would have to do needs some careful thought.
When I have a teaching session about depression with a group of health professionals I usually begin by asking how they feel when they are with a depressed person and what images they have of this experience. One day I met a group of nursing auxiliaries whose job it was to visit old people in their own homes and to help them bathe regularly. Thus these women had to deal with a great deal of unhappiness and depression in their patients. As we talked of the feelings that looking after these old folk aroused, one of the women mentioned that her husband had been depressed since he had retired. As she spoke it sounded very much like what many women say after their husband retires – how she cannot get her work done because he is around the house, how grumpy and difficult he is, wanting meals at particular times and expecting things to be done when he wants them, and so on. The group continued talking, and later we came to the question of what images we had of being with a depressed person. Then this woman spoke again. She said,
OUTSIDE THE WALL:
LIVING WITH A DEPRESSED
PERSON
‘I feel that I’m in a boat in a heavy sea. Sometimes I feel I’m at the top of a wave, and then I go down into a trough again.’
‘What sort of boat is it?’ I asked.
‘An open boat – a rowing boat – but there’s no oars or sails or rudder.’
‘Are you alone in the boat?’ ‘Yes.’
‘When you’re at the top of the wave, can you see land or another ship?’
‘No. There’s nothing in sight. Just rough ocean.’
As she described her image we each became aware of how terrible her plight was. Her husband, in his depressed state, made her feel helpless and alone. The doctors, she said, gave confusing advice and no help. She could only react to things as they happened and could not change or control them. She was trapped in an isolation as terrible as that of her husband. She was sorry for her husband, but she also felt angry and frustrated – and then guilty because she knew it was not right to be angry with someone the doctors said was ill.
This is the curious thing about depression. People call it an illness, but if you live with it you know it is not like any other illness. If someone you care about has a physical illness or an injury – bronchitis or cancer or a broken leg – you feel simple concern and sympathy for that person. You might feel anger at the injustices of life or at the carelessness of other people who have inflicted this suffering, and you might occasionally feel impatient with your loved one who fails to rest properly or to take his medicine regularly, but you do not find yourself possessed by a terrible rage with your loved one. Sick people can be querulous and difficult, but they do not turn on you and say hurtful, cruel things just as you are giving them extra love and comfort. Sick people are not usually impervious to reason. They do not demand that you never leave the house while most of the time refusing to speak to you when you are there. Sick people do not rush upstairs and lock themselves in their bedroom when a neighbour drops in, nor do they sit in silence all day, brighten up and chat happily when visitors call,
only to relapse into a hostile silence when the visitors leave. Having someone sick in the house can disrupt family routine, but sickness does not usually create a continual atmosphere of anger, mistrust and uncertainty. No matter how serious an illness is, you can come to understand it, and even if you can do nothing but let the illness run its course, you can see the pattern and not feel as if you are the helpless victim of uncontrollable and dangerous forces. You might say to someone in the family, ‘Don’t come too close. I don’t want to catch your cold’, and if someone has a dangerous infection medical science will protect you, but how can you be protected from the danger you feel of having a great well of despair open up in you? Being with a depressed person can be a very difficult and dangerous business.
It is not just relatives who report a confusion of feelings, many of them bad, which arise when they are with a depressed person. I have talked with psychologists, nurses, doctors and social workers, and they all say how they begin by feeling great sympathy and concern for their depressed client, but soon find themselves feeling confused and helpless. Now if you are in the business of helping people and you think that you are quite good at it, then being made to feel helpless is very threatening.
Some professional people, too, report the sense of danger, that being with a depressed person will awaken their own latent depression. It is no wonder that some professionals refuse to treat depressed people or bring consultations to a quick end by reaching for the prescription pad.
The images of being with a depressed person that professional people give are of two kinds. There are the images of wandering in a fog, not knowing where you are going, or being involved in some strange geometric pattern that cannot be completed in any satisfactory way. The other kind of image is that of being on the outside of a prison wall, knowing that the depressed person is inside the prison, wanting to help the depressed person but being unable to reach him. One image given by a psychologist was of being outside a circular brick prison. There were no windows, but the depressed person inside would remove one brick. The psychologist told me, ‘When I see a brick being removed I try to put my hand through the hole to touch my client, but as I do he slams the brick back into place. Then he removes a brick on the other side of the prison, and I dash round there to try to get my hand through the hole, but as I reach there, he slams the brick back into place and I’m left on the other side of an impenetrable wall.’ This image shows very clearly how the message that the depressed person gives is, ‘Help me, help me – stay away’, and how painful and confusing this is to the person outside the prison.
What can you do?
Ways of thinking about the problem
When something goes wrong in our relationships with other people there are three kinds of questions we can ask in order to discover what happened and what should be done to put it right.
1. Who is to blame for this? 2. Who is responsible for this? 3. What does this mean?
Each of these questions represents a different way of conceptualising the problem. Often in discussions about relationships we use all three kinds of concepts and so we get very muddled. If you are worried that I am going to blame you for your relative’s depression then you must read this section very closely and make sure you understand it.
1 Laying blame
Something goes wrong and we look for the culprit. ‘You dropped my best teapot’, He backed the car into the gatepost’, ‘He took the car without permission’, ‘She spent the house-keeping money at bingo’. When we find the culprit we can say, ‘It’s your fault. What are you going to do about it?’ We expect the person at fault to be contrite and to make reparation. If he or she does accept the blame and does make some reparation then all (or most) is forgiven and life proceeds smoothly again. But sometimes the person does not accept the blame and instead puts up arguments like, ‘It’s your fault I dropped the teapot. You gave me a fright when you shouted’, ‘If you had cut the hedge back I’d have been able to see where I was going’, ‘You said I could take the car – don’t you remember?’, ‘If you took me out more I wouldn’t need to go to bingo to give me a break from all this cooking and cleaning and looking after you and the children’. Then the argument starts and goes on for hours, weeks, and, in some families, for years.
Matters are not made any simpler by saying that the offence is a crime and calling in the police. The culprit may be found and brought to court, and, if found guilty, fined or sent to gaol. Just why people get fined or sent to gaol is not quite clear – is it to punish them or to teach them better ways of behaving? This whole question of crime and punishment is very complex, and I raise it here only to say that if we think in terms of blaming, feeling guilty and never forgiving, all we do is make our relationships worse and make even greater problems for ourselves. So, please, leave blame and guilt aside and think about these issues in terms of responsibilities and connections.
2 Being responsible
In the course of my work as the chief administrator of a department of clinical psychology I often had to draw up a job description for one of the posts in the department. The job description had to show very clearly what the holder of the job was responsible for and whom the holder was responsible to. All this could be clearly defined and followed. If a problem arose about who was responsible for what, we could resolve it through discussion and reference back to our job descriptions.
From this orderly way of defining and limiting responsibility I would go and talk to my depressed clients and what did I find? They were responsible for everything! There wasn’t anything which could happen in the entire universe that they could not see themselves as responsible for and feel guilty about. Usually they confined their responsibility to their family and their job. They were entirely responsible for the happiness of their spouse, children, parents, brothers and sisters, grandparents and, if they were so minded, to the entire range of their cousins and in-laws. None of these relatives was capable of being responsible for himself or herself. If my client was working, then no matter what his job was, he was responsible for the welfare of the entire organisation, no matter if it was an international business or vast government department. My client saw himself as responsible for everything, and when he saw himself as failing in his responsibility he would say, ‘I feel so guilty. I should take mum and dad out more often/ I should have made sure my son worked harder for his university exams/I should have set an example to the others in the office/If I had given my sister more help her husband wouldn’t have left her/It’s my fault if any of my pupils fail their exams, and so on.
The essence of a job description was the understanding that the holder of the post agreed to carry out certain tasks and to be responsible for himself in doing these tasks. He had to report to or be accountable to a senior colleague, but in his work he was responsible for himself. When I talked to my depressed clients I found that while they were prepared to be responsible for everything and everybody in the universe there was one exception. They were not prepared to be responsible for
themselves. They saw themselves as passive and helpless. Things happened to them. They didn’t choose to do anything. They were compelled to do things by forces out of their control. They saw themselves as unable to avert disasters or to take positive steps to achieve success. The black cloud of depression descended without reason, without any choice or design on their part. They were compelled to meet other people’s demands and they could not choose to refuse. The world was the way it was and they had no choice but to live in it at its behest. They were the people that they were and they had no choice but to suffer themselves, to be the cross which they had to bear.
When I sent the first part of this book to Jean for her comments she wrote back,
One thing I have chewed over and over is the first part where you set out the six opinions. In nos 2 and 6 you use the word must. I have never felt the compulsion of must in holding these opinions, though they are two of my ‘favourites’. I don’t feel that I must fear people. I just do. I don’t see anything about them that must be feared – they just are terrifying, and the same with forgiveness. I don’t feel that I mustn’t forgive myself – I just don’t. I rather feel that the element of compulsion that ‘must’ gives these makes them seem more of a positive decision than I think they are. In adopting such hopeless attitudes I don’t think there is a positive decision. It’s really a small point, but I immediately thought, ‘I don’t feel that “must”’.
It is not a small point. It is the essence of living your life in a prison, and of finding your way out of that prison. There are more prisons than the prison of depression. Each of us builds our own prison when we decide upon the opinions which we want to regard as the solid, enduring truths of our world. Some of us build large, spacious prisons where we can roam with ease and where we feel free enough to change some of the boundaries of the prison when we wish. But some of us build narrow, dark prisons where we feel cramped and pressed
upon and where we feel we cannot change any aspect of our prison. Our prison simply is. We do not even feel that we must behave in a certain way, because, as Jean said, ‘must’ contains a positive decision. Deciding that I must do this implies that there is an alternative, albeit one that appears impossible. A decision is the outcome of a choice. If we make decisions, then we are responsible for those decisions, but if the decisions which determine our lives are made by other people, then we are not responsible. If, when we build our prison, we deny that we have made any decisions and claim that all the decisions have been made by other people or powers beyond our control, then we can feel that we are not responsible for ourselves. If our prison is cramped and miserable, it is not our fault, and so we can come back to the sorry round of blame, guilt and not forgiving.
Freedom consists of recognising that we choose our own prison and of deciding to create a spacious, light, airy prison filled with delightful things, a place where change is created and welcomed. Freedom means recognising that everything we do is the outcome of a choice (bearing in mind that not all choices are made consciously, and that ‘not deciding’ means ‘choosing not to decide’). Freedom means being responsible for yourself, and it also means looking very closely at your relationships and deciding to what degree and in what way you are responsible for the welfare of other people.
Within organisations it is fairly easy to decide what responsibility we have for other people. For instance, as head of a department of psychology, I accepted that it was my responsibility to provide the appropriate experience and opportunity for study for the psychologists who come there for training, but it was not my responsibility to make sure that they worked hard enough to pass their examinations. That was their responsibility. But where loved ones are concerned it is much harder to set limits to our sense of responsibility. I want my son to have a happy life, so I find it hard sometimes to say nothing when I think he is making the wrong decision. It is not just a matter of wanting our loved ones to be happy. It is the pain we feel when we know they are not happy, or are weak or in danger. I remember, as quite a small
child, feeling an overwhelming and exceedingly painful pity for my mother. To end this pain I had, in some way, to help her, but it was help she neither understood nor wanted. What she did want from me was something I could not give. When my depressed clients talk to me of their sensitivity in their relationships and when they say things like, ‘As much as my mother annoys me, I couldn’t ever say anything to upset her’, or ‘Dad can manage to look after himself, but I go round to see him every morning, just in case there’s anything he needs’, I know they are talking, at least in part, of their painful, loving pity and of how they try to deal with it. We try to protect our loved ones in order that we should not pity them.
But there are limits to what protection we can and should give. When our children are babies we need to protect them, but once they start to move around and explore we have gradually to decrease our protection, for if we try to go on protecting them we prevent our children from growing up to be ordinary, confident adults, capable of looking after themselves. So many of the depressed people I have met have told me of loving parents who protected them and of how they find the world such a terrifying place (it must be – why else would their parents need to protect them?) and of how they lack the confidence to live their lives. As parents we must define the limits of our responsibility to our children, limits which change as the child grows older, until the child is an adult and our responsibility is that of a good friend. For the child, growing up means seeing our parents become older and in need, sometimes, of our help. But the relationship and responsibility should still be that of good friends – loving concern and interest, with minimal criticism and advice, help when asked, and allowing one another to make our own decisions since we are all grown up.
What we should always remember is:
It’s not what happens to us which matters but how we interpret what happens to us.