Long Reads

“How holding down a job helps me manage my depression”

Posted by
Lauren Slater
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After living with depression for years, one author found relief in the structure of building a career.

I was in the midst of a severe depression. Rain fell, sounding like tiny tacks when it spit against the windows. Puddles glimmered on the ground. The trees bent with the wetness of their load, branches scraping the sidewalk where the waterlogged gravel lay scattered. The sky was the color of cement without a single cloud or crack, just grey, grey, grey. I remember lying in bed and listening to the drops knuckle the red roof above my head, the house otherwise silent, my children in school, my husband at work, books I could not concentrate on sitting in stacks on the floor.

The sound of the phone ringing cleaved the torpid air and when I picked it up I heard, at first, just static. Then the sound of a chipper voice telling me I had the job I’d managed to interview for just the week before, a job working as a psychologist in an inner city clinic, where my patients would be worse off than me. 

There would be schizophrenic men who heard the voice of the Mother Mary in their heads, chronic schizophrenics and men recently released from jail, the ankle monitors they had to wear clacking at the hems of their trousers. There would be women whose babies had been taken away because they could not care for them, who were seeking, instead, the oblivion of a heroin-filled syringe or the scatter of cocaine powder on a scratched mirror. These were my patients-to-be.

“Rain fell, sounding like tiny tacks when it spit against the windows.”

I told the chipper voice I could start right away. For one thing, we needed the money. For another, I know myself well enough to understand that I always do better with structure, no matter how badly I may feel. There was not a single speck of me that wanted to leave my rumpled sheets but, when the time came, I heaved myself to my feet, forced my limp body into a suit, pushed my feet into high heels, slid my calendar and wallet and comb and brush into my briefcase and I was off. 

I drove down the highway and exited onto the ramp that took me to the inner city, a place where there were rats the size of skunks lingering by the garbage piled at the curb. I heard the clicking of my heels on the concrete and then there was the clinic with its sad little sign, its waiting room crowded with slumped people and a harried receptionist and clinicians rushing to and fro, ushering patients into their offices above.

I was immediately assigned a caseload of 25 and then handed a stack of paperwork I was expected to master right away. There were intake forms, assessment forms and progress notes that needed to be written for every patient I saw. The stack was about 40 pages high, the assessment form itself composed of 20 pages on which were printed innumerable boxes I was supposed to check. There were boxes next to phrases on “suicidal ideation” (yes? No? Check), on manic behavior, on substance abuse, on fear of abandonment, on psychomotor retardation, on sleep disturbances. It went on and on. 

I noted that my heart, which had previously been sluggish from depression, was pattering in my chest and that somehow another emotion had made its way through my mud, that feeling of fear, or anxiety: however would I master all these forms? As it turned out, I didn’t have much time to think about that because, as I was sat in my cramped office, my telephone rang, with the receptionist telling me my first patient was ready to be seen. I put the sheaf down and went to get him.

He was just a tad over six feet, with visible biceps. His shirt was unbuttoned to the tattoos that raced over his chest: roses on vines and serpents writhing upward, and strange symbols I had never seen before. He had been incarcerated for the murder of his wife and was, after 25 years, on pre-release, which meant wearing the ankle monitor, p**sing daily into a cup for toxicology screens and seeing not only me, but his parole officer every day. He told me a story that fascinated me. 

He told me, in a rusty gruff voice, why he had held a gun to the temple of a woman he supposedly loved and pulled the trigger. “Voices,” he said. “My voices told me to do it.” He described the voices that had instructed him so badly and said he heard them still, muffled by medication but nevertheless very much there, and they terrified him. Inside me something uncoiled and reached towards this massive man, a feeling that was almost fondness, or admiration, or empathy. I was warmed by my own responses and by the burgeoning of a relationship on which every therapeutic encounter is based.

The session finished in what seemed no time at all. In total that day I saw 16 very sick patients. I had made 16 connections and heard 16 stories, and my ears were ringing with them all. I had started my clinic day at 9am and it was now 5pm. The rain had stopped, the sky had cleared, and the grass was glittering in the setting sun.

Freud famously said that a person needs love and work in order to live a fulfilled life. I believe he is right. When we are lacking one or the other our lives go off kilter, and depression or deadness can set in. I was held aloft by my 16 stories, yanked right out of myself and into disparate worlds that were at once very far away and also very close. In every instance in my life, work has proven to be a tonic to the depression that always wells around my border, like a dark puddling of ink that rims my boundaries and threatens to spill over in a black mess.

I have used this ink to write but it is not enough. I need the eight hour day. I need real responsibilities. I need to be held accountable to the humans who place their faith in me, and to the supervisors who hold me to high expectations, which I will reach for, stretching out of myself. In doing so I am shedding my heavy flesh and rising up into lighter layers where there is much to do, much to be accomplished, some of it rote, most of it fascinating.

“I need to be held accountable to the supervisors who hold me to high expectations, which I will reach for, stretching out of myself.”

For me, work is about stories. As a psychologist I listen to peoples’ stories all day. I have learned that stories can make you sick, but they can also make you well. Peoples’ lives go awry when the stories they tell themselves about themselves are maladaptive, and when they learn to alter their plotline and seek new themes, opportunities emerge from what had seemed like an impossible mist. Work reminds me that my own mental health is dependent, in part, on the story I tell myself about who I am. When I lie in bed bemoaning my failures, unloved, unwashed, disinterested and without motivation, I feel like hell. But when I stand up straight and force myself into clothes that flatter, and take myself off to my workplace, I am able to see a different sort of self emerge from the skyline. A self with something to give, a self that takes interest in the lives of others, a self that genuinely wants to help, and, finally, a self that can care. My story changes and my depression recedes. Work and love, yes.

As an adolescent and young adult, I frequently visited mental hospitals for treatment for depression and anxiety. I remember the clatter of the food cart and the quiet room which was anything but quiet, with patients raging away their hours behind its walls. I was 15, 16, 18, 21, and with every year that went by I got sicker and sicker, finishing high school and college by the skin of my chin, my arms a single welt of cuts I’d made with razors. And then something happened to change all of this. Well, two things really.

Prozac came out, and the medication helped enormously. But there was something else as well. At the age of 25 my father ceased to support me. It was the most loving thing he could have done. I went to work, then went to school to earn a degree that would allow me to find better work. With each job I gained more confidence, more heft, more knowledge, until at last, and almost despite myself, I became a real professional in the working world.

As I write this I see my briefcase, leather, leaning against the railing. I have had it for over 20 years. It is broken in but not broken, just soft from the touch of hundreds of hands. Sticking out of my briefcase is my appointment book and, were I to open it, I would see evidence of a very robust life: the little squares filled in with appointments written in blue pen, each one a story waiting to be told.

When the time comes, you can bet that I’ll be listening. I’ll uncurl like a cat and my ears will be magnets, catching every intonation, every phrase, and listening hard to the silence between sentences. For those silences, too, are part of the plot, part of the movement that brings us down the lifeline and into a pure pool where the water is warm and you are held, aloft.     

The Drugs that Changed Our Minds by Lauren Slater is available now, £14.99 from amazon.co.uk

Images: Jose Fontano, Aaron Burden, Alex Boyd, Martin Grincevschi, Unsplash