When was the last time you had a good natter with a friend, or spent some time on whatever your particular passion is? I hope it wasn’t too long ago that you did either of these things, but for people with depression they can feel impossible. Struggling to talk to others and not feeling able to spend time on hobbies are both symptoms of cognitive dysfunction and the results of a survey by ComRes and Depression Alliance suggest that 99% of people diagnosed with depression suffer from it. Add to that happy mix difficulties in concentrating and making day-to-day decisions and you have the recipe for a pretty miserable life, limited in opportunity and full of strained relationships.
It’s a recipe I know well. The effects of cognitive dysfunction have a daily impact on my life and along with 45% of those surveyed, I find them as disabling as the emotional symptoms of depression. Having the concentration span of a gnat is outrageously inconvenient as a self-employed writer; I’m forced to take regular breaks and have to do so with such frequency that it severely limits the amount of work I can get through in a day.
My social life has taken a big hit too. The thought of spending time with even the loveliest of people causes me huge amounts of anxiety and talking to those I find to be not quite so lovely usually ends in me stammering and tripping over my words. As for hobbies, I haven’t been able to pick up my ‘cello all year – the longest break I’ve had since I went through a rebellious phase that involved a bass guitar and a borrowed amp. These days, even playing pianississimo feels too loud so heaven knows what the guitar would do to me.
Conversations have recently been a real stumbling block and I’ve had a couple of occasions that have been so disastrous that I’ve found myself reluctant to talk too much at all. I just can’t seem to communicate what I need to say and it’s had me feeling cornered and forced to make decisions I’m not ready to make.
A couple of weeks ago I asked to meet with my art therapist. The group wasn’t working out for me so I thought it was best to talk to him about what was happening. How I wish I hadn’t. I found the pressure of a one-to-one conversation so difficult that I couldn’t communicate what I really wanted to say. I tried to focus, be concise and to the point but I can only assume that I came across as spiky because he became very defensive about how the group was organised. The conversation deteriorated even further and as he seemed to have already decided that I should leave the group I did, that very afternoon.
If I’d been given time and support to process what was going on, I think I would still have left, but the effects of such a big decision would have been very different. I was left feeling impossibly hurt, rejected and given up on. I still do. The NHS seems to have run out of patience with me and the demise of the art group means that I now have no therapy, no care-coordinator and no practical support. I’ve barely been able to work since that meeting and feel far more hopeless about life than I usually do – and that’s quite a statement considering my usual mindset. For the six months that I was part of the art group I put my heart and soul into it. I engaged with the process even when it revealed the most painful wounds that I carry. I supported other group members through their own journeys. I even baked for birthdays. Then in just a few minutes it was all gone and I’m supposed to know how to deal with it.
I spoke to the therapist again last week, hoping to figure out how to move on, but the conversation was just as bad as our meeting had been. I was trying to communicate that I simply wanted a good end to my time with the group but he wasn’t hearing what I was trying to say or affording me any allowance for how distressed I was. He just kept repeating that it had been my choice to leave and made it clear that he no longer had anything to do with my care.
I used to work with young people with learning difficulties and I occasionally encountered colleagues who would sit back and not do anything when a child was munching their way through their sixth chocolate bar or standing up to their waist in freezing cold pond water because ‘it was their choice’. Sometimes people need support to make the right decision. It’s why the young people I worked with had support staff – and it’s why I asked to meet with my therapist. I really wish that I didn’t need the support of professionals, it’s a constant source of shame to me, but I do.
If cognitive dysfunction is a common symptom of depression, why isn’t it more acknowledged – and why don’t mental health professionals recognise when it’s at work? My art therapist certainly didn’t – and according to the Depression Alliance survey, 50% of people with depression said that the effects of cognitive dysfunction were never discussed by their healthcare professionals.
Life’s hard enough – but when something that has a significant hold over you is ignored or swept under the carpet it just gets harder. So can we stop pretending that cognitive dysfunction doesn’t exist? If you know someone with depression then yes, they’ll more than likely be feeling helpless and hopeless – but please don’t forget the result of the ComRes/Depression Alliance survey. Chances are they’re also struggling to access social occasions, hobbies and interests. They might be finding even simple conversations really difficult and asking them if they want to watch Breaking Bad or House of Cards might seem like a nice thing to do, but it could feel like the equivalent of being asked to personally choose the next leader of the free world.
If we acknowledge that these things exist, we can learn about them and work around them. Perhaps texting is easier than talking, a half hour visit might be kinder than planning a big day out, or turning up with one box set to watch could be a better move than taking your entire back catalogue of US dramas.
And if you’re a mental health professional, maybe you’ll understand how stressful the conversation you’re having is for the other person and give them the time and space they need to mindfully participate. Surely it’s the least you can do.