When my second child was born at the end of 2008, everything went horribly wrong which resulted in my wife losing 7 litres of blood (all of her own and a whole lot of someone else’s), and ending up with an emergency hysterectomy. It was all such a mess that they took an ovary with it. That meant that, once my girls were home (the baby spent a week in intensive care as she was born with an Apgar score of 1. Healthy babies score 8-10; dead is 0) we had a newborn, a two year old, and my wife was recovering from major surgery, after a pregnancy with morning sickness every day for the entire nine months (try puking every day for nine months and see what it does to your resilience), while suddenly going into the menopause at the age of 35.
A difficult time, I think you’ll agree.
So it was no wonder really that about eighteen months after the birth she developed a severe, acute, case of depression. Sitting in the waiting room for five hours wondering if she would live or die was hard. Insisting that she tell me what she was thinking, only to hear that she was working out ways of killing herself, was way harder. She refused to go to a doctor, because she believed that they would take her children away. (This is of course not accurate, not least as there were no grounds to take them away from me.) Tip number one for dealing with depressives: you can’t reason them out of it. Depression is about affect, not evidence. All the data in the world proving that the doctor wouldn’t just take the kids away was irrelevant, she knew that they would, and so would not go. So I had to come up with a different approach. For the benefit of those who may be in a similar situation, here it is.
Own the problem.
Nobody could reasonably say that the depression was my fault, but I am still responsible for my wife’s well being, and her being was far from well. So I had to do something about it. Being a martial artist, I naturally cast the problem in tactical terms. The enemy: the depression. Weaknesses? unknown. Strengths? Unknown, but clearly vast.
Nobody who knows my wife would imagine for an instant that she would ever get depressed. It was not in her nature. But trauma can change everything. And this problem could prove fatal, so there was no time for fucking about.
The first step in every campaign should be:
Given that I knew almost nothing about the enemy, the first step was to go through all my friends and acquaintances and gather allies and intelligence. I focussed on women with kids who had experienced depression. A good friend of mine fit the bill perfectly, so I called her to ask advice. And to get a categorical statement that the doctor would not take the children away. (Not that that helped particularly, as people can’t be reasoned out of their articles of faith. But at least I had one ally who had fought the same enemy in similar conditions.)
Next on the list- a doctor. A friend who is a doctor made time for me, and I asked her advice. Her first tip was hugely important: depression is exacerbated by fatigue. So minimise fatigue. Her second was: get professional help (I was trying to!). Her third: look after yourself. This last was especially useful, as of course I was running myself ragged trying to deal with all this, and if I didn’t make time for maintenance, the machine would break and be useless.
Note that these two allies were also spies: people with specialised knowledge of the enemy. So I came away with spies in the enemy camp and the beginnings of a plan of action.
Thirdly I let the senior students at the school know that I would need to take some time away from class. I have the best students in the martial arts universe, and they stepped into the breach without hesitation.
Fourth: I let other friends know what was going on, and many of them helped in all sorts of ways. All of this took less than a day.
The process of recruiting allies, especially my spies, gave me access to a whole load of intelligence about the enemy and how it behaves. I added to this with internet research. But already I had enough data to formulate a plan.
Make a plan, and execute it ruthlessly.
Step one: ideally, step one would have been to take her to a doctor, but she point-blank refused to go. So straight on to step two:
Step two: make more time for sleep. Our normal evening routine has me getting home from work about 9.15pm, then we eat, then maybe watch some TV, then to bed, reading (of course), lights out about 12. It is not easy to go from being at work to being asleep in less time. But I changed our routine, and was fanatical about it. All screens off by 10pm. Lights out in the bedroom by 11pm at the latest. I took over any night-time issues with the kids. This lead immediately to about an hour extra sleep a night (for her anyway!).
Step three: reduce her workload. I took several weeks off work to deal with the kids, and made sure that she spent as much time as possible resting, or doing her own thing. We also agreed to put our younger daughter into daycare earlier than we had originally planned, and not have my wife go back to work. This meant we lost her maternity leave pay. This was going to be expensive, but what is money for? I grew up in places where children died of starvation and related ailments (my father is a veterinarian, who spent most of his working life on aid projects in the third world), so the fact that I could blow every penny we had and the culture we live in would not allow my kids to be homeless or starve, is something that I don’t take for granted, and the conscious knowledge of which gave me a freedom to act that I would not otherwise have had.
Step four: encourage healthy habits. We were already on top of the nutritional aspect; we have always eaten healthily. But I encouraged her to go to the gym, to take Pilates classes and similar, to get out and do something healthy that she enjoyed.
Step five: Professional help. I recruited a friend of mine who is a Chinese doctor (both by nationality and training), and made an appointment for my wife. Local doctors have the worst bedside manner I have ever encountered. They don’t seem to understand that their job is to give comfort to the afflicted- they seem to think it is to tap away at a computer and write prescriptions. For a depressive especially, the feeling of not being listened to is particularly unhelpful. I even arranged for her to go to a private gynaecological specialist, and this dumb arrogant fuck sat there and told her she was not menopausal. She had to break down in tears and demand a hormone test before he’d order one, and when it came back, guess what? Menopause confirmed, HRT prescribed, symptoms improved. This was after the depression had lifted, or I’d not have been able to get her to the doctor in the first place. But my Chinese friend, a professional and dedicated healer whatever your opinion of traditional Chinese medicine may be, gave her an hour of his undivided attention every time, listened to what she had to say, all the while giving her a massage. And not being a “proper doctor” he could not order the social services to abduct our children, so I could persuade her to go. To begin with she was going two or three times a week, and she kept going for some months before she no longer needed it.
Have a backup plan
My back-up plan, if I didn’t see significant improvement in a month, was to hire a doctor to come to the house, and see my wife whether she liked it or not. I can’t make her go to the doctor, but I could damn well make a doctor come to her. Drugs were a last line of defence, and a holding strategy, not a cure. If I had to deploy them, I would have. They bring their own problems, but especially in cases where the depression is long-term and not obviously triggered by trauma of some kind, they may be the only working solution.
We were lucky. The combination of more sleep, less work, and time for herself started working quite quickly, and in about six weeks the depression lifted: my wife came back to me. I could literally see her spirit returning, bit by bit, until she was herself again. You may imagine my relief. I do not imagine that this plan will work with every case of depression- far from it. If someone you love is in that horrible place, you might find this approach useful, is all.
What with losing the maternity benefit, and my wife not working, and the private medical bills, this all cost us a fair chunk of change, enough that it added about a year and a half to our mortgage repayments. Without doubt the best investment I ever made. The fight is not over though; once this animal has tasted blood it is always waiting for the slightest show of weakness to strike again. So I am always watching for fatigue, or the slightest sign of low affect.
It was utterly terrifying to be faced with something so far outside my experience that was threatening my family in such a dangerous and insidious way. God only knows what I would have done without my training. Being able to cast the problem in familiar terms, and come up with a workable plan of attack, was critically important to my mental health, and, I think, to my wife’s.
The system in brief:
1) Own the problem.
2) Recruit allies. You have a support network, use it.
3) Gather intelligence. Find out enough to make a plan.
4) Make a plan.
5) Execute it ruthlessly.
6) Have a back-up plan.
7) Recognise progress, or the failure of plan A so switch to plan B.
One final thing: act fast, act now, and if your loved one can be persuaded to do so, take them to a doctor. Do not for an instant mistake what worked for us as a guaranteed cure. It can’t hurt to arrange for more sleep, less stress, a friendly professional ear, etc., but there is no substitute for qualified medical advice, and if needed, intervention.
Thank you so very much for sharing this story/system! First of all I didn’t even know one could lose so much blood and survive it! Thank modern medicine!
I was also wondering if you had any tips on recognising the condition of depression itself. In my experience people suffer for a whole while from depression before anyone noticing it due to the gradual onset of fatigue. How do you recognise the problem (before owning it…)/ distinguish it from bad moods, etc?
Anyways, this story is very impressive and you are lucky to have each other.
In our case, recognising it was easy; massive personality change and loss of affect. In more insidious cases? Honestly, I don’t know.
I can offer a few tips I it helps Dominik of how I would spot depression as someone who has grappled with it in various forms over the years…inability to look forward to things, stopping making contact with people, avoiding crowds/social situations, inability to accept a compliment. (I offer the last one as a simple test, I wouldn’t say its foolproof but it could be a good red flag).
Wow, you’ve all been through the wringer! As someone almost recovered from burnout and associated depression with suicidal thoughts, I am delighted and inspired to read how you rallied and got through your difficult time. More power to you!
Best wishes to all your family!
What an incredible act of love.
Further to the question of diagnosis (having been on the front lines myself a number of times), my cognitive behavioural therapist gave me this questionnaire, which I did before every session to track variation in mood/state/etc. Dead useful: http://www.integration.samhsa.gov/images/res/PHQ%20-%20Questions.pdf
Brave and thoughtful post, thanks for sharing.