WHEN THE DARKNESS COMES

One Man’s Journey Through the Rabbit Hole

Chapter 10

The Chemical Accountant

Once the doctor and his questionnaire had finished with me, my anger had acquired a name. I had walked into his surgery believing I was a bloke with a problem controlling his moods and occasionally his temper, but the doctor was calling it depression, which was a considerably different proposition from the one I thought I had brought through the door. The possibility of hospitalisation had already demonstrated just how seriously he regarded it, and suddenly we weren’t simply discussing how to stop me becoming angry quite so easily; we were talking about treating something I hadn’t realised I had.

That change in terminology mattered because I still didn’t particularly feel sick. I could understand anger because I had seen it, experienced it and occasionally inflicted the consequences of it upon people around me, whereas depression belonged to a category I hadn’t previously attached to myself. Nevertheless, the doctor had given the thing a name and, having rejected hospitalisation, the next question was what we were going to do about it. Medication became part of the answer, and Xanax was the first attempt at chemically treating what I had walked in calling anger and walked out knowing as depression.

Looking back through my diaries, I think that was around 2012. There had certainly been no previous pharmaceutical campaign against depression because, until that doctor’s appointment, I hadn’t really been conducting a campaign against depression at all. I thought I had moods, anger and a tendency to react rather more enthusiastically than circumstances occasionally warranted, and I wanted something done about those. The terminology had changed rather more quickly than I had.

Xanax, or alprazolam, is actually a benzodiazepine rather than an antidepressant, although that distinction wasn’t particularly important to me sitting on my side of the doctor’s desk. I was the patient, he was the doctor, and one of the things I did throughout this period was follow his lead rather than decide that an accounting qualification also entitled me to dabble in pharmacology. Whatever label belonged on the medication, my interest was considerably simpler: would it do something about the moods?

What I remember much more clearly than the medical reasoning is the absence of anything dramatic happening afterwards. There was no morning when I woke up, threw open the curtains and discovered that somebody had returned the world in Technicolor. Robyn didn’t look across the breakfast table and announce that the man she had married had suddenly reappeared, and I didn’t bounce into the office singing because modern medicine had finally discovered where somebody had hidden happy.

The change, to the extent that there was one, was almost imperceptible. It reminds me of the narration accompanying Rick Wakeman’s Journey to the Centre of the Earth (1974 – A&M Records), where the travellers are moving through the tunnels and one colour gradually becomes another, brown giving way to a dullish grey so subtly that there is no identifiable point at which one ends and the other begins. That was much closer to my experience of medication than somebody switching on a light.

The mood swings seemed to become less severe. The peaks weren’t quite as high and the troughs weren’t quite as low, but there wasn’t any corresponding movement of the whole thing towards somewhere I particularly wanted to live. Brown had become dullish grey, perhaps, but nobody had mentioned that dullish grey was supposed to be the destination.

That distinction mattered because I hadn’t gone looking for emotional mediocrity. I wanted to feel better, and in my fairly unsophisticated interpretation of that word, better involved some movement towards happy. I wasn’t expecting to spend every morning skipping through fields singing show tunes, because even without depression that would have represented a fairly substantial personality change, but I did expect there might be some identifiable improvement in the underlying bloke.

What I hadn’t understood was that reducing sad wasn’t necessarily the same thing as producing happy. I had assumed there was some sort of emotional continuum, with depression sitting down one end and happiness somewhere up the other, and that successful treatment would start moving me along it in the right direction. If the troughs became shallower, surely at some point the whole emotional landscape would begin to rise with them.

That wasn’t what I experienced. The troughs could be clipped and the peaks could be clipped with them, leaving me operating within a narrower band, but narrowing the band didn’t necessarily shift it upwards. I could be less down without being more up, and that was a distinction I hadn’t contemplated when we started.

Perhaps that sounds ungrateful because reducing the depth of a depressive trough is hardly an insignificant outcome when you are the bloke sitting in it. I wasn’t dismissing the value of being less angry, less volatile or less capable of plunging as deeply as I had before, and there were undoubtedly people living under the same roof who had an interest in those outcomes as well. The difficulty was that I hadn’t walked into the doctor’s surgery simply asking him to remove some of the worst parts of me; somewhere in my head I had assumed we were also trying to recover some of the best ones.

I was seeking happy, not merely a reduction in sad. Happy didn’t have to mean euphoria, and it certainly didn’t mean wandering around with a permanent grin while everybody wondered what else the doctor had prescribed. I meant the ordinary version of happy: looking forward to something, enjoying it when it arrived, laughing without having to manufacture the laugh, feeling the satisfaction of solving a problem, enjoying Robyn’s company, the boys, golf, fishing, music or simply reaching the end of an ordinary day and thinking it had been a pretty good one.

That was what I thought better meant. I wasn’t looking for the absence of something so much as the return of something, and perhaps that expectation was unfair to the medication or based upon a complete misunderstanding of what it was intended to accomplish. I didn’t know enough about depression or its treatment to make that distinction at the time, and I certainly wasn’t sitting opposite the doctor debating the philosophy of happiness.

I just knew what I was waiting for, and it wasn’t arriving. If anything, the experience began to expose a question I hadn’t previously known enough to ask: if you take some of the depth out of sadness but don’t restore the capacity for happiness, exactly where have you moved the person?

There was another complication because life wasn’t providing particularly clean laboratory conditions in which to find out. The accounting practice was becoming increasingly stressful during those years, with the pressures continuing to build towards its eventual sale, so every attempt to judge whether I was feeling better was being conducted against a background that kept supplying perfectly legitimate reasons not to feel particularly wonderful.

Clients still had problems, deadlines remained deadlines and telephones continued to ring with the remarkable ability telephones possess to do so precisely when you would prefer that they didn’t. Whatever was happening chemically inside me had to occur while I continued being an accountant, employer, husband, father and all the other versions of Jeff who didn’t disappear simply because somebody had written a prescription.

That made the accounting considerably more difficult because there was no control group and no alternative Jeff available for comparison. I couldn’t run one version of myself through those years medicated and another without medication, then sit them beside each other at the end and compare the results. There was only me, living the life I already had, while waiting for some indication that treatment was doing more than sanding the sharpest edges off both ends of my emotional range.

Perhaps that was the fundamental mismatch between what medicine was achieving and what I thought we were trying to achieve. A reduction in the severity of the troughs could reasonably be called an improvement, and from the outside a reduction in the volatility of my moods might have looked like progress as well. From where I was standing, however, I kept looking further up the scale for happy.

I wasn’t finding it.

That is probably one reason I don’t have a wonderful catalogue of physical symptoms from the period. We weren’t sitting around conducting a controlled experiment and recording the results on a clipboard; we were moving along, changing things under the doctor’s direction when they didn’t seem to be doing what we hoped, then moving along some more. The practice wasn’t going to suspend operations while I determined whether Tuesday’s mood represented an improvement over Monday’s, and neither was the rest of my life prepared to provide particularly useful experimental conditions.

There certainly wasn’t a John Denver Rocky Mountain High (1972 – RCA Records) experience waiting on the other side of the prescription, with friends gathered around a campfire while everybody communed with nature and discovered how wonderful it was to be alive. I didn’t have those sorts of friends anyway, and had I suggested that we all head into the mountains to sit around a fire contemplating the majesty of the universe, most of the blokes I knew would probably have asked what the hell the doctor had put me on. That wasn’t the sort of high I was looking for, nor was I expecting medication to manufacture some chemically enhanced version of happiness that had never previously belonged to me.

What I wanted was considerably more ordinary and, to my mind at the time, considerably more reasonable. I wanted to recognise happy when it arrived and perhaps have it stay around for a while, rather than merely discover that sad had become slightly less sad. If the treatment took a little depth out of the troughs, that was useful, but I kept waiting to see whether anything corresponding appeared at the other end.

Mostly, however, we simply got on with things. I went to work, dealt with clients, worried about the practice, came home, kept Robyn informed and periodically reported back to the doctor while we tried another adjustment or another medication. There was no campfire, no Rocky Mountain high and certainly no chorus of friends celebrating my emotional rebirth; there was just ordinary life continuing around an experiment whose results remained frustratingly difficult to identify.

Robyn knew what was happening because she was living under the same roof and deserved to know what I was trying to do. She wasn’t standing over me with a laboratory coat and a checklist, reporting changes in the subject, but she was beside me watching while I tried to work out whether anything useful was happening. I kept her in the loop because whatever happened inside my head inevitably had consequences outside it.

Something was happening, although it wasn’t necessarily what I had ordered. There was one side effect that was considerably less imperceptible than the change in my moods because sexual function disappeared, or at least enough of it disappeared for the matter to become impossible to ignore. I had gone looking for assistance with something I wanted to lose and discovered that the medication was quite capable of taking away something I had absolutely no desire to surrender.

There is no particular need to become coy about that because sex was part of my life, just as anger, work, golf, sleep, family and everything else was part of my life. If I am going to write honestly about the consequences of depression and the attempts to treat it, it would be rather peculiar to become Victorian because one of those consequences happened below the waist. More importantly, it was the first consequence of the medication that seemed considerably easier to identify than whatever benefit I was supposed to be receiving from it.

So we changed things, although I don’t remember an enormous procession of different medications and I don’t intend to reconstruct one now merely to make the story more medically impressive. The experiment probably occupied no more than a year or two, different options were tried under the doctor’s direction, and I followed that direction. I wasn’t adjusting doses myself, stopping tablets because I’d read something on the internet or arriving at appointments with my own treatment protocol.

For all my willingness to question experts in areas where I know enough to question them, medicine isn’t accounting. I could describe what was happening to me and decide whether I liked the result, but I wasn’t pretending to understand the chemistry responsible for it. My contribution to the exercise was essentially to report whether the tunnel looked any different, and mostly it looked dullish grey.

If I put my accountant’s hat on now, I can see why the idea of a ledger is tempting. Accountants like transactions because something happens on one side and something corresponding ought to happen on the other. We become suspicious when the accounts don’t balance, and I have probably spent much of my life assuming that emotions should demonstrate a similar respect for double-entry bookkeeping.

The medication ledger, however, wasn’t particularly complicated. The mood swings moderated a little, which belonged on the benefit side, while the sexual consequences sat rather more prominently on the other side. The entry I kept waiting to make was happy, and there was never sufficient evidence to bring it to account.

That was the problem with any notion of a trade-off because a trade-off assumes that there are two things of sufficient value sitting on opposite sides of the transaction. If medication had delivered a significant improvement in how I felt while extracting a price somewhere else, I would at least have had something to consider. There would have been an uncomfortable calculation, certainly, but at least there would have been a calculation to make.

That wasn’t the calculation confronting me. I wasn’t choosing between being happy and having a functioning sex life, difficult though that discussion might have been. I was looking at slightly reduced peaks and troughs, no meaningful movement towards happy and a side effect I definitely didn’t want.

There is a danger, looking backwards, of turning that experience into an argument about antidepressants generally, and it isn’t one. I don’t know enough about them to conduct that argument, and even if I did, somebody else’s experience could be entirely different from mine. My evidence is limited to what happened to me during that relatively short period when medication became one of the things we tried.

Nor did medication hollow me out until there was only some chemically compliant approximation of Jeff wandering around in one of my suits. I could still work, think, advise clients, solve problems and function in the world in much the same way I had before. I don’t remember losing my humour, ambition, concentration or appetite for whatever new project had attracted my attention, and I shouldn’t manufacture those losses now simply because they would make the chapter more dramatic.

In some ways, that was precisely the point because I was still recognisably Jeff. I was simply Jeff with somewhat flatter peaks and troughs and a new problem I hadn’t possessed before we started trying to solve the old one. If the purpose had been to make me easier to plot on a graph, perhaps we were making progress, but that wasn’t why I had walked into the doctor’s surgery in the first place.

I wanted to be happy, although even writing that now makes me wonder whether I was asking medicine to provide something no tablet could reasonably be expected to manufacture. Happiness isn’t a blood-pressure reading and there isn’t a neat numerical range where somebody can point at the result and declare the patient successfully happy. Perhaps what I meant was simply that I wanted the darkness lifted sufficiently to allow happiness to get back in, but I doubt I was making distinctions that sophisticated at the time.

Whatever definition I was using, I knew we weren’t getting there. The practice pressures continued to build around me, which makes it impossible now to separate every emotional movement from everything else that was happening. Was a particular trough depression, medication, exhaustion, business pressure or simply a shitty Tuesday? I don’t know, and reconstructing the period fourteen years later doesn’t give me licence to pretend that I do.

That uncertainty is important because depression has repeatedly frustrated the accountant in me by refusing to reconcile. I can identify some triggers with considerable confidence and others only with hindsight, while on still other occasions I can find nothing on the other side of the entry at all. Medication briefly offered the possibility that perhaps chemistry could impose some order where logic had failed, but my experience of it was considerably less decisive.

It seemed mainly to narrow the range. That wasn’t nothing, because reducing the severity of mood swings was one of the reasons I had gone looking for help in the first place, but neither was it the movement towards happy that I had imagined treatment might produce. Somewhere between those two observations sits the fairest description I can give of the experiment now: there was an effect, but it wasn’t the effect I had gone looking for.

Eventually we stopped pursuing that particular avenue. There wasn’t a dramatic consultation in which I threw the tablets onto the doctor’s desk and announced that Western medicine had failed me, because that isn’t what happened and isn’t what I believe. We simply reached the point where, other than those slight adjustments to the peaks and troughs, there didn’t seem to be enough useful change to justify continuing the experiment.

I have always had a fairly simple view about repeatedly hitting your head against a brick wall. There may be some satisfaction in demonstrating your determination, but eventually the evidence suggests that the wall is considerably less likely to move than your head is to hurt. Persistence is an admirable quality when something is changing, but it becomes considerably harder to defend when the principal result is another bruise in exactly the same place.

There is a quotation routinely attributed to Einstein about insanity being the practice of doing the same thing over and over while expecting a different result. Whether Einstein actually said it is considerably less important to me than the logic behind it, because by then that was effectively what our medication experiment had become. We weren’t literally taking the same tablet repeatedly and expecting magic, because different medications were tried, but we were repeating the broader experiment: change the chemistry, wait, watch the peaks and troughs flatten a little, discover an unwanted side effect and then look around for the happy I had assumed would eventually appear.

The accountant in me couldn’t ignore the pattern forever. Cause and effect had been part of the exercise from the beginning: take this and see what changes, change that and see whether something else changes, reduce one effect and discover another. The problem was that the one effect I was actually seeking remained stubbornly absent from the accounts, because nowhere in that sequence could I find a convincing entry for happy.

Perhaps that was because I had misunderstood what medication could reasonably be expected to deliver, and I am still prepared to leave that question open. I had walked into the process thinking that if depression was what had taken happiness away, then treating the depression ought somehow to allow happiness to return. Instead, my experience was that we could alter the dimensions of the darkness without necessarily introducing any more light.

I had given it a go, followed the doctor’s lead, tried the medications and waited to see whether brown would become grey, grey might become something lighter and eventually there might be enough light ahead to suggest we were travelling somewhere worthwhile. Brown did become dullish grey, and for a while we kept walking because continuing down the tunnel made sense while there remained a reasonable prospect that the next change might be the one we were looking for.

Eventually, however, continuing began to feel less like travelling towards something and more like repeatedly walking into the same wall. The medications could change, the dosage could change and the precise shade of the tunnel could change, but the outcome that mattered most to me remained much the same. At some point Logical Jeff had to acknowledge the evidence: changing the shade of the tunnel wasn’t the same thing as finding the way out, and hitting my head against the wall again wasn’t making a door appear.