Student depression

University terms are starting all over the country. When I was an undergraduate, the Cambridge term started late, in early October, and our terms were only eight weeks long. That first one was seven weeks six days too long for me.

I have had several responses from students to my blog on dysthymia – low-level persistent depression, or what is now called persistent depressive disorder. The people who contacted me are just the tip of the iceberg. In your class of a hundred fellow students it could be that as many as nearly twenty of them are mentally ill, to some degree, right now. That’s a lot of sick people; imagine a class where twenty people were sneezing and coughing non-stop. Who are these people? Can you tell? Are you perhaps one of them? And a couple of lecturers are probably depressed right now, too.

What’s the leading cause of death for young people aged 20-35 in the UK? Those risky boys speeding round blind bends in their sporty cars? Drugs? Falling under a bus blind drunk? Being mugged and murdered? No, by some way, it’s suicide. Suicide is also the leading cause of death for men under 50. And most people kill themselves because they can’t take the hopelessness and pain of depression any longer. And if suicide doesn’t kill you, depression is associated with a host of disorders, such as heart disease, cancer,  and dementia, which might get you later.

Depression and anxiety are closely related, and usually go together. Epidemiological studies show that anxiety and mood disorders are remarkably common: it’s estimated that one in three people will suffer in their lifetime, and between one in six and one in ten are ill now. The reporting of mental illness has increased, but whether that’s because of better understanding of the disease, better diagnosis, reduced stigmatisation of the ill, increased pressure of contemporary life, or, most likely, all of these, is unclear.

When I was young (under twenty, say), I didn’t know what depression, anxiety, and obsessive-compulsive disorder were, although in retrospect I suffered from all of them. I was aware of something my relatives talked about in rather hushed tones called “a nervous breakdown”. I’m still not entirely sure what one of these was, but I think it was a sudden mental illness requiring some kind of treatment, and even incarceration in an “asylum”. Treatments were very limited back in the 70s; remember that chlorpromazine wasn’t released to the market until 1953, the first benzodiazepine, Librium, in 1960; and the first antidepressants in 1957 (iproniazid, a MAO inhibitor) and 1958 (imipramine, a tricyclic), although these drugs have many serious side-effects. The relatively more benign Prozac (fluoxetine) wasn’t available until 1987. I don’t think I knew about these drugs until I switched as a student from Natural Sciences Physical to Psychology. Indeed when I was a teenager, I thought of treatment as shock treatment; that’s about all there was.

Attitudes started to change when Prozac became widely available; perhaps that’s generally true – diseases only begin to lose their stigma when there is some hope. When I was young “cancer” was another dirty word, sometimes just called the “c word”. Don’t ask my younger self about swearing though; when I was ten, I thought the filthiest word in English was “pub” (where my father went Sunday lunchtime).

I was the first person in my family to go to university, and I had no idea what was involved, no idea really what a degree was (although I knew students “read” for it on University Challenge), no idea how to manage money (fortunately credit cards weren’t available then), no idea how to manage my time, no idea how to study independently, no idea how to live, no idea how to make use of what was available, no idea what a girl was, and no idea of how to cope when I was a raving loony without realising it. I was extraordinarily shy, which didn’t help. I wasn’t lazy; I tried my best, but I had no idea how to organise my time. I expected university to be like school, which of course it isn’t.

I stuck out the first year, mostly because I drift through things and staying was the easiest thing to do, and I was just clever enough to get by in spite of my deficits. The turning point was joining a society where I met other people. I still can’t say that I felt at home, and at the end of the first year I got a summer job where I did. I was earning good money, I had friends of sorts, I seemed to have some purpose, I felt like I was part of a community, and I wondered why go back to Cambridge. At that point I nearly gave up.

I don’t really know why I didn’t; it was easier to stay than not. And when I went back to Cambridge I discovered psychology, and things started to look up.

If I knew then what I know now I would have got professional help. I would have started with meta learning rather than learning. I would have been bolder about asking questions. Mostly I would have realised that I was ill, I wasn’t alone, and that I should talk to people.

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.

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.

The future is bleak (updated)

As regular readers will know, I am obsessed with death, and I do not understand why everyone else isn’t too. What could be more depressing than the knowledge that it is all going to end for each of us relatively soon, and that eternal annihilation is all that lies in wait for us, whatever we do?

As regular readers will know, I am obsessed with death, and I do not understand why everyone else isn’t too. What could be more depressing than the knowledge that it is all going to end for each of us relatively soon, and that eternal annihilation is all that lies in wait for us, whatever we do? I saw a very old gent in the café last week, and he was enjoying his coffee and smiling beatifically at all around him. Was he perhaps just simple, I wondered? Why isn’t he petrified by the imminence of his extinction? I spoke to my therapist about it, and she pointed out that perhaps he was just enjoying his remaining time (how, I wondered), and was practising radical acceptance of his situation rather than thinking so catastrophically. It’s true that it seems to me that most people I talk to just don’t to give a damn about their own death. And I agree that it is bizarre that I am so afraid of dying that the existential despair sometimes almost drives me to suicide.

On the other hand, in a way I am glad I am not young in these troubled times. Life must surely be much more worrying and stressful for people in their teens and twenties than it was for me, in the good old simple days before pocket calculators. There is so much pressure on you to do this and that, so much political presence and political correctness in your lives, “free space” that are really prisons, with mobile phone cameras you can be in the public eye all the time in an instant, you have social media contributing to enormous peer pressure and perpetuating your simplest most honest mistakes for eternity. And then after working your way through university while building up enormous debts you might struggle to find a good job – or any job at all. But then there’s plenty else to worry about; the end of the world is near for you. I doubt if many of the young today will die a natural death. The things below worry me, and I think I’m rational to be scared by them, even if I am a nutter; they would terrify me if I were any younger, and probably just immobilise me with fear. Or drive me to suicide.

Terrorism. Surely top of anyone’s list of worries? I worry about being personally involved every time I fly or catch a train, drive over a bridge, or visit London, but I’m sure I’m not worrying enough. They will find a way to get to us in places and ways I can’t imagine. And that’s just in the short term. Surely in the long run terrorists will acquire biological and nuclear weapons; we only have to wait long enough for the worst to happen. So in a hundred, too hundred, three hundred years, whatever, they will lay waste to London, Paris, New York, and doubtless many other places. It’s just a matter of time. Verdict: grim.

Russia. Now even as a proud liberal I’m more pro-Russian than most people I know. I appreciate its geography and history, and therefore that they feel threats many of us can’t imagine. I can see why they needed Crimea as west Ukraine headed in the direction of even more west; Sevastopol is their only warm water port, and not a particularly good one at that. I also am a great admirer of Mr Putin, and have my own ambition to be photographed naked holding a machine gun one day. Oh those Russians. And if Russia doesn’t scare you, what about China or India? And the Middle East isn’t going to become a happy place anytime soon. Apologies to all my readers living in those countries; you’re probably worried about us (as well as each other). Yes, the geopolitical situation keeps me awake at nights. Scary.

Viruses, biological, and chemical warfare. We don’t even need people actively searching for ways to kill us; accidents and mistakes will happen. But why people would want to unleash a virus that is just as likely to kill them in the end as kill us in the short term is a mystery to me, but that’s nihilism for you. Perhaps they’re just hoping for a little local mega-tragedy. But if the terrorists don’t get us first then nature surely will; new viruses are always appearing and mutating, and even good-old fashioned bacteria are becoming increasingly antibiotic resistant. Eventually something really bad is bound to turn up. Yes, a pandemic such as the Great Plague of 2026 will wipe most of us out, probably in an unimaginably horrible way. Boils on the brain or something. Time to prep! Frightening.

Nuclear explosions. See also under terrorism. With a new cold war round the corner, and rogue states acquiring weapons, surely it can only be a matter of time before something happens somewhere. And if countries somehow manage to restrain from throwing their nukes at each other, and if mad men (and men they always are) don’t take charge of the arsenal, mistakes will happen; we’ve come surprisingly close to accidental nuclear war before. Within the next millennium it’s almost certain to happen. Megadeaths will leave humanity looking like the worst kind of survival disaster movie. I expect to see a double flash most days. Horrifying.

Nanotechnology. Now we get to future technologies that most people don’t worry about much at the moment – but they should. Nanotechnology means lots of very tiny things that may be able to replicate and might turn out not to be that controllable. Nanobots crawling around your veins and arteries scraping away cholesterol and plaque sounds wonderful, until as a result of some coding error they start scraping away at your artery walls too. Who you going to call? Perhaps we should retrain the unemployed (everyone – see worry below) as Botbusters. And nanobots munching away on rubbish and plastic bags turning them into compost is an excellent idea, until by mistake they decide that everything organic, including humans, is there to be munched on as well. Disturbing.

The disappearance of work. Jobs are disappearing all the time. Those that can be are being outsourced to countries where the wages are much lower and where they don’t have troubling legislation such as a minimum wage. Computers and online resources are claiming many other jobs – when was the last time you went to a travel agent? Robots already do much manual labour in garages, and I see that they are now taking over the jobs of at least some surgeons. What will be left for us to do in a few decades? A few high tech jobs; some teaching; creative work; maybe. Politicians, for sure. The overall effect will be to reduce the availability of work and so drive wages down. But there is a problem here that I don’t think has been much thought about: the owners of most of the computers and robots are making products for people to buy. But what will happen when the people can’t afford to buy anything because they have no money because the robots took their jobs? The whole system will collapse. We will be reduced to a nation of people working in coffee shops so that we can earn just about enough to go and buy coffee in another coffee shop in our breaks. I’m glad I don’t have to worry about starting out on a career just now. Unsettling.

AI and robots. I have recently finished reading Nick Bostrom’s Superintelligence, which talks about the threat posed by the development of artificial intelligence (and the associated robotics industry). Apparently the average prediction by “experts” of when we will develop an artificial intelligence with intellectual abilities greater than that of a human is 2040. Now of course as a professor of cognitive psychology I foresee all sorts of difficulties: our intellectual abilities and our consciousness arise because we develop from  birth, endowed with genes that prepare our brains and intellect for life that have been honed by hundreds of thousands of years of evolution, grounded in the world, surrounded by other people, and with five sensory inputs (with feedback). I think 2040 is very optimistic. But I don’t see that as “in principle” argument against the development of super-intelligent conscious artificial intelligence – just that it’s more difficult than many people image. It isn’t merely a question of developing a computer with enough megaflops. Some might be surprised that I accept the idea of a conscious computer so easily, but if it has the right stuff, I don’t that it’s possible, I think it’s inevitable. You can’t have a zombie that acts as though it’s indistinguishable from a conscious being but isn’t conscious. (More on this topic in my forthcoming book, The Science of Consciousness, due to be published in 2017.) But what reason do we have to suppose that when we develop a real AI that it will be friendly towards us? Might we not instead face a Terminator-like future where the missiles are fired and machines turn on the remaining few? I don’t find there to be much comfort in ideas such as those proposed by the science fiction writer Isaac Asimov that if we programme machines with his three laws of robotics (“a robot may not injure a human being or, through inaction, allow a human being to come to harm”; “a robot must obey the orders given it by human beings, except where such orders would conflict with the First Law”; “a robot must protect its own existence as long as such protection does not conflict with the First or Second Laws”) that all will be well. Humans live by laws, and they do a lot of people no good at all. People can’t even manage to drive without using their mobile phone. Why should a super-intelligent AI, with its own personality, life history, and at least the delusion of free will, feel obliged to do whatever we do them? We act in accordance with our own best interests (or at least think we do), so why shouldn’t an AI? I see disaster down the line. And will AIs suffer from existential despair? Will they worry about the power supply being switched off? And will they act to stop that happening? And then we’re assuming that intelligent AIs which have their own goals and personalities will be sane. Humans aren’t, so why should artificial humans? Why shouldn’t an AI become traumatised, or suffer from depression, or anxiety, or even personality disorder? Doesn’t mental illness come with the territory of being conscious? What would a psychopathic super-intelligent AI connected to the internet do? Or a suicidally depressed AI in charge of nuclear weapons contemplate? Alarming.

The network of things. My central heating is connected to the web, so when I’m in California I can play with turning the heating up to 30C back home. My pressure cooker is already pretty smart, but presumably the next generation will be networkable, so I will be able to cook my beans at a swipe of my iPhone from anywhere in the world. There are already robot vacuum cleaners, and fridges that check what you put in and take out and order food automatically for you. What happens if your fridge goes haywire and refuses to open, or if it orders a million toilet rolls instead of a nice piece of cheddar? Will you starve to death? So if terrorists, Russians, germs, the plague, nukes, tiny things, and robots don’t get you, your fridge probably will. Terrifying.

… To which I add a few weeks later:

Genetic engineering. How could I possibly overlook this one? I foresee nothing but trouble. Bring on the Daleks. Worrying.

Social media and surveillance. Isn’t Britain already the most watched society in the world? Aren’t there many calls of many people who should know better to monitor the press and curtail freedom of speech? Don’t we already have libel laws so draconian that people flock here from other more liberal counties (e.g. the USA) to press their grievances? I have just finished reading David Eggers’ “The circle”; although I think it is a flawed novel in some minor ways, it is immensely readable and thought provoking. With our obsessive use of social media, our pursuit of fame without effort and the idolisation of celebrities, and our ignorance of how our liberties are being eroded, we are sleepwalking to the sort of disaster chronicled in “The circle”. China is apparently working on a scheme that sounds like it should be left in science fiction where citizens accrue points for “good citizenship” (see this BBC article for example) – well, you can guess the sort of thing that makes you a worse citizen than your neighbours, and some of the possible consequences. Scores in the first instance might affect your credit worthiness or enable you to jump a queue for a good flat. But you can imagine a society where our Facebook posts and blogs are monitored, and all of a sudden things happen like your bin is “accidentally” not emptied one week. Or you get carted off to a gulag at dawn. Perhaps we already are monitored in this way and it was no accident that my supermarket home delivery last week didn’t include macadamia nuts. Thought provoking.

And then if we do somehow manage as a species to survive all that, and colonise space avoiding the doom of the solar system, we will eventually face the heat death of the universe. Surely anyone rational should all be very depressed.

Obsession

Depression alone is bad enough, but unfortunately it is rarely a pure affliction: people with mental health issues are usually doomed to suffer many versions of misery. Depression and anxiety go together, so much so that many researchers believe that there is a deep relationship between the two. Unsurprisingly then, both benefit from the same sorts of pharmaceutical treatment (SSRIs).

Anxiety comes in many forms, and many of us suffer from more than one. At different times I’ve had my share of social anxiety, generalised anxiety, panic attacks, agoraphobia, and other phobias. I have found that one of the most striking – I want to avoid the word distressing because all forms of anxiety are distressing to those who suffer from them – is obsessive compulsive disorder (OCD). When I was a young teenager my life was blighted by OCD, often in florid forms. In the night I would go down the stairs dozens of times to check that the front door was shut; I would get up multiple times throughout the night to check that my bus pass was still in my school jacket pocket; I would repeat things in multiples of three. I was afraid of contamination, the idea that germs and disease could spread by touching something that touched something that touched something, or even by having seen someone with a disease. I would then wash my hands several times (in multiples of three of course). I was afraid other people could read my thoughts, or would misinterpret an innocent gesture as an offensive one, so would apologise inwardly to them (in powers of three; twenty seven sorries is bad enough, but just try eighty one).

All classic stuff. I didn’t know what OCD was then, and I just suffered, alone, in misery. OCD is, to use a cliché, living hell, and it’s even worse if you think you are alone and have no idea what’s going on. In retrospect something should have been done about it, but I just grew out of it. Mostly – I still have a tendency to overcheck things, usually three times, but no more, and only occasionally, so it doesn’t bother me. We can live with some pathology. Being obsessive even has its advantages as an academic; there’s nothing wrong with checking your data a few times, or being careful about proof reading and checking your facts are right. Being a writer is sometimes obsessive; we often feel a pressure to write. I think you need to be a bit obsessive just to overcome all the negative feedback writers get. The boundary between OCD and having an obsessive personality isn’t always clear – as ever the problems start when what we do makes us unhappy, or interferes with our lives. We also have a problem if our behaviour doesn’t make us unhappy, but affects those around us.

As with all mental illness, the precise causes are unknown, but as with depression there is almost certainly there’s both a genetic and environmental component. The brains of people with OCD look different, but again whether that’s a result or cause of the illness, or whether both result from something else, is not know.

But not all obsessions involve an obvious compulsion other than one to keep the obsession going.  We all have things we worry about from time to time. Most of us are familiar with “ear worms”, tunes that get stuck in your head. I suffer very badly from these (I speculate it’s to do with my psychopathology). It can drive me mad – or more precisely even madder than I already am. They’re the strangest tunes too – I once endured a week of John Denver singing “Annie’s song” non-stop. Worst of all though are obsessive thoughts, the rumination on particular events, ideas, or people that takes over our minds. It is horrible. The compulsion, in as much as there is one, is to continue the obsession. The thoughts – bad thoughts – involve regret, guilt, and fear. When I was in my OCD phase as a teenager at the end of every school term I would struck by the idea that I had done something wrong, and the school holiday would then be ruined by the fear of punishment that would await me on my return at the start of the next term. Of course I never had done anything, and was never punished; it was all in my head. It’s impossible to reason yourself out of OCD.

I think obsessive thinking is verging on psychosis, because things really are out of control. We might refuse to accept that the obsession is irrational, and some people might even act upon their obsessions – I assume that is how people become stalkers. I just suffer though.

Obsessions without compulsion is called “primarily obsessional OCD”. I was encouraged to see that the Wikipedia entry on OCD says that “Primarily obsessional OCD has been called one of the most distressing and challenging forms of OCD”; it’s more than distressing, it’s mental agony. I almost envy people with OCD because at least enacting the compulsion provides a little relief, no matter how short.

However illogical and crazy the behaviour might seem to someone who has never experience OCD, it is impossible to reason your way out of the illness. You can’t tell yourself that it’s irrational to wash your hands so many times. First, the compulsion is stronger than our belief system. And second, there is always a grain of truth we can cling to – it is just possible that a disease might be passed on by touching something that was touched by someone who touched someone with a disease, for example. There is though a clear treatment plan for OCD that involves breaking the link between obsession and compulsion. One of the best books I have read on OCD is Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, by Jeffrey M. Schwartz. He identifies four stages in treatment: relabel (you must recognise what is obsessive and clearly label it as such); reattribute (this thought is not me – it’s my OCD); refocus (the really hard bit, where you have to shift attention, at least for a while); and revalue (to take the whole cycle as something not to be taken as face value, and to adapt the view of a more impartial observer – being mindful). He suggests gradually building up a delay between having the compulsion and having to do it – you might only be able to manage a few seconds at first, but you increase it, perhaps very slowly.

Such treatments, while effective for dealing with the compulsive actions, don’t immediately help us in being able to stop the bad thoughts coming in the first place. In a recent bout, ruminating on a mistake I had made, I tried saying internal loudly and firmly, “It was my choice”, which I eventually simplified to a loud “STOP!” in my inner speech. This approach eventually worked – or the bout blew itself out. A friend told me that a common technique is to visualise a STOP road sign, and I have since tried combining visualising the sign with thinking STOP! It is exhausting work though; bloody exhausting. At least my obsessions appear to have a natural life span, and eventually, after much pain, they eventually peter out.

The intrusiveness of thoughts is one reason why I find meditation so difficult. My thoughts just won’t go away. Even when counting breaths the thoughts overwhelm my inner voice counting. There is a paradox here because if I could just be mindful and live in the present, I wouldn’t be so obsessed by Bad Thoughts, but the Bad Thoughts stop me being able to attend to the present. Coming back to the now and trying to be present does help me when I’m being obsessive, and I think it’s a skill at which one can get better with practice.

I am grateful to and encouraged by everyone who has written to me about my blog. So many people suffer alone; it is time to stop the stigma of mental illness. For a long time I thought I was alone in suffering from obsessional thinking; if we all shared more we would be less isolated, less frightened, and maybe just a little better off. Please feel free to share this blog with whoever you might think would benefit from it.

 

 

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.