BILL LEAK, CARTOONIST: I would be terrified of standing in front of mirrors, especially during my adolescent time, because I'd stand in front of the mirror and suddenly I wouldn't recognise the person in the mirror. I thought, "Who is that?" And I'd think, "Now, look, logically, I know that that's a reflection of me, I am that person," but I wouldn't know who that person was.

JANINE COHEN, REPORTER: Cartoonist Bill Leak has had depression all his life. But he's not alone. One in five Australians will get depression.

DR IAN CHUNG, BILL LEAK'S DOCTOR: Our society, unfortunately, still has these strange ideas about depression - that weak people get depressed. If weak people get depressed, then why did Winston Churchill get depressed? Why did Abraham Lincoln get depressed? Why did Charles Darwin get depressed?

JANINE COHEN: Depression, dubbed "the black dog" by Winston Churchill, is one of the biggest medical problems facing the world today.

KEN NIELSEN, MANIC DEPRESSIVE: When I woke up early in the morning, when things were at their blackest, I would often think of death, sometimes wish that I hadn't woken up in the morning. I'd say to Liz, "I'm... When I wake up in the morning, I feel I'm in a hole. I'm in a deep hole and I've got to try and climb out of it."

JANINE COHEN: More than ten million prescriptions for antidepressants were written last year in Australia.


KATE O'CONNOR, ARTIST, DESIGNER: There is definitely a great life out there to be had and I just would hate for any people that have been...or any individuals that have been diagnosed with this particular condition, to feel as though it was the end. I have a great life. I'm really happy and, you know, definitely there's bad days and all of that sort of stuff, but there's great ones too.

JANINE COHEN: Hundreds of thousands of Australians live with depression. It's a disease that has many variations. Tonight on Four Corners we see how some people not only manage to survive but to beat the black dog.


SUE O'CONNOR, KATE'S MOTHER: Kate was the second in a family of four and the only girl. She was always vivacious and bright. She was good at sport - very, very good runner - and she loved drawing.

FELICITY DWYER, KATE O'CONNOR'S FRIEND: Kate's background is quite similar to mine - middle class. She went to a private school, grew up in Mosman, quite, you know, a privileged upbringing. Dad's a judge, and her mum, although didn't really work when we were younger, but was a councillor in Mosman.

Kate and I met when I first started at Loreto. We were about ten years old. I remember, we were really young, but being instantly attracted to Kate. She's one of those girls who was always a real all-rounder. She was really good at school, obviously very talented at art, great at sports, really popular, and funny, really funny.

One of the reasons why I love Kate...because she's just...she's just...she lights up the room when she walks into the room.

JANINE COHEN: Kate O'Connor had it all. After excelling in her Higher School Certificate, her future looked like the rest of her life had been - full of promise and reward. Then six months into university, things started to go terribly wrong.

SUE O'CONNOR: Kate came home from a skiing holiday in her first year at university - she was 18 and a half - and she was behaving very strangely.

FELICITY DWYER: I just thought that she was becoming a bit moody. She was also becoming a bit more eccentric in the way that she dressed and the...sort of the things that she said.

KATE O'CONNOR: I'd noticed towards the end of the ski trip that things started to look and even feel really different. I hadn't really slept much on the ski trip and was finding it really difficult to sleep.

SUE O'CONNOR: The mood swings became so erratic that week that she was...could be friendly one minute and magnificently groomed, which was most unusual for a university student - and her particular style anyway - to a screaming charlatan with language you couldn' wouldn't find in some of the worst streets in the world.

FELICITY DWYER: We had a university party and Kate and I ended up having a fight, which was really quite unusual for us. Like, we've been friends for nearly 20 years now and we don't have the sort of friendship where we fight. I was really scared because, you know, I was petrified about losing my best friend and know, wasn't quite sure about what the future held.

JANINE COHEN: What Sue O'Connor found that night in the gutter outside their family home petrified her too.

SUE O'CONNOR: It was a freezing August night and it was three in the morning and she was, um...obviously, you'd have to say almost, raving.

KATE O'CONNOR: It was almost like I was talking in tongues to a degree but I was actually, you know, sprouting words, passages from the Bible and really felt like I mission was being interrupted.

SUE O'CONNOR: I was the enemy, and she lashed out. And no, she didn't want to come in. And it was screaming and yelling and telling me to whatever - you know, "You fucking bitch," and "Get out."

DAVID O'CONNOR, KATE'S BROTHER: I was lying in bed. I just wasn't sure what was happening. So I was a bit...I was more upset because of Mum and Dad becoming upset.

SUE O'CONNOR: And it was terrifying, absolutely terrifying - freezing on the outside and like a rod of ice put through you, because I felt I... (Sighs) ..I have to do something. What do you do?

JANINE COHEN: Kate's father forced her into a car. He was taking her to the Royal North Shore Hospital in Sydney but at a set of lights she jumped out and escaped. Later, her mother drove to the hospital, only to find that her daughter and husband had never arrived.

SUE O'CONNOR: We came across a scene outside Cremorne Junction, which is the area in which we were coming from, and there was an ambulance and a police car.

JANINE COHEN: Kate by now was completely psychotic and refusing to cooperate. After being threatened with a straitjacket, she gave in and was taken by ambulance to the Royal North Shore Hospital. The next day, she was scheduled involuntarily into a psychiatric hospital, where she remained for nine weeks.

KATE O'CONNOR: In any moments of what I thought, I guess, was lucidity, I...I definitely didn't think I should've have been there. I was definitely always thinking about some plan of escape, some plan of getting out. It was a conspiracy, that I had this special information and that I was obviously a threat to the government and the system and I knew way too much, and, you know... Just shut me up.

FELICITY DWYER: She always used to say, "Where's the car? Have you got the car? Is it outside? Come on, let's go." And I would seriously contemplate how I could get her past the guards and past the security to get her into the car and we'd go up the coast and everything would be fine. Because I just thought, "My friend doesn't belong in this place. This is horrible."

JANINE COHEN: Kate O'Connor was eventually diagnosed with bipolar disorder, or manic depression as it used to be known. Hers was one of the most extreme forms of the condition - dominated by manic and delusional highs, then followed by crashing lows. Depression is one of the most debilitating aspects of this disorder.

The news was shattering for Sue O'Connor, whose own mother was bipolar. It's a disease that can be up to 70 per cent genetic. Episodes can often start with psychotic behaviour. Sue felt guilty for passing on the gene to her only daughter.

SUE O'CONNOR: I think I've dealt with that. I felt that it was my fault, I had passed this on. And, yes, I have. But, heavens, my mother had had it passed onto her.

Kate got that gene. She also got a bunch of really good genes.

KATE O'CONNOR: I was depressed and I was still in hospital. Then I came out and I was, like, "Oh, what was that all about?" And I still...I think, you know, definitely, in retrospect, was not convinced deep down that I had a real condition.

JANINE COHEN: For five years after that first devastating episode, Kate was well and life continued as it had been. She started painting and finished university, qualifying in design and visual communications. She convinced herself she did not have bipolar disorder and would never have to return to hospital. Then one morning, she started to feel invincible. Her creativity knew no bounds. 48 hours later, she was on a mission.

KATE O'CONNOR: I would never have said that I was God, or necessarily was the Virgin Mary as such. I'm just very closely linked to...being on a mission for God, maybe one know, maybe I was John. Maybe I was...I was one know, John the Baptist.

JANINE COHEN: Kate was scheduled once again into a psychiatric hospital. She hated being there and thought it was all a conspiracy. She escaped three times by climbing over the fence.

FELICITY DWYER: We'd heard that there were sightings of her down at the docks in Balmain, and so we spent, I don't know, the whole day driving around.

KATE O'CONNOR: I'd been in Balmain and I'd walked down to the shores at, I guess, it's Rozelle Bay or just there, and had gone asking if someone could just take me on a boat out of the country. I mean, most of them just had fishing boats, so I don't really know how we would've gone. I didn't want to go home, get my passport and fly overseas because I knew there'd be someone waiting for me.

SUE O'CONNOR: She'd jumped in the harbour and had been swimming. So I have no idea why, what was going through her head, but she was cold and wet so she got in his truck and fell asleep. When he found her, she wouldn't say who she was or where she belonged, but eventually he must have been able to get my phone number from her.

JANINE COHEN: By the time Sue O'Connor arrived, Kate was gone. Hours later, dishevelled and disoriented, Kate knocked on a stranger's door. They took her to hospital after she complained of having a microchip implanted in her brain.

FELICITY DWYER: We arrived soon after and she was still thinking that she had the chip in the brain but somehow it had come from the brain onto her finger. And I think she had a heart monitor on her finger, so when you spoke to her, she wouldn't speak to you, she'd speak through the finger, so would go, "Hello, how are you?" That sort of thing. Which was quite bizarre.

KATE O'CONNOR: I thought that was a device in which I could speak to them. So I had a lot of people entertained. I'd just be..."Guys!" "Turn it down." Yeah, it was pretty funny. Flick and David saw the whole thing. They're going, "Do you remember the finger?"

JANINE COHEN: Kate O'Connor continued to fight the diagnosis of bipolar disorder and over the next two years had three more psychotic episodes. One was on the Greek island of Santorini.

DAVID O'CONNOR: One thing common with the episodes is you think you're invincible and can spend as much as you want. And she started spending, and more partying and less sleeping, which lead to a bomb ready to explode.

JANINE COHEN: After the last episode, Kate went through another crushing period of depression. By now she'd had five major psychotic episodes. It had interfered with her life, her career and her relationships.



KATE O'CONNOR: It's just amazing, how we just kept up the stamina on that holiday.

JANINE COHEN: One of the constants throughout her illness has been her best friend Felicity.

FELICITY DWYER: Don't worry. I'm not going anywhere.


FELICITY DWYER: She's like my sister. She's not my friend anymore. She's my family. She's... I need her as much as she needs me, I think, so it's... I can't put it into words how much she means to me. She's been such an amazing friend for so many years now. I can't even imagine my life without her, so...

JANINE COHEN: Has the friendship ever been too much of a burden?

FELICITY DWYER: Never. No. No way.


MAN: It's a lot more colour than what we've used before, which is a little more graphic.

KATE O'CONNOR: Yep. Great. OK, did you want to go over some of the other stuff?

MAN: Yeah, for sure.

JANINE COHEN: In the last two years, Kate has turned her life around. She's had an exhibition of her paintings and started her own very successful design business.

KATE O'CONNOR: Thinking, like, the civic pin-up woman. She's got a tattoo here of the gramophone.

JANINE COHEN: And she has finally has accepted her diagnosis of bipolar disorder and changed her life to deal with it. She also regularly sees a psychiatrist.

DR RALF ILCHEF, KATE O'CONNOR'S PSYCHIATRIST: I think the two mistakes that people with bipolar disorder can make are either to completely ignore it and say, "That was just a situational thing, it'll never happen again," or to just take it incredibly seriously and let it absolutely dominate their lives. Kate, I think, runs a fine balance. She doesn't do either of those things. She's very respectful of her illness and I think she's very keen to make sure it has as little impact as possible. Over the last year or two, I think she's made enormous advances.

KATE O'CONNOR: I've learnt through my journey with this particular basically to have respect for the condition, and that is something that is always going to help me manage it, basically, by being aware of it and, you know, basically giving it respect, which sort of means being aware of my limitations.

JANINE COHEN: Kate O'Connor decided a year ago to come off all her medications, including the antipsychotics and mood stabilisers.

DR RALF ILCHEF: They're all medications that are hard work to take. Generally, they can cause sedation, they can cause slowed mentation, they can cause weight gain - lots of things a young, active person doesn't want to have. And for Kate, particularly, these were incredibly burdensome. I think there are certain circumstances in which it is reasonable for a patient with bipolar disorder to have a trial off medication. Those circumstances would include being very well informed about the illness, being motivated, having a good relationship with her doctor or care provider and having very supportive family and friends, and Kate certainly has all those things.

JANINE COHEN: This approach is not one her psychiatrist would agree to for many people. Kate is a rare exception. There is a real risk that she could have another psychotic episode. Most doctors do not agree with stopping medication and advise people to consult them first. But Kate does have a strategy in place. Her family and some friends have her permission, if they see any early warning signs, to contact her doctor and she will be medicated.

KATE O'CONNOR: For me, it's a gamble either way because I've been on medication and gone back to hospital. So, yeah, there's always going to be a risk for me. It's something that I can never rule out of my future, that it will never happen again. I'd like to think it's something that can be managed out of hospital in the future. Um, more than likely, there will be another episode. Hopefully it won't be so bad.

DAVID O'CONNOR: I know I get a lot of inspiration from her because what she has to go through, just in her day-to-day life, you know, as opposed to everyone else. We can all go out and, you know, sleep as little as you want, drink when we want and do this and do that. She has a really good balance now.

FELICITY DWYER: What Kate has shown me over the years is that...although it is horrible to have a mental illness, it's not the end of the world. It doesn't mean the end of your life as you know it.

SUE O'CONNOR: I hope one day she finds a lovely partner who will support her and she her life as she would like. And I see great signs of that happening now. She has... She is blossoming. And long may it last.

JANINE COHEN: A lot's changed in the diagnosis and treatment of bipolar disorder and depression in the last two decades. No-one knows more than Meg Smith. She took part in this ABC documentary 20 years ago.


MEG SMITH, MANIC DEPRESSIVE, IN CLIP: The crazy psychotic part of me was telling me that, "God is putting you through some kind of test. You've got to ride your motorbike through red lights." Which of course I did. And a cop pulled me over. We had this strange conversation, saying, "Why is this young woman riding through red lights? She'll get herself killed."

MEG SMITH, ASSOCIATE PROFESSOR IN SOCIAL SCIENCES, TODAY: I think at the time that I was diagnosed, it was basically, "You've got manic-depressive illness." You know, "Expect to stay on this medication. But even then, we're not sure you won't end up with great chunks out of your life spent in a psychiatric hospital." I don't think that's the case anymore.

JANINE COHEN: Now an associate professor in social sciences at the University of Western Sydney, Meg is testimony to how you can manage your bipolar disorder and excel in life. She manages her condition by having a balanced life, healthy diet, taking vitamins and exercising. And on occasions when life becomes too stressful, Meg will take antidepressants.

MEG SMITH: Sometimes for me, I do want to see the world clearly and I'm prepared to experience the depression. But then, there's other times when...I want to preserve my relationships, I want to keep my job, I want to function in the world and I don't want to look at the world that clearly. I want to wear...well, not rose-coloured glasses, I suppose, but I want a buffer. And maybe the antidepressant drugs provide a bit of a buffer, um, sometimes.

JANINE COHEN: Meg Smith is president of the NSW Association for Mental Health and has started many support groups for people with depression and bipolar disorder. And the one thing she has learnt is that if you are poor and you live in the outer suburbs, your struggle with depression will be so much harder.

TABATHA WATKINS, CLEANER: Um, two weeks ago, I took an overdose and ended up at Liverpool Hospital. And I did that because I felt really unloved and I felt really, um...just frustrated and sick of myself, basically. And... Um... I just wanted to end it.

JANINE COHEN: Tabatha Watkins lives in Mount Druitt, one of the most disadvantaged outer suburbs of Sydney. She cleans buses for a living and her husband Phil is a bus driver. They have been married for five years, and in that time Tabatha has tried to kill herself as many as a dozen times. On one of those bad days recently, she filmed herself.

TABATHA WATKINS ON SELF-MADE VIDEO: You think of a day where you're really, really sad. Times that by 20. And that's what depression is. It's, um, really, really horrifying.

JANINE COHEN: Tabatha, 29, has chronic depression and borderline personality disorder, which her doctor believes manifested because of an unstable childhood. Her genetic history is unknown.

JANINE COHEN: How many suicide attempts have there been?

PHIL WATKINS, TABATHA'S HUSBAND: Quite a few. I couldn't count them now.

JANINE COHEN: What goes through your mind when you think about suicide?

TABATHA WATKINS: At the time? It just... You just don't want to be here. Just, you know... It's like everything's gone black. There's no colour. There's no happiness. There's nothing. Nothing. For me, there's been... At the time of feeling like that way, nothing can help me. I'm just sort of like out of control and it's just... You know, I'll just overdose.

JANINE COHEN: Phil's come home many times and found Tabatha has overdosed on her antidepressants. He's had to rush her to hospital. Now he keeps her drugs locked in a safe and gives them to her daily.

PHIL WATKINS: There's been a lot of times, like...coming home and thinking, "Is she alive today?" Thinking, "Is this actually going to be the day that that's it?" You never know with depression.

TABATHA WATKINS: Well, I was just, um, feeling just really lousy about myself and just, you know, thought, "Well, you know...I'm annoying to everybody because, you know, I...have these episodes and, you know..." I didn't want Phil to go through this anymore or anyone to go through this anymore that...that cares for me and watches me go through this.

JANINE COHEN: When you met Tabatha, did you know she had depression?

PHIL WATKINS: Uh, yeah, I did. She did tell me. OK? She said that this was... And I was pretty naive to it. And I thought, "Oh, yeah, this will be a pushover." (Laughs) Depression is not a pushover.

JANINE COHEN: When Tabatha is in the depths of her depression, she sometimes cuts herself with a knife.


TABATHA WATKINS: Well, I've done this to my arm back in February. And I was feeling really...just frustrated, frustrated with the depression and just frustrated that no-one really can understand what I'm going through. So I, um, just grabbed a knife and decided to just slash it. I didn't feel anything.

JANINE COHEN: Having a mental illness is expensive. If you are poor and you can't afford private health insurance, then often you can't afford non-drug therapies. And the public hospital system is not always accommodating. Tabatha and Phil have sat in emergency wards for many hours. One night they were sent home with just a Valium after a brief meeting with a psychiatrist. There were no beds available.

TABATHA WATKINS ON SELF-MADE VIDEO: I to see psychiatric hospitals become more available. Because it's really, really needed, um... And, you know, as I've said, it is very, very hard to get into psychiatric hospitals these days, and, um... But they should be widely available because there are so many people that are out there untreated. And left untreated is... is quite a scary thing.

PHIL WATKINS: They put more money into these cancer programs and I support that 100 per cent. Why can't we throw more money into this as well?

JANINE COHEN: What would your life be like if they found a cure for depression tomorrow?

PHIL WATKINS: Probably magic. (Laughs) It'd be like winning a million bucks.

JANINE COHEN: During the making of this program, Tabatha had another bout of suicidal thoughts and returned to the emergency department of a public hospital. She's also waited for four weeks to see a government-appointed psychologist. One of the things that can keep Tabatha from plunging into despair is her love of singing.


JANINE COHEN: What does the future hold for you and Tabatha?

PHIL WATKINS: That one, I don't think anyone knows.

JANINE COHEN: Are you optimistic?

PHIL WATKINS: Um... I honestly... I really don't know what's going...what our future is.

JANINE COHEN: Ken Nielsen wanted to kill himself too. But unlike Tabatha, he had the money and support to do something about his condition. The 63-year-old was diagnosed eight years ago with depression after a crippling episode that left him almost bedridden. This was despite the fact that the corporate high-flyer was successful, wealthy, had a loving family and a great marriage.

KEN NIELSEN: The strongest thought, in a way, is this feeling of uselessness. "I'm not worth anything. I haven't achieved anything very much." That nobody could care for me.

JANINE COHEN: Ken first started to have bouts of what he now knows was depression when he was in his 40s, but nothing like the episode that left him almost paralysed eight years ago. It turned out his depression was genetic. There was a strong family history. If you have a parent or a close relative with depression, you have as much as a 30 per cent chance of inheriting the disease.

JANINE COHEN: Ken said he had suicidal thoughts. Did you have any idea what was happening for him?

LIZ NIELSEN, KEN'S WIFE: I didn't realise it was that black.

JANINE COHEN: Why did you not act on those suicidal thoughts?

KEN NIELSEN: I realised how much it would hurt Liz and our daughters if I was to die.

JANINE COHEN: So life became that black?

KEN NIELSEN: Oh, yes, yes. Um, it was searching for an escape, anything to switch off, to escape the devils that were chasing me.

LIZ NIELSEN: I still find it very hard to think about because I couldn't imagine life without him, but, um, it's something that he had to deal with.

It's... It's probably the balance that is hard between when he needs me to take over because he can't cope and stepping back when, of course, he can cope beautifully, and far better than I can. So learning how to get out of the road is probably the hardest thing.

JANINE COHEN: After years of struggling, Ken Nielsen went to see a psychiatrist who prescribed him an antidepressant.

KEN NIELSEN: I take 40 milligrams of Citalopram each morning. That's a fairly straightforward antidepressant. Just something I do each morning after I clean my teeth.

JANINE COHEN: Citalopram belongs to a newer class of drugs known as Selective Serotonin Reuptake I
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