Ian’s story – Part 3: Functional depression

Ian’s late twenties and early thirties were something of a muddle of dips and hills and flat plains, but without the crashing crises and drama of his earlier twenties. He often went through low patches when he would ring me sounding fed up, miserable, resigned, panicky or apathetic.  These times were in marked contrast to other times when he was full of fun, when he could laugh at life, when he had genuinely happy periods and everything felt lighter – for him and for me.
During his inpatient stay in 2004, part of Ian’s treatment was to work with a mental health occupational therapist.  Over the months and years following his admission, as he was building himself back up, he began to talk about the idea of re-training in occupational therapy.  He never talked in great detail to me about it, but in private he obviously reflected about how beneficial the OT input was in hospital, and the possibility of pursuing a career in this area began budding in his mind.  It was still the glory days of NHS bursaries so financially it was a feasible option, and eventually he bit the bullet and enrolled on a masters course in OT.  I felt so encouraged and a lot lighter in my own worries – I hoped with all my heart that this step would put to bed the difficulties he had leaving the police and would give him a new vocation and a new motivation.  I hoped with fingers, toes and everything crossed, that this was going to be the permanent turning of a corner.
Like anything which is worth achieving, the course itself presented challenges and at times Ian found it hard to cope.  He made some good friends at university who somehow instinctively knew how to support him, but there were times when he would phone me in distress.  In his mind this was another thing he was going to fail at, and he could not find a way to get through the demands of assignments and placements.  During one particular conversation, Ian said accusatorily, angrily – whether at me or at himself I do not know – that I had not struggled with my studies in the way that he did.  I found that difficult to hear.  Of course I struggled at points when I was doing my own training, as every student does at some time, particularly with a professional qualification which requires placement hours to be met as well as assignments written and lectures attended.  There were times when I was studying when it felt like a huge load, and I wasn’t sure how I’d ever qualify and how I would ever know enough to actually be called a nurse.  It seemed impossible that I would complete all the thousands of words I needed to write, that I would make it to every placement hour I needed signing off, or that I would ever feel confident enough to qualify.  The difference was that my instinct was not to phone him for support.  This conversation again demonstrated the unbalance in the dynamic of our relationship and highlighted that Ian seemed to genuinely think I was infallible; that I could cope with anything, that I never needed any support, and that ultimately I had an easier life.  I acknowledge the part I played in contributing to this perception, and perhaps he would have actually liked me to phone him for support sometimes.  It just was never my instinct to do this, because throughout my life on the occasions when I had needed support – for example following relationships breakdowns and during one very difficult period when I was in hospital with a life-threatening condition – it was quite clear that he could not offer me any meaningful support.  I don’t know if he did this consciously or subconsciously, but I was left with no doubt about it in my mind.  I see now that this conversation, and his apparent perception of me, simply showed that Ian’s brain could not really process any difficulties that I might have had, and that he didn’t have the emotional resources to offer me. This still makes me sad now, but I have come to terms with the fact that this was not his choice and it was not because he was cold and was not because he did not care – he could not give me the support I gave him, and he could not see my vulnerabilities.  I suppose in a way it is a compliment as he thought of me as somehow unflappable, I guess.
Ian battled on and – along with the whole family – was incredibly proud when he graduated as a qualified OT.  His first choice of specialism in which to work was mental health, where he felt a natural empathy and affinity.  He worked in this area for the duration of his career, from qualifying until he died.  He initially worked in an acute mental health inpatient setting and, despite delicate self-confidence, he used his training and his own personal experience to develop as a very competent and well-liked practitioner.  When he died, many of  his colleagues contacted us and came to his funeral.  They had nothing but amazing, complimentary things to say about his work and the way that he related to patients.  This made me terribly proud of him.  I hope he knew how highly he was thought of at work and I hope that he genuinely knew for certain that he made a positive difference to the patients he worked with.  He brought a lot of his character to the role.  He had always been a naturally likeable and trustable person, which I imagine would have helped him no end when he was building rapport and when he was caught in some tricky situations.  One of the aspects about Ian which I imagine would have made him such a good practitioner is that he had a normality and a genuineness about him which would have broken down any hierarchy between him as the professional and others as the patients.  Of course, this would have been enormously impacted by his personal experience of being the patient.
I would say that throughout this time – probably six years, give or take – Ian lived with high-functioning depression.  By this I mean that he did not become acutely unwell like he had in 2003-4, but the depression was always there in some way.  Ian achieved many fantastic things, he got up and went to work every day, and the vast majority of family and friends remained without any idea that Ian experienced depression.  It is testament to Ian’s mask of ‘being OK’ that despite working in mental health alongside highly qualified and very experienced colleagues, the only ones who knew anything of Ian’s difficulties are ones who he actually confided in.  Although they were specialists in the field, he was so skilled at functioning despite his mental illness that they could not see it.  Functional depression is something that I can relate to now in myself; feeling pretty low at times but continuing with life in a way that, to most people, would not reveal any feelings of depression; functioning every day despite feeling very low at times.  There were many times when Ian made a doctor’s appointment to discuss his mental health, but when he arrived at the appointment he found that he was having an OK day or week, and could not find the words to speak about how he felt the rest of the time.  He talked often about worrying that people would not believe him; that they would think he was making it up because of the way he presented.  I believe that functional depression is probably something that is relevant to many people, and with this in mind I am going to write a fuller blog on this topic in future.
I think it is fair to say that Ian felt things in extremes – when he was happy he was almost elated; when he was down life felt very heavy, as the weight of the world lay on him.  A couple of times I questioned him as to whether he thought he might have bipolar disorder.  He dismissed this immediately.  As he worked in an acute mental health setting, in his mind and experience, bipolar symptoms were much more extreme – impulsive and reckless spending or behaviours, not sleeping for days on end, hypersensitivity to sensory stimulation, psychosis.  It is one of my regrets that I did not look into this more closely or try to encourage him to give it more thought.  Since he died I have learnt that there is such a thing as bipolar disorder type 2.  Although we will never know for sure, I feel that this diagnosis would have fitted with Ian.  His lows were always more noticeable than his highs, but his highs were undoubtedly there.  He could be reckless and impulsive, doing things which ended in mildly harmful and often amusing consequences, and he did speak of feeling elated at times for no real reason.  I do wonder, with enormous regret, had he received a diagnosis which fitted properly and which could be treated appropriately whether this would have been the key to helping Ian in a meaningful, long-term way.  And whether this ultimately might have prevented his suicide.  I find it difficult to think too deeply on this topic as it is too unbearable.  I have talked about regret in previous blogs, and this is a big one.
At this time in his life, the events which triggered Ian’s downs were to do with his life situation, rather than being job-related.  He had brilliant friends and was very sociable, so while he was not lonely, he would have loved to get married and have children.  He talked of finding weddings and christenings increasingly difficult as he moved through his early 30s, as although he did not resent other people’s happiness, these events highlighted that his situation was different.  He was self-conscious of still living in a shared house and felt that at his age this should have been a stage he had left behind.  He saw lives all around his moving on, mine included.  He saw me marry (with an incredibly proud smile on his face), and he adored my son when he was born.  I think he looked at my life enviously – with my lovely husband and baby and Victorian terraced house – and he questioned why he had not found his family.  He compared himself and his situation to others, and consistently came to the conclusion that everyone else had found the place where they fitted, their niche and their soul-mate, while he remained alone.  His confidence was low, but this was not necessarily visible in the ways you might think; he certainly wasn’t shy and he could make conversation with anyone, he was gregarious, outgoing and funny.  His low confidence instead could be seen in more subtle aspects of his character, the one springing to mind most immediately being his decision making abilities.  He would often need to talk though even fairly minor decisions, almost as though he could not just trust in his own opinion or perspective, and he needed to defer to someone else to validate it.  He once wrote to me in an email that he often did not feel sure of himself and he felt that ‘women want men who are sure of themselves’.  This almost made me weep, as it seemed to sum up so much of how he felt about himself and how we wished he was different.  In reality, of course, everyone adored him because of who he was, not despite it.
I try to treasure some of the happiest memories of times with Ian during this particular period – the time we went to stay in a very odd B&B near to our 95 year old Granny’s nursing home and, with much faffing and hilarity, managed to take her out for lunch – the time he met his new nephew for the first time – both our mum and our dad’s 60th birthday celebrations – Christmases together at our parent’s house.  Although it is very difficult not to let these memories become infiltrated with sadness, I try to put them in little bubbles and not allow the genuine happiness we felt then to be tainted by his absence now.  Easier said than done, but as a family I think we are all pretty good at reminiscing on good times for what they were, and of being able to say Ian’s name without awkwardness or sadness.  In truth the happy memories probably have got me through more difficult moments than I realise, and I am grateful for them as I know that some people who have lost loved ones in similar circumstances may have very few happy moments to reflect on.
My next blog is going to consider the year leading up to Ian’s death.  I think about this year all the time, but I will need to brace myself to actually write it in black and white and press publish.  However, I continue to feel confident that going through this ‘timeline’ process is ultimately helpful.  My hope is that it will help me move events more decidedly into the past.
Until next time…
As ever, thank you for reading
Louise x

2 comments

  1. Didn’t want to just put a “like”on fb
    Deep,thought provoking words deserve more than a bloody thumbs up.
    More than anything,when I read your description of Ian, your love of him shines through and what a top geezer he sounds.
    Thank you for posting.
    X x

    Like

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