Interview: Mark Rice-Oxley, author of Underneath the Lemon Tree: A Memoir of Depression and Recovery

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‘Ihave of late – but wherefore I know not – lost all my mirth, forgone all custom of exercise; and indeed it goes so heavily with my disposition that this goodly frame the earth, seems to me a sterile promontory.”

Suppose that was what Hamlet had told to his GP instead of himself. Would he be prescribed Lorazepan? Would he be sent to a cognitive behaviour therapy group? Would the GP even diagnose clinical depression in the first place?

Forgive the facetiousness, but it’s a natural reaction to crushing statistical gloom. Depression affects more than 100 million people throughout the world, one middle-aged person in ten is on anti-depressants, and we are getting to the point where only heart disease places a bigger burden on society. Most of us know these stats are right because we know some of the people behind them. They might be friends, often good friends. But they don’t call, because they feel incapable, or vulnerable, or because they don’t want to worry us.

Embarrassed at not knowing what to do or say, we often don’t get in touch with them either. “No-one ever sends a Get Well Soon card to anyone suffering from clinical depression,” says Mark Rice-Oxley, who has just published a memoir of depression about living with, and recovering from, the illness.

He wrote it, he says, because when depression first struck, he tried and failed to find anything that would tell him what to expect, and what the path to recovery would entail. There are, in fact, quite a few depression memoirs – William Styron’s Darkness Visible, Andrew Solomon’s The Noonday Demon, and Elizabeth Wurtzel’s Prozac Nation among them – but those are all written by Americans. Among the British, Stephanie Merritt had written about postnatal depression in The Devil Within, but that didn’t exactly apply either. Wasn’t there anything out there written by someone like him?

At the time he had his breakdown, he was holding down a stressful, deadline-driven job at the Guardian, doing his best to look after three young children in the few spare hours that allowed him. Yet he was and is happily married, had just turned 40, was in good health, hadn’t suffered any traumatic loss, had good parents, three lovely children, an idyllic country childhood, and was doing a job he adored. He is affable, isn’t short of friends, and when the breakdown happened, people said he was the last person they’d expect it to happen to. So why weren’t there authors out there writing about what is, after all, such a common, if debilitating, illness?

On one level, of course, there are. Clark Lawlor’s just-published From Melancholia to Prozac reminds us of just how many writers suffered from what we might now classify as clinical depression, and it’s a roll call of some of the greatest ever: Boswell, Beckett, Hume, Johnson, Proust, Tennyson and Woolf among them. Descriptions of what melancholia – what a pre-scientific age called depression – feels like, go all the way back to the Iliad, where Lawlor argues that Homer’s depiction of Bellerephon as “a lonely wanderer on the Aleian plain, eating out his heart and shunning the paths of men” marks him out as one of literature’s first melancholy heroes. That connection between writers and mental illness was underscored only last week in a survey for the women’s writing magazine magazine mslexia which revealed that 69 per cent of women writers had been treated for it as opposed to 29 per cent of women and 17 per cent of men in the general population.

Language is a poor servant here, because depression suggests an illness that is little more than feeling a bit sad. In reality, of course, depression can be ferociously debilitating. In Boswell’s Life of Johnson we get a hint of what it feels like to the sufferer, of how mental turmoil can be even worse than physical pain:

“He was so ill, as, notwithstanding his remarkable love of company, to be entirely averse to society, the most fatal symptom of that malady. Dr Adams told me, that as an old friend he was admitted to visit him, and that he found him in a deplorable state, groaning, talking to himself, and restlessly walking from room to room. He then used this emphatic expression of the misery which he felt: “I would consent to have a limb amputated to recover my spirits.”

No two patients are the same, and it is unwise to compare illnesses across centuries and cultures. Johnson, for example, seems to have had none of the oppressive lethargy that struck Rice-Oxley as the most defining marker of depression, even if their black moods seem similar.

When his depression was at its worst, Rice-Oxley explains, he would have been completely unable to concentrate on reading in the first place. But he did have at least a couple of treatments that Dr Johnson could never have known. A psychotherapist made him realise he’d overloaded himself with commitments to others. Anti-depressants seemed to help for at least one of the 18 months he suffered from depression. Then again, so too did rest, the support of friends, and meditation, and going for a gentle walk rather than pounding away obsessively in the gym.

It might seem counterintuitive, he adds, but the company of other people undergoing treatment for depression also assists recovery (it’s not: just think of Johnson’s friendship with his fellow-sufferer, Boswell). At least they will know what it feels like when the brain’s neurological circuitry wobbles under pressure, how you might feel like you are wrapped in Cellophane and not hearing things straight, and what you can see through your eyes looks like a film shot by a camera held by a six-year-old. At least they will know the depth of your fears that you’ll never get better, and what it feels like when you’re at your worst.

“Once you open up, help pours in,” he says. “I told my friends and colleagues at work and two or three asked me whether or not I had tried meditation. Actually, I’d always rather scorned it, but they said it was a good way of getting busy minds to quieten down and I thought I’d give it a go. My psychotherapist said that because I had this busy, energetic mind, trying to step back from it might help.

“He was right too. Because depression is like quicksand – the more you struggle, the deeper you sink. Mindfulness is the antithesis of thinking. It’s about stopping thinking, about seeing thoughts as just another projection of reality. It’s the hardest thing to do, trying to stop yourself being drawn away into a long narrative of thought, but I still try to do it every day.”

As Lawlor reminds us, Johnson would have agreed. “Talking of constitutional melancholy, he observed: ‘A man so inflicted, Sir, must divert distressing thoughts, and not combat with them.: Boswell: “May he not think them down, Sir?” Johnson: “No, Sir. To attempt to think them down is madness.”

“The other thing,” adds Rice-Oxley, “is to do things mindfully. So for example, when I go swimming, instead of trying to pound out 50 lengths as I used to, I would just try to concentrate on every moment, to feel the water on the skin of my hand, things like that. It’s all about being, not doing.”

Gradually, as he got better, he started reading again. Maybe, he says, it’s just like when you discover a new word and start seeing it all the time. Maybe he was subconsciously seeking out fiction with mental illness in it, like Sylvia Plath’s heroine Esther Greenwood in The Bell Jar: “The only reason I remembered this play was because it had a mad person in it, and everything I had ever read about mad people stuck in my mind, while everything else flew out.” Whatever the reason, he is amazed by just how much depression fills the pages of contemporary fiction:

“There is Hannah from The Reader and Hans van den Brock in Netherland and Hector in The Slap and Ma in Room and Eva Khatchadourian from We Need to Talk About Kevin – all clearly suffering from depression. I pick up a wonderful book by Sarah Waters called Affinity, a compelling yarn that centres on a 19th century character bearing most of my symptoms. Poor love. In those days they gave you laudanum and generally forgot about you. I’m struck by how little has changed.”

And it’s not just fiction. Depression features heavily in a whole raft of contemporary non-fiction titles. Last month, for example, Marian Keyes wrote about how baking cakes helped her recover from depression and Sugar Ray Leonard talked about his own bouts with the illness, while only today in St Andrews, Matthew Hollis will be talking about his Costa-winning biography about Edward Thomas and Robert Frost, two poets whose own lives were blighted by depression.

But Rice-Oxley is already ahead of me with his own list. Alan Bennett on his mother’s fragile mental health in Untold Stories. Marcus Trescothick’s breakdown in Coming Back. Even re-reading In Cold Blood and coming across Capote’s description of murder victim Bonnie Clutter.

“I made Victoria Cohen’s delightful book about poker last as long as possible,” says Rice-Oxley. “Then, bang, within a couple of hundred pages she too is on antidepressants. Yes, books are a great help: they make you realise you are not alone.”

• Underneath the Lemon Tree: A Memoir of Depression and Recovery by Mark Rice-Oxley is published this week by Little, Brown, priced £13.99. Clark Lawlor’s From Melancholia to Prozac: A History of Depression, is published by OUP, priced £14.99