Category: therapy

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.

Dream a little dream

I’ve been experimenting with lucid dreaming by taking supplements last thing at night, including lecithin, choline, huperzine A (an alkaloid found in some plants that’s been investigated for treating Alzheimer’s disease), GPC (l-alpha glycerylphosphorylcholine), and galantamine (found in snowdrops), They’re all available from retailers such as Amazon and pretty harmless in terms of side effects, at least, it seems, for me. All of them in some way or another increase the amount of the neurotransmitter acetylcholine. I’ve tried taking them in isolation and in combination, and in combination is the only thing that has had any effect on me. My sleep and dreaming appears to be remarkably robust.

I still haven’t had a proper lucid dream, which as I understand it is an awareness that you are dreaming, and therefore you have an ability to influence your dream. I have though on many occasions had the curious sensation that I can only describe as that I am dreaming that I am having a lucid dream, or dreaming that I know I am dreaming, but lack any ability to influence my dream. These supplements reliably promote this “dreaming of lucid dreaming” state in me.

I also on two occasions have dreamt of what others call “the shadow” – a shadowy hostile figure who lurks threateningly close by (see here and here for examples from others). On both occasions this dream has started with a feeling that someone is in the room or outside, or outside the bedroom window. If I catch a glimpse of them, they are grey and featureless. I’ve had them for years; I remember very clearly being terrified as a young child by a grey shadow figure standing like a statue beside the bed. In my case they are not accompanied by sleep paralysis. Figures of this sort are widely described across time and cultures (in olden times it might have been called an incubus), so clearly are some fundamental, but poorly understood, feature of dreaming.

Most people love to talk about their dreams, and once you tell someone that you’re a psychologist, you’re in trouble. I have always been fascinated by my dreams – those strange images that arise unbidden with sleep, sometimes with frightful clarity, that follow complex and often bizarre storylines, and surely, surely must tell us something important about ourselves? And if you could have a lucid dream, could you not systematically manipulate some of the variables of dreams to find out more?

There are many theories about the origins of dreams, and they are covered in detail in my forthcoming book, The Science of Consciousness, to be published by Cambridge University Press (hopefully next year). Many people are familiar with Sigmund Freud’s psychoanalytical theory that dreams disguise repressed and unwelcome thoughts so that they do not wake us; hence for Freudian psychoanalysis dream interpretation is a question of interpreting the surface of the dream, particularly its symbolic nature. Hence for psychoanalysts dreams are the most important method of treating mental illness. Other depth psychologists think that dreams serve different functions (e.g. Jung thought they addressed issues to do with individuation and spiritual growth), but all these approaches share the idea that dreams have some meaning, and that interpreting dreams is a means to recovery and growth. Revonsuo views dreams as an evolutionary adaptation to dealing with threat; we can safely rehearse methods of escaping threats in dreams. Many researchers link dreams with creativity, and there are several accounts of ideas being generated and problems being solved in dreams (see here for a discussion of Kekulé’s famous account of dreaming of a worm swallowing its tail seen in flames in a dream). And then there is Allan Hobson’s idea that dreams are essentially random constructed by the cortex from random activation of thoughts and ideas by subcortical input.

I kept a detailed dream diary for a year, and still record as much of my dreams as I can. I don’t think there is any one correct theory of why we dream; I am sure all of the above are true at times. (Another thing I am sure about is that there is little merit in dictionaries of dream symbols.) I never cease to be amazed at the bizarreness, complexity, and creativity shown in my dreams, but I doubt if I am alone in this regard. The activation-synthesis hypothesis has a great deal to commend it, but I don’t think internal activity is random: some memories are stronger than others, some anxieties occupy us more than others; we desire some things more than others; and some threats are more worrying than others. The mind is always bubbling away, and some bubbles sometimes come to the surface. Dreams are the default mode network, the system that generates daydreams, running without control or censorship.

But can we learn from our dreams, and can recording and interpreting dreams help us on the path to spiritual growth and healing mental illness? I was slightly surprised that during my therapy my therapist seemed totally uninterested in my dreams (and this is in the context of that therapy being one of the most useful experiences of my life). If the idea that dream content is the interpretation of randomly generated but largely prominent memories, ideas, and emotionds is correct, you might expect an analysis to be revealing. However, when I analyse the dreams in my collection, I find there is little obvious to learn from them. They show recurring thoughts and concerns, but I am aware of them from everyday life. I dream of death, dying, and nuclear war most nights. We can’t learn much from dreams because we already know most of what they tell us.

The one surprise is how often I dream about my father, when I think about him so little in waking life – or at least did. He left when I was aged ten, and I barely saw him again afterwards. He died, alone, in 2004, 15 years after I had last seen him. This persistent dreaming makes me realise that I wish I had tried to contact him, if only to ask him why he had co up my life.

A warning though: some dreams take on a life of their own. I have for decades dreamed about watching a plane fall out of the sky, I think this idea has just become a very highly activated idea, one likely to bubble to the surface some nights. That’s why we get recurring dreams. So perhaps my dreams of my father are no more than a simple recurring dream, and reveal nothing deeper.

Note that I am giving a talk on the meaning of dreams in London on 4 July 2017. Please come along. I promise to try and answer every question I get.

Stay well, and dream on.