Month: June 2016

Retiring and getting old

Mar 15 eclipse 6Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
– Dylan Thomas, “Do not go gentle into that good night”

I realise that at least part of my recent mental malaise is to do with “retiring” and getting old. There’s been a lot of personal stuff too, which is also related to ageing, being alone, contemplating death childless and alone. There has been an unfortunate conjunction of traumas coinciding with nearing the end of the day job. Heavy shit has been going down, as they say.
As of writing this sentence, today I have 40 days left in the wilderness as an employee. Unfortunately many people are insisting on calling it my retirement. It’s only a word, but it gets to you, after a while. Many people don’t want to retire; many do and then regret it; a few look forward to it and really enjoy it. I must admit to having doubts. Suppose I can’t cut the mustard on my own? Suppose instead of writing I drift and each day follows the preceding one in a (hopefully) long line before the grave? Suppose I write and it’s no good? Suppose I have only a life of grinding poverty to which to look forward? Suppose (particularly living in the country) I become socially isolated? Suppose I never find love? Suppose I become more and more inward looking? Suppose I starve? Suppose I trip over my teddy bear and break a leg; how long would I lie there before anyone notices? And because I’ve been so unwell recently I’ve written very little, and that makes me feel like a failure, which in turn makes me feel more depressed …
I’m pretty sure I’m doing the right thing but doubts about major transitions are perhaps only natural. I’m not enjoying my job any more, and so much of it seems pointless. I’ve recently been so mentally ill I don’t think I’ll be able to do the job properly much longer. I don’t think it’s fair on my colleagues to have to carry me. Already I feel like I don’t have the energy or enthusiasm to carry out really good novel research any more; I was out of it as a manager for too long. I tootled along with research for a while. but am now out of tootling. It’s time to let someone younger have a go. There are things I want to do and can do; I believe I can still make a contribution through writing. So my plan is to maximise time for how I think I can make a difference. But I am doubting the plan. I am doubting whether I can execute the plan.
Why do people not rage more about getting old? It’s horrible. Why do so many go against Dylan Thomas and go gentle into that good night? Most other people I know either accept the prospect of getting old and infirm and then dying, or don’t even see that there’s an issue. Why am I cursed to be so different? Why can’t I just accept getting it like everyone else?
Perhaps we all rage against the dark, but most people keep do so quietly. The highest suicide rate of all is among elderly men. Am I an elderly man yet? We’re lonely, we feel useless, we feel that we’re a burden, we look at young people around us enjoying themselves and feel envy and regret. Our bodies afflict us with increasing troubles and increasing pain. People expect us to be depressed in a way that wouldn’t be tolerated in other demographic groups. Those of us alone and without children are even worse off. Although as far as I can tell everyone who is severely depressed feels very alone, even if they surrounded by friends and family, so perhaps really being alone doesn’t matter as much as I think it does. I don’t know.
Leaving a job is one of the great transitions in life – particularly for academics, who tend to stay in the same career all their lives, and often at the same institution for decades. I know many people who have only worked at the same place from the beginning of their careers. We lose our focus, our purpose, our social setting, all one day. Overnight any meaning in our life has gone. It is sad to define meaning and purpose in terms of work, but for many work does much more than pay the bills.
On another note, I consider it possible that the relapse has been exacerbated by cutting back on my medication – particularly the quetiapine. I was boasting about this success only two blogs ago, but it could be that as the drugs fell beneath a critical level the depression and anxiety kicked in when life events conspired. My resilience has gone. So my healthcare professionals have urged me to increase the dose again, at least in the short term. I hate it. I hate the sedated feeling, the necessity to sleep so much, and I live in fear of starting to put on weight again after I’ve fought so hard to lose a little. And I particularly hate the fact I can’t concentrate on anything. No wonder I can’t write. I can’t even read much, and that makes me feel like a failure, which in turn makes me feel even more depressed …
Last year I experimented with reducing the dose of my anti-depressant, Duloxetine (Cymbalta), and that experiment was a disaster for my mood. Within five days of increasing the dose again I started to feel better. It could be that I will need this dose of both drugs for ever. And that makes me feel like a failure, which in turn makes me feel more depressed …
Once I have left the job perhaps my life will be defined by having to empty the dishwasher every day, or periodically buy a new tube of toothpaste. It’s these things that I find to be overwhelming, and that make me think most of that savage god, suicide. (I have been reading Andrew Solomon’s The noonday demon, and am relieved to find that he thinks exactly the same way.) I do the dishes today and fuck it, they need doing again tomorrow. It overwhelms me. What is the bloody point?

Hubris: Collapse

Venus sunsetAfter my last blog on how I have fought to cure my depressive illness, the gods would have it that I have had a relapse; it was in fact not so much a relapse as a collapse. Things have been pretty damned awful.

It was triggered by a life event, the details of which I’d rather not go into. It wasn’t unexpected and it wasn’t objectively that bad. But I switched from a state of feeling good and optimistic about everything, to total suicidal despair and extreme anxiety, within a few hours.

Of course being very depressed is incapacitating, and it has really put back the writing. I couldn’t have written this blog from scratch, but fortunately I had some of it ready and am just filling in the gaps. Blogging by numbers. I have written before about how one of the worst aspects of depression, and one that is rarely mentioned, is how it steals our life and our time. I occasionally wish that I was bipolar, when I would have highly creative, fertile periods between the down times. But for me it’s just all time wasted.

I suppose no one is depressed in just the way the textbooks say a person is. We each have our own way  of being mad. I have written about what severe depression feels like to me in the book I am currently writing on the science of depression, No birds sing. (Note to publishers and editors: I am looking for someone to publish this book.)

Imagine feeling sad, but much, much more so, sadder than you’ve ever felt before. Imagine all the lights being turned off in your head. Imagine your mind turning black; black is the colour of depression. All of sudden you’re living in a monochrome world where all feeling and emotion except pain has been turned right down. Imagine a dark ball at the centre of your being that is so cold it hurts. It’s like an icy knife in your soul; it’s worse than any physical pain. You just want to go to bed and cry, to fall asleep, or even die. Die; don’t care if I do. It would be a relief. Death is an end to the misery. In any case, who cares: alive or dead, what’s the difference in the end? I hate myself and my life and I want to die. The idea of doing anything is impossible to contemplate. There’s nothing to look forward to, and nothing gives me pleasure, not even the things that in better mental states I can rely upon to excite me. My despair is utter. Everything is hopeless; I’m never going to get better. I feel a terrible sense of doom and fear, not just that I’m not going to get better, but that the universe is a threatening, mysterious, evil place. And everything is such a bloody fight; everyday life is exhausting. Managing to do the little things can wipe me out after I’ve used up so much energy making myself do them. I feel exhausted all the time. Imagine not being able to concentrate long enough to be able to complete simple tasks, and in any case often forgetting what you were going to do nearly as soon as you form the intention to do it. I make mistakes in the simplest tasks. I have no motivation do to do anything anyway, and no interest in anything. I feel nothing other than total despair. Oh, I do feel amazingly, incredibly guilty about everything, as though I’m lazy, incompetent, and everything wrong with the world is my fault. I deserve to suffer so much. Everything is overwhelming, and I am paralysed. I don’t just have very low self-esteem, I am also full of self-hated. I am the lowest of the low and completely worthless; the world would be a better place without me. If I’m depressed for any period of time self care tends to go a bit out of the window: what is the point of shaving? Can I really be bothered to wash my hair? Who cares if the kitchen sink is filthy? I overeat and overeat convenience food, because that’s all I can be bothered to cook. I sit, finding myself in tears, and I’m not sure why. I feel completely alone; no one can possibly understand how I feel just now, and even it there is a person who can, I couldn’t be bothered to speak to them. And in one final little trick of the mind, time seems to slow down to prolong the agony. Every second is torture. So I try to sleep for as much of the day as possible, and I drink wine and take pills to make sure I can sleep. You feel physically ill as well, with aches and pains exaggerated to distraction. There’s a tickle and lump in your throat. I perpetually tug at my eyebrows, and occasionally pull them out so that they contain strange bald patches. And the ear-worms – those annoying tunes stuck in your head that drive you mad. I also worry that I’m a black hole when I’m depressed, sucking in joy around me, ruining the lives of others – so it’s fortunate that I prefer to suffer in isolation. It is paradoxical that I am lonely and yet want to be alone at the same time, but depression is full of paradoxes.

Most people who aren’t depressed think that being depressed is like being very sad, as though a loved one has just died. A sense of strong sadness and a sense of loss pervade depression, but there is much more besides that to it. Anhedonia is the inability to gain any pleasure from anything; the things that normally give me pleasure, such as reading, watching movies, my garden, and music, give me nothing at all other than a sense of profound boredom. I get up in the morning and I see the day stretching ahead with nothing to look forward to other than being able to go back to sleep again. But what most people don’t seem to understand is the pain of depression: it is mental torture. It is a knife being stuck in your mind and being turned around and around so that you want to scream with the pain – or more realistically just kill yourself so that you can get away from it.

I wake up every morning filled with dread. I have great difficulty in getting going. Often I find that the murk lifts for a few hours around 11. I usually have coffee then, which helps even more, but I get the uplift even if I miss coffee out. I haven’t seen a great deal about this 11 am effect in the literature, but I know from speaking to others that I am not alone in getting some relief then. When I was an undergraduate at Cambridge I was taught about a distinction between reactive and endogenous depression (a distinction that no longer stands up), with endogenous (or psychotic) depression being the worse, and characterised by particularly low mood early on in the day.

And then throughout the day there is panic. There is a persistent low level of anxiety that’s worse before 11 but to some extent there every day. Then there are occasional panic attacks; today I had a panic attack while in a car in a tunnel. I just wanted to escape. I wasn’t driving, it was dark, and I could sense all these other cars and people around me, and I just needed to be out of there. I couldn’t breathe. My heart felt ready to explode, and I was drenched in sweat. When you’re really anxious consciousness seems to shrink to a pin prick; the reduction in awareness feels physical, as though your sense organs have been eviscerated. We now at least understand how depression and anxiety are two sides of the same coin.

There is  a huge literature out there on OCD, but I find while I get very obsessed, I no longer suffer much from compulsion. (I did when a teenager.) I can find very little on thoughts just taking over our minds, other than rumination, the idea of going over and over some thought, such as the meaning of life. I find that I just can’t stop thinking about something. The thought is all consuming but there is nothing I can do to release it. I think I’d rather the O be accompanied by a C so that at least I could discharge it occasionally. Instead the same thought, image, or just idea, goes round and round in my mind.

I seem to be very prone to ear worms – tunes stuck in the head. I think I get these worse immediately before an intense depressive episode, but I don’t know of any research on this speculation. But when a song gets stuck in my head – and I mean stuck! I can hear it with crystal clarity, at loud volume, every intake of breath and strum of guitar – I know I’m in trouble, And there’s a limit to the number of times a chap can hear John Denver sing “Annie’s song” and stay sane.

How to cure yourself of depression

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That’s a big claim to catch your eyes and score highly on the search engines. I hope.
To be honest I don’t think you can cure yourself without help from others or drugs or both. I didn’t. And in fact I don’t think you can be cured of depression: I’m not. In fact this blog has been delayed because I’ve had a relapse, and have been feeling extremely depressed this past few days. At the moment (who knows in the future?) depression is a life sentence without a cure; the best we can do is keep it in abeyance for as long as we can, and if we’re very fortunate, that might be for the rest of our lives.
But there are many things we can do to help to help ourselves, and I’m going to talk about some of the things that have helped me. I think everyone might find them helpful; if you’re not suffering from depression, then maybe these will help you to live just a little better life.
And apologies if they seem blindingly obvious to you; they weren’t to me. I’ve learned them the hard way.

Drugs.
If you are really depressed, and if it has been going on for any period of time, you almost certainly need them, and you have to see a medical practitioner to get them. In the UK that means your GP or a psychiatrist, who then writes to your GP. They will almost certainly start you off with an SSRI. Do some research: there are many anti-depressants out there, and they work in slightly different (and mysterious) ways. They take time – weeks, months – to take effect though, so don’t be too dismayed if nothing has happened the next day. You should hopefully start to see an improvement within a few weeks. If the first one doesn’t work, then you will need to try another. It’s preferable that you have someone to monitor your mental state and behaviour, because you are often not the best person to judge if you are getting any better. Different drugs have different side-effects on different people, and if you find yours unbearable, again you should discuss changing drugs with your medical advisor. There are alternatives you can get without prescriptions (e.g. St John’s Wort, SAM-e), but these had no discernible effect on me. If you’re interested, after many years and changes of medication I have settled on Duloxetine (Cymbalta) for depression and Quetiapine for anxiety.

Other people.
You cannot fight severe depression alone. You hopefully have already seen your doctor, but probably should be seeing a psychiatrist as well. I have tried different sorts of clinical psychology and therapy, and have eventually found a cognitive-based therapy system that looks at your childhood, attitudes, and relationships to be a revelation. Different things though seem to work for different people. You will need your friends too, and need to be open with them that you are depressed. Fight that stigma!

Changes.
There are many changes I have made that I think have contributed to my shift towards wellness.

Work.
For want a better name – that thing that someone else pays you to spend your time doing. In the first instance you might need a period of time off work – look into your sick leave entitlement. Contact your HR department.
I took a long hard look at my academic job and decided I had had enough. There are many things I liked about it, but an increasing number of things I no longer enjoyed and that seemed to me to be pointless. On the other hand I love writing and journalism, so I decided to “retire” and become a full-time writer. It’s a financial risk. It might not work out. I might be poor for the rest of my life. But at least I feel that I am in control, and doing only what I think is worthwhile.
You might say I’m lucky being in the position to retire and become self-employed, and you’re probably right. But what is your health worth? What big changes can you afford to make? Is the big house and fast car really worth what you’re having to endure? And big changes don’t apply just to work either: is that toxic relationship really worth staying in?

Exercise.
I think you have to be starting to get well to make some of these changes, or at least not in the pits, but I decided I had to lose weight and get fit. I, like many depressed people, am pretty useless at self-discipline. So I joined a gym and signed up with a personal trainer. It’s one of the best calls I’ve ever made. I’ve lost over 25 pounds so far and my weight is still going down. I feel so much better; I have more energy and after each exercise session my mood is lifted. There’s plenty of evidence for the positive effects of exercise so get to it. And no, I still don’t really enjoy doing exercise, particularly cardio, which I find painful and boring.

Fresh air and light.
Many of us who are depressed really benefit from more light. I try and maximise my exposure to sunshine, even sitting outside when it’s sunny but in the cold depths of winter. I have a light box that I use even in summer when it’s dull. I try and get as much fresh air and to get outside as much as I can even when I’m busy working at home.

Diet.
I have tried many diets (in the sense of modes of eating) and as I have blogged before find the science complicated, confusing, and contradictory. One certainty is that you have to cut sugar and refined and processed food right out of your diet. I have also greatly decreased the amount of carbohydrates I consume. My breakfast will be something like prawns, berries, another piece of fruit, and nuts; my lunch fish, sweet potato, and home-made baked beans; dinner lean white meat or fish, lots of vegetable, and nuts. It’s a bit boring and expensive, as I don’t like spending large amounts of time cooking for myself, but I see no alternative. I also take good quality fish oil supplements. I have cut back on the amount of wine I drink but still find some each evening calms me down; fairly harmless self-medication in moderation.

Mindfulness and meditation.
I find meditation difficult – sometimes it hurts my mind too much to sit still with nothing but my thoughts, even for as little as ten minutes – but I try. And I do gain a great deal from being mindful – trying to live in the moment and be present. The evidence suggests that mindfulness training might be as effective as medication. There are many good books and resources on mindfulness training, so give it a try.

Thoughts.
I have tried to change my cognitive structure – saying “I am not my illness”, working out what the really important things are in my life and changing those things, trying to be honest with myself, and trying to be kind. I accept responsibility for things I do wrong and acknowledge the role of others when things go well. Or rather at least I am trying to do these things!

Routine.
I have written about my search for a perfect routine so many times before (blogs ad nauseam). How can the writer find a perfect day when they can write something good every day and yet fit everything else in? But a routine of some sorts is essential if you are or have been depressed. It’s boring and others might mock you for it, but you’re the one that’s ill or have been ill.

Sleep.
My problem, particularly under medication, is staying awake at night and waking up in the morning. However I used to have terrible trouble getting to sleep. The most important thing is to choose regular times and stick to them, come what may. I have a particular problem with waking in the morning, so I set my alarm for 7.20 and get up at 7.30. Occasionally I really struggle, but I will always be out of bed by 7.55.

Gratitude diary.
My friend Ian Jay swears by a gratitude diary – somewhere towards the end of each day you list three things that day for which you’re grateful.
It’s important to do the things you have decided help you, particularly if you feel yourself becoming ill again. If you’re getting a bit down and start skipping your exercise you’re going to be in trouble. So write out a list and tick the things off every day.
I hope you find some of these ideas useful. Good luck with the fight regardless.