Interview 22

Age at interview: 40

Age at diagnosis: 37

Brief Outline: Is now managed by a skilled team in the NHS, which includes long-term therapy. Therapy is addressing her distorted thinking patterns and difficult past. She now understands she can move beyond depression.

Background: Is a divorcee who is currently on Cipramil (60mg/day). She has had dysthymia and bouts of depression throughout her life, yet she has only been diagnosed recently. (Played by an actor.)

At university she was dealing with grief from her father's death when she was 3 years old.

It was, it was quite good in a way, because it was the first time somebody had sat and listened to me, listened to my concerns, exclusively and that worked quite well. I remember being quite distressed at times because the counsellor had brought up things for me that were difficult to cope with. I was quite perturbed, I guess, about... I think there were lots of issues to do with bereavement, to do with my father, who died when I was three and I think moving away from home ... 

And being with other people had brought up a lot of issues for me, around my father, his death, and where I was going in life, and how when I was with other people who seemed to have parents bringing them there at the end of term, you know a mother and father, I think that had brought up a lot in my mind. So in counselling we dealt quite a lot with those bereavement issues, with how I was as a person and in the end I think I went for about three terms, and then the counselling kind of fizzled out at the end.

Believes that people make assumptions about children's mental health, and are not necessarily looking for the sorts of problems she had as a child. (Played by an actor)

If you were to look at a child you could probably think of any reason why they may be unhappy at that point. Exams, marital break up, whatever. But there will always be a child like me, where that isn't the case, where there is something more deep, and I think there's a lot of assumption about why children are unhappy. 

I think with the, new child and adolescent mental health teams hopefully there is more recognition there, that children do have mental problems. But I think when I was a kid it just wasn't the case'. I mean not even educational psychologists, there just was nobody'. I was perfectly average at school. I didn't get noticed for being bad or good, which suited me fine, but nobody ever looked beyond that. 

I guess the system doesn't look for anything that appears to be going right. I think I probably could have benefited greatly, from some help.
 

Explains how she presented to her GP with minor ailments, felt she was wasting his time, and was not given a clear explanation of her depression. (Played by an actor)

I'm aware that over a very long period I used to have lots of, minor ailments, and again, I didn't think that any of the GPs I saw took seriously anything that was wrong with me. And they certainly didn't look at the bigger picture and think, 'Is this person unhappy, is that what all of these ailments are about?' So again I didn't think I was necessarily, looking back, I don't think anyone was taking a proper view of my health, as a whole, and saying perhaps it's actually, you know, if I'm saying to this person, you know, it's all in your head then maybe I should be looking at your head [laughs] and that decision didn't seem to be made. 

So you came away from these consultations feeling what? 

Feeling there was something, feeling I was being a nuisance for going to the doctor. For saying there was something wrong with me when the doctor didn't think there was something wrong with me, for time wasting. I felt like I was just being a drain on my doctor. 

I was given antidepressants at one point, I think it was Prozac, and I was on those for about eighteen months or so. But I was never given a particular explanation of what they were to do with, other than they might help - have a side-effect of weight loss. Well that's [laughs] I don't think that's a particularly good thing, but it helped me explain away why I was on antidepressants.
 

Her GP knew he did not have the skills to manage her and referred her to a psychiatric team. They understood and could help.

But I had a GP that was quite interested in how I was, which was good. And then I had Bell's Palsy, which really, really threw me - the facial paralysis. And I had a high dose of steroids, and I think that was just like the icing on the cake, that was just the end of it. I was very low physically and clearly very low mentally, and the GP'. and I'll be forever thankful for him, actually said, ' I don't think I am helping with the right kind of medication for the right reasons, and if you agree I'd like to refer you on to somebody'. And it was like an immense relief, it really was an immense relief. Half of me was thinking this was a disaster for me because I was going to see a psychiatrist, and the other half was thinking, hooray, somebody's actually going to treat me as somebody who has a problem here. 

So I went along, to the assessment, and as soon as I said out, lots of things about my life and about the way I felt in my life, there was no sense of you're in the wrong place, it was, ' Fine, we think we can help you with it'. And it really was a huge relief, and they immediately put me on a proper dose of antidepressants, and saw me regularly, and I actually felt that somebody was for the first time, somebody was actually listening to me.

It was only about the third appointment that I felt brave enough to say, 'What do you think is wrong with me?' and the psychiatrist at that time said, 'I think you have what's known as a double depression. So you have dysthymia, which is chronic depression, which you've probably had since your teens' and I thought well, that makes sense - And he said, 'And at the moment you have a depressive episode.' And I thought yeah, I can understand that.
 

Felt numbed by Lustral (sertraline) and stopped taking her tablets, but suffered strange withdrawal symptoms, and so re-started her medication. (Played by an actor)

You stopped taking your Lustral, you were angry?

[laughs] Yes, I was remarkably angry, distressed, frustrated. I was very angry with the therapist for being off sick, and I thought, no, I'm not feeling anything. I thought these tablets are stopping me feeling things, I'm just being passive, and I'm coping. So I thought, no, I'm going to stop taking them, and I stopped taking them for a week. And by the end of the week I realised it was a really, really bad idea. You get the fuzzy head'. Yeah, I had a week of withdrawal. 

And well when you experience those they're the strangest things ever. When you make a movement, a muscle movement, you get this incredible, uh... it's not a tingling, you get this incredible buzz in your head. Which is quite bizarre, and that's the first time I'd really experienced them, so I wasn't very happy with the physical side effects. 

So after a week I thought, 'That was a really silly idea, I'd better go back on them', but of course, after even a week the damage is done, because then you've got to build back up to the level you were at. So it took me, that probably set me back about five or six months.
 

Was surprised when her therapist told her she needed to be more stable on medication and have more social support before she was ready for therapy. (Played by an actor)

Yeah, but she (the therapist) wouldn't see me then. She interviewed me and said that I wasn't'. at that point I wasn't suitable for therapy. And bearing in mind what I'd said about me choosing to go into, you know choosing to go and see a counsellor before, it came as something of a surprise to be told that I wasn't well enough. 

And I was thrown by that. And she said, no I need a proper support network I need to be a bit more stable on the medication, and I was quite amazed, because I thought, well I need to talk about my problems, I don't understand the delay. I guess I do now, I think that was probably the best thing for me, that actually I did need to concentrate on - if I'm going to have therapy properly, who was going to support me? 

But nobody had ever said to me before, 'Where's your support network? What are you doing to get yourself to the point where you can have therapy?' And I think that kind of almost withdrawing, not withdrawing, holding back on treatment, was actually very, very, it was a really strong thing.

Strong in what way?

It's not quite the right word. But it was a very powerful thing that I felt, initially I felt, well I need this help, and I thought, well, they obviously know what they're doing, and if they say I have to be better, then clearly I'm not better. And I think there was a reality check there - that, hang on a minute, I'm actually not well enough to have somebody help me. And they put in a community psychiatric nurse for a couple of months before I started seeing a psychotherapist, so they didn't completely leave me hanging.
 

Therapy can involve a long and meaningful relationship where you work on highly personal issues, and that requires a trustworthy and skilful therapist. (Played by an actor)

I think one of the things about therapy as well is that it's a relationship. It's probably one of the longest, most meaningful relationships in my life, and the fact that that person is there, pretty much week in, week out, for you exclusively, for the purpose of helping you get better, is really quite awesome, but you have to want to get better. 

Even if you don't know what getting better looks like, you have to trust the other person that they know what they're doing enough to be guiding you in the right direction, and that comes from that relationship. And I'm only at the point now of saying things to the therapist that I wouldn't have dreamed of saying two years ago, because it is a long relationship, and it only exists in that room, and you have to work between the sessions. You have to go away and assimilate what's happened, you have to think about what you said, what you didn't say, why didn't you say what you didn't say - you know there's an awful lot to process.
 

Says that once you are well and can judge, you need to view your sessions with your potential therapist as a relationship, which needs to have trust, positive regard and concern.

Yeah, but she (the therapist) wouldn't see me then. She interviewed me and said that I wasn't'. at that point I wasn't suitable for therapy. And bearing in mind what I'd said about me choosing to go into, you know choosing to go and see a counsellor before, it came as something of a surprise to be told that I wasn't well enough. 

And I was thrown by that. And she said, no I need a proper support network I need to be a bit more stable on the medication, and I was quite amazed, because I thought, well I need to talk about my problems, I don't understand the delay. I guess I do now, I think that was probably the best thing for me, that actually I did need to concentrate on - if I'm going to have therapy properly, who was going to support me? 

But nobody had ever said to me before, 'Where's your support network? What are you doing to get yourself to the point where you can have therapy?' And I think that kind of almost withdrawing, not withdrawing, holding back on treatment, was actually very, very, it was a really strong thing.

Strong in what way?

It's not quite the right word. But it was a very powerful thing that I felt, initially I felt, well I need this help, and I thought, well, they obviously know what they're doing, and if they say I have to be better, then clearly I'm not better. And I think there was a reality check there - that, hang on a minute, I'm actually not well enough to have somebody help me. And they put in a community psychiatric nurse for a couple of months before I started seeing a psychotherapist, so they didn't completely leave me hanging.
 

Describes her illogical yet powerful thoughts that she was responsible for an office argument. (Played by an actor)

I've been doing diaries about thinking, of my thoughts, and there was recently an incident at the office - just a normal day-to-day one for me, where there were two colleagues. I get on well with both of them, I was sitting doing my own job, and there was some altercation in another room between these two people, and I felt completely responsible for this. I had nothing to do with it, I didn't even know what they were arguing about, but I was responsible for it, and nothing could shake my view that I had brought this about. Something about me had caused them to have this argument, and, I know that's completely illogical. I wasn't in the room, I still don't, to this day know what they were arguing about, but it was my fault, because that was the most obvious thing that I could think of. If nothing else makes sense, then I have to be in the wrong, which doesn't make any sense at all, but it does when you're… when you are living through it, and there are lots of situations where I do take on responsibility for things that are not my responsibility and therefore not my fault.

Her friend has educated herself about depression and is accepting, and so she can talk to her about her depression and feelings of suicide.

Yeah I have one friend, who was actually, I actually went to university with, and was there when I was first unwell, so she knows me quite well, and has seen me very low before, so she's you know, stood by me, quite well'. And it's got to the situation now when I can actually acknowledge to her that I do get periods of feeling suicidal and she will actually have that conversation with me, whereas previously that was far too scary. The thought of actually mentioning it, but now that's out in the open it's made our relationship a lot stronger, that has'. I think what has helped my friend is that she's read a lot about it, she's learned a lot about it, she's been interested. She cuts out magazine articles for me, I've lent her books that she's gone away and read. She wants to know more, but at the end of the day, just being there, consistently. Consistently being there, not necessarily asking why, you know, why you're in this situation, just accepting that this is how you are, and that at some point you may choose to say, 'This is why I think I have depression'. And just really being a friend in that sense.
 

Feels she can't tell her family about seeing a psychiatrist as she fears they would see her as weak. (Played by an actor)

But I can't talk to my family about it. They don't know about the therapy. I think it's the stigma thing. I think it's the... I'm the youngest of a big family and I think I would be seen, my perception is that I would be seen as weak and not coping, so it's easier for me not to admit to that weakness and just say, oh, just fudge the issue really. I could  never dream of saying to my family that I was seeing a psychiatrist. I mean that would be you know, horrendous. Because they wouldn't understand, certainly where I am now, the position I'm in now that it is actually a good thing. Whereas if I said I'm seeing a gastro-enterologist - fine, no problem, but seeing a psychiatrist that's it, there's something deeply wrong with you. So I've chosen to keep that from my family, and living on my own I can do that to a certain extent.
 

Has met someone else with depression who has gone further towards recovery and the experience has been inspirational.

I've recently met somebody through work, who has suffered from depression in her life, and is further along the road to recovery than I am, and that has been quite inspirational, because I can see that you can come.... you can come out of it okay. She was in hospital, she's been through an awful lot, she didn't have the benefit of therapy like I'd had, but she's, she's not just surviving, she is enjoying her life. 

And I think that's been really helpful for me to meet somebody who - I'm at a point now where I can talk openly about it. If I'd have met her two years ago there's no way I would have said, "Yeah, I also have depression", and I think it's helped her and it's helped me.
 

Through therapy has discovered why she is unhappy, including feeling at fault for things that go wrong around her, and so can tackle her depression better.

I think the difference now is that now I understand why I'm unhappy. I wouldn't say I'm blissfully happy up against that, but I think I know what I do that makes me unhappy. 

I haven't got to the point of being able to turn it around yet, fully, but I do know that there are certain things ingrained, about how I live, about how I conduct myself, that are very detrimental to me being a happy person. And there are things that keep me in a place of being depressed, and that's what the therapy really helps with it.... in helping me understand how I perpetuate the depression..... 

I think for me it's about blaming myself for most things, thinking that I'm a bad person, and I can expend huge amounts of energy on the mental processes that go into making me responsible for everything that goes wrong in the world. And that's really very tiring, but I'm really very good at it.
 

Therapy can lead to stepping out of the 'prison of depression' into the unknown, which can be frightening but rewarding.

You know, I can actually see that there might be a third way, of me moving forward in life, but it's been a very long process. I didn't imagine that two and a half years later I would still be having weekly therapy, to get better. It is, but it's scary, if you're used to living in a very constrained band in your life, then the actual idea that you can take charge of your life... The bigger world is very scary. I think it's something to do with when you live with depression the way that I have, you are limiting your life. You don't necessarily know why you are limiting your life, but through your thought processes and the way you are as a person, you concentrate on surviving life. 

You know, you're getting through life but you don't necessarily get any pleasure from it. There may be the odd day here and there that are great, but you're surviving, and you don't really have any sense of why you are doing that. But if I choose to live differently, if I choose to, and can, set aside the depression, and think, right, I'm going to live life as other people seem to live it, that's really scary because that's been so much part of my life. And to actually live life without worrying every minute about what's going to happen next, about what people think of me, about what, am I doing a good enough job, you know to actually take life as it is, and to take knocks on the chin, and you know, dust myself off, and not worry about it, it's just a completely different way of living. And it's scary because I've never done that before, and I clearly need a lot of help to get to that point. But I do know that I want to live life and be more happy, and be more settled, and have a point to my life, you know, have a purpose, other than just getting through it.