Month: April 2016

Removing the stigma of mental illness

 

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My planned post can wait: last week was UK Depression Awareness Week.

I used to be sceptical about these special days and weeks, but now I think there is a great deal of benefit to having a concerted surge of activity because at the very least it generates publicity.

There used to be a great deal of stigma and shame associated with any kind of mental illness. People felt forced to hide their suffering. They were discriminated against, made fun of, and even bullied – things that of course just made people even worse. At our school, many years ago, boys who were slightly odd were given nicknames based on the local mental hospital. People found it more difficult to get and keep jobs. I remember an employee, a long time ago and in a place far away from here, feeling forced to tell me that he had been off work for some weeks with a “very bad cold in the head” – whereas there were rumours that he had had a “nervous breakdown”. There was very little advice available in the NHS, and there was a much more restricted choice of drugs. Prozac only became widely available in 1988.

Things are by no means perfect even now, but every time a celebrity “comes out” as mad, there’s another step forward. Every time someone is honest at work or with their friends all of us are a little more liberated. Those of us who can owe it to the others to stand up and say we’re GLAD TO BE MAD. Well, maybe not glad, but we are, and there’s nothing to be ashamed of. Stop the stigma now.

 

Making big changes the small way

NW Scotland

 

If you want to change yourself for ever, make the change in tiny steps. We’re all familiar with people who make big resolutions at New Year (I’m just as guilty as anyone else), who then take out gym membership on 1 January but who have stopped going by the 10th. When I reflect I’m ashamed by the number of times I have resolved to eat less, drink less, exercise more, work more, travel more, go out more, and so on, and so on, and so on.
A few years ago the book Nudge by Cass Sunstein and Richard Thaler (2009) was very popular; apparently politicians were taking it on holiday as beach reading. I see that there is a forthcoming book (2015) by David Halpern called Inside the Nudge Unit; its Amazon description starts:

“Behavioural scientist Dr David Halpern heads up Number 10’s ‘Nudge Unit’, the world’s first government institution that uses behavioural economics to examine and influence human behaviour, to ‘nudge’ us into making better decisions. Seemingly small and subtle solutions have led to huge improvements across tax, healthcare, pensions, employment, crime reduction, energy conservation and economic growth.”
The much debated “sugar tax” is presumably a recent application of the nudge principle: a small increase in the price of sugar-containing goods will (or might) change behaviour by stopping some people eating quite as much sugar as they have, leading to a reduction in obesity levels. With millions of people you don’t need to make a big change to make a big difference.

Nudging means changing behaviour by making small changes. We know dramatic diets are often ineffective; indeed people often end up weighing more than they before dieting. When people fall off the diet wagon they think “what the heck”, and binge. Small changes to lifestyles are more likely to persist and have long-lasting effects than dramatic resolutions.

So I am reducing my medication, and doing it gradually. (A caveat: always discuss it with your healthcare professional before you change medication in any way. I did with mine, and they’re monitoring me in case I go downhill without appreciating it.) I’ve cut quetiapine from four to one a day, very gradually. I don’t feel so good after going down to just one but I’m hoping it’s just a blip.

And of course only change one thing at once, and give that change a chance to bed in and observe its effects. There are still many more things I want to change about my life so that I can find more time for writing, reading, and thinking, but this change is the big one for now. It will mean I need to sleep less and am more alert in the day.

This technique should work for everyone – including depressed non-writers and non-depressed writers and even non-depressed non-writers. Look at your life. Decide what is the most important thing you have to change. Decide upon a small step towards that change. Implement the change. Give it time until what you’ve changed is now habit, then repeat. The technique is good for diet, exercise, working more, working less, and so on.

One thing I am not so sure about is whether gradual change is better for making a permanent change in areas such as smoking and alcohol and drug addiction. In these areas many people appear to have success with going cold turkey. Whether nudging would be even more successful for these sorts of things I don’t know, and I don’t know of any figures either way.

So vow to make one small change today.

 

 

The daily schedule of a depressed writer

 

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It’s not easy being depressed, and it’s not easy being a writer. Being a depressed writer is worse than the sum of the parts. I often wonder why I bother; why not just go for the easy life of staying in bed all day long, which is often what I most often most want to do? Instead I struggle to make time for my writing.
It does mean that for depressed writers there is the question of how can we best arrange our time to facilitate writing? Of course it’s a problem all writers and creative people share. One of the best books I have read recently is Daily Rituals: How Great Minds Make Time, Find Inspiration, and Get to Work by Mason Currey (2013). Unusual creativity comes from unusual people living unusual lives. It is quite difficult to discern a pattern in the most creative lives. Have a look at this nice graphical representation of the daily routines of a sample of creative people (including creative scientists):

https://podio.com/site/creative-routines

With all sorts of caveats, and with many exceptions, the pattern seems to be get started early, exercise, relax. I’m not being prescriptive: until I cut down my quetiapine medication I was incapable of getting started early. And when I was Dean I had countless 8.30 and 9.00 am meetings, which really got in the way of getting deep work done (see my earlier blog on “Deep work”). There is robust evidence that some people are morning types and some evening, and if I were going to be prescriptive about anything, it would be to work out when you have most energy and feel best, and do your most creative work then. So of course there are many exceptions to this general pattern of writing first thing: some writers can only really get going at night after a few martinis. (Amazingly though Ernest Hemingway always started writing at six in the morning, even if he had been up late the night before with hard drinking, and worked until about noon.)
For me it ‘s good though to get the writing out of the way. I can never relax until I’ve completed my writing goal for the day. Another problem with starting late is that I never know how a writing task is going to take until I’ve done it. I’m writing a book on consciousness at the moment and I’ve set myself the target of a thousand words a day. It preys on my mind until the target bar in Scrivener (my currently preferred book writing software) reaches 100% for the day.
It is worth spending time on working out what is the perfect day for living the perfect life, in the sense of maximising quality time to get what we want to get done, done. It’s obvious that routine is important; routine crystallised to the point of ritual in many cases, as the title of Currey’s book suggests. Routine does bring its own problems for living – routine is the enemy of spontaneity, unless we schedule some hours in which to be spontaneous, which almost defies the purpose. But when on a creative burst, writing a book with a deadline, I need routine. A rigid routine or else I will not get it done. This routine means being tough on myself as well as other people. No exceptions.
I do wonder how some people manage to get so much more than me. I struggle at the moment with work, let alone writing. I try and free up as much quality time (for reading, writing, and thinking) as possible by outsourcing things like cleaning and mowing the lawn. I’m lucky that I can. How do people with children manage? But there are some days when I am so depressed that I just want to sit and cry and stare into space. Fortunately these days are much rarer when I’m writing; perhaps the sense of purpose writing provides helps us lift my mood. But one of the most depressing things about being depressed is how much time is lost to being ill. It is tragic.

Changing my life

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In my last blog I described how I had decided to take the leap from being employed to self-employed, and become a full-time writer. I’ve done this in part because of course I want to spend more time writing, and in part because I think being wholly responsible for my life will help my battle with depression and anxiety. So far – and I’m aware that it’s very early days – I’m optimistic; mostly, at the moment, I feel remarkably happy and anxiety free. Taking complete control of my life has almost been an instant cure. I still have some bad days when I feel a bit depressed, but the bad is now nowhere near as bad as it has been. Of course the days are getting longer as well, and the perpetual gloom of the Scottish winter has started to lift; I’m sure that helps, but I don’t think the weather is the main reason for my improvement. Being free is I think the major factor. I’m sure the feeling won’t last for ever – people soon adapt to changes in their circumstances – but I think it’s a good and important change.
So I have decided to reduce my medication. I have gone down to only two quetiapine a day. Quetiapine is an atypical anti-anxiety drug that is very effective against anxiety. It worked great for me, but made me extremely sleepy. I was worried that this reduction in dosage might interfere with my ability to sleep: I love the instant unconsciousness quetiapine gives you at night; I like the way I put my head on the pillow and I am asleep. In the morning I don’t even remember switching the light out the night before. I was afraid that I would lose this instantaneity of falling asleep, but I haven’t (so far). I don’t sleep quite as deeply later in the night, but I do find it easier to wake up in the morning. I hate the way quetiapine makes it so difficult for me to wake, and leaves me feeling like I just need to go back to sleep for the first couple of hours of the day. Reducing the dose has greatly reduced this zoned out feeling. So far, so good. And I’ve had no rebound in anxiety levels, which I also feared might happen.
I’ve decided I need to make other changes too. Now the general advice when changing your medication and life when mentally ill is only to change one thing at a time. So I’ll give the reduction in quetiapine some time to bed down. My previous “big change” was to try to get fit and go to the gym. This change has more or less worked out, and I’m now fitter than I have ever been. I still can’t say I particularly enjoy the gym or exercise though; I find cardio painful – literally and metaphorically. I hope to reduce the dose of quetiapine to one a day soon.
But it is also time to rethink my daily schedule to see how I can maximise writing time. The research shows that many great writers start early in the morning and get going with those words. I would need at least a cup of tea before I could do anything, but I could make writing the number one priority of the morning. No checking of email or Facebook until those thousand or whatever the target number of words are out. At the moment I go to the gym some mornings, and as the anxiety builds up, take quetiapine. Although it calms me down I feel a bit sedated as well, and I don’t like that feeling. Often (and of course it’s not always possible to do so) I fall asleep. I then feel good and perky for the later afternoon, evening, and early night. Of course at the moment the writing time is naturally heavily constrained by the day job; I won’t be able to change my life fully until I actually finish. At this time of the academic year student project work and marking more than fills the day. For now though, work comes first. The writer’s life is not an easy one. And being depressed is not easy. Being an employed depressed writer is very difficult indeed.