Tag: mental health

Obsession

Depression alone is bad enough, but unfortunately it is rarely a pure affliction: people with mental health issues are usually doomed to suffer many versions of misery. Depression and anxiety go together, so much so that many researchers believe that there is a deep relationship between the two. Unsurprisingly then, both benefit from the same sorts of pharmaceutical treatment (SSRIs).

Anxiety comes in many forms, and many of us suffer from more than one. At different times I’ve had my share of social anxiety, generalised anxiety, panic attacks, agoraphobia, and other phobias. I have found that one of the most striking – I want to avoid the word distressing because all forms of anxiety are distressing to those who suffer from them – is obsessive compulsive disorder (OCD). When I was a young teenager my life was blighted by OCD, often in florid forms. In the night I would go down the stairs dozens of times to check that the front door was shut; I would get up multiple times throughout the night to check that my bus pass was still in my school jacket pocket; I would repeat things in multiples of three. I was afraid of contamination, the idea that germs and disease could spread by touching something that touched something that touched something, or even by having seen someone with a disease. I would then wash my hands several times (in multiples of three of course). I was afraid other people could read my thoughts, or would misinterpret an innocent gesture as an offensive one, so would apologise inwardly to them (in powers of three; twenty seven sorries is bad enough, but just try eighty one).

All classic stuff. I didn’t know what OCD was then, and I just suffered, alone, in misery. OCD is, to use a cliché, living hell, and it’s even worse if you think you are alone and have no idea what’s going on. In retrospect something should have been done about it, but I just grew out of it. Mostly – I still have a tendency to overcheck things, usually three times, but no more, and only occasionally, so it doesn’t bother me. We can live with some pathology. Being obsessive even has its advantages as an academic; there’s nothing wrong with checking your data a few times, or being careful about proof reading and checking your facts are right. Being a writer is sometimes obsessive; we often feel a pressure to write. I think you need to be a bit obsessive just to overcome all the negative feedback writers get. The boundary between OCD and having an obsessive personality isn’t always clear – as ever the problems start when what we do makes us unhappy, or interferes with our lives. We also have a problem if our behaviour doesn’t make us unhappy, but affects those around us.

As with all mental illness, the precise causes are unknown, but as with depression there is almost certainly there’s both a genetic and environmental component. The brains of people with OCD look different, but again whether that’s a result or cause of the illness, or whether both result from something else, is not know.

But not all obsessions involve an obvious compulsion other than one to keep the obsession going.  We all have things we worry about from time to time. Most of us are familiar with “ear worms”, tunes that get stuck in your head. I suffer very badly from these (I speculate it’s to do with my psychopathology). It can drive me mad – or more precisely even madder than I already am. They’re the strangest tunes too – I once endured a week of John Denver singing “Annie’s song” non-stop. Worst of all though are obsessive thoughts, the rumination on particular events, ideas, or people that takes over our minds. It is horrible. The compulsion, in as much as there is one, is to continue the obsession. The thoughts – bad thoughts – involve regret, guilt, and fear. When I was in my OCD phase as a teenager at the end of every school term I would struck by the idea that I had done something wrong, and the school holiday would then be ruined by the fear of punishment that would await me on my return at the start of the next term. Of course I never had done anything, and was never punished; it was all in my head. It’s impossible to reason yourself out of OCD.

I think obsessive thinking is verging on psychosis, because things really are out of control. We might refuse to accept that the obsession is irrational, and some people might even act upon their obsessions – I assume that is how people become stalkers. I just suffer though.

Obsessions without compulsion is called “primarily obsessional OCD”. I was encouraged to see that the Wikipedia entry on OCD says that “Primarily obsessional OCD has been called one of the most distressing and challenging forms of OCD”; it’s more than distressing, it’s mental agony. I almost envy people with OCD because at least enacting the compulsion provides a little relief, no matter how short.

However illogical and crazy the behaviour might seem to someone who has never experience OCD, it is impossible to reason your way out of the illness. You can’t tell yourself that it’s irrational to wash your hands so many times. First, the compulsion is stronger than our belief system. And second, there is always a grain of truth we can cling to – it is just possible that a disease might be passed on by touching something that was touched by someone who touched someone with a disease, for example. There is though a clear treatment plan for OCD that involves breaking the link between obsession and compulsion. One of the best books I have read on OCD is Brain Lock: Free Yourself from Obsessive-Compulsive Behavior, by Jeffrey M. Schwartz. He identifies four stages in treatment: relabel (you must recognise what is obsessive and clearly label it as such); reattribute (this thought is not me – it’s my OCD); refocus (the really hard bit, where you have to shift attention, at least for a while); and revalue (to take the whole cycle as something not to be taken as face value, and to adapt the view of a more impartial observer – being mindful). He suggests gradually building up a delay between having the compulsion and having to do it – you might only be able to manage a few seconds at first, but you increase it, perhaps very slowly.

Such treatments, while effective for dealing with the compulsive actions, don’t immediately help us in being able to stop the bad thoughts coming in the first place. In a recent bout, ruminating on a mistake I had made, I tried saying internal loudly and firmly, “It was my choice”, which I eventually simplified to a loud “STOP!” in my inner speech. This approach eventually worked – or the bout blew itself out. A friend told me that a common technique is to visualise a STOP road sign, and I have since tried combining visualising the sign with thinking STOP! It is exhausting work though; bloody exhausting. At least my obsessions appear to have a natural life span, and eventually, after much pain, they eventually peter out.

The intrusiveness of thoughts is one reason why I find meditation so difficult. My thoughts just won’t go away. Even when counting breaths the thoughts overwhelm my inner voice counting. There is a paradox here because if I could just be mindful and live in the present, I wouldn’t be so obsessed by Bad Thoughts, but the Bad Thoughts stop me being able to attend to the present. Coming back to the now and trying to be present does help me when I’m being obsessive, and I think it’s a skill at which one can get better with practice.

I am grateful to and encouraged by everyone who has written to me about my blog. So many people suffer alone; it is time to stop the stigma of mental illness. For a long time I thought I was alone in suffering from obsessional thinking; if we all shared more we would be less isolated, less frightened, and maybe just a little better off. Please feel free to share this blog with whoever you might think would benefit from it.

 

 

How to lose weight: How I lost 31 pounds (and put on muscle) in six months

Several people have asked me about the weight loss part of my self-improvement-for-retirement plan. I have now lost 31 pounds since January while, thanks to my gym efforts and my wonderful personal trainer, at the same time I have put on detectable muscle. I know it’s noticeable because people comment when they meet me. One to two pounds a week is generally considered to be a sustainable and healthy rate of weight loss. How have I done it?

The first point sounds obvious: you have to really want to lose weight. I’ve intended and tried to lose weight before and failed. It’s well know that many people go on a diet and then lapse, and within six months they’re back to where they were before – or even heavier. You have to make a commitment. By all means make a social commitment tell your friends what you hope to do, but the most important commitment is to yourself. Accept that it won’t be easy.

I remind myself of my goals several times a day. I use nudge techniques such as putting my scales in the middle of the bathroom floor so I have to look at them and walk round them. I bought some compression exercise gear which I wear all the time to remind myself of the shape I want to lose. I look in the mirror often. At the end of the day I think about what I’ve eaten – and what I haven’t eaten. I continually remind myself of why I’m getting fitter. I tell myself healthy body, healthy mind.

I became really, really fed up with psycho-tummy. Someone said I was developing a beer stomach – I don’t drink beer, with coeliac disease, and I couldn’t face explaining that it was a result (in part) of my medication. Having been thin all my life, a natural ectomorph, it hurt. Then I weighed myself and worked out my BMI (body-mass index), and I saw that I had edged into the “obese” category. I know there’s a so-called “obesity epidemic”, but obesity is something that happens to other people!: the couch potatoes who stuff their faces with cake and crisps in front of daytime television. Not me. And because I felt fat, my self-esteem was falling. Self-esteem is a big problem for depressed people, and the last thing we need is people telling us bad things when we meet them on the street, or looking in the mirror and being reminded of how feeble we are. My blood pressure had crept up and being overweight is a major influence on blood pressure. I want to live to be over a hundred and be healthy, and you are unlikely to be able to do that if you’re overweight. So there were many converging factors that made me resolute about changing.

Weight, food, and diet are of course just part of becoming healthy. You have to exercise too. There is now a huge amount of data on mental health, cognitive function, and fitness, so I don’t think most people need convincing they need to exercise. I used to walk a lot and play football, but in recent years I have become increasingly sedentary. I have had enthusiastic spells of trying to exercise, starting to run and cycle, but it just took something to disrupt my pattern and I would stop. So again I made a commitment and signed up with a personal trainer. She won’t let me stop, and pushes me more than I would push myself, and after a year I think that was one of my best life decisions. Of course exercise by itself isn’t a very efficient way to lose weight: it takes about ten minutes of running for an average person to burn off a banana, and well over half an hour to get rid of a typical candy bar. However it is widely thought that exercise increases our resting metabolic rate both in the short and long term, meaning that we burn off more calories just sitting around doing nothing, although some of the evidence is mixed (see this paper for a review).

That’s enough background. You want to know what I’ve done. I should as usual provide a caveat that I am neither a sports nor a nutritional scientist, but I am a scientist and have read a lot of the research. And I mean a lot. Unfortunately much of this research is contradictory, and any diets strike me as faddy and having no scientific motivation. The Paleo and Primal diets are most logical, although the evidence about them is controversial at best, and I don’t understand some of the more extreme claims. But thinking from an evolutionary point of view does make sense to me: how have we evolved to eat? I simply try to eat healthily, with as much variety as possible, hoovering up nutrients and micronutrients, without going to any great extreme. Perhaps the following is obvious to you, but it wasn’t to me.

So forget points, on and off days, food mixing, going to meetings, treats, and spending money on how to diet. Here is the Harley Diet in 25 easy to digest points.

  1. For everything I eat, I ask myself would one of my ancestors, ten thousand years ago, have been able to eat it? If the answer is probably not, I treat it with caution.
  2. That means I try and eliminate processed foods of any description. No cakes, no biscuits, no cook-chill curries, no free-from fishfingers, no pork pies. They’re often full of bad ingredients, particularly bad fats, and usually have far too much salt.
  3. Sugar is evil. There is a splendid book (derided by the food industry) by John Yudkin called Pure, white and deadly. It’s about sugar (sucrose). I have tried to eliminate it altogether.
  4. High-fructose corn syrup seems to manage to be even worse than sucrose. I try and avoid it completely.
  5. That means for anything that isn’t really obvious (e.g. a banana) you have to read the label. With coeliac disease I’m used to reading labels, because it’s amazing how gluten can creep in to what you buy, but I’m learning that very little can be taken at face value. I discovered yesterday that Marks and Spencer cooked Honduran king prawns have salt and sugar added. I tweeted M&S about it and they said it was “to balance the flavour”. I asked them what that meant, and they didn’t reply. Then I checked the raw prawns – and they have added salt too!
  6. Fruit is high in fructose (another sugar), so I approach it with caution. Fruit varies in its fructose content; dried fruit has the highest content; grapes, apples, and pears have a moderate amount. I eat a lot of berries.
  7. If you have to be careful with fruit, then fruit juice is a complete no-no. It is very high in sugar and has little of the good supporting other stuff (such as fibre). Liquidised fruit is OK.
  8. I can’t eat grains with gluten in, of course, but I try to avoid grains altogether. That includes rice and quinoa. Farming and consumption of grains is a huge topic in itself, but suffice it to say I have been convinced by the evidence that they’re best avoided. I see some merit in the claim that the first agricultural revolution (around 10,000 years ago) was one of the worst disasters to befall humans. I’m not puritanical about it; I occasionally eat some rice.
  9. I try and keep my carbohydrate intake low. This goal is easier to achieve avoiding processed food (including bread and pasta) and grains; the main temptation left is potato. I allow myself some Marks and Spencer crinkle cut chips (no added salt, very little added oil, or batter, mostly potato) for lunch. Sweet potatoes are good. Note that my diet is the inverse of the current government recommendations.
  10. Legumes are controversial. A lot of people are against them (Pythagoras had a legendary aversion to beans, and was murdered because he refused to escape through a bean field), and I find the research literature a bit confusing. I allow myself some. I like baked beans, but even reduced salt and sugar beans still have a lot of salt and sugar, so now I make a large batch of my own every three or four days, completely free of added salt and sugar. I find a pressure cooker to be invaluable; I have a combination pot by Andrew James which Amazon sells at a very reasonable price, but there are almost certainly other good ones out there. Baked beans are particularly important for the lycopene, which comes from processed tomatoes – raw tomatoes are no good. Tinned and pureed tomatoes may help prevent prostate and breast cancer.
  11. If the above sounds a bit obsessive, wait until you hear that I weigh everything I eat. I have some digital kitchen scales and use the app Perfect Diet Tracker to keep track of everything (there are almost certainly other good apps out there). I think keeping track of what I eat is the single most important thing I’ve done. It’s very easy to go over target. After a while you get an idea of how much to eat and what sort of thing. I weigh myself weekly and of course keep a graph going. I have experimented with daily weighing but there’s just too much noise.
  12. What is my target? I’m aiming for under 2200 Calories a day, preferably under 2000. From that I want about 85 – 100 g of protein, at least 25 g fibre, and under 100 g carbohydrate and 1 g of salt. I know there is a lot of talk about good calories and bad calories,, and being able to eat as much fat as you like, but at the core of my diet is the belief that more or less, the calories in has to be less than the calories out.
  13. I’m not too worried about my fat intake but remember fats and oils are stuffed with calories. 100 g of olive oil has almost a thousand calories. On the other hand there are many health benefits of many oils so I add them to my diet – carefully. I watch the amount of dairy I eat. I love cheese, but it’s high in calories. I eat it, but only in what I call “extreme moderation”. I never have cream.
  14. I have cut back on red meat and eat a lot of fish, chicken, and turkey. I have prawns a lot for breakfast. I like smoked salmon but it has a high salt content, so I have it rarely. Eggs are good.
  15. Breakfast can be a bit repetitive – a typical breakfast is prawns, berries, and nuts.
  16. Nuts are good too – early hunter gatherers would have eaten a lot of seasonal nuts and berries, supplemented with fish and meat when available. However nuts are high in oil and calories, and some nuts have a better ratio of Omega 3 to 6 oils; macadamia nuts (fortunately my favourite) and walnuts appear to be best.
  17. I mostly eat grilled meat and fish, and season liberally with fresh garlic, ginger, and chillies.
  18. When you’re careful with food you can get hungry, and volume helps prevent hunger. Some foods take up a lot of space, are healthy, and deliver very few calories. Learn to make broccoli and mushrooms your friends.
  19. I reserve a number of calories for daily Champagne, although I have cut back on wine in general – too many empty calories.
  20. I know many disagree with me about this point, but I don’t snack. I’m lucky in that I rarely get hungry between meals. But of course if you do snack you’re going to have to find something that’s not too calorific, and to watch your daily calorie intake and reduce the size of your three main meals accordingly.
  21. I have experimented with partial fasting (which many swear by; sometimes our hunter-gatherer ancestors went a bit hungry) by skipping the occasional breakfast. I don’t make up the calories through the rest of the day.
  22. I have removed all temptation from my house. I particularly love the meal of (gluten-free) pasta, cheese, and garlic fried in olive oil. I used up the pasta in a final memorable blow-out, and just haven’t bought any more since. I miss it though.
  23. Remember to stay hydrated. I now sip water throughout the day. There’s some evidence that being well hydrated reduces hunger.
  24. You can’t weigh food when you’re away your home, and you can’t control everything about what you eat out, but you can still be careful. I don’t eat out as much now, but I still enjoy travelling, and I accept that when I do I will probably put a bit of weight back on. But I enjoy eating local food, and it doesn’t take that long to lose it again.
  25. Apart from travel, I don’t believe in treats and days off. It’s a slippery slope. But you have to be forgiving with yourself if you do slip up.

If this all seems like a lot of effort, that’s because it is, but it’s your health, mood, and longevity, not just your weight, that are at stake. And much of it becomes a habit after a while; the more you do something the more automatic it becomes and the less long it takes to do it. I still think it’s easier to implement than many other diets out there, and I also think mine is a very healthy diet. I should say that I still have some way to go before I reach my target, but I’m getting there and I’m confident that when I get there, I will stay there.

Finally, thank you to everyone who has wished me well in my battle with anxiety and depression. It hasn’t been easy, but I detect a glimmer of light in the darkness. I am sure being fitter and eating healthily has helped.

A reminder you can contact me through the comments section here, or by email at trevor.harley@mac.com. You can follow me on Twitter at @trevharley. Good luck with losing weight.

Retiring and getting old

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

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

Hubris: Collapse

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

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

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

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

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

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

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

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

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

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