Masked Depression - The Sadness That Dare Not Speak Its Name

Most illnesses are honest. They arrive on your doorstep one day, with a small suitcase of symptoms, and they announce themselves. If you are lucky, they won't stay for too long. But whatever happens, at least most illnesses behave predictably, and don't try to disguise themselves. You don't find chicken pox masquerading as rheumatoid arthritis. When you have influenza, you get a raised temperature, sore throat, runny nose - it's not hard to know when you've caught it, and to seek treatment.

Depression is not nearly so honourable. It is possible to have depression for months and not even know it. The illness can work in very subtle ways, affecting the mood and thought patterns more than outward, visible elements like the skin or body temperature.

The mind's link to the body

Many people stagger on through their daily lives, sleeping poorly, snapping at friends and loved ones, entirely unaware that they have become ill, or that there is something they can do about it. If you were to ask them about their situation, they might tell you that they've 'got a lot on at the moment'. They might admit to being in a more or less permanent bad mood, to enjoying life rarely, or not at all. But invariably they will say that this is because life is 'getting them down'. They don't need therapy, or medication, they argue, because everything would be alright if only…

You can insert your own 'if only' into the gap. But in a number of cases, people with depression develop an obsession with their health. They decide that they have some serious, life-threatening disease. They can genuinely feel it - every single one of the body's routine aches, pains and tremors suddenly becomes a symptom of the most deadly illness. And this is how their depression escapes diagnosis and cure. The imaginary illness has become their 'if only'. All the energies of the patient and the doctor are focussed upon diagnosing and treating the mysterious illness, with its elusive and ever-changing symptoms. Test upon test is run, to no avail. Medications may be prescribed which have no effect, or which have upsetting side-effects that further increase the patient's worry that their health is declining. They sink into deeper depression. So does the doctor.

The lucky few, of course, will have doctors with sufficient time, patience, compassion and insight to suggest that - after every other avenue has been exhausted - their patient might be experiencing a masked form of depression. But this will usually be a 'last resort' strategy. It will occur after weeks and perhaps months of harrowing depression and wasted time. The patient may be so convinced that there is something physically wrong with them that they refuse to accept this blatant bit of medical guesswork and simply go off in search of a second, third, fourth opinion. Those who accept the diagnosis and any treatment offered will experience a further delay before it starts to work. And all these delays mean prolonged suffering. The depression grows stronger, becoming more ingrained and harder to treat.

When a sore throat is not a sore throat

I have experienced fairly major bouts of depression roughly every other year for the last ten years. And in every case, these have been 'dishonest depressions', manifesting themselves, not as any sort of psychological complaint, but as an unfathomable physical illness, beyond the ken of Western science.

The first time, I developed a sore throat after going to a pub where the music was so loud that you had to shout in order to communicate. I fretted and fretted over it the next day. It didn't seem to get any better. Over the following week, I developed a habit of poking and prodding my Adam's apple, trying to see if there was anything growing there. Before long, it felt as if there was.

I went to see my doctor - who examined the back of my throat, remarked that he couldn't see anything, but that I might have a mild case of pharyngitis. He sent me home with antibiotics.

Needless to say, penicillin did nothing. Meanwhile I sank into a miasma of misery and guilt. It was all my fault, I decided, for smoking all those illicit cigarettes. I had left school by this time and was having a year out before University. Most people get jobs or go travelling. I had had similar plans myself, but by now I had stopped getting up in the mornings. Where was the point? I was going to die.

The only glimmer of hope was a further appointment with my doctor. I told him that the antibiotics weren't working. He took another look at my throat, shook his head in puzzlement and asked me a few questions about my background.

This doctor had known me since I was two. A knowing look appeared in his eyes when he learned that I had left school now and was preparing to leave home and go to University. A time of great change and stress, he suggested artfully. Had I considered that I might be experiencing depression?

Not a 'real' illness?

I took umbrage, not so much at the suggestion, but his refusal to accept that my 'illness' was real. I could feel it - every second of the day, a dragging, grating pain in the centre of my throat. Of course I was depressed! Who wouldn't be?

I demanded a referral to a specialist. Wearily, my doctor complied, warning me that it could be a long wait. He mentioned anti-depressants - saying I could perhaps try taking them anyway. They weren't addictive, they wouldn't interfere with my functioning and they might help, whatever was or wasn't lurking in my throat. I agreed, largely because I had known him all my life and didn't want to offend him.

I tried taking the anti-depressants for a week or two. But I noticed no improvement. The pain in my throat seemed to be growing more intense. It struck me as ludicrous, taking anti-depressants to cure what was obviously some life-threatening tumour of the oesophagus. So I stuck them in a drawer.

A letter came from the hospital - offering me an appointment with the ENT consultant in three months' time. I pinned it to my bedroom wall and, as winter closed in, I entered a bleak hinterland of late night television and long, cold days under the duvet.

Dealing with depression

Somehow, I survived without harming myself. The pain in my throat started to become less predictable. Some days it would be there, very intense. Other days it was milder, and sometimes it was entirely absent. I noticed that, whenever I drank alcohol, the pain not only vanished, but I would also be unable to recall what it felt like. Until the inevitable hangover the next morning, that is, when the pain would be worse than ever.

Reasonably, I wondered if alcohol made the pain worse. So I stopped drinking it. I started to take other 'readings'. I noticed that the pain was mild or non-existent on days when I had had plentiful sleep, and at its most intense when I had stayed up all night watching television. So I started to be more careful about getting a good night's sleep.

By the time the appointment with the specialist came round, spring was on its way, and I hadn't experienced any pain in my throat for three weeks. It seemed pointless attending, but some lingering paranoia hinted that the pain might return, so I trekked over to Liverpool where, needless to say, yet another skilled expert was unable to detect anything amiss.

By then, I was not particularly bothered. I had taken a part-time job a few days previously, and this was fully occupying my thoughts. For the first time, life seemed to opening up rather than closing down, full of possibilities rather than threats. Who wanted to waste time being ill?

Recognising the 'disguise'

I wish I could report that some blinding insight led me to the understanding that my mystery throat illness had been a case of depression masquerading as something else. It would have saved me a lot of mental pain. Unfortunately, I did not discover this, or that anti-depressants (in particular, those which have a sedative effect) could help, until many years later. This occurred after numerous further illness, including 'heart disease', 'brain tumour', 'skin cancer' and 'kidney failure'. And also after many months of quite debilitating depression, which have had a permanent effect on my life.

Nowadays, I'm inclined to be philosophical. Whenever I develop some strange, life-threatening illness, that can't be treated any more that it can really be diagnosed, all I have to do is remind myself that this has happened many times before. It's all in my notes. I know which anti-depressant works best for me and I know how long I'll have to wait before it starts to help. Know thy enemy - they say. I do, and in that respect I'm fortunate, because there are thousands of depressed people who don't even know what's wrong with them.

Matthew Baylis is a novellist, journalist and scriptwriter.