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A letter from Joanna

17 September 2019 - Dr Jan Orman

Recently I received a letter from a patient of mine.

Joanna is a 50 something woman who suffers from recurrent unipolar depression. She has given me her permission to share her letter with you.

“Dear Jan

Does anyone ever say to you that they wish they could just cut out the part of their brain that is causing them trouble? I’ve been tempted to say that from time to time – especially when the depression is very bad and the negative thoughts won’t leave me alone. I haven’t said it because I’m afraid you might think I am planning to harm myself and that is not so. I know better than to take the conversation down that path because it just uses up precious time.

You know, sometimes when I am really unhappy all I can think about is the bad of things. There is bad everywhere I look. The world is bad. The future is bad. Everything I do and say is bad and sometimes everything everybody else does and says is bad.

You have taught me things I need to do to combat those thoughts and I try very hard to do them but at times nothing works. I cannot engage with the positive at all. I try to run out the negativity and I try distracting myself from it in many ways. I talk to friends and I talk to you. It’s as though there is something missing from my brain.

Sometimes in the past I have been able to nip a bad patch in the bud before it takes hold, but I don’t always know it’s coming. I get SO angry with my husband if he says he thinks I am getting depressed again that he has stopped telling me. I’ve learnt that the anger itself is a sign that all is not well. Sometimes I can only see that I am unwell because of his reaction to the way I am treating him.

Sometimes I only know that I have been unwell when I start to get better. Once or twice I have had the experience of the world changing from grey scale to full colour before my eyes as recovery switches on.

One morning last week I woke up feeling odd. You already know that I’ve been struggling for months with the negativity. I haven’t been able to find joy in anything, even though good things have happened. It’s inexplicable. There is nothing wrong in my life or my world – nothing at all.

Despite that, every morning for months I have woken up with negative thoughts swirling in my mind. The thoughts have no specific content. The theme might be anything from personal inadequacy to world affairs, but they are always full of misery and hopelessness. On this particular morning I woke up and, before the thoughts had a chance to take hold, I smelt the coffee brewing and saw the sky was blue. It’s not much I know but it suddenly felt like a part of my brain that had been switched off had suddenly switched itself on again.

I’m actually OK now. The change has been sustained and I ‘m back to myself. It’s as though the part of my brain that runs the engine had been offline and is now back up and running again. I am able to see, and actually engage with, some of the aspects of life that had seemed totally gloomy for months. The joy that was totally out of reach is back.

Don’t worry, I can still see the negative side. Nuclear weapons, global warming and Mr Trump all still exist. But the engine that drives the positive side has spluttered into life for no good reason other than it was time to do so.

It does seem that when the depression strikes me the only thing to do (apart from all the good stuff that doesn’t always work) is to keep on keeping on and wait in the knowledge that it will get better eventually. To remember that the part of my brain that switches itself off will switch back on when its ready.

The challenge is to not do any damage to myself or the ones I love while I wait for it to come back online.

It seems its not about cutting a piece out of my brain to get rid of the negativity but about restarting the motor on the positive side so the bad doesn’t have it all its own way.



I learn a lot from the people who come to see me about problems with their physical and mental health. Much of what I have learnt I would not find in textbooks focusing on the medical model or any other model of health and disease. Its about individuals and their personal experience.

Joanna has a new view of her illness that finally makes sense to her. She is calmer and more able to cope with the downtimes. Her new understanding tells her that her depressions will pass and that all will eventually be well – even when she is feeling very low. Her positivity centre needs a regular reboot and she just needs to wait patiently and look after herself until it comes back online.

Our job might be to help people find the narrative that is the best fit for them.

Dr Jan Orman
Dr Jan Orman

Jan is Sydney GP, private psychological medicine practitioner in Sydney’s inner west and a GP educator for Black Dog Institute.

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