Writers on Mental Health gives a window into real experiences to paint a picture of mental health without taboo, stigma or caricature.
Topics include therapy, medication, depression, anxiety & more. Each installment takes the form of an essay or interview.
Episode III: An interview with Dan Shewan
In this installment, Dan Shewan talks about anxiety and depression.
I'm here with Dan Shewan, a nonfiction writer and essayist based in New England. Dan has written about his experience with anxiety and depression in a few publications, including The Billfold and The Independent. Let's start at the beginning: when did you first start to feel your mental disposition was different?
Well, I was always introverted, sometimes painfully so, but I never really suspected that I may be dealing with actual mental health problems until I was in my mid-twenties. I sought help from my doctor, who told me I was exhibiting almost all the "classic" symptoms of mixed depressive anxiety disorder.
Sleeplessness, or the opposite, sleeping too much. Poor appetite. Difficulty concentrating. Irritability. Lethargy. Initially I thought there must be some sort of physical cause for the symptoms I was experiencing, but after some routine tests, I was told I was physically in pretty decent shape. That's when my doctor began to explore other diagnoses, including depression.
Did you discuss what might have caused the onset?
Honestly, I didn't. I couldn't bring myself to, because deep down, I was convinced that my drug use in my teens had something to do with it. I worried that I'd somehow done this to myself, and I was so ashamed, I couldn't bring myself to tell him. I did confess that I was drinking far too much, which was its own issue, but we never really got to the bottom of it.
All this happened before I emigrated to the United States, and so I was seeing a doctor on the NHS, Britain's socialized healthcare system. My doctor did refer me to a cognitive therapist to try and work through some of the issues surrounding the causes of my depression and anxiety, but after being on a waiting list for eighteen months, I eventually let go of that idea.
I had always been nervous and socially awkward, particularly in even modestly large groups, but my drinking and drug use allowed me to get through these situations and actually feel like a normal person. Looking back, I suppose it was rather obvious I was suffering from some kind of anxiety disorder, but it didn't occur to me at the time.
What was your initial plan moving forward when your doctor diagnosed you with depression?
Initially, I had no idea how to handle it, or what the "appropriate" way to cope with it was. I was living alone in London, with no real friends, and so I didn't really have a support system to rely upon. I had lost my job three days before Christmas in 2008, the fallout from which was what finally prompted me to seek help, but I had no idea what to do, or what to say.
Since I wasn't working, it was actually pretty easy for me to avoid dealing with the problem. I was practically nocturnal for eighteen months, but I was taking medication so it felt as if I were doing something. In hindsight, that period of isolation was probably highly detrimental to my recovery, as it allowed me to avoid contact with other people, and even avoid discussing it with my family.
Can I ask further what role your friends and family took—and when—in your recovery/management? At one point did you meet your wife?
My family is very small. I'm estranged from both my brother and sister, so it's really just my parents and I. My parents have always been supportive of the decisions I've made, but they didn't really know what to do with my mental health issues. My father and I speak twice a week by phone, and even when I actually described my depression and anxiety as mental health problems, my father didn't really know what to say. He has a much better understanding of it now. My mother has suffered from depression in recent years, which I think has made my issues easier for him to relate to.
I met my wife shortly after I moved to the United States. My first wife was American, and she had moved back to Massachusetts while I waited for my visa paperwork to be processed. Things broke down during that time, so when I arrived here to give it one last shot, I discovered she'd been sleeping with another man. We divorced, and shortly afterward, I met Nicky. We've been together four years at this point, and she has been so wonderfully supportive.
She suffers from anxiety and depression herself, so I don't have to explain how I feel when things are difficult - she gets it, which makes things a lot easier to deal with. I think one of the hardest things about mental health problems, aside from the isolation and stigma, is adequately explaining what it feels like to people who've never experienced these problems firsthand.
In reading your nonfiction, I know that you're quite talented at transmitting a very personal, subjective experience with clarity and care. Do you find that you can write about your struggles with mental health during difficult times, or do you need time to get perspective?
I find that time and distance from a situation or difficult time is always beneficial to the work because it allows me to really unpack why I did the things I did during that time, or to more thoroughly explore my feelings about it, but I wouldn't say I need that time and distance to write about these experiences.
Even long before I started writing, I was always very concerned about being misunderstood. In fact, the idea of being misunderstood is one of the earliest triggers for my anxiety that I can remember. One thing I try very hard to be cognizant of is the limitations of my experiences with mental health problems. As a topic, I think it's quite difficult to write about depression or anxiety or any other mental health problem in a general way. There's a danger of generalizing too much or calling the validity of someone else's experiences into question. Whenever I try to "write through" a particularly difficult time, I try to remain aware of that as much as possible.
This worry, of generalizing the wide spectrum of a single disorder, is brought to light in your article in The Billfold (you reference all the number crunching we do instead of true dialogue). I believe (hence the series) that one of the best ways to discuss the issue is through the telling of unique experience. What about your anxiety and depression do you think is unlike the generic telling, singular to you?
Honestly, I don't know if any aspect of my personal struggles with depression and anxiety could be considered truly unique to me. I definitely react to my symptoms in ways that I would say are characteristic of me in general, such as my tendency to progress from depressed to periods of intense self-criticism, but I'm sure many people do that, too.
Similarly, my anxiety often makes me feel somehow inadequate, especially in social situations. I tend to internalize my worry and make it about me - how I should be able to cope with normal, everyday situations but somehow can't, or why I feel this way when it seems like everyone else is having a good time or enjoying life without dissecting and analyzing everything.
If I'm honest, I'd say my symptoms and how I react to them are ultimately reflections on my own self-esteem, or my perception of myself, rather than truly unique experiences.
There's a caricature of the writer dealing with mental health and feeling a surplus of creative energy. Has this been a reality for you, or has your anxiety (and depression) only hindered your output?
I think that's one of the most dangerous assumptions about mental health and so-called "creatives." I'm sure some people do feel inspired by their depressive episodes or their anxiety or whatever they're dealing with, but for me, I find it very difficult to get any work done when things are bad. I may make notes here and there, or do some research (which allows me to momentarily step away from myself and how I'm feeling), but for the most part, I usually have to wait it out until I can get anything done, or at least anything I'd feel comfortable publishing.
I think part of that stereotype of the tortured creative soul or the depressed, struggling writer is romanticized far too often. I see a lot of articles about the writing life that touch on the fact that, yes, if you experience hardship, you're inadvertently gathering material for future work, but I think there is far less discussion about the very real danger that mental health problems can cause.
And how about medication? In the other direction, there's a stereotype of drugs taking "the edge" from the creative worker.
That's very true, and I think that differs hugely from one person to the next. I know that, for me, I couldn't hope to function as a "normal" person without medication. For me, medication allows me to think clearly, and so I'd consider it essential to my work. On the other hand, I know several people who have had terrible experiences with prescription medications, and their work has suffered.
I don't personally feel that medication dulls my edge, but I can see how some people might feel that way.
Are you willing to discuss which meds you've tried?
Sure. Initially, I was prescribed citalopram, which is a generic antidepressant that many doctors prescribe as the first port of call, as it were. It actually worked pretty well, but I felt it wasn't working as well after I had been taking it for a couple of years, so I sought other medications.
I'm currently taking Wellbutrin, another popular antidepressant. I've been taking that for about six months now, and it's working very well. No discernible side effects, and I generally feel much better than I did, so I'd say that's been successful. I take Xanax for my anxiety, which many doctors won't prescribe because it can be extremely habit-forming, but I've been very careful to keep my usage infrequent and only when things are particularly bad. I also take a twice-daily anti-anxiety medication called Buspiron, which is more of a preventative measure, whereas the Xanax is for reactive situations.
You mentioned coming off some of your medications in an article. What made you decide to do that?
Honestly, that was a horribly irresponsible decision, and one that was embarrassingly naive. Despite knowing how antidepressants work, and being extensively familiar with them, for whatever reason I decided that I was just fine, that I didn't need the meds anymore, and that I'd be better off without them. It was as simple as that, really.
However, it quickly became apparent that I wasn't okay, and that coming off my medication without consulting my doctor was a terrible idea. Ultimately, that incident was what prompted me to try Wellbutrin, which actually works far more effectively for me than the citalopram did, but it was a grossly irresponsible decision, and one that my wife had to deal with. It was a very dark winter, to say the least.
Besides that, what has been your biggest learning experience? What do you wish you could say to your 25-year-old self?
For me, the greatest learning experience was emigrating to the U.S. Before I left, I consulted my doctor and told him that since I had something to look forward to, I was actually feeling much better and wanted to try stepping down the dosage. When I arrived in America, I thought everything was going to be wonderful - and it was, for a time. However, when the depression and anxiety started to resurface, I finally realized that mental health is rarely circumstantial. Obviously situations in our lives can test us more intensely than others, and this can exacerbate mental health symptoms, but I really believed I was depressed and anxious because something was happening, or wasn't happening, or whatever. Moving here finally showed me that my mental health problems weren't solely caused by external circumstances.
If I could give my 25-year-old self any advice, it would be to seek help sooner. Like many other people who are struggling, I resisted seeking medical help because it felt like an admission of weakness. Of course, it's anything but, and it's the responsible thing to do, but we don't live in a culture in which mental health is taken as seriously as physical health conditions.
Thanks for your time and your story, Dan.
Thanks for having me, Andrew.