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.

Loneliness

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

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

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

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

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

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

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

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

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

 

 

Getting the words out

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

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

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

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

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

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

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

 

 

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

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

 

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

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

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

 

Commitment and commitments

Some people seem to have more time than others. There are only 24 hours, only 1440 minutes, only 86,400 seconds available for all of us each day. Yet some make more of those minutes than others; they make their minutes count more than the rest of us.

Such a perfect day – how often can we say that, even on those rare days when we are fit, well, and happy? I usually finish the day with a profound sense of disappointment, feeling that I could and should have done more that day, which means that I should have done things differently.

I have just finished reading Mark Forster’s Secrets of Productive People: 50 Techniques To Get Things Done. I enjoyed it a great deal, and there were several thought-provoking points that stuck with me. I must admit it wasn’t quite what I expected from the title; I was hoping for an analysis of how really productive people actually spend their time (see below). Nevertheless Forster’s books are ones I would recommend to anyone interested in time management, productivity, writing, creativity, or generally living a better life.

I was particularly struck by this quote:

“Don’t say you don’t have enough time. You have exactly the same number of hours per day that were given to Helen Keller, Pasteur, Michelangelo, Mother Teresa, Leonardo da Vinci, Thomas Jefferson, and Albert Einstein.”- H. Jackson Brown Jr.

I must admit I thought I hadn’t heard of H. Jackson Brown Jr. before (it turns out that he is author of Life’s Little Instruction Book, which was a bestseller in the early 90s), but I am now sure that I have seen some of his homilies on calendars and tea towels (“Drink champagne for no reason at all” strikes a particular chord with me). Of course the meaning of the quote is obvious and indisputable, but it really brings home how some people seem to have more time than others. There are only 24 hours, only 1440 minutes, only 86,400 seconds available for all of us each day. Yet some make more of those minutes than others; they make their minutes count more than the rest of us. I accept a few people appear to need less sleep than others, but most of us need around seven to eight. Currently I seem to need seven; any less and I notice I really don’t function at all well. Saving on sleep is a false economy (sadly).

So that means I have 17 hours left after subtracting my sleep hours left every day, and let’s assume that a very successful person has about the same. But even the hardest working person must eat, exercise, shower (occasionally), dress, travel, perhaps shop occasionally, keep the house maintained, clean, pay bills, maintain social and family contacts, and so on. I outsource as many of these as possible, and try and cut back on non-essential activities, but there are limits on what you can do. You might be able to prepare two meals at once, but try going out without dressing. Please, yes try it. And maybe you can multitask a bit (although being mindful means to me that when you shower you focus on the shower and enjoying the water, not thinking about something else). So you end up with considerably fewer than 17 hours a day. I also find hard work, including writing and reading tiring, and there’s a limit on what I can that pushes the limit even lower.

Ah, but some will say, the people named in the quote were geniuses: they need less time to get big things done. Maybe. But what makes a genius? Thomas Edison observed that “Genius is one percent inspiration and ninety-nine percent perspiration”, and the latest psychological research shows that he wasn’t far wrong. Success in anything takes real commitment. We now know that although native talent has a role to play in success, above a certain level of intelligence and ability, sheer hard work and the number of hours put in matters much more than most people think. Where do these hours come from?

Are you happy with what you get done? If not, then the key point that struck me after reading Forster’s book is if you want to do more of something else, you have to do less of something you’re doing now. What are you not going to do that you’re doing? I know it seems obvious, but on reflection it struck me as profound point: if I want to do more reading, writing, and thinking, I need to stop doing something else. What?

I probably do less “inessential” stuff than many people. I don’t watch much television; I don’t go shopping; I don’t play computer games; I am fortunate enough not to have to mow my own lawn; and I count writing this blog as work. I’m not addicted (I think) to email and social media, and although I enjoy food and cooking, I don’t spend too long on it, particularly since I’ve gone on my new “diet”, and I don’t spend as much time napping as I used after making substantial lifestyle changes to fight depression. What else can I give up? Perhaps it’s time for a time audit, but they’re quite a lot of effort and I doubt it will show I waste much time. My vices are reading the opinion columns of two newspaper, but that doesn’t take long, and keeps me informed, and occasional shopping on Amazon and iTunes.

In spite of all those I still feel I have too much to do and not enough time to do it all in. I am not alone: most of us feel overloaded all the time. You might be one of lucky few who think they haven’t got enough activities to fill their days, but if so you’re probably not reading this article. We should be trying to drop things from our lives, but often we take on new stuff. We say yes to things that interest us, or yes to our managers (perhaps we have no choice), or we want to write another book or take up a new hobby. These are new commitments. But we start off already over-committed! So every time we take on a new commitment, we have to ask which of our current commitments are we going to drop (or reduce) to make room for the new one? I want to get back to playing the piano. So what should I drop that I’m currently doing, when I already feel under tremendous time pressure?

So if you want to take on something new, or find more time, you first have to choose something to drop something you’re currently doing. Obvious perhaps, and easy to say, but much less easy to do.

Over-loading creates other pressures. Most people I know say they’re drowning in a sea of email. Many have hundreds (at least one chap I know is almost proud to say that he has thousands) of emails in their inbox. That’s obviously inefficient – I bet if you’re one of these people you’re wading through the same emails day after day, and often miss important, job-critical commitments. It involves handling the same piece of virtual paper more than once, often many times. And exactly when are you going to deal with the backlog? Most people say “one day”, but one day rarely if ever comes. (My favourite email tip is one I learned about some time ago – perhaps from a previous book of Forster: never answer an email the same day that you get it, unless the consequences will be really terrible – or, I suppose, unless you’re conducting a romance by email.)

Every successful person I have read about swears by their routine. I’ve talked about creativity and routine before. It’s a little tedious, perhaps, doing the same thing at the day after day, year after year, but successful people make time for their perspiration by sweating it out at the same time, every day.

Managing time is even more difficult for people with mental illness. Illness steals time. The unfairness of it all burns, but I think it has just to be accepted. We will never get as much done as “normal” people.

Finally, I am still very interested in my original idea of how some people to get so much done in a day. I would really love to interview an assortment of politicians, Nobel prize winners, Silicon Valley success stories, and business magnates, to find out what they do differently from me. Publishers and agents: if you want to commission such a book, please contact me! If you think you are particularly successful in life and have tips to share, please post a comment below or email me at trevor.harley@mac.com.

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.

Big baby: Taking responsibility for our lives

It’s not my fault my blood pressure is too high, manufacturers put too much salt in processed food. Let’s sue the food multinationals! It’s not my fault I tripped up, the council should have put more effort into levelling the pavement. Let’s sue the council! It’s not my fault that I’m fat because I stuff my face with chips, it’s the shops for selling them. Let’s sue the shops! Let’s appoint a government chip tsar to tell me to eat fewer chips! And a salt tsar, and a council tsar, and chip tsar, and a tsar tsar to look after them! And when anything goes wrong, let’s sue the tsar tsar!

I’ve read a lot of life coaching sites and books, and there’s a strong belief that taking responsibility for your life, mistakes, and happiness is essential for personal growth and mental health. It certainly sounds plausible, and there’s plenty of anecdotal evidence, but I’ve found experimental data hard to come by. It’s the sort of idea that would be very difficult to test in practice. We do know from the work of Victor Frankl that the people who found purpose and meaning in their lives, who accepted their situation and who took responsibility for their lives, were those who were most likely to survive in concentration camps. So taking responsibility and accepting the situation can save our lives.

Then there is the well-known related result that when we are successful, we think that it is due to our efforts, and when we fail in some way, we have been unlucky; but when other people  are successful, they’re lucky, and when they fail, it’s because they didn’t try hard enough. [If you want to find out more, the original source is Jones and Nisbett’s (1971) work on the actor-observer bias. In terms of attribution theory we generally prefer external attribution to facing the possibility that we are at fault (that is, internal attribution); this work dates back to Fritz Heider in the late fifties. The fundamental attribution error is the name given to the cognitive bias that we overestimate internal factors in explaining the behaviour of others, while underestimating their role in our own behaviour.]

The other side of responsibility is blame. It is YOUR fault that I didn’t succeed at doing this or never even tried doing that in the first place. The UK is now starting to resemble the USA in being a blame culture, full of lawyers and ambulance chasers and people taking out insurance without reading the small print and then blaming the banks, and people eating too much and blaming the food manufacturers and supermarkets and advertisers. In researching this blog I came across the following, unattributed, quotation: “When you blame others, you give up your power to change”. That rings very true to me.

It’s not a healthy situation, either for society or for ourselves.

Self-employed creatives have it harder than most. Although being self-employed as a writer (or retired, depending on your perspective) is liberating, it is also frightening. Writers are wholly responsible for their own work. If anything goes wrong, they only have themselves to blame. Employees do as they’re told, however high-level their job: in the end they have tasks they have to do, and places they have to be – and if they don’t do them, or if they’re not there, ultimately they get fired. But if I don’t write my two thousand words today I can’t fire myself or sue the council. Being responsible for your own time is also dangerous because it’s so easy to misuse it. Procrastination must surely be the writer’s biggest enemy – why do today what can be put off until tomorrow? Writers must take responsibility for their time.

When however we apply the idea of responsibility to mental illness the issues are less clear. I’m not saying we should blame ourselves for our illness. Why am I mad? The reasons are complex; it’s not one’s person’s fault, it’s just the way it is. But there’s no point feeling sorry for ourselves either – in fact wallowing will just make things worse. If we can’t blame others for our predicament, we can at least take responsibility for our mental health and trying to get better. Yes, I know there are times when you’re unable to get out of bed, or move from the chair – I’ve been there. But most of us have some better days, and then we can make a plan to live by.

The first step, which surprisingly many don’t take, is to acknowledge to yourself that you’re ill. Or, if you’d rather, that you have a particular set of problems. Life isn’t going to be as easy for you as the cheery soul at the next desk who is never faced by self doubt, never wants to spend a week in bed in tears, and who has never thought about suicide. We are, I’m afraid, different. We have it harder.

The second step is to implement the plan. I’ve talked in another blog about what we can do to improve our mental health, and how physical health is an important part of mental health.

The final step, which even fewer take, is to come out; perhaps we don’t quite have to go so dare as  to say we’re glad to be mad, but we can at least announce that we’re mad.

How are we ever going to remove the stigma of mental illness if we ourselves are embarrassed about it, or if we try to hide our problems from others? Would you hide cancer or a heart attack? Are people ashamed about having arthritis? Of course not. Unless we decide there is no shame in being depressed, or obsessive-compulsive, or schizophrenic, how can we expect other people to think anydifferently?

 

References

Jones, E. & Nisbett, R. (1971). The actor and the observer: Divergent perceptions of the causes of behavior. New York: General Learning Press.

Note: The title of this blog is a nod to Michael Bywater’s excellent book Big babies, arguing that that is what we’ve all turned into.

Oh to be an optimist

There are a number of ways of dividing up the spectrum of personality types; the Big Five model is the most popular, but there are others. Some people are born lucky: they’re optimists. How I envy them! Their glass is half full rather than half empty – when I look at my glass, I’ve just had a sip and it is already a third empty.
Although optimism-pessimism is an important personality construct in its own right, it’s unsurprising that optimism correlates with other aspects of personality. I consult my favourite book on individual differences, Maltby et al.’s (2013) text Personality, Individual Differences and Intelligence, to confirm what we might have expected: that in terms of the “Big Five” personality factors, optimism is significantly positively correlated with extraversion, agreeableness, and conscientiousness, and negatively correlated with neuroticism (see in particular Sharp et al., 2011). I’m surprised there isn’t a negative correlation with openness; how can you be open to new experiences if you expect everything to turn out badly? Better the devil you know.
Needless to say optimism is correlated with good health and well-being. Continue reading “Oh to be an optimist”

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.

 

 

Retiring and getting old

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

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

Hubris: Collapse

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

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

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

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

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

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

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

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

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

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