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Week 5 summary: Depression and bipolar

Week 5: Depression and Bipolar

Each week, we’ll be reading through your comments and reflections to collate them into a summary, giving an overview of some of the conversations that have been taking place on the course. You can read the summary for week four below. We know that lots of you have taken part in Jonathan’s other University of Warwick FutureLearn course Shakespeare and His World, and we’re delighted that you’ve decided to join us again! If you’ve taken part in Shakespeare and His World, you’ll be used to watching video round-ups at the end of each week. These round-ups provide an excellent opportunity for us to reflect on the week’s content and comments, but they are time-consuming to produce, and we felt that, for this course, it was more important to spend that time getting involved in the conversations on the discussion feeds. For this reason, we’ll be writing text summaries, based on our collective experiences over the week.

The black dog

When Winston Churchill spoke – as he often did – of his own depression as ‘the black dog’, he was in fact borrowing the metaphor from the great 18th century writer Dr Samuel Johnson. ‘Depression’, as a clinical diagnosis, did not exist when Dr Johnson was writing; yet his metaphor has endured as a potent and apposite way of characterising the experience of the condition. A number of learners were already familiar with ‘the black dog’ as a term for depression, some because of Matthew Johnstone’s illustrated book I Had a Black Dog, the animated version of which can be viewed here. This link has already been shared by several of you in the discussions this week, but we wanted to give those of you who haven’t seen it yet the opportunity, particularly because a number of learners have commented on the reassuring simplicity with which it explains some of the symptoms of depression. We’ll be thinking more about some of the challenges faced by friends, family and loved ones later in the summary, but we also wanted to share another ‘black dog’ video here, entitled Living with a black dog. This short cartoon offers advice to those living with and supporting people who are suffering from the condition.

Several learners who had not come across the metaphor before were nonetheless struck by the aptness of ‘the black dog’ as a description of depression, observing, for instance, that this canine embodiment captures the persistence of the condition, its ‘dogged’ refusal to leave. Others, meanwhile, chose to share their own metaphors in the discussions, characterising depression as a monster, or as a large black bird that sits on the sufferer’s head, blinding and stifling with its feathers. Though there are evident similarities between these descriptions, the fact that several different metaphors have emerged in our conversations serves as an important reminder that the experience of depression will differ from person to person.

Learners’ responses to John Clare’s ‘I Am’ also speak to this variety of experience. Many of you commented to say how moved you were by the poem, with some of you able to identify with the profound sense of isolation and emotional turmoil that Clare’s words convey. Yet the particular lines or images that learners picked out to illustrate this identification ranged widely. For some learners, the ‘shipwreck’ metaphor was most powerful in its evocation of confusion and hopelessness. For others, the sense of having been ‘forsake[n]’ by friends and loved ones was familiar, while others, again, remarked that the feeling of detachment that can often accompany depression was more movingly articulated in the poem’s second stanza, in which the ‘dearest’ are described as ‘strange – nay, rather, stranger than the rest’. The kind of solitude evoked in the final stanza of the poem, meanwhile, seemed appealing and comforting to some learners, who could identify with Clare’s ‘long[ing] for scenes were man hath never trod’.

Week 5: Depression and Bipolar

We were very fortunate, this week, to be able to talk to three of our course contributors about their own experiences of depression or bipolar disorder. Melvyn Bragg, Rachel Kelly and Stephen Fry spoke with incredible openness about the impact of these conditions on their lives, and we are immensely grateful to them for offering to share their stories with us. Learners were able to recognise elements of their own experience in these three, very different testimonies. While Rachel’s physical suffering was unfamiliar to some of you, others could identify almost entirely with her account of the condition. Melvyn’s description of becoming ‘obsessed with yourself’ during periods of depression, meanwhile, was a source of comfort and reassurance to many, who were encouraged to hear this talked about as a necessary response to the condition, rather than – as it sometimes, sadly, still is – a selfish or self-indulgent behaviour.

Our focus, in the second part of the week, was bipolar disorder. Particularly in response to our conversation with Mark Haddon about his play Polar Bears, a significant number of learners reflected in their comments on the language of mental health, and on the possible issues surrounding the labels that are typically used to refer to mental health conditions. Some of you agreed with Mark that the positive and interesting connotations of a word like ‘eccentric’ are preferable to medical categories that seem to overlook difference and close down conversation. Others, however, felt that it was important to acknowledge bipolar disorder as an illness, and that a euphemistic term like ‘eccentric’ overlooked the difficulty and suffering caused by the condition. Similarly, a number of learners were wary of the stereotypical association between bipolar disorder and creativity, emphasising, like Dr Andrew Schuman, the often destructive and distressing nature of the condition’s manic phases.

A few learners remarked on the tendency for ‘bipolar’ to be used as an adjective, rather than as the name of a condition. Whereas we’d usually say that someone has depression, dementia or PTSD, it’s not uncommon for a person to be described as bipolar. This, for a number of you, is a deeply troubling use of terminology, which leads to a person being defined by their condition. Although the diagnosis is now medically outdated, some learners still prefer ‘manic depression’ as a name for condition, observing that it more accurately describes their own experience. Given the intensely personal nature of mental health, it is unsurprising that no general consensus has emerged, this week, about how we should refer to particular mental health conditions. We hope, however, that these conversations will encourage us all to think more about the language of mental health, and to listen to and respect individual preferences.

The thing with feathers

In our conversation, Rachel Kelly spoke to us about how a single line of verse became a ‘lifeline’ for her in the grip of depression. Many of you liked Rachel’s idea of being ‘verbally stroked’ and soothed by the repetition of familiar words, and a few learners could identify very closely with Rachel’s experience, having also been helped by lines of poetry when no other forms of treatment were working.

After listening to Rachel’s testimony, we invited you to share any lines or sentences that have served as mantras for you during difficult times. Although some people chose short extracts from novels and other prose works, it is unsurprising that the majority of you shared lines of poetry, religious verse or song lyrics. Emily Dickinson’s ‘“Hope” is the thing with feathers’, a poem that Rachel often turns to, was mentioned by a number of learners in the discussion. Several other mantras also featured multiple times in the comment section, including the opening line of Max Ehrmann’s Desiderata, ‘Go placidly amid the noise and haste’, and the adage, first appearing in the work of Persian Sufi poets, ‘This too shall pass’. We’ve included these and a few of the other lines shared by learners in the PDF of this week’s poems, which can be downloaded at the bottom of the page.

Week 5: Depression and Bipolar

Several learners, this week, have expressed their concern about the concept of ‘curing’ depression. Some of you have remarked that the pressure to ‘be cured’ of depression – to ‘get better’ – is unhelpful and potentially even harmful, causing people to feel as though they’ve failed if their symptoms haven’t yet gone away. The term ‘care’ struck many of you as a more helpful and appropriate way of thinking about the treatment of depression; Rachel Kelly stressed the importance of a holistic approach to looking after mental health, and this was a sentiment echoed by a significant number of learners. Along with reciting or listening to lines of verse, Mindfulness, regular exercise, caring for pets and listening to music were among the therapeutic activities discussed by learners this week. There have also been a number of conversations in the comment sections about the use of medication in the treatment of both depression and bipolar disorder. As we heard from Rachel, medication is ineffective for some people, while for others, concerns about potential side-effects understandably outweigh the possible benefits of pharmacological treatment. However, for many people – including a number of learners who’ve commented this week – medication can be incredibly helpful, either for the short-term alleviation of symptoms or for the ongoing management of a condition. Throughout the course, so many of our contributors have stressed that a single approach to treatment will not be effective for everyone. It’s hugely important, therefore, that people are made aware of the various different treatment options available, without judgement and without any pressure to ‘get well soon’.

Coming soon

We can hardly believe that we’ll soon have reached the final week of Literature and Mental Health: Reading for Wellbeing. We’re incredibly grateful to those of you who have chosen to join us over the past five weeks of this course, and we hope that you’ll carry on the conversation with us in week 6 and beyond.

In the course’s final week, we’ll be reflecting generally on the experience of ageing, as well as finding out more about the associated mental health condition, dementia. We’ll hear from GP Dr Simon Curtis, who’ll be talking to us about the causes, symptoms and treatment of dementia, and explaining that the term ‘dementia’ in fact refers to a collection of symptoms that can result from a variety of different conditions, including Alzheimer’s and vascular disease. We’ll also be speaking to Melvyn Bragg about his autobiographical novel Grace and Mary, and we’ll be reflecting with the actor Sir Ian McKellen on the depiction of ageing in Shakespeare’s tragedy King Lear.

Although dementia can sometimes develop earlier in life, it is a condition that predominantly affects people in old age, so as average life expectancies increase, it seems inevitable that dementia will become more and more common. Impeding memory and communication, dementia can be very distressing for the sufferer, as well as for friends and family members. We still understand relatively little about treatment and prevention, but studies are beginning to demonstrate the therapeutic value of poetry workshops for dementia sufferers. In the final part of the week, we’ll be thinking about the relationship between poetry and memory, and about how poems learned ‘by heart’ are often retained long after other memories are lost.

Final thought: the kite string

In the third scene of Mark Haddon’s play Polar Bears, John describes himself as ‘the person holding the bottom of the kite string’. We’ve touched on the effects of mental health conditions on friends, family and loved ones a few times in the course, but we wanted to end this summary by thinking a little more about the people who live with and, in some cases, care for someone who suffers from depression or bipolar disorder. Mark’s play, Rachel’s memoir and the Living with a black dog cartoon all emphasise how difficult it can be to understand what someone with a mental heath condition is experiencing, and to know how to help them. In Black Rainbow, Rachel describes how her mother distributed an Anne Sexton poem among her friends in an attempt to give them some insight into how Rachel was feeling; interestingly, our course GPs have also used works of literature when training other doctors, to help them better to understand their patients’ experiences.

A number of you have reflected, this week, on your own experiences of being close to somebody with depression. Learners have written bravely and honestly about feeling helpless, isolated and emotionally exhausted while trying to help a loved one affected by the condition. It is, of course, important to support friends and family members through difficult times, even when that support might seem in vain; but it is also vitally important to take care of yourself. We’d like to end this this week by encouraging all learners who live with or care for someone with a mental health condition to make sure that they, too, have people with whom they can share their feelings, and to pay attention to their own wellbeing.

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Literature and Mental Health: Reading for Wellbeing

The University of Warwick

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