Thursday, 6 May 2021

Some notes on having a nervous breakdown

I didn’t much like 2020. Just before it started, I found myself having a deep gash stitched on Christmas Eve (2019) in A&E. (One gets such a sinking feeling on realising that one really will require medical attention at such a time of year!) Then I developed a painful neuroma, as a result of five hours of standing teaching, which stopped all thoughts of exercise for a few months. But then Covid-19 hit and everything else seemed unimportant. I ‘saw’ in the denuded shelves of Asda in March, one Sunday morning when I am normally pretty much alone in the shop, the likely end of civilisation. We were led by a government of corrupt idiots at a time when much more was needed.

But 2021 started worse when I was forced to commit a kind of career suicide by declaring to all concerned that I could no longer work. The attacks of anxiety, the retching and vomiting, had spread through the week even to the weekends and I was ‘done in’. Various important things had to be finished, or so it seemed, but equally I couldn’t go on. And so I borrowed a few days of energy to finish some tasks and delegate others (to generous and understanding colleagues) and then walked away from work one Monday morning. ‘Walked’ is wrong. I pretty much fell onto the sofa and didn’t get up for a month. Three months later, I’m still weak as a kitten.

Since my memory seems affected, I just want to scribble some notes and there’s less chance I’ll lose them if I put them on the web.

I want to say that I’ve had a ‘nervous breakdown’ because that best balances the rational exogenous causes with the internal madness and collapse. But ‘really’ it’s GAD and depression. The latter started in 2015 or 16, a year or so after the death of my parents. Grief segued into depression. This surprised me because, despite myself, I’d let grief take its course. If, like a wave, it swamped me in a rough Liverpool pub and I ended up weeping like a child, so be it. Nor was there any corrupting guilt in the mix. We’d all done the very best by each other in that final year. And yet something went wrong. I spent much of my time fleeing the world by retiring to bed and drifting into sleep. I became worried at the boundaries of the bedroom. My safe world shrank to one room and then to under the duvet.

At some point, I realised I’d lost happiness in two quite specific ways. I was never struck by happiness any more. Never, walking in the sun up to pick up a newspaper and flirt a little with the station buffet staff, did I think: Gosh I’m happy! Second, I could never anticipate happiness. I might know – purely cognitively - on a Wednesday morning that it was likely I’d be happy in the pub on Friday, but I didn’t get to experience a foretaste of that happiness in advance. And that made dark work-day mornings rather bleak. I could never feel any happiness in advance. The belief I had in future prospects was pure belief. Not affect. This ‘anhedonia’ continues though sometimes I wonder whether I can feel a little more, like hearing returning after a noisy gig. (Am I happy in flow activity? I’m inclined to say yes, like a cat. It would be wrong to say I wasn't happy when, say, talking or teaching. It’s just that I cannot feel that I am.)

Anxiety began to grow as the Cumbrian autumnal darkness arrived (this had happened in 2019, too). Somatised as nausea and retching, I’d learned to live with this as a localised once or twice a week ‘attack’. I could cycle across Preston retching as I went merely feeling embarrassed and stupid. But it began to spread through the week as a constant feeling of dread and my body decided that since I just ignored the retching it would sometimes, playfully, unpredictably, up the stakes to vomiting. Perhaps this is what was so tiring over time, though I didn’t notice so much that I was exhausted until this year. Even as I arranged sickness leave, I didn’t spot the physical aspect of the mental illness until I was permitted to give in to it. From the first Monday I was off, I was unable to do anything. My fond thought of three months of pottering and philosophy was replaced by the most tedious of incapacity. 

I realise that my image of a nervous breakdown came from reading Saul Bellow’s novel Herzog. The titular Herzog has been left by his wife, rather cruelly, and retires from life to write letters. For example, to Heidegger. “Dear Doktor Professor Heidegger, I should like to know what you mean by the expression ‘the fall into the quotidian’. When did this fall occur? Where were we standing when it happened?” I thought I’d be able to maintain some sort of inquiring mind and write experientially grounded philosophy as a catharsis. I could study my own illness but at one remove. This immediately proved a ridiculous hope.

After a little while I decided to come off the second of the SSRIs I’d recently tried (the third of the illness as a whole). Coming off Paroxetine in a hurry turned out to be a form of ‘cold turkey’. Quite physically unpleasant. But also, as I slowly recovered, I realised just how much madder I had been. Being emotionally out of sync with the world had been like living in a mildly disturbed dream for a few weeks but I’d only occasionally realised that I was dreaming. Strange that I’d not noticed the loss of sanity, only its return (cf dreaming scepticism disjunctivism). 

As a philosopher with a particular cognitivist bent - language, thought, and intentionality being guiding interests - I’d always assumed that madness was only really a matter of what Jaspers calls ‘primary delusions’, belief-like states that strain their belief-status, are hard for others to make sense of, and occur only with particularly severe forms of mental illness. But madness is also a matter of doing, saying and feeling as well as pure reasoning. To begin with, I was obviously tearfully distressed. Phone calls, even a couple of initial reassuring calls from managers, left me attempting to press the phone into the duvet as though trying to get rid of it by submerging it. More generally, because the whole mood of the world was wrong, so was I. One evening my partner photographed me watching some trivial television programme. I was upside down with my head on the ground, the small of my back against the seat of the sofa and my legs resting up its back. I’d been like that for an hour and hadn’t noticed. Basic norms of comportment would normally have indicated to me that this was, at the very least, unusual and hardly comfortable. Self respect might have made me offer a reason to my beloved. But none of this occurred to me. The picture now makes me feel a little sick just as one might feel if one realises one wishes to turn away from a dying sheep found on a hillside.

One evening everything seemed so wrong and strange that my partner darkened the room, stoked the stove, and left a long slow piece by Max Richter playing hugely loudly on the hi fi, filling the room as though to exclude everything else from the space. It calmed me but also contaminated Richter for me afterwards. I no longer play him.

I’m returning to working now. I don't know whether it is too soon but it seems right to try. Perhaps nothing will improve very soon whatever I do. My anxiety is no better - on the morning I reviewed my email inbox, I vomited on my study carpet, having forgotten the usual safeguards - but I seem to know more fundamentally that it is irrational. My energy levels are poor. But while I don’t have the energy to be out on the hills, I no longer fear the outdoors. I could imagine being better. It doesn’t seem likely right now. But it doesn’t seem impossible as it did a few weeks ago.

There is a postscript here.