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I have just been sacked as a customer. I think it’s the first time in my life that it has happened. The incident is arcane. But the behaviour of the service provider to whom we paid £120 a year is instructive.

If you hire a nanny, you have to pay their taxes and NI contributions. To do this, you will need a payroll company. They sort out how much you pay and let you know. So far so good. Recently, we had a request from HMRC for an outstanding amount. We asked for clarification from the payroll company. Only to receive an astonishing outburst of petulant, hostile ranting from Nannywage ltd.

I’ll paste some examples.

We asked for additional payslips to be sent so we could check any outstanding amounts.

They said: “As you have had all Tax & NIC due notices for each quarter sent to you at the time each quarter was due we find your request redundant and an insult to Nannywage Ltd as you are clearly saying you do not trust Nannywage Ltd to process your payroll.”

We said we were worried that HMRC were demanding a payment we knew nothing of

They said: “Unfortunately as a payroll provider we cannot be held responsible for where another body in this case HMRC send correspondence so we find your first comment redundant.”

We said we would like to work in partnership with them, not be treated as a nuisance

They said: “We would not like to discuss any of this with you or your husband as you kindly offer and do not really wish to continue to act on your behalf.”

So there you go. We have been sacked. Have you ever been sacked as a customer?

Another week, another fallen sporting icon. Though in truth we have known for years that all was not well with Paul Gascoigne. I feel for Gascoigne and wish him a speedy recovery. But his case has me wondering again – is it the intensity of top flight sport that breaks people? Or the other way round? I suspect the latter – that’s to say it is edgy, uncomfortable, vulnerable people who tend to be attracted to the limelight to compensate for the difficult emotions they have to contend with. Sport is a theatre in which people with depressive tendencies can forget it all, focus on something simple, albeit demanding, and use the rush of success and achievement to compensate for any low self-esteem lurking from their upbringing.

And not just sport. How many tortured geniuses have come and gone in performing arts over the years? I suspect it’s the same in business and politics too: that it is people with a restless, unquiet mind who tend to keep bashing away at their thing until they break through. Sooner or later the past catches up with them. And then it’s a long long way down.

The hard thing then is to realise that even if you’ve scored 100 for England, or run a government ministry, even if you were CEO of a FTSE 100 company or danced Swan Lake to a full house at the Royal Ballet, you won’t get well again until you accept that you’re no longer special. In fact, you were never special, just another of the seven billion who enjoyed a brief moment of glory. Until you can teach yourself that you’re OK even without the adulation of the fans, that there is much to live for beyond the braying of the crowd; until you understand that you don’t need the affirmation of others to enhance your own feelings of self-worth, you will struggle to be comfortable in your own skin. Actually the breakthrough realisation is this: that self-esteem is a pointless exercise, a futile, counterproductive judgment of the self which is by definition subjective, and thus almost always skewed, wrong, harsh and often poisonous. The opposite of low self-esteem isn’t high self-esteem, it’s not estimating oneself at all. Stop judging. Observe instead.

I hope someone is telling Paul Gascoigne that.

Reading helps. That’s reading as in books, not Reading the football team.

I know this not just because reading helped me to understand what was happening to me when I had a breakdown three years ago. But because dozens of fellow sufferers have told me the same thing: books help you make sense of the most baffling of illnesses.

In fact, the medical profession already knows this. Psychiatrists and psychotherapists have told me that they regularly recommend books to their patients, depending on the nature and severity of their condition. It gets trickier of course when people are too ill to read, as I was for several months, but even then there are books like Matthew Johnstone’s wonderfully illustrated “I had a Black Dog” that can soothe even the weariest of eyes.

So a reading list makes good sense – on a number of levels. Firstly, because a great many first-time sufferers might not suspect that relief can come from books as well as boxes of pills. Secondly, because it gives GP another option other than just reaching for the prescription pad. Availability of talking therapies on the NHS is still woefully patchy; there is concern that GPs end up overprescribing anti-depressants as a result.
But the reading list they are suggesting for GPs to prescribe to patients seems quite narrow. Self-help books come in many guises. Depression is not something, in my experience, that can be “overcome” in “five easy steps”. I wonder if memoir (and there are no shortage of titles out there – see below) and even fiction (Silvia Plath’s The Bell Jar, Sarah Waters’ Affinity) might not be equally as helpful. The three titles listed to help sufferers cope with depression all centre on Cognitive Behavioural Therapy, which may help resolve some of the more straightforward cases of depression and anxiety but won’t work for everyone.

GPs might equally usefully steer patients towards the healthtalk websites, where fellow sufferers tell their stories. It’s a powerful moment of insight and relief to understand that you are not alone, that others have been through what you are enduring — and survived to tell the tale.
We must also be careful that prescribing a book doesn’t take the place of proper therapy. People with mental health problems really need specialists to help them work through what is wrong with them. Until we do better at providing this (and I’ll warn you now – it’s not cheap) we won’t get to grips with the fastest-growing illness of our times.
In fact, it may make more sense to prescribe reading lists to the healthy, not the sick.

Prevention is better than the cure, particularly when it comes to mental health. Understanding why some people like me fall over will help people like you avoid doing so.
My own reading list? Tim Cantopher’s Depressive Illness: Curse of the Strong. Sally Brampton’s Shoot the damn dog. And Gwyneth Lewis’ Sunbathing in the Rain.

A version of this blogpost appears on the Guardian’s website at http://www.guardian.co.uk/society/2013/jan/31/self-help-books-many-guises

I mean, I don’t think it is. But then again…

When I was ill, we were very conscious that if we weren’t careful I might drag others down into the hollow with me. Particularly my wife. She had her job, the family, me, so much pressure, so much stress. I think if she wasn’t as tough and straight as she is, it might have got to her. She took sensible precautionary steps: talking, talking, talking, to friends, her mum, my mum, even a counsellor. She was a good nurse, but refused to climb down in there with me. She maintained the broad contours of her life. She admits now it was a relief to leave the house and close the front door on the misery behind her.

But now I’m wondering about more subliminal reactions in my children. At the time, one had quite bad abdominal pains for several months. Growing pains said the doctor, but I wondered – anxiety? Another had problems sleeping. The insomnia seemed to come and go, broadly in line with my own fluctuating wretchedness.

Is it possible that people, children, can pick up on stress, anxiety, depression in adults and develop sympathetic symptoms? Would love to hear from clinicians on this.

You are not your usual self. Unable to concentrate. Butterflies, and swooping moods. Thoughts that go round and round on themselves like traffic on a ringroad with no exit. Obsessive, repetitive self-centered rumination, I, I, I… A total abdication of reason and common sense; flights of fancy, soaring, dipping, wakeful nights, dismal days…

Depression and falling in love are two sides of the same coin. Falling in love has nothing to do with the heart. Like depression, it’s all in the head, the product of some subtle shift in alignments, some new arrangements of the fantastical array of chemicals that we call the mind, an urgent reaction to absences and longueurs and that quickening sense of time and life running out. You fall in love when you are weak, lonely, excited, stimulated, feeling your mortality. It’s an antidote to noxious ennui, a squirt of colour into the grey. I wonder if there are any stats on how many people think they have fallen in love, when actually they are just suffering from a bit of depression. I doubt it. These things are hardly measurable. But that doesn’t mean they don’t happen.

Where does it end? With familiarity, routine, sameness. With a sense that there are no more surprises, no more suspense, just the certainty of a relationship, steady and comfortable. You are no longer in love, no longer out of your mind.

Until the next time.

When sporting superstars admit to suffering from depression, I start thinking about cause and effect. Was it all that pressure, all that overexertion that drove them into the pit? Or was the exercise, the sport, a way to deflect the cloying exigencies of the illness.

With Ian Thorpe, the latter at first appears to be the case. Here is a world beater who just felt different from an early age. The swimming seems to have been a crutch, an escape, something to take his mind off the fact that something was wrong. It worked for a while, so well in fact that he was unbeatable for a few years in the mid-noughties.

But Thorpe is smart enough to acknowledge that the former may also be true.

Exercise can play a very powerful role in managing stress, but I sometimes wonder if the relentlessness and intensity of my training schedule over more than a decade did the opposite and exacerbated the condition, the physical exhaustion wearing me down psychologically.

Relentlessness, intensity, exhaustion. If we are ever surprised by how many top sportsmen end up with depression, just come back to these words. A little physical exertion can certainly help an individual reduce stress levels. But the constant need to perform, train, push oneself, take everything so very seriously: this is a recipe for mental agony. If I’m surprised about anything, it’s that more and more top sportsmen aren’t all lining up behind Thorpe to pick up their anti-depressants and book in their sessions with psychiatrists. Sport was meant to be recreation; it is in danger of become the exact opposite.

I don’t normally pick fights with columnists and OpEd writers. Their function is to stimulate debate, so they have to write provocative stuff. But @indiaknight gets it wrong this weekend in a column that starts out complaining about celebrity memoir and misery lit, and ends up with sweeping generalisations about depression.
Knight makes three specific points that require addressing.

First: that we just don’t need to hear from famous people who’ve been depressed:

“What irritates me is the idea that by “speaking out”, celebrity autobiographers are being heroically honest and somehow doing us all a favour.”

Depression makes you feel alone, afraid, an outcast. Hearing that it is an illness that can and does affect anyone is enormously helpful. Learning that rich and starry people suffer too makes you feel less broken, less bereft. Understanding that it affects rich and poor, successful and not so successful, men and women, old and young also helps you to comprehend: this is a universal scourge. It picked you, you didn’t pick it. You really are not to blame.

Second: that there is no taboo or stigma surrounding depression:

Taboos exist, certainly, but they concern people who are eating from bins and shouting at pigeons. They do not concern privileged, talented people who are depressed in the considerable comfort of their own home, with the best drugs regime that money can buy. I’m sorry for them, just as I’m sorry for anyone depressed, but, really, do they want a medal?
…Occasionally a campaign starts up on social media with the aim of removing the “stigma” from these issues. I can’t say it enough: there is no stigma.

No stigma? That would be funny if it wasn’t so serious. Ask anyone with depression who has a job and they will likely tell you of a tortuous process of concealment and subterfuge. Ask anyone with depression who doesn’t have a job and they will talk about an agonising dilemma in the hunt for work: to front up and risk not getting the job, or to lie and then risk being ‘outed’ in future. And that’s just in the world of work. In our wider social circles, few people really want to come clean, particularly men. Of all the men I’ve spoken to about their “thing”, very few have been happy to be named or identified. Depression reminds me of what it might have been like to be gay in the 1950s. A nasty secret that you keep to yourself as long as you possibly can. The current incidence of depression is thought to be around three women for every man. I have a strong suspicion that that imbalance is simply down to the fact that a great number of men are keeping their wretched conditions very well concealed.

Third: that we’ve all been depressed, so what’s the fuss all about?

Everybody gets depressed, and one person’s depression is not a million miles from another’s. It also seems a given that depression is an adjunct of fame, at some point and for some period — it’s so obvious that it’s not necessarily worth wasting three chapters on. Of course fame is weird and discombobulating.

Wrong. We haven’t all had depression. It’s around one in four or one in five. Depression is very different from feeling a bit down. It’s not that Monday morning feeling, or returning from holiday to find the house has been burgled. It’s not even the end of the affair, or the loss of a friend. It’s far more all-consuming. We’ve all had a cold, but we haven’t all had pneumonia.

Yes, we read a lot about depression at the moment. Yes, it might be irritating for those who don’t really come across it in their lives to be constantly reminded of the agonies of the most miserable species on the planet. As one critic of my book Underneath the lemon tree wrote: “Far from being the illness that t dare not speak its name, it is actually quite hard to get it to shut up.” That may be true. But it’s irrelevant. We don’t want to shut up until everyone understands that this is not a lifestyle choice or a niche thing that happens to a few wretched people in our midst but a very real, ubiquitous, debilitating, paralysing, often lethal illness that we should address and treat, not punish and marginalise.

Next week I’m going to take part in a panel/project about whether antidepressants work for healthtalkonline. It could be a long discussion. The jury’s been out on this for a long time. It may be a question we can never answer.
Why? Because it’s very difficult to pinpoint the role that antidepressants play in any recovery. Or to say with conviction what would have happened if the sufferer had not taken the medication. There is no control experiment.
Take my own case. I started taking citalopram in October 2009 as the extent of my depressive breakdown became clear. Before I took it, I was unable to function and quite suicidal. As I’m still here to write about it, it must have done some good, right?
Well, yes… but. It was at least three months before I started to feel better. In fact I felt worse to begin with, and soon ended up taking a second anti-depressant, mirtazapine. At the same time, lots of other variables were changing: I took six months off work; I spent time quietly, doing very little; I learned how to meditate; I began to understand the meaning of “be gentle with yourself”. How do I know it was not one of these factors that spurred me to recovery, and not the pills?
Then there is my story of weaning myself off them. When I first dumped mirtazapine at the end of summer 2010, I relapsed. Quite quickly in fact. When I tapered citalopram a year later, there was a similar blip, though not as dramatic. Is that empirical evidence? Or an indication that I’d become used to the medication? Or just a sign that I don’t like September? Hard to say.
Data suggests two thirds of people will experience some relief after they taking antidepressants. I would count myself as one of those. But did the pills CAUSE the improvement? Of that I’m not so sure…