3

DON’T WORRY, BE HAPPY

I was, to say the least, a worrisome child. If my parents exchanged a terse word over the division of household chores, I was convinced divorce would swiftly follow. An evening news bulletin about nuclear weapons testing would have me investigating the logistics of building a fallout shelter in our back garden. Every setback was a disaster. When I was 10 and my gym teacher didn’t pick me for the school netball team, I was in pieces. More than a decade passed until I could accept that being denied the wing-attack bib did not make me a failure as a person, and that despite having the hand–eye coordination of a milk-drunk baby trying to thread a needle in a sandstorm, I was still good at other things.

Mum would watch me getting lost in my thoughts and try to soothe me with helpful truisms such as, ‘There’s no point worrying about the day that’ll never happen.’ She may as well have been speaking in Mandarin. It was impossible to stay in the moment when there was always a chance of imminent doom. My glass wasn’t half-empty: it was drained to the bottom.

In adulthood, the struggle continues. If you tell me to ‘calm down’, expect the same expression you might see on your dog’s face if you asked him to explain the current geopolitical tensions in sub-Saharan Africa. Relaxation does not come naturally. I find the phrase ‘go with the flow’ baffling, like applied mathematics or the way that leggings have become acceptable stand-alone outerwear. When people say, ‘Don’t worry about it’ or ‘What will be, will be,’ I want to shake them by their foolish, untensed shoulders and scream: ‘AND JUST HOW DO YOU PROPOSE I DO THAT, MR MYAGI?’

If a friend is more than ten minutes late for a dinner date, I assume they’ve been involved in a terrible car crash. A call that goes straight to voicemail means they are almost certainly dead. Once, my Dad didn’t reply to an email for a day and I was already making funeral plans. In my defence, he’s ordinarily a very prompt messenger, so his tardiness was noteworthy. But even if it hadn’t been, my go-to position is often the most catastrophic. It happens in an instant — like a bullet train reaching its destination before the luggage has even been loaded. I’ll barely have time to consider whether Dad might be busy, or whether his server is down and he hasn’t received the email — which, in this case, turned out to be what happened — before my brain goes straight to dead. If I get up in the morning and my cat, Hamish, isn’t immediately visible or audible, I expect to walk into the kitchen and find his furry little corpse splayed out next to his water dish. So far, my track record for being wrong on these assumptions stands at 100 per cent. But this fact has done little to stop the thoughts. I worry about everything. Pain in my abdomen: early-stage ovarian cancer. Boss wants to catch up for a coffee: almost certainly getting sacked. Call from an unknown number: the possibilities are so varied and potentially awful I simply can’t answer.

Recently, I was invited to a fancy cocktail reception at Victoria’s palatial Government House. When I received the very official-looking envelope in my mailbox, marked with the seal of the Victorian governor, my immediate thought was that I was being deported.

I am the person who packs for an overseas holiday a fortnight in advance. If I could sleep at the airport check-in desk the night before my flight, this would be my preference. I am pathologically punctual to the point that I always take a book when meeting friends as there’s a more than 80 per cent chance I’ll arrive stupidly early. A weekend away requires days of logistics, lists, and all-weather wardrobe planning. The last, and only, overnight music festival I went to was in Glasgow in 1995 because the uncertainty of where I will sleep/shower/use the bathroom makes the whole prospect horrifying.

Over the years, when the anxiety has become more than I could manage, I’ve sought help from a range of medical professionals. I’ve tried doctors and drugs, cognitive behavioural therapy and mindfulness techniques, psychologists and anxiety counsellors and various meditation courses. I’ve exercised, changed my diet, followed strict gut-cleanse regimes, taken supplements and vitamins, and drunk freshly squeezed super juices. Some of it has helped. Much of it hasn’t. Nothing has ‘cured’ me.

Unlike some physical conditions, there are no biomarkers for emotional pain we can pick up with diagnostic screening. You can’t tell from an X-ray, brain scan, or blood test how much depression a person has. Treatment can be hopelessly inadequate or a gruelling process of trial and error. The dearth of solid evidence on what works and what doesn’t can mean that, for people with continuing problems, there is no shortage of medical experts promising the quick fix. And although a problem may be psychological in nature, its effects can impact on the whole body.

I’ve seen respiratory specialists and taken tests to work out whether my breathlessness might be caused by an underlying lung-capacity problem. It isn’t. In my early twenties, I spent two years visiting a specialist orthodontist who fitted me with a retainer to wear at night and gave me a biofeedback machine, which delivered an electric pulse to the back of my skull and my temples. He said the crippling headaches I’d developed were coming from a misaligned jaw, causing my muscles to spasm. They weren’t. I’ve had ultrasounds to explore the cause of intermittent nausea, pelvic, and abdominal pain; blood tests to investigate my continued fatigue and to rule out immune disorders, thyroid problems, or inflammatory disease; stool samples to see whether my chronic gut problems are caused by bowel infections, coeliac disease, or Crohn’s disease. All negative. I’ve spent a fortune on massage therapists, and visited osteopaths and chiropractors who said that my chronic body aches and sore head were due to neck and spinal misalignment. They pushed and pulled and cracked my back until it made a sound like a gun going off, telling me this would be the end to all my troubles. It wasn’t.

The symptoms are real and at times utterly debilitating. But so far, touch wood, I have found no sinister underlying pathology. The dry mouth, body sweats, fatigue, and breathlessness I grapple with are not signs of an undiagnosed sickness. It’s just my body set to fight-or-flight mode, bringing with it a constellation of aches, pains, and troubling sensations. When things are bad, I’m in a constant state of hyper-arousal, like a boxer ready to step into the ring. It amplifies every twinge and can trick me into thinking I’m dying.

The internet age hasn’t helped. When I feel something in my body that I can’t explain, Dr Google is on hand to fill in the gaps. Conditions I have diagnosed myself with include meningitis; stroke; heart attack; melanoma; tinnitus; alopecia; Crohn’s disease; rheumatoid arthritis; glandular fever; type one (and two) diabetes; chronic fatigue; Parkinson’s disease; multiple sclerosis; measles; motor neurone disease; endometriosis; vertigo; sleep apnoea; cancers of the brain, breast, bowel, cervix, lung and ovaries; and, for a brief period as a 14-year-old, an ectopic pregnancy — despite never having had sex — which perhaps says more about the Scottish education system than it does about my anxiety. When your default position is to worry about the sky falling in, hypochondria is a common problem.

My friend Edwina has similar problems. She messaged me recently to say, ‘I almost parked in a doctors-only carpark the other day because I have convinced myself that Google is pretty much the same as a twelve-year medical degree.’ There is nothing she doesn’t know about all the ways in which the body can turn on itself. A mother of two with a doctor for a father and a mother who’s a nurse, Edwina is no stranger to the medical system. She has always worried about her health, but when she was diagnosed with a benign brain tumour a few years ago, the anxiety escalated dramatically. The tumour — which can only be removed with delicate and needless neurosurgery — was picked up because she’s hyper-vigilant to even the slightest change in her body. Three times she’s ended up in the emergency department, convinced by a misbehaving brain that she was gravely ill. She’s had colonoscopies, ultrasounds, MRIs, blood pressure monitors, mammograms, skin checks, and scans on almost every organ in her body. Working as a communications specialist at Cancer Council Victoria, where she has intimate knowledge of the most awful diseases and routinely tells the stories of the worst moments of people’s lives, has been challenging, to say the least.

‘It’s a bit too easy to imagine yourself with ailments because maybe someone without anxiety can be very sensible and think, “Well, only one in 100 people get this,” but I see that and I go, “Yeah, that one’s going to be me. I see those ones in 100 every day at work, so what makes me so special?”’ she told me once.

Like me, Edwina has battled her brain’s faulty messaging for years. And she too has been inundated with advice from people who want to help. Her condition has gotten better and worse, and then better again. She describes herself as ‘highly functional’ but lives with her physical and emotional symptoms every day. One of her biggest frustrations is the unspoken expectation that she should be over this already. ‘Even people who I love and who I’m super close to will say, “But you’re all better now, aren’t you?” And I’m like, “Yep, that’s fine,” but the reality is I’m going to need to manage this for the rest of my life. I will need to have strategies, or potentially medications in place, because if I don’t I’ll get sick.’

This is not the script we’re given as kids. We’re supposed to be happy; persistent emotional problems don’t fit that story. My continued struggles with anxiety have often felt like proof that I’m unfixable — damaged goods. People are starting to talk more about mental ill health, but the stories I read are still so black and white. You’re either mentally ill or you’re mentally well. Emotional distress is viewed as an abnormality. Depression and anxiety are conditions you can develop, like a chest infection, and then you get help and go on your way. The narrative is a romantic hero’s journey, with individuals emerging from their battles healed and bulletproof. When we’re on the road to the fairytale ending, our troubles are supposed to be short-lived and resolved neatly — a linear path from sickness to cure. It leaves no room for a backward step. As I’ve careered back and forth throughout my life between bouts of depression, times of acute anxiety, and periods of relative calm, I’ve felt as if I was constantly failing.

My experiences with doctors have only amplified this feeling. In Scotland, after seeing me many times about my anxiety, the family doctor told me in my early twenties that it was time I ‘snapped out of it’. Another GP, in Melbourne, treating me for depression recommended I ‘stop being so gloomy’. It felt like the equivalent of asking someone with two broken legs to just make more of an effort and give walking a crack. Another time, again in Melbourne, when I began having blinding stress headaches, I visited my local medical clinic for help. Exhausted, barely eating, and feeling overwhelmed by the basic demands of life, I didn’t know what I needed. But what I got wasn’t it. As I walked into the consulting room, a silver-haired lady was hammering the keys on her computer, eyes fixed to the screen as she pushed a sheet of paper across the desk. Having been on the mental health merry-go-round for some years, the form was familiar to me. The Kessler Psychological Distress Scale is a universally recognised tick-box exercise designed to determine the severity of a person’s depression. The questions are brutally direct and immediately focus the mind on just how fucked up one’s life has become. During the last 30 days, how often did you feel hopeless? … During the last 30 days, how often did you feel so nervous that nothing could calm you down? … How often did you feel so sad nothing could cheer you up? There are ten questions, all in a similar vein, scored from one to five, with one being ‘none of the time’ and five ‘all of the time’. Your number reveals your current state. Under 20 is well. Over 30 is a severe mental-health disorder.

The doctor totted up my scores. ‘You got 25, which means you’re only mild to moderately depressed, so there’s not much to worry about.’

I was crying so hard that snot was dribbling from my nose. She didn’t look up, and began scribbling on a prescription pad. I’d been on and off antidepressants since I was in high school. I wasn’t convinced they had made much difference. This time I wanted an alternative. Or at least to discuss the options. My questions seemed to frustrate her. Medication would help, she insisted. I didn’t have the energy to fight so I urged her not to prescribe the class of antidepressants I’d been on as a teenager, which had given me horrendous withdrawal symptoms when I came off them. For several weeks it felt as if electric shocks were zapping my brain as I grappled with crippling dizziness and tremors travelling up and down my body.

‘They’re the best antidepressants we have,’ she said.

‘Maybe not for me,’ I mumbled.

She sighed and reluctantly agreed to put me on an older generation of antidepressant medication. But not before asking, ‘Are you suicidal?’

I thought about it for a while and said no.

‘Good,’ she said. ‘These ones aren’t prescribed very often these days because they’re much easier to overdose on. But you’re not suicidal, so that’s fine.’

The whole interaction was over in 15 minutes. And now, I had the knowledge that should I want to kill myself, the drugs she’d prescribed were well equipped for the job.

So on a hot October morning in 2014, when I realised I could no longer carry on without help, I was less than confident about finding it. By now, I was having daily panic attacks in even the most benign circumstances — with friends, on the tram, lying in bed staring at the ceiling at night. Being awake was becoming an exercise in unremitting terror.

I chose a medical practice that my friend Loretta, a free-spirited yoga teacher, recommended. She said the doctors were particularly good with mental-health issues and took an integrative approach that combined Western medicine with modalities such as meditation, Chinese medicine, acupuncture, and nutritional support. The clinic was described online as a ‘wellness centre’ and a ‘community of healing’, which made my sceptical health journo ears prick up. But despite my reservations, I was ready for a different approach.

Sitting in the doctor’s waiting room, I felt as if the walls were contracting around me. This was the same sensation I had had in my early twenties when an acid trip went bad. Lying under the stars with friends, in the school playing field behind my parents’ house, I had felt as if suddenly the sky was tightening around my head. It was as though the universe was crushing me — that vast expanse of nothingness wrapping around my limbs and squeezing the breath from my body. Almost 20 years later, the sense of helplessness was the same. But this time, I’d manifested the crazy without chemical assistance.

All around me, people were leafing through magazines and tapping on their phones. I longed for the ease they seemed to find in living. My sprinting thoughts were so loud I was amazed nobody could hear them; anxiety was a fighter jet roaring through my cells, dropping grenades from head to toe. I placed my hands flat on the fabric of my cheerful orange summer dress to stop them from shaking.

When the doctor called my name, I shuffled after her into the consultation room. Her name was Fiona — a woman about my age, with a blonde pixie cut and kind eyes. When she asked what she could do for me, I broke down. Then I braced for the judgement and the prescription pad. Instead, she handed me tissues and told me she could see I was in a great deal of pain. Together, she said, we would make a plan to get me to a place where living was not so hard. And then she asked me to start from the beginning. Not from the start of that week or even that year, but from childhood. She wanted to know everything. It was the first time in more than 20 years that a medical professional assessing my mental health had seen me as a whole person, not just as a collection of symptoms.

Fiona spent an hour and a half going through my family history, my friends, my school days, my working life. She listened attentively when I listed all the ways in which I was going mad. What made this doctor different was her willingness to share a piece of herself. She wasn’t just a clinician; she was a woman who had suffered, just as I was now suffering. Fiona told me that in 2007 she had volunteered with her husband in Africa, and came home burdened by the awfulness of the world, carrying a sense of hopelessness about her ability to make a difference. They moved to Darwin and she threw herself into her work in emergency medicine. But soon her self-worth was tied to an ideal of what a ‘great’ doctor should be. The more she worked, the louder her inner critic became. She began comparing herself to colleagues but always pulled up short. She finally hit a wall when a two-month-old baby died during her intensive-care rotation. While other staff members expressed their grief, she felt nothing but anger. All she could think was children are dying every minute in Africa and nobody cares. Unable to sleep, and experiencing such intense anxiety that she had developed a tremor, she was on the fast track to burnout. Soon after, she quit emergency medicine, moved into general practice, and became a meditation teacher, with a mission to offer care that went beyond the physical and looked at psychological and spiritual wellbeing. It was her passionate belief that six-minute medicine was failing patients. So she started offering longer consultations, integrating conventional medicine with counselling, cognitive behavioural therapy, healing, and emotional support.

In the past, I’d felt that things were happening to me. Now I had a doctor who actively involved me in the decision-making process. A doctor who didn’t expect me to be cured within a few weeks. She went through a range of possibilities in detail. Medication was discussed, but she stressed this was only an option. There were many other things we could try first. But as a matter of urgency she wanted me to see a psychologist. She jotted down some names. She also suggested that I cut out caffeine and alcohol, start taking a magnesium supplement, and try to get out of the house every day for some exercise, even if it was just a brisk walk. And she wanted to see me again in two days.

By the end of the consultation, it felt as if I’d been in therapy. I was grateful to Fiona for her care, but I was still daunted by the road ahead. My face was drained of colour, my body exhausted with the constant surging panic. I felt small, hunched over in my chair, a shrunken, child version of myself. I glanced down at the chipped polish on my toenails and wondered if there would ever again be a time when I could contemplate something as frivolous as painting my nails. When I looked up, Fiona was watching me. She had tears in her eyes. Before I left, she wrapped me up in a tight hug, and for a moment I felt that perhaps I might survive.