'The depth of my depression was irrational . . . Give yourself time. Get the support you need'

As well as helping other people look after their mental health, Tony Bates, one of Ireland's best-known psychologists, has had to cope with his own demons, writes PAUL CULLEN

EVEN AFTER ALL the years, Tony Bates remembers the exact date when his life fell apart. It was December 2nd, 1985, and he was a successful academic with a promising future. But instead of being filled with hope, the young Irish immigrant in the US was inconsolable.

Trained as a clinical psychologist, he had recently started working in a clinic in Pennsylvania popularly known as the Feeling Good Institute, yet he was anything but.

“I couldn’t stop crying,” he says. “One time I banged my head off a stone wall to try to stop the pain. It was awful for everyone.”

Today Bates is a sought-after columnist, author, broadcaster and advocate on mental health. Yet his writing, including his latest, bestselling book on depression, is shot through with the lessons learned from dealing with this experience of profound depression.

“I was lost for many years, at odds with my adolescence, but it all caught up with me when I was 33,” he says. “It took the small trauma of losing a home, a silly thing I did in a moment of panic, and suddenly I lost everything.”

Through his many “dark nights of the soul”, he couldn’t stop crying. “The depth of depression I experienced was irrational. I was horribly difficult to live with, but I knew it had something to do with my early life.”

Bates knew something of his tumultuous childhood. He had wet the bed, mitched from school, even set his bedroom on fire. “I was a very disturbed child. I was lost.”

In adolescence, he put these difficulties and a six-month bout of rheumatic fever behind him to make it to University College Dublin, where he obtained a doctorate in psychology. On the surface everything was fine, but, inside, the time bomb was ticking. “I think my body knew all the time. I had felt for years this tendency to get down, to be in a lonely place.”

Digging himself out of the hole that opened up when he was in Philadelphia took almost two years and some painful detective work. Convinced that the roots of the problem lay in his early life, he contacted his mother, and his family travelled to the US for therapy.

The information this process unearthed confirmed his hunch. For the first time, he learned from his mother that he had been struck down at the age of three by German measles and encephalitis, as was his brother.

His brother died within 24 hours, but Bates survived. He spent three months behind glass in hospital in Cork, cut off from the rest of the world and his family.

“Dad was in the Army and had been moved to Dublin, so I was alone in the hospital,” he says. “They told my family not to come, because it distressed me a lot when they left. They were told I was probably going to die, and the hospital would phone them or put it in the papers.”

He says his parents “did what they were told” because they were “compliant people”. When Bates emerged from hospital he couldn’t walk, and the bond with his mother was broken. Further hospitalisations followed, and the later difficulties he knew about.

BATES'S PERSONAL TRAVAILS don't feature in his new book, Coming Through Depression, which is intended primarily as a guide to recovery for anyone affected by depression, and a support guide for relatives and friends. It is clear, though, that his thinking is informed by the way he resolved this trauma: by engaging with and confronting the past, and by doing so without medication.

All of us, he says, try to manage our inner lives as best we can. “Sometimes we’re drinking too much, and that’s a way of dealing with it, though not a very smart way. People who walk the Camino , who jog or attend yoga classes, are all trying to make peace with themselves.”

The curse of depression lies not in the bald fact of being depressed, he says, but in its tendency to come back again and again. Half of those who experience a bout of depression will suffer a recurrence; this figure rises to 70 per cent for those experiencing a second episode, and to 90 per cent after the third bout.

Perhaps it’s the times we live in, but sometimes the country seems to be floundering in depression. Or is that just my impression?

“There is more of it,” Bates says. “It used to be a middle-aged thing. Now the most common age of onset is 13 to 15 years of age. So it’s happening sooner, and recurring more often.

“In spite of all the treatments, we haven’t found the means to stop it recurring. We haven’t been able to relate to it in a creative way. It keeps coming back, because it’s saying to us, ‘You need to learn something about this, you’re not getting it.’

“We keep talking about it as a disease, like a plague that hits us out of the blue. We need to recognise that social circumstances make people feel helpless and trapped, and then they become depressed.”

Both the language we use and our tendency to treat depression with medication long-term are problematic, he feels. “We talk about trying to get over it, or beating the blues – all these militaristic analogies rather than an ecological analogy, which is to accept that this is part of your experience.”

Depression, while it has the potential to be debilitating and terrible, also presents us with the opportunity to learn about ourselves and about what was lurking in the shadows.

Bates speaks with a voice that would calm a storm and an accent that is hard to pin down, perhaps from his years overseas. He has an effortless ability to restate and refine his message in such a way as to make each distillation appear completely fresh.

We shouldn’t “write it off as a disease and say it’s all to do with drugs, when in reality it’s to do with stopping and looking at your life and asking: ‘Is there something I need to pay attention to here, something from the past or in the present that needs to be healed?’ Am I being bullied, for example, or under financial pressure, and need to let someone know?”

He urges people with depression not to waste the experience or rush the treatment. “It can be a very painful journey, but a very important one too to go through. Give yourself time with it, get the supports you need, take it one step at a time, know what you’re capable of. Think about exercise, nutrition, therapy, medication, if that’s important. Use everything, but don’t let it be something you’re hell-bent on getting rid of. You have to go through it, not around it. If you try to get rid of it, it’ll bounce back.”

I search around for reasons for the growth in depression. The recession? “More and more people are feeling more stressed out and less connected to communities, to families, to society. All of these things reduce a person’s ability to cope with life, which is hard anyway.”

What about our collective loss of faith? “Absolutely. There’s no doubt that for all its limitations, religion gave us a map of the world that, curiously, had a place for suffering. We lived in a vale of tears, mourning and weeping, so it didn’t feel peculiar to feel down. In fact, there were moments when we reached out and prayed and felt we were going to a better place. You couldn’t have a deep spiritual life without hitting some dark nights along the way. One of the things that has changed is that we’re now very frightened of these experiences.”

Are Irish people predisposed to depression? He says there is no hard evidence that the Irish are more prone to it than anyone else is. “I think Irish people have this phenomenal capacity for humour and fun, but behind it there’s a sense of the tragic. We know life can break our hearts, and we’re wary of that.”

Creativity is the upside of this entanglement in dark corners. “We have an incredible gift of being able to articulate these troubled experiences because we’re very close to them. But the other reality is that often we cannot cope with the closeness of our hidden lives. We’re much closer to our hearts than other people, and we pay a price for it.”

At the moment, he believes, “we’re broke and we’re broken and we’re really a bit lost. The co-ordinates that gave our life stability – religion and economics – have let us down badly. We had a more manageable, stable, insular population, and that’s all gone.”

The way out of this mess lies in getting the broader picture and balancing the bad news on the radio with “a sense of what isn’t broken. How I’m still able to make a cup of tea, go for a walk or welcome a grandchild. There are still beautiful things there that are a true part of my life and in fact are more real than the anxiety of what could happen years hence.”

Ireland, he says, is in shock but needs to move on, to grieve and to “let things go. There’s nothing bad that can happen to us that the mind can’t make worse. The mind can turn heaven into hell, or hell to heaven. We need to be careful about not allowing ourselves to be consumed by the stories we hear. Bad things will happen – we can’t stop that – but how we react to them is something we can control.”

BATES SAYS HE wasn’t interested in writing the masterwork on depression or in selling loads of copies. “I wanted to connect with people who were struggling with depression. I wanted to say something simple and relevant to families that would show them a way through the experience.”

The previous version of his new book sold more than 30,000 copies and has been translated into 10 languages. Since then his understanding of depression has changed and matured, he says. In the book, Bates takes great care to avoid words that, he believes, disempower people, such as “suffer” and “disorder”.

After spending most of the 1980s in the US, he returned to Ireland to work as a clinical psychologist at St James’s Hospital in Dublin. Apart from a year in Oxford in 1995, he has lived in Ireland since.

His wife, Ursula, is also a psychologist, working in the hospice sector, and his daughter, Rachel is just starting out on a career in clinical psychology. His two sons work in engineering and physics.

His media profile, which includes an Irish Times HealthPlus column that is now in its ninth year, regularly provokes a flurry of mail from people in difficult situations. The irony is that he no longer has a clinical practice.

In 2006, he left his secure job at St James’s to found Headstrong, an advocacy and support group for youth mental health. Headstrong is about “Ireland changing how it thinks about young people and their mental health, and giving young people a map for living”.

The need is greatest among young people, but the mental-health system is weakest for them, he says. “I wanted to work on a big idea rather than staying within my comfort zone,” he says. “It’s the best thing I ever did. I know I’m more alive than I’ve ever been.”

He believes we perform best when we move towards an edge in our lives. “Staying within your comfort zone is safe, but it can lack vitality,” he says. “Moving towards the edge of the unknown, that’s where we become creative. Those edges bring out in us our resilience. Until we have our hand near the fire, we don’t learn how to manage fire, even though we can write books about it forever.”

Coming Through Depressionis published by Gill Macmillan, €14.99

Medication: Yes or no?

To medicate or not is one of the most profound, and often controversial, issues raised by depression. Because many of the symptoms are physical, treatment often starts with an attempt to change the physical chemistry of the brain.

Bates believes that medication can be of great benefit to severely depressed people by relieving some physical symptoms, such as exhaustion, lack of energy and sleep disturbance, in a short time. “However, medication cannot correct the painful social or emotional factors that have caused depression,” he writes.

The downside of medication is the dependence it can lead to in many people, along with side effects such as weight gain and lethargy.

Bates opted not to take medication for his own depression as, he says, its causes were clearly psychological. “Because I didn’t medicate, other people had to bear with me longer, but it hasn’t recurred. I’ve had bad days since and I’ve sailed close, but I haven’t gone there again.”

He is critical of the “dogmatism” of many professionals dealing with depression, who make it confusing for people trying to work out a recovery plan. Some insist that medication alone will do the job and that the reason why people feel sad is that they have a “chemical imbalance”. “This point of view persists despite the fact that there is, as yet, no specific imbalance that can be identified in people with depression,” he writes.

But Bates also criticises those who view depression narrowly as a psychological problem that should be worked out exclusively by long-term psychotherapy. This approach may ignore ways in which the body and the brain influence our moods, thereby denying people some of the benefits that drugs can bring.

Bates says depressed people need someone who has their best interests at heart and who is willing to consider their unique circumstances.

In the book, he stresses the techniques of “mindfulness”, described as a form of mind-body training that enables people to change the way they think and feel about their experiences. Many of the drills will be familiar to anyone who has done yoga: breathing techniques, focusing thoughts on the present, discovering the stillness in our lives.

“Mindfulness is being present with an attitude of appreciation and kindness, anchoring yourself in the moment,” he writes. “You get to a place where you’re able to welcome difficult feelings and not push them away.”

It all sounds quite low-tech, but Bates says the practice of mindfulness has halved the risk of relapse in depression.

Shadow of suicide: Helping families who fear losing a loved one

Like many Irish people, Tony Bates has personal family experience of suicide. A quarter of a century has passed since a young member of his family, a person with outstanding prospects and no symptoms of depression, shot himself, but he says he can still feel “the ricochet of that bullet”.

Although suicides invariably leave behind devastated family and friends, Bates will not label their perpetrators selfish. “Selfish is not a word I would use. They are often terrified and hopeless. In the mind of someone who takes such a step, it can very often feel like the most selfless act. They often feel the world would be better off without them. They can feel distressed and in pain, and their ability to think beyond this one option is radically compromised.”

He says he has received countless calls from parents who fear they could lose a loved one unless they do exactly what is being demanded of them by a depressed son or daughter. “On the one hand, they want to be tough and insist that their son or daughter do something to help themselves. On the other hand, they are afraid that if they take their eyes off them for even a moment, something really bad could happen.”

Although the vast majority of people with serious depression do not take their own lives, Bates acknowledges the risk, particularly with long-term depression.

The thinking of severely depressed people is often so constricted that they cannot think creatively or problem-solve the way the rest of us do. Part of the solution in therapy is to get people “to look at what is important and approach it from another view”.

Bates points to Scottish research that showed no difference in the dreams and aspirations of different groups of people with and without depression. The difference lay in people’s confidence that they could make their dreams happen.

“Hopelessness is not the absence of dreams and aspirations; it’s the experience of never being able to make those things happen,” he says.

In the book, Bates counsels families in crisis to trust in the fact that their concern about a son’s or daughter’s welfare really matters to the young person. They might not be thanked for them, but their presence and willingness will be appreciated.

Parents should also consider whether they need professional help themselves, Bates says. In some situations, they need someone, often a GP, who can direct them to a service that can provide the most appropriate help.

Video Tony Bates discusses suicide: irishtimes.com/itmatters/storiesofsuicide/