Week 5 reflections: depression and bipolar
At the end of each week, we’ll invite you to take a few moments to reflect on the texts, topics and ideas that we’ve been exploring together in the week’s course steps. We’d love to hear any further comments or insights that you have about the course materials we’ve been looking at over the last few days, and we’ll also be sharing a few of our own final thoughts as we round up the week.
You can read our reflections on Week 5 below.
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 of ‘the black dog’ has endured as a potent and apposite way of characterising the experience of depression, capturing both the darkness of the condition and its persistence, its ‘dogged’ refusal to leave. A number of learners may already be familiar with ‘the black dog’ as a term for depression, and some because of Matthew Johnstone’s illustrated book I Had a Black Dog, the animated version of which can be viewed here. We wanted to give those of you who haven’t seen Johnstone’s video the opportunity, particularly because of its very straightforward approach to explaining 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.
We began this week by looking together at John Clare’s ‘I Am’. Separated from Johnstone’s book by nearly two hundred years, Clare’s poem nonetheless seems to evoke many of the same emotions and experiences as the ‘Black Dog’ cartoon. Clare’s descriptions and metaphors convey a profound sense of isolation and emotional turmoil; his ‘shipwreck’ metaphor is powerful in its evocation of confusion and hopelessness, while his sense of being ‘forsaken’ by his friends is suggestive of the isolation, as well as the loss of self-esteem that so often accompanies depression. In ‘I Am’, even loved ones – the ‘dearest’ – are described as ‘strange – nay, rather, stranger than the rest’, capturing the bewildering, seemingly insurmountable detachment from those closest to them that depression sufferers often feel. The final stanza of the poem, meanwhile, evokes solitude as a comfort, a relief, ‘untroubled and untroubling’. Like Dr Johnson, Clare lived at a time before the clinical diagnoses of ‘depression’ and ‘bipolar disorder’ existed, yet his words still resonate, capturing an experience that is familiar to many people today. We believe that poems such as Clare’s ‘I Am’ can help people to realise that they aren’t alone in their thoughts and emotions, and can also give the friends and family members of someone affected by depression an invaluable insight into the condition.
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. Their accounts shared some notable similarities; all three, for instance, spoke of the impossibility of reading anything as long as a book – or even, in some cases, a whole poem – in the grip of depression. In other respects, however, Melvyn’s, Rachel’s and Stephen’s experiences differed markedly from one another. Rachel’s account is a potent reminder of the impossibility of separating the mind from the body. Some of you may not have been aware that depression could manifest itself so physically; yet we’ve learned, over the past five weeks, that stress can weaken the immune system, that ‘heartbreak’ is not just a metaphor, and so it’s not surprising that depression can cause intense physical pain.
Our focus, in the second part of the week, was bipolar disorder. After talking to Mark Haddon about his play Polar Bears, we were encouraged to reflect on the language of mental health, and on the possible issues surrounding the labels that are used to refer to mental health conditions. Mark explained his own concern with labels, suggesting 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. Language undoubtedly has the potential to shape thought, and it is vital that we think of people as more than just categories and diagnoses. On the other hand, it is often still the case that mental health conditions are taken less seriously than other health conditions; euphemistic words like ‘eccentric’, therefore, might contribute – albeit inadvertently – to the trivialisation of mental health. For the same reason, we have tried to scrutinise the stereotypical association between bipolar disorder and creativity this week, so as not to gloss over the often destructive and distressing nature of the condition’s manic phases.
Not only is the language of mental health complex, powerful and personal, but it is also changing all the time. We are no longer familiar with more archaic descriptions like ‘melancholia’, or even with Samuel Johnson’s ‘depressed spirits’, but the term ‘manic depression’– though medically outdated – is still relatively common in everyday conversation. Indeed, some people, including a few learners from the first run of Literature and Mental Health, prefer ‘manic depression’ as a name for the condition, as they feel it more accurately describes their own experience.
Given the intensely personal nature of mental health, it is unsurprising that there are no easy answers when it comes to deciding 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. Rachel likened the repetition of familiar words to being ‘verbally stroked’, and we’ve invited learners to share their own memorable lines in the discussions this week. Certain sentences from novels and other prose works can serve as powerful, personal mantras, but we feel that the rhythmic, even incantatory quality of poems, songs and religious verses lends them a particularly soothing quality.
Like Rachel, we find Emily Dickinson’s ‘“Hope” is the thing with feathers/ That perches in the soul’ an immensely reassuring phrase, characterising hope as a small and fragile but nevertheless constant comfort at turbulent times. Other popular mantras include 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 some other favourites – including a few of the lines shared by learners in the first run of Literature and Mental Health – in the PDF of this week’s poems, which can be downloaded at the bottom of the page.
In last week’s summary, we reflected on some of the problems and concerns associated with the concept of ‘curing’ PTSD. Depression and bipolar disorder are also complex conditions to treat, and putting pressure on people to ‘be cured’ – to ‘get better’ – can be unhelpful and potentially even harmful, causing those affected by the conditions to feel as though they’ve failed if their symptoms haven’t yet gone away. Perhaps it is more helpful to think about treating or managing depression and bipolar disorder in terms of ‘care’, both of others and of ourselves. Rachel Kelly stressed the importance of a holistic approach to looking after mental health. Medication, Mindfulness, regular exercise, cognitive behavioural therapy, counselling, support groups, listening to music, caring for pets: these are just some of possible methods for combating or coping with depression, but it is unlikely that a single one of these will offer a quick or permanent ‘fix’, like a course of antibiotics or a routine of regular exercises to strengthen weak knees. We’re aiming, in this online course and through the other work of ReLit, to explore reading as another tool in the kit for helping people to look after their mental health, but we by no means want to detract from other options, including pharmacological treatments. Medication is ineffective for some people – as it was for Rachel Kelly – and for others, concerns about potential side-effects understandably outweigh the possible benefits of pharmacological treatment. However, for many people, 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’.
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.
Lisa Genova’s novel Still Alice tells the story of a woman diagnosed with early-onset Alzheimer’s disease. We’ll be reading and discussing some extracts from the novel this week, in order to better understand the difference between dementia and normal, age-related memory loss.
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.
We’re sure that many of our learners will, at some point in their lives, have been close to somebody with depression. This can be an isolating, upsetting and emotionally exhausting experience. We all want to help our loved ones when they are suffering, but it can be incredibly hard to know what to do for the best. 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.
© University of Warwick