Reasons to Stay Alive. Matt Haig

you are depressed your pain is invisible.

      Also, if I’m honest, I was scared. What if I didn’t die? What if I was just paralysed, and I was trapped, motionless, in that state, for ever?

      I think life always provides reasons to not die, if we listen hard enough. Those reasons can stem from the past – the people who raised us, maybe, or friends or lovers – or from the future – the possibilities we would be switching off.

      And so I kept living. I turned back towards the villa and ended up throwing up from the stress of it all.

A conversation across time – part one

      THEN ME: I want to die.

      NOW ME: Well, you aren’t going to.

      THEN ME: That is terrible.

      NOW ME: No. It is wonderful. Trust me.

      THEN ME: I just can’t cope with the pain.

      NOW ME: I know. But you are going to have to. And it will be worth it.

      THEN ME: Why? Is everything perfect in the future?

      NOW ME: No. Of course not. Life is never perfect. And I still get depressed from time to time. But I’m at a better place. The pain is never as bad. I’ve found out who I am. I’m happy. Right now, I am happy. The storm ends. Believe me.

      THEN ME: I can’t believe you.

      NOW ME: Why?

      THEN ME: You are from the future, and I have no future.

      NOW ME: I just told you . . .

Pills

      I HAD GONE days without proper food. I hadn’t noticed the hunger because of all the other crazy stuff that was happening to my body and brain. Andrea told me I needed to eat. She went to the fridge and got out a carton of Don Simon gazpacho (in Spain they sell it like fruit juice).

      ‘Drink this,’ she said, unscrewing the cap and handing it over.

      I took a sip. The moment I tasted it was the moment I realised how hungry I was so I swallowed some more. I’d probably had half the carton before I had to go outside and throw up again. Admittedly, throwing up from drinking Don Simon gazpacho might not be the surest sign of illness in the world, but Andrea wasn’t taking her chances.

      ‘Oh God,’ she said. ‘We’re going now.’

      ‘Where?’ I said.

      ‘To the medical centre.’

      ‘They’ll make me take pills,’ I said. ‘I can’t take pills.’

      ‘Matt. You need pills. You are beyond the point at which not taking pills is an option. We’re going, okay?’

      I added a question mark in there, but I don’t really remember it as a question. I don’t know what I answered, but I do know that we went to the medical centre. And that I got pills.

      The doctor studied my hands. They were shaking. ‘So how long did the panic last?’

      ‘It hasn’t really stopped. My heart is beating too fast still. I feel weird.’ Weird nowhere near covered it. I don’t think I added to it, though. Just speaking was an intense effort.

      ‘It is adrenaline. That is all. How is your breathing. Have you hyperventilated?’

      ‘No. It is just my heart. I mean, my breathing feels . . . weird . . . but everything feels weird.’

      He felt my heart. He felt it with his hand. Two fingers pressed into my chest. He stopped smiling.

      ‘Are you on drugs?’

      ‘No!’

      ‘Have you taken any?’

      ‘In my life, yes. But not this week. I’d been drinking a lot, though.’

      ‘Vale, vale, vale,’ he said. ‘You need diazepam. Maximum. The most I am able to give for you.’ For a doctor in a country where you could get diazepam freely over the counter, like it was paracetamol or ibuprofen, this was quite a significant thing to say. ‘This will fix you. I promise.’

      I lay there, and imagined the tablets were working. For a moment panic simmered down to a level of heavy anxiety. But that feeling of momentary relaxation actually triggered more panic. And this was a flood. I felt everything pull away from me, like when Brody is sitting on the beach in Jaws and thinks he sees the shark. I was lying there on a sofa but I felt a literal pulling away. As if something was sliding me towards a further distance from reality.

Killer

      SUICIDE IS NOW – in places including the UK and US – a leading cause of death, accounting for over one in a hundred fatalities. According to figures from the World Health Organization, it kills more people than stomach cancer, cirrhosis of the liver, colon cancer, breast cancer, and Alzheimer’s. As people who kill themselves are, more often than not, depressives, depression is one of the deadliest diseases on the planet. It kills more people than most other forms of violence – warfare, terrorism, domestic abuse, assault, gun crime – put together.

      Even more staggeringly, depression is a disease so bad that people are killing themselves because of it in a way they do not kill themselves with any other illness. Yet people still don’t think depression really is that bad. If they did, they wouldn’t say the things they say.

Things people say to depressives that they don’t say in other life-threatening situations

      ‘COME ON, I know you’ve got tuberculosis, but it could be worse. At least no one’s died.’

      ‘Why do you think you got cancer of the stomach?’

      ‘Yes, I know, colon cancer is hard, but you want to try living with someone who has got it. Sheesh. Nightmare.’

      ‘Oh, Alzheimer’s you say? Oh, tell me about it, I get that all the time.’

      ‘Ah, meningitis. Come on, mind over matter.’

      ‘Yes, yes, your leg is on fire, but talking about it all the time isn’t going to help things, is it?’

      ‘Okay. Yes. Yes. Maybe your parachute has failed. But chin up.’

Negative placebo

      MEDICATION DIDN’T WORK for me. I think I was partly to blame.

      In Bad Science Ben Goldacre points out that ‘You are a placebo responder. Your body plays tricks on your mind. You cannot be trusted.’ This is true, and it can surely work both ways. During that very worst time, when depression co-existed with full-on 24/7 panic disorder, I was scared of everything. I was, quite literally, scared of my shadow. If I looked at an object – shoes, a cushion, a cloud – for long enough then I would see some malevolence inside it, some negative force that, in an earlier and more superstitious century, I might have interpreted as the Devil. But the thing I was most scared of was drugs or anything (alcohol, lack of sleep, sudden news, even a massage) that would change my state of mind.

      Later, during lesser bouts of anxiety, I would often find myself enjoying alcohol too much. That soft warm cushioning of existence that is so comforting you end up forgetting the hangover that will ensue. After important meetings I would find myself in bars alone, drinking through the afternoon and nearly missing the last train home. But in 1999 I was years away from being back to this relatively normal level of dysfunction.

      It is a strange irony that it was during the period when I most needed my mind to feel better, that I didn’t want to actively interfere with my mind. Not because I didn’t want to be well again, but because I didn’t really believe feeling well again was possible, or far less possible than feeling worse. And worse was terrifying.

      So I think part of the problem was that a reverse placebo effect was going on. I would take the diazepam and instantly panic, and the panic increased the moment I felt the drug have any effect at all.