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Mothers on the brink

RACHAEL WAS sitting at the table having a cup of coffee and a sandwich when suddenly she began to feel very uneasy. 'I felt as if I was being smothered — the feeling built up until I was almost struggling to breathe,' she says. 'It was like there was a balloon...

wrapped round my face. My heart was pounding. I was scared, petrified actually. I clutched the tablecloth and waited to die. After, perhaps, five minutes, it went away.'

That was Rachael Malai Ali's first full-blown panic attack — although she had no name for it then — and it heralded the beginning of a downward spiral into a nervous breakdown so severe that she likened the task of getting better to 'the cow jumping over the moon'.

She has now written a book about her experiences of depression and anxiety — which aims, she says, to 'hold the hand of anyone else going through this, to let them know that they can get better and that they are not alone'.

Tragically, there are many who will find themselves in similar depths of despair. Depression and anxiety are increasingly common in the UK — one in five of us will suffer from depression at some point in our lives while about one in 20 will be affected by anxiety disorders.

Nearly 30 million prescriptions for anti-depressants were written in 2005, and another 16 million for anxiety drugs (the latter alone at a cost of £38 million).

Depression is characterised by a pervasive and inescapable low mood — sufferers often describe feelings of such unhappiness that they are incapable of coping with their normal social and professional life.

Anxiety relates to feelings of fear and dread, and can include physical symptoms such as palpitations and rapid breathing. The two conditions often coincide, as Mike Isaac, consultant psychiatrist and senior lecturer at the Institute of Psychiatry in London, explains: 'They are two sides of the same coin.'

Twice as many women are diagnosed with depression and anxiety as men. Part of this difference is because women are more likely to see a doctor. But, even taking account of this, women do seem to be more likely to suffer depression and anxiety.

The causes are almost as diverse as the individuals afflicted, but one thing that is known to predispose a woman to depression, says Dr Isaac, is having two or more pre-school children, particularly if the mother does not have a trusted confidante. Dr Isaac says that commonsense tells us that very young children are exceptionally demanding and — in adult terms -— not very companionable. 'So it is easy [for a woman] to feel overwhelmed and isolated, especially if she has no one to share it with,' he says.

At the time of her first panic attack, Rachael had three small children and, although married, her husband — who was much older —wasn't entirely supportive. She was the main breadwinner, too, working in a kindergarten to make ends meet. But even more crucially, she believes, she was 'a great pretender'.

As the eldest of three girls, Rachael explains: 'I had always been "the responsible one", you know, "Rachael will sort it out." ' Her parents split up when she was 15 and she says: 'I had to be there for my younger sisters and for my mum. But I never really grew up; I just learnt to pretend.' When she got married, she says, she was 'on a mission to prove I was an excellent wife and mother who could run a house, work, look after the children, cook and probably fly, too'.

The problem was, of course, that like most of us, she couldn't do it. A survey just released by leading parenting organisation Parentline Plus shows that nearly 80 per cent of mothers feel under pressure to be 'supermum' and, for most, it destroys their enjoyment of being a parent.

With that drive to be perfect was a sense of loss for her identity before babies. 'I used to dress fashionably — short skirts and high heels — and had the trendiest hairstyle,' says Rachael. 'I was the founder member of a comedy theatre troupe and wrote scripts for TV, and songs.' After attending drama school, she landed some TV work in the Far East. 'I had successful boyfriends — a pilot, a director. I was out there being competent, having meetings, looking good.'

But that Rachael disappeared when she married and had children. When she was 22, she moved to Brunei and within a year she was pregnant. Determined to be a good mother and wife, she turned down offers of TV work and had three babies in quick succession.

It was soon after the arrival of the third child that things began to unravel and Rachael found herself falling into the grip of serious anxiety, panic attacks and clinical depression. 'I was the biggest fake on the planet,' says Rachael, 'In reality, I was still a child myself; I still occasionally sucked my thumb and was afraid of the dark.'

She began to comfort eat, putting on masses of weight. 'Looking back now I can see I was a mess,' she says. 'I resembled a blob in a baggy T-shirt and ugly black leggings and wore huge granny knickers. I lost my identity. I was getting fatter by the day and more stressed out by the second. But I didn't complain or tell anyone I needed a break. That would mean I was weak and selfish. So I lived a lie.'

Then came the first panic attack, followed by another the same evening. They soon became regular, setting up a cycle of anxiety — the fear of attacks triggering an attack. Rachael didn't know what was wrong with her. Anxiety often manifests itself in physical symptoms — aches, pains, palpitations — and she convinced herself she had a serious physical illness.

A medical encyclopaedia became her bedtime reading and she had every available test. She thought it was her heart, or maybe her brain, but she admits now that she always knew deep down that it was a mental problem; she was just desperate to pin it on something people would understand.

All the physical tests came back normal but the symptoms got worse. To take the strain off painful muscles she would drape herself over the balcony and just hang there for hours, or walk around hunched with one arm over her head like a monkey. She didn't sleep, lying drenched in sweat and fear.

On bad days, her au pair (without whom she dreads to think what would have happened) not only had to feed the children but also Rachael — literally, a bite at a time. The world went completely grey, Rachael says, 'no colour, no taste, no meaning'. She was having a 'nervous breakdown' — a catch-all term used to describe severe symptoms of stress, anxiety and depression resulting from a mental disorder.

It is important that this is seen as an illness, says Rachael. It should not be something to be embarrassed about and it is not a weakness. 'People think breakdowners are weak; we really aren't. We have to be very strong just to get out of bed. Getting dressed is a huge effort. I once wrote in my journal, "I am going to have a shower. I hope I come back." We are fighting a monster in our mind. I wanted to snap out of it — nobody wanted it more than I did. But how?'

Rachael spent some time in hospital and at a psychiatric day centre, which gave her both time to think and a distrust of medication.

She saw a variety of doctors and psychiatrists and they gave her pills — anti-depressants and anti-anxiety medicines, which work by targeting receptors in the brain and chemical pathways that control mood and arousal.

'The pills were lovely colours and came with some great sales pitches,' she says. But she went home and looked each medicine up, finding lists of side-effects, many of them similar to her existing symptoms. 'I couldn't risk not knowing what was symptom and what side-effect,' she says, 'and I needed my mind.' The few pills she did take she found disoriented her and 'I knew I had to think my way out of this. I didn't want to be glazy and hazy, and then in a year's time be taken off the drugs — and then what? I needed a permanent solution, so I squirrelled the pills away in my bedside drawer'.

It is not necessarily good advice, but in Rachael's circumstances this may have been wise, says psychiatrist Dr Isaac. 'Drugs are not a cure — their value is in lifting the symptomatic burden so people can use their mental resources, see things in perspective and engage with psychological treatments.'

Drugs, he says, are short-term measures and should come with a tailored programme of psychological treatment and support. The problem for many patients, as Good Health has reported in the past, is that although under Government guidelines they are meant to be offered a form of psychological treatment or 'talking therapy', provision of such services is patchy — and average waiting lists can be many months.

Rachael desperately wanted such help. Her mother was very supportive and most friends and family did their best, but she says 'you need someone who really understands what you are going through. "Cheer up", "look on the bright side", and "pull yourself together" really do not help.

'What the depressed and anxious need is a non-judgmental listener who they can talk to.' But slowly and painfully, with the help of books and time away from family duties, Rachael began to think herself better. She learnt to let the feelings come without battling them and to talk herself through, reminding herself that these were only feelings — that they couldn't actually do anything. She decided to express her emotions and wrote a diary — a safe outlet and a way of seeing the pattern of her days. She also overcame her embarrassment and began to talk to people about her illness.

Rachael's children were part of what got her through. 'I love them so much, and I had to get better for them,' she says, and one good thing came out of it. The boys know she had a hard time and was afraid of many things, so they now admit their own fears and talk openly. Recovery doesn't happen overnight, Rachael warns, but there are milestones.

One day, out on the balcony, she suddenly noticed that the trees were green. For the first time in two years, she saw this bright, beautiful colour. Overwhelmed, she sat there and wept. She started going for walks in a nearby national park. One day she decided to climb one of the hills. But, standing at the bottom, she wondered what she had been thinking. She panicked, and left — shaking all the way home and then hiding herself in her bedroom.

A few weeks later, she returned. This time she took it slowly, rested when she felt tired and took in the view. This time she wasn't going to stand there in a panic. She was, she realised, learning how to handle it: Accept how you feel, wait for the feelings to subside and then carry on. Rather than assuming the worst she told herself her breathlessness and tiredness was a sign that she was just unfit and not panicking. She resumed her climb.

After an hour-and-a-half she arrived at the top. 'I was sweating buckets and as muddy as a hippo — but I was there. Me, who a year ago could barely leave the house. Me! It was amazing.'

Rachael lost 4st, began to write again and, in due course, entered a new, loving, relationship. She has been healthy now for seven years — despite some very difficult life events, including an acrimonious divorce and bankruptcy.

Life has not been easy, she admits, but she says nothing the real world can throw at her, nothing, will ever induce her back into the grey, tasteless, meaningless hell of a nervous breakdown.