Does a psychiatric diagnosis mean anything?

I have a new psychiatrist and a new tentative diagnosis. Or rather, a new additional diagnosis. So at the moment I have been diagnosed at some time by somebody with: severe depression, bipolar disorder, obsessive-compulsiveness disorder, obsessive thinking, anxiety disorder, social anxiety disorder, panic disorder, dissociative disorder, autistic spectrum disorder, narcissistic personality disorder, borderline personality disorder, and now adult attention deficit disorder. I have might forgotten one or two. Although I am certain I have depression and a batch of severe anxiety disorders, parts of all these diagnoses seem right, but none of them alone fits perfectly. I don’t think I’m special in feeling confused, even frustrated, about the problems in getting a clear diagnosis.

When you have a problem with your gallbladder or spleen, the diagnosis and treatment are comparatively obvious. Your just look at the spleen and you can usually see what’s wrong with it, and if that doesn’t work (I’m no spleen specialist) you run a few simple tests, like a blood test, and look at those results. But looking at the brain won’t help for mental illness. You can see a brain tumour easily enough, but you can’t see depression or anxiety. (I admit that this claim isn’t quite true, as there are some correlations between some structural changes to the brain and some mental illnesses some of the time, but the correlations are complex and not perfect predictors – yet – so I think my statement is essentially true.)

And then there is the pathologising of the extremes of normal behaviour. It is perfectly normal to grieve when a loved one dies, or to be upset when something important goes wrong. When does grief edge over into depression? It isn’t easy to say. When is a child abnormally hyperactive and not just rather boisterous? When is a person manic and bipolar rather than just lively and extraverted?

So at the moment mental illness is different from physical illness. Things might change in the future, with more sophisticated imaging and the means of visualising neural circuits and neurotransmitter system in real-time action. But even then we are left with the fact that the brain is a hugely complicated organ and the relation between what it does and its structure is also extremely complicated, and mental illness results from the interaction of developmental, situational, and genetic structures to the whole brain. Although we obviously have many working hypotheses, we don’t have any good complete models of mental illnesses and how exactly they arise, and how changes to the brain and its neurochemistry changes behaviour. I think this difficulty in seeing what is wrong contributes to the stigma of mental illness: with a physical illness, you can see, and therefore point to, your problem – look at my swollen spleen! – but people with mental illness look the same on the outside and on the inside.

Simple diagnoses make life easier for clinicians. You have a label, and then you also have a range of possible treatments: the label will determine that treatment. If you are diagnosed with depression and are given anti-depressants, and you respond to anti-depressants, then you must have had depression. Everything else, like poor concentration, tiredness, anger, lack of empathy, and inability to sit still, or whatever, must have been caused by the depression. But why should disorders of a very complex organ that we barely understand map nicely on to simple linguistic categories devised by clinicians in order to enable them to classify and treat people? I doubt if they do.

I don’t see that for mental illness we are in any better situation than physicians at the time of the Black Death who thought that the plague was caused by a miasma rising from the ground. But at least they could see the buboes. Just look at the mess the idea that depression is caused by a lack of serotonin is in.

In practice there is no point going in to see your doctor, psychologist, or psychiatrist, saying that their diagnosis is rubbish and unscientific. They have busy, difficult lives and can’t know everything. Do though make sure that every symptom that troubles you is taken seriously, and that you receive appropriate treatment for these symptoms. And if after a while things don’t get better you need more or a different sort of help. If your mood improves a lot but your concentration doesn’t, then you shouldn’t feel bad about trying to find out why. Good luck.

Dream a little dream

I’ve been experimenting with lucid dreaming by taking supplements last thing at night, including lecithin, choline, huperzine A (an alkaloid found in some plants that’s been investigated for treating Alzheimer’s disease), GPC (l-alpha glycerylphosphorylcholine), and galantamine (found in snowdrops), They’re all available from retailers such as Amazon and pretty harmless in terms of side effects, at least, it seems, for me. All of them in some way or another increase the amount of the neurotransmitter acetylcholine. I’ve tried taking them in isolation and in combination, and in combination is the only thing that has had any effect on me. My sleep and dreaming appears to be remarkably robust.

I still haven’t had a proper lucid dream, which as I understand it is an awareness that you are dreaming, and therefore you have an ability to influence your dream. I have though on many occasions had the curious sensation that I can only describe as that I am dreaming that I am having a lucid dream, or dreaming that I know I am dreaming, but lack any ability to influence my dream. These supplements reliably promote this “dreaming of lucid dreaming” state in me.

I also on two occasions have dreamt of what others call “the shadow” – a shadowy hostile figure who lurks threateningly close by (see here and here for examples from others). On both occasions this dream has started with a feeling that someone is in the room or outside, or outside the bedroom window. If I catch a glimpse of them, they are grey and featureless. I’ve had them for years; I remember very clearly being terrified as a young child by a grey shadow figure standing like a statue beside the bed. In my case they are not accompanied by sleep paralysis. Figures of this sort are widely described across time and cultures (in olden times it might have been called an incubus), so clearly are some fundamental, but poorly understood, feature of dreaming.

Most people love to talk about their dreams, and once you tell someone that you’re a psychologist, you’re in trouble. I have always been fascinated by my dreams – those strange images that arise unbidden with sleep, sometimes with frightful clarity, that follow complex and often bizarre storylines, and surely, surely must tell us something important about ourselves? And if you could have a lucid dream, could you not systematically manipulate some of the variables of dreams to find out more?

There are many theories about the origins of dreams, and they are covered in detail in my forthcoming book, The Science of Consciousness, to be published by Cambridge University Press (hopefully next year). Many people are familiar with Sigmund Freud’s psychoanalytical theory that dreams disguise repressed and unwelcome thoughts so that they do not wake us; hence for Freudian psychoanalysis dream interpretation is a question of interpreting the surface of the dream, particularly its symbolic nature. Hence for psychoanalysts dreams are the most important method of treating mental illness. Other depth psychologists think that dreams serve different functions (e.g. Jung thought they addressed issues to do with individuation and spiritual growth), but all these approaches share the idea that dreams have some meaning, and that interpreting dreams is a means to recovery and growth. Revonsuo views dreams as an evolutionary adaptation to dealing with threat; we can safely rehearse methods of escaping threats in dreams. Many researchers link dreams with creativity, and there are several accounts of ideas being generated and problems being solved in dreams (see here for a discussion of Kekulé’s famous account of dreaming of a worm swallowing its tail seen in flames in a dream). And then there is Allan Hobson’s idea that dreams are essentially random constructed by the cortex from random activation of thoughts and ideas by subcortical input.

I kept a detailed dream diary for a year, and still record as much of my dreams as I can. I don’t think there is any one correct theory of why we dream; I am sure all of the above are true at times. (Another thing I am sure about is that there is little merit in dictionaries of dream symbols.) I never cease to be amazed at the bizarreness, complexity, and creativity shown in my dreams, but I doubt if I am alone in this regard. The activation-synthesis hypothesis has a great deal to commend it, but I don’t think internal activity is random: some memories are stronger than others, some anxieties occupy us more than others; we desire some things more than others; and some threats are more worrying than others. The mind is always bubbling away, and some bubbles sometimes come to the surface. Dreams are the default mode network, the system that generates daydreams, running without control or censorship.

But can we learn from our dreams, and can recording and interpreting dreams help us on the path to spiritual growth and healing mental illness? I was slightly surprised that during my therapy my therapist seemed totally uninterested in my dreams (and this is in the context of that therapy being one of the most useful experiences of my life). If the idea that dream content is the interpretation of randomly generated but largely prominent memories, ideas, and emotionds is correct, you might expect an analysis to be revealing. However, when I analyse the dreams in my collection, I find there is little obvious to learn from them. They show recurring thoughts and concerns, but I am aware of them from everyday life. I dream of death, dying, and nuclear war most nights. We can’t learn much from dreams because we already know most of what they tell us.

The one surprise is how often I dream about my father, when I think about him so little in waking life – or at least did. He left when I was aged ten, and I barely saw him again afterwards. He died, alone, in 2004, 15 years after I had last seen him. This persistent dreaming makes me realise that I wish I had tried to contact him, if only to ask him why he had co up my life.

A warning though: some dreams take on a life of their own. I have for decades dreamed about watching a plane fall out of the sky, I think this idea has just become a very highly activated idea, one likely to bubble to the surface some nights. That’s why we get recurring dreams. So perhaps my dreams of my father are no more than a simple recurring dream, and reveal nothing deeper.

Note that I am giving a talk on the meaning of dreams in London on 4 July 2017. Please come along. I promise to try and answer every question I get.

Stay well, and dream on.

 

Loneliness

Lonely people tend to die younger. They have more health problems when they’re still alive, and tend to be more anxious than average. They tend to suffer more from high blood pressure. They have weaker imune systems. And I’m lonely.

Lonely people tend to die younger. They have more health problems when they’re still alive, and tend to be more anxious than average. They tend to suffer more from high blood pressure. They have weaker imune systems. Bummer.

Of course as with all findings about mental health, you must be careful talking about causes when all you have are correlations (feeling unwell might prevent you going to social events, for example), but it does seem likely that being lonely is bad news. The findings on the positive effect of social support – people with plenty of good friends and a strong social network tend to be happier and healthier – are after all just the other side of the coin.

We can distinguish acute loneliness (loneliness that persists for a relatively short period of time and that arises as a result of loss or transition, such as the death of a partner, change of job, or a geographical move) from chronic loneliness (loneliness that goes on and on and is part of a person’s life over some years). I’m currently reading Emily White’s book Lonely, about her chronic loneliness, and enjoying (or identifying with it perhaps) very much.

I think there is now more of a stigma attached to being lonely than there is to being mentally ill. Most people now accept that mental illness is a result of many factors, and that the ill person is not to blame. However, many people appear to believe that if you’re lonely, it’s your fault. You should just try a bit harder: join a club, do volunteering work, or take a dancing lesson. Or perhaps, they think, you’ve got no friends because you’re not a very nice person.

I admit it: I am chronically lonely – and I’m a very nice person.

Being chronically lonely (just lonely from now on) is related to many other things. White clearly thinks that being lonely and being depressed are very different; the main evidence for this claim is that many people report average levels of depression. I’m a bit sceptical that people have good insight into their mental states (we know from cognitive psychology that our insight is limited), but loneliness does seem to be related to social anxiety and personality factors independently of depression. I can feel lonely at a crazy party. In fact I sometime feel loneliest at a crazy party, where everyone else is obviously enjoying themselves, playing party games and singing songs. I have been in a packed football stadium where everyone else is singing and chanting and cheering and I just can’t join in; it feels false, wrong. I’m not looking down on the people who join in – although it must often look that way to other people – I just can’t make myself feel like other people. I’m an outsider (or as my mother used to say, “weird”, the irony being that she also is a lonely outsider).

I do wonder if people who think of themselves as very lonely mean “lonely” in the same way as others do. I think most people have acute loneliness in mind, whereas I think people like White and me are struggling for a word to capture a sense of alienation and otherness that pervades our lives even when others are present. A lot of what White talks about in Lonely makes me wonder if she just means “single”: a lack of intimacy, having somewhere there, the sound of voices and feet padding on the carpet at home, havint someone to touch, having someone with whom to share everything. But then I have felt lonely when with other people, including partners. Perhaps some of us are just destined to feel different. And for me it is entwined with depression.

But these are simple labels for complex experiences. I have no advice for others in the same party. I don’t want to go to a party or start dancing. Perhaps that’s why I enjoy the gym so much: I can be with other people, who vaguely share the same aim, but who don’t expect anything of me.

 

 

How to lose weight (continued)

I posted some time ago about my great success in applying science to losing weight. At one point I had lost about 30 pounds in 6 months. Most people who lose weight go on to regain it, sometimes even eventually weighing more than they had when they started, so after six months I thought it was time to revisit my diet – or more precisely, my lifestyle.

The news is mixed.

I posted some time ago about my great success in applying science to losing weight. At one point I had lost about 30 pounds in 6 months. Most people who lose weight go on to regain it, sometimes even eventually weighing more than they had when they started, so after six months I thought it was time to revisit my diet – or more precisely, my lifestyle.

The news is mixed. I have regained a bit of weight, but I am now fitter than ever before, as measured by endurance capability, maximum weight I can lift, resting pulse, and blood pressure. Most of the weight I have put back on (about 12 pounds) is muscle, not fat. My visceral fat is down to 11%, and my body fat 17%. I still feel flabby around the middle though, and would like to lose more weight there. Some of the weight gain – a few pounds – is fat, so it is a work in progress with many gains and a few losses.

So I think overall the verdict is that a version of this “diet” works, at least for me.

As with most things, life gets in the way sometimes. It’s difficult to stick to a particular lifestyle  when there are events such as Christmas come along, or when you’re travelling. I try, but relax things a bit. After all one of my greatest pleasures is eating out, and one has to have some fun. I nearly always pass on the dessert though.

I have also had time to consider what were the essential aspects of my original diet. I still think for me then the big thing was obsessively weighing and measuring food, and calculating the nutritional content of what I ate. This monitoring enabled to stick to a diet of around 2000 Calories a day, with about 75 g protein, 25 g fibre, and 50 g or less of carbohydrate (and often less than 1 g of salt a day). (I didn’t and still don’t care about the fat/oil content because I am convinced by the data showing that fat does good rather than harm.) Note again that this intake is the inverse of the traditional food “pyramid” with a large carb intake at the base. I also aimed for as wide a variety of micronutrients as possible, by supplementation and by eating as many different vegetables, and some fruit, as possible.

I stick by these things although I have relaxed the carb limit a bit. In particular I enjoy baking, and make my own gluten-free bread, which is largely seed rather than grain-based, containing walnut pieces, linseed, flaxseed, sunflower seeds, chia seeds, and pumpkin seeds. It tastes good (others say that too), but doesn’t keep well. I still try and avoid sucrose (sugar) like the plague.

I think the increased carb intake, especially bread, makes it more difficult to lose more weight. My main struggle however has been finding a way of eating that enables me to continue gaining muscle while losing fat. I don’t yet have an answer. When you work out six times a week for 45-60 minutes a day you’re going to need more calories, but what is the ideal proportion of fat, carbohydrate, and protein? How many times should you eat a day, and when, relative to the workout? I have scoured websites and books on exercise physiology without finding any answers that convince me. It is also difficult to work out how many calories you need when you have a complex exercise regime with many different types of exercise. I’m pretty certain the answer is more than 2000 though!

I recently saw a television programme that monitored someone trying to lose weight rapidly by calorie restriction over a week. At the end he had lost weight – but it was all fluid and muscle, and muscle is the last thing I want to use. On the other hand this was a television programme not a scientific study (although the measurements appeared to be taken under laboratory conditions), his diet was extreme, and he was very fit and lean in the first place.

I am sure that the principles of my diet work if you want to lose weight and become healthier. Restrict your carbohydrate intake, watch the total calorie intake, drink plenty of water, and exercise – the more and the more different sorts the better. But to become super-fit and super-lean is a further challenge. If you know anything about the science of doing so, please let me know.

The other issue outstanding is why so many people who start to diet do well at first and then go downhill. There are of course several possible reasons.

  • You don’t really like the food in your diet. I am lucky in that I don’t like the taste of sugar that much and love blueberries and fish. It would be much more difficult if it were the other way round. So you have to include as much good food that you like and also re-educate your palate.
  • You’re not really too bothered about your current weight and appearance. That’s fine, it’s your life – just remember if you’re obese it might be quite a short life.
  • Not giving yourself enough rewards. Rewards work! If you find the going tough, decide on a reward programme. You’re doing something important so the rewards should be reasonable: stay on the diet for a week and you deserve that new book you thought was a bit of a luxury. I’m not a great fan of “treats” in the diet as rewards: after all a diet with two days of cake treats is really just dieting for five days. Similarly all these points-based systems are over-complicated for many people (like me) and it’s easier just avoid the cake than working out if you can have it, and buy a trip to California instead.
  • Lack of support. It’s difficult if everyone around you is gorging all the time. It’s difficult if you’re trying to diet alone. One of the reasons diet clubs work better than other things isn’t because of the system, but because they provide social support to encourage you.
  • Yo-yo dieting. Going on a diet and then stopping and starting again, perhaps with a new system, and your weight oscillating as you diet – and don’t. You have to ask yourself why do you stop after a while. Perhaps you don’t like the food. Perhaps there is no support around. Perhaps you haven’t rewarded yourself sufficiently.
  • Thinking of it as a diet rather than a lifestyle. I know I’ve used the word diet, but that’s just a shorthand. You should realise that you’re not just eating fewer cases, but embracing a new, better way of living. You’re not going just going to lose a few pounds, but you’re going to become a healthier, happier person, with a longer life expectancy and better quality of life. And a healthy body is important for a healthy mind.

Now pass the blueberries.

Getting the words out

I’ve been silent because I’ve been busy. I have found that writing my “great work”, The Science of Consciousness, is good for my mental health – although whether I’d be able to write at all without a certain level of mental health is a moot point. Writing gives my life direction and purpose, and structures my day. The amount of work involved makes a mockery of any notion of being “retired”; writing is fulltime job. Consciousness is the most difficult subject I’ve ever written about: to paraphrase the British psychologist Stuart Sutherland “an awful lot has been written on consciousness, mot of it rubbish”; why do I think what I’m writing isn’t rubbish too? I suppose you can only do your best and then just hope. I’m not going to fall into the trap that many psychologists fall into, of equating consciousness with attention, or even just visual attention. I recognise it’s a big, difficult topic.

I have been reflecting about why I have found this writing so enjoyable and so therapeutic. Perhaps it’s obvious, but it’s because I really want to do it. I would probably write it even if I didn’t have a publisher and a contract. The only downside of a contract is often a fairly tough deadline – but if I didn’t have a deadline I almost certainly would work more casually, so it’s an advantage as well as a curse. (And usually the deadline wouldn’t be so bad if only I had started earlier.)

In the odd spare moment that I have, I wonder if my mood would be as good without this purpose. As ever there is circularity: doing stuff makes your mood better, but you have to be well enough to be able to do any stuff in the first place.

Of course in the end I will die (unless I decide to have my head frozen, and even then I expect eventually to die regardless) and eventually my books will go out of print, and I will be forgotten. At this point I envy people with children; they will live on through their genes. As others have observed, our lives are like stones thrown into a pool, causing ripples to spread out. Eventually the ripples fade and it is, for most of us, as though our stone was never thrown into the pool.

When writing a book I try not to think about it too much. I have 150,000 words to deliver before the summer. If I think of it in that way, the task is an enormous one. So I break the task down into 1000 words a day (number of words left divided by number of days left, allowing Sunday off – or rather do those jobs that have accumulated in the week) come what may. I think deciding to miss one day is a slippery slope; of course choosing to miss one day wouldn’t make much difference, but it’s easy for that one day to become two, and before I knew it, a month would have gone, and a 1000 words a day has become 1250. And then there’s reading, researching, and checking. You have to treat it like a job, or any other job I suppose, and just get on with it. I know there’s no point putting off starting to write every day because I know that it has to be done regardless, and starting at 5 pm is much more miserable and difficult than starting at 9 am. I still procrastinate a bit first thing, but I gather many writers do. I think it was Derren Brown who said something like “all self-help books just boil down to – just do it”. If you’re writing a book, writing an essay, or just have to mow the lawn – get on with it now.

Also on the positive side, I have had three outputs this week, and nothing lifts my heart more than seeing my name somewhere.

First, the second edition of my book, Talking the talk: Language, psychology, and science has just been published by Psychology Press. See:

 

 

This book is a gentle introduction to psycholinguistics, the science of how we produce and understand language. I still think the first edition was the best thing I have ever written (so far).

Second, I had a letter in the Daily Telegraph on Tuesday about futurology, robots, AI, and the implications for the economy. I’m a pessimist about these things:

 

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Rather to my surprise, it generated a great deal of interest. There were letters in reply (none of which really addressed the problem, I thought) and offers to write about the subject elsewhere. I think the future is a pretty scary place, and although I would have loved a laptop with fast internet connection when growing up, it could be that I have lived in the best of times – a rather optimistic conclusion for someone as usually as negative as me.

And third, finally, I gave a talk at Durham University on How to be successful in academia, particularly if you’re suffering from mental illness. I’m told it was very successful.

So a good few weeks. Success and achievements lift the spirits – just as you would expect. If you can, do something. But there will be times when you are too depressed to do anything. My advice, based on my experience, is to sit it out. Things will get better eventually, because they always have in the past. I promise.

 

Emptying the mind

It’s been a while since my last blog. Who would have thought that being self-employed would mean being so busy? I have been trying to focus on what’s important: my goals in taking early “retirement” from the full-time job have always been to increase my reading, thinking, and writing time.

But we live in a world of distraction. Distraction makes procrastination very easy. I even know of academics who have been encouraged by their “line managers” (what a repellent phrase) to “multi-task” their administration and research. I’m not sure at what level they’re supposed to multi-task – reading a paper while giving a lecture perhaps? – but we know that multi-tasking reduces efficiency: it just doesn’t work. Doing two things at once has a cost (which is why even speaking on the phone while driving increases the chance of an accident, let alone texting and driving). It also increases stress. And we know that doing important, creative work requires focus – you can’t carry out great research while students back their essays. I even have my doubts about one of those great sacrosanct beliefs in academic life that great teaching and research must go together: good teaching requires time, and research requires time, and you can’t be doing two things at once (see above).

I have tried to simplify my life, for peace of mind both for being mentally ill, and in order to be able to think more clearly. I have just been reading Timothy Ferriss’s excellent (if lengthy) Tools for Titans, and it is obvious that I am not alone in pursuing this strategy. Physical clutter is distracting – some of us even find it distressing. Mental clutter is just as bad, perhaps worse.

And how much mental clutter we all must have! How can you live in the moment when you are worrying about what you did wrong this morning and what you have to do this evening? How can you write well when your mind is on the telephone bill?

So here are some of the things that I’ve done to reduce mental clutter.

  1. Write down as much as possible. First I carried out a brain dump of everything I had to do, everything I was worried about, and everything on my mind. This task took a while, and I kept adding to the dump over a few days.
  2. Make structured lists. Over the years I have experimented with several types of list and time management systems. Now someone with an obsessional personality has to be careful of lists – they can easily take over and become an obsession and a distraction in themselves. I recently tried a complex system of email folders with tasks for doing today, tomorrow, the day after tomorrow, this week, waiting for, and so on … (I am familiar with Dave Allen’s Getting Things Done system and implement a simplified version of it. I have tried dedicated software but am aiming for a simple solution.)
  3. To do. Currently I am using Apple’s Reminders, with several types of list organised by location and time. I am trying to keep it simple. I have tried complicated systems and apps and remain to be convinced that a to do list can be bettered. The important thing is that nothing gets lost, and that I know everything will be dealt with by the deadline. I don’t want to have to think about peripheral things.
  4. Removing distractions. Social media distracts us and increases mental clutter. I can’t go as far as some and remove myself completely from Facebook and Twitter, and I don’t want to delete all my email accounts (and I don’t think it would be a good idea for future employment possibilities). But I don’t need to check my email every hour. Emails generate emails. I have reached the fabled “Inbox zero”, partly by moving things I can’t do now to an appropriate folder. (Actually as I write it is Inbox 1.) There are some emails I can’t do anything about just now, either because they refer to future events or because I need to do something to be able to answer them – they are moved to a “Waiting” folder. I do feel bad about several emails in my “Weather” folder that I plan to get round to when I have time. These are questions about or suggestions for or things to add to my British weather pages (http://www.trevorharley.com/trevorharley/weather_web_pages/britweather.htm). I do feel a bit bad that people have gone to the trouble of writing to me, and I always thank them, but it’s not my day job, and my time is very limited, so I can’t process them all at once. Recognising that we have limited time is a big part of the fight. WE CAN’T DO EVERYTHING. And that means MAKING CHOICES. (Apologies for shouting these statements.)
  5. Meditation. Everyone says meditation is good for clearing the mind and improving mental focus and clarity. I though with my monkey mind find the process very difficult, and probably as a result find the benefits – so far – limited. I will persevere though. I am using Andy Puddicombe’s Headspace site; I like the structure it provides and the implicit coercion. My jury is still out on meditation.
  6. Mindfulness. At all other times I am trying to be mindful of what I am doing now. If a distracting thought arises I try to push it away or if it is something I need to pay attention to add it to my list. It is easy though for obsessive people to get obsessed with clearing our minds, so we are for ever writing down minor thoughts. We all also occasionally at least need to plan what we’re going to do: living in the present doesn’t imply drifting.

Interestingly, as I was half way through writing this blog, the following landed in my inbox and caught my eye (I know, I know):

http://calnewport.com/blog/2016/12/18/on-digital-minimalism/

Finally, we should think about whether it’s even a good idea to strive for an empty mind. Life isn’t that simple. Things are always cropping up, and surprises are always happening. Rather than avoiding shit we must learn to respond to shit in the right way. The more I think about it, the more important I think this point is: we will never achieve a perfectly empty mind. It’s our responses we need to change.

Have a good Christmas and New Year everyone. It’s a difficult time of year for people with mental health problems – if nothing else it’s so dark in the northern northern hemisphere. So just hang on in there.

I’m mad, but so is BT

My blog on dealing with a typical British industry, BT (British Telecom), their surreal behaviour, and incompetence, and its toll on my mental health.

I’m going to take time out from writing about writing and madness to describe my difficulties with BT (British Telecom, the main telecommunications company in the UK – they provide the lines, but other companies can also provide the calls, which is altogether a rather bizarre situation). It is relevant to my blog though because it’s been such a distraction to me, and has taken up a large amount of time I could have spent much better doing worthier things. The problems have become something of an obsession – I find myself thinking about it a lot of the time, which is never a good sign for someone with mental health problems. At several points I have felt like giving up, but then thought damn it, if not me, whom? I suspect my difficulties in dealing with a big company are not unusual, but most don’t have the time or energy to pursue the culprits.

I think BT is fairly typical of British (perhaps most western) companies (and the public sector, including education) today: it’s too big, it outsources too much, it uses overseas call centres, and generally making it difficult for the individual customer to get anywhere with it. Its online system seems designed to sell, and not much else. The big managers, who make the big money, insulate themselves as much as possible from the customers, or “clients”. They probably have no idea what’s going on, and probably don’t want to.

It all started innocently enough just under year ago when BT phoned me, right out of the blue. Now I will swallow my pride here, and admit that it all serves me right for breaking my vow of never answering the phone to an unknown number, let alone never making a decision during a phone call. But the chap was very persuasive and informative: did I know that BT fibre optic “Infinity” broadband (very fast broadband, up to 80 mbps), was available in my area? I didn’t, and I was pleasantly surprised, because I live in a Scottish village pretty much in the middle of nowhere, so I had been expecting to get super fast broadband sometime around 2269. Furthermore, said this helpful and cheery chap, BT had an offer on, where they would give me BT TV on a special introductory offer for something like £10 a month for the first year. It would save me altogether £30 a month or so compared with what I was paying Sky just then. I was a bit incredulous: you mean I could get Sky Sports and Sky Cinema too? And all my other usual channels? I quite like Sky. They have a good range of channels and everything just works (most of the time). Yes, he said, you will have everything you have now, but it will be £30 a month cheaper. AND you will get UHD (4k) TV? Really? YES! Wow. What about Sky? He said BT would deal with Sky and sort out everything – I wouldn’t have to do anything. So I agreed. Emails detailing the contract were promised and an appointment with the engineer arranged for the near future. And BT would sort out EVERYTHING!

The engineer arrived the next week and set up the fast broadband with a new router and BT TV. Oh no he said, BT won’t sort out Sky TV; who told you that? You’ll have to speak to them yourself. BT would only take over Sky Broadband. But I had never had Sky Broadband – I’d always been with BT! Funny BT didn’t know I was their own customer. PIECE OF BT RUBBISH No. 1. I told the engineer I had never received the email contract, and he said he would have to send it again. PIECE OF BT RUBBISH No. 2.

Eventually he got my admittedly rather sophisticated television working with the set-up. Everything seemed to work and off he went. I started to explore the channels. It turns out there’s hardly anything to watch in UHD. But more importantly, where were Sky Movies and Sky Sports? I only had Freeview channels. Oh you have to order those separately said BT. I THOUGHT I ALREADY HAD. PIECE OF BT RUBBISH No. 3. But to be fair the price was as stated. But what was this, BBC News channel in standard definition? Where is the high definition version? It turns out that Sky beams everything down to you from their little satellite, while BT just sends the special stuff down the line, and picks up the Freeview channel from the air (confused yet?), and in my area I couldn’t get BBC News in HD. No one had explained that to me before. PIECE OF BT RUBBISH No. 4.  Talking of explanations, where was my promised contract? Needless to say, it never arrived. PIECE OF BT RUBBISH No. 5. But the good news was that I now had Sky Sports and Cinema. Or rather, I had Sky Sports 1 and 2, not all the Sky Sports channels, including Sky Sports News. Turns out these aren’t included, and the cinema package was similarly crippled. PIECE OF BT RUBBISH No. 6. And even worse, the channels I did get were only in standard definition, which is nearly as bad as watching black and white. It turns out that BT don’t provide them in HD. PIECE OF BT RUBBISH No. 7. So much for providing every thing I had before with Sky; I consider this PIECES OF BT RUBBISH No. 6 and 7 together to constitute mis-selling. I am tempted to use stronger words. If I had been told this at the start I would have put the phone down after ten seconds. So it was a good job BT hadn’t closed down my Sky contract after all, and that I had kept my Sky Box connected. But instead of having a perfectly satisfactory Sky contract, I now had a perfectly satisfactory Sky contract,  fast internet, and a perfectly unsatisfactory BT contract, and I instead of saving £30 with faster broadband, I am paying £50 more than I thought I would be.

And don’t get me going on the television box. I never did get the knack of the forward and rewind, but this might have been my clumsiness. It did keep on crashing though, which wasn’t me. It’s the software, not the hardware, and it will probably improve with time. I still consider the functionality to be PIECE OF BT RUBBISH No. 8.

Months passed. I seethed inwardly. I thought about complaining but as my regular readers will know, I was very ill, and had enough on my plate, as my gran would have said. After all, in the great scheme of things I haven’t been left without emergency cover, and I did have fast broadband. And TV. Two TV systems in fact, one though I never used.

But as the bills mounted up I seethed more and more, and then one day, I got a Sky Q box. And it worked just fine. Tidying up the wiring I decided I had had enough, so I packed up the BT TV box. This is crazy, I thought, so I went to the BT site to work out how to make the point that I thought service hadn’t been that great. I also wanted to find out when the BT television contract ended. The only thing I could find on their site was phoning someone up, or an online complaints system. So I filled in the complaint form.

At this point, if they had just said we’re very sorry, there seems to be some misunderstanding, and we’ll let you off your television contract a month early, I’d have been ecstatic. But they didn’t. They didn’t even understand what I was talking about.  PIECE OF BT RUBBISH No. 9.

From now on things become increasingly surreal. One has to be careful here because it turns out that the BT complaints system is nothing more than a glorified out-sourced call centre, and some people think you can’t criticise call centres based in other countries without being a racist. I have no great objection to call centres as long as they work, but the problem is that usually they don’t. I find I often have difficulty understanding what the person is saying, and they certainly don’t seem to understand me. (I don’t think that’s a racist thing to say, but these days, who knows.) I do feel slightly aggrieved that British Telecom outsources these jobs to non-British people, but that’s globalisation for you. I also feel sorry for the workers in these places: presumably they are poorly paid, crammed into a room, and spend hour after hour having to deal with irate people. No, it’s the senior managers who deserve our wrath.

I remember reading an article in the press by a BT manager saying that their Indian call centre was wonderful but some of their customers were disgustingly rude. There is no excuse for rudeness but I can see why people get so upset. I bet the head of BT doesn’t try to resolve their problems by going through their call centre. I don’t think it’s a sensible way to run a complaints system – and certainly it shouldn’t be the only way. PIECE OF BT RUBBISH No. 10.

So the first response was an email back saying that they were very sorry my equipment wasn’t working, and did I want an engineer to come out?

What? I replied saying that wasn’t the real problem. I hadn’t made myself clear. I repeated about the mis-selling.

They replied saying they’d been trying to phone me …

I replied saying my hearing isn’t that good (particularly with foreign accents on the phone, and in any case I prefer things in writing, so could they please not phone me). I repeated again that the main problem was one of mis-selling, and also cancelling my television contract. They’d told me when it ended, but I could get no one to confirm in writing that they had cancelled it from that date as I had asked. The person said they’d need to transfer me to a different department. What, I thought complaints dealt with things when nothing else worked? PIECE OF BT RUBBISH No. 11. The other department would email me.

Oh no they didn’t. PIECE OF BT RUBBISH No. 12. A few days later the phone started ringing. Guess who it was? So now I add to my list of issues that they phoned when I asked them not to phone. Guess how they tried to respond to this? You’ve got it. Let’s add poor customer service to the list. PIECE OF BT RUBBISH No. 13.

So someone was meant to write back. And they never did. PIECE OF BT RUBBISH No. 14.

I left it a while and then complained that they had never answered, through their strange complaints system again. The response was as you never CALLED back. What? PIECE OF BT RUBBISH No. 15. This person gave a lengthy apology in a very tiny font saying that BT values their customers and that people had been spoken to. Don’t they realise how annoying being told this can be when they hadn’t yet done a thing to help? This person said they had revised my complaint and identified that I had issues with BT TV. Yes but not technical issues; they didn’t address at all the point that it did nothing that I had been told it would be, and that it was working out to be more expensive, not less. And you can’t get Sky Movies and Sport HD, I reminded her. Yes you can! she (I think) replied. NO YOU CAN’T I said. Oh no, not in HD, she eventually conceded. And still no one had confirmed that they had cancelled my television contract! PIECE OF BT RUBBISH No. 15 (and I’m almost tempted to make this double rubbish given they deny themselves).

So I decided to try what seems to be the only thing that works these days: tweeting in the public arena. Again, I feel sorry for the poor individuals who are paid to reply to my rants. But at least they respond!

So then I get a bizarre email saying they are sending out an engineer. I never asked for an engineer! How on earth is an engineer going to sort out mis-selling? Their complaints department seem incapable of understanding what the problem is (another issue I have with overseas call centres). I feel sorry for this engineer. There is no easy way I can see on the email of telling them I can’t be in that time (other than phoning). PIECE OF BT RUBBISH No. 16.

I email again, and guess how they respond – yes, you’ve got it, by phoning me again. PIECE OF BT RUBBISH No. 17. I admit I get a bit irate at this point. I keep on saying that now I just want the email address of someone to talk to who understands English, but that is clearly too much to ask for with BT. The one easy thing they could they never attempt to do. By this point my blood pressure is soaring, I have dozens of emails not addressing any of my substantive points, the phone is ringing, the Twitter people seem perplexed, I am still paying £50 more than I used to, an engineer is coming out to sort out a non-existent technical problem, and the managers are still drawing their obscene salaries. And I’ve started obsessing about all this so it is really getting to me and not doing my recovery any good at all.

UPDATE: I think I’m getting somewhere with my Twitter campaign. They want me to send them my telephone number. And then a couple of hours later, I get a message back saying … they’re sending an engineer out tomorrow! I wonder about the ability of their complaints staff to read simple English. Or perhaps I don’t write simple English. Or perhaps now they’re just having a laugh. PIECE OF BT RUBBISH No. 18. I despair. I just want somebody sensible to talk to.

The engineer phones to confirm his appointment the evening before. An excellent idea, I explain the situation to him, and tell him not to come. He is very good. BT GOLD STAR!

If anyone can reduce the above to under 140 characters, please let me know. And if any of them are reading this and feel bad enough about themselves to do anything about it, here is a reminder that my email address is trevor.harley@mac.com.

FINAL UPDATE: I emailed the CEO, and his complaints department sorted it out the next day. BT GOLD STAR! But it shouldn’t have been so difficult. I just wanted someone to talk to. After a while the complain took on a life of its own because no one could be bothered to listen properly.