anxiety – What is the meaning of my life?

How to help recovery from depression

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

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

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

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

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

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

About me

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

Links to healthy eating sites

The Mediterranean diet for general good health and increased longevity.

The DASH diet for hypertension.

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

What does it feel like to be depressed?

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

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

Depression is very different from feeling a bit down, or having a moment of passing sadness. It’s an extraordinary “pain in the mind”. Imagine feeling sad, but much, much sadder than you’ve ever felt before. Imagine all the lights being turned off in your head. Imagine your mind turning black; black is the colour of depression. You’re living in a monochrome world where all feelings except pain have been turned right down. Imagine a dark ball at the centre of your being that is so cold it hurts. It’s like an icy knife in your soul; it’s worse than any physical pain. You just want to go to bed and cry, to fall asleep, or even die. Death would be a relief, because death is an end to the misery. In any case, who cares: alive or dead, what’s the difference in the end? And who would miss you anyway? You hate yourself and your life. The idea of doing anything is impossible to contemplate. There’s nothing to look forward to, and nothing gives you pleasure, not even the things that in better mental states you can rely upon to excite you. Your despair is utter. Everything is hopeless; and you are sure you’re never going to get better. You feel a terrible sense of doom, foreboding, and fear, not just that you’re never going to get better, but that the universe is a threatening, mysterious, evil place. And everything is such a fight; everyday life is exhausting. You can’t concentrate long enough to be able to complete simple tasks, and in any case you forget what you were going to do nearly as soon as you form the intention to do it.

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

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

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

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

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

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

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.

Am I normal?

I have always been troubled by labels such as “normal”, and its opposite, “abnormal”, particularly when applied to mental health and personality. I am glad that it is no longer fashionable to talk about “abnormal psychology”, the preferred term being “psychopathology”. (You wouldn’t call someone with cancer “abnormal”, would you?) Normality is defined statistically, and just means the typical, or average behaviour or personality. If you’re some way from the mean on some personality trait it doesn’t mean, usually, that there is anything wrong with you. There is nothing wrong with being very introverted, and something very right about being highly creative. But we do like labelling people, and sometimes the labels take on a life of their own.

Here is a list of the disorders or syndrome with which I have been officially and unofficially diagnosed – the labels I have been given.

1. Moderate to severe depression. No arguing about this one. Yes.

2. Bipolar disorder. Yes my moods go up and down but I don’t think I have ever been manic. The moods also change quickly, even for rapid cycling. But perhaps bipolar and unipolar disorder are on a continuum, and I am just a little away from the unipolar end?

3. Anxiety disorder. Another obvious yes.

4. Phobias. I do have some mild phobias, particularly arachnophobia and trypophobia, but they’re mild. More troubling are claustrophobia and social phobia.

5. Obsessive-compulsive disorder (OCD). Definitely, particularly obsessiveness, and I should have been treated for compulsive behaviour when young. But hey, it was the early 70s, and no one knew anything then.

6. Attention deficit hyperactivity disorder (ADHD). I made the grade for a psychiatric diagnosis, but my blood pressure is too high for Ritalin.

7. Autistic spectrum disorder (ASD) definitely. I score 40 on the AQ.

8. Developmental prosopagnosia. I have never been able to remember or recognise faces, and when I imagine them, only face-shaped blankness comes to mind, although I can remember the hair.

9. Depersonalisation and derealisation. Funny turns. Yes, occasionally.

10. General phonological deficit (GPD). Trouble processing novel speech sounds. Definitely: I have trouble learning and remembering new words, learning nonwords, learning new languages, and recognising speech, particularly against a background of other speech sounds (although my general hearing is fine).

11. Personality disorder. Borderline personality disorder. Or narcissistic personality disorder. Or obsessive-compulsive personality disorder. I disagree with this one, but perhaps I would.

12. Authority defiance disorder. Who likes to be told what to do? (From the research on authoritarianism and compliance, quite a lot of people, actually). Are we starting to get silly?

13. Task avoidance disorder. Now I fear I am guilty of pathologising normal behaviour. Who doesn’t procrastinate occasionally?

Is it likely that I would suffer from all of these things independently? That’s 13 labels for me, and let’s suppose that each condition occurs in 5% of the population, which is almost certainly an over-estimate. That means the probability of them co-occurring if they are independent is about 10 to the power of -18 – that’s extraordinarily small. I am special, but not so special as to think I’m the only person who has ever lived that has these problems. That means the conditions can’t be independent. That makes sense, because we know anxiety and depression usually go together, as do some neurodevelopmental disorders.

And so is it likely that these “peculiarities” of mine are explained by a single faulty gene? Of course not. Like our physical appearance, our brains and mental life are determined by the interaction of many genes with our upbringing. And just as some people are considered more physically attractive, and some of us less so, some people have more adaptive or happier personalities, and some of us struggle.

I like the terms (labels) neurotypical and neurodivergent for just the reason that we can talk about people as being very different from the population norm without implying that there is necessarily anything wrong with them. Neurodivergence is a cluster of semi-related characteristics, including primarily what used to be known as Asperger’s syndrome.

The labels clarify my thinking a bit, but do the conditions marked by the labels map on to clearly identifiable brain states? Although there are genetic markers of depression, some brain abnormalities have been observed, there may be neurotransmitter differences, and some differences in fMRIs between the brains of depressed and non-depressed people, we cannot yet reliably identify a depressed person by their brain alone. And, if you are in doubt, if you had a brain scan which came back completely normal, what kind of psychiatrist would say that you are wrong about your suicidal ideation, that you can’t really be experiencing it because your brain looks normal?

When does unusual behaviour cross over into becoming illness? Very simply, when it causes you distress. You might argue that we should also include when someone’s behaviour causes others distress, but that is a risky path to take.

Of course our mental states are related to our brain states, but our understanding of the nature of the relationship is still rudimentary, and that is part of the problem with treatment: we don’t really understand what we’re treating. We have to rely on how our symptoms are changed by some treatment, and have only a basic understanding in some cases of how (see for example the recent and misunderstood fuss about SSRIs and serotonin levels).

The brain and the mind that works in it is among most complex structures in the universe, so please be patient with your psychiatrist or psychologist if sorting things out takes time.

Anxious about anxiety

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

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

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

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

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

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

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

I don’t have the time to work

There’s a meme going round academics at the moment about the professor (the American sort, where all lecturers are called professor; not the real sort, the rarified breed we find in Britain) who has told his students that surveys show that the average academic works 60 hours a week. The implication is that if students want to be successful, they need to work 60 hours a week too. By coincidence I had just read a description of the massively successful Harvard Business School which said that they expected their students to work 55.1 hours a week (a curiously precise figure). I am reminded that I always told my students who invariably demanded to be told a simple answer to “how hard should I work” that they should consider being a student like having a job, so that they should work 40 hours a week – although now I would revise that down to 35-36 hours. And don’t forget that Elon Musk famously once said that the secret of his success is that he works 100 hours a week.

Students were often surprised, frightened, shocked, and disbelieving when I told them that just 36 hours a week for four courses a term meant that they should be devoting 9 hours every week to each course. Take away 2 hours for a lecture, say, and that leaves 7 hours a course a week when they should be working on that course, reading, thinking, preparing for exams, and writing essays. Seven hours is a scary amount of time. Try it – and that’s just one out of four.

There is though some hope though. A few decades ago we were having the same argument about how hard you should work (this time without the means of the internet), and people were saying everyone should be doing 70 hours a week. So some reason has evidently set in as the expectation has dropped from 70 to only 60 hours a week.

What is a 60 hour work week like? Assuming you take Sundays off, that’s 10 hours a day. Say, from 8.30 a.m. – 7.00 p.m. if you allow yourself half an hour a day for lunch and other stuff.

I am sceptical. Can anyone really work 10 hours a day? I have spent three hours this morning writing, and I am knackered. And still I have had to get up a few times, make a cup of tea, go to the loo, and yet I am almost done for the day in terms of energy. Now I know I am depressed and depression saps energy and concentration, but I am doubtful that I am that lazy and pathetic. I suspect that people who say they work 10 hours a day really don’t work anywhere near that amount. They might be at work, but they’re not always doing work. They might get in, arrange their desk, check their email, glance at The Guardian (after all, it’s Education Tuesday, and that’s work isn’t it?), make a cup of coffee, go to the loo, chat to the person next door, go to the water cooler, go to the loo again, check the news, book their holiday online, check their email again triaging spam, move emails around folders, make more coffee, go to the loo again, chat to a couple of people they meet along the way, and suddenly it’s 7 pm. Of course people do have to and do do some work through the day, but I am very sceptical they really work all that time.

So I don’t believe that most people who say that they do, do really work 60 hours a week. These peopl don’t define work, and they don’t record what they do, and psychology tells us that most people tend to view their own activities through rose-tinted glasses.

I have often thought of carrying out a survey of academics, or even anyone who says they work hard, and writing a book about it. I have pared my life down to an essential minimum and I really struggle to write, read, and think anywhere near as much as I would like to. I outsource, I shop online, I do the minimum in everything non-academic, and yet … I’m time poor. Don’t other people have to brush their teeth (two minutes three times a day plus flossing), do washing, do some kind of exercise, sleep, have the occasional shower, install new software only to find nothing works any more, eat, stay hydrated, deal with burst pipes and lost keys, and so on?

I end up feeling most sorry for students, because they have these expectations laden upon them by people who don’t know what they themselves do, and often have to fit in a part-time job and take advantage of having a social life at what will later prove to be the best time of their lives. Their friends often do not help; some of them boasting, exaggerating, lying, or just deceiving themselves about how hard they work. Have you noticed that there are only two types of people – those who put a lot of work into the essay that they started three months ago, and those who left it to the last minute and spent hardly any time on it at all>

I am not advocating a culture of laziness. Psychology has taught us that if we want to become successful at something, we have to work very hard. Genius is indeed nearly all perspiration, and above a certain minimum level, how you succeed depends mainly on your attitude and how much effort you put in. There is no shortcut to success, I’m afraid, but that doesn’t mean you have to put in 60 hours nonstop work a week. And instead of panicking, being insecure, and deceiving ourselves and others about how hard we work, let’s be honest and realistic, because overwork and stress lead to disaster. I know.

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.

Emptying the mind

It’s been a while since my last blog. Who would have thought that being self-employed would mean being so busy? I have been trying to focus on what’s important: my goals in taking early “retirement” from the full-time job have always been to increase my reading, thinking, and writing time.

But we live in a world of distraction. Distraction makes procrastination very easy. I even know of academics who have been encouraged by their “line managers” (what a repellent phrase) to “multi-task” their administration and research. I’m not sure at what level they’re supposed to multi-task – reading a paper while giving a lecture perhaps? – but we know that multi-tasking reduces efficiency: it just doesn’t work. Doing two things at once has a cost (which is why even speaking on the phone while driving increases the chance of an accident, let alone texting and driving). It also increases stress. And we know that doing important, creative work requires focus – you can’t carry out great research while students back their essays. I even have my doubts about one of those great sacrosanct beliefs in academic life that great teaching and research must go together: good teaching requires time, and research requires time, and you can’t be doing two things at once (see above).

I have tried to simplify my life, for peace of mind both for being mentally ill, and in order to be able to think more clearly. I have just been reading Timothy Ferriss’s excellent (if lengthy) Tools for Titans, and it is obvious that I am not alone in pursuing this strategy. Physical clutter is distracting – some of us even find it distressing. Mental clutter is just as bad, perhaps worse.

And how much mental clutter we all must have! How can you live in the moment when you are worrying about what you did wrong this morning and what you have to do this evening? How can you write well when your mind is on the telephone bill?

So here are some of the things that I’ve done to reduce mental clutter.

Write down as much as possible. First I carried out a brain dump of everything I had to do, everything I was worried about, and everything on my mind. This task took a while, and I kept adding to the dump over a few days.
Make structured lists. Over the years I have experimented with several types of list and time management systems. Now someone with an obsessional personality has to be careful of lists – they can easily take over and become an obsession and a distraction in themselves. I recently tried a complex system of email folders with tasks for doing today, tomorrow, the day after tomorrow, this week, waiting for, and so on … (I am familiar with Dave Allen’s Getting Things Done system and implement a simplified version of it. I have tried dedicated software but am aiming for a simple solution.)
To do. Currently I am using Apple’s Reminders, with several types of list organised by location and time. I am trying to keep it simple. I have tried complicated systems and apps and remain to be convinced that a to do list can be bettered. The important thing is that nothing gets lost, and that I know everything will be dealt with by the deadline. I don’t want to have to think about peripheral things.
Removing distractions. Social media distracts us and increases mental clutter. I can’t go as far as some and remove myself completely from Facebook and Twitter, and I don’t want to delete all my email accounts (and I don’t think it would be a good idea for future employment possibilities). But I don’t need to check my email every hour. Emails generate emails. I have reached the fabled “Inbox zero”, partly by moving things I can’t do now to an appropriate folder. (Actually as I write it is Inbox 1.) There are some emails I can’t do anything about just now, either because they refer to future events or because I need to do something to be able to answer them – they are moved to a “Waiting” folder. I do feel bad about several emails in my “Weather” folder that I plan to get round to when I have time. These are questions about or suggestions for or things to add to my British weather pages (http://www.trevorharley.com/trevorharley/weather_web_pages/britweather.htm). I do feel a bit bad that people have gone to the trouble of writing to me, and I always thank them, but it’s not my day job, and my time is very limited, so I can’t process them all at once. Recognising that we have limited time is a big part of the fight. WE CAN’T DO EVERYTHING. And that means MAKING CHOICES. (Apologies for shouting these statements.)
Meditation. Everyone says meditation is good for clearing the mind and improving mental focus and clarity. I though with my monkey mind find the process very difficult, and probably as a result find the benefits – so far – limited. I will persevere though. I am using Andy Puddicombe’s Headspace site; I like the structure it provides and the implicit coercion. My jury is still out on meditation.
Mindfulness. At all other times I am trying to be mindful of what I am doing now. If a distracting thought arises I try to push it away or if it is something I need to pay attention to add it to my list. It is easy though for obsessive people to get obsessed with clearing our minds, so we are for ever writing down minor thoughts. We all also occasionally at least need to plan what we’re going to do: living in the present doesn’t imply drifting.

Interestingly, as I was half way through writing this blog, the following landed in my inbox and caught my eye (I know, I know):

http://calnewport.com/blog/2016/12/18/on-digital-minimalism/

Finally, we should think about whether it’s even a good idea to strive for an empty mind. Life isn’t that simple. Things are always cropping up, and surprises are always happening. Rather than avoiding shit we must learn to respond to shit in the right way. The more I think about it, the more important I think this point is: we will never achieve a perfectly empty mind. It’s our responses we need to change.

Have a good Christmas and New Year everyone. It’s a difficult time of year for people with mental health problems – if nothing else it’s so dark in the northern northern hemisphere. So just hang on in there.

The future is bleak (updated)

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

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

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

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

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

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

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

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

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

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

… To which I add a few weeks later:

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

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

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

Hubris: Collapse

Venus sunset After 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.

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