Depression: Under the sun. Under the sink

Before we left Zambia I'd started to wake at 3am with dead hands. I thought it might be from the way I had been sleeping, on my belly with my hands under my pillow. In the weeks before we moved again, this time to Tanzania, we took a holiday in Ireland. I was driving to Galway one morning for a wedding when my hands started to tingle on the steering wheel.

That was when I started to worry, because I thought about a friend who had pins and needles during her first multiple-sclerosis attack. By the time we arrived in Tanzania it was becoming hard to shake it out in the morning. I tried to ignore the feeling creeping up my arms and the fuzzy sensation in my legs.

It was my first time at a clinic in Tanzania, and I was not looking forward to trying out the country’s healthcare system. The first doctor thought it might be diabetes, but that was ruled out, and I was sent to another doctor, who had more knowledge of neurological disorders. I gulped when he said that he couldn’t rule out a blood clot, a brain tumour or multiple sclerosis and that I’d have to go for an MRI scan.

My husband, Maurice, was working in the bush for 10 days, we were new to the country and I had no friends. I was tired and alone and scared. I didn’t want to tell my family, because I didn’t want them to worry helplessly from far away.

The machine is malfunctioning, the Asian technician told me, and someone was coming to fix it in an hour, but he could fit me in if we moved quickly. I was confused and tried to ask some questions, but he told me everything was fine, handed me a thick orange gown from a filing cabinet and told me to put it on. It was damp and covered in army ants. I flicked it out, and the ants flew on to the wall of the toilet.

The MRI room was freezing and the walls were orange, like the gown. The machine looked comfortingly high-tech. The technician told me to lie down on the slab, put a heavy wool blanket over me, then clicked a plastic latch around my neck. He said that he was going to review various parts of my body and that each scan would take about 15 minutes. I would get breaks in between.

He put big headphones on me, and lifted one side up to say, “You might hear some funny noises, okay?” Then he put a pen-like clicker in my hand. “Only for emergency, okay? Don’t move,” he said as he left.

I thought the 15 minutes would be manageable until I started to move into the machine. The space I was in was tiny, and the noises – hammering, thumping, whirring, throbbing, screaming – were overwhelming. My wedding ring seemed to buzz, and I worried that I was going to stick to the machine.

Bang-bang-bang-bang-bang. Is this the machine malfunctioning? My heart was pounding, the blanket itched, the noise was frightening, the metal was too close. I tried to keep my eyes on the slice of orange paint to remind myself that I was close to a real place with real walls and humans. The noises changed every few minutes, deep pulsing nightclub sounds – ince-ince-ince-ince-ince – and speaking sounds: die-die-die-die-die.

I was finding it hard to breathe. I couldn’t cry, because I knew that would send me into a panic. Eventually I felt myself being dragged out of the hole. The technician was quite cheery as he released the plastic latch around my neck. I bolted up, letting the blanket slip off. Tears rolled down my face.

“That’s very hard,” I told him.

“Don’t cry,” he said, laughing. “We don’t have much time left. We will do another 15 minutes and another break, and then one more time. You don’t have to have the thing on your neck this time.”

That sounded like a bonus until I realised I was being pulled farther into the machine this time. I couldn’t see the wall, just white metal. Fifteen minutes. I am quite good at sensing how much time has passed, and it seemed like so much longer. I saw from the clock when I got out that it had been 40 minutes. I knew the technician just didn’t want to have to deal with my tears, but I was too relieved that it was over to be angry.

The line was bad when I spoke to Maurice that night, and it was hard to explain how tough the day had been. It was just an MRI scan. I collected the results alone the following week. Nothing was showing up, which was good. Probably something postural, the doctor said: I should go to a biokineticist, a kind of South African version of a physiotherapist.

I rolled over balls and touched my toes and stood up straight and worked night after night, week after week to let these exercises make my body strong and hoosh these haunting pins and needles away.

They didn’t go away. They got worse and were joined by pain and burning. My right leg felt as if it had been dipped in boiling water. When the diarrhoea, cramps and nausea came they were distractions from the pins and needles. I had hardly noticed how tired I was. I had hardly noticed that I didn’t know how to get through a day.

Crying more than not crying

I had hardly noticed that I was crying four times a day, that I was crying more than not crying. It changed over the days to sobbing and then, one day, to wailing. For hours and hours I howled nauseous cries into my stunned husband’s chest. “What’s wrong?” he asked, desperately. “I don’t know.” I felt as if I was going mad. I felt as if I was going to die. I knew I had to go back to the doctor.

It all clicked for the doctor immediately. The pins and needles, the sick stomach, the exhaustion, the crying. “I think you have depression and anxiety.” Although he was gentle, it grated when he tried to reassure me that it was very common for expatriate women to become depressed with the stress and loneliness of moving.

Depression I could accept. But being put into a category of whiny, privileged women in a place where the daily challenges of those around us included hunger, disease and oppression seemed more than ironic. The problems expatriates face are not worthy of this type of reaction, I thought. I had only crossed a border.

I was apprehensive about going to a psychotherapist because of what it might be like and because of my idea that my little life and little dilemmas were unworthy of this type of attention. I was back in the hospital and she spotted me, the only white person in the outdoor waiting room, the hot air heavy with the pungent smell of the nearby sea.

She told me that I shouldn’t underestimate how stressful it is to move country and to be somewhere that you didn’t want to be. I was still finding it hard to buy into how hard the transition had been. Her help was all very practical and physical. She drew diagrams and wrote lists and notes and helped me to see what was wrong and the obvious way to fix it. Within a week the pins and needles were gone, and I felt an immense energy that I had not known for months. It was very liberating.

I worked hard to keep my head above water and to make my environment and my day navigable. I was doing okay, I think. And then I fell down again. This time I didn’t want to get into bed. I wanted to get under it. Everything was noise and aggression. I felt as if I had no skin. I couldn’t sleep. I found a nook under the bathroom sink where I could hide from my beautiful children and the rest of the world.

It was time to see the doctor again. I buried my wet face in my husband’s T-shirt after I took the first tablet. “I didn’t want to have to take these,” I said. It was so hard to succumb to the fact that I was sick.

Zoned out

I knew I wasn’t just an upset trailing spouse any more. The tablets helped. After two weeks or so I stopped feeling sad, which was strange. And then I stopped feeling anything, which was also strange. My friend is pregnant. Okay. My friends are coming to visit. Okay. My daughter broke her arm. Okay.

I was zoned out. I took it as time to rest. Months on, I feel ups and downs, but I’ve stopped crying.

I still go to the psychotherapist to fix things that are broken. Take things out of the messy cupboard, clean them off, pack them all in strong boxes and stack them back in again.

The guilt is hard, looking on at my handsome husband and laughing children, the best things I could ask for in life, and still not being able to kick off these heavy boots. There is a sense of embarrassment that what is going on with me is not a real problem. So many people around me have been through so much heartache and have real challenges, yet they just soldier on. But now I understand that there is a difference between trauma and depression, between them and me.

That is because I have begun to grasp, with help from the psychotherapist and her extensive library, that depression is a physical illness. I found part of the book Depressive Illness: The Curse of the Strong, by Tim Cantopher, particularly helpful.

He explains that the limbic system, a part of the brain that controls mood and other functions of the body, can malfunction under too much strain. Cantopher says the levels of neurotransmitter chemicals such as serotonin and noradrenaline will fall when the limbic system is overwhelmed, removing the body’s natural ability to control mood.

A strong person, he says, is the type of individual who will push themselves beyond their limits to overcome obstacles, because of their sensitivity to failure and judgment, and will begin to show the physical symptoms of depressive illness.

I’m not sure if I’m here – depressed – because I’m here – in Africa. Africa with its goodbyes and heat and isolation and parasites and corruption and insecurity. It’s hard to get rid of the voice that says I’m not trying hard enough to make this place work for me.

When I knew what was wrong and had found a way forward I wrote an email to my parents in Donegal. I didn’t want to start crying over the phone. They rang every day to ask how I was feeling. I appreciated being thought of and cared for, but it was hard every day to have to consider and answer the question “How are you feeling?” So I told them that. They still called, but they asked less frequently.

The baby of the family, I have always looked to my siblings as protectors. It was easy to tell my sister in Ottawa, her reaction composed and understanding. I sniffled down the phone to my brother in New York while he tried to shop in Whole Foods; he offered practical and kind support. My brother in Dublin applauded me for taking action and told me I was not alone. Their calm, loving encouragement was perfect. I leaned heavily on my forever friend, Jess, in Dublin. I could text her free on an old iPhone she had given me. We were in contact so often, that it normalised my “I’m in the doctor’s office” updates.

Telling them felt a bit like opening the windows in a sick house: it made our home less heavy and lightened some of the burden that I was sorry for putting on Maurice’s shoulders. But I would have loved to see them in the flesh: to have a hug, a walk, to share a pot of tea or eat a rake of biscuits together. To laugh. The type of effortless laugh that comes easily only with people you know well. I didn’t have that here.

It wasn’t easy to tell people in Africa that I was depressed, but I did to try to shake off the sense of embarrassment. Some people didn’t say anything. Some people said they didn’t know what it was like. Overwhelmingly, what people said was: “I’ve had that, too. How come I didn’t know that it was depression? It would have been easier if I had.”

There are so many things we all talk about openly. Nobody is ashamed to have contracted malaria or to describe their diagnosis and the months of illness and exhaustion. When I realised how many people I knew who had ended up under the sink – the people who, to me, are the the funniest, the kindest, the most together – it made me feel less weak. I didn’t think, But you have X, Y and Z in your life, what have you got to be depressed about? Which is what I worried people might think of me.

They told me about things they did to make them better, and that helped. They weren’t here in Africa, and that helped. It helped me to realise that it happens to people in all sorts of circumstances. It helped me to realise that they didn’t think I was upset because the ice in my gin and tonic was melting too quickly. It helped me to realise that they understood and that they didn’t judge. And it helped me to know that they are all still standing.