Personal views: Stars disappear
Authors: Diana Strange Khursandi
Journal: BMJ (1998)

Why do I write? Because my mother killed herself. Twenty five years ago, one sunny autumn afternoon my father was mowing the lawn. My mother went down to the dank cellar of their Georgian house. She looped a belt around her neck, tied the other end to a beam, and stepped off a chair. She was 60. Because mental illness remains an unmentionable topic. Because sharing my experience may give you some insight into depression—30% of you may have this disease. Because I am alive today due to her suicide. 

What happened to me? Twelve years ago, after a long crescendo of stress, I stopped singing and started to cry—at night, while driving, at work—in fact anywhere and any time when my brain was not actively engaged. My attention in theatre was not significantly affected, but I watched the patient and the monitors through a veil of tears. Few knew how I was feeling—I was very good at covering up. Pain took up residence in my chest, lodged stubbornly beneath my sternum, and stayed for three years: an overwhelming ache, a tight band, a pervasive feeling of doom. 

The evenings were the worst. I couldn’t sleep; I woke at 4am. The hideous circuits of pain were particularly distressing at night. I resorted to sleeping tablets very early in the illness. Without sleep I could not work; without work I had no hold on life, no direction, no future. The tears came more easily when I was tired. I took no joy in any former pleasures. My thoughts became obsessional; when not distracted, they snapped back to misery and loss. Frighteningly, I was no longer in control. I was at the bottom of a deep, dark, hole, with slippery sides. It was night. I could not see any stars. I was trapped, with no prospect of escape. 

Suicide was the only option: death would stop the pain. I considered methods. Anaesthetists can kill themselves easily. But that solution was not available to me. Residual insight and logic allowed me to realise that, having suffered, as an adult, from my mother’s death, I could not inflict that suffering on my teenage children. I cannot remember how I got through the next year—in a haze of tears and pain. As doctors you will have noted all the symptoms of depression. Friends and family were supportive, but neither they nor I recognised the symptoms. 

What did I do? I did nothing. The disease raged unrecognised. I rationalised that I was experiencing an exaggerated grief reaction to several major losses (the latest being the trigger in precipitating the illness that had been incubating all my life). In the enforced solitude of driving, I listened to music—the same music repeatedly. I played tapes at high volume, in the hope that pounding decibels would be a catharsis. I cried. I continued to work—it was a necessary anchor to stop complete breakdown. I was barely coping. I took each day as it came. The pain defeated constructive thought. I could see no way out. I wrote a journal—expressing my feelings fragmented the pain. I wrote poems. The discipline of choosing the right word concentrated my mind, despite perpetuating obsessional thoughts. After 15 months of tears and pain, I consulted my general practitioner, who referred me to a psychiatrist. 

Why did it happen? Despite the tragedy of my mother’s fate and a family history of depression, including another suicide, I never considered myself a candidate for depression. I was mistaken; I had misjudged my vulnerability. Could the cell poisons I inhaled over 20 years have catalysed the onset of depression? Or was it the result of years of stress, of chronic fatigue, of juggling onerous professional and domestic duties ? I do not know. Perhaps a combination of these factors uncovered the depressive tendency, but I suspect nature and nurture were more major influences in its development. 


What helped? Initially I had no idea how to obliterate the demons, and no energy to try. It was not until some years later that I was able to look back and analyse the elements in my recovery. I crystallised the factors into seven “Ts.” 


“I am enormously glad I did not kill myself”



Talking—Talking to friends and family. I would not have survived the first year of my illness without their support. I leaned heavily on dear friends, putting friendships at risk and losing one. Talking through stress and painful feelings is an essential part of the healing process. 

Tears—Crying was inescapable and seemed eternal. It was not until later that I realised the release the tears afforded. Crying is a recognised aspect of dealing with pain. 

Tom—It was a relief to have a paid listener—the psychiatrist. Professional help is essential in times of significant mental disturbance, for both diagnosis and treatment. We must allow ourselves to be patients. 

Tablets—I was on antidepressants for two years. I was a compliant patient. I wanted to get better—to get rid of the pain. I thought the tablets were not working, but I continued to swallow them. Drug treatment must be initiated only after professional consultation. 

Temazepam—Sleep was a relief from the pain in mind and body. I took no days off for the duration of the illness. I do not recommend such stoicism. Coping with mental illness is easier if sleep disturbance is corrected, but medication must not be self prescribed; sick leave must be taken when necessary. 

Therapy—For two years I talked and wept in sessions with the psychiatrist. Later I went to a psychologist, to gain some insight, to identify the stresses in my life, and to develop coping mechanisms. Psychotherapy is another essential ingredient of recovery. 

Time—Perhaps the most important in my recovery. This element is eliminated by suicide, which I now know is totally unacceptable. This unacceptability must be emphasised repeatedly. 

How long did it last? I thought I would never feel normal again. It took nearly four years before I felt back in control, and another three before I could look back on the experience with any degree of equanimity. Today’s “normal” is a different “normal.” Even now, if I hear the old music, or drive into the town where I felt worst, fleetingly but physically I feel the pain in the chest. 

How do I feel now? More vulnerable, yet paradoxically stronger. I am enormously glad I did not kill myself. Life is precious. I consciously appreciate the beauty of friendship and flowers, sunshine, and sky. I tell my dear ones I love them. I seize the day. I dread the thought of a recurrence, but now, with more insight, I will recognise it sooner, and push the black bear of despair off my shoulder again. I hope it will never come back.