Dispelling the fears and frights

Times journalist Oliver Kamm tells the story of his encounter with depression.

“We don’t kill ourselves. We are simply defeated by the long, hard struggle to stay alive.” Thus wrote Sally Brampton, the Sunday Times agony columnist, in 2008 in her memoir of depression. I corresponded with her a bit. We once had a disagreement on social media about some impossibly trivial issue. The next day she decided she was wrong and sent me not one but three boundlessly gracious and totally unnecessary messages of apology. They exemplified a generous nature and also a ruthless self-criticism. I only properly grasped the second of those characteristics when reading in 2016 that she’d drowned after walking into the sea near her home.

Stephen Tindale was a leading environmental campaigner and former head of Greenpeace in the UK. His willingness to think freely drove him to support nuclear energy, a stand that cost him many allies and some friendships. I knew him for 30 years, unaware for most of that time that he suffered from depression. He attempted suicide in 2007, which left him with brain damage and caused him to walk with a stick. He took his own life in 2017. Noting his thoughtfulness and the scorn of his former allies in the environmental movement, the Times obituary said: “It is not known to what extent the opprobrium heaped on him affected his mental health, but he continued to suffer from severe depression.”

I can’t begin to conceive of the anguish they suffered and that eventually overwhelmed them. There’s no bleaker place than the human mind when it’s unmoored from reason. But I can recognise the state of dislocation and despair. I lost hold of my rationality in 2014; the condition was diagnosed as severe clinical depression and it dominated my life, everything I did and thought in every waking minute, for about a year while I sought to piece my rationality back together. For great stretches of that time my overwhelming thought was a fervent desire not to see another day. It was a type of insanity in which the mind no longer functioned and the personality felt broken, in function and emotion. Through the herculean efforts of others to reach me, I came out the other side.

Depression can afflict anyone of any age. It can be a constant demoralising presence or a terrifying precipitous descent yet, unlike a broken limb, its effects are observable to others only indirectly. The stigma of mental illness remains a powerful deterrent to admitting to it, even to yourself. Yet the evidence is that it’s as old as civilisation and that it’s treatable. I resolved to write about it one day in the hope that it would explain this most debilitating and terrifying of maladies to those who haven’t known it, and to help others in the same state.

My disorder gestated slowly but emerged suddenly. One day I went to pay for something in a shop, only to be told by the surprised assistant that I’d done it already. I had no recollection of it. Realising there was a problem, I decided to get a taxi home but my plan fell apart. Normally I can recall obscure details of things I’ve read or seen, or names and faces from years past. Now I was unable to remember my home address. I sat by the road. In a line that came back to me but I couldn’t immediately place, it was curiouser and curiouser. I was fully awake but nothing could come to mind beyond immediate sensations: the traffic in front of me and spots of rain, amid an overwhelming sense of oppression, darkness and exhaustion.

I’ve determined to tell my story in print; I’ve done so in an essay for the Times magazine and will be doing so in a forthcoming book. What I’ve tried to stress is that mental disorder is beyond rationality but can be understood by the same means that humans have come to understand other once mysterious phenomena: the process of critical inquiry. Our mental capacity is without parallel in time or place. No other species through geological ages has managed to understand the external world. 

We’ve gained that knowledge through critical inquiry, not the fruits of revelation. Reflection doesn’t lend itself to dogma; there’s always the possibility that our conclusions about the nature of things will be overturned, or at least overtaken, by new discoveries. Liberal civilisation is averse to claims of certainty. Hence it’s easy to discount just how vast is the field of reliable knowledge. The permanent possibility, however remote, of error makes scientists look askance at words like certain and indisputable yet for all practical purposes these adjectives do apply to knowledge of atoms or genes or the evolution of organisms. Nothing will diminish that body of knowledge. All that will be discovered about the external world, for the rest of time, will be consistent with the known laws of physics, chemistry and biology.

There are two areas of scientific exploration, however, where what we know is so partial as to be minuscule: what’s out there, in the rest of the universe; and what’s in here, the stuff of mind. It’s the second of those questions where you’d imagine the scope for understanding is greater because the physical distance is much, much smaller. We’re talking about an organ that’s about the size of a cauliflower: the human brain.

The brain is the most complex entity we know of and our understanding of it is minimal. It contains around 90 billion neurons (or nerve cells) and a vast number of connections between them. We know that thought is the outcome of neurons firing within the brain. But we understand little more about consciousness than this. Neuroscience is in its infancy. Only in the past century did scientists discover that neurons are the building blocks of the brain and the connections they make produce perception, cognition and emotion.

If mental disorder were directly observable, like a physical wound, no one would doubt its severity. Yet many are sceptical. In a review of a well-meaning book urging psychological therapies in public healthcare, in The Times in 2014, the conservative writer Theodore Dalrymple scorned “the authors’ extreme naivety, which is refreshing almost in its innocence…. For the authors, such phenomena as anxiety and depression are facts of the same order as earthquakes and hurricanes, and they ignore entirely the evidence that they have largely been constructed by, among others, the purveyors of useless but expensive drugs.”

Anxiety and depression are facts, not imagined ailments. They’re as organic as cancer but much harder to recognise as there is no brain-imaging machine or scan that can diagnose mental disorder. The brain of someone with depression is essentially the same as the brain of someone without. Depression is the outcome of brain circuitry that everyone has. We recognise it only by its symptoms but these are real. I know them and so have countless others through millennia. They are not some modern construction. They’ve been part of human existence for as long as civilisation itself. Hippocrates, whose name is synonymous with the ethic of medical care, knew of them and wrote acutely: “It is the brain too which is the seat of madness and delirium, of the fears and frights which assail us, often by night, but sometimes even by day; it is there where lies the cause of insomnia and sleepwalking, of thoughts that will not come, forgotten duties and eccentricities.”

The fears and frights are never the same. They’re distinctive to the person who labours under them. But to realise that they’re intrinsically human, have been known through generations and are illuminated in the written experience of others was, for me, a step to understanding and dispelling them. 

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