of passive misery. It is an experience of tremendous fear. Just what this fear is and how we try to deal with it was the subject of my next book, Beyond Fear.⁸ How we can use our understanding of this fear to develop ourselves and become the person that we want to be was the theme of my following book, The Successful Self.⁹

Because I have been talking to depressed people now for over twenty years and have kept in touch with many of them, I have been able to follow how these people changed themselves and their lives. In the second edition of my first book, now called Choosing Not Losing,¹⁰ I added postscripts to the chapters about my depressed clients, describing how, ten years later, they were living their lives. In this present book I have brought together what I have discovered about how people can take charge of their lives and so change.

With all that I have written about depression in my earlier books, I do not feel that I have said everything that could be said or ought to be said about depression, because depression is not a problem which strikes just a few unlucky people. Depression is a problem from which no one is exempt.

It is impossible to estimate in any way accurately just how many people are depressed. It has been estimated that in the USA some four per cent of the population is depressed at any one time, and for around the world, an estimate of a hundred million has been given, but these are likely, for a number of reasons, to be underestimates.

Many people, when they consult a doctor, feel that they should speak only of physical complaints. It is very easy for the doctor to give just physical treatments and overlook the unspoken misery of depression. Julia West, an American psychologist working in Saudi Arabia, found that her women clients would describe their aches and pains, tiredness and illness, but not their personal misery of depression. This may have been because they experienced their depression only in physical terms, or it may have been because, in their discussions with Julia, they were always accompanied by their menfolk.¹¹ There are many of us who feel that our relatives, even when they are present only in spirit, prevent us from speaking freely about our misery.

Many depressed people do not seek any kind of medical help. It may be that they do not wish to reveal their misery to a doctor, or it may be that they do not realize that their dull, grey, lonely, cramped, trapped way of living can be called depression.

Amongst those people who lead apparently happy and successful lives, there are many who would say, ‘I’m not depressed’, but who know that depression, like a great black bird, hovers above them, ready to settle with a heavy, smothering weight upon their shoulders should they act, or speak, or even think without due care. Such people often ask me, ‘Doesn’t being with a depressed person make you depressed?’, and they look disbelieving when I answer, ‘No’. They are convinced that depressed people are dangerous because their depression can magically and malignly call forth the depression lurking in themselves. Rather than confront their own depression, they spurn all contact with depressed people, or strive to isolate and confine them. If you are depressed you might have had experience of such people, perhaps even your own doctor, treating you as if you had the plague.

This fear of depression can prevent us from realizing that no matter how fortunate and far-sighted we may be, not one of us can be certain that the circumstances of our life will not change and all that supports our way of life vanish. Neither by hard work nor by goodness can we control every aspect of our life and ward off all tragedies. It may be that at some time all the people we love and need abandon us or reject us, or that the projects which gave our life meaning and purpose crumble or fail. When such disasters befall us, we feel great fear, and if we do not understand the nature of this fear we can defend ourselves against it by turning against ourselves, despairing, and locking ourselves in the prison of depression. On the other hand, if we do understand this fear and ourselves, we can, when disaster strikes, become appropriately unhappy but not depressed, courageous and not defeated.

Generally in the following chapters I use the pronoun ‘we’ when referring to something we all do, and, when I want to speak of the things which depressed people do, I use the pronoun ‘you’. There is a difference between the way we think, feel and act when we are laying down the foundations of the prison of depression or living in the prison, and the way we think, feel and act when depression plays no part in our lives. However, I could have used ‘we’ throughout, for we are all capable of doing all that I describe if we are not wise.

By ‘wise’ I mean knowing what we fear most, and why; knowing what we need most, and why; and knowing how to defend ourselves in ways inexpensive of time and strength, and how to get and hold what we need in ways that enrich our life and our relationships.

Thus this book is for all of us.

The book is divided into five sections.

Section One, The Meaning of Depression, describes how we create the world of meaning (that is, our beliefs, attitudes, conclusions, opinions, expectations, wishes and fears) in which each of us lives. We live in meaning like a fish lives in water. Creating meaning is what each of us does all the time, but while we are very good at doing this, we often have difficulty in understanding just how we do it. As the ancient Chinese philosophers said, ‘The fish is the last to discover the water’. Yet an understanding of how we create meaning is essential to an understanding of ourselves.

The world of meaning we each create is like a landscape in which we live. The landscape has limits, so in a sense we all build ourselves a prison, a prison made up of ‘This is where and how I live, this is the kind of person I am, these are my obligations, duties, attachments and responsibilities, these are the rules I must follow’. However, some of us create landscapes which are vast and open, full of interesting and exciting possibilities, while others build landscapes which are cramped, monotonous and confined. The most cramped and confined of these is the prison of depression. In Section One I show just how we create such a prison.

Section Two, Why Is It So Hard to Change?, is concerned with why we so often do not want to leave our cramped prison, or re-structure it into something open and various. Depression is such a horrible experience that at first it seems that no one would want to remain in it, yet if you are depressed you know that being depressed does have advantages. As a university student said to me recently, ‘My depression is like an old sweater. It’s comfortable, so I keep it on. I think it’s risky to change it for something new.’

The fear of change keeps many of us from changing; so does our pride, and the way we take things personally and hang on to hopes. Then there are the people who do not want us to change. Our loved ones do not want us to be unhappy, but, equally, they do not always want us to change the way we live our lives. What would happen to them if their depressed wife or mother gave up being depressed and went to college instead, or their depressed husband or father gave up being depressed and instead of battling on as a captain of industry became an opera singer? Even if, in giving up being depressed, you do not change your way of life, you do behave differently, and that means that your loved ones have to respond to you differently. They might not want to make the effort of thinking about you differently, and they may not be all that pleased when you no longer play the role of the martyr, sacrificing yourself for them, and instead insist that there are times when your needs must take priority. So it can happen that while you are making valiant efforts to unlock your prison of depression your nearest and dearest are resolutely barring the door.

You have to face these issues before you begin what is the subject matter of Section Three, The Journey Out of the Prison of Depression.

Here I tell you what the Expert’s Secret is, and what preparations you need to make for the journey. Since at some time when you are depressed you will think of suicide, I have presented my argument that suicide is not a solution. I list some of the things you will need to find on your journey, and, since loneliness is such a problem, I give some suggestions as to how you might leave it behind. Before reaching journey’s end, I show how some people have helped one another and tried out something new.

The key to the prison of depression is the discovery that you are not the bad, worthless, unacceptable person you thought you were, but that you, with all your strengths and weaknesses and peculiarities, are a person you can love and accept wholeheartedly. This discovery sometimes comes like a flash of blinding light, but more frequently it comes slowly, through a process of understanding which we can undertake like a journey, preparing for it beforehand, and then making sure that we visit certain places along the way. As with all such journeys in search of wisdom and understanding, we realize when we reach our goal that what we sought was in our possession all the time.

As you read this book you might at different points exclaim, ‘Aha!’, or think, ‘I wonder how that applies to me?’ It is a good idea to make a note of the Aha! experiences in case you forget. Sometimes, underlining the passages in the book is not enough, especially if you want to comment and the margins are not wide enough. So you might like to use a separate notebook where you can put your Ahas!, as well as do any of the Discovery exercises I suggest as ways of answering the question, ‘I wonder how that applies to me?’

These exercises I have put in Section Four, Discoveries. Whenever in the first three sections it might be useful to do a relevant Discovery exercise I have marked this with the letter D and the number of the exercise.

The Discovery exercises are NOT compulsory, and there are no right answers except those which are right for you.

Occasionally, in the first three sections, I refer to what might be called technical matters, things which you might like to know more about. So, in Section Five, there is a series of Technical Footnotes. You might want to dip into these while reading the main part of the book.

Thus, if you want to know more about the research and arguments about the biology of depression, this is presented in Section Five under ‘Is Depression a Physical Illnees?’ Whether or not to use antidepressant or tranquillizing drugs is discussed in Drags – Friend or Foe?’ Since, try as I might to write only in ordinary, everyday language, I sometimes have to use the jargon of psychiatry and psychology, the glossary, Technical Terms – Keys to the Jargon’, gives the definitions of these words. Whether or not to seek the help of a therapist and, if so, how can you tell if someone is a good therapist are questions which I have attempted to answer in ‘Choosing a Therapist’.

All too often in life we neglect to take proper account of the stuff of our heart, our own inner truth. All too often other people tell us that our own inner truth is wrong, crazy, unacceptable. If you are depressed, perhaps some people have silenced you by saying, That’s not you speaking. It’s your illness’. To be silenced in this way is the utmost cruelty. Jill Tweedie, novelist and journalist, once wrote:

Ex-depressive as I am, with only the occasional lapse, I cannot dismiss the idea that the vision of life seen in depression has the truth in it, the bare-boned skeletal truth, and an intrinsic part of depression is knowing this and being told that it is not so. Reality, however terrible, is bearable if others allow its reality. When they refuse you that, when they skip around you pretending you’ve got it wrong, that’s rock-bottom time.¹²

Somehow, if we can face ‘the bare-boned, skeletal truth’ we can find the courage to go on with our lives. We can find that courage because, as the ordinary people that we are, we are brave. We know that life is full of uncertainty, not just the uncertainty we all face in terms of nuclear war, or of the destruction of the ecological balance of the planet, or of huge national debts, or of terrorism, or of Aids, but the uncertainties we each face in our own way: ‘Will the firm I work for go bust?’ ‘Will my child get to school safely?’ ‘Is the lump in my groin cancer?’ ‘How will I manage if my husband dies?’ We each have to live with our own uncertainties.

We are brave in the way we keep on going. We get up and go to work, no matter that our work is dull and unrewarding or demanding and stressful. We go on cleaning, cooking and looking after our children, knowing that many of the things we would like for ourselves and our children are not going to come our way. We go on trying to make our children brave by telling them that they are wonderful and that the future is opening up before them full of promise. We try not to tell them that their future might be tough and miserable, even though we fear it may be so. We go on loving one another, even though we know that out of that love will come the terrible pain of separation and loss.

Sometimes we lose our nerve. Sometimes our courage falters, and then we feel great fear. This happens when we lose confidence in ourselves and we find that there is an unacceptable discrepancy between what we thought our life would be and what it actually is.

Such a discovery is made by just about all of us at some point in our lives. When it does, we feel an immense fear which threatens to overwhelm and annihilate us. One way of dealing with this fear is by locking ourselves in the prison of depression. In there we can shut out other disturbances and give ourselves time to think things through and so come to terms with the discrepancy between what our life is and what we want it to be.

For some of us, coming to terms with the discrepancy and building another life is not too difficult, and so our period of depression is brief. However, for others of us the task is much more difficult. So much more has been staked and lost, so much time and effort has been wasted, and so few alternatives for the future are on offer. Most of all, if you have grown up believing that you are bad and unacceptable and that you have to work hard to be good, then in the prison of depression you can doubt that you have the right to change your life and to claim something for yourself. Thus your sojourn in the prison of depression goes on, until you can discover in yourself that sense of intrinsic acceptance and worth with which you were born.

This is not an easy thing to do because you have been told so many confusing things, not just by psychiatrists, but in the past by your parents and teachers, and in the present by people who want you to be the sort of person they want you to be.

Many people, not just psychiatrists, want to believe that depression is a physical illness.

If you are depressed and believe that it is a physical illness you may be holding this belief because it allows you to be irresponsible – no matter what you do, you can say, ‘I cannot help what I do, I am ill’. Or perhaps you believe depression is a physical illness because you are trapped in an impossible situation and being depressed is the only form of escape that you can find. Or perhaps you have been brought up to believe that you must never question what anyone in a position of authority says, and so if psychiatrists, backed by the whole medical profession, say that depression is a physical illness, you believe them without question.

Many people want to believe that depression is a physical illness because that allows them to ignore the suffering of other people and the complexities of life. It requires very little mental effort to think, ‘Depression is a physical illness’. Whereas to understand how we think, feel and act, how we affect and are affected by the people around us, how we respond to and are affected by the customs and beliefs attached to our gender, dass, race, religion and nationality, and how we respond to and are affected by the propaganda that we are subjected to and the political, economic and ecological changes in the world we live in requires considerable mental effort and a tolerance of uncertainty. To say, ‘Depression is a physical illness’ requires one sentence. To describe the multitude of matters which are relevant to our experience of depression requires many sentences, indeed, a large book.

The aim of this book is to help you sort out this confusion and to be a signpost for your journey out of the prison of depression. Depression is not an illness. It is an experience out of which we can gain greater understanding of ourselves and other people.

My friend Pat Wakeling, a psychiatrist who, having found that the treatment his colleagues gave him for his depression did not work, had to find his own way out of the prison, wrote:

Depression is not – as I have eventually and painfully learned – something to sweep under the carpet: to deny, to forget. It is an experience that brings great misery and causes a great waste of time, but it can be, if one is fortunate, a source of personal wisdom and worth more than a hundred philosophies.¹³

This book is a distillation of my work not just on depression but on all the suffering which we can encounter. In it you will hear the voices of some of the people who have talked to me over the last twenty years, people living in the United States, Britain and Australia. To them I give my gratitude and love.

I The Meaning of Depression

1 An Ordinary Story

‘My family insisted I see a psychiatrist. So I went along expecting to have to tell him all about my life, but all he said was, “We don’t need to go into all that. You’re obviously depressed”, and he prescribed me some pills. That wasn’t what I wanted at all.’

Pat looked tired and much older than her forty-five years. She had read my book. Beyond Fear, and had written to me to say that she would like to talk to me because in that book I had described what she was going through – experiences of terrible fear and a sense of despairing and painful isolation.

So now she sat on my sofa and diffidently and simply told me her story.

She was a doctor’s daughter and had wanted to be a doctor too. But her father had said that medicine was not a profession for a woman. So she trained as a nurse and met Simon, a medical student, and fell in love. They planned to marry, but Simon was killed in a car accident.

Later she married one of her patients, a Korean veteran who had acquired the habit of drinking to maintain his courage, a habit which he did not relinquish after the war. For ten years Pat tried to maintain her marriage for the sake of her son, but eventually had to admit failure. She was offered the chance to train as a teacher and, even though this, like all the jobs she had done previously, in no way stretched her ability, she was glad to have a secure job which allowed her plenty of time for her son. Soon, though, there were other demands on her time. Her parents were now old and infirm, and her sisters had compelling reasons why they could not look after them. So Pat nursed her father and then her mother through long, painful, and finally fatal illnesses.

When Pat was a child she had enjoyed drawing and painting, but her parents and teachers discouraged her. Her parents had belittled her efforts, and her teachers told her she could not study both art and science. Though she had put aside this interest, she was delighted when her son showed artistic talent, even though he went to Paris to study. Pat had plans for herself.

Pat said, ‘All my life I’ve been looking after other people. But I’d always told myself that when Peter was grown up I was going to travel. I intended to go absolutely everywhere. I felt that I deserved that.’

So, at long last, Pat could begin to fulfil her ambition to travel. In the summer holidays she and a woman friend went to China. In Peking Pat fell dangerously ill and was rushed to hospital. An immediate operation was necessary. She survived, but her friend had to return home before Pat was well enough to travel. So Pat found herself weak, in pain and alone in a foreign hospital whose standards of care and cleanliness were far below what she had expected.

Pat told me how she had summoned up every iota of strength to travel home. Then she had to go into hospital again, and there she was told that she should plan to take early retirement, for now she would need to lead a quiet life with little physical effort and certainly no stress.

All this she endured in the same stoical way she had endured the troubles of her life. She left hospital and returned home feeling tired and uncertain about what she would do. Her son had returned from Paris to be with her, but as soon as she could Pat urged him to go back to his studies. She assured him that she would be quite all right.

However, when the taxi taking him away had disappeared down the road and she closed her front door behind her she was assailed by the most terrible fear. She felt that her very being was shattering. She clung to the coats hanging behind the door, trying to get from their softness a sense of being held, but knowing that they were only coats. She hoped that if this were death it would come quickly.

Eventually, the fear ebbed and she made her way carefully upstairs. She sat on the edge of her bed, hardly daring to breathe lest an untoward movement brought back the fear again. She saw it as a dark, foreboding ocean whose tide at any time would rise and engulf her.

Much later she lay down on the bed, and much, much later she slept. When she awoke it was to a new world, a world from which all colour had been drained and where the familiar objects of her bedroom had taken on a strange, sinister meaning. She lay in bed all morning, fearing to traverse the vast distance between bed and door and to face the impossible tasks of bathing and changing her clothes. She longed for someone to come and rescue her, but when she heard her neighbour knocking she buried her head under the pillow. Her kindly neighbour now seemed to her as someone she must fear.

Only the thought that her neighbour might well call the police got her from her bed and into a semblance of living. As the days passed she discovered in herself a facility for lying, declaring to all who might ask that she was well. She gave all kinds of reasons why she could not accept their invitations out but never the true one, that she was frightened to leave the security of her own home and venture into the company of people who, in the guise of friends, threatened injury. She felt exposed and vulnerable and needed to hide away, yet that isolation was near unendurable. She said, ‘I feel that I’m in jail and they’ve thrown away the key.’

Some friends were not deceived. They contacted her son, and he came again to see her. He told her to consult a psychiatrist. Her friends and sisters said the same. She felt that she could not refuse, and so heard her life of striving, hard work, devotion and self-sacrifice dismissed as unimportant and her profound experiences reduced to a label and a pill.

Pat’s experience of fear and painful isolation is very common. For many people it comes towards the end of a life of hard work, self-sacrifice and disappointments bravely born. For many others it comes in the middle years, when the rewards for hard work, unselfishness and devotion do not materialize, or, if they do, prove to be a disappointment. For many women the experience comes in their twenties and thirties when, after childbirth, they do not discover in themselves the bountiful fountains of mother love which society assures them resides in all good, natural women. For many teenagers the experience comes when they face the insecurities, the hurdles and the dangers of adult life and they doubt that they have the strength and ability to deal with these. For many children the experience comes when the world which they took to be solid and secure is shattered by the death, defection or disloyalty of someone on whom they depend.

So terrible is this fear and the painful isolation that follows that few people have the courage to talk about them as they actually are. Instead we conspire to pretend that the fear and the isolation do not exist. Some of us maintain the pretence by remaining silent about our experiences, and others conspire to deny the fear and the isolation by ignoring, belittling and redefining them.

The aim of this book is to break the silence and to show that the fear and the isolation are not shameful aspects of inadequate people but are central to our experience and understanding of ourselves and our lives. Through understanding our fear and isolation we find courage and relationships.

Let’s begin with the isolation, for we have a word for that – depression.

2 Depression – the Painful Isolation

‘Depression’ and ‘depressed’ are very common words. We often use them, and usually when we mean something else.

We say, ‘Isn’t it a depressing day?’, when we mean, ‘I don’t like this weather’.

We say, ‘This job is so depressing’, when we mean, ‘I’m bored with this job’.

We say, ‘I’m really depressed about having to spend Christmas with my in-laws’, when we mean, ‘I’m angry’.

We say, ‘I’m depressed about my child’s exam results’, when we mean, ‘I’m disappointed’.

We say, ‘I feel really depressed’, when we mean, ‘I’m unhappy’.

Until we have actually been depressed we do not realize that there is a great difference between being depressed and being unhappy. When we are unhappy, no matter what terrible things have happened to us, we still feel in contact with the rest of the world. When other people offer comfort and love we can feel it warm and support us.

When we are depressed we feel cut off from the rest of the world. When other people offer us comfort and love that comfort and love does not get through the barrier and we are neither warmed nor supported.

When we are unhappy, even if there is no one there to comfort us, we comfort ourselves. We are kind to ourselves and look after ourselves. We are close to ourselves. We are a good friend to ourselves.

When we are depressed we do not comfort and look after ourselves. Instead we hurt ourselves and make life even more difficult. We become cut off from ourselves. We become our own worst enemy.

Tom described the difference between his experience of unhappiness and depression. He said. The time of my greatest unhappiness was in early 1976. I had a good chance of being selected for the Olympics in the long jump when I was knocked down and run over by a car. It smashed my right leg. I was in hospital for weeks, and most of the time I was miserable and angry with the guy who’d done it to me. But one of the best things that ever happened to me happened then. I knew Dad cared a lot about my going to the Olympics, but when he came to see me in hospital straight after the accident I could see he was upset about me and not about the Olympics. He put his arms around me and gave me a big hug and said he was so glad I was alive. He came to see me every day in hospital and we had some great talks. I felt really close to him.

‘That memory’s very precious to me because he died about five years after. At least he wasn’t here to see what a fool I made of myself when my firm let me go. There I was, thinking I had this great job for life, then one afternoon, no warning, the message, dear your desk and go. I should have realized that something like that might happen. The firm had been taken over by a large conglomerate, but then I didn’t think about it, and afterwards I blamed myself. If I’d been any good they’d have kept me on. At first I couldn’t believe it. I wandered around in a daze, thinking that at any minute I’d wake up or there’d be a message from my boss saying they’d made a mistake.

‘When it started to get through to me that I’d actually been let go I felt that I’d lost my identity and that was terrifying. For years I’d thought of myself as Tom McPherson, accountant with Intercel Inc., and now I wasn’t an accountant with Intercel Inc. I felt I wasn’t anybody. I got so scared I didn’t know what to do with myself. I holed up in a hotel room and phoned my wife and told her I had to go on an urgent business trip. I stayed in that hotel room for three days. I couldn’t speak to anyone and I didn’t want anyone to see me. Finally, when the hotel management were getting suspicious and making a nuisance of themselves, I went home. My wife was beside herself with anxiety. Someone from the firm had phoned her, so she knew.

‘I couldn’t talk to her and I didn’t want her to touch me. Her sympathy just made me feel worse, and when she got angry with me I’d get so angry inside that I thought I might hit her. So I’d stay in my room or go for long walks. Walking didn’t make me feel any better. Most of the time I felt I was in a dark tunnel under the earth, but when I was walking I felt that that tunnel was going down deeper and deeper. It didn’t level out until months later when an old friend came and literally dragged me off to a group for executives who’d been let go. I hated it at first. I was so scared I couldn’t speak, but once I realized that everyone there had been through what I’d been through, I could open up and talk. That group saved my life.’

When Tom spoke of walking in a tunnel which was going down deeper and deeper, and Pat of being in a jail where ‘they’ve thrown away the key’ they were describing vividly and accurately what they were actually experiencing. They did not say, ‘I feel as if I am …’, but ‘I feel I am in a tunnel, in a jail’. When we say that experiencing something is like experiencing something else, we put a distance between ourselves and the similar experience. For instance, if we say, ‘Listening to Beatles music is like being a teenager again’, we know there is a separation between ‘me now’ and ‘me as a teenager’. When we say that experiencing something is the same as experiencing something else, we make these two experiences into one and show that the experience is important and intense. To say, ‘When I listen to Beatles music I am a teenager again’, gives an account of a profound and absorbing experience.

Thus it is that when depressed people speak of what they are experiencing, they say, not It is like …’, but ‘It is …’, and what it is is something fearful.

These images can stay with us all our lives. One elderly woman, describing an act of betrayal by her father when she was twenty, said, ‘I felt that I had been skating on thin ice and then I fell through into utter blackness, and afterwards I always knew that I was skating and the blackness was always underneath.’

Each of us experiences depression in an image which is idiosyncratically our own, and yet which shares a meaning with all other people’s images of the experience of depression.

‘I’m at the bottom of a black pit.’

‘I’m trapped inside a black balloon.’

‘I’m in a glass cage. The glass is blurred and I can see people only vaguely and they can’t see me.’

‘I’m wrapped in a thick black cloth that I can’t undo. I’m trapped and helpless.’

‘I’m alone, immobile and weighed down by a huge black bird sitting on my shoulders. Even when I’m not depressed I can feel that bird hovering over me.’

‘I’m trudging across an empty desert and I can’t find water. The desert is endless.’

‘I’m lost in a swirling black mist.’

‘I’m in an empty boat on an empty ocean. No sail or oars, and night is coming on.’

‘I’m locked in a tomb and no matter how much I cry out nobody hears.’

‘A hole, grey, very grey, a closing greyness like a cave, a hole that goes down for ever and it holds on like crazy. The hole is inside me and I’m inside the hole.’

What would you say if I asked you, ‘If you could paint a picture of

(D 1) what you are feeling what kind of picture would you paint?’

Does your image have the same meaning that all the images mentioned here have, namely,

I am alone in a prison.

If you are simply unhappy, your image would not have the quality of you being alone and trapped in some kind of prison. For instance, an unhappy person might say, ‘I feel that I’m at my attic window looking out on a cold, wet day’. If asked, ‘Can you leave the attic?’, the unhappy person will say, “Yes, I can go downstairs and be with my family’, whereas the depressed person will say, ‘No. The door is locked on the outside and in any case the house is empty”.

It is this sense of isolation which is the essence of the experience of depression.

It is a powerful and compelling sense of isolation which is different from all other experiences of aloneness and isolation. In those other experiences you could, if you had chosen, have contacted other people. From your camp in the woods you could have gone back home. From your lonely college room you could have found a phone and called home. But from the prison of depression there is no path, no telephone that will connect you with others. All paths peter out, all telephone lines are down. You are surrounded by a wall which, though it is invisible, is impenetrable.

Outside the wall those who know you realize that the wall is there. They reach out to you and, though their hands may touch your flesh, what they feel is the wall which resists all their love and entreaties. Their cries of, ‘You’re shutting me out’, and ‘I can’t get through to you’, are not empty clichés but reports of real experience. To them the wall is as palpable as it is invisible.

Banging our head against a wall is frustrating, but what makes the wall around a depressed person doubly frustrating is that the person inside knows and the person outside senses that in some way the person inside wants to be there.

The prison of depression is so terrible that it seems inconceivable that anyone would choose to enter it.

Yet, as anyone who has been there knows, inside the prison of depression you are safe from all those forces on the outside which threaten to destroy you. All the horrors and the disappointments of the outside world lie far beyond the walls of your prison and have less power to frighten you or even claim your attention, and all the demands, importunings, expectations and criticisms from your loved ones do not penetrate the walls to inflict their usual hurt.

So, as the prisoner and the jailer, you stay safe in your prison.

However, life in such a prison is not pleasant.

Your only company is your jailer, and you are a cruel jailer, taunting yourself with even worse criticisms than those you have shut outside. ‘You’re bad,’ your jailer says. ‘It’s your fault everything has gone wrong.’

With only the cruel jailer for company you start to feel the worst torture human beings can ever experience – complete isolation. As torturers the world over know, courageous people can withstand the greatest physical pain, but the one torture which will eventually destroy the strongest person is complete isolation. We all need other people just as we need air food and water. Without other people our body aches, then ceases to function properly and becomes vulnerable to illness, while our mind, without the encounter of other minds, loses its capacity to distinguish its own contents from the contents of the world around it. Visions in the mind’s eye seem like objects in the real world, while objects in the real world take on sinister, persecutory meanings.

Thus the isolation of depression begins as a place of safety and goes on to become a place of torture.

What leads you to seek such a place of safety and to remain in it, even through such torture?

It is fear, the greatest fear we can ever know.

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