Let's talk about talking about depression
This post contains graphic descriptions of self-harm and discussion of depression, anxiety, and suicide.
I started cutting myself when I was 19. Young enough that it became a habit; old enough that it was embarrassing. I started before I was diagnosed — back when I thought that to be depressed you had to have Real Problems in your life.
My first few attempts were woeful: a blunt pen-knife and scissors that didn’t do much more than leave bruises on my skin. Just as with any other skill, I learned. In my second term of university I smuggled a needle out of a pathology practical and used it to leave scratches down my left forearm, deviating outwards as they bled toward my hand.
That was when I discovered the profound and distressing ecstasy of self harm. That release was unlike anything else: I could punish myself for my inadequacies, assert control over my life through the sharp edge dragging through my skin, leave marks that showed the world I was incontrovertibly Not OK, but only if you knew where to look.
I messaged a friend I knew had done similar, lying in bed in tears, asking for advice on what to do next. That that was how I learned the aftercare practices that became routine, passed on from one depressive to another. Antiseptic cream, tissues, clean it off, cover it if you can. Almost more soothing than the act itself — the feeling of looking after yourself, treating your body as something that deserves care, contrasting the pain you’ve just inflicted.
In the right kind of light you can still see those first thin strips of scar tissue. They’re faded, but they’re there.
I graduated on to razor blades, bought from Boots with a safety razor I told myself I wanted to use to shave my face. I did, in fact and unfortunately, use the razor for that purpose — it turns out there are quite good reasons for the existence of the multi-blade razor and electric beard trimmer.
When my forearm became overpopulated I moved to my torso. I don’t know why there, except I used to watch myself do it in the mirror, slicing through my skin slowly, waiting until the blood welled up out of the wound, feeling the pain and shame and cursed relief.
I stopped for the first time quite soon after I got into a relationship. Hurting myself was fine. Hurting another person through the emotional distress I knew I was causing wasn’t. Rock blunts scissors. Empathy and anxiety beat depression.
That, plus I genuinely did get better. The razor blades didn’t feel necessary anymore. I kept them in a drawer.
I started again when that relationship ended and I found myself in a new city with few friends and a lot of darkness and cold and a basement flat with three other men I never spoke to and only a sliver of natural light from the window on to the maintenance bay of the student halls. I don’t remember if they were the same razor blades, but it was the same pain, same release, same habit. Cry, cut, clean, repeat.
I would say something like “it’s hard to know when it stops being about anything in particular and starts being just a habit”, but it’s not hard. I can tell you exactly when that happens. You’re sitting in your room with nothing in particular going on. You could read a book, play a game, masturbate — but instead your mind wanders to whatever sharp implement you have nearby. For a while you toy with the notion. The trick is to get distracted by something else as quickly as possible, because the longer you think about it the more likely it is that it just happens. If you pick up the blade, it’s basically going to happen. Habit.
And how does the habit break? Stay distracted long enough that it just doesn’t happen for a while. So long as there are no emotional traumas thrown at you in the interim, it gets easier with every passing day. You can make it easier by making it harder for yourself to do it. When I started to get into another relationship, I was still cutting. I threw away my razor blades after I voted in the Brexit referendum. I filmed them going into the bin. It felt final.
Reader, it was not final. Over three years later, it happened again. Standard, boring story: bad thing happened, bad thing was my fault, got very sad, felt lonely, took fabric scissors to forearm. Stupid. Effective. I knew I was going to do it before I did it. I went to Superdrug to see if they had razor blades. They didn’t. Then there was the requisite period of dithering in bed, crying, numbness, staring at the ceiling, staring at my arm, hating that I knew it was going to happen but still getting the catharsis of knowing I could do it without it feeling meaningless. I had a reason that other people would understand when I had to tell them.
The same can’t be said for the most recent time. As above, it happened for what felt like no reason at all. I should have been going to the gym. Instead my mind went to the box cutter I’d bought so that I could make my room resemble a human habitation rather than the creepily empty space of a workaholic police officer in a procedural drama. Now there are lines on my stomach again. They’ll fade and merge with the others. The ones in the shape of a square I made because I was feeling creative. The deep ones from when I really wanted to see how far I could go. The other sets of lines all close to one another because something feels right about localising your pain to one area, or maybe just because it makes clean-up easier. Doesn’t matter. Scars are scars are scars.
A week ago I stopped myself from cutting my forearm again by tattooing over the scars. It’s a molecule of sertraline, the drug I’ve been on for the longest. The night before I had it done, I saw a tweet which pointed out that everyone with a molecule tattoo is either high, trans, or mentally ill, and they only want organic chemists to know which one. I still got it. The gentle tease felt like a good omen. Maybe after I’ve explained it to the hundredth person I won’t feel that way. It’s better than the scars.
Still, the tattoo, this story, this - whatever this is - they’re all narratives. Stories about pain. And pain - mental, emotional, physical - doesn’t conform nicely to a story structure. This story will end with a feel-good take-home message because that’s what’s demanded of writing like this. It shouldn’t. The banal reality is that the pain will continue, in one form or another, growing and attenuating at different times and for different reasons, and no ink in your skin can contain it within its lines.
When I was 20 I wrote an article about having depression. The ubiquity of “just talk” in 2019 might make this seem farfetched, but in early 2013 the discursive landscape was quite different. As far as I’m aware, I was one of the first people at my university to put my name to a piece about my own mental health. We turned the comments section in an ask-me-anything, and to this day I think it was probably one of the most positive and productive comment sections a Tab article has ever had. A low bar, I know.
For a long time after that I thought “navel-gazing mental health chats” were my Writing Niche. I would produce semi-regular articles, occasionally putting in a radio or TV appearance. I managed to get the Tab to publish a piece I wrote about self-harm, but I wasn’t allowed to frame it as a personal essay. Instead, it was called Self-Harm: A Story, which confused some readers to the point that they assumed I was writing from the perspective of an outsider who had never done it. In the piece I pointed out that self-harm isn’t a sign that someone is suicidal (which shouldn’t need to be said, but does). I then went on to make the slightly edgier (heh) claim that self-harm is a coping mechanism that should be judged no differently from any other: drinking too much, binge eating, not eating, getting into fights, taking copious drugs, and all the other forms of self-destruction people engage in when they’re in pain. We shame it, I said, because it’s unambiguous in its intention: you write your pain on your body and, depending on the location, force others to look upon it. Does that make it uniquely worrisome or worthy of stigma? At the time I said no; today, I don’t know. Ask me tomorrow.
That period of Writing About My Depression lasted a while, but commodifying your pain for the edification of anonymous readers ultimately wears you down. You find yourself carving out an identity that depends on your continued suffering and immiseration; to recover is to lose your niche, which might be the only thing that makes you interesting. Not only that, but you have to twist and contort yourself into the role of the Ideal Depressive: open and honest and willing to bare your scars, but not to make anyone too uncomfortable. I did a radio appearance on BBC London after a young girl killed herself. She’d been viewing self-harm content on Tumblr, and this was beig presented as linked to her death. As you might expect, I tried to make the argument I outlined above, and was summarily shut down by the presenter, who said “well, we can’t endorse that kind of behaviour” and cut me off. There was no aftercare, nobody to check that I (who had explicitly been called upon as someone who had self-harmed, which they considered to be tantamount to suicidality) was ok. I’d done my bit, and they never checked in on me again. I wrote a piece about it, framed as a letter to the presenters. Silence. I felt used. Just say the line, Bart.
Writing this worries me, too. Am I romanticising self harm by talking about what it did (does) for me? Probably not, especially if I explain the negatives: the pitying looks, the pain of contact with your clothes, the scars that never go away, the risks attendant to ever being in a room alone with sharp objects (and the consequent difficulty of performing any form of DIY). Then there’s the well-intentioned people: the ones who ask you to please-call-me-next-time-you’re-thinking-about-it; the lovers who kiss your scars as though you’re a child with a bump on your head; the generation above you who just Don’t Get Why You Would Do That To Yourself.
And then the question becomes, to what extent is this - whatever this is - playing into that need to rationalise and commodify my pain? To describe is to explain; to explain is to give reasons; to give reasons is to mould and taxonomise and classify and categorise. And that need to explain is part of the problem, surely. I don’t know why, and there’s a limit to how my language can express this, but I just have this instinct that explanation is somehow wrong but necessary, all at once. Maybe it’s the exploration of the limits of language itself that’s the problem: pain demands to be felt, but feelings aren’t always permeable to reason or explication. Trying to write my depression is like trying to mould smoke.
So expressing pain is not only exploitative of yourself; it reshapes that pain in the image of the narrative you create, and that narrative is always and indefeasibly incomplete, imperfect by virtue of being too perfect, under-explaining through its over-explanation.
But that’s not the core of what I want to say — what needs to be said. For all my frustrations with The Mental Health Discourse, there’s a point to make here about the nature of depression. Commodifying and rationalising your pain requires you to make it interesting, or at least explicable. But so much of what it means to be depressed - for me, at the very least - is that life and everything in it becomes so fucking boring. You lie in bed, thinking of all the things you should be doing that would make it better: go to the gym, make some real food rather than eating dry cereal from the box like a gremlin, make plans with friends, write, read, play games, do anything. And your mind, or your body, or some combination of the two just won’t let you. “No,” says your brain, “I don’t think I will.” So you just stay in bed, paralysed, desperately wanting to want to do the things that would make your life worth living.
Slowly, you rot. Your inability to eat and exercise and stimulate yourself feeds back into your deteriorating mental state. You sleep more in the day and less at night, waking up to check your social media notifications every ninety minutes in the hope that one of them will be someone or something that will pull you out of whatever this is. None of them are, because nobody can do that for you, but god do you wish they could. Emails are unopened or un-replied-to. Messages are left on read or just unopened. Guilt piles up. Work doesn’t happen. Food is uneaten. Your body is under-nourished, under-stimulated, under-loved, and that just makes you hate it all the more. You look in the mirror and see a stupid fucking sack of shit who can’t even summon up the energy to do the things that it knows will help.
It’s this all-consuming blank that hollows you out and takes away all of the things that made you an interesting person to be or to be around. And you can’t self-care your way out of it. At some point it might just stop, or at least start to stop. It usually does. But it might not. And that thought, that “what if this is it, forever?” is terrifying. What if I’m just broken?
That last thought - what if I’m broken? - was ubiquitous for me earlier this year, and its disappearance is a large part of the motivation for the ink now on my skin, covering some of my scars.
To contextualise: around the time I started hurting myself, I was diagnosed with mixed anxiety and depression. Common or garden Sad Nervous Wanker Disease. The doctor put me on venlafaxine, which for anyone who knows their antidepressants will elicit quizzical looks. It’s a heavy duty second-line antidepressant, an SNRI which works on both your serotonin and noradrenaline receptors. Contrast that with SSRIs (fluoxetine — Prozac, citalopram, sertraline, escitalopram) which act solely on serotonin. The drug was fine, but I didn’t feel like I was getting a massive benefit and the £16 I paid per month for my prescription and the energy needed to make myself go and get that prescription written and filled combined with my general low mood to result in me taking myself off it after about six months. Later, I tried citalopram. Another six months, another self-abatement.
A period of around two and a half years followed in which I was better, for a variety of reasons. It got to the point where I didn’t even identify as depressed anymore. And then I moved, and my relationship ended, and I got super sad again. It took a solid four months before I finally sucked it up, went to the doctor and got put on sertraline, another SSRI.
I stayed on sertraline for two and a half years, only coming off last September. It genuinely helped enormously. It’s not that it makes you happy, per se; it’s more that it facilitates you doing the things that might allow you to be happy. More than that, it modulates your moods, blunting the worst of the lows and the best of the highs. Some people hate that. I hate it. It’s better than the alternative, as I found out. When I came off in September I did it properly — titrated my dose down slowly over months until there was nothing left. At first there was no noticeable change. Then I started becoming more emotional. I never used to cry at movies; I found myself bawling my eyes out for the second half of About Time and then for over an hour afterwards. I started crying all the time. And you know what, I was fine with that. It felt good to feel. I miss it now. I can’t cry very easily on these drugs, and sometimes it makes me feel like a clogged pipe.
Then the death thoughts began.
At first it was once every day or so: I would think, “what comes after death?” and I would try to imagine it. You can’t, of course; we can’t compute our own non-existence. So then my brain started running through all of the arguments about death: whether to fear it, what it is, what happens afterwards, whether there is any possibility of further life, and so on. Not particularly sophisticated arguments, but then I’ve never found any arguments around death to be particularly sophisticated.
When that round of internal arguing was done, I would automatically move on to examine life: what’s the point? Everything comes to nothing, everything fades, I am Ozymandias King of Kings look on my Works ye Mighty and despair — nothing beside remains. And if my choices don’t matter and nothing I do matters, why am I living at all? It’s not that I was suicidal, because I was petrified of death and had no desire to find out what it looked like first hand. But, and I know this makes no sense and I’m not going to pretend it does, the whole process stultified me into inaction.
What began as a daily occurrence became more and more frequent, until every minute of my day was occupied by these same thoughts, cycling through in my head. What happens after death nothing happens after death then what’s the point but you have to pretend there is a point but why do that when you’ll die anyway and on, and on, and on. It felt like I’d just thought the wrong thing, one time, and now my brain was stuck in a loop, running the same subroutines over and over again. I genuinely thought I was broken, and this was how I was going to spend the rest of my life. No argument could help me; no advice could assuage me.
And then my girlfriend, who had blessedly put up with me worrying about this constantly for weeks, suggested that maybe I ought to try SSRIs again? After all, the side effects were minimal: some emotional blunting, some sexual stuff. I thought it was hopeless — clearly this was a philosophical problem, impermeable to pharmacological solutions! But sans other options, I tried it anyway.
The results were immediate. A day later, 90% of the anxiety was gone. It hasn’t come back. I don’t care if it’s placebo. My mind works again. I’m still depressed, but I’m functioning. Mostly. In that way, sertraline saved my life.
And that’s why it’s on my arm: a reminder of the things I’ve done, problems I’ve muddled through, and the fact that sometimes there is no rational, reasoned solution to a problem. Sometimes you just have to take the fucking drugs.