Hold On, Pain Ends
One of the deepest, darkest depressions I have ever witnessed was in a young man, aged just 18, who I shall call Gareth.
His mother, a very worried woman, had dropped him off for his first session having outlined to me what she felt was the essence of the problem.
Gareth’s mental health issues began around the age of 14, when he started using drink and drugs to excess. At 16, he had spent some time in a mental health unit where he was given powerful antipsychotic medication which he felt had damaged his brain beyond repair.
He had dropped out of sixth form, unable to cope with the building pressures of exams and now spent most of his time in his room, often up all night, sleeping all day and only emerging to eat.
Gareth's energy was so depleted he had difficulty actually forming the words to tell me his story. There was a sense of sorrow and stillness around him which was almost tangible and which felt to me like grief. Even with his hood up, I could detect the haunted expression in his eyes I have witnessed before in severe depression.
However, when he did speak, it was clear this fragile young man was both intelligent and articulate. Halfway through the session, he leaned forward and quietly spoke the words, in a flat, emotionless voice, which made my blood run cold;
‘I will be dead by the age of 21’
‘How can you be so sure?’ I asked.
‘Because’ he said, ‘if I still feel like this, I will kill myself.’
Gareth had lost hope. When people lose hope, they consider suicide and, it was clear to me in that moment, that Gareth and I were going to have to work very hard together to make sure his dark prediction did not come true.
A perfect storm
In February 2016, figures published by the Office for National Statistics showed that youth suicides are on the increase. In 2014, 201 young people between ages of 10 and 19 killed themselves in the UK; more than 10% up on 2013.
It is an accepted fact that suicide is the biggest killer of people under the age of 35. Shockingly, in a recent report by the University of Manchester, it was identified that 29% of those who committed suicide, were facing exams, or exam results, and that 4 children had died on the actual day of an exam, or the day after.
Modern life, and our refusal as a society to deal adequately with the building stressors, is providing all the conditions for ‘a perfect storm’ in mental health and it is our children that are suffering the most.
The advent of 24/7 access to intrusive social media has added to the problems of peer pressure. There is an epidemic of online bullying. The traditional family structure is shifting, changing and becoming ever more complicated with single-parent families, divorce, separation and remarriage. We are seeing more and more children placed in a ‘care system’ which, on the face of it, doesn’t actually seem to care.
There are increasing multicultural and intercultural pressures as never before, as well as the threat from those who see a dark opportunity to radicalise and fill with hate, young people just at the point when they are trying to create their own sense of identity, meaning and purpose.
Growing academic pressures result in some children feeling crushed, not just by life, but by a school system which is not geared to take a holistic view of education and some of which have become what Norman Lamb worryingly described, in his 2015 mental health report, as ‘exam factories’.
Paradoxically, it seems the government is now criticising the very ‘tick box’ systems they have helped to create. Children and teachers need support, but they need the right kind of support; something really effective that gives the quickest benefit at the lowest cost.
In the classroom, children’s emotional problems can show up as low mood and lethargy, low confidence and self-esteem, or underachievement and lack of focus.
There may be high anxiety which tips over into aggression or bullying; and for some, even more significantly, the kind of loss of hope I saw in Gareth, which can lead to thoughts of self harm or suicide.
It’s not enough to simply identify the problem. We have to have a sense of the most effective solution or, better still, prevention. Endlessly fighting of forest fires is not the answer. We must manage the conditions which lead to the fires in the first place.
I wondered whether, in the moment my young client expressed his intention to end his own suffering, whether he had any sense of the deeply intimate connection he made with me, not just professionally but personally.
His tale of ineffective NHS mental health support resonated with my own, near-fatal experience of post natal depression many years earlier. It seemed in the intervening years, nothing much had changed for the better.
Also, the beautiful young man sitting so sadly in front of me reminded me of my own eighteen year old son; similar in so many ways and yet so different. Having achieved successful A-levels, he was now far away in India on a gap year that would become a life changing spring board to his bright future.
Gareth should be on his gap year now too, I felt, not here in my office, crushed and broken by his depression and crushed too by our mental health system’s inappropriate and ineffective response to his needs, which had so cruelly robbed him of hope.
Psychiatrist and holocaust survivor, Viktor Frankl observed, ‘we have seen that a man can survive three weeks without food, three days without water, but barely three minutes without hope.’
It was clear to me, that the starting point for my work with Gareth was to begin to try and restore that hope.
As his energy was so low, I asked him to just close his eyes and listen as I began to teach him how to bypass the damaging thoughts present in his left brain. I would now speak directly to his right hemisphere, which understands the world in a deeper, more intuitive way. This is what I said:
‘Gareth, I believe there is nothing wrong with your brain. The problem is the depression which has got in the way for a while. I believe the old you, the real you, is now waiting to re-emerge, like the sun, from behind those passing clouds.
Your body has the amazing ability to heal if you provide the right conditions for that to happen; something you can see clear evidence of when you cut your finger and put a plaster on it. It is not the plaster which does the healing, but your body which knows how to grow new skin over old wounds.
And it’s good to know your amazing neuro-plastic brain can heal too. It is constantly rewiring itself, forming new neural pathways to replace old, outdated or damaged ones. That is how stroke patients are able to re learn the skills they have lost. Our brains know how to reconfigure. All we have to do, like the plaster, is provide the right conditions for that healing to happen.
Your amazing brain knows how to ‘time travel’ as well and, as you sit there, in your imagination, you can drift forward to a time in the future when any current difficulties are just a thing of the past, and you can look around you in that happy future life, see what it looks like and, more importantly, from that point in the future, allow yourself to look back and notice what you had to do to get you there.
And, while a part of you considers your bright future, another part of you can listen to a story, much as a child would listen to a story at bedtime. It’s a story about a river:
In a distant land, far off, a long time ago, there was a river.
The river was a powerful and vibrant river and served its community well. But the river knew it must go on a journey onward and towards the sea.
So the river set off, passing through green valleys and pastures until, one day, it came to a desert; a dry, cracked and cruel land and, try as it might, the river could not cross this desert. The river grew exhausted and called out in its frustration ‘Can no one tell me how to get past this terrible place?’
The sun and the wind heard the cries of the river and said ‘do not worry; you have all the resources you need. Simply allow us to help.
The sun shone and the wind blew and turned the river into light and fluffy clouds that were carried high into the air and which floated effortlessly across that terrible place into the safety of the mountains on the other side, where they collected as heavy raindrops into a powerful and vibrant river once more.
And, in this way, the river was able to continue its journey onward and towards the sea.’
Gareth came to see me for many months as he returned to his studies and I knew things were improving when he passed his driving test and started driving himself to see me rather than being dropped off by mum.
Like the path of the river, our work together took many twists and turns. Sometimes I was counselling, sometimes I was coaching. Often, we were both tossed and turned by the storms created by his intense thoughts and emotions, but the waters gradually calmed and stilled.
In the time I was with him, I passed on to Gareth, all the skills of mind management I hoped would build a 'wall of resilience' to protect him after our work together was complete.
All this happened many years ago.
But the image of Gareth sitting on the old velvet sofa in my office, returned to me quite clearly, when he contacted me recently on LinkedIn to tell me he had just started work on his PhD in cognitive neuroscience.
Sometimes it just feels good to be alive.