Depression and fiction

The plan to refer people with mild depression and anxiety to books has provoked some fascinating discussions, not least the discussion here of how fiction can be more helpful than non self-help. Having studied philosophy, I still haveElizabeth Anscombe's injunction to stop doing philosophy and start reading novels ringing in my ears, so this is no surprise. What I want to make the case for is those works of fiction that go beyond the positive, beyond stories of survival, works many wouldn't imagine offering help, would even want to keep out of the hands of the mentally fragile.

I made the case for the dangerousness of the blanket prescription of self-help in the comments on other posts here, the guilt when we do not succeed in pulling ourselves from the mire, the placing of responsibility squarely on the shoulders of those already weakened, vulnerable and sinking between the weight of helplessness.

I say blanket because the thing about mental health is everyone's experience has unique elements, affects them in subtly different ways, and the thing about treating everyone as the same is that we deny people the uniqueness of their voices. We become complicit with a condition that has already stripped people of so much of themselves, play the role of the seemingly good Samaritan who finds a victim on the road, proffers a seemingly friendly hand, and uses it to administer the final beating.

So the only real starting place I have is not a generality but my own experience. Depression for me is like the thickest, blackest fog. When it shrouds you, you see nothing. There is just you, alone with your thoughts, any screams dampened instantly and being met, in return, by silence. The far horizon of wellness is unimaginable. All you can hope for in your isolation is to feel the nudge of human contact beside you. Like a character emerging from the ground into a post-apocalyptic dystopia, you long to breathe out the long, toxic sigh of utter relief that you are not, after all, alone.

There have been four times in my life when the fog has descended. Each breakdown has had its own characteristics but, and I know this is not universal, each time fiction has been able to nestle itself alongside me inside that blinding blanket. I know for many others, depression takes away the ability to concentrate altogether, so storytelling of any kind becomes white noise, meaningless squiggles dancing on the page. I was lucky, but even for me I am careful to say fiction because there were times when just holding a book was impossible, when only film could reach me.

I want to talk very briefly about the fictions that spoke to me, kept me warm in the loneliness, slowly cajoled me through. They were never survivors' stories, though many of the protagonists did survive. What mattered to me was always the honest, detailed, unflinching accounts of their darkest moments, of the reality of those moments and how they blanked, greyed, sensually cut short and tortured their lives. What these fictions, or rather characters within them (much more than the stories of which those characters were a part), provided was the knowledge that I was not alone, that there was someone somewhere who was ale to articulate the seething, jumbled, brutal, pre-linguistic, thrashing, writhing, hazing, dulling pounding in my head. It wasn't just me. That single thought was the most important thing in the world to me, sometimes the one thing that kept me alive – a single false note of optimism would have shattered it all for me, left me thinking yes, it really is just me – the words people offer me really are just that, words, the hope they contain utterly irrelevant because they relate to an experience that is not mine. Two-and-a-half decades after my first breakdown, when I curated the event What There Is Instead of Rainbows, I wanted to capture that lack of false promise, that focus solely on the moment, asking a selection of authors to write about the what-it-was-likeness of their darkest moment.

So, these are the characters who held my hand under those stifling blankets as it were – Teresa from Milan Kundera's The Unbearable Lightness of Being, Betty from Philippe Djian'sBetty Blue, Julie from the film Three Colours: Blue and finally someone real, Holly from Blood and Pudding, a memoir from New York-based writer, artist and model Katelan V Foisy about a childhood friend whose life ended in the tragedy of an overdose. Each reached through the fog, made points of contact in different ways.

Aside from the fact that there is a Juliette Binoche theme here (Damage's Anna Barton or Michèle from Les Amants du Pont-Neuf would also have been at home on the list), let me look at what it was about these characters that spoke to me. Teresa and Betty are both doomed, and their journeys to their doom are in man ways opposites. Betty's story is that of a spiral from anarchic abandon, a life completely outside of society, ever downward to the hospital bed in which she will ultimately die – every ounce of her life force has been sucked from her until she is just a shell.

Teresa's life on the other hand is cut short at just the moment she has found happiness. For me at my lowest, their tragedies felt very similar to each other and to my own experience. Both Teresa and Betty strove (something the current ludicrous "striving" propaganda would do well to note) with every sinew to expand their worlds and both were thwarted. Betty is thwarted from outside, by a world whose demands crush down on her; Teresa from inside, from an inner fragility – what she describes as a weakness in the resonant line "I am weak; I am going back to the country of the weak" – that simply cannot weather the rough waters of life's open sea. Teresa finds a kind of comfort in her shrunken horizons, in no longer having to strive, whilst the fence the world builds around Betty's dreams forces her restless mind in on itself until she implodes. Teresa longs to be something she is not, Betty longs to be something that she is but is not allowed to be. These two books express those simple frustrated longings that felt like the two halves of my deepest self with honesty, poignancy, and not a false note.

Three Colours: Blue is a strange one, because it is a survivor's story. In many ways it is the archetypal survivor's story. Its heroine, Julie, loses everything when her husband and daughter are killed in a crash. She makes that "everything" into a reality, selling her home, giving away everything in it, cutting herself off from everyone she knew in her former life only to emerge from a cocoon of absolute numbness to a future whose content we don't really know other than that her freedom from the past offers her endless possibility (symbolised by the colourless sugar cube soaking up coffee in one of the most famous takes in 20th-century cinema). As a survivor's story, this should have left me cold, hurt, alienated. Maybe one reason it didn't, when I first saw it in the mid-1990s in the midst of a breakdown that had stripped me of every vestige of self-worth, has to do with my deep love of the textures of Kieslowski's films, or of Zbigniew Preisner's soaring scores. But there's more to it than that. Again it's the honesty of Julie's total numbness in the weeks and months after she comes out of hospital following the crash. The way Julie divests herself of her old life as though she is washing away a dirt that has crept beneath her skin, the absolute lack of emotion, a void at the centre of her being that comes not from an inherent coldness but a coldness that life has planted in her, an ice crystal grown from seed. What I learned from Julie was not that it was OK to feel down, but that it was OK to feel nothing.

Holly's story in Blood and Pudding is absolutely not that of a survivor. The book is a series of transcriptions of recordings from a teenage roadtrip, intercut with anecdotes from the brief years between those few days and Holly's death from a heroin overdose. It is difficult subject matter to discuss in the context of mental health. Holly was bipolar, she didn't survive, and more than one person I've spoken to about this remarkable story (which includes wonderful moments such as the time she and Katelan were ejected from a video peep show booth for playing spaces invaders on the "select a screen" joystick) has asked whether it's not a dangerous glorification of a reckless lifestyle.

I think, rather, it's the perfect illustration of the way everyone responds differently to things. For some people, a how-to book will be the ladder out of hell. For others, the guilt it induces, the sense that "so this is one more thing I cannot do" will be the thing that finally pulls the ladder out of sight. For me, Blood and Pudding is a book that shows the light and shade in every life. At my lowest ebb it showed me that there could be moments of joy, showed me that even the briefest, bleakest life could be a life fully lived – and it was that which helped me on the road to making my life not so brief. Yes, for others it may have the opposite effect. But it asks the vital question – why is there a general assumption that a book that "ends well" is a good thing and one that "ends badly" is not? Do we instinctively value those people whose problems are easier to fix or is it just that we would rather put our heads in the sand when it comes to those who respond to something we don't understand?

Everyone's depression is different. That is one of the things that makes it so hard to treat. Acknowledging the differences is one of the most important things we can do, both because no one is an expert as much as the person who has the mental health problem, and because this is the first step to re-empowering people not further stripping them. So widening what we do for mental illness to include books can play an important role in finding the right blend for each person. But it should be part of finding an even more, not an even less personalised approach to mental illness, and using it either as a replacement or the narrowing it right back down by offering only a tiny list of titles riddled with preconceptions is a step backward from that person-based approach.