Mental Health Talk

Patient Talk – What does severe clinical depression feel like?

Patient Talk - What does severe clinical depression feel like?

Why did first you come to Oaktree?


I first came to Oaktree because I had lost trust in the service my GP practice was offering me, having seen 4 of the GP’s at the practice with no resolution of my problems, multiple changes of medication and no plan for taking things forward towards a satisfactory outcome.


Could you describe the daily struggles you faced beforehand?


I had no energy, and no motivation. I felt suicidal and had planned how and where I would carry out this act. I carried the means for doing this with me. I felt there was no point in going on with my life if this was all I could expect. I had had bouts of depression before but had been free from these for a significant period of time, following being prescribed fluoxetine (Prozac). In my mind I believed that if this didn’t work, nothing would. I couldn’t sleep at night, and couldn’t do anything during the day. I stopped going out and taking care of myself. I would go weeks without showering or changing my clothes. 


How would you describe your worst days? Your best days?


My worst days, strangely, were the days I had slightly more energy. My anxiety levels rose on these days and I could not control my thoughts. anything and everything was a cause for concern, but my main problems were to do with my depression and me not recovering and how I could go on if this were the case. My best days were not a lot better than this, frankly, but I did feel able to do a little more in terms of self care, though this might only be one thing out of the raft of routine activities that constitute looking after oneself. 


Were those around you aware of what you were going through? Friends/Family/Co-workers?


I wasn’t working at the time and did not see friends. My partner was aware to a limited extent but unsure how to handle or manage my moods or behaviour. Despite this he looked after me as best as he could.


Was there an event or trigger that made you decide get an assessment? 


I decided to get an assessment because the fourth doctor I saw at the surgery put me on a medication which raised my blood sugar to a dangerous level and I could not get this down. On phoning and speaking to him he said to leave it off for a week and then start taking it again. I was horrified by this medical advice and decided at that point I would find an alternative. I felt totally let down.


What did you learn about yourself from that first visit to Oaktree?


That I had severe and lifelong depression, well of course I knew that, but I needed to know that someone else believed that too, as it appeared to me that my consultations with the various GP’s I had seen indicated that they did not think so. 


How has your life improved since then? 


My depression has lifted with the prescription of two different types of medication, which, together, appear to increase the anti-depressant effect of both and provide a safety net, in case one or the other stops working. I have also benefitted tremendously from the skilled support of a consultant psychologist, which has helped me to determine the life events that have led to me suffering from this horrible illness, and to counter their effect through understanding them with a different perspective.


What advice would you give to people going through the same thing?


Don’t think your GP knows everything there is to know about severe clinical depression. They probably don’t. If your mood hasn’t improved in three months, ask for a referral to a community psychiatric team, it will probably take several months to get an appointment anyway. If that doesn’t work, find a way to consult a practicing psychiatrist privately, even if you get no more than a change of medication after your assessment, that may be enough to improve your mood and at the very least, your GP will be provided with a report on your medical condition, and hopefully a treatment plan that they can follow. Try to see a GP who is prepared to listen, make a double or triple appointment if necessary. and don’t get bullied into thinking there’s nothing much wrong with you. There is and if you are ever going to be a productive, reasonably normal person again, you need professional help.

Mental Health Talk

Anorexia Nervosa: Recognise the Quiet Killer


Anorexia Nervosa: Recognise the Quiet Killer

In the modern era, pressure to be thin is immense, originating from the social media “selfie” culture more than ever before.  1.25 million people in the UK have an eating disorder of whom 25% are male. This is increasingly becoming a major problem within the child & adolescent population. Children as young as 6 years of age being diagnosed with severe anorexia; one of the most fatal mental illnesses causing death through starvation, malnutrition or suicide. Less severe forms or if lucky, would still cause bone weakening, growth defects, psychological withdrawal. 


Anorexia is a mental disorder that stops people eating in order to lose weight, this results in complete preoccupation with eating (rather not eating), weight and shape. The sufferers develop a distorted sense of their own body image so that they believe that they are overweight when in fact they may be extraordinarily thin and dangerously so. This disease is dangerous and lethal in many cases and debilitating, disabling in most. However, the major issue with this is that it is not only hard to recognise but also encouraged and endorsed within many professions. 


The first hurdle in treating the sufferers is that only 1 in 10 will seek professional help. This could result from a multitude of factors:

  • The sufferers may not have an insight into their own eating difficulties and may consider their behaviour “normal” or in keeping with the trend. Unfortunately, thinness can be further reinforced by peers, employers in certain professions and even elders within the family.
  • Many of the sufferers do not want to have treatment for the fear of gaining weight. Even in treatment the disorder makes them hesitant or ambivalent towards receiving treatment.
  • In many cases, anorexia is not recognised by those even closest to the sufferer due to lack of understanding. In addition, people with anorexia sometimes become experts at camouflaging their obvious weight loss by wearing loose clothing, avoiding being weighed at the doctors’ or eating in front of others to not be detected as suffering from an eating disorder. 

In case of children and young adults at least, the onus of recognising signs & symptoms of anorexia, and prompting a them to see a doctor is upon the family or friends.

If someone in your family or amongst your friends:


    • Counts calories excessively 
    • Misses/ bins meals at home, school and work
    • Avoids eating with others
    • Weighs self repeatedly or avoids it completely
    • Spends inordinate amount of time exercising
    • Becomes dizzy, has episodes of loss of consciousness
    • Loses large amounts of hair 
  • Is uncharacteristically irritable
  • Inattentive in class
  • Becomes socially isolated with very little interest in going out 


It goes without saying that the earlier we are able to detect and recognise anorexia the better the outcome and lower the impact of this silent killer on the sufferer’s health and quality of life. 


Seek help and advice from your general practitioner or a psychiatrist. 

Mental Health Talk

Preventing Online Burnout

Preventing Online Burnout

COVID-19 pandemic has changed our lives beyond recognition, the forced social isolation, working from home or “hybrid working” meant that we had to swing into a world of online meetings. It is estimated that currently 300 million people are using zoom every day and whilst working from home has been a sought after benefit for many, the lack of physical communication has led to a form of video conferencing burnout.


Why is this happening?


Now that a vast majority of workers have evolved into remote positions and everything from medical appointments to business meetings have gone online, there are increasing reports of fatigue related to screen time. In part, this could be due to complete physical inactivity as  we sit at our desk looking at the screen for an extended amount of time and straining our eyes without rest. There is no walking around the office, rush to get to the train, bus or car to get home, no change of environment either. 

More alarming issue however is the sense of social isolation and inability to communicate with colleagues, clients and even strangers. How lovely is it to compliment someone on how radiant they look or express your dissatisfaction about the way something was done without having to email something unpleasant or smile at a kind stranger at the bus stop or in the coffee shop round the corner from your office. Unfortunately, all this is lost whilst sitting in front of the computer. 

70- 80% of our communication during work is nonverbal, so when in an online meetings there is often difficulty reading facial expression and body language, communication becomes that much more cumbersome as everything has to be verbalised by all present.  It is unsurprising that we feel less connected to others and the meeting that would have taken 30 minutes would now be much longer and tough. 

We then have the non-human factors which are tiresome and frustrating that cannot be ignored. Anyone have the instinct to throw the laptop out the window when the screen is frozen  mid-sentence or when you are making the most ridiculous face at the camera (may have been hilarious if you weren’t as frustrated) or when you utter the most important statement and the person on the other end says they did not hear a word due to audio failure. The combination of these factors alongside poor wifi signals have created challenging barriers to overcome.


So what can we do to prevent burnout?


Give yourself a break

Like all forms of social communication, it is important for us to regularly take breaks from our screens. Most of us will be flicking between our laptops, computers, phones and tablets throughout the day and so it is essential to get outside when we can and give our eyes and minds time to wind down.


Make yourself comfortable

Making sure that your immediate environment is suited to your schedule is an absolute must. 

  • Take a few moments to look at your desk and ensure that your camera is at the right height and angle so you are not straining.  
  • Consider your posture- is your chair comfortable, are your feet touching the floor, are you straining your wrists to type, 
  • Is the lighting good enough for you not to strain your eyes? 

These are all important aspects of reducing burnout and ensuring you can safely and comfortably complete your day-to-day tasks.


Communicate in different ways

Although it is difficult at the moment to not take part in some form of video conference, remember to take time to communicate in a variety of ways. 

  • If you find that you are struggling with your screen, maybe try taking a few phone calls instead or send a well crafted email. 
  • Most importantly however, if you can, take the opportunity to speak to people face to face. This could be family in your social bubble or meeting friends outdoors.

When it comes to video conferencing and burnout, we think that the key ingredient is a balance. Remember to make things as comfortable for yourself as you can, but don’t be too hard on yourself if you need to take a break!


We wish you love, peace and joy this holiday season. Merry Christmas and Happy New Year.


Sad At Christmas? Help Is at Hand

Written by Aaron Gaur, Assistant Psychologist, The Oaktree Clinic

The holiday season can bring about lots of joy and fun for many people, it’s known as the time to be merry, mingle with family and spend time with closest of friends. However, for many people the holiday season can be a very sad time.

There are the multitude of demands that holiday season brings. Cooking the best meal of the year, pleasing family and friends with thoughtful presents, making the home sparkling clean for the \once a year’ relatives and all the planning that goes with it etc. etc. that can make the holiday season extremely challenging for so many people. However, the worst of all is everyone’s expectation that we ought to be outwardly jolly, sociable, looking forward to the festivities, irrespective of how we feel inwardly. The excessive eating and drinking, lack of sleep and every form of indulgence does not help in any way, Having said that though, It seems however that this is a better problem to have compared to those who have no one to share the festivities with.

Older people may end up feeling more isolated and lonelier as all those around them go about their business happily enough, similar to how people in hospitals, care homes, the army serving abroad or just stuck somewhere far from the family for any reason, would feel.

Have we considered people who may be at a financial disadvantage and may feel devastated during the holiday season with the societal pressures of having the ‘perfect holiday’ which entails all the expensive presents, food and wine, travel, brought about by the commercialisation of the holiday. Reasonably enough this can be overwhelming and is very present every holiday season.

The loneliness and isolation has multiplied several fold with the forced lockdowns and regulations, the general curtailing of ones liberty to socialise like before, with the rise of COVID-19.

The most worrying fact though is that this sadness can potentially escalate into a full-fledged depressive illness. Unfortunately, the prevalence of moderate to severe depression has increased three fold in the last 2 years.

The most important information to remember though is that THERE IS HOPE. Use the following strategies:

Structure your days

Put in place a number of things in advance that can help you during this time, here are some ideas:

    • Watch a film in the cinema
    • Volunteer- cooking for someone less fortunate, singing and entertaining those stuck in hospitals can be a rewarding experience and many more.
    • Make something- for those of us not the happiest in company and even the most ‘uncreative’, everyone is capable of this.  Maybe 5-minute crafts, knit, embroider, paint…
    • Visit neighbours
    • Bake
    • Go out for a cuppa with a friend

Exercise regularly

Exercise has been proven to help reduce symptoms of depression and sadness. Although difficult to stick to for many, the payoff is worth it.

Relax, Meditate, Put your feet up

Finding time for yourself to relax and do the things you love is extremely important during the holiday season. Especially if you are planning a lot of festivities and gatherings, leave some time out for relaxing and reflecting over the year gone past, look after yourself. Learning to take a break and enjoy ourselves is not a priority for many of us but it ought to be. This can really help reduce symptoms of sadness and stress.


It is easy to get lost in our own world and f
orget that all important keeping in touch with old friends. Maybe find the time to write to or ring or even text an old friend, especially if feeling alone.

Communicating with oneself can be equally important, consider putting down your feelings and thoughts on paper. Processing these feelings and letting them out in a healthy way is a very effective tool that can help overcome sadness and helplessness.

It is true that loneliness is hard at any other time of life, but being alone and sad at this time of the year can make you feel helpless, but its imperative that you bear in mind that there is hope and you can do something to help yourself.

However, if you feel utterly hopeless and your symptoms are escalating, then do seek professional help from your doctor or book an appointment with our clinicians.

Contact Oaktree Connect team on 0121 3140330 or email

Mental Health Talk

Business Spending on Mental Health, Worth it?

Business Spending on Mental Health, Worth it?


Author: Dr Meetu Singh, General Adult Psychiatrist


As a business owner, when it comes to envisioning a new venture sustainability and success, mental health and emotional wellness is not often even considered at the outset, much less focused upon.  In this article, hope is to inform on how and why it ought to be.

Primarily, an understanding of the scale of the problem must be known and understood:

  • In 2020– a staggering 79% employees experience work-related stress, compared to 59% in 2018. (1)
  • Around 15% of people at work have symptoms of an existing mental health condition, at any given time. (2)
  • Annually, up to 300,000 people with mental health problems lose their jobs. (3)
  • Annual Cost to UK businesses due to mental illness is between £33 billion- £42 billion, due to staff turnover, sickness absences and presenteeism, latter defined as, “when individuals are less productive due to poor mental health in work.”
  • Every £1 spent on mental health of employees returns £5. (4)

It can therefore be stated with some confidence that it makes ethical sense that employers shoulder some responsibility of taking care of their workforce. The next question that comes up is, is a considered approach towards mental health and wellbeing required by law?

Employers have a ‘duty of care’. to do all they reasonably can to support employees’ health, safety and wellbeing. This includes, making sure the working environment is safe, protecting staff from discrimination, carrying out risk assessments to ensure they can dispose of their duties safely and effectively. (5)

What are the financial implications?

Do measures taken by businesses to improve mental health and wellness make business sense? On exploring the current research evidence, the following comes to light:

  • Better mental health support in the workplace can save UK businesses up to £8 billion per year. (6)
  • In another large study within a company with 500 employees, promoting wellbeing at work through personalised information and advice, a risk-assessment questionnaire, seminars, workshops and web-based materials will cost approximately £80/ employee/ year, therefore for all the employees to undergo the intervention, an initial investment of £40,000 will result in a net return of £347,722 in savings, mainly due to reduced presenteeism (lost productivity that occurs due to an employee working while ill) and absenteeism (missing work due to ill health). (7)
  • Spending £30.90 per employee for assessment, and a further £240.00 for the use of CBT to manage the problem, on screening and care management for those living with (or at risk of) depression in a company of 500 employees where two thirds are offered and accept the treatment, an investment of £20,676 results in a net profit of approximately £83,278 over a two-year period. (8)
  • A study in Geneva, found that every €1 invested in occupational health and safety generates a return of €2.20. So, health and wellness schemes not only save money, but they also lead to increased profitability. (9)
  • Healthy workers build a positive brand image in terms of public relations, talent acquisition and employee retention, boosting the morale and loyalty of those in the company, therefore reducing recruitment costs.

What can businesses do?

Are you left wondering, well the world is a tough place, how can the employers help that? To the relief of 1/3rd of the workforce who suffer and live with mental health challenges, businesses can make a significant difference to the quality of life at work, safety and general wellbeing of the employees as demonstrated by the studies above. This is what caring businesses can achieve with a relatively small investment:

First Step:

Produce, implement and communicate a mental health at work plan with perhaps the following aspects

Provide Good Working Conditions 

  • Promote effective people management– A firm but gentle management style with empathy and understanding encouraged in the organisation, would go a long way in preventing work related stress. The work ought to be fairly and reasonably distributed in keeping with each person’s capabilities and pace. Bullying and harassment, a major cause of stress at the workplace, needs to be dealt with swiftly and appropriately.
  • Healthy physical environment at work is more important than people think, well lighted, airy, non-cluttered and aesthetically pleasing offices provide a healthy environment as proven by the “hit” designs of Google (USA), Missing Link (South Africa) offices.

A Culture of Openness about Mental Health & Wellbeing

A culture of wellness can be cultivated without a great deal of spend, Mental health ought to be a topic people discuss openly without the stigma of being labelled or discriminated against. Encourage open and honest conversations about mental health.

“Mental Health First Aid” 

Developing mental health awareness throughout the ranks. It must be understood that mental illness is just that, not weakness or something to be ashamed of, after all statistically speaking a third of the most successful people suffer from it.

  • Formal training- to be able to identify, bust the myths & learn the facts, how to support people with these issues is of paramount importance in this process.

Routine monitoring of employee mental health and wellbeing

Making monitoring of general mental health and wellbeing through open discussions with line managers, forums and questionnaires, will in the medium and long term be useful.

Workshops About Managing Stress and Anxiety

These can be valuable, regular grounding, mindfulness, relaxation and breathing exercises should and hopefully be deemed as important as physical exercise is to boost physical health. In the past, some of these practices have been branded part of the “hippie” movement, again time to change attitudes, right?


1.      The 2020 UK workplace stress survey, Perkbox

2.     Managing and supporting mental health at work: disclosure tools for managers, Dec. 2011

3.     Thriving at Work: a review of mental health and employers, An independent review of mental health and employers by Lord Dennis Stevenson and Paul Farmer, Nov. 2017

4.    Mental health and employers: refreshing the case for investment, Deloittes 

5.     Supporting mental health at work, ACAS

6.    Briefing 40: Removing Barriers. The facts about mental health and employmentSainsbury Centre for Mental Health. 2009

7.     Mental Health Promotion and Mental Illness Prevention: The Economic Case. Knapp, M., McDaid, D., & Parsonage, M. 2011

8.    Mental Health Promotion and Mental Illness Prevention: The Economic Case. Knapp, M., McDaid, D., & Parsonage, M. 2011

9.    Calculating the International Return on Prevention for Companies: Costs and Benefits of Investments in Occupational Safety and Health International Social Security Association (ISSA)

For information or formal consultation about effective Mental Health at Work Strategic Plan, Contact Dr Meetu Singh at Oaktree Connect on 0121 314 0330

Mental Health Talk Treatments

Informative Video About Fear & how to tackle isolation during COVID-19 Outbreak, Dr Francesca Mantia Conaty

Events Mental Health Talk

COVID-19: The Gift of Time

COVID-19: The Gift of Time


Author: Farzana Rashid, Assistant Psychologist


The current coronavirus pandemic has been frenetic and a scary time for all. At the Oaktree Clinic, we urge you to at stay home as suggested by the government. However, this period of time does not have to be all doom and gloom! For most of us, our day to day lives are very busy and we are always on the go. How many of us have thought ‘I don’t have time’?. If you find no positives in this situation, take this as one of them: you have been given the gift of time. In this post, read on for tips on how to fill your new-found time.


  • It can be very stressful constantly trying to stay up to date with the news and scrolling through social media. Therefore, it may be wise to take breaks from hearing about the pandemic so try to have a tech-free hour! In current times, we are so immersed by technology. Challenge yourself to try something new for an hour. 


  • Exercise is really important whilst we are trying to practice social distancing. Research shows that exercise has benefits for physical well-being as well as mental health. Exercise has been proven to help with decreasing symptoms of depression and anxiety through the release of endorphins. 


  • If you love learning and want to feel productive, stimulate your brain by taking an online course. There are many free online courses in a variety of subjects with just a google search, there is no doubt that something will spark your interest. 


  • Cook something new! Personally, this is something that I have been doing. I am not a great cook, but I have found cooking to be very therapeutic and it has helped me to feel productive. I recently and successfully made pizza from scratch and this has inspired me to explore more recipes. Let us know below if you have recently tried a new recipe!


  • Have you been meaning to unwind but until now you haven’t been able to? This is the perfect time to have a movie marathon. Let us know your favourite movies below.


  • Stay in touch with loved ones. Is there a friend who you haven’t spoken to in a while? Why not call, text or video call them? This is a perfect time to reconnect or strengthen social bonds with those who are dearest to us. 


  • Structure your day. Time can seem never ending as there is so much of it at the moment. It can be good for your mental health if you like to have structure and stability. Chunk your time into work and social time to make sure your day is well rounded. 

Self-isolation, although tough it doesn’t have to be boring and unproductive. If the above activities are something you have been doing recently, let us know in the comments as we would love to hear from you. Alternatively, if you have further suggestions, we would also love to hear from you too! For now, stay safe. Stay strong.

Farzana Rahim, Oaktree Clinic Administrator

Mental Health Talk

Burnout at Work, Dr Meetu Singh

Burnout at Work


Dr Meetu Singh, Consultant Psychiatrist


You may be experiencing burnout if you have: –

  • Decrease in motivation at work
  • Reduction in energy levels, fatigue
  • Feelings of cynicism or reduced professionalism

Burnout can be managed and prevented using techniques like:

  • Establishing boundaries between your work, personal and social life: Setting specific times for you to be engaged with work and stop it from spilling into your personal and social life is the cardinal rule to prevent burnout.
  • Taking regular short breaks and more importantly moving is vital! This improves your focus on the important tasks and prevents mental fatigue.
  • Practicing Mindfulness: Self-awareness and being present here and now is a key component of understanding your emotions, thoughts and behaviours.
  • Try some breathing exercises such as breathing in for 4 seconds, holding for 7 seconds and then releasing for 8. This will help you especially when you feel overwhelmed.

However, sometimes no matter what you do the work-related stress or a mental disorder like depression and anxiety disorders that you have no control over may occur. In this case seeking professional help maybe the best step forward.

Contact The Oaktree Clinic for further information or assistance on 0121 314 0330


Mental Health Talk

Dear Mum: A Story by an Oaktree Patient with Depression


Dear Mum


By A Patient


Through persistent denial of the looming, black – bellied thunderhead of his shadow, she had tried to keep still – as still and as quiet as a bunny in a bush – for one move, one rustle, one hitched breath and he’d see her. She didn’t want to look at him. she knew she shouldn’t through years of learning that one look was enough – Calypso Barbie when they first met ‘Hello, Penelope, my name is depression…did Santa bring you lots of nice things today?’ A blood stain on her summer dress, the sixth form exit button, Lady McBeth, gin. And now, famished through the weight gain, through the medication, through the doctors – and a cauliflower for dinner. ‘Why, Penelope, you know we really shouldn’t keep meeting like this.’ She stared down at that pathetic cauliflower before her and felt her foot slip, the brambles in the bush snapped and seemed to cackle, she caught her wrist on a thorn and everything that she had been hiding from billowed in the air and fell upon her like a 50-mile-wide, black parachute. ‘What’s the matter? Are you not enjoying your cauliflower?’ Through time and familiar sights and smells one can sometimes run – but where is there to go when the innocuous cauliflower is no longer just a cauliflower and ‘produce’ turns ‘trigger.’

‘No, I’m not.’

‘Well now,’ he said. She felt a familiar hand rest lightly upon her shoulder as he bent down and whispered in her ear with that intoxicating purr she both missed and loathed ‘what a pity.’

Dear mum,

Please forgive me, please don’t blame yourself, I know you may not understand, and this is selfish…


In placing a heavy chess board between herself and her mother, chequered with life and death (was her mother white or black? Is death white or is death black?) he once again accompanied her to therapy and split a gut it at the comedy. ‘TRIGGERS,’ he bellowed, clutching his stomach, ‘why this fellow should do stand up.’ He went with her on long walks ‘gosh, isn’t nature ugly. Look at that fat ox over there, trying to better himself.’ He sat with her when she tried to read ‘I wrote this book, you know,’ he said, leaning over her shoulder. ‘Silvia Plath, pure plagiarist.’ He kicked things about her room when she tried to tidy, he sprinkled soiled cat litter on her food, he tucked her in at night and kissed her forehead, he stroked her hair in the mornings. she lay with him, lovingly cradled in the crook of his arm. He listened to her, he smoked cigars and watched her from across the room. ‘You will always be someone to me, Penelope.’

Dear mum,

I don’t want to ruin your life and hate that you might not now ever have a merry Christmas or that you’ll forever live in dread of my birthday – a day in remembrance of a life given and then thrown away. But I hope that you will come to see, in time, that all the other days are actually all the better. You’re a great mum…  


Picked up by the nerve strings, the pickup – or rather the drag down – is merely preliminary and he rarely bothers with it himself. In his tricky subterfuge, he recruits his cabinet to break her so he can play the hero.

First, there comes the woman, with her taunting beauty and her words spoken so sweetly – a vacuum in and of themselves – with a sinister distractedness, she prods at the flaws on Penelope’s face ‘Did Satan spit you out? You’re just so ugly’. The ever-self-destructive profligate, stinking of vodka and poking Penelope with a gnawed toothbrush ‘you’re hungry. Here, you can take it out again afterwards.’ The fearless musketeer and his watchful python ‘what’s the matter, Penelope…why…I think you’re having a heart attack…you’re choking…you…can’t…breathe.’ The hag of the haunted house ‘do you remember…do you remember…do you remember?’ The petulant child, ‘that therapist is a hateful brute!’ And the old man and his wild and frenzied raven, who give her sticky thoughts – thoughts that stick to everything, so that she can blindly appreciate nothing. They make her teeter and question, gulp sulphuric puss in wondering – am I? Should I? Will I? Did they? Is that true? With each one of them a kettle weight, the descent is perpetuated by a heavy thought process, until he catches her like a dark prince and the mind begins to melt as if doused in acid, seeping through the eyes – I’m not crying, my mind is melting – into a world of ‘HE.’

HE is the solitude of a dripping tap, the mould eating the plaster, the cockroaches, the infestation. He is the old man weeping in a broken chair – his mind melting. HE is the girl who opens her legs and immediately feels need to apologise – her mind melting. HE is the waste that chokes the seahorse and dirties the plumage of the noble swan, HE is the bullet that fells the proud stag, the warm needle in the shivering vein. It is HE, who suckles the breast of every man, girl and abandoned child as the mosquito does blood, who has made her face no longer a face – her eyes do not tear, her eyes her mother will no longer meet, her eyes now the red of picked-at sores. Each organ slows to its final pulsing beat – from tissue to turning leaf and she will soon to be dust.

Dear mum,

I’m frightened…I’m frightened of it and I’m frightened of the battle, the Same battle I must keep fighting as his numbers grow while mine diminish. Will I ever be able to turn my back? It is said that Abraham Lincoln used to storm through the woods with a shotgun in his hand on every successive assault…


Two weeks have now passed, and he comes to show her what her life is. She sees herself lying on the bed asleep, or awake dreaming, lying amongst his allies who will never leave her to ensure that she will never leave him. She sees the old hag tormenting the mouse that was her rationality. She sees the fluttering faun, once her feather of happiness, chained to her self-destruction and covered in cigarette burns. Her beautiful insecurity blows a kiss at the squawking raven as the beloved pet of her fear is snaked around the chandelier and watches her sleep with eyes meaner than cat piss. Linen in anarchy and waste scattered like blasted brick, are swathed beneath the hovering wraiths of her dreams. Above they twirl and float as the ballerina floats – but their skin has now taken the form of their bones and the residual, oscillating ribbons of putrid hope left to rot, smell of sewage and nicotine.

He scoffed in the face of dreams. ‘Dreams,’ he’d say, ‘dreams are like lily pads for the croaking toad. But one must plop back into the pond to sustain oneself and SNAP comes the cunning water snake. It is better to learn to hide than to fool oneself and forget what is lurking.’  So, she let them die. Dreams die a slow death, and they let one know it for the lingering stench.

Dear mum,

I do not feel like a person because I am so afraid of people. Does a zebra fear the zebra as it does a lion? Why is it that when I look at a person’s face, they seem less human to me? Why is it that a woman is ugly when she whispers but a man is oh so beautiful? Men do not whisper to me… I left the reading and the man thanked me for coming. If he hadn’t thanked me for coming, I’d have said ‘he hates me.’ But he did thank me for coming and so I say, ‘he hates me.’ I was in a lift with a boy, when we got to his floor, he walked out too fast. Do you understand, mum?  Does this help…a little. 


‘So,’ he says. He stands behind her with his hand on her shoulder. The slick black of his cane slices through the periphery of her vison. ‘How are we doing on the food front?’

‘Good. I’m on two weeks.’

‘Not a morsel?’

‘No, nothing.’

‘And your mum?’

‘Great, said I look thinner every day.’

‘Good,’ His voice is warm with stoic pride as he gives her shoulder a gentle squeeze. ‘You’ve done very well – if you’re sure this is how you want to go about things. There are…easier ways.’

‘I know,’ she answers and swallows down the modicum of doubt once again blossoming, as persistent as the dandelion, in her throat and chest and stomach. ‘But I’m a coward and I don’t want to hurt anyone. I don’t want her to…find me, and I can’t get the note right. Its better this way.’

‘Very well,’ Let’s be off then.’


The gym is empty, there’s no one there, no merciless humming of machines, no jousted joints. He leans languidly against the treadmill and adjusts the speed every two minutes, until she’s on 6mph and can feel her feet and trainers infuse into one static mass – it crawls upwards, ankles now frighteningly numb, then the knees begin to lose pressure. ‘I hate it here,’ he scoffs. Disgust etched on his face with a hard grimace, he observes the room from beneath the velvet rim of his top hat as if afraid to expose his eyes to the pungency. ‘The place REEKS of endorphins.’

‘Endorphins are good for people.’

‘Endorphins are a lie!’ He snaps and fixes her with a hard, penetrating stare that seems to manifest as a ringworm in her gut. ‘You feeling anything yet? Chest pains?’

‘I feel sick.’

‘Right stop!’ He slams his hand down on the stop button and yanks her backwards by her elbow. His grasp is hard and violent, and yet his face remains impassive as he drags her weak and stumbling to the door.

‘Why did you stop me?’

‘Because,’ turning to face her and cocking his head in mock perplexity which makes her shiver, ‘you’re going to faint, and a fainting spell will only work against us. On to the next.’


He takes her to the city centre, his cane tap…tap…taps against the cobbles – it sounds like the beating of a rusty heart – where they sit by the fountain and the ice-cold marble travels up her spine, from arse to aorta. ‘You’ll get piles,’ her aunty Beth used to say. The bottom of the sleeping fountain is peppered with coins, clutching the dedicate little wishes of children. In the daytime they glimmer and twinkle like rebellious stars, but in the dark they lie in the murky water dead and dirty and useless. There are no stars in the sky tonight. Drunks stumble about beneath, laughing coarsely like syphilis infested libertines. ‘Well now,’ he says, ‘If your heart won’t do the dirty work, perhaps someone else’s will. Now, make yourself look vulnerable.’ He straightens her back and overbearingly lifts her chin with his fingers.

‘In case you haven’t noticed, I am vulnerable.’

‘No, you’re too hard in the face.’ Leaning in close, he winks with the dark luminosity of an onyx and murmurs behind a wayward grin: ‘Sweet little girls are much more fun to strangle.’

Dear mum,

I know I shouldn’t do this, I don’t want to hurt you. I tried, I promise I really tried but I can see nothing and feel everything while empty and the still silence thunders and I can’t catch my breath while I sleep. The man sits there, before the girl without a gun to her head so he’ll just talk to fill the time. There is wanting to die and then there is dying – is there? The man sits there, before a withering mess who wants to die but is not dead and is therefore, as he declares, contradicting herself. Then he leans back in his chair oh so pleased with himself for isn’t he clever – check mate. I am contradicting myself? Of course, I’m contradicting myself! By definition, the suicidal mind is a contradictory mind. A mind that has found a way to deny the very nature of its being, the most primitive and potent instinct engrained into us since the beginning of man – self-preservation, survival. So yes, well done, alert Sweden, I AM contradicting myself. I am choking on my contradictions. For example, do you know how frightening it is to feel nothing… 


So, she tries to smile and cross her legs like some languorous starlet or the silk-clad concubine. She tries translucence, amiability, panting puppy, sex kitten, lucid and gagging for it, pissed and pleasantly puzzled – but, despite her best efforts, she remains unnoticed. In an indolent oblivion they move past and around her as merely blurred outlines and they can no more see her than she can see them. ‘Unfortunately,’ he declares, to her relief, ‘I don’t think you are going to get anything out of this lot. Nothing but horny little boys, Eros without an aim for his arrow and abandoned old dogs! Not a psycho in sight, the bold-eyed slatterns. Don’t worry,’ he adds, slipping his hand into hers, their fingers entwine like slithering smoke, ‘you will always be beautiful to me, Penelope.’


They arrive back at Penelope’s house and walk up the back stairs. ‘Penelope,’ he says suddenly, breaking the silence. His voice is quiet and serious, equal parts assertion and interest. ‘How do you feel about South Africa?’

‘Why?’ She answers. She is devastated and baffled to need to use the bathroom – why is her body still working. She looks down at her shoes, they shrivel with every step to the tiny toes of a toddler. These shoes don’t know where they are going, she thinks.

‘Well, you know…sharks have an excellent success rate…. SLOBS!’ They find Penelope’s room still and quiet, permeated only by the occasional, tepid murmurings of a room asleep. Even the Raven, usually blabbering on with the hardy vigilance of a tomcat, was snoozing upon the old man’s shoulder.  ‘Slobs,’ Depression reiterates through gritted teeth, ‘Don’t I do enough! Oh, Penelope, why so glum? We can try again tomorrow.’

‘How about you just go away,’ she answers. She sits down on the edge of her bed. Her eyes, limp and painfully hooded, are blunted with the inertia of being open.

‘Why would you want that? I mean, look at all these wonderful books I have allowed you to keep – have I not been very good to you?’ He wanders over to the book shelf and begins picking them out one by one: ‘wrote this one,’ flings it over his shoulder, ‘oh, and this one too…and this one…why, you’ve got some of my best works here. Ahhh, ‘No Longer Human,’ I must say Dazai was a pleasure to work with.’

‘Don’t say that,’ she snaps. In that moment he sickens her. His callousness sickens her. His unabashed vulgarity starts to fill her with a formidable revulsion that begins to steam through her body – until, eventually, it groans and starts to clatter and clang against its russet tracks, breaking down somewhere around her left leg.

‘Oh, and why ever not?’

‘Because…he… killed himself.’

‘I know,’ he says, half turning, still with Dazai’s book in his hand, and throwing her that salacious wink she could neither resit nor bare to look at.

‘Well, it’s in very poor taste, even for you.’

‘Poor taste? What other option was there? Of course, there’s always therapy,’ he wretches and spits the word out as if coughing up phlegm. ‘But does the artist live longer through the latter?’

‘It depends on how you look at it…’

‘It depends on nothing. Therapy aims to untangle the web, but without its web, how will the spider eat? Intriguing little creature, the spider. Most will see one, scream in revulsion and pounce to a nearby perch. They wait for it to scurry away and yet… they can never quite stop staring at it. No web, no spider – imagine that. Look at him over there, with his slippery snake – can you imagine a world without him? A world without fear?’

Dear Mum,

I can’t see anymore. I have two friends – one is a god to me and the other makes me laugh – but I can’t see anymore.

‘Can you imagine a world without crippling insecurity, pain and bladesmith memories that sharpen their knives upon the bone?’

Dear Mum,

I love you…

‘No planned, well devised, bordering meticulous schemes to destroy oneself…’


Dear Mum,

I hate you…

‘…no questions, no answers, rose petals in the place of blood?’

Dear Mum,

I’m sorry…

‘A world without…ME?’

Dear Mum,

I love you…

‘Do you think it would be a better place?’

‘So, we should all just be…miserable. For the sake of the so-called spider?’

He approaches and crouches down before her – his long fingers entwine around the tip of his cane as his dark eyes gleam within the hollow shadows of his face. ‘It depends on how you look at it,’ he answers. There’s an undertone of mocking in the forlorn resonance of his words, in his voice coated in silk and sugar. With the tranquil stillness of a lily pond, he smiles the lazy, slow smile of a prince, of the insatiable wolf, of the devil courting.

They sit in silence for a while. She keeps her head down, he bores into her. She is thick, she is sloppy, she is a viscous blob of distilled meaning. ‘You want me to die…’ she whispers. She feels her throat tighten and close over the word die – that serrated, final word that can mean one of a million different things while thought, definition and meaning flap about inside her skull like bats with broken wings.

‘Do I? I don’t recall telling you to die. I recall you wanting to die and, as always, I have offered my unflinching support. But, don’t confuse things, Penelope. Death at the hands of oneself is the purest choice a person can make and, contrary to consensus, is totally detached from one’s afflictions. I am what you make of me.’

‘I hate you,’

‘No, you don’t.’ he calmly asserts. ‘I only want what is best for you. I want you to be who you are…’ he shoots his hand out and pinches her chin between his fingers. Locked in a struggle of submission and fear and a cloying need, their hard indent forces her eyes up to meet his ‘…and I am a part of who you are.’

Her self-destruction, draped across a chair and holding an empty bottle close to her chest as if it contains a love letter from captain Morgan himself, snores a resonating grumble from the depths of her gullet. Depression sneers over at her with searing contempt and with one giant swoop of his cane, bonks her on the head shouting: ‘GET UP! We’re leaving.’ Suddenly the room leaps awake with feigned alacrity as the insidious glitter in the eyes of his flock is replaced by an embarrassed submission that never fails to surprise Penelope – the fire breathing dragons now doe-eyed and wheezy.

‘Are you going?’ She asks.

‘Must I’m afraid, got a meeting with a chap in canary Warf – you know, there’s nothing like the newly bankrupt to keep me feeling young.’


‘I’ll be back tomorrow,’ he coos and smiles down at her – it’s a warm smile, a tender smile, but a smile written in cypher that speaks of the interspersing paradox hidden beneath. ‘You will always be special to me, Penelope.’

After he leaves, she sits listening for the tender tweeting of a wagtail outside her window, the one she sees every morning – it probably isn’t the same one every morning, but she likes to believe it is – and has named James Brown for its funny little wiggle. But delicate little birds are not accustomed to singing in the dark and are often replaced by the lonesome cawing of a distant fox. Delicate little birds that can shit on the head of an unsuspecting child, replaced by the ruthless fox, howling like a banshee, that was also the charming and irreverent Basil Brush from her childhood and teacher to the lost little prince.


Dear Mum,

 I suppose things are not always what they seem and the things we see are like clouds in the sky, lured by shifting currents of air. The trees are bare. They have given the last of their bounty to the earth and remind me of emaciated orphans, naked and waiting. I can’t see the clouds, but I know they are there for the sky is black – thick and heavy, its velvet veil seems so impenetrable even the wind can’t billow its weight. I don’t think I’ll ever see through that sky. But then, as I sit in quiet submission to the vast desolation above and the good in me labours to breathe, suddenly the sky reveals an imperfection. Blown by a distant wind like the metamorphosing wind that pursues the caterpillar – that thick, imposing curtain becomes merely a gossamer wisp of smoke, unfurling before a lone star- or is it Venus? Was it always there? I’m not sure, it doesn’t matter I suppose, it’s there regardless. Perhaps if I hadn’t looked closely at the sky just now, I wouldn’t have noticed it at all- a hopeful wink amidst the waves of shifting darkness – there… incomparable… merely waiting for a wind to shine its shoes.


A Patient has been having treatment with us at Oaktree and written an account of her experience.  She would like to be a published writer and has agreed to share her story with us.  The sketch is also by the Patient. [Note: Patient’s name has been edited due to privacy.]