Category: stigma

Weird

All my life, people have been calling me weird, so many that I have at last accepted that they are probably right.
“Weird” is a statistical label; people are weird if they’re out there on the extreme of some behavioural dimension … be free, be yourself, indeed rejoice in your weirdness. And if you don’t think that you’re weird, please don’t judge anyone else.

All my life, people have been calling me weird, so many that I have at last accepted that they are probably right.

“Weird” is a statistical label; people are weird if they’re out there on the extreme of some behavioural dimension, or more likely dimensions. A dictionary definition is:

“Very strange and unusual, unexpected, or not natural.”

That definition doesn’t capture the usually pejorative way in which “weird” is used as a label. Also, it’s not simply being extreme on any behavioural measure. You can be very clever, or very extravert, and I doubt anyone would call you weird. No, weirdness implies a special sort of unusualness. It’s thinking or behaving in some unusual way that catches the attention of most people and makes them want to pass some slightly negative judgement. Looking odd, having an unusual hobby that is considered esoteric (or “boring”, as though the activities of most people have some inherent meaning that makes them worthwhile), saying inappropriate things, or repeatedly breaking social norms, are all likely to get you called a weirdo.

Being weird obviously troubles many individuals because the internet is awash with worried weird people looking for reassurance. My favourite question is “Is being weird normal?” – to which the answer was, surprisingly, “yes”. There is apparently, no normal. But while no one might be exactly average, I don’t think that really lets me off the weird hook.

There are even apparently benefits to being weird. Weird people tend to be more creative. Many scientists and mathematicians are distinctly odd. This finding shouldn’t be too surprising because people who achieve great things must be very unusual in some way.

I think my weirdness is a consequence of my neurodivergence, one of those increasingly fashionable terms that I think does have some value.

Neurodivergent people think and behave in atypical ways, and go against social norms, because our brains are different, either through genetics or upbringing or most likely both.

I have previously listed all my psychological symptoms, and here is a recap: depression, anxiety, obsessive-compulsive disorder, phobias, general phonological disorder, and autistic spectrum disorder (not to mention noise sensitivity, task avoidance disorder and completion anxiety and completeness obsession). Is it likely I have all of these independently? Of course not. They all stem from an underlying brain that’s significantly different from normal; my brain is sufficiently different from others to warrant a label.

You can be neurodivergent without it being a problem for anyone. It’s only difficult if it causes you pain or distress: in my case the depression, anxiety, and occasionally OCD do. I hesitate about adding “or if it causes other people distress” because people are sometimes upset by the behaviour of another when it is questionable whether they should be. A psychopath might not suffer but can hurt others, but is the naked rambler recalling doing anyone any harm?
There are even some people who seem weird to me. There is a chap who wanders around town with no shoes on, whatever the weather. But doubtless he has his reasons, and it’s none of my business. The world would be a happier place if people stopped telling others what to do so much.

So to all you self-confessed weirdos and freaks out there, with the caveat about being or causing psychological or physical pain: be free, be yourself, indeed rejoice in your weirdness. And if you don’t think that you’re weird, please don’t judge anyone else.

Sometimes I almost feel sorry for all you neurotypicals out there.

Please visit my website at www.trevorharley.com for much more. I am Emeritus Professor of Psychology at the University of Dundee, contact me on trevor.harley@mac.com.

Sing if you’re glad to be mad, sing if you’re happy that way

As I write it’s World Mental Health Day. Should we take pride in being mad? Is it indeed something to celebrate? How do remove the stigma surrounding mental health problems?

As I start writing this entry, today, Monday 10 October, is World Mental Health Day, so I thought I’d write an entry to celebrate it.

“Mad Pride” is a movement of people who argue that individuals with mental health issues should be proud of their “mad” identity. According to its Wikipedia entry, the movement started in 1993 in Toronto in response to local prejudice towards people with a psychiatric history, and grew from there. Mad Pride seeks to educate people about mental illness, and also to “reclaim” terms of abuse such as “nutter”. I have mixed feelings about this idea. On the one hand educating people is obviously good, as is identifying and preventing psychiatric abuse. We also need to be wary about what is labelled as “ill” or “mad”. In 1860 Elizabeth Packard was committed by her husband to Jacksonville Insane asylum for three years by her husband because she disagreed with her his religious and political beliefs and with the way he treated her. Most people have heard of the misuse of psychiatry in the USSR, with the hospitalisation and enforced treatment of people with anti-state and anti-communist views, a “disorder” that was charmingly called “delusion of reformism”. There was also Walter Freeman’s use of lobotomy, performing several thousand lobotomies across the USA spanning decades, including one on a child of just four. Virtually everyone would agree that these sorts of things are wrong, but on the other hand, being anxious or depressed is utterly miserable. Would anyone say they’re glad to have cancer? I doubt it very much. We can have pride in coping, pride in surviving, definitely, but pride and joy in being mad?

Perhaps I’m misinterpreting the idea of the movement. Of course some mental health conditions have positives as well as negatives, such as the bursts of energy and creativity that go with bipolar disorder, but whether people think the ups are worth the downs is highly debatable, and the suicide rate in this group suggests many don’t. I don’t also mind – indeed I quite enjoy – being neurodivergent. There is nothing “wrong” with me just because I’m very introverted, and don’t much care for social activity, or am “on the spectrum”, but these things don’t cause me suffering, apart from when other people tell me I shouldn’t be this way, and in that respect I am right behind “difference pride” movement. There is also some vagueness associated with the term “mad”; people say so-and-so is mad because of their unusual behaviour, but they don’t really mean that person is suffering from a mental illness. The key word here is “suffering”: the suffering mental illness can cause is horrible, and definitely not to be celebrated.

It is extremely important to be able to say that you have mental health difficulties without feeling shame or with there being any stigma attached. The situation used to be much worse, and still many people feel embarrassed about being mentally unwell. They shouldn’t. To take my favourite analogy, people don’t feel stigmatised and ashamed because they have cancer (although admittedly once there was some stigma attached to it, because it was so poorly understood and usually a death sentence; my mother would never refer to it by name, simply calling it “tthe c-word”””, which was often confusing for the young me just learning a few swear words). The brain is an organ like any others, and mental illness is a brain disorder (albeit a complex one, involving genes and upbringing). You wouldn’t feel embarrassed to say you had a pancreatic disorder; so why should you feel shame about your brain going wrong? My mother, yet again, though often very ill with depression and OCD, would refuse to do anything about it, because, she thought, she should be able to control it; if only she were strong enough the depression would go. I am not saying that attitude and taking some responsibility aren’t important, simply that we should accept mental illness has some physical basis and that we should not feel shame because we are ill. Neither am I saying that there are not psychological influences on physical health and illness, when there clearly are, but there are limits to what we can do.

If I could excise mental illness from my health, would I? It is so difficult to imagine life with just the bad bits cut out, and the bad bits influence the good too. Would I be able to write and be a scientist without any OCD, for example? It makes me think of that episode of Dr Who, The genesis of the Daleks, when the Doctor decides against killing all the Daleks at their inception because he concludes they have done more good in uniting the universe than they did harm. I wouldn’t be me without my mental health problems. It has shaped my personality, and given me a degree of resilience I probably wouldn’t otherwise have. “That which does not kill us makes us stronger”, as Nietzsche said in his Twilight of the Idols.

Finally some explanation. I let my subscription to WordPress lapse because it costs money and like most others I am trying to cut back. I tried hosting this blog on my website, but it’s clear that many people prefer this way of reading the material, and I can see why, so I have renewed my subscription. Please do check out my website though because there is a lot of material there:

www.trevorharley.com.

Anyway, stay healthy, stay proud, don’t feel shame or embarrassment about mental health, and seek help if you need it. There is no point in suffering in silence. And the best of luck to Mad Pride; the only way we will overcome stigma about mental health issues is by being honest.

Mental illness at work

The news that people with mental health problems suffer at work will not come as a surprise to anyone with those problems. In my experience it isn’t down to malice on any one’s part, but clearly something isn’t right if so much talent and money is wasted. Remember that people with mental health problems include some of the most creative people around.

One major problem at work is that mental illness …

“Mental health sees 300,000 people leave their jobs each year”

And I was one.

I should immediately qualify this statement by making clear that I was in no way forced to leave. I was one of the lucky ones: I just didn’t feel strong enough to do that job properly any more, and I had many other things I wanted to do instead. Like writing this blog, and producing the best book ever on consciousness. I was tired and worn out and lucky enough to have alternatives. But if I had been mentally stronger I might have carried on for longer.

The news that people with mental health problems suffer at work will not come as a surprise to anyone with those problems. In my experience it isn’t down to malice on any one’s part, but clearly something isn’t right if so much talent and money is wasted. Remember that people with mental health problems include some of the most creative people around.

One major problem at work is that mental illness is often not considered to be a “real” illness or disability. I know of many people with problems (including myself) who have never been asked what reasonable adjustments could be made to their work environment, and indeed whose requests for relatively minor changes have been met with something between pained resignation and aggressive exasperation. This aspect of things could be improved by better training of managers.

But the power of institutions and employers is limited: institutions and businesses are made up out of people. Generally instititions in the UK at least now have very good rules, and often there’s not much more they can do apart from making sure that they implement those rules, and to help change the attitudes of their employees.

It’s that final bit that’s difficult. How do you change centuries of stigma and ignorance? On the bright side things have changed for the better very quickly, but there is still a long way to go.

We can learn by looking at three areas where there have been enormous strides over the last fifty years: women’s rights, LGBT issues, and race. Again, I am not saying that everything is now perfect – clearly it isn’t, and there are still massive changes in attitudes to be made. They have all though made progress because those discriminated against have formed strong movements and taken direct action. We lunatics are hardly among the strongest people in society, but perhaps we have a duty to stand up and say we are ill, we are disabled, we need help at work. You wouldn’t treat someone with cancer or in a wheelchair this way, so don’t treat me like it.

I’ve lost track of how many mental health support groups and societies there are; there are too many. We need to unite, and we also need to mobilise. It’s difficult when you’re too depressed to move, and difficult when you’re worried everyone is going to mock you, but if you have the strength, it’s time to come out and be counted, and not let yourself be pushed around. Sing if you’re proud to be mad.

 

 

 

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.

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.

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.

 

 

How to cure yourself of depression

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

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

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

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

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

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

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

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

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

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

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

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

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

Removing the stigma of mental illness

 

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

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

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

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