I’m an assistant psychologist and just finished my position in Cumbria for the NHS. I studied for my BSc in Psychology at Anglia Ruskin University in Cambridge and I am now pursuing an MSc in the Foundations of Clinical Psychology. I will soon be working at another NHS Trust as an assistant psychologist once my DBS has cleared. My background has mostly been as a support worker in an autism domiciliary care agency, to the working as a researcher in COPD research, to my most recent position. On a voluntary basis, I peer review papers for Oxford University. In my spare time, I like to Cuban Salsa and like to cycle at the weekends.
- What does depression mean to you?
I have experienced depression for nearly 10 years now since my teenage years.
Depression for me, I have now accepted that it is part of my personality. For years, I kept on trying to challenge my low mood but after a while, I felt that with the help of ‘fight or flight’ my mind felt like it just gave up in questioning and accepted the symptoms of depression.
In my opinion, I feel that we need to modify our views both from a clinician’s perspective and societies in the word ‘depression’ and the many different ‘faces’ that it appears in people. For example, I feel that there is types of depression called ‘high functioning’, I guess in brief just like the autism spectrum. On one side of the spectrum you have classic symptoms of the original list of autistic symptoms and then on the other end of the spectrum, you used to have Asperger’s (which is now Autism Spectrum Conditions), with the added bonuses such as the ability to be fluent in verbal communication and to be able to ‘fulfil’ a ‘neurotypical’ life with minimal support in some cases (generally speaking). So in the context of depression, I feel that yes there are many people with depression around the world, despite whichever society or culture they are living, however not every person suffering people can actually notice until it is often too late.
For example in my own life I have managed to have a large group of friends from all over the world, I am now studying for my Masters at Anglia Ruskin University in Cambridge, I peer review papers for Oxford University and work as an assistant psychologist in the NHS and also provide talks and lectures to local universities in regards to depression or the autism spectrum through The British Psychological Society and the list goes on.
When socialising with people I have just met and the topic of mental health comes up or I am questioned in a talk that I have provided I can sometimes get asked ‘Sam how do you understand the perspectives of someone with a mood disorder so thoroughly, as no disrespect but you are still young and you have yet to study for your doctorate’ and that is when I reply with, that’s because I live and experience the condition every single day and people are left shocked and inspired at the same time.
I had one student that I could overhear and was talking to his peers that I was only admitting this because I wanted attention, I am consciously choosing to think negatively and it is a form of narcissism and I’m not depressed at all, if he was, he should be in an inpatient or psychiatric ward somewhere’. I have to admit that it has stayed with me, as I felt that is was an out of order comment but at the same time felt that times need to change and people need to be educated, hence why I lecture and try and express through research and blogs such as Fraser’s to express what it is like to raise awareness.
Depression is like ivy growing over the front of somebody’s house. Without realising, the owners have no idea that the roots have formed underneath their house, because of a leaking water pipe allowing for drops of water to fall on the ground to feed the ivy, helping it to grow further and therefore allows it to start to creep up to the front window. People then realise and before they know it, it has grown up to the top of the roof. It looks nice in the summer with bright green leaves and in the autumn the leaves turn a reddish brown and the leaves finally drop off in winter. Even though the leaves have fallen off, the roots are still underneath the house and also stuck on the exterior of the house like a leach. I feel that depression is like that, in that no matter what season, the depression may get to the point that the symptoms of low mood have disappeared, and then all of a sudden it comes back and it feels as hard as the first time you experienced it years and years ago the struggle continues.
The winter months with a significant decrease in the sunshine and therefore vitamin D, even though I am unsupportive of pharmacology for mild to moderate depression, I genuinely think that Vitamin D supplements are a great help, as well as an accredited lamp for Seasonal Affective Disorder. I use both and it takes time over a course of around 4 weeks but I really recommend, as the winter months not only affect those experiencing depression but also people who do not suffer from any mood disorders.
- How has depression affected your life?
I appear confident, happy and well-liked, with an incredible family and upbringing but underneath the mask, I feel sadness and guilt from the time I wake up to the time I go to sleep, even my dreams create the same feelings of worthlessness. It is tough. Really tough. However, I am not as bad as some people who live in a hospital ward, so I have full empathy and compassion for people who have not received the help and support they need.
To put this mask on requires and consumes mental energy that is limited and it is about preplanning on a daily basis on what to do. Some days my calendar could be full from 8 am to 11.30pm, other days I may struggle to get out of bed before 10 am, and I am unable to do anything. On a good day, which means that the clouds have gone and the sun has been able to appear through the greyness, I am able to plan ahead and decide what to do. For example if I have been invited to a party in the evening, the limited mental energy I know that it is best to be by myself in a library or in the office and then when I socialise at the party I will have enough energy to smile, join in conversations, appear positive and appear to fit in.
If I had meetings throughout the day at work and then invited to go to a party in the evening, I just would not have the energy to be able to put the mask on and be what everyone wants me to be, which is to be the entertaining and joker of the group. Instead, I sit in the group, daydreaming, questioning about my existence in the world, thinking about when the party will finish, getting short tempered when someone talks to me about something I am not interested in and therefore drains me even further. When going back home I would just sit on the edge of my bed or in the bath and think how negative I must appear to my friends who think the world of me and then it triggers my low mood further; insomnia and under eating for the next couple of days, as it adds fuel to the fire in my opinion on myself, which is using other people’s energy in me moaning, criticising and being negative. Again I must stress, in my heart and core I am happy, optimistic and outgoing but it just feels that there is a fault from my core to how I think, to how I then express and communicate.
What annoys and frustrates me the most is when somebody would tell me how negative I was and that I just think about myself, and it is so far from the truth. If only people realise that to even get out of bed in the mornings takes so much mental energy and to then try to fight back every millisecond in each day negative thinking, achy muscles and joints, as all I want is to make people happy, for them not to feel pain and to not feel distress that I feel and so many out there on a large scale and that is why I am so adamant to become a psychologist, as to be understood is such a powerful behaviour, regardless of having a diagnosis or not.
However, depression has not all been negative. I feel that the nature of depression, by reliving the memory or the experience that triggered the depression and the ability to keep thinking about it repeatedly in a visual way the memory has helped me to think creatively. When studying, it is second nature when studying to use mind maps, hand-drawn diagrams and the ability to remember these mind maps and diagrams when in exams or when in lectures for debates. I feel that before the depression I was ok for remembering things but thanks for the depression, for reliving memories visually, has strengthened long-term memory, especially for facial recognition! On the other hand, with the nature of depression, I score poorly on facial emotion recognition and think that the person is thinking in a negative way, which they are not. Therefore, there are advantages and disadvantages of living with the mood disorder.
As well as this, being able to see through someone’s ‘mask’ that many people are oblivious by but because you are experienced in acting, you can see what that person is doing and straight away can feel their pain, again an example of high functioning depression. I now have the confidence when I am socialising to go up and ask the person how they are (when the time is right) and when they say ‘Yes perfect thanks’, you know straight away to probe further. It has been useful in my line of work in clinical services as an assistant psychologist. A few patients who were going to be discharged, when just not ready but ‘appeared’ to be ready because of the reliance on verbal reassurance, rather than observing the person’s pattern of behaviour and their non-verbal cues.
- How do you think societies appreciation of depression has change, if atoll, in recent years?
I think yes society’s appreciation of depression has increased in awareness, thanks to advertising campaigns through MIND, the Samaritan’s and celebrities such as Rio Ferdinand and the boxer Ricky Hatton.
I believe that even though there is now awareness of depression and anxiety, I feel that it has raised a simplified and generalised image of what depression is like. In images, it is portrayed to be someone rocking on the side of the road, overdosed on drugs or drink and ending up in hospital. Of course, that does happen but in regards to my idea that there is a type called ‘high functioning’, we need to continue to raise awareness. Like in my case, I have everything ticked to appear as if I am successful, strong and ambitious, with the rare case that anyone would question my mental health. If I were unemployed for 5 years, taking drugs or abusing alcohol, someone would then question my mental health. So I guess that even though we have raised awareness that it is ok to have depression, the early stages and those that can hide their struggles, as most of the time you are at work or university, it can be covered not only the severity but the poison of the depression, slowly being injected each day, when you least expect it.
Perhaps if society could perhaps genuinely ask people ‘Are you ok, how are things at home?’, we could maybe prevent mood disorders becoming a problem. Most of the time if you answer someone who asks ‘How are you’, it is often because they want to talk about themselves for the next 40 minutes and feel bad that if they don’t ask how you are, they would appear selfish and arrogant. Instead, if we asked and were able to genuinely answer, yes it may take more time but could save so many people from carrying out something extreme such as suicide.
What really helps is that I am able to go home after work, university or a social event and I can literally stay quiet, which is when I am most comfortable, to be able to think and to concentrate on the near future. My family and close friends are fully aware that I am quiet and if I am loud and outgoing, it is normally because I am compensating my social anxiety or low mood, so I can see people smile and feel welcome, so I do feel so lucky and fortunate, as to be able to hibernate by isolating myself is key for me to be able to function and to regain the mental energy to balance the depression, general life duties and other life administration, including thinking of other people’s emotions and not just focusing on my own. As you can understand when in a depressive episode, as you are trying so hard to live and to function, it can be hard to then think about someone else’s mental state and can come across as cold or rude, so again it is about being aware and to prevent that in my personal life and at work with patients.
- What are your coping mechanisms when you experience depressive episodes?
My coping mechanisms have come from trial and error, to be honest.
Before my depression kicked in, I had bad anxiety that was blinding my ability to succeed and was making me doubt myself in everything that I did. Therefore, my first experience of a coping mechanism was cognitive behavioural therapy. This was a mixture of online exercises, by challenging my anxious thoughts and to try to find evidence that the thought that was irrational, whether it was actually true or not. Unfortunately cognitive behavioural therapy made my anxiety worse, leading to anxiety attacks, as I was adding even more limited mental energy to the thought that was disabling me, so instead of thinking about it every 3 or 4 minutes, when challenging my thought, it was then adding components to the thought, that I had previously forgotten about, so I was then thinking about the thought 1-2 minutes. By the evening, I was exhausted. However cognitive behavioural therapy has been effective for my depressive thoughts and when in depressive episodes. I use CBT less because my mind did not need to challenge the thoughts anymore, as I have remembered each challenging point and certainly helped me to focus on life and to put the thoughts that were triggering my depressive episodes into context.
Exercise helps; you hear it in the media so often now. When I say exercise, it can sometimes be to aim to walk to the shop and others could be a 20-mile bike ride. Again, it depends on how I am feeling and taking in to account what is going on in my mind and in life at that point in time. Just walking to the shop, getting out of your bedroom or study for just 5 minutes, what a relief it can sometimes be. Sometimes exercise is the last thing I need, if for example, I am tired/fatigued, it can be very uncomfortable, so I then decide to sleep and try again the next day, but not being critical of myself.
What I seem to do now is to use coping strategies from Compassion Focused Therapy.
My passion for both of these came from my lecturer at Anglia Ruskin University Dr Fiona Ashworth, who has been able to apply Compassion Focused Therapy to people with brain injury, to increase their self-compassion, decrease their feelings of guilt and worthlessness and to try and increase their behaviours that can help self-sooth and make them put irrational thoughts in to context, e.g. the brain injury has happened, it wasn’t their fault, give yourself compassion for wanting to get back on track and not dwell on the past but the near future instead (Wilson, Winegardner & Ashworth, 2013). So in this context, when I have been really unproductive because of a depressive episode, I think to myself that today just isn’t the day, I’m feeling low, I allow and accept depressive and irrational thoughts to come in to my mind and because I don’t challenge the thought, they seem to go for a couple of hours, which in time is a great relief and I can then focus. To help me feel soothed, I can sometimes just go to the pub with friends and have a pint or sometimes it can mean to go to the local spa and go in to the sauna to try and sooth the pain in my shoulders, where most of my pain is when in a depressive episode. Through the compassion focused therapy system (drive, soothing and threat), it is very effective and I feel that it is a well-recommended read or Youtube clip (Professor Gilbert in Derby).
Wilson, B. A., Winegardner, J., & Ashworth, F. (2013). Life After Brain Injury: Survivors’ Stories. Psychology Press.
- How has your line of work changed your appreciation of your depression?
I would say that my line of work has increased my appreciation for depression, even more so than before. Seeing how it can appear by itself and the patient does not experience any other psychological condition, in other patients, the depression can be secondary, as the primary problem is a chronic condition such as chronic obstructive pulmonary disease. It really has opened my eyes that depression is so varied and to simplify such a large condition should not be permitted. Depression is a mind disability if left unmanaged. When I say unmanaged I feel that if you get into a routine, you normalise it and when it comes to therapy, it can be conflicting when you are informed by the clinician that what you are thinking is ‘faulty’ and irrational. Preventing the depression from getting to moderate and severe is paramount.
- What advice would you give to someone who feels they are experiencing depression for the first time?
Someone who is experiencing depression for the first time I strongly feel for and reach out too. The pain and shock and how quick it operates into your mind and body is tough. Straight away, the feeling of shame, embarrassment and weakness kicks in and within 12 hours, feel like you are the only one, you feel lonely and have no idea what to do. Going to A&E, you think I do not have a physical problem; I cannot talk to my partner or family as they will laugh and then months and years can go by with such a negative effect on life by covering it up and in some cases trying to find the trigger by blaming everyone around you.
Therefore, what I strongly advise is to talk to your closest friend first, as sometimes it is nice to speak to them, as it is less pressurising then your partner or family. If not of course speak to anyone you are close to and express how you are feeling. Depending on the severity, self-refer by going online and finding your local Improving Access to Psychological Therapy service, as that would be the quickest form of action. In the meantime, go to your GP to inform them of what is going on and contact your local MIND, as they are funded to also provide assistance with a wide range of mental health conditions, with many very helpful brochures and leaflets that are written in a non-clinical sense and are so helpful. If it is too soon, there are helpful online resources through the Improving Access to Psychological Therapy service and can make you self-aware of the symptoms and behaviours of depression and hopefully in that way can educate you on what is going on.
- Would this advice be different to those who have been experiencing depression for a number of years?
I guess it depends if the person has followed all of the processes already through the NHS and MIND or if they have experienced depression for years and never has had any support, then the above does apply yes.
For those that have not received support for their depression that have experienced the condition for years, are a credit to themselves and I have lots of respect for them. I have had a couple of patients who had experienced depression from a childhood experience and self-referred years later because an unexpected bereavement had increased the behaviours that they have got used to, all of a sudden have increased in severity – i.e. the varied rate of eating, sleeping, irrational thinking and therefore started to increase anxiety and was too much and came in. Perhaps this is an example when the high functioning depression symptoms, change on the spectrum and become more centralised, so the symptoms become moderate, half classic symptoms and half high functioning i.e. the person is no longer able to cover up their symptoms and the symptoms are strong enough to disable their ability to function. I feel that with the Improving Access to Psychological Therapies are doing a great job, despite a small pot of money and again it is not perfect but we should be grateful that such a model exists because we do not currently have enough psychologists to see every patient that has a mental health issue.
The quote that I use on a daily basis is ‘Comparison is the death of happiness’.