Estimated reading time: <10 minutes
Across from me, a research volunteer is telling me about their week. As I’m assessing whether they qualify for our study, I internally smile at just how much I’m relating to what they’re saying. But it’s only afterwards, when I score their responses and realise yeah, they definitely meet the criteria for major depressive disorder, that it hits me. Oh. I look back at my day, my week, my month. Here I am again.
Those are the times working in mental health research can really help, where my environment and my training hasten that sharp, sudden bit of perspective: I need to do something.
Other times, it’s not so simple.
I have deliberately crafted my life around my mental health. Thankfully, my longest and darkest spells were back in my teenage years, but I’m all too aware of how comfortably my mind finds falling into that place. I cannot afford to not be vigilant. As I write this, I realise I can’t even imagine what that would be like. I am mostly content – and my reputation as someone who celebrates joy and affection is not unfounded! – but only because I work hard to keep that peace.
I am strict about the hours I work and stricter yet about the company I keep. I spent years transforming my relationship with my body and now carefully curate the people and media I interact with to protect that. My phone is well stocked with habit trackers to catch me when routines start slipping; alarm bells ring when I can’t find the motivation to even brush my teeth. And when I say that walking everywhere keeps me sane, I say it lightly, but I mean it deeply.
Most of these practices are things I’ve experimented with on my own, but knowing they’re supported by scientific evidence usually helps keep me on track. The literature on behavioural activation forcefully reminds me to keep moving and socialising when my mood dips. The clarity and simplicity of cognitive-behavioural frameworks nudge me out of avoidance when anxiety is holding me back. Part of what keeps the words of my psychologist ringing in my ear is how skillfully she could ground her advice in Acceptance and Compassion Therapy (ACT).
Inevitably, though, the practices I have so carefully cultivated sometimes falter, and I come crashing down. In that all-too-familiar darkness, my insight turns on me. I could write a great, well-referenced paper on all the reasons why I shouldn’t be lying in bed, staring into space, berating myself, but not only does that not stop me, it becomes a form of punishment. What the hell is wrong with me? I know exactly what will help and I’m just choosing to wallow. I tick off a checklist of cognitive biases – black-and-white thinking, jumping to conclusions, catastrophising – and yet every dark thought feels like incontrovertible fact. I’m fundamentally incapable of true connection with anyone. I’ll always be alone. I speak to myself in a way I would never speak to anyone else with depression, whether supporting them professionally or personally. Taking time off work is grossly indulgent – this misery is just a result of my weakness.
This dissonance between rational insight and what I feel to be true in every ounce of my being just makes me feel like I am going, very literally, insane. I can’t find a second of mindful detachment, can’t step back an inch, can’t let my feelings pass through me. I feel completely unrecognisable.
When that mental shift happens, everything feels different.
I’m plagued by questions about that distinction.
Is there a line between depression and those parts of life that are inherently difficult – struggles with motivation, the pain of self-criticism, occasional intense sadness?
If there is a line, is it a question of severity, or does the experience transform into something new?
Is my depression a part of me, or is it something separate and external that’s been imposed on me?
Is everything I’m experiencing “normal”? Am I overreacting?
Does answering any of these questions even matter?
It feels important. Not just scientifically or therapeutically. It feels important – no, utterly essential – to me. I desperately long for some perfect framework to help me understand it, understand myself, even just a little more. I know what my therapist would ask, and, no, Nicola, I’ve no idea what that framework would even look like. I still want one.
In bed, I scroll Twitter, reading endless threads of academics debating these very questions.
I resent every perspective I read.
I resent colleagues discussing serotonin receptor mechanisms that could not feel more irrelevant right now. I resent the very notion that some equation in a computational neuroscience paper could possibly be helpful to me. I resent psychodynamic therapists ascribing meaning to the pain I know is meaningless – this isn’t an ‘opportunity for growth’ and I want it gone. I resent anti-psychiatrists claiming that the pain I’m feeling shouldn’t be pathologised – I’m desperate for this all-consuming virus to be wiped out. I resent the people arguing that how I feel is just a response to capitalism or oppression, as if solving those problems would even make a dent. I even resent threads of other people describing their depression in ways that I can’t relate to.
By the time I reach “Top Five Tips for Well-Being”, I want to scream.
I close Twitter.
I’ve had incredibly painful experiences, ones that have changed and moulded me, and have taken time and support to heal from, but this feels different. Even in the worst of those times, I was still me. I could always see some of the good in my life, feel the love of those around me, and have some insight into my emotions. I still fundamentally liked myself.
This feels… indescribably different. I feel alien to even myself. Everything I value in myself, anything remotely loveable or worthwhile, I feel robbed of. I am utterly sick of myself, and my self-absorption. I switch between feeling a deathly numbness and a despair that makes my chest burn. I have no clarity and don’t absorb anything sensible that is said to me. My pain grows and grows and I fear I will never emerge from under it. I feel completely trapped. When I try to reach out, I find a way to feel more alone. Kindness becomes only more evidence that the people who say they love me don’t know me, not really.
I wonder how my research on negative bias – how a keyboard response to a facial expression – can possibly capture the cruelty of my own mind.
I make a series of incredibly depressing google searches, with highlights including ‘movies about teenage social rejection’, hoping to feel understood. Everything feels irrelevant to me.
I turn to my default comfort watch, Grey’s Anatomy, and see De Luca suffer through a depressive episode. As his colleagues try to intervene and lift his spirits, he cries out that he would give up every life he’s ever saved to just not feel like this anymore. I cry with him. It makes me feel more seen than any academic paper ever has.
As I write this, I hope that it just might make someone else feel seen, in a way my academic work may never do. Each time I start questioning whether I’m really going to share something so vulnerable, that hope keeps me going.
Talking openly about my own mental health has an extra weight to it. I worry that, in my moments of hopelessness, my lack of answers – as an “expert”- may feed the despair of others. I worry that this will be read not as my account of my experiences, but as a universal account of depression. Many of the people I love struggle with their mental health, and they all conceptualise it differently, wanting different forms of support, each as valid as the other. I worry that friends outside the field will take what I say as gospel, rather than one perspective among many.
I feel caught in the middle of the many ongoing battles in psychiatry. There are psychiatrists I respect, psychiatrists I love, psychiatrists who make me cringe, and psychiatrists who infuriate me (no, a few minutes of cheerful small talk doesn’t disqualify someone from having depression). Sometimes, those are the same people. In discussions about psychiatric diagnoses, medication, research trends, and NHS care, I take on different roles, trying to judge when to fiercely defend and when to aggressively criticise.
Writing this, I feel more caught in the crossfire than ever.
I worry about the response of my friends and colleagues within mental health. While I generally feel reassured of a level of understanding and validation, there’s a fear that I am particularly exposed in front of people who spend their life thinking about depression. I worry that I will become a case study, my behaviours monitored for symptoms. Oh god, I could be deemed a fraud. I think of other scientists reading this and worry that I should be adding citations. And there is an unfortunate reality that even those most qualified don’t always get it. I return from a period of sick leave for depression and get asked if I feel better – “what with all the bugs going around”. I don’t know what to say. It’s well-intended and I love my workplace and I know I have it better than most. I’m sure I’ve done the same thing. It’s still… tiring.
Finally, I worry that what I’ve written will be picked apart or used to further some agenda, because this is not a clear-sighted critique. When I feel ‘well’ (what word should I even be using?) I can see the value of the same perspectives I resented while in the middle of it. I can feel a sliver of compassion for the very same parts of me I hated. Maybe that Amy isn’t quite so incomprehensible. But I honestly can’t tell if this is true insight, or if I’ve simply already forgotten just how sadistic my mind can be.
I have no answers or conclusions or even suggestions. This is just one attempt to articulate one (thankfully temporary, if recurrent) experience.
Of course, the situation I find myself in is not a coincidence and you’ve heard it before. My story is that of countless others in this field: a depressed teen, wanting to help others like her, studies psychology. She worries that clinical work is too much for her own mental health and falls in love with research instead.
Sometimes it feels like I’ve trapped myself. One day, after struggling to get out of bed, the journal club topic of the day is social isolation and it feels almost too much to bear. I wish I could laugh but can’t so I cry. I thank my lucky stars I’m watching on Zoom.
But then, another day, not long after, I realise I feel… okay. I don’t know why, or how long it will last. A week or so later, I think I actually feel happy. And there’s no neat narrative to where I am now, but maybe I’ve found some solace. When my head is dark and I loathe the part of me that led me there, I desperately wish I had a magic wand, to be free of it – screw all the philosophy about meaning in the suffering or the empathy it provides, I’ll gladly sacrifice that. Truly. But, as things lighten, I can just about see something. I see my day-to-day research in a subtly altered light, see with striking, personal clarity the way that an ambiguous face can appear terrifyingly critical. And, emerging, I can see how what I fear – never being free of that darkness – grounds me, teaches me, and motivates me to keep going. How it keeps me connected to the people I’m trying to help. Maybe this is what keeps alight, year after year, the flame that drove me into this field. And in lieu of a magic wand, these frayed threads of silver linings, offering a little peace, will have to do.