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