WHEN THE DARKNESS COMES

One Man’s Journey Through the Rabbit Hole

Chapter 9

Uppers, Downers and Better Living Through Chemistry

I grew up through the sixties and seventies, when better living through chemistry seemed to be occurring all around us. There were things to pick you up, things to bring you down and apparently something available for most of the territory in between. Some came from doctors, some came from friends and some were effectively self-prescribed on the fairly uncomplicated medical assessment that somebody else had taken one and appeared to be having a wonderful time.

The language itself became part of the culture. There were uppers and downers, pep pills and tranquillisers, while Valium became sufficiently familiar for the Rolling Stones to sing about Mother’s Little Helper without needing to provide an explanatory footnote. Chemistry could wake you up, calm you down, help you sleep or apparently make whatever was happening inside your head more agreeable than it had been half an hour earlier.

I was never particularly attracted to any of it. That wasn’t because teenage or young-adult Jeff Banks had conducted a sophisticated assessment of pharmaceutical risk and reached an evidence-based conclusion about psychoactive substances. I simply had an aversion to the unknown, particularly when the unknown involved putting something into my body and waiting to discover what it might do to my head.

Alcohol was at least familiar territory and its effects were reasonably predictable, even if the quantity required to produce them occasionally interfered with the prediction. A tablet or substance somebody handed you with an assurance that it would make you feel terrific required a considerably larger act of faith. I have never been especially good at acts of faith when there was an unanswered question sitting beside them.

There was something else in there as well, although I doubt I would have articulated it at the time. I liked being in control, or at least believing I was in control, and voluntarily handing the controls of my brain to an unidentified piece of chemistry didn’t hold much appeal. I had enough confidence in Jeff Banks to prefer whatever was already happening inside his head to something chemically rearranging the furniture without first providing me with a floor plan.

Decades later, that certainty became considerably less useful because the thing happening inside my head was precisely what I could no longer control. The bloke who had once been wary of swallowing something because he didn’t know what it might do to his brain eventually reached the point where he had to contemplate swallowing something because he didn’t know what his brain was doing to him.

By my fifties I was dealing with anger that could no longer be dismissed as simply part of my personality. Staff could irritate me, clients could irritate me and things that might once have produced a grumble were capable of producing something considerably more explosive. Robyn inevitably received some of the fallout because she was the person closest to me, and eventually I reached the point where the bloke who had spent much of his life believing problems should be understood before they were attacked had to admit that he didn’t properly understand this one.

That was what took me to the doctor, and taking Robyn with me was important. I wanted her to hear whatever he had to say because I needed her to know that whatever was happening wasn’t her, despite the uncomfortable reality that she had probably received more of its consequences than anybody else. More significantly, making the appointment meant I had finally moved beyond my long-held proposition that stress existed only in the mind and therefore the mind should be perfectly capable of dealing with it.

In hindsight, walking through the doctor’s door was the first shot in the war against the Black Dog. I didn’t know what weapon we were going to use, whether there was actually a weapon available or even quite what we were fighting, but for once I had accepted that pushing harder wasn’t providing the answer. For somebody with my lifelong preference for understanding and controlling the things around me, that admission was probably more significant than I appreciated at the time.

The doctor then handed me a piece of paper, which seemed a remarkably ordinary response to something that had taken me decades to acknowledge. There were no machines, scans or blood tests involved, just a questionnaire that looked considerably less threatening than the problem that had finally brought me into the room.

The test didn’t look capable of changing very much. From memory it was a single sheet containing perhaps twelve questions, each with four possible answers ranging from something like all of the time through two variations in the middle to none of the time. You circled whichever answer seemed closest to the truth, handed the piece of paper back to the doctor and he assigned points to the circles. Add up the points, compare the total with a range, and apparently somewhere among those numbers was me.

There was something almost reassuring about that part because numbers had finally entered proceedings. Numbers I understood, and if depression could somehow be reduced to twelve questions, four possible answers and a total at the bottom of a page, perhaps Logical Jeff had finally been given something he could work with. The problem was that when the doctor added up those numbers, they told him something about me that I wasn’t remotely expecting to hear.

I had gone to the doctor because anger was becoming a problem. Staff could irritate me, clients could irritate me and things that might once have produced a grumble were capable of producing something considerably more explosive. Robyn inevitably received some of the fallout because she was the person closest to me, which was one of the reasons I had asked her to come to the appointment. I wanted her to hear whatever the doctor had to say because, whatever was happening inside my head, I needed her to know that it wasn’t her.

Going to the doctor had been my idea, which was significant in itself. For years I had maintained that there was no such thing as stress in the way people commonly described it because stress existed in the mind, and if it existed in the mind then surely the mind should be capable of doing something about it. It was a wonderfully convenient theory for a bloke whose preferred response to most problems was to identify them, work harder and push through until they surrendered. This particular problem, however, wasn’t surrendering.

I had spent a lifetime dealing with problems by attacking them. A difficult tax problem required research, a struggling business required decisions, a cash-flow problem required cash, and a deadline generally required more hours until the bloody thing was met. Problems belonged on one side of the desk and I belonged on the other, preferably armed with enough information and determination to beat them into submission.

Eventually I had to entertain the possibility that whatever was happening inside me might require the same treatment. The first shot in the war against the Black Dog wasn’t a tablet, psychiatrist or hospital bed; it was making the appointment and taking Robyn with me. I had finally moved beyond arguing that the problem existed only in my mind and therefore ought to respond to me telling my mind to pull its head in. Then the doctor gave me that bloody test.

I don’t remember agonising over the answers or attempting to manipulate the result. I answered the questions, circled the responses and handed the sheet back, after which the doctor performed whatever calculation the test required. There was something almost comfortingly familiar about that part of the process because numbers were involved, and numbers are supposed to make things clearer. These particular numbers didn’t.

The result was sufficiently concerning for the doctor to raise hospitalisation. That landed a considerable distance from where I thought we were heading because, as far as I was concerned, I wasn’t sick. I was just a little angry, perhaps more than a little angry if Robyn had been invited to give evidence, but anger was something that needed adjusting rather than something that required putting me in hospital.

I had walked into his surgery believing that I had a problem with moods and an increasingly short fuse that needed some attention. I hadn’t walked in thinking of myself as mentally ill, incapacitated or incapable of functioning, and there was plenty of evidence available to Logical Jeff to support that position. I was still running an accounting practice, dealing with clients, managing staff, solving problems, generating income and doing all the things I had been doing before somebody handed me twelve questions and started assigning numbers to my answers.

Hospitalisation therefore seemed completely disproportionate to the bloke I thought was sitting in the chair. Surely hospitals were for sick people, and I didn’t regard myself as sick; I regarded myself as pissed off far too often. There was an enormous conceptual distance between I need to do something about my temper and perhaps you should be admitted to hospital, yet apparently I had crossed it simply by answering a dozen questions honestly.

That was probably the moment the battle acquired a seriousness it hadn’t possessed when I made the appointment. Going to the doctor had been my first shot at something I had finally accepted I couldn’t fix simply by telling myself to get over it, but I had still imagined this would be a relatively contained engagement. Perhaps there would be some advice, perhaps some medication and perhaps Robyn would leave reassured that the anger wasn’t about her, after which I would presumably get on with the business of getting better.

The word hospitalisation changed the scale of what I thought we were fighting. I had arrived believing I was a functioning bloke who had become too angry too often, while the piece of paper in the doctor’s hand was apparently describing somebody requiring considerably more urgent intervention. For perhaps the first time, there was a substantial gap between the Jeff Banks I thought I knew and the Jeff Banks those twelve circles were describing, and I wasn’t remotely convinced they could possibly be the same man.

We therefore rejected hospitalisation, and part of the reason was stigma because this was still a world in which I worried considerably about being regarded as a nutcase. I knew I was living on the edge, or at least that was how I understood what had finally brought me to the doctor. I was angrier than I should have been, the fuse had become dangerously short and Robyn was seeing a side of me that I knew needed attention, but in my mind I was still standing on the edge rather than tumbling over it.

The bloody test apparently disagreed. According to the score the doctor had just calculated, I wasn’t standing near the edge looking down and recognising that I should probably move somewhere safer; I had effectively already fallen off it. Hospitalisation belonged, in my mind at least, to people who had gone over the edge, people who could no longer function normally or whose illness had become so obvious that the rest of life had to stop while something was done about it. I didn’t recognise myself in that description, yet the number at the bottom of that sheet of paper apparently put me somewhere uncomfortably close to it.

That distinction mattered enormously because I had a professional reputation and an accounting practice to protect. Clients trusted me with their businesses, money, tax affairs and sometimes their futures, and I wasn’t particularly keen to discover how comfortable they might be knowing that their accountant had scored sufficiently badly on a depression questionnaire for his doctor to contemplate putting him in hospital. There was a considerable difference between privately admitting that I was living on the edge and publicly allowing anyone to think I had fallen off it altogether.

Perhaps that was part of the contradiction I couldn’t yet see. I was using my continuing ability to function as evidence that I hadn’t fallen, while the doctor was using my answers to twelve questions as evidence that functioning wasn’t necessarily the same thing as being well. I could still put on the suit, walk into the office, advise a client and push the billing out the door, and from where I stood that meant I was still clinging to the edge; according to the score in his hand, I was already somewhere below it.

There was also a much more practical consideration. If I didn’t work, I didn’t get paid, and if I wasn’t at the practice driving the work, pushing the billing out the door and keeping everything moving, then the cash flow didn’t magically wander in by itself. There were staff depending upon the practice, a family depending upon the income and clients depending upon us continuing to do what they paid us to do. Hospitalisation might have been about looking after Jeff, but Jeff was carrying quite a few other people through the front door with him.

That probably sounds contradictory when placed beside a test suggesting that I was sufficiently depressed for hospitalisation to be considered. In my mind, however, I was still functioning, and I had decades of evidence to prove it. I was turning up, dealing with clients, solving problems, running the practice and earning money, so there was a considerable difference between what that sheet of paper was telling the doctor and what I thought the observable evidence was telling me.

I now know that functionality can be magnificent camouflage. Depression can answer a telephone professionally, discuss a tax problem, produce a set of accounts, make a joke, send an invoice and then go home carrying something nobody who spoke to you during the day knew was there. At the time, however, I wasn’t standing outside myself making those observations; I was the bloke inside the suit wondering how twelve circles on a sheet of paper had escalated into a discussion about hospitalisation.

Medication became the alternative we were prepared to try, and the pharmacy was adjacent to the doctor’s surgery. Robyn and I went next door and filled the prescription, and I don’t remember any great ceremony surrounding that first tablet or standing there contemplating a major turning point in my life. We had been told what the medication was supposed to achieve, I had agreed to take it, and as suggested I swallowed one straight away.

That tablet was the second shot in the war against the Black Dog; walking into the doctor’s surgery had been the first. Having finally accepted that there was something to attack, I was prepared to use the weapons being offered, so Robyn and I waited for the miracle to occur.

I don’t mean miracle quite as cynically as it sounds because I genuinely believed the doctor knew what he was doing. I had finally conceded that there was a problem requiring medical intervention, the doctor had identified depression through his testing, and medication had been prescribed to do something about it. My job, as I understood it, was to follow instructions, which is precisely what I did.

The explanation made sense. My moods had peaks and troughs, with the peaks sometimes producing anger and the troughs taking me somewhere considerably darker, so the medication was intended to reduce the distance between them. Bring the peaks down, lift the troughs, even everything out and presumably leave me functioning somewhere more comfortably in the middle. The slight complication with that proposition was that, as far as I was concerned, I had been functioning already.

Long before I arrived at that pharmacy, medicine had spent decades learning how to interfere with the chemistry of human mood. The story wasn’t a neat progression in which doctors suddenly discovered depression and then invented one increasingly perfect tablet after another. Some of the earliest modern antidepressants emerged in the 1950s almost accidentally, including the MAO inhibitors and tricyclic antidepressants that became important pharmacological treatments for depression. Later generations of drugs changed what doctors could prescribe and, in many cases, how tolerable treatment could be, but every advance brought its own limitations.

The wider culture had already become familiar with the idea that chemistry could alter how we felt. Librium arrived at the beginning of the 1960s and Valium followed a few years later, with benzodiazepines initially welcomed enthusiastically because they appeared to offer advantages over older sedatives such as barbiturates. By the 1970s they had become extraordinarily widely prescribed, while the problems of dependence that would later temper some of that enthusiasm were still becoming clearer. Medicine had discovered increasingly sophisticated ways of turning emotional dials, although it would continue learning that the dials were connected to rather more things than anyone might originally have hoped.

SSRIs changed antidepressant prescribing again from the late 1980s onwards. The pharmacology is interesting and the history matters, but I am not sufficiently interested in pretending to be a psychiatrist to take the reader through a guided tour of neurotransmitters. My experience was much simpler: I had a problem, medicine had drugs intended to attack that problem, and my doctor and I were going to find out whether one of them worked on me.

The first medication I remember by name was Xanax. There were others over the following months, but I can’t reliably remember their names and I have no intention of reconstructing my medical history by guessing at labels on boxes that disappeared decades ago. What I remember much more clearly is the process of trying something, discovering consequences, discussing them with the doctor and then trying something else.

In that sense, the doctor was experimenting on me, but I don’t use the word as an accusation. He wasn’t some mad scientist standing over me waiting to see whether smoke came out of my ears. He was trying to help, we were cooperating with him and the only practical way to discover how I would respond to different treatments was for me to take them and find out. We did that for the better part of a year.

The bloody test remained part of the process. I would answer the questions again, circle the appropriate responses and the doctor would assign the points, producing another number that could be compared with the ranges on his scale. Despite everything we were doing, I continued to fail the test miserably.

I find the word fail interesting because, strictly speaking, I don’t suppose there was anything to pass. It was a measurement rather than an examination, and nobody was going to give me a certificate if I eventually circled enough of the correct answers. Yet that is how my mind interpreted it because I was doing what I had been told, taking what I had been prescribed and still producing a score suggesting that something wasn’t right.

Some things were changing. The peaks and troughs were being reduced, and the medications could produce a numbness that I suspect was at least partly what we were trying to achieve. Angry Jeff was less likely to reach the same heights, while the emotional movement at the other end was also being constrained. If the objective was simply to flatten the graph, there were times when we were making progress, but the difficulty was that I lived on the graph.

My enthusiasm was there on that graph, as were my humour, ambition, frustration and excitement. My relationship with Robyn was there too, along with work, sex, irritation, satisfaction and all the other things that make a human being considerably more complicated than a line travelling across a piece of graph paper. Turning down emotional extremes sounds wonderfully precise until you discover that the control panel doesn’t necessarily contain separate knobs labelled ANGER, DEPRESSION, HAPPINESS, ENTHUSIASM and SEX LIFE.

The medication did its job with varying amounts of cost. What I particularly remember is that the cost wasn’t primarily some physical symptom such as a headache or upset stomach that could be dismissed as annoying but tolerable. It intruded into the physical relationship between Robyn and me, which was hardly an insignificant corner of the life we were supposedly trying to improve.

I will put this gently because there is no need to drag the reader unnecessarily far into our bedroom. The medications caused sexual dysfunction, including difficulty performing sexually, and it happened sufficiently consistently across what we tried for it to become an important part of the calculation. Depression had already interfered with our marriage through my anger and moods, and now some of the treatments intended to address that problem were interfering with another part of the same marriage.

There is an irony in there that even I can’t resist. The doctor had carefully explained that we were trying to reduce the distance between my peaks and troughs, but nobody had mentioned that one particular peak I had every intention of retaining might become considerably more difficult to achieve. Medical terminology can make these things sound wonderfully dignified; living with them tends to remove some of the dignity.

It wasn’t simply about sex, however, and reducing it to that would miss the much larger problem. The numbness mattered because eventually I began wondering what we were actually trying to create. I didn’t want to explode at people, I didn’t want Robyn receiving the consequences of something she hadn’t caused, and I certainly didn’t want to continue scoring badly enough on a questionnaire for hospitalisation to remain anywhere near the conversation. At the same time, there was one fairly basic thing I still wanted from whatever treatment we were attempting: I wanted to be happy.

Happiness was the part I couldn’t find. For nearly a year we tried different medications and different regimes while continuing to test where I sat on that piece of paper, and there were reductions in the peaks and troughs that made it unfair to say the drugs did nothing. They did something quite noticeable, but the place they were moving me towards didn’t contain enough of what I thought I was supposed to be trying to save.

There was no happiness, and that caused me considerable angst. I could understand the medical logic of reducing damaging extremes, particularly when one of those extremes was anger affecting the people around me, but I struggled with the proposition that a flatter Jeff was necessarily a better Jeff. If the trough was less deep but the top of the landscape had disappeared as well, I wasn’t sure we had arrived at the destination I thought we were travelling towards.

Perhaps that was an unreasonable expectation to place upon medication. A tablet designed to treat depression doesn’t arrive with a contractual obligation to make somebody happy, and happiness itself is too complicated to fit neatly into a prescription. I understand that now, but the man taking the tablets wasn’t conducting a philosophical inquiry into the proper objectives of psychopharmacology; he wanted to feel better.

There is a difference between less bad and good, and it is a distinction accountants should probably understand instinctively because reducing a loss does not automatically produce a profit. I wasn’t thinking about it in those terms at the time, though. I simply knew that we were apparently moving some of the numbers in the desired direction without producing the outcome I had imagined would accompany them.

The whole process was occurring behind a fairly firmly closed door. Other than Robyn, people around me didn’t know much about what was happening because we kept our cards very close to our chest. Part of that was simply the way I dealt with personal matters, but part of it was undoubtedly fear of what disclosure might mean.

The word depression carried baggage, and hospitalisation carried considerably more. I was running a professional accounting practice whose clients expected their accountant to be stable, rational, dependable and capable of helping them when their own worlds became unstable. Announcing that I had just scored badly enough on a mental-health questionnaire for hospitalisation to be discussed didn’t strike me as an obvious marketing strategy.

There was also the family income sitting underneath all of it. The accounting practice wasn’t a hobby I could temporarily place on the shelf while I concentrated on myself. It generated the money that supported the family and paid the wages, and my role was still heavily connected with keeping the work moving through the system and getting the billing out the door. Whatever was happening privately, life had to continue publicly.

So I went to work. I dealt with clients, managed staff, solved problems, generated bills and did all the things Jeff Banks was expected to do while Robyn and I privately went through this strange process of tablets, side effects, doctor’s appointments and that bloody test. If anybody looking from outside thought there was a war going on, they kept it to themselves.

There is something about that now that makes the suggestion of hospitalisation even more confronting in retrospect. I had walked into the surgery under my own steam, taken Robyn because I had enough awareness to recognise that something was wrong, and continued running a business throughout the period that followed. Yet the numbers on that piece of paper were telling a doctor that the man sitting opposite him was in considerably more trouble than the man himself believed.

Logical Jeff had plenty of evidence for the defence. The practice was open, clients were being serviced, wages were being paid and I was still capable of doing complicated work requiring concentration and judgement. Depressed Jeff apparently had twelve questions and a scoring system appearing for the prosecution, and the difficulty was that both sets of evidence belonged to the same bloke.

I never rebelled against the medication by suddenly deciding I knew better than the doctor and throwing the tablets away. When medications were changed or eventually stopped, that process was managed with the doctor because I had decided to seek medical help and I wasn’t going to ignore that help merely because parts of it were inconvenient. I had decided to attack the problem and, having done so, I followed the rules.

That matters to me because I don’t want this part of my story rewritten into a tale about Jeff Banks seeing through the pharmaceutical industry and bravely throwing away his pills. Nothing of the sort happened. Medicine had identified something I had failed to identify properly myself, the doctor was genuinely trying to help me and some of what he prescribed genuinely changed what we were trying to change. The problem was that every treatment also had to be judged against what it cost.

Sexual function was part of that cost, but emotional flattening was probably the more fundamental problem because it went directly to what treatment was supposed to achieve. If you remove some of the darkness by also dimming the light, at what point do you decide whether the exchange has been worthwhile? I don’t think there is a universal answer to that question, and I certainly wouldn’t presume to answer it for somebody else.

For me, eventually, the equation didn’t work. That doesn’t mean medication doesn’t work, because even within my own experience that statement would be too simple. The drugs changed things, and some of those changes were exactly what we had been seeking. What they didn’t do was deliver the version of better that I wanted badly enough to tolerate everything else that came with them.

Medicine itself has spent much of its history confronting variations of that problem. The early antidepressants were genuine advances despite their limitations, benzodiazepines genuinely helped people despite the dependence problems that became clearer with time, and later antidepressants provided options that changed treatment again. Progress does not require the previous treatment to have been useless; sometimes progress occurs precisely because something useful turns out not to be useful enough.

My own little experiment was considerably less grand. We attacked, observed the results, adjusted the weapon and attacked again. Somewhere along the way I discovered that collateral damage isn’t merely something happening outside the target area; sometimes the thing being damaged is another part of the person you were trying to save.

I also discovered that depression didn’t respond particularly well to my usual management style. There wasn’t a clean problem definition followed by a strategy, implementation, review and successful conclusion. I couldn’t put a line through it, mark the job complete and move it into the filing cabinet, because the Black Dog was considerably less cooperative than the Australian Taxation Office.

There have been plenty of years since then for me to think about what happened, and I remain reluctant to turn the experience into a grand conclusion about medication. Somebody else may take a drug that changes their life profoundly for the better, and their calculation has nothing whatsoever to do with mine. Even my own calculation might have been different with another medication, another doctor, another period of my life or another manifestation of depression.

What I can say is what happened to me. I finally acknowledged that whatever was happening required an attack, I took Robyn with me to the doctor and discovered through a surprisingly ordinary sheet of paper that the problem might be considerably more serious than I had allowed myself to believe. We rejected hospitalisation, walked next door to the pharmacy and fired the second shot. Then, for almost a year, we kept firing.

Today our medicine cabinet contains no medication for depression. There is a minor blood-pressure tablet in there and the obligatory cholesterol medication, so I can hardly claim to have developed some philosophical objection to better living through chemistry. If the medical equation makes sense to me, I am perfectly capable of swallowing the tablet and getting on with the day.

Depression medication became different because, in my experience, the side effects eventually cost more than I was prepared to pay. That is a statement about my experience rather than anybody else’s treatment, and I remain conscious that the original decision to seek medical help was still one of the important decisions I made during that period. The first shot mattered even though the subsequent ammunition didn’t ultimately win the war.

Perhaps that bloody sheet of paper remains the best object through which to remember the whole episode. Twelve questions, four possible responses, circles around letters and a doctor adding numbers until my answers placed me inside a range that told him what the rules said should happen next. There is something appealing to the accountant in the idea that even depression might eventually surrender to arithmetic.

The trouble was that the question I eventually cared most about didn’t seem to fit neatly among the circles. We had reduced some of the peaks, raised some of the troughs and discovered several things I would rather the treatment had left alone, yet I was still trying to work out whether the bloke occupying that narrower space between the extremes was actually better. Somewhere among all those appointments, tablets, side effects and repeated tests, the question became much simpler than the scoring system.

I wasn’t looking for permanent euphoria, and I wasn’t expecting a tablet to turn every ordinary Tuesday into Christmas morning. I wanted the anger reduced, the darkness lifted and enough of everything else left intact for me still to recognise the bloke who emerged on the other side. Most of all, I wanted there to be some happiness in the space we were creating, and for me there simply wasn’t enough.