Reasons to Stay Alive

  Also, if I’m honest, I was scared. What if I didn’t die? What if I was just paralysed, and I was trapped, motionless, in that state, for ever?

  I think life always provides reasons to not die, if we listen hard enough. Those reasons can stem from the past – the people who raised us, maybe, or friends or lovers – or from the future – the possibilities we would be switching off.

  And so I kept living. I turned back towards the villa and ended up throwing up from the stress of it all.

  A conversation across time – part one

  THEN ME: I want to die.

  NOW ME: Well, you aren’t going to.

  THEN ME: That is terrible.

  NOW ME: No. It is wonderful. Trust me.

  THEN ME: I just can’t cope with the pain.

  NOW ME: I know. But you are going to have to. And it will be worth it.

  THEN ME: Why? Is everything perfect in the future?

  NOW ME: No. Of course not. Life is never perfect. And I still get depressed from time to time. But I’m at a better place. The pain is never as bad. I’ve found out who I am. I’m happy. Right now, I am happy. The storm ends. Believe me.

  THEN ME: I can’t believe you.

  NOW ME: Why?

  THEN ME: You are from the future, and I have no future.

  NOW ME: I just told you . . .

  Pills

  I HAD GONE days without proper food. I hadn’t noticed the hunger because of all the other crazy stuff that was happening to my body and brain. Andrea told me I needed to eat. She went to the fridge and got out a carton of Don Simon gazpacho (in Spain they sell it like fruit juice).

  ‘Drink this,’ she said, unscrewing the cap and handing it over.

  I took a sip. The moment I tasted it was the moment I realised how hungry I was so I swallowed some more. I’d probably had half the carton before I had to go outside and throw up again. Admittedly, throwing up from drinking Don Simon gazpacho might not be the surest sign of illness in the world, but Andrea wasn’t taking her chances.

  ‘Oh God,’ she said. ‘We’re going now.’

  ‘Where?’ I said.

  ‘To the medical centre.’

  ‘They’ll make me take pills,’ I said. ‘I can’t take pills.’

  ‘Matt. You need pills. You are beyond the point at which not taking pills is an option. We’re going, okay?’

  I added a question mark in there, but I don’t really remember it as a question. I don’t know what I answered, but I do know that we went to the medical centre. And that I got pills.

  The doctor studied my hands. They were shaking. ‘So how long did the panic last?’

  ‘It hasn’t really stopped. My heart is beating too fast still. I feel weird.’ Weird nowhere near covered it. I don’t think I added to it, though. Just speaking was an intense effort.

  ‘It is adrenaline. That is all. How is your breathing. Have you hyperventilated?’

  ‘No. It is just my heart. I mean, my breathing feels . . . weird . . . but everything feels weird.’

  He felt my heart. He felt it with his hand. Two fingers pressed into my chest. He stopped smiling.

  ‘Are you on drugs?’

  ‘No!’

  ‘Have you taken any?’

  ‘In my life, yes. But not this week. I’d been drinking a lot, though.’

  ‘Vale, vale, vale,’ he said. ‘You need diazepam. Maximum. The most I am able to give for you.’ For a doctor in a country where you could get diazepam freely over the counter, like it was paracetamol or ibuprofen, this was quite a significant thing to say. ‘This will fix you. I promise.’

  I lay there, and imagined the tablets were working. For a moment panic simmered down to a level of heavy anxiety. But that feeling of momentary relaxation actually triggered more panic. And this was a flood. I felt everything pull away from me, like when Brody is sitting on the beach in Jaws and thinks he sees the shark. I was lying there on a sofa but I felt a literal pulling away. As if something was sliding me towards a further distance from reality.

  Killer

  SUICIDE IS NOW – in places including the UK and US – a leading cause of death, accounting for over one in a hundred fatalities. According to figures from the World Health Organization, it kills more people than stomach cancer, cirrhosis of the liver, colon cancer, breast cancer, and Alzheimer’s. As people who kill themselves are, more often than not, depressives, depression is one of the deadliest diseases on the planet. It kills more people than most other forms of violence – warfare, terrorism, domestic abuse, assault, gun crime – put together.

  Even more staggeringly, depression is a disease so bad that people are killing themselves because of it in a way they do not kill themselves with any other illness. Yet people still don’t think depression really is that bad. If they did, they wouldn’t say the things they say.

  Things people say to depressives that they don’t say in other life-threatening situations

  ‘COME ON, I know you’ve got tuberculosis, but it could be worse. At least no one’s died.’

  ‘Why do you think you got cancer of the stomach?’

  ‘Yes, I know, colon cancer is hard, but you want to try living with someone who has got it. Sheesh. Nightmare.’

  ‘Oh, Alzheimer’s you say? Oh, tell me about it, I get that all the time.’

  ‘Ah, meningitis. Come on, mind over matter.’

  ‘Yes, yes, your leg is on fire, but talking about it all the time isn’t going to help things, is it?’

  ‘Okay. Yes. Yes. Maybe your parachute has failed. But chin up.’

  Negative placebo

  MEDICATION DIDN’T WORK for me. I think I was partly to blame.

  In Bad Science Ben Goldacre points out that ‘You are a placebo responder. Your body plays tricks on your mind. You cannot be trusted.’ This is true, and it can surely work both ways. During that very worst time, when depression co-existed with full-on 24/7 panic disorder, I was scared of everything. I was, quite literally, scared of my shadow. If I looked at an object – shoes, a cushion, a cloud – for long enough then I would see some malevolence inside it, some negative force that, in an earlier and more superstitious century, I might have interpreted as the Devil. But the thing I was most scared of was drugs or anything (alcohol, lack of sleep, sudden news, even a massage) that would change my state of mind.

  Later, during lesser bouts of anxiety, I would often find myself enjoying alcohol too much. That soft warm cushioning of existence that is so comforting you end up forgetting the hangover that will ensue. After important meetings I would find myself in bars alone, drinking through the afternoon and nearly missing the last train home. But in 1999 I was years away from being back to this relatively normal level of dysfunction.

  It is a strange irony that it was during the period when I most needed my mind to feel better, that I didn’t want to actively interfere with my mind. Not because I didn’t want to be well again, but because I didn’t really believe feeling well again was possible, or far less possible than feeling worse. And worse was terrifying.

  So I think part of the problem was that a reverse placebo effect was going on. I would take the diazepam and instantly panic, and the panic increased the moment I felt the drug have any effect at all. Even if it was a good effect.

  Months later a similar thing would happen when I started taking St John’s Wort. It would even happen to a degree with ibuprofen. So clearly the diazepam wasn’t entirely to blame. And diazepam is far from being the strongest medication out there. Yet the feeling and level of disconnection I felt on diazepam is something others claim to feel on it too, and so I think that the drug itself (for me) was at least part of the problem.

  Feeling the rain without an umbrella

  MEDICATION IS AN incredibly attractive concept. Not just for the person with depression, or the person running a pharmaceutical firm, but for society as a whole. It underlines the idea we have hammered into us by the hundred thousand TV ads we have seen that everything can be fixed by consum
ing things. It fosters a just-shut-up-and-take-the-pill approach, and creates an ‘us’ and ‘them’ divide, where everyone can relax and feel ‘unreason’ – to borrow Michel Foucault’s favourite word – is being safely neutered in a society which demands we be normal even as it drives us insane.

  But anti-depressants and anti-anxiety medication still fill me with fear. It doesn’t help that the names – Fluoxetine, Venlafaxine, Propranolol, Zopiclone – sound like sci-fi villains.

  The only drugs I ever took that seemed to make me feel a bit better were sleeping pills. I only had one packet of them because we’d bought them in Spain, where the pharmacists wear reassuring white coats and talk like doctors. Dormidina was the brand name, I think. They didn’t help me sleep but they helped me be awake without feeling total terror. Or distanced me from that terror. But I also knew that they would be very easy to become addicted to, and that the fear of not taking them could rapidly overtake the fear of taking them.

  The sleeping tablets enabled me to function enough to go home. I can remember our last day in Spain. I was now sitting at the table, saying nothing as Andrea explained to the people we were working for and technically living with (it was their villa, but they were rarely there) – Andy and Dawn – that we were going home.

  Andy and Dawn were good people. I liked them. They were a few years older than me and Andrea, but they were always easy to be around. They ran the largest party in Ibiza, Manumission, which had begun as a small night in Manchester’s gay village a few years before and morphed into a kind of Studio 54 in the Med. By 1999, it was the epicentre of club culture, a magnet for the likes of Kate Moss, Jade Jagger, Irvine Welsh, Jean Paul Gaultier, the Happy Mondays, Fatboy Slim and thousands of European clubbers. It had once seemed like heaven, but now the idea of all that music and all those party people seemed like a nightmare.

  But Andy and Dawn didn’t want Andrea to leave.

  ‘Why don’t you stay here? Matt would be okay. He looks fine.’

  ‘He’s not fine,’ Andrea answered them. ‘He’s ill.’

  I was – by Ibiza standards at least – not a drug person. I was an alcohol person. A Bukowski-worshipping eternal student who had spent my time on the island sitting down in the sun selling tickets at an outside box office while reading airport novels (during my day job selling tickets, I had befriended a magician named Carl who gave me John Grisham novels in exchange for Margaret Atwood and Nietzsche) and drinking booze. But still, I wished madly I’d never taken anything in my life stronger than a coffee. I certainly wished I hadn’t drunk so many bottles of Viña Sol and glasses of vodka and lemon during the last month, or had eaten a few proper breakfasts, or got a bit more sleep.

  ‘He doesn’t look ill.’ Dawn still had glitter on her face from wherever she had been the night before. The glitter troubled me.

  ‘I’m sorry,’ I said, weakly, wishing for a more visible illness.

  Guilt smashed me like a hammer.

  I took another sleeping pill and then my afternoon dose of diazepam and we went to the airport. The party was over.

  While on diazepam or the sleeping pills, I never felt any closer to being ‘fixed’. I stayed exactly as ill as ever. The most pills could do, I supposed, was place a distance there. The sleeping pills forced my brain to slow down a bit, but I knew nothing had really changed. Just as, years later, when I was back to drinking alcohol again, I would often cope with lower-level anxiety by getting drunk, all the time knowing that it would be there waiting for me with a hangover on top.

  I am reluctant to come out and be anti all pills because I know for some people some pills work. In some cases they seem to numb the pain enough for the good, real work of getting better to happen. In others, they provide a partial long-term solution. Many people can’t do without them. In my case, after my disorientating diazepam panic attacks I had been so scared to take pills that I never actually took anything directly for my depression (as opposed to panic and anxiety).

  Personally, for me, I am happy that I largely mended myself without the aid of medication, and feel that having to experience the pain minus any ‘anaesthetic’ meant I got to know my pain very well, and become alert to the subtle upward or downward shifts in my mind. Though I do wonder whether, if I’d had the courage to battle those pill-fearing panic attacks, it could have lessened the pain. It was such relentless, continuous pain that just to think about it now affects my breathing, and my heart can go. I think of being in the passenger seat of a car, as leaden terror swamped me. I had to rise in my seat, my head touching the roof of the car, my body trying to climb out of itself, skin crawling, mind whirring faster than the dark landscape. It would have been good not to have known that kind of terror, and if a pill could have helped, then I should have taken it. If I’d had something to lessen that mental agony (and really that is the word) then maybe it would have been easier to recover from. But by not taking it, I became very in tune with myself. This helped me know what exactly made me feel better (exercise, sunshine, sleep, intense conversation, etc.) and this alertness, an alertness I know from myself and others can be lost via pills, eventually helped me build myself back up from scratch. If I had been dulled or felt that otherness meds can make you feel, things might have been harder.

  Here is Professor Jonathan Rottenberg, an evolutionary psychologist and author of The Depths, writing in 2014 words that are strangely comforting:

  How will we better contain depression? Expect no magic pill. One lesson learned from treating chronic pain is that it is tough to override responses that are hardwired into the body and mind. Instead, we must follow the economy of mood where it leads, attending to the sources that bring so many into low mood states – think routines that feature too much work and too little sleep. We need broader mood literacy and an awareness of tools that interrupt low mood states before they morph into longer and more severe ones. These tools include altering how we think, the events around us, our relationships, and conditions in our bodies (by exercise, medication, or diet).

  Life

  SEVEN MONTHS BEFORE I first swallowed a diazepam tablet I had been in the office of a recruitment agency in central London.

  ‘So what do you want to do with your life?’ the recruitment agent asked. She had a long solemn face, like a sculpture on Easter Island.

  ‘I don’t know.’

  ‘Do you see yourself as a sales person?’

  ‘Maybe,’ I lied. I was mildly hungover. (We were living next to a pub. Three pints of lager and a Black Russian or two was my nightly routine.) I had very little idea of what I wanted to do with my life but I was pretty sure it didn’t involve being a sales person.

  ‘To be honest, your CV presents something of a foggy image. But it’s April. Not graduate season. So we should be able to find you something.’

  And she was right. After a series of disastrous interviews, I got a job selling advertising space for journalist trade paper the Press Gazette in Croydon. I was placed under the supervision of an Australian called Iain, who explained to me the fundamentals of selling.

  ‘Have you heard of Aida?’ he asked me.

  ‘The opera?’

  ‘What? No. AIDA. Attention. Interest. Desire. Action. The four stages of a sales call. You get their attention, then their interest, then their desire to do something, before they want to commit to an action.’

  ‘Right.’

  Then he told me, from nowhere. ‘I’ve got an enormous penis.’

  ‘What?’

  ‘See? I’ve got your attention.’

  ‘So, I should talk about my penis.’

  ‘No. It was an example.’

  ‘Got it,’ I said, staring out of the window at a bleak grey Croydon sky.

  I didn’t really get on with Iain. True, he asked me to ‘join the boys’ at lunch, and have a pint and a game of pool. It was all dirty jokes and football and slagging off their girlfriends. I hated it. I hadn’t felt this out of place since I was thirteen. The plan – mine and Andrea’s
– had been to sort our lives out so we didn’t have to go back to Ibiza that summer. But one lunch break I felt this intense bleakness inside me as if a cloud had passed over my soul. I literally couldn’t stomach another hour phoning people who didn’t want to be phoned. So I left the job. Just walked out. I was a failure. A quitter. I had nothing at all on the horizon. I was sliding down, becoming vulnerable to an illness that was waiting in the wings. But I didn’t realise it. Or didn’t care. I was just thinking of escape.

  Infinity

  A HUMAN BODY is bigger than it looks. Advances in science and technology have shown that, really, a physical body is a universe in itself. Each of us is made up of roughly a hundred trillion cells. In each of those cells is roughly that same number again of atoms. That is a lot of separate components. Our brains alone have a hundred billion brain cells, give or take a few billion.

  Yet most of the time we do not feel the near-infinite nature of our physical selves. We simplify by thinking about ourselves in terms of our larger pieces. Arms, legs, feet, hands, torso, head. Flesh, bones.

  A similar thing happens with our minds. In order to cope with living they simplify themselves. They concentrate on one thing at a time. But depression is a kind of quantum physics of thought and emotion. It reveals what is normally hidden. It unravels you, and everything you have known. It turns out that we are not only made of the universe, of ‘star-stuff’ to borrow Carl Sagan’s phrase, but we are as vast and complicated as it too. The evolutionary psychologists might be right. We humans might have evolved too far. The price for being intelligent enough to be the first species to be fully aware of the cosmos might just be a capacity to feel a whole universe’s worth of darkness.

  The hope that hadn’t happened

  MY MUM AND dad were at the airport. They stood there looking tired and happy and worried all at once. We hugged. We drove back.