the fire in the control room

Saturday, January 28, 2012

the fire in the control room

I read an interesting article in the Guardian before Christmas, called “A lack of physical symptoms makes depression harder to bear.”

I thought the headline was pretty accurate, and this bit makes sense:

There is a certain luxury to indulging a bout of physical illness, quite absent from my experience of periods of depression, for instance. Lying in bed, with a mug of hot Lemsip, surrounded by tissues – and sleeping dogs – thermometer gratifyingly high, cheeks flushed for additional validation. (…) There’s something unarguable about physical illness. No need for justification. You’re ill. You need to take it easy. Nobody ever asks why you’ve got flu. Flu exists and you’ve got it. End of.

But I think the writer misses the key point when she says:

With mental health problems people want to know why. With physical illness it’s different. You’re ill. It’s not a question of choice. It’s the subjective nature of mental health problems – the lack of obvious physical symptoms, the lack of a measurable temperature – that encourages self-reproach.

Rather than having demonstrative value to others, I think that the most important thing physical symptoms provide is a way to engage and grapple with illness. Physical pain has a location and a certain timbre that suggests a respective response. It’s enormously helpful, psychologically speaking.

Take a particularly sore throat. The first thing about it is, it’s your throat that’s sore. You can talk about it in the possessive. “I’m here, and among many parts of my body is a throat, and it hurts.” We’re already distanced from it ontologically speaking. That helps.

Next we can start thinking about how to respond to the pain. One type of response is to care, alleviate and tend to it. A soothing lozenge. Warm compresses. That sort of thing.

But perhaps a deeper desire is to combat, overwhelm and destroy the pain. If sipping a hot drink momentarily soothes the inflammation (or perhaps distracts from it with a more novel stinging sensation) then we start to fantasize about gargling with liquids even hotter, perhaps almost scalding, so hot it would utterly sterilize the pharynx and burn away the nerve endings and yes, yes, that might just work.

If you ever got chicken pox as a child, you probably remember being told “not to scratch” and let various ointments do their work. But the instinctual suspicion you probably harboured was that perhaps, just perhaps, you weren’t scratching enough. A bitter inkling that given the right abrasive material - a wire scourer, some extra-course sandpaper - and freedom from adult oversight, you could make a small piece of medical history and become the first child to scratch themselves back to health. “The itching,” the researchers would later admit, “did operate on the outer layers of the skin after all. And this brave young lad didn’t rest until every last fucking bit was mercilessly scoured into oblivion. Well done.” [1]

So the initial problem with depression is that it isn’t your anything that hurts, it’s you. There is no distance between you and the pain. Physical pain you watch and strategise about from a remove, like a captain watching blinking red ‘FIRE’ lights on the control panel of a ship and issuing commands in response. Now, without warning, the bridge itself is full of flames and choking, acrid smoke, and the heat is searing your very skin.

And because it’s here, so close, too close, you can no longer seek solace in the last resorts of expulsion and excision, which are the ultimate manifestions of the impulse to dominate and defeat the pain. You can shit and vomit out whatever you ate, a doctor can take a scalpel to your tonsils - but you can’t cut out yourself. Obviously. Right?

Right, of course, except we’re human, and the bloody-minded urge to kill pain at any cost doesn’t go away. Which is why, I think, even a short-lived and moderate attack of depression can leave someone feeling totally suicidal. It’s the same fantasy we had about scouring pads when we were itchy children, or gargling with boiling tea as throat-swollen adults. We know it’s not what we’re meant to do. We know it’s not what we’re really going to do. But goddamnit, for as long as the pain lasts, it’s all we’ll dream about doing.

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[1] If that made you feel itchy, read this New Yorker article about two cases of incurable itching in the New Yorker. “I don’t normally tell people this,” she said, “but I have a fantasy of shaving off my eyebrow and taking a metal-wire grill brush and scratching away.”