When a doctor asks whether a patient is ‘low in spirits’ or ‘low in mood’, what does he mean? For me, it was a very visceral feeling. I compared it to feeling like an empty shell or a dark cave.

‘I feel like I am always going to have this hollow emptiness inside me. I feel like I am a shell within which there is infinite darkness, like a cave of which one can see only the mouth but which has a dark, slimy-walled interior extending deep into the cold bowels of the earth. It is musty in there and untold horrors lurk in its deepest recesses. The stagnant, icy water which lies upon the floor has been in that same state for years, removed from the cycle of transpiration, evaporation and condensation by its separation from the outside reality. There are parts of me which are just like this water: bitter and unpalatable, discoloured, stale. I used to be frightened by caves but intrigued at the same time by the possibility that treasures might lie within. I used to be frightened by the deepest invaginations of my soul but intrigued by the possibility that to explore them might yield great riches. Now the intrigue has faded: I expect to find not jewels and gold but black rock, threatening-looking stalactites and glutinous sludge. Thinking about my soul leaves me cold rather than excited. Nothing could be heartwarming enough to heat me to the core. Where is my heart, this part of me which has ached and has been broken and now is as numb with cold as if it had been preserved in liquid nitrogen? Will it ever thaw? One thing is certain: if it does, it will be even more painful than warming frost-bitten fingers on a winter's day.’