Living with depression is a bit like being trapped inside Pandora’s box. You are in a dark place, surrounded by guilt, shame, anger and despair, by envy of those who are mentally healthy, by self-hatred despite your achievements, by loneliness and isolation despite the presence of loved ones. Encircled by so much misery, it’s no wonder that depressed people lose sight of hope, tucked away in the corner.
When my partner and I saw my psychiatrist a couple of days ago I was convinced there was no hope for me. I no longer believed that hope was just hidden from view at the moment, that I would get it back when I was less depressed. As far as I was concerned, it had gone for good. And so that’s what I told my Consultant: that I could not see any hope going forward. This period of depression had begun with the conviction that I could not go forward into middle and old age with bipolar, but during January those thoughts developed into the idea that I could not go forward – full stop. I could not see how I could be expected to continue living through mood shift after mood shift, never knowing how I would be from one week to the next. I had tried very hard to take responsibility for managing my bipolar, but this had metamorphosed into feeling that the disorder had become like a heavy weight I was compelled to carry around by myself, with no possibility of putting it to down to rest for a while. The result was that I was thinking a great deal about death. I didn’t have an active suicide plan, but I continually fantasised about not being around. I don’t have a belief in God as most people understand the term, but I had been obsessing over a 17th century poem by Francis Quarles I learned while singing Howard Goodall’s Eternal Light requiem:
Close now thine eyes and rest secure;
Thy soul is safe enough, thy body sure;
He that loves thee, He that keeps
And guards thee, never slumbers, never sleeps.
The smiling conscience in a sleeping breast
Has only peace, has only rest;
The music and the mirth of kings
all but very discords, when she sings;
Then close thine eyes and rest secure;
No sleep so sweet as thine, no rest so sure.
That was what I craved: giving over responsibility to someone else so that I could rest. If forever, so be it.
I was startled when my psychiatrist asked what I thought would be helpful. I had got to a point where I had almost forgotten why we were seeing him; I was so convinced there was nothing to be done for me. And yet here was my doctor asking calmly whether I would like to consider any of the crisis interventions we’d previously discussed. Home Treatment Team was there, he reminded me. I only had to say the word, and if I couldn’t make the call myself, my partner could do it. Admission was also an option, although not one I thought would be beneficial. In terms of medication, although there was little wriggle room in terms of dosage increases, he did suggest pushing my antipsychotic up to maximum. Had I been using PRN diazepam? No, I said, surprised. Despite having plenty in my med store and it being part of my self-management plan, I just hadn’t thought of it. My thinking was so warped I simply wasn’t able to come up with strategies I usually used.
Between us, as I sobbed, we thrashed out a plan. I am going to take the maximum dose of quetiapine for the next two weeks, and use diazepam once or twice a day if needed. If by the end of the week I am not feeling any better, or feel more actively suicidal, we will call on Home Treatment Team. I will see my Consultant again in two weeks and in the interim my partner will work from home as much as possible and try to be able to be on the end of a phone when at the office.
The meeting had an immediate effect on me (I’m crying just writing about it). I learned that I didn’t have to carry my burden around by myself. The professionals were willing to take some of the load, up to and including admitting me if I genuinely couldn’t keep myself safe. My partner was also ready to take on more of the burden than I had been allowing him to. I awoke the following day feeling a little better – but not great, not happy, certainly not “fixed”. I recognise it will take some time to recover from the depths of this low, but I can see that there is after all a safety net. Today for the first time I feel like I might actually be able to fight back against the depression. The weight can be passed around. I have seen hope.