Nell Casey

What effect did your sister's depression have on you personally?
Because I didn't understand how to ration my energy, I ended up with some emotional and physical complications afterward. I had terrible anxiety even when she was doing much better. My anxiety was feverish and high about everything. I had a huge amount of hypochondria. I lost a lot of weight. I thought I was dying because I couldn't gain weight. I remember saying to people 'I think I might be dying' and I was clearly thinking irrationally. I had horrible headaches for months. I threw myself into care giving so wholeheartedly. It took a long time to downshift. I was still revved and people would say 'But Maud's better, she seems so well.' My mother had a more realistic expectation, having gone through it the first time.

Also, Maud's depression didn't seem that far away from where I might go. At times Maud had me convinced that we were all suffering from mood disorders. Even in her delusions, the leap from me to her didn't seem that far. I didn't worry that I would suddenly develop manic depression, but I did worry about my mental health because my anxiety was so high. In trying to imagine what she was going through, it became too easy to feel my mind not being able to hold on.

What motivated you to create your book, Unholy Ghost?
Initially it was from the personal experience of dealing with Maud's illness. The book was a home for us to express and write about Maud's experience. Then, the book grew to include many other writers' experiences with depression. I find the questions surrounding depression and mania so relevant and powerful. The vulnerability, loneliness, isolation, and worry are issues that everyone can understand.

What advice do you have for families?
It is really critical to have a tag team of care giving in the family. You need to understand how to ration your energy, although it's hard to do because you don't know how long the situation will last. You need to be supportive of each other.

Know that you are being helpful to a depressed family member even when it seems like you're not. I was surprised to hear Maud say that it was important to have the consistent stubborn support of family there all the time. There were so many moments when I thought that I was not getting through to her.

Also, realize that there are so many aspects of getting better and one of them is that the depressed person has to decide to get better. Maud made the decision to pull her life together and leave some of her support systems. There has to be a decision by the person with depression to get better, among other factors, such as medication, therapy, and family support.