Shoot the Damn Dog: A Memoir of Depression (17 page)

I never did find out the patient’s name. I knew only that every few hours or so, she would get out of bed and throw herself with thunderous force against the walls, bruising herself badly and cracking her head against the plaster. And then they would pick her up and put her back into bed. And so it went on.

Suicide attempts in psychiatric units are, not surprisingly, frequent and the desperation of the suicidal is, in the old sense of the word, pathetic. The cutlery is plastic and so are the cups in order to avoid serious injury (broken china makes too effective a sharp edge to be allowed) but that does not stop people sawing at their wrists with a barely serrated plastic knife. When I was there, a woman soaked her bed pillows in water then climbed into a full bath and held them over her face. When the staff found her, she was very cold, with skin like a prune. She was also alive and inconsolable at the thought. Another gouged bloody holes in her wrists with a pair of eyebrow tweezers. There was nothing to be done about the glass light bulbs and most of us in there wondered why it was that they were not used more often, either as blades or ground up and eaten.

The hospital was divided into floors, according to particular conditions. I was on the ground floor, with the depressives—‘the saddos’ as we were known—as well as those suffering from severe anxiety disorders, or both, as depression is often accompanied by severe anxiety. On the floor above us, there were more saddos, depression being the most prevalent of the mental illnesses, and above that was another floor containing the sectioned patients, put there against their will because they were too sick, too violent or simply too unwilling to be admitted voluntarily. On the top floor was the detox unit, for alcoholics and drug addicts (‘alkies and druggies’), who were often moved down to be with the saddos, once they had cleaned up. Then there was the eating disorders unit across the road, containing mainly teenage girls but some older, long-term anorexics and bulimics.

All of us, with the exception of the sectioned patients (or ‘sections’ as they were known) ate together in the canteen. Most conditions clustered at tables together, saddo with saddo, alkie with druggie and the anorexics with a nurse, to supervise their eating. The talk was always of medication (depressives sound like they’ve swallowed medical textbooks whole) or therapy, with particular attention given to the inadequacies, real or imagined, of each therapist.

It was like being back at school; the therapists, like teachers, were each given nicknames, none of them flattering. But that’s what happens when the balance of power is catastrophically disrupted; when you are incapable of fending for yourself or staying alive and feel powerless to do it in any adult sense, you slip easily into the role of the dependant.

It was not long after I had been admitted, perhaps the second day, when I was confronted as I helped myself to a plate of food.

‘Hello,’ he said, in a tone so knowingly familiar that I stopped in my tracks.

‘Hello,’ I said.

He peered down at me. He was very tall, with black curly hair hiding most of his face.

‘I know you.’

This is always a tricky situation in a mental hospital, particularly when the person in question is skeletally thin and wearing full black leathers and multiple piercings. I had no recollection of him but my memory, at that time, was not at its best. Did he know me or was I part of some virtual reality playing in his head?

‘Of course,’ I said, because it seemed simpler to agree.

‘What are you in for?’

‘Depression. You?’

‘Drugs,’ he said, as if I would have guessed for sure. ‘You know. The old days.’

I tried to place him. Fashion? Magazines? Fleet Street? Nothing about him was familiar. I shrugged. ‘Well, they got us both, in one way or another.’

‘They sure did.’ He raised a benevolent hand. ‘Be well,’ he said and faded away.

‘Who was that?’ Nigel asked.

‘I have no idea.’

‘Consorting with the druggies already,’ he teased.

‘No, I mean I really have no idea. Absolutely none. But he knows me. Or, he thinks he does.’

‘He’s Thin Lizzy,’ said Nigel. ‘Or he thinks he is.’

We are standing on a cobbled mews street in London. It is ten thirty at night and a faint drizzle makes the pavements shine. I am wearing a nightdress and a pair of flip-flops. According to Nigel, I wore flip-flops all the time, mostly unsuitably he says, but I don’t remember. They were jewelled, and my toenails were painted red. I remember the painted toenails. I had developed a fixation with my hands and feet, believing that if they were perfectly manicured and painted, then I still had some semblance of control. I chose to ignore the fact that I couldn’t manage the parts in between. I had worked in or around fashion for twenty years but had so lost any connection to or understanding of myself, that I no longer knew how to get dressed. Getting dressed requires an identity I seemed to have lost or, at any rate, mislaid.

Standing in the mews in flip-flops in the rain, I realise that most of us are out of our heads on drugs. Or, rather, more out of our heads than usual. Our medication is always handed out at nine thirty precisely, so we are an hour into our dose. There’s a faint buzzing in my ears from the sleeping pills I have taken. Max dosage, or so the nurse who gave them to me said.

‘Now you’ll sleep,’ she pronounced cheerfully.

That was before the fire alarm sounded and the entire intake of the hospital spilled out into the back street. Some, the most serious cases, had to be carried, bundled in blankets.

One man is propped in a wheelchair, head lolling, spittle dribbling across his cheek.

Around him, people talk excitedly, voices high-pitched and hyperactive. Most smoke furiously. It looks like some mad rave, a warehouse pyjama party. A phalanx of nurses stands further up the street, arms crossed like bouncers, although they are there to keep us penned into the mews, not to keep us out.

A woman is shouting. She is bone thin, with transparently white skin and wild red hair and is wearing a ripped lace negligee under a battered old leather jacket.

‘My fucking psychiatrist fucking sectioned me,’ she yells, at no one in particular. ‘I said to him, “What the fuck are you doing, fucker?” I’m not mad. How dare you section me? Don’t you fucking know who I fucking am? I’m fucking Janis Joplin, you fucker!’

And she starts to sing, her voice rising over the wail of sirens as the fire brigade arrive. As Joplin imitations go, it’s not bad but everyone ignores her.

A voice says, ‘Sally?’

I turn around. A sweet-faced woman is staring at me. She is young and pretty although the bloat of alcohol is in her face. She must only be in her thirties, and is hugging a Gap hooded top over striped men’s pyjamas. For a moment, I can’t place her.

‘It’s me,’ she says. ‘Lily.’

I do know her. She’s a fellow writer.

‘Hello,’ I say. I don’t ask her how she is. In the loony bin, you learn not to ask questions like that.

‘What are you in for?’ she says.

‘Depression. You?’

‘I’m with the alkies, top floor. They put me in here, occasionally, to dry out. Then I go and do it all over again.’ She pulls a face. ‘I drive everyone mad. Have you got any money?’

I look down at my nightdress and flip-flops and my empty, bare hands. They look half dead under the neon of the street lights. ‘No.’

‘Pity. The pub up the road’s still open. We could get a swift one in before closing time.’

A man behind us takes off, starts running up the road, whooping loudly. The great escape. The phalanx of nurses edge together nervously.

‘He’s got the right idea,’ Lily says, watching his progress towards the pub.

Halfway up the road the man stops, his arms held wide, then swoops back towards us like a deranged bird.

‘Got any money?’ Lily says to him.

‘It’s a blast,’ he says, panting. ‘You should try it. It’s like
freedom
!’

‘Have you got any money?’ Lily says.

‘Silly bitch,’ he says, then all energy seems to leave his wire-thin body and he flops down on to the wet pavement. ‘Do you think they’ll let us back in soon?’ he whines plaintively. ‘I’m tired.’

Lily turns abruptly and disappears into the crowd. I hear her voice, trailing high above the noise. ‘Anybody got any money?’

It is the last time I see her. Two years later, I hear from some mutual friends that she is dead from an accidental overdose, complicated by excessive alcohol. I am sad, but not surprised.

A nurse appears, framed in the lit doorway. ‘Back to bed, everyone,’ he says. ‘Excitement’s over.’

We shuffle back in to the building like obedient children. Apparently some madman set fire to his bed. Or a pile of magazines. Or a letter he took exception to. The stories vary.

There are two more fire drills that week. Neither are false alarms.

Tom comes to see me every night, after the six o’clock meal. We lie on the hard single bed, arms around each other. I kiss him and he kisses me back, and then he pulls away.

‘Too weird,’ he says. We lie together, not talking much. I don’t know what he’s thinking. I don’t ask and he doesn’t say. I try to tell him something about my day, the routine that we slip into as easily as a warm bath. It is comforting to be told where to go and what to do, and even what to think, when you haven’t the strength to decide for yourself. It is hard, though, to explain that to somebody who still carries the smell of the outside world, sharp and clear and tearingly familiar, so I don’t.

Tom never stays long. I feel his eagerness to be gone, even as he arrives. I don’t blame him. It’s not a place to linger, unless you have to.

I have begun to make friends among my fellow patients. There are around thirty of us depressives but, even though I listen to their stories in group, most of them remain as opaque to me as they, presumably, do to themselves.

One of the friends I make is Andy, who is suicidal. He was admitted after stabbing himself six times in the stomach, with a kitchen knife. He was discovered, early in the morning, lying under a bush on an empty stretch of common ground, quietly bleeding to death. He cannot remember how he got there or, even, really why. They took him to hospital and stitched together his innards and then sent him here, to have his head examined. His head is shaved, or perhaps it is bald, and he has a bullish neck and a belly on him that must, or so one can only hope, have cushioned some of the severity of the blows.

‘Did it hurt?’ I say.

He rolls his eyes. ‘Of course it fucking well hurt. And only a loony would ask that question.’

Despite his appearance, he is a gentle man and a graphic designer by trade. Business is bad. It’s an unforgiving profession and Andy feels, more than anything, unforgiven. Not just by his work, but by everything.

He is inquisitive and makes friends easily, almost too determined to be liked, and is not in the least disconcerted by his surroundings. He seems, more than that, to enjoy them. Some people do. After the lonely hell of mental illness, a hospital with all its rules and regulations can seem like a safe haven.

He’s not one of the smokers, although he hangs out with them. They gather outside my room, which is right at the end of the corridor, tucked away on its own. There is a table, a cluster of chairs and two overflowing ashtrays and, at any given time, three or four people smoking furiously. I don’t know why we need a smoking area, as we’re allowed to smoke in our rooms. I encounter the smokers every time I step out of my room to go and make a cup of tea in the small kitchen up the corridor.

‘Sorry, sorry.’ Kate flaps her arms furiously to dispel the smoke, but only manages to shoo it straight through the open door into my room. Not that it will make much difference. My room is already thick with smoke.

Kate is big and loud and glamorous with dark hair, streaked with tawny blonde, and hazel, cat’s eyes. She wears hoodies and track pants ‘the only thing that’ll fit my fat ass’ and white trainers with fluorescent stripes. And false nails, ‘these are perfect, the best, I’ll tell you where to get them done, if you like’ and lots of jewellery. She works in advertising. It seems the wrong job for somebody with a crippling anxiety disorder. Not that you’d credit it now.

‘You wouldn’t recognise her as the same person who arrived here,’ Nigel says later. ‘She hardly spoke, and kept her arms wrapped tightly around herself and her head right down. And she wore these spooky glasses, very narrow and severe. We were all completely terrified of her.’

Kate is laughing at something that Susie has said. ‘Silly cow.’ The two are inseparable, bound together by their mutual diagnosis of a severe anxiety disorder. ‘Sorry about the smoking,’ she says again, flapping her arms inconsequentially in the air.

‘It’s fine,’ I say. ‘No problem.’

Andy says, ‘We’re having a party. Would you like some birthday cake?’

I shake my head. I’ve been crying for hours. I’m not in the mood to face people.

‘Bad day?’ Kate says.

I shake my head again, not trusting myself to speak, and start walking up the corridor.

‘Catch you later,’ Kate calls.

We meet again in group therapy and bond in Negative Automatic Thoughts. This is one of the strands of Cognitive Behavioural Therapy (CBT), the form of therapy used most often in psychiatric units and by the NHS. This is partly a financial decision as CBT is thought to be effective after ten sessions, rather than the ten years, or more, usually devoted to Freudian-based analysis.

Unlike analysis, CBT pays only a nodding reference to the past and concentrates instead on solving present problems. One of those, or so it is thought, is that depressives hold to a rigid pattern of negative thinking which leads us to act in self-defeating ways. The central tenet of CBT is that thoughts beget behaviour—hence its name,
cognitive
, as in thoughts, and
behavioural
, as in actions.

In essence, it consists of a number of repetitive exercises designed to identify and then challenge those negative thought patterns and put fresh ways of thinking and behaviour in their place. It is designed as a course of exercises; it has a beginning, a middle and an end, so by its particular nature it is possible to assess results empirically, a virtue that no other form of therapy (which is by nature, unstructured; wandering through childhood, stopping off at adolescence, coming into adulthood and meandering back to childhood again) can lay claim to. And, because hospitals and health services like to see results, or evidence-based programmes and because it is time-limited, it has become the most highly regarded and therefore most popular form of therapy on offer. In many local health services, it is the only form of therapy available.