The Mind Matters

At the end of the day it may well have all come down to which gave out first - my body or my resolve.  By my body I mean, unsurprisingly, my physical form, albeit it a form critically damaged in a traffic accident.  The resolve I refer to was my mental capability to keep on fighting long enough and hard enough to survive my injuries.

For the record, “I” is me, Cuthbert Algernon Rufflebottom, Cuffy to my friends.  That perhaps greatest of English writers, the inestimable Charles Dickens, once said he could not create a character in his stories until he had first created their name.  I would hazard a guess that many have heard of Uriah Heep from “David Copperfield” or even Pumblechook from “Great Expectations”, but what of the literally hundreds of other characters he created?  Names as rich and diverse as Mr Turveydrop in “Bleak House”, Luke Honeythunder in “The Mystery of Edwin Drood”, Peg Sliderskew in “Nicholas Nickleby”, Paul Sweedlepipe in “Martin Chuzzlewit”, Augustus Snodgrass in “Pickwick Papers” and, possibly my personal favourite, Anne Chickenstalker in “The Chimes”.

What Mr Dickens would have made of my name can never be known for he has (as he himself may well have put it) been dead these one hundred and forty-three years.  It is not, however, merely to celebrate his skill in conjuring names for his characters that I bring him to your attention.  It is for his reputation as a social commentator, and indeed innovator, that I turn the spotlight upon him.

The biographer Peter Ackroyd says of Charles Dickens that “never has a writer so well understood the poor and the outcast” and that “by his mid forties [he] had acquired as much social influence as any politician”. 

In “Pickwick Papers”, in describing the filth and degradation of the Fleet prison, he tackled the need for debtors’ reform.  In “Oliver Twist” he “dwelt on the miseries of the poor and the perils of childhood”, railing against both London’s lockups and the country’s workhouses.  In Nicholas Nickleby he set his nib against the spectre of private academies, the “dumping ground for unwanted or illegitimate children” (as a result of which they virtually disappeared), while in “The Old Curiosity Shop” it was child labour and inhuman factory conditions that fell beneath his mighty sword…sorry…pen. 

Again in “Oliver Twist” and also in “David Copperfield” he alluded to the plight of ladies of let’s say, a certain calling, while outside of his writings so concerned was he by the capital’s widespread prostitution he went so far as setting up a home for “fallen” women.  “A Christmas Carol” was written in answer to the poverty he saw around him and he later established - and for over twenty years edited and regularly contributed to - two weekly periodicals, the original “Household Words” and its successor “All the Year Round”, and highlighted subjects such as health, sanitation, clean water and public education. 

It is in the spirit of Charles Dickens therefore, but with neither his immeasurable skill as a wordsmith nor his prowess as a public speaker, that I will now furnish you with a commentary of my own, on an issue that has had a direct bearing on yours truly.  I have no idea as to the answer to the question I wish to raise, yet I feel it is vitally important that I ask it all the same.  I do so in the hope of at least bringing it to the minds of those who may not have considered it before, possibly even to those who can make a change for the good and thereby prevent others from experiencing something similar. 

I began this account with the words “...it may well have all come down to which gave out first - my body or my resolve”.    As such the issue in a nutshell is this:  by failing to treat my ongoing and, to be blunt, by then exacerbated mental health problems with as much urgency and diligence as my bodily injuries, could all the physical treatment and care I received have been doomed to fail?

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As I have said before, my name is Cuthbert Algernon Rufflebottom, and although I have poked a small degree of fun at my undeniably outrageous moniker, I would ask that most of what follows is taken in all seriousness.  I say “most” because I’ve discovered over the years that I can usually find something amusing in even the direst of situations.  The drawback to this is that to others it can undermine the seriousness of what I’m trying to say.  As such I ask you to indulge me as much as you can while you winnow the wisdom from the wit.

Like many people I’ve battled against depression, and have done so for all my adult life which, in many ways, began when I was barely out of short trousers.  In the years since my mind has already come perilously close to giving up on a number of occasions: the overdose of sleeping tablets when I was barely eighteen; the determination at twenty-two to jump from a London Underground platform, a determination which crumbled only at the final second when I felt unable to inflict my personal misery upon an innocent train driver, the man whose very eyes I found myself staring directly into; the second overdose at age thirty-seven, scuppered in part perhaps by the basic but possibly happy mistake that the anti-depressants I swallowed en-masse were specifically designed to release their potency over several hours as opposed to all at once; the reconnoitring of the multi-storey car parks where I live to gauge which would be best, and mostly by that I mean the least inconsiderate, to jump from.

Most days for me are a struggle: the whispering voice that talks of taking the “easy” way out; the dark hand that penetrates my skull and crushes my brain; the nightly broken sleep and stress filled dreams; the repeated panic attacks in supermarkets; the bouts of overwhelming self doubt; the ongoing terror of engaging with other people; the self-defeating urge to hide under the duvet; the debilitating absence of self-motivation; the nagging compulsion to self-harm. There are many references there to “self”; I pray you won’t think I’m “selfish” because of it.

For the record, the last item on that long but not exhaustive list, the compulsion to self-harm, is not, as some would have it, an exercise in attention seeking.  I would ask you to think instead of those old pre “political correctness” movies in which the “stiff upper lip and all that” gentleman gives the “weak and emotional” lady a hearty slap on the cheek to snap her out of her hysteria.  To me self-harm is pretty much the same thing, a controlled and calculated shock to the system to snap me out of the downward, self-propagating spiral of depressive thinking.

I could go into great detail as to the causes of my mental illness, both past and present: the unremitting, undefended and un-allayed bullying at school, brought about in part by the outlandish name with which my parents landed me, in part by the heinous crime of having buck teeth and intelligence; the social ineptitude coupled with incredible shyness; the confidence sapping experience of working as “the new boy” fresh out of college in a female dominated office; the isolation of being the wimp in a company of macho antipodean demolition workers; the “it’s not rocket science” mentality of a line manager whose computer obviously had a magic key which produced instant results; too often hearing that most painful of phrases “I like you as a friend but...” ; the lack of a “significant other” which has endured to this day; the external pressures to succeed which later became internalised as both an insidious fear of failure and an inescapable expectation of that very thing.  As I said, I could go into detail but I won’t, I prefer to keep that between me and my therapist.  Let’s just say I’ve spent much of my later life on anti-depressants of one kind or another and much of that same time in the company of one of many a “psych” prefixed health professional.

Having just mentioned self-harm as well as suicidal thoughts and actions, you could be forgiven for assuming the  incident which had left me lying critically injured in intensive care for more than six months was in some way my own doing.  Ironically it was an entirely opposite thought process which led to my accident.

There is a widely held view in mental health circles that physical exercise can help in the treatment of maladies of the mind.  Lack of motivation not withstanding I have at times attempted to give this idea a try, most recently by purchasing a bicycle and a new pair of swimming trunks.  It was while riding my bike to the swimming pool one morning that a “white van man”, intent on using his mobile phone instead of observing the road ahead, not only ploughed into me from behind, he also propelled me into the path of an oncoming truck.

Severe head injuries left me in a coma for nearly a fortnight while serious facial injuries left me with a fractured jaw which had to be wired shut.  Add to this multiple cuts, internal bleeding, two busted arms, several crushed fingers, a number of cracked ribs, a fractured pelvis, a shattered kneecap and both legs broken in a total of six places, you could say I was in a bit of a bad way.

I could not speak for six weeks because of my wired jaw and then because of the breathing tube they had to stick down my throat when I got a never-ending lung infection.  What is more I could hardly write on account of my damaged fingers, and thanks to the drugs I could barely think straight.  I was attached by a tangle of multicoloured wires and tubes to a raft of machines and a plethora of glass and plastic containers, some putting stuff into my body, others taking it out.  I won’t dwell on the “taking it out” part but as for the stuff going in, much of it was medication.  Unfortunately I’m convinced that none of it was anti-depressants.

A very pleasant and thoroughly professional nurse asked me one morning how I was feeling “in myself” – painfully and slowly I scratched a word on the pad they’d given me to allow me some communication: “depressed”.

‘Oh, you’ll be fine,’ she said breezily.  ‘It’s no wonder you’re a little down, all things considered.  We all have our off days don’t we?’

A few days later a volunteer hospital visitor arrived cheerful and unannounced at my bedside.

‘Mr Rufflebottom, isn’t it?  My my that is an unusual name, where does it come from?  Oh silly me, you can’t answer can you?  Anyhoo, I’m here to keep you company.  May I call you Cuthbert?  Mr Rufflebottom is so formal.  So how are you keeping?’

Once again I went through the protracted process of forming a reply.  It was the same one word answer as I’d given the nurse: “depressed”.

‘Oh come come Cuthbert!’ the stranger trilled.  ‘There’s no need to be feeling like that now is there?  I always find in these situations that it’s best to trust in God and in Jesus.’

He’d sat by my bedside for two hours, extolling the virtues of putting one’s faith in God, trying his damnedest to convert me.  I’m an atheist at the best of times; by the time he’d left I was a homicidal one.

The next time I’d tried to make my feelings known was to the Senior Consultant himself, the senior consultant for that week at least, they seemed to change regularly.

‘Feeling low are we Mr Rufflebottom?’ he queried, once I’d penned my tortuous response to his bog standard enquiry of: ‘And how are we today?’

‘That’s not really my field,’ he continued, ‘but I’ll ask the duty psychologist to put his head around the door.’

Three days later the psychologist’s head duly appeared.  My inability to talk plus the impossibility of writing more than one or two words at a time saw him on his way with little more information than he had when he walked in.  In my defence, you try having a serious conversation when you’re feeling drunk, exhausted or both and where everything you want to say, that you need to say, must be cut down into unfeasibly short hand written statements.

‘Let’s see how things go,’ the psych guy said as he left.

So how then had I been feeling?   The simple answer, though no less truthful for it, would be the one I had given before: “depressed”.  But there was more to it than that.  If you take nothing with you from this account other than the next one hundred and sixty-nine words then hopefully I will have succeeded in my goal of bringing attention to what so recently befell me.

I’m the first to admit I’m no expert in these things, but it seemed to me at the time that my state of mind was as important to my recovery as any amount of operations (of which there were several), bandages and painkillers.  When my depression was particularly bad, when all I wanted to do was die and get it over with, my physical condition worsened.  During the times when I was heavily sedated and thereby incapable of thinking about my situation or of being affected by my depression, my body healed faster, I actually grew stronger when my mind was removed, albeit temporarily, from the equation.

Don’t get me wrong, I am unspeakably grateful for the medical care I received and I fully realise without it I would have had zero chance of surviving and no possibility of ever living a normal life.  Having said that, as a patient with a severe mental illness, could you really treat my body without, at the same time, treating my mind?

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Having voiced those most important one hundred and sixty-nine words, my humble attempt at social commentary is almost done.  For the record, the fact it was one-six-nine was pure coincidence; it also happens to be the square of unlucky 13!  On that note, let me wrap things up firstly by reminding you again of just what I said at the start:

“At the end of the day it may well have all come down to which broke first - my body or my resolve”. 

Next, having referred extensively at the outset to the writings, methods and convictions of Charles Dickens, I wish to refer once again to “A Christmas Carol”.  Arguably his most well known and well loved creation, and especially beloved by me, it opens with the words:

“Marley was dead to begin with.”

In hindsight, and to put right any misapprehension you may be under as a result of my original opening, this narrative should perhaps have begun with a similar statement:

“I, Cuthbert Algernon Rufflebottom, Cuffy to my friends, am - like Jacob Marley before me - dead to begin with.”

I really have no clue as to which did “give out first”, whether I died of my injuries or if I simply lost the will to live, and like as not nobody will ever know for sure.  Suffice it to say, had all the bases been covered, physical and mental alike, then maybe, just maybe, the whole situation might have had a different outcome.

 On that bombshell I’m afraid I really must be going.  So long.