Anxiety and depression in an evangelical context: part 3

(Part 2 is here.)
Therapy

Early on, Dr James Duthie my GP referred me to a clinical psychologist at the local hospital, I guess to help me confront and cope with the crippling panic. I saw her just once, making my way to her office through the psychiatric wards. I found walking past people who were visibly suffering from mental health problems both frightening and fascinating. I tried to distance myself from what I was seeing, while at the same time knowing that I was one of them.

For a Christian in those days to seek professional help with a mental health issue was to face being stigmatised, for you were regarded as having somehow ‘let the side down.’ It was argued that the transformation which takes place in you when you embrace God affects your life in its every aspect – not just spiritually, but emotionally, mentally and psychologically as well.  The conclusion was often reached that when a Christian had mental health problems, it was indicative of some kind of spiritual failure, and that the appropriate solution wasn’t psychiatric support, but spiritual counselling, and greater openness to the Word of God.

What folk who held these views conveniently forgot was that since Christian faith of even the most dedicated variety was no guarantee of protection from physical health problems, why should believers expect to be free from mental health conditions, given that mind and brain are inextricably linked. Granted, some spiritual problems (a stubborn persistence in distancing yourself from the God who lovingly pursues, for example, or an exclusive focus on guilt without the liberating vision of God’s grace) can give rise to mental health issues, but I believe passionately that for a Christian to experience depression or anxiety or schizophrenia is no reflection whatsoever on the quality of their faith and Christian commitment. I suspect this tendency on the part of some Christians to stigmatise people with mental health conditions arose from their instinct to protect themselves from something which they feared, and couldn’t understand since it didn’t fit easily into their neat schemes of theology.

As a sensitive, anxiety-prone teenager I had been terrified by the left-behind theology I had been taught. I felt that I had been able to find the entrance to the family of faith, and feared that at the coming of the Lord I would be left without the support and love of all those I trusted most.  Some mental health issues are exacerbated by harsh doctrines harshly communicated. The Church can be part of the problem, rather than an agent of healing.

I sat down in Eileen’s room. She smiled, and we talked. Although this fact hadn’t affected my decision to accept her help, I’d been told she was a believer. To see a Christian professional was deemed by those of my fellow-Christians who saw mental health issues as a sign of spiritual failure to be somehow less dangerous, less culpable. A Christian would be aware of the transforming, divine power (so the argument went) as well as the dubious, God-excluding theories of Freud and his successors.

Eileen listened to me sympathetically. She proposed a course of what she called ‘aversion therapy’, which would involve me exposing myself gradually with her presence and encouragement to the things I was most afraid of, and discovering through this experience that I could look fear in the face and survive. Eileen sent me home feeling positive and hopeful with a relaxation tape to listen to.  There was no mention of God, but this was fine from my point of view. I believed God was there in the room with us.

My mother was very negative about my visit to Eileen in general, and especially negative about the relaxation tape. I played it the next night in my bedroom, listening to the soft, hypnotic voice, trying to follow the its calm instructions. But downstairs in the kitchen the sound of the voice as it penetrated the floorboards was having quite the opposite of its intended effect on my mother, who became increasingly fraught. Afterwards, she made quite clear that in her opinion visiting Eileen would do me no good whatsoever, and that I should cancel my next appointment. My father said nothing to disagree with her.

And so it was that, not for the first time and certainly not for the last, I unwisely sacrificed my own interests to avoid disturbing my mother and shattering her illusions. I wrote to Eileen, telling her I’d found our session together very helpful, and thanking her for it, but explaining that I now felt there was no need for a return visit. I enclosed an article I’d written, illustrating from my own experience how Christian faith can sustain you through emotional and mental turmoil. This was, I’m sure, a perceptive and honest piece, and it was perfectly true that I felt sustained and comforted through my faith however wavering it might frequently be. However in writing to Eileen I was turning my back on the potentially deeply beneficial additional support, insights and therapy which I would have received from her. 

The second mental health professional I had dealings with was, like Eileen, extremely encouraging. I saw him at time I retreated to my parents’ house having felt at work that I was being asked to give beyond my resources, and was signed off for three weeks by the local GP.  I was plagued by thoughts of suicide, and was uncertain whether this negative barrage was merely fear-induced – which I could cope with – or whether I was genuinely suicidal, and might be driven, against my will and better judgement, to harm myself. The GP kindly arranged for me to have an emergency home visit from a psychiatrist.

He came and sat beside me on the couch in my parents’ front room and listened carefully as I described what I was feeling, interacting warmly with genuine interest and concern. His patient, empathic presence was in itself a healing reassurance, and I suppose also that having someone apparently show an intense interest in your symptoms induces a certain vanity. I remember describing my sense of smallness and vulnerability when out walking, on the edge of the world’s crust, on the shore of the vastness of space, and my fear that I might fall off into nothingness. My listener mentioned a well-known psychiatrist who had described similar symptoms, and I was somewhat heartened to know firstly that I was not alone, and secondly that I shared an experience with someone famous!  My visitor concluded that I was no risk to myself, and reassured for a time, I was deeply grateful for his help.

In contrast to this experience, my third encounter with a mental health professional was discouraging. My father was concerned when I abandoned my Welsh holiday: he was perturbed by what I’d reported James Duthie had told me – that I would simply have to learn to accept, and to live within the limitations imposed by my condition. James had described to me the distinction as he understood it between reactive and endogenous depressions – the former being triggered by some life event or series of events, the latter arising from chemical imbalance in the brain. You could, he said, more easily walk away from reactive depression once the underlying cause had been dealt with; endogenous depression was not only potentially always with you, but also much harder to treat.

In his judgement, my depression was of the endogenous variety. I’m not sure how accurate this was – mental health experts disagree on whether you can, in fact, so easily distinguish between reactive and endogenous depressions. You could argue that my depression was a reaction to my experiences of reality, but in fact you could never identify which came first, the anxiety or the depression – each fed destructively off the other. However, I found James’ analysis helpful, in that it enabled me to concentrate on coping with the symptoms rather than probing for a cause.

However my father felt that I was unnecessarily surrounding myself with barriers I felt I’d never be able to cross because of the limitations I believed my condition imposed on me. He rightly considered this to be an unhealthy development, and remembering how encouraged I’d been by my previous encounter with the psychiatrist some years before, arranged for me to have a private consultation with another professional who, like Eileen was known to be a Christian who did his psychiatric work in the context of a Christian understanding of human nature.

On a bright July morning in 1989 my father drove me through Glasgow to Ross Hall Hospital. I sat in the psychiatrist’s office for forty-five minutes answering his questions, baring my soul, unwrapping my fears and presenting them to him, eager to help him help me by giving as accurate and honest a description of my experience as I could. He listened impassively. Eventually, the torrent of sentences dried up and I paused. There was nothing more to say.

I sat back, and waited for the words of understanding and empathy, for the encouragement which I was sure would enable me to go forward with hope. But there was nothing. Not a word. He would write to James Duthie, he said. The consultation was over. I left the room feeling violated. One by one I had shared the precious, repugnant treasures of my darkness, but I had been given no light in return.

Eventually his letter arrived at the surgery in Airdrie. James read it to me – it simply confirmed what he doubtlessly knew already, that the patient was suffering from ‘chronic anxiety and neurotic depression’ and that this was ‘very hard to treat.’  It concluded by recommending medication which James wasn’t comfortable about prescribing. He told me that as a treatment it had been superseded by more effective drugs, and that it could be dangerous when combined with certain foods. The letter was filed away and never referred to again. Eventually the £50 bill for the Ross Hall consultation arrived, and I paid it grudgingly.

James Duthie, a small, nervous, sensitive man was absolutely brilliant. You’d see him, and he’d listen to what you had to say, and affirm you, reassuring you that your symptoms were not that uncommon. He’d say, just before I left ‘You’re doing fine!’ and those words were calming and therapeutic, encouraging me through that day and through the days ahead. Sometimes I wondered if he really meant what he said, if he really thought I was doing fine, or if he merely mouthed the words to bring the consultation to a positive conclusion, but I think he was genuine. I certainly wanted to believe him, and believing him helped, and so I tried to bury my doubts.

Dr Duthie was not as accessible as I’d have liked. He worked in a large surgery, where the policy seemed to be to make it as difficult as possible for patients to speak to their doctor on the phone. However I knew that if I really persevered, I’d eventually get past the defences of the front-desk staff and be put through to him, and when I did he was unfailingly kind and sympathetic.

Over the years, he tried me with a range of medication without much success. The only time I ever doubted him was when he put me on a trial of one of the then-new beta blocker drugs. This didn’t address the real issue, and was worse than completely ineffective, in that the pills somehow made me (or I imagined that they made me) more prone to anxiety. Yet James encouraged me to persevere until the course of treatment was over, which I felt had more to do with satisfactorily completing the trial than with my best interests, since while I was taking the beta blockers I was not prescribed any other medication which might have been more helpful. And these weeks on beta blockers immediately preceded my abortive holiday to Wales, with which I might have coped with better had I been prescribed a more effective drug.

But in the end, after my futile visit to the psychiatrist in Glasgow, it was Dr Duthie who found a treatment which actually worked. Instead of the medication recommended at Ross Hall, he prescribed Anafranil (Clomipramine), one of the family of drugs which maintains in the brain a higher level of the chemical serotonin than would otherwise be present. As in the case of all these treatments, he explained, it would be about two weeks after beginning the course of pills before I’d begin to feel the benefits of them.

I will never forget the Saturday morning exactly a fortnight later. I had gone to the Gospel Literature Outreach bookshop in Motherwell to do some business in connection with the church bookstall for which I was responsible. I was standing at the counter waiting to sign a cheque. I realised that whereas normally my hand would be so tense that, afraid I wouldn’t be able to sign my name legibly, I’d produce a hurried, tortuous scrawl, today there was a sense of calm. A tide of peace was flowing into a dark, empty cavern. I smiled, and wrote my name on the cheque slowly, with the straight line and the dot on the end underneath. To celebrate the treasure of this joy, I went to a nearby café, and had coffee and a jammy scone, tranquil and relaxed for the first time for many years.

That a small dose of medication could work such a profound change in outlook seemed miraculous. I was too glad at this lifting of my spirits to question whether I should have been given access to that particular treatment much earlier.  I am not cured. The sense of peace is still intermittent. I still struggle with my emotions; I am still prone to fear, anxiety, and melancholy. When my kids complain that I check two or three times to ensure the door is locked I mutter that it could be much worse. But the medication continues to help enormously, and that bright Saturday morning in Motherwell when I was 37 marked the beginning of the rest of my life. Recently, a young doctor looked at my notes and said ‘Anafranil! That’s really old-fashioned!’  ‘It works!’ I grunted.

(Part 4 is here.)