Is this all there is?

The holidays are over; normal life is resumed. We are heading towards Blue Monday, the third Monday in January, the alleged day of the year on which most people tend to be most miserable, and for which there is no scientific evidence at all. (I’m happy to be proved wrong.) Nevertheless there is a sense that people are ground down by the lack of sunlight at this time of year, the absence of anything to look forwards to after Christmas, with work or school to resume as normal, and perhaps left to reflect on having spent money over Christmas that they didn’t really have on things they didn’t really want. What can cheer us up?

I enjoy Christmas, but as I said in my previous post I don’t make too big a thing of it, or overdo things. Even so I am left feeling both a bit empty apart and full of dread. The rest of the year stretches ahead. Maybe I’ll go away a few times. I might enjoy a few days in the sun in summer. I might finish writing a book or two. But soon the days will start shortening again, and then it will be my birthday. Another year since the last one. And not long after that it will be Christmas again. A year nearer old age, a year nearer infirmity, a year closer to death. And so the cycle repeats.

People tell me that this is a negative, depressive way of looking at things, to which I say: this is exactly what it means to be depressed! “Normal” people often appear to think that a person who says they’re depressed won’t have any symptoms.

I realise too that I am luckier than most: I’m in relatively good health, I achieve some fulfilment in my work, and I’m not struggling to eke out a tough existence doing a biring repetitive job (which is one of the things I dread most in the world). That knowledge doesn’t help. I feel lonely and I feel alone, an alien on the sidelines watching everyone else enjoying life and finding meaning in mundane things, helping giving their children a good life, or comfort in their God.

I can’t even imagine what meaning there could be to make up for the grind of everyday life. THIS is all there is.

An interesting seeming paradox then is my Kurzweilian obsession with life extension. I don’t think there is in fact a paradox: who wants to go to a football match if you know it’s going to be abandoned because of a water-logged pitch after ten minutes? Part of my ennui is because it hardly seems worth starting anything if I’m going to be dead in forty years. (Again, please don’t tell me this is crazy messed up thinking.) I’ve got to rush to finish writing my book on consciousness and the next one on weather and psychology because bits will start falling off me in a few years. So yes please, sign me up for freezing my head, having my blood vessels cleaned by nanobots, neural implants, and uploading my intellect to cyberspace. To paraphrase Woody Allen, I don’t want to become immortal just through my work, I want to become immortal through not dying. Life extension would give my life real meaning.

Scientific progress in the quest for eternal life is one of the few things that stops me from killing myself at this time of year.

 

 

 

 

 

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.

 

 

 

Winter is coming

The autumn equinox this year was 22 September. From then on the sun peaks at midday overhead somewhere in the southern hemisphere until the spring equinox late next March. In practice, day and night are of equal length on the equinox, or would be if our earth fortunately didn’t have an atmosphere. In London, on 21 June the sun rises at 4.43 and sets at 21.21; on 21 December the corresponding times are 8.03 and 15.53. That’s nearly nine hours more light in the summer. With such a dramatic difference at this latitude, no wonder so many react to the difference.

Light plays a central role in regulating our biological clock. …

Winter is here – almost.

The autumn equinox this year was 22 September. From then on the sun peaks at midday overhead somewhere in the southern hemisphere until the spring equinox late next March. In practice, day and night are of equal length on the equinox, or would be if our earth fortunately didn’t have an atmosphere. In London, on 21 June the sun rises at 4.43 and sets at 21.21; on 21 December the corresponding times are 8.03 and 15.53. That’s nearly nine hours more light in the summer. With such a dramatic difference at this latitude, no wonder so many react to the difference.

Light plays a central role in regulating our biological clock. We live on a natural rhythm called the circadian rhythm, and our internal clock is set by the action of light on the retina of the eye, transmitted by special tracts of nerve cells to the pineal gland. The pineal gland, situated near the centre of the brain, manufactures a hormone called melatonin. Melatonin helps send us to sleep, so much so that in some counties it is available without prescription as a sleep aid, and melatonin is also used in overcoming jet lag.

Light then is essential for keeping us awake, and sleep plays an important role in maintaining our mood. Most people have heard of seasonal affect disorder (SAD). The definitive mental illness diagnostic system, the American Psychiatric association Diagnostic and Statistical Manual of Mental Disorders (DSM, now in its fifth edition) officially classifies seasonal effects on mood as “recurrent major depressive disorder with a seasonal pattern”. In winter people with SAD are – well, sad. Some people become depressed only in the winter months, and maybe autumn and spring too, and for some people their pre-existing depression becomes worse. Unsurprisingly, given that in winter days are shorter the further north (and south in the southern hemisphere) you go, there are substantial geographical variations in the incidence of SAD, In the USA, in Florida the figure is very low, just over 1%, and in Alaska nearly 10% of the population is affected. Pity the three hundred thousand inhabitants of Murmansk, situated north of the Arctic Circle, which does not see the sun at all between 2 December and 10 January.

I should point out that not ever researcher accepts the existence of SAD. Some studies have failed to find any correlation between mood and time of the year. As with all studies on this sort of subject, much depends on the detail of exactly how mood is measured, how many people are studied, and whether or not they are receiving any treatment.

If people’s moods are affected by the amount of sunlight available then you would expect the suicide rate to vary with the seasons. It does, but not in the simple way you might expect. In the northern hemisphere the suicide rate increases dramatically in May and to a lesser extent June, and in the southern hemisphere in November. This pattern is strange and there is no accepted account of why it happens. One explanation is that when people are very depressed they are too ill to kill themselves, and need the upsurge in energy when they are starting to feel better. I don’t find this explanation wholly satisfactory because I have always felt most suicidal when I feel most depressed; it’s then that I want the pain to end. Most people when they start to recover feel relief. Another possibility is that when people are improving there is a surge in the chemical, or neurotransmitter, serotonin in the brain, and serotonin is associated with aggression as well as mood. In depressed people aggression can be directed towards themselves, leading to self-harm and suicide.

Suicide rates also vary across regions. If you look at a map of Europe there is an increase as you go from the south and west to the north and east, and again it is not simply the case that suicide is always more common in cold, dark regions; socio-economic and cultural factors play a large role too,

I graph my own mood, as I suggest everyone with a depressive disorder does, and have noticed a slight seasonality effect, but it is much less pronounced now I that I am on fairly effective medication.

We are not completely helpless when the nights start drawing in. Those fortunate to be able to overwinter in southern California should now start thinking about packing their bags. Those a bit less fortunate should book their winter holidays, going somewhere likely to have as much sunshine as possible. For the rest of us, there are still things we can do. SAD lights, which emit very bright light (look for at least 10,000 lux) and which produce light in the shorter, bluer frequency range, are now cheaper and much more widely available than they were just a few years ago. But one of the best therapies is free: being outside in natural light as much as possible, particularly in the morning, especially if it’s sunny. Wrap up and get outside.

(The above is an expanded version of my new column in What’s hot London!)

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.

What is “normal” for a depressed person?

“Dysthymia, now known as persistent depressive disorder (PDD), is a mood disorder consisting of the same cognitive and physical problems as depression, with less severe but longer-lasting symptoms … dysthymia is a serious state of chronic depression”. Wikipedia.

As part of my mental maintenance, I keep a mood diary. I’ve experimented with several kinds, including apps, but now just use the very simple system of noting one number at the end of each day, on a scale of 1 (extremely, suicidally depressed) to 7 (ecstatically happy), with 4 being “average”. Here is my chart for the last 18 months or so.

moodgraph

The first point to note is that this graph is by no means representative of my life. It begins in April 2016, when I had already been in weekly therapy for well over a year and had at last found the medication that worked (to some extent) for me. I’ve shown the trend line (a guess at the average) which shows a continuing slight improvement over time, although I think this is line is affected by a prolonged and severe relapse I had in the summer of last year. To complete the statistical background, my scores do seem to follow an approximate Gaussian (“normal”) distribution, with my mean score in the middle of the range, at about 4. (Actually it’s very slightly beneath, at 3.8.)

It’s the word “normal” that causes me trouble. What is normal? How can I gauge my mood and experience against what other people feel? And is it reasonable to expect mood scores to follow a Gaussian distribution, and if so what will the mean be?

To give a concrete example, consider someone with PDD (persistent depressive disorder). Their daily mood ratings will presumably be low every day, for long periods of time. Hence compared with people without PDD you would expect their mood rating, if they were comparing themselves with the rest of the population, to be low (as they’re not severely depressed, probably in the 2 to 3 range).

But how do people give ratings of their behaviour? Maybe, completely reasonably, people compare their mood with what they think other people experience – so the moods are relative to the population rather than the individual. But how do we know what others feel?

I use a strategy between the two. And I’m not happy about treating a rating in this inconsistent if not incoherent way. I think a 7 should be “extremely, unusually happy”, although no one should expect to be ecstatic all day long. A 4 should be average for me but not too bad. When I rate a day as “average” I mean I’ve been a bit depressed that today, but no more so than average for me

If you have PDD, your normal is low. I don’t know how other people feel most of the time, but I suspect it must be better than I do. Do you wake up looking forward to the day? Does a day pass without you thinking about suicide and death? Does your day bounce along when you’d say you feel happy? Does your life have meaning? Can you sleep naturally? Do you feel like you have the energy to do everything you want to do? Does the thought of emptying the dishwasher or taking a shower fill you with despair? If so I envy you. Your 4 is not my 4.

The opposite is also presumably true: someone who isn’t depressed has no idea how those of us who are feel. So please keep your comments about “when I’m down I always find going for a good run sorts me out” to yourself.

As I have said before, being depressed steals your life.

Loneliness

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

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

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

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

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

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

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

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

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

 

 

Commitment and commitments

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

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

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

I was particularly struck by this quote:

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

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

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

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

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

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

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

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

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

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

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

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