anxiety – What is the meaning of my life?

How to help recovery from depression

How can we help ourselves to recover from depression? There are several things we can do.

I have been overwhelmed by responses to my previous post on the experience of being anxious and depressed.
The comments fell into four broad categories:

1. Commiseration and agreement. The most common response, and I thank you all. It helps to feel supported and that others feel similarly.
2. I should turn to God. I realise this works for some people, but it is not for me. I am not though going to talk people out of it, or try to persuade them that they are wrong (even if I think they are). If you have faith, and it helps you, I am pleased for you.
3. You should choose to make yourself feel better. This sort of comment is fortunately rare, but the underlying belief is unfortunately quite common in society more widely, and misunderstands the nature of mental illness. It essentially says we are choosing to be ill; to use my favourite analogy, would you say that to someone with cancer? Pull yourself together and snap out of it? It is the sort of belief that stigmatises depression because it’s essentially saying that we are weak and can’t be bothered to help ourselves. It’s all our own fault. It just makes me annoyed.
4. It’s depressing. What did you do to feel better?

I’m going to focus on the final point. I’ve covered many of these things before but I’m putting them altogether here. This list covers how, with much help, I’ve made myself better from the nightmare described in my previous post. Note I say better, not well. Rather like an alcoholic, I fear I always be on the edge.

1. Seek help. There is no need to suffer alone. Call your GP or other health professional, call NHS Direct, or, if you are desperate and thinking about suicide, call the Samaritans. They are wonderful.
2. Remember that there should be no stigma attached to mental illness. You might meet the odd person who tells you to pull your trousers up, or that you brought it on yourself, or whatever, but they are wrong (see above). It’s not easy, but just ignore them.
3. Take medication. You’d take medication for flu, or TB, or cancer, wouldn’t you? Yes, many psychoactive drugs have side effects. You might have to experiment, and go back to your GP and psychiatrist, but remember it takes time for some medication takes time to work and for side-effects to settle down. A bit of constipation is a price worth paying for not feeling suicidal, but remember the extent and severity of side-effects varies from person to person. Consult your GP or psychiatrist if you are worried.
4. All things must pass. You will feel better, eventually. When I am bad I always remind myself of this fact.
5. Exercise as much as possible. I know it’s what everyone says (“when I feel down I just go out for a run”, a doctor once helpfully told me), and when you’re really depressed it’s one of the last things you’d rather do, but it does help. Even a brief walk will make a difference.
6. Go outside as much as possible. Nature makes you feel better.
7. Get as much natural light as possible in the morning. If necessary get a SAD light box.
8. Eat well. Eat for the brain, heart, and against inflammation. See below for some links
9. Stick to a routine you have worked out in advance. Routine might be a bit dull, but it helps mental health, minimises stress, and helps you sleep properly. Talking of which …
10. Get enough sleep at all costs, but not too much. Find a schedule that works for you. I swear by an afternoon nap.
11. Avoid toxic people like the plague. Do not make the mistake I have made many times of believing that you can reason with them or get them to change. Do not perseverate about what they say and just do not engage with them.
12. Consider getting a dog. A dog increases your lifespan by over a year. You have to go outside and exercise ever day. And it releases so much oxytocin. Beau (above) has been a lifesaver for me, perhaps literally.

I should say that of course I don’t have any magic bullet for depression, or any form of mental illness. If I did I’d be well myself, and probably rich. These things have helped me though. I apologise if it all sounds a bit trite and simple.

About me

I am Emeritus Professor of Psychology at the University of Dundee. There is much more information on mental health and other things on my website, http://www.trevorharley.com. Please pass details of this blog on to anyone who might find it useful. There is no need for anyone to suffer in silence. If you are depressed or anxious contact your GP, or NHS 111, or a psychology or medical practitioner, or call Samaritans or Samaritans USA.

Links to healthy eating sites

The Mediterranean diet for general good health and increased longevity.

The DASH diet for hypertension.

The MIND diet for a healthy brain and reducing risk of Alzheimer’s.

What does it feel like to be depressed?

What to does it actually feel like to be severely depressed? To be very anxious? To suffer from OCD?

People who don’t suffer from mental illness often think that being depressed is a bit like being sad, that being anxious is like having a touch of nerves before an exam, and that having a compulsion is simply an urge to do something. They’re all much worse.

Depression is very different from feeling a bit down, or having a moment of passing sadness. It’s an extraordinary “pain in the mind”. Imagine feeling sad, but much, much 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. You’re living in a monochrome world where all feelings except pain have 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. Death would be a relief, because death is an end to the misery. In any case, who cares: alive or dead, what’s the difference in the end? And who would miss you anyway? You hate yourself and your life. The idea of doing anything is impossible to contemplate. There’s nothing to look forward to, and nothing gives you pleasure, not even the things that in better mental states you can rely upon to excite you. Your despair is utter. Everything is hopeless; and you are sure you’re never going to get better. You feel a terrible sense of doom, foreboding, and fear, not just that you’re never going to get better, but that the universe is a threatening, mysterious, evil place. And everything is such a fight; everyday life is exhausting. You can’t concentrate long enough to be able to complete simple tasks, and in any case you forget what you were going to do nearly as soon as you form the intention to do it.

Managing to do the little things can wipe you out after you’ve used up so much energy making yourself do them. You feel exhausted all the time; deep fatigue goes with severe depression. You make mistakes in the simplest tasks. You have no motivation do to do anything anyway, and no interest in anything. You feel nothing other than total despair, and feeling amazingly, incredibly guilty about everything, as though you’re lazy, incompetent and everything wrong with the world is your fault. So you deserve to suffer so much. Everything is overwhelming, and you are paralysed. You don’t just have very low self-esteem, you are also full of self-hatred. You are the lowest of the low and completely worthless; the world would be a better place without you. If you‘re depressed for any period of time self care tends to go out of the window: what is the point of shaving? Can you really be bothered to wash your face? Who cares if the kitchen sink is filthy? You overeat and overeat convenience food, because that’s all you can be bothered to cook. You sit, finding yourself in tears, and you’re not sure why. You feel completely alone; no one can possibly understand how you feel just now. You can’t bring yourself to speak to other people anyway. And in one final little trick of the mind, time slows down to prolong the agony. Every second is torture. So you try to sleep for as much of the day as possible, and you drink wine and take pills to try to ensure that you can sleep. You feel physically ill as well, with aches and pains exaggerated to distraction. There’s a tickle and lump in your throat. You perpetually tug at your eyebrows, and occasionally pull them out so that they contain strange bald patches. And the ear-worms – those annoying tunes stuck in your head – drive you even madder. You also worry that you’re a black hole of misery, sucking in joy around you, ruining the lives of others – so it’s fortunate that you prefer to suffer in isolation. It is paradoxical that you are lonely and yet want to be alone at the same time, but depression is full of paradoxes. When you’re severely depressed you can’t do anything. You just want to sit still and let the pain wash over you. Some people kill themselves because they can’t take the pain any more; and some people are so ill they can’t even initiate the act of suicide. You have contemplated suicide many times because everyday life hurts too much, and often you really don’t care if you wake up tomorrow morning or not.

That’s what it’s like for me at its worse, but fortunately therapy and medication has helped me enormously. It’s been a while since I’ve felt that bad, but I still get occasional relapses, occasional inklings of those feelings.

I find severe anxiety more difficult to describe. It is a bit like being anxious before an exam, or giving an important presentation or wedding speech, but much more intense and persistent. It is also highly visceral; it gets to your gut. You can’t concentrate on anything, but instead worry about everything. You’re completely on autopilot.

Anxiety often goes with depression, giving a condition imaginatively known as “anxious depression”. There is also agitated depression, which is similar but with more activity – of a bad sort.

It is my misfortune to suffer from obsessive-compulsive disorder (OCD) as well (which is occasionally co-morbid with depression). An obsession is not just like a pre-occupation; it is all-consuming, and you can think of nothing else. A compulsion isn’t simply an urge to do something, or check that you really did lock the door; you must do it, usually many times. My OCD started when I was about 11. I would repeatedly get up in the night to check that my bus pass was in my jacket pocket, and go downstairs to check that the front door was shut. I think it was about fifty times a night, possibly more. Why didn’t anybody notice? Then when a passenger in the back seat of my uncles’ cars I would worry that passing drivers would be able to read my thoughts (even though I knew that was impossible), and might be insulted by them, so I had to apologise to them by saying “sorry” mentally – in powers of three. Occasionally I would reach 243 sub-vocalisations. I suffered greatly performing these compulsions, but the prospect of not doing them filled me with even greater pain. Performing these compulsions also releases the mental pressure somewhat, perhaps in a similar way that self-harm makes some people feel a little better. Eventually the compulsions faded away, to be placed with slightly less compulsive compulsions, such as hand-washing (but much less excessively). I still tend to do things in multiples of three (such as checking the front door is locked behind me nine times), and I am still a very obsessive person, with curious obsessions like having to have complete sets of things such as books all in the same format.
That’s what it’s like when it’s bad, but even then perhaps I have failed to capture the full horror. I am sure that for some people it is even worse.

I am Emeritus Professor of Psychology at the University of Dundee. There is much more information on mental health and other things on my website, www.trevorharley.com. Please pass details of this blog on to anyone who might find it useful. There is no need for anyone to suffer in silence. If you are depressed, anxious, or suffer from OCD, contact your GP, or NHS 111, or a psychology or medical practitioner, or call Samaritans or Samaritans USA.

Fear of death

When I was three or four I was afraid of television aerials, dogs (particularly black ones), plugs, painters, thunder, and pneumatic drills. As I grew up these specific fears resolved into more general anxiety disorders, but I still have mild arachnophobia (I bear spiders no ill will, but they have far too many legs and move much too quickly for their size), and thanatophobia, a profound fear of death.

When I was three or four I was afraid of television aerials, dogs (particularly black ones), electrical plugs, outdoors painters, thunder, and pneumatic drills. As I grew up these specific fears resolved into more general anxiety disorders, but I still have mild arachnophobia (I bear spiders no ill will, but they have far too many legs and move much too quickly for their size) and thanatophobia, a profound fear of death.

Most people don’t want to die, but I am surprised how casual most people are about their eventual demise. Why isn’t everyone raging against the dying of the light from the moment they first realise that the light will some day die? I think that in twenty-five years or so I could well be dead, and I think back twenty-five years from now and that doesn’t seem to be any time at all. Even if I die peacefully in my sleep, which seems to be most people’s goal, I won’t be happy. When I reflect on my fear I’m particularly afraid of not being conscious ever again. The universe will roll on perfectly well without me. A few people will grieve, but that will fade, and the ripples of the effects of my life will soon die down and I will be forgotten. Just writing that makes me very, very miserable. And angry, as does thinking about the unfairness of having to get old.

Mental illness requires consciousness. Your computer can’t be depressed, but a dog can be; we know from Martin Seligman’s studies on learned helplessness that dogs can show symptoms akin to depression, and of course other animals can suffer mentally too. Social outcasts in groups of social primates also give the appearance of being depressed. But can a wasp be depressed? We can’t know for sure, but it doesn’t seem likely. A wasp has very little consciousness, not enough to feel depressed. I explore animal consciousness in my new book, The Science of Consciousness.

Some forms of mental illness require more than consciousness: they require self-consciousness: thanatophobia is one example, and illnesses to do with the meaning of life are another. I am pretty certain Beau, my poodle, is not afraid of his death. Of course (non-human) animals are capable of fear and other negative emotions, but not of concepts that require self-reflection. I don’t think he has any concept of death, so he can’t be afraid of it. I’m not saying that if something happened to me he wouldn’t be very upset, but that he can no more appreciate the meaning of mortality than he can understand quantum mechanics. These concepts are utterly beyond his comprehension because he doesn’t have the mental capacity for them. It isn’t simply that the concepts are too complicated for him, it’s that reflecting on the death of his self requires a complex concept of his self, and for that he requires self-awareness. Awareness and self-awareness are very different things. Many animals are (probably) aware, but few are self-aware. I’m not sure it’s right to talk about awareness and self-awareness as if they are a dichotomy – he might possess a bit of self-awareness, but not enough to worry about his death.

Can we learn anything useful from all this? On the whole I’d say Beau is much happier than me, and he doesn’t spend his life reflecting on canine existential concerns. I think his happiness and restricted self-obsession are related; sometimes humans reflect too much. Of course some thinking is good: it’s good to be aware of our situation; it’s important to prepare for our deaths and leave our affairs in order, and I wouldn’t want to put existential philosophers out of a job, but for many of us too much reflection can be a bad thing. We should look at Beau and realise that it is good to live in the moment, which is essentially what studies of mindfulness and mental illness tell us to do. This obsession with death is also utterly futile because there is nothing I can do to prevent my impending obliteration. And maybe that’s true of much mental illness: we need to learn to stop thinking. Easier said than done of course.

Psychologists occasionally reflect on what makes humans unique. To the list of language, a highly convoluted cortex, and opposable thumbs, I think we should add the ability to suffer mentally in particular ways. Our uniqueness has given us unique ways of being tormented.

Anxious about anxiety

Severe anxiety is just as crippling as severe depression. Depression and anxiety aren’t in opposition: they’re comorbid, with a person who suffers from one being much more likely to suffer from both.

It’s getting to be almost acceptable to be depressed. Public awareness has improved immensely over the last few years, and while people with depression still face a great deal of ignorance and discrimination, I think the corner has been turned. Every day sees some celebrity coming out as mad; even famous footballers are admitting to being depressed, even suicidal.

I can’t say the same about anxiety, particularly generalised anxiety disorder. Severe anxiety is just as crippling as severe depression. Depression and anxiety aren’t in opposition: they’re comorbid, with a person who suffers from one being much more likely to suffer from both.

And as I sit here writing I am really suffering. Anxiety is more difficult to describe than depression. Everyone is occasionally a little down, and can at least begin to imagine depression by magnifying the feeling. I don’t think there’s a healthy equivalent of anxiety. Perhaps the flutters you feel when you’re late for a train or plane or having to give an important talk or public speech. But for me anxiety and nerves are very different.

Severe anxiety is just as crippling as severe deoression. You don’t want to do anything because you can’t. You don’t want to travel. You don’t want to talk to people. You don’t want to catch a train. You don’t want to go into town. You don’t think you can give the talk you’re just supposed to be giving. You don’t want to go outside. I hate the outside. I can just about manage the garden, but the village shop? It might as well be Antartica.

The Wikipedia entry talks about excessive worry, and worry is part of the problem, but there is also a huge physical element: sweating, racing heart, breathing shallowly, and shaking. But the bit I hate most is the shrinking of consciousness, the narrowing of the mind, so that you can’t concentrate on anything. Oh, and the irritability. I am not a nice person to be around around at the best of times, but when I am anxious – avoid me.

I know there are things you should do, including mindfulness, relaxation, and deep breathing, but these activities all presuppose that you have enough focus to be able to begin to focus. There are drugs, but they make you feel sleepy and brain dead.

The academic life and mental illness

The academic life for staff and students defies common perceptions and is one of the most stressful jobs around. It contains many triggers for depression and anxiety.

My mother thought that being an academic was one of the cushiest jobs she could imagine – a couple of lectures a week and holidays for six months of the year. She thought students had it even easier having to go to those few lectures, take an exam or two a year, and spend the rest of the time travelling the world. She also thought they were out partying every night, finishing drinking at 3 a.m. and then trashing the town. I suspect she was not alone in her prejudices. How wrong these common perceptions are. I think being an academic, and being a student, is one of the worst careers for aggravating, even causing, mental illness. The job has the following triggers.

The work is open ended. How I used to envy people with 9-5 jobs. Academics and students are never finished because there is always just one more job to do, whether it’s another paper to read or write or a textbook to go through again. When I was Dean it amused me that HR had a workload model for academics of 40 hours a week. I don’t know anyone who worked less than 50, and many did much more. What is there to stop us? We don’t leave the building and down keypads just because the clock moves on to 5, or because it’s the weekend. And if you should finish one job, there’s always another to do. There’s nothing to stop us doing more. Few things are more stressful than knowing you have an uncompleted task to do, and that you could be doing it, and that you have the time to dot it.
What is work anyway? The same analysis is true of holidays as is true of the working week. I know of several academics who have booked annual leave in order to carry out research. When I go on “holiday” I read psychology articles and books, as do most people I know. When I was a student I would spend the vacation working in a factory in order to earn money as well as studying while travelling and in the evenings and weekends. Those maths worksheets seemed never ending. Christmas will find us reading and writing. For us there’s no such thing as a proper holiday.
The work contains contradictory elements. We’re expected to carry out world-leading research as well as teach to the highest standard, and you get evaluated on both. I know there is some carryover between teaching and research, but time you spend teaching is time you can’t spend doing research, and vice versa. Contradiction is stressful.
Giving a lecture or presentation or tutorial is stressful. Fear of public talking is one of the most common fears, being strong enough to count as a phobia for many people. Yet we have to do it all the time. Training is often inadequate. Some students find they’re not really prepared and although they might be taught how to organise their material and how to use Powerpoint I don’t know of anywhere that teaches them about the fear of speaking and how to overcome it. I’ve known of several students being physically sick before having to give a seminar. Speaking feeds fears.
Deadlines. The life of the teacher and student are very similar in they they’re both full of deadlines. You have to give that lecture tomorrow or hand in that essay by 4 p.m. You can’t decide you’re going to take the day off instead. You need to be really, really sick before you call in. Deadlines are often too close together or even on the same day. Deadlines are exceptionally stressful.
You have to organise your own time. One day you think you’re settling down to finish writing your 4 p.m. lecture, or finish your essay, when something happens. Your manager or supervisor wants to see you urgently (and it’s nearly always urgently). Your car won’t start. Your child or dog is unwell. There are suddenly 15 new pressing emails. Someone wants to see you and just won’t stop talking about their problem. And worse than deadlines are jobs with no deadlines because unless you’re very careful they never get done. You live from one deadline to another, one essay or lab report handed in to the next. So just when do you do that background reading, or write that important paper that could help you get promoted? When there’s no deadline and you’re tired and fed up it’s easy just to stop. And many deadlines aren’t real, anyway: do a a journal review by the end of the month? Sure, I’ll agree tot hat. Get to the 31st, and no problem, because everyone knows that if you send the review on the 1st it won’t matter, and what’s the difference between the 2nd and the 1st? When I was Dean I was always giving deadlines for jobs that I needed to follow up on, and less than half the staff would do the job before my deadline. What was I to do? Fire someone for being two days late with a document? In any case they were probably just busy with the last thing I asked them to do. The problem is that delays cascade. No-deadlines are often worse than deadlines.
There is far much more rejection than praise. Journal acceptance rates are very low and grant rejection rates are very high. I’ve known people to send off an excellent grant proposal ten times before it gets accepted, and much outstanding research never gets funded. How demoralising it that? Feedback for students is mainly a long list of things you’ve done wrong. Of course that’s good in a way because you want to learn and improve, but persistent negative feedback gets to you. After a while people develop learned helplessness. Continual negative feedback is stressful and causes depression.
It’s an exceptionally competitive environment for staff and students. Not everyone can get promoted every year. Not everyone can get a grant. The top journal can’t publish everything. Not every student can get an A every time. Perpetual competition is stressful.
Some people are stars (but you’re not). But if you don’t succeed you sure will be aware of someone who has. You have to congratulate them through gritted teeth. Although you are struggling just to manage, you will know at least one person who seems to sail though. In every field or every department or ever class there is at least one Einstein. We admire them, we have to praise them, but really they just make us feel worse. Comparison makes us feel sick.
EMAIL is evil. When I was Dean for every email I had to send I would get at least three back. It would be easy to spend all day doing nothing other than email. I am not alone: everyone I know is dreaming in a sea of email. And then there’s social media which some find compulsive. Often when lecturing you suspect every student is checking their messages or Facebook status. How demoralising is that? How do we cope when we’re striving in a sea of email that gets deeper every day? Smash up every computer or phone you see.

These triggers are more numerous than in many jobs. You might say other careers are bad too, but often they are better paid, and students aren’t paid at all – in fact they have to pay to have all this fun. And staff and students are often the sort of people who are least able to cope, having been brought up learning to expect to succeed.

I have no solutions. If you decide you’re going to take a real holiday for a month, you know that the departmental Einstein won’t, and they’ll have a stronger case for promotion than you at the end of the year. Off sick for a week and dare not to do that marking? When you come back that marking will still be there, but with another pile to join it, now with the same deadline. Oh, and whatever you do there will be two hundred emails in your inbox.

One thing we can do is face our weakness and admit we’re struggling, that we’re feeling anxious, that our agoraphobia has been triggered and we’re scared to go out, that we’re too depressed to talk, that our OCD has come back and is making us check every mark ten times (actually for me it has to be a multiple of three). To return to where I started, my mother thought mental illness, unlike physical illness, was a weakness. She was very, very wrong. Mental illness is nothing to be ashamed of, and talking about it is better than getting so bad that all you can think about is suicide.

I wish

I wish I had blue eyes.
I wish I had a smaller nose.
—
I wish I wasn’t depressed.

I wish I had brilliant blue eyes.

I wish I had a smaller nose.

I wish my thigh bones were two inches longer.

I wish I didn’t have a psycho tummy.

I wish I had had a better relationship with my mother.

I wish I had just 10 more IQ points.

I wish I had children.

I wish I had a strong jaw.

I wish I had been to Australia.

I wish I had just a bit more money.

I wish I wasn’t pigeon chested.

I wish I had tracked down my friend Carl before he died.

I wish I wasn’t crippled by anxiety.

I wish I had known my father.

I wish my mother hadn’t died last year.

I wish I had more friends.

I wish I hadn’t messed everything up

I wish I could go outside.

I wish my mind wasn’t mud.

I wish I wasn’t depressed.

I wish quite often that I was dead.

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.

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? 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.

	trevorharley on What does it feel like to be…
	ssergosum on What does it feel like to be…
	trevorharley on What does it feel like to be…
	ssergosum on What does it feel like to be…
	trevorharley on Ups and downs