What's Normal Anyway? Celebrities' Own Stories of Mental Illness (27 page)

Reading this collection of powerful and moving personal accounts of well-known individuals' experiences of mental distress reminds me that being a psychiatrist is a humbling and unique profession. During my day at the office, I have the privilege of treating the whole spectrum of society: from the homeless to the aristocracy, ‘ordinary' people to ‘celebrities'. Yet despite the differences in people's circumstances, I regularly hear strikingly similar accounts of the complex and distressing symptoms of mental illness. For mental illness – or the more self-contradictory term of ‘mental health condition' – is a great equaliser; it respects no boundaries of age, race, culture, wealth, or intellect. Thus, while the accounts in this book may be the experiences of unique people, their stories are common to many.

These testimonies are a valuable contribution to the literature. They give a rich insight into the confusing world of a variety of mental health problems and have the potential to help others manage their distress. Mental illness is part of the human condition and sufferers usually experience a vast and frustrating array of emotions and thoughts. One of the most distressing aspects of mental illness can be the feeling that you are alone with your suffering: that no one understands, that you are the only one to have gone through such discomforting experiences, and the fear that you are descending into madness. Hearing that famous, capable individuals can experience these mental conditions can be a great comfort and ease the burden of solitary suffering.

I also believe that this book will encourage those suffering from mental illness to reach out for support, access and accept treatment, and begin their recovery journeys. There is a myriad of therapies, medications, and self-help techniques available out there and it can be a daunting task to choose between them. So how do people decide how and why to seek help, and what that help might be? In recent research that my colleagues and I conducted on bipolar disorder it rapidly became apparent that individuals do not appraise scientific literature in order to decide whether to take Lithium, or an SSRI, or to undergo art therapy. Instead, decisions about treatment are strongly influenced by anecdote, hearsay, and other people's accounts of what worked for them. So I believe that these stories – which bring to life celebrities' personal struggles with a range of common mental illnesses, what treatments they have tried, and their successes and frustrations – will be very powerful tools in motivating others to seek treatment, because: ‘If it works for them, it can work for me.'

These accounts are also helpful on a societal level. For despite the prevalence of mental illness – and the recent advances in understanding and treatment – there remains a widespread social stigma attached to it, born mostly out of ignorance. The mentally ill may no longer be tortured, lobotomised, sterilised, or executed, as in past centuries, but according to a recent survey nearly nine out of ten sufferers still experience negative reactions to their conditions. In extreme cases this is described as worse than the illness itself, discouraging openness, making people feel ashamed, and isolating sufferers. I therefore hope that these stories can help to raise general awareness and knowledge about mental health and dispel some of the more persistent and damaging myths and stereotypes surrounding it.

So what does this book ultimately leave us with? As a practising psychiatrist it reinforces to me how mental illness can affect
anyone
and, at times, be a source of enormous distress. However, as it further illustrates, those who live with mental illness may still be among the most successful people in their professional fields and lead happy personal lives. Mental disorder is not necessarily a bar to having a fulfilled life. Rather, it is something that can be lived with, treated, recovered and learned from, and in this sense these stories are positive ones of hope and triumph over adversity.

Dr Richard Bowskill, MA MRCP MRCPsych
Consultant Psychiatrist and Medical Director

Depression

What is depression?

Everyone sometimes feels a bit down or blue, but being clinically depressed is something very different. Depression, which is a type of mood (or affective) disorder, may be diagnosed when a person suffers from a low mood that lasts all day every day over a prolonged period of time, or comes and goes repeatedly, adversely interfering with their life.

What are the symptoms of depression?

People suffering from depression may have emotional, behavioural, physical, and cognitive symptoms. These may include feeling sad, having negative and pessimistic thoughts, taking less pleasure in activities that are usually enjoyable, and feelings of low self-esteem and self-confidence. People who are depressed may also have less energy than normal, feel tired all the time, find it hard to concentrate, and suffer from memory problems. They may feel guilty, worthless, numb, in despair, irritable, impatient, restless, anxious, and/or agitated. They may also eat and sleep less or more than normal, cry a lot, lose their sex drive, and have unexplainable physical symptoms. In the most serious cases, sufferers may also have suicidal thoughts and may attempt, or commit, suicide.

Are there different types of depression?

M
ILD DEPRESSION
:
People suffering from mild depression usually feel in generally low spirits and have two or three of the symptoms listed above but can continue with most of their day-to-day activities, although these may be more of an effort.

M
ODERATE DEPRESSION
:
People suffering from moderate depression frequently have extreme difficulty continuing with their daily lives, and have four or more of the above symptoms.

S
EVERE DEPRESSION
:
People suffering from severe depression have many of the above symptoms, including suicidal thoughts and attempts, and may need to be treated in hospital.

P
OSTNATAL DEPRESSION
(PND):
It is thought that up to 85 per cent of women experience a low mood after giving birth, commonly called the ‘baby blues', which usually gets better by itself. However, around 10–15 per cent of new mothers develop PND, which is a more serious and longer-lasting condition. As well as suffering from the usual symptoms of depression, women suffering from PND may also feel unconnected to, or hostile towards, their baby and/or partner. PND may be caused by hormonal changes, a lack of support, major lifestyle changes due to having a baby, social circumstances (such as poor living conditions), and previous mental illness.

How common is depression?

It is thought that around 10 per cent of the general population is suffering from depression at any given time.

Are certain types of people more likely to develop depression?

Anyone can become depressed, including children, adults, the elderly, men, and women. However, it has been found to be more common in females, people of a lower socio-economic status, and those who are unmarried.

Why do people get depression?

Depression is usually the result of a combination of factors:

G
ENES
:
Some forms of depression, such as bipolar disorder (see bipolar disorder factsheet), seem to be highly influenced by genes. More common forms of depression have less clear genetic roots, although depression may often appear to run in families.

E
NVIRONMENT AND LIFE EXPERIENCES
:
Distressing events or circumstances as a child (such as poor parenting, sexual and physical abuse) and/or as an adult (such as divorce, bereavement, and work stress) may trigger episodes of depression or make a person more likely to develop it at a later stage.

B
ODY CHEMISTRY
:
Abnormal levels of neurotransmitters in the brain (such as lower serotonin levels) and hormonal changes (such as those that occur in pregnancy and menopause) may also trigger depression.

P
HYSICAL ILLNESSES
:
Illnesses (such as an underactive thyroid) can cause depression, and some medications (such as beta-blockers) may also have depressive side effects.

What is the treatment for depression?

Most cases of depression can be treated at home, although hospitalisation may be needed for severe cases, particularly if a person feels suicidal.

L
IFESTYLE CHANGES AND SELF-HELP MEASURES
:
In milder forms of depression, healthy eating, exercise (such as walking, swimming, or yoga), good sleep hygiene (such as getting up at the same time every morning and not napping in the daytime), and avoiding drugs and alcohol may help alleviate symptoms. Self-help materials – which may include information on mood monitoring and management of symptoms – and self-help groups (face-to-face or online) may also be beneficial.

A
LTERNATIVE AND COMPLEMENTARY THERAPIES
:
Some people also find treatments such as homeopathy, aromatherapy, massage, and acupuncture helpful. In addition, some studies have found the herb
Hypericum perforatum
– commonly known as St John's Wort – to be as effective as antidepressants in relieving mild depression. (This should not be taken alongside standard antidepressants.)

T
ALKING THERAPIES
:
In moderate to severe depression, talking therapies – which may include psychotherapy, interpersonal therapy (IPT), counselling, and cognitive behavioural therapy (CBT) – are usually recommended. CBT is currently the most commonly used talking therapy and broadly involves identifying negative thoughts, feelings, and behaviour and trying to replace these with positive ones.

M
EDICATION
:
Antidepressants, usually in the form of selective serotonin reuptake inhibitors (SSRIs), may also be prescribed. If these don't work, tricyclic antidepressants or monoamine oxidase inhibitors (MAOIs) may be tried.

E
LECTROCONVULSIVE THERAPY
:
ECT may still occasionally be used for severely depressed people who have not responded to other forms of treatment.

What are the risks associated with depression?

Depression may make people more likely to suffer from physical health problems, such as diabetes, cardiovascular disease, and strokes. Over half of people who suffer from depression also have an anxiety disorder, and some may self-medicate with alcohol and drugs. Those with severe depression are at increased risk of self-harm, suicidal feelings, and committing suicide.

What is the prognosis for people with depression?

Many people with depression, particularly in its milder form, go on to make full recoveries. However, around half of people who have one episode of depression will have at least one more during their lifetimes, and for about one person in five the condition becomes chronic. The earlier that people get the right treatment, the better the outcome.

Who can I contact for help if I think I have depression?

Your first point of contact should be your GP, who will rule out any physical or medical problems that may be causing your depression. Depending on the severity of your symptoms, they may then refer you for talking therapy (usually CBT) and/or prescribe antidepressant medication. If you have severe depression and may be at risk of harming yourself, have psychotic symptoms, or do not respond to standard treatments, you may be referred to your local community mental health team (CMHT). In addition, the below organisations may be able to offer help, support, and advice:

Depression Alliance
Tel: 0845 123 23 20
Web:
www.depressionalliance.org

Depression UK
Email:
[email protected]
Web:
www.depressionuk.org

Mood Swings Network
Tel: 0161 832 3736
Web:
www.moodswings.org.uk

Black Dog Tribe
Web:
www.blackdogtribe.com

Pre- and Postnatal Depression Advice and Support (PANDAS)
Help Line: 0843 289 8401
Web:
www.pandasfoundation.org.uk

Please see the ‘Useful contacts and links' pages for more resources and organisations that may be able to help, including national mental health charities such as Mind, Sane, and Rethink.

Bipolar disorder

What is bipolar disorder?

Formerly called manic depression, bipolar disorder is a severe mood (or affective) disorder. The condition is characterised by extreme mood swings, from episodes of overactive, excited behaviour, known as mania, to deep depression. Between the ‘highs' and ‘lows' there can be periods of stability and normal mood.

What are the symptoms of bipolar disorder?

M
ANIC EPISODES
: During manic episodes people with bipolar disorder typically feel euphoric, high, and elated, or restless and irritable. They may talk very fast, have racing thoughts, be unable to concentrate, and need little sleep. Sufferers often have an inflated sense of self-importance and poor judgement, and may exhibit risk-taking behaviours such as excessive spending, sexual activity, drug and alcohol use, and/or aggressive behaviour. Some people may also be highly productive, driven, and creative.

D
EPRESSIVE EPISODES
:
Conversely, symptoms during depressive episodes may include a sense of hopelessness and worthlessness, feelings of emotional emptiness, and guilt. During such lows, sufferers may experience chronic fatigue, sleep too little or too much, lose or gain weight, lose interest in daily life, and take no pleasure in normal activities. They may also have recurrent thoughts about death or suicidal feelings, and some may attempt suicide. Around half of people with severe bipolar disorder also have psychotic symptoms, including hallucinations, and/or delusions.