Am I better? How can I know?

I’ve spent much of the past year stuck in a depressive episode. Sometimes I’ve felt a bit better, and at those times I’ve tried harder than anything to haul myself out of the pit – sometimes it works a little, but mostly it’s just made it harder. But because I can talk a bit, maybe even smile if I try very hard, I think – I know – that I’m better and should be able to do all the things I want to do, and all the things that I can normally do. But this last year has, for me, been a confusing disaster, as, even when I’ve thought I was better, I was very rarely (almost never) able to do these things.

Naturally I took the depressive approach – I must be lazy, useless, unlikely to ever again be the person I was. I had also had a lot of ECT over the year, so came to the conclusion that I probably had memory impairment and brain damage, which was extremely upsetting. My psychiatrist told me that this was very unlikely, and that any cognitive decline was almost certainly due to my underlying illness. I’m not sure whether that was reassuring or not, either way it was fairly devastating.

Fast forward a few months from then, and I was off work again, after a brief return, with a plan to have right unilateral ECT for maintenance treatment. My hopes were not high. I was already on lithium, admittedly remarkably free of side effects; fluoxetine, less free of side effects; and quetiapine, sedating and compelling on the appetite front.

My life was at that time fairly free of action, with no immediate prospect of getting back to work, and, perhaps for the first time in many years, a fear that this might never happen. The problem was that I wasn’t really able to do much else, unless organised by my husband or others. I like writing, and normally I find it relatively easy, but I was stuck. I did write a series of about sixty poems between my two courses of ECT – approximately one a day, but they genuinely weren’t very good, and I only wrote them to prove to myself that I could. As they were short, they were a lot easier to write than prose. Here is a relevant example:

Treatment

Years of treatment have left me different
fatter sometimes, dazed and angry
that all this is necessary.

I feel I should ignore it
shout at it, run from it
but it whispers meanly 
grasping at my heels.

What is my mind but a mass of nerves
tripped up by electricity
and chemicals.

Is it the same as it would have been
or do I miss the things that once
I would have seen?

Can I write the way I used to write?
I cannot tell
because there is no way
to know. 
What is the point
of weeping for
what can’t be known?

I listen silently to sounds made
and clutch myself and my love
to my wondering chest. 
I am lucky, I think
to be here.

And another, also relevant, and perhaps a bit more hopeful:

Undepressed

I don’t feel very sad now
more what I’d call undepressed
quite cheerful and disposed to
talk and laugh with you.

The question is where depressed ends
and undepressed begins
Is there a gap, a slope
a sudden change, or what?

What is the point at which you
turn from one and clasp the other
soft in your arms?

And undepressed – is that happy? 
or simply just not sad.

I don’t know when depression hits
it takes me by surprise
but the long haul out is a journey
where every step and stone,
every clench at tufted grass
is remembered.

Since starting my second lot of ECT I haven’t written any more poems. I have written very little prose in the last year, mainly just a few short blog pieces and articles. I had been working on a novel, but this had become very stuck. I couldn’t write much that was new, and what I did write left me unhappy.

I am also a keen amateur musician, and play the violin and viola in small groups and local orchestras. While I still knew how to play, I found it so much harder. Reading the clefs, keeping the rhythm, not bouncing my bow – it was all so hard. But, a few weeks ago, things started to change a bit. I didn’t suddenly become a wonderful player, but I felt I was playing more how I used to. And I could also write – not brilliant, but in the way I used to write. I started to think that maybe my psychiatrist was right, after all. Perhaps what I needed was to get better.

I’m still more anxious, and my mood is still quite up and down. I think that without sleep (quetiapine required for this) I would end up back where I started. But it does make me think – what is undepressed? How can I define it? And how is it for others? For me, the immediate, acute depression can lift, or be lifted more quickly; but the inability to think properly, the loss of creativity is a sign that all is still not right. Understanding depression, and indeed hypomania, and where they begin and end, and what one can hope for from recovery – these things are vital.

I still don’t know how recovered I am, but I’m in a better place than I was. Don’t just ask me – How are you feeling? Ask me – What are you doing? Why are you doing it? Is this what you used to do?

You might get a useful answer.