The dark place: another dispatch from the Dungeon of Dopamine Deficiency #3

Darkness falls. Hell gapes. Clad in shades of night, the language of depression strengthens its grip on the mind. Except that darkness does not prevail. Other metaphors are available…

I saw a very fine pastiche of a Bosch Apocalypse a couple of days ago at an art gallery. It was beautifully drawn in a somewhat illustrative style yet, despite that, it was entirely contemporary in feel. I looked at the surging tide of skeletal Death figures swallowing up the earth and sticking blades into the flesh of terrified living humans, who were trampling on one another in animal fear, and I thought, “This person can really draw.”

Subsequent to that, I also thought, “And I suppose this artwork, for all its origins in a 16^th-century projection of inevitable, ultimate horror, it should also be read in the context of 21^st-century genocide and pandemic — and we really must read it like that. You know? But leaving all that aside … Wow, it’s great to see such a fabulous piece of drawing. How delicious is this representation of the vast agony at the end of the world! It is always refreshing to follow the movement of a hand across a pristine field of white…”

I became aware that my limbs were beginning to ache.

So I shuffled a couple of feet to the right and found myself in front of a beautifully rendered view in subtle oily striations of reed beds and a distant church — an elegantly ‘mid-century’ modernist, almost abstract work of great painterliness that seemed also highly familiar somehow. I felt something creak in me. “Uh-oh.” And then a few seconds later: “Oh God, this is depressing, it really is.” My spirits were beginning to crumble along the edges where they meet. Air was needed. So I went outside and walked slap-bang into the same view of the self-same reed beds, the water of the estuary graduating in subtly luminous neutral hues to the skyline where it was just possible to discern in a hazing furze of trees the silhouette of the top of an Anglo-Saxon church tower.

It was hideously beautiful. Or rather, they were: both the view and the painting of the view of the estuary in all its muted loveliness. I won’t irritate you with a full account of what went on inside my mind in response to this curious inversion, but I am able to report on the twisting physical pain that rapidly stiffened all four of my limbs; the fatigue that stole over my entire mind and body in a clinging, spiteful fog and, before we’d reached our vehicle, where it squatted a mere handful of yards from the edge of the sighing reed bed, I had all but broken down in horror at the manifest beauty of this place. And the stiffness and the pain.

It was bright and warm there on the estuary and the subtle movement of the water visible beyond the feathery reed-tops was a mirror congruent with the highest ideals of our flawed devotion to Nature. The world’s surface shimmered with water and was drenched in light.

It is the great horror, beauty.

No. It is.

The dissonance is too much. Or perhaps there is too much dissonance. Whatever, we all know this to be true. Every day we experience this dissonance as a part of life — it is a norm. Gaza and the women’s football. The pissy little racist Nigel Farage and the radiance and grandeur of the Alde estuary. We all get that. But when the dopamine fails to rise in the substantia nigra you can no more regulate the horror than you can stop the tremors spreading across your body like a viper’s poison. Soon I will be completely immobile and the pain will fill every notch and fissure of my body. I really ought to go now, get away from this putrid display and spend the rest of the afternoon alone in a room.

IT OCCURS TO me that, quite often, the most obliterating feature of depression is the language we use around it — by which I do mean the language we use in its vicinity, to describe its effects, but also the language for it, the thing itself, the words we use to help express how depression feels, what it makes out of us — almost as if depression confers a new identity on its sufferers that has to be registered in language that tells us what the experience of depression is not “like”, but is. You are this thing. For the time being at least.

One adjective we use over and over again [also, of course, available as a noun], which is understood universally in the UK to signify an entrenched state of depression, is “dark”. It doesn’t matter where you are or what time of day it is, should your response to a kindly enquiry be “things are pretty dark at the moment”, then something of what you are will be understood: you’re depressed, or in depression’s near room, or sunk in low mood. You are, in the therapy demotic, “in a dark place”. You are a dark place.

That’s all right. I am not inclined in the least to tick anyone off for the use of cliché in what are often desperate circumstances. Those who have enlisted the expression to signal their own private distress are acting sensibly: “I’m in a dark place” does the job well, in so far as it does anything at all. “Dark” stands effectively as both a sign and signal. I am in a dark place, we are in a dark place, this is a dark place…

We get the picture instantly.

“A dark place” is not a technical expression, though, still less jargon. It cannot be defined as jargon because it is not a technocratic term designed to facilitate understanding among the membership of a cognoscenti — and by implication to exclude those who are not members. In that last sense it is the opposite of jargon. Yet, in a funny kind of way, it might as well be. It is an element of what has become a fixed sub-categorical lexicon which is understood by the depressed and the non-depressed alike to furnish a sort of cut-through — a short cut even — to the real essentials of bad feeling. It is felt to be a way of getting there quickly. It’s the Polaroid camera snap of the therapeutic process, the image providing an essentially true but abbreviated impression instantly, supplying the information you need to absorb before any deeper consideration is given. Just think how arduous the journey to talking straight must have been in the 1940s and ’50s, pre-Polaroid lingo, when “Trevor Howard” would first have to hunch forward anxiously on his uncomfortable seat in the doctor’s surgery while he remembered to remove his trilby, then buy a little time by blotting the rain-spotted titfer on his lap with a gabardine sleeve, gulp slowly three times and then whisper, “Doctor, I hevven’t been feeling quite myself lately.” Several minutes later the euphemising really kicks off and the two men in the room begin hesitatingly to forge a vague understanding.

As a certain kind of 21^st-century therapist might observe, “Without first acknowledging the presence of darkness, how can we possibly expect to begin the journey to light?”

So let us consider the Polaroid lexicon of depression, in either noun or adjectival form, as deployed by so many of us at some time, if we have any sort of history of low mood. These are the words that get you straight to the nub and no woolly euphemising; the words that will get you attention of the right kind, immediately — theoretically. There are two basic vectors: “the dark passage” and “the low road”.

Dark Passage’s team is composed of the sliding scale of dimming: dusk, twilight, darkening, then darkness, which hollows an ideal environment out for the roil of black, blackness and blacker. The colours of night, enclosure, blindness and the absence of light. Team Deep goes deeper, deeply, deepest to suggest a vector too, that of the plunging variety. The Deep Team’s natural inclination is towards the bottom, below which you may not go — until you find that having been there a while, actually you can go further if you need to, just by saying so. Of course, it gets ever darker, murkier as you descend away from light. But still there is scope for sinking further to the sub-bottom where you are truly sunk. Thunk. And that has to be that, hasn’t it?

By no means. Still there remains, despite all logic, all understanding of physical Nature, the possibility of a deeper darkness on an even lower road. If depression can take you there, then language will allow it. Language will always make a way and it will always tag along, keen as horseradish, ready to spill.

Yes, it will; except that we know from experience that this is not a useful truth. Depression is more likely to rob you of language than charge you up with it. We know this. That’s what the Polaroid stuff is for: to save you from having to be Trevor Howard. “I am a dark place”. Boom. There it is. Done. Then the hard work begins.

Depression is not a literary experience or a shareable one, not in reality. It is what it is. It is the thing that makes you a dark place and no one else. Yet the only tools that enable us to get at it are words — get at it and get the lid off, so we can see what’s inside. We would do well, then, to remember that, while words are the heftless materials we use to construct a socially usable model of depression, so that we are at least able to make meaningful (and hopefully wholesome) communications about it, they can also be a fog in which depression hides.

I do not believe that words in themselves are “healing” but they are a way of bringing to bear such factors as may be, such as connection, understanding, awareness, exercise and love (and pharmaceuticals, if required). We really do need to take care of the words we use because they are certainly a part of the problem as well as the key to some kind of a resolution. Respect them. Husband them well. Use them accurately — and as honestly as we can.

And we do, usually, when close to despair. But not always.

IT WAS AMONG my very first batch of clients after I qualified as a psychotherapist seven years ago that I found myself struggling hard to find any kind of give in the rapidly setting emotional and cognitive concrete of a very depressed middle-aged man. Let’s call him John.

John was the most challenging client I’ve seen in that time. His cement footings were close indeed to becoming concrete, and in those places in him where there remained a little plasticity, he guarded that slight softness implacably. Quite aggressively sometimes. He’d rather take you on on your ground than allow you onto his. He was also implacable in his contempt for the world, nor was he trying all that hard to cover up his disdain for me. Every week he would turn up on time, pretty much, pass through the door I held open for him without a look or a word in response to my greeting (I stood well back from the door so as not to invade his space even passively), then he’d present his rear elevation to me for as long as possible while slowly hanging up his various accoutrements on the hooks in the wall.

Eventually he would plonk himself down heavily in the chair provided and stare at the floor while he waited for me to say something. We spent many minutes in silence together, John and I. Invariably I would break the silence in the end with a simple question as to his well-being or whether there might be something particular he would like to talk about this week; or perhaps I would enquire into the toils of his journey to see me today, given the foul weather. Apart from the very first session, when he delivered what sounded to me like a pre-prepared speech about the depths of his depression, he would do little more than grunt, shrug and then, after another long silence, utter his standard refrain, the one thing he had to say.

He would always glance up as he said it, I think to just make sure I was listening, perhaps even to ensure that I was still there. It was as he performed this routine that I was visited by the chilling, almost animal feeling that this was a man who spent far too much, in fact all, of his time alone. I felt desperately for him.

The thing he had to say was this. “I am in a very dark place. I can’t get out of it and I don’t know whether I want to really … not now. You can ask me any question you like. I probably won’t be able to answer it, because I have nothing to say about anything— everything’s dark. That’s all there is. There is really nothing to see in here.”

Reminding myself of my own brushes with depression in the past, I persevered as gently and kindly as I could, gradually pulling harder on the few threads that poked out of the tightened thread-ball of what he seemed to have the capacity to say (I had a real good go for the best part of a session on “there’s nothing to see in here” — I thought “see in here” was promising in its recognition that “in here” exists, as distinct from “out there”), but either the threads would stick fast as soon as I’d tugged at them or they’d just come away from the ball, with nothing attached.

In our very first session I’d asked him whether he’d been prescribed anything in the way of anti-depressant medication, by his GP or any other agency, and he’d inclined his head in affirmation, and added that it had only been a couple of weeks since the prescription had been delivered by the pharmacy. I’d asked what they were and whether he’d had any benefit from them at all. He said he couldn’t remember how they were branded and, anyway, he’d felt no benefit from them whatsoever.

And so we slogged on. John did not at any stage play the game, by indicating that he wanted to explore his feelings therapeutically, and yet it was quite clear that he expected me to run through the entire gamut of what he saw as therapeutical tricks, illusions and sleights of mind to… what? Keep him entertained? And slowly it began to dawn that what he wanted of me, first and foremost, was to disprove his darkness, if I could — to show him that it couldn’t possibly exist. If I could promise to do that, then perhaps he might take this nonsense seriously. It was in the fifth session, for reasons that are not entirely apparent from my notes, that I asked him whether he’d felt any benefit from the meds now, given that we were a further five weeks into the course.

John sat back in his chair and looked at me squarely — it seemed as if for the first time — while a slow smirk spread over his features. He said nothing.

“You haven’t been taking them, have you, John,” I said.

“Well, you asked whether I’d been prescribed medication,” he said, taking his eyes off me to sit forward again. “And … well … I had. They’d been prescribed.”

“John, I’m not your enemy,” I said, feeling suddenly as if I wanted to kick him out on his arse.

“I know that,” he said, reverting to his previous posture, shoulders down, unapologetic, the pallor returning to his features again following the flush of triumph that had briefly suffused his whole being.

“But is it really what you want? To be doing therapy, here every week, with me?”

“Well, I don’t want to be rude, you know. I mean, it’s not you personally … but no, no, I don’t.”

“So why do you come?”

“My sister made me. She’s paying for it…”

I SHOULD HAVE clocked John’s games-playing earlier than I did. I would do so now, I think, now I’m a decent number of Johns enriched in experience. However, it’s sewn deeply into the ethical fabric of talking therapy that you take the client’s words seriously at all times, just as you take the individual uttering the words at his word, at least as if the words are sincerely spoken and authentically meant, even if you know they’re not — you do so until such time comes that they are self-evidently, unignorably not sincere and then you point out the words’ inconsistency with objective or observable truth, and that becomes the work for a spell: I wonder why you don’t want to be entirely honest today? What need is it meeting in you? What do you hope to gain? And so on. You must be kind as you do it.

I have found that it is very important that jargon be kept out of the room as far as is possible. I dislike jargon in all its corridors. But in this one, the closed space where psychotherapy is practised, I think it is potentially very obstructive indeed and, as I suggested at the start of this piece, sometimes obliterating. It is rather like bamboo. It can take over.

There is absolutely nothing wrong with a little Polaroid lingo, mind. Indeed I would encourage its use to begin with, while client and therapist are getting their bearings. “I am (in) a dark place” is a good instant flash into the emotional cave system of a troubled individual. But it is not sustainable as a description of the sludgy mechanics of depressed feeling, at least not in any way I find useful as a listening ear with a duty to grasp and help unpick feelings as they arrive. In fact I actively — albeit very gently — discourage the use of either Polaroid lingo or psych jargon once a working alliance has been established in the room and trust is in place. How often have I heard a sophisticated young man or woman in my care utter the words, “Maybe I was inaccurate in my assessment of my attachment style…”? Or, “Everything about him screamed Narcissist from Central Casting”?

A lot, is the answer. I never respond in kind.

IT IS AS IF, because the depressed are in a faulty state, therefore it must follow that they are capable of only speaking authentically of it. There is no dishonesty in a depressed soul, and so on. If a seriously depressed person says “it’s blacker than VantaBlack” in here, and he’s neither smirking nor setting up a deadpan (probably avoidant) joke involving Anish Kapoor, then if the relationship is in its earliest stages, my internal response would in all likelihood be “why is he choosing to use a fairly obscure technical term when ‘very‘ would do? What is he trying to indicate here? Is he testing me?” But then I’d respond sincerely, as if at this moment in his life, it feels to him as if he is living in the blackest black that can be conceived of. So black it has a technical name. The depressed cannot possibly be inaccurate or manipulative or lazy or, worse (heaven forbid), wrong. Not to begin with.

This is not an ideal arrangement, I think. It is one of the very toughest things you have to deal with as a therapist: the compulsive need experienced by some clients (usually but not always male) to be not entirely truthful. On those occasions, the Cart of Language is often hitched in front of the Horse of Feeling, and this halt and buffeting contraption will then either go nowhere or shuffle off in a direction that is not remotely relevant to where you need to be going. It happens a lot. We have only got language to describe feeling with, and it very seldom seems adequate to the task. It is hardly surprising that people often lie, just for something to say. To fill space where words are supposed to go. I can understand that.

I can also understand why some depressives, whether depressed or not, embark on “creative” flights of thought and feeling, but come off to the attendant ear as if designed to impress the room, like a fanfare of the self. This was a habit of mine when I first saw a therapist as a depressed “patient”, more than thirty years ago (and also for a couple of therapists subsequent to that one, as I found that I was unable to restrain myself from doing it again): I would launch into it, as if soliloquising in a wit-stream of Falstaffian prose, and I’d make great airy arcs of “feeling” in the room that I knew were probably suspect, even as I flapped and sawed — and it was plain the therapist thought I was full of shit. But I still had to be brought down out of the sky otherwise I would have gone on for the full fifty, sky-bound, gyring, because… well, I suppose because I felt safer up there. The first therapist who shot me down didn’t trouble himself to gentle me to earth. He just pulled out a metaphorical twelve-bore, took aim and down I came in a flutter of embarrassment. I like to think I am kinder than that when required to put an end to an unruly fanfare of the self — I do know how much damage can be done by a single wounding shot. But still, it has to be done, and quickly once the flyer is deemed to be doing more harm than good up there.

In the very early days of my practice I dreamed that Charlie Parker came to see me, ostensibly to help sift through a larder full of his self-esteem issues, as he’d expressed it in a surprisingly articulate email. He turned up 15 minutes late looking unkempt and after he’d sat down and made himself at least nominally comfortable, his shirt tails out, boss-eyed, I asked him how he was feeling, right now, in this moment. He had a tatty hard case on his lap and he’d been caressing it absently, as if it were a sleeping cat. For a moment he seemed dead. And then the lights went on in his eyes and he opened up the case, took out a plastic alto saxophone and began to play…

Reader, I once shot Charlie ‘Bird’ Parker out of his own sky.

MY OWN EXPERIENCE of depression is / was extensive, in the sense that I suffered depressive events in four of the six and half decades I have lived life: the end of my twenties, the whole of my thirties and forties and then the first half of my fifties.

I am very glad to say that I have not spent time in the hole in more than ten years now (that was my Polaroid idiom for it: “the hole” — not even “my” hole). These events were not continuous, nothing like, but they were persistent and terrifying and made me want to do the direst things, if only I might summon the energy to do them. I have always thought of my depressive episodes as the remote kin of Churchill’s ‘black dogs’, only not so laced with nobility, yet relatively short and devastatingly punchy. And that is all okay and settled in me. It seems to have gone, that habit. It may come back one day, but I suspect, genuinely, that it won’t. It is of course intriguing that serious depression ceased to plague me in 2015, the year in which I started to train to become a psychotherapist — and also I experienced the very first symptoms of Parkinson’s disease.

IT WAS PARKINSON’S which got me by the water at the gallery on the estuary. It was a grotesque experience. Parkinson’s depression, which is notorious for its hope-killing cruelty, is not the same thing at all as the other sort, not in my experience, and that is probably because it stems from a different bio-chemical out-, contra- and overflow. In fact we know that Parkinson’s has very little to do with flow at all. It has plenty to do with proteins, as nervous system issues usually do, and above all it has to do with not the depletion of but the non-production of dopamine in a very dark, deep and hard-to-reach part of the brain called the sepultra nigra. It isn’t the only area of the brain that produces dopa but I believe it is the only dopa mine that yields up the hormonal ore that enables us to regulate movement.

The rest I suspect you know a little of: that it is incurable and degenerative, that we sometimes shake and sometimes stiffen (I’m principally a stiffener not a shaker) and that the stiffening can lead to excruciating, twisting muscle contractions that are as painful as a heart attack when the whole lot start doing it all at once. I’ve had both and I’d rather have a heart attack every single sucking time: the pain goes quicker. And surgeons can operate.

And of course there are many other awful things that can and do happen too, although I am sure you’ve had enough edifying on that front. However I do want to wise you slightly on the matter of Parky depression, as I experienced it for 72 hours only just now — because it may be of relevance to many other things that happen in your life.

It’s this. In my limited experience, when a Parkinsons’s depression stops, it stops. It leaves no trace of itself, even if you are still a-shakin‘ and a-stiffenin’ like a leaf on a tree or a stud horse on a stud farm that’s run out of jam. The despair goes, you emerge from your hole, you stop being a hole composed of the absence of light; you still feel the dissonance but it is now only a jarring in one of the more interesting chords of life’s supposed harmony, and the existence of sunshine is not an indication that the universe is hellbent on destroying you. Most of all you remember that some people love you and you love them, which is, as you know, quite an important thing in life.

Oddly, and mostly disconcertingly, it seems to me that you find things that you thought were lost long ago — but actually they were there all along, and you’d just forgotten to notice them. Or look for them. And it’s in the looking through new eyes, not the description of what you once saw, that you begin to understand that life really is worth living.

Nick Coleman is the author of three books: ‘The Train in the Night: a story of music and loss’ (shortlisted for the Wellcome Book Prize and a BBCRadio4 Book of the Week; ‘Voices: how a great singer can chnge your life’; and ‘Pillow Man’, a novel for bedtime. All are published in the UK by Jonathan Cape / Vintage and Counterpoint in the US.