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.

True grit

Cheviots from Carter BarIt is easy to get out of the habit of writing. In spite of my blog a few weeks ago (Nulla dies sine linea – not a day without a line, first said by the painter Apelles of Kos, but which applies just as much to writing as painting), quite a few of my recent days have sadly passed without a line.

I can attribute this failure in part to what remains of the day job (especially marking, a task that I particularly detest but which is one of the most important things that academics do, and which requires time and concentration), but I know thats a feeble excuse. I should have had plenty of time. I have just found it difficult to find an independent working routine that suits me.
All the data shows that we work best when we follow a routine. Depressed people function better when they follow a routine that imposes some structure on our lives. Finding a good routine is good. In fact to be creative you might need one. If you look at the lives of highly creative people they all have very highly structured periods when they’re working – routines bordering on rituals (hence the title of one my favourite books on the subject, Mason Currey’s Daily rituals, a book I’ve talked about before in this blog). One of the most popular rituals is to get up early and start writing, stopping around lunchtime, and then taking the rest of the day “easy” (including do those low-value, distracting tasks such as email). I can see the advantages of such a schedule: you get your words under your belt first thing. I always feel better about the day after I’ve written at least a thousand words. But life is not so simple for a depressed writer: my medication (even though I’ve really cut back) really interferes with my morning. I feel tired on waking around 7.30, and it takes me a few hours to get going properly. Maybe one day I’ll be able to cut out that final Quetiapine, but I still can’t really imagine waking at 5 am, because I can’t imagine going to bed at 9 pm. I love midnight too much. And in any case I’ve talked to a few depressed people who say they can’t really get going until 10.30 or 11.00 am.
Let me take yesterday as an example. I woke at 7.15, and rushed to get out before my preferred two hours easing in time, leaving before 9 for gym at 9.30. At least exercise makes me feel better overall, and has the advantage of waking me up. Then I had a few errands to run, and back for coffee at 10.45. I did some useful reading while drinking coffee. Then as rain was forecast for later in the day, I did a few garden jobs I’d been putting off. Then I had my Primal living lunch (yet another type of diet, or rather lifestyle, I’m trying out). After that there were some “real work”-related things I had to do, and particularly several pressing emails to answer. That left me pretty tired, so I had a short nap. Then it was 4.45. I had a few work things to do again, and some washing to sort out, which took me to 6. That left me two hours of creative time, by which time I felt horribly guilty about not doing enough earlier.
Sound familiar? That’s how my life often goes. I can’t point to anything and say I shouldn’t have done it, so what else could I have done? Now you unlucky souls in a 9-5 job are probably thinking “lazy f*cker, he should have my job to see what can be done in a day”. But I “work” after 5, and all weekend, and most holidays too. And as I’ve talked about before in this blog, if you look at how much real work can be done in an hour, it’s surprisingly little. My own measurements suggest I cant do more than 35 minutes an hour over 8 hours without hitting the wall. This figure of 3-5 hours of real work – deep work – a day is consistent with what Cal Newport says in Deep work, with how highly creative people schedule their time in Daily Rituals, and how much deep practice can be sustained in one day (a discussion of which can be found in Duckworth’s superb book Grit, which I’ve just finished reading). Passion and perseverance are tiring.
So I am still searching for the perfect routine, the perfect ritual, the perfect day. And of course every day is different: some days I don’t go to the gym, some days there are other things to deal with, and some days it’s Christmas. Nulla dies sine linea says nothing about stopping writing just because it’s Christmas (but I have).
So one reason why we don’t we stick at what we want to do is finding the time to do real work. It’s difficult enough for the best of people with the best of intentions. Those of us with mental health problems suffer additional burdens that eat into our time in addition to the time-killing side-effects of medication.
Being mad really does steal your life.

Mens sana in corpore sano

chives

 

It’s under a hundred days to go now before my official “retirement” date and when my life as a full-time writer begins. I’ve made the big change – or at least the decision to make the big change – that I hope will lead to a more satisfying and mentally healthier life, and now it’s time to look at smaller changes I can make. I’ve already taken up exercise in a big way and been going to the gym regularly for some months now; I’m pleased – and surprised by myself – that I’ve stuck to it. I’ve reduced my medication gradually without too many ill effects. I have now sorted out my life, to some extent, and my depression is in abeyance, at least for now. I have identified a purpose – writing, in the first instance on consciousness. I now need to go further and tweak my mental and physical well-being. I also face many years (I hope) “post-work”, and I want them to be healthy, happy years. I can already feel a bit of arthritis in the fingers of my left hand, and I still feel more tired than I would like. I am at last doing enough exercise, so what else can I change for a better life?The obvious answer is diet.
Now I don’t think my diet is too bad – as I have coeliac (celiac) disease (I don’t like the phrase “I am celiac”, identifying myself with the disease), I already avoid gluten and wheat and too much dairy. I am fortunate in not particularly liking the taste of sugar, and avoid processed food. What else can be done for a better diet and hence better life? We are after all what we eat Note that I am using the word “diet” in a loose sense to refer to everything we eat, not specifically a means of calorie restriction.
Unfortunately the world of improving your health through diet is a nightmare. It used to be so straightforward: eat with the pyramid of a little fat, lots of complex starches, fruits, and vegetables, and avoid saturated fat, while doing moderate or more exercise three to five times a week.We can say with some certainty what is bad: smoking, too much alcohol, no exercise at all, processed food, sugar, modified sugars, trans and hydrogenated fats, and too many calories. But then things get very confusing. It’s pretty much agreed that leafy green vegetables are good for us (although opinion is divided on whether they are better lightly cooked or raw). But here is the list of some of the disputed foods:

– carbohydrates: much loved by “official” dieticians, treated with great suspicion by many food movements (e.g. Paleo, Primal, to a lesser extent South Beach). I’m assuming we’re talking about good carbs (no crisps, no cakes) that you get directly from vegetables. Sweet potato seems to be the healthiest.
– grains: many are a no-no already when you cut out gluten, but things like rice are disputed. I don’t like them much anyway.
– fruit: you thought you were on safe ground, but many are very high in sugars, particularly fructose, and Paleo and Primal limit their intake. Best fruit: berries.
– nuts: high in calories and oils and many have the wrong Omega 3:6 ratio.
– oily fish: generally agreed to be good, but some worry that they’re a source of contaminants, heavy metals, and colourings: wild or organic are best (if you can get them!).
– meat: disliked by many diets, but preferred in Paleo and Primal, particularly grass-fed and organic (again if you can get it).- saturated fat: despised in the traditional diet, but desired as a major source of calories in Paleo and Primal.
-mushrooms: full of fibre and vitamins – but argued by some to aggravate intestinal yeast infections. Is this anything more than superstitious thinking?
– garlic: how can garlic be evil? The Bulletproof diet says avoid because of its mind-altering properties.
– omega 3 oils (fish oil): as long as they’re heavy metal free, although the extent to which they are beneficial to adults remains disputed by some scientists.
– organic or not: surely it’s got to be better to eat stuff that’s free from pesticides and herbicides? Some scientists have argued it makes no difference.
– alcohol: preferably as red wine, a little is generally thought to be good by many.

What is most problematic is whether most of our calories should be coming from carbohydrates, or from fat, oils, and protein. Will fat kill us, or stave off the heart attack? It’s a high-stakes game.
But in the end, as my finger hurts and my back hurts and I decide to skip that glass of wine and measure out a nice, I sometimes just despair at the confusion. It’s difficult being an anti-ageing biohacker.

Nulla dies sine linea

 

sun rays

 

I have to finish the first draft of my book on consciousness by the start of November. I want to leave about two months for rewriting, clarifying, and improving the style. That means. 1339 words a day every day before 1 September to reach my target 160,000 words. (My writing software of choice, Scrivener, will automatically calculate the daily target based on your deadline and target length, and keep track of your daily writing total against the daily target.) There are probably going to be some days when something goes wrong and I can’t write, so I should be aiming for about 1500 words a day. I don’t know whether that sounds a lot or little to you; most days I have to read and think to be able to write those words, and I have to keep track of citations (not included in the total) as I go.

It would be easier if I didn’t have a day job too. Fitting writing in spare moments is difficult and stressful. Whoever thought that a writer has an easy life? At the very least it requires great discipline and great dedication.

When writing like this it is difficult to fit much else in to life. The mundane tasks are piling up. I really should wash the car, clear the vegetable patch, and change my energy suppliers, but such things always come last.

But the end is in sight. I finish the day job on 31 July. As of today that’s exactly 100 days.

Hopefully then things will be easier. But then there are these things called “holidays”. No wonder holidays can be among the most stressful of life events! Holidays for the writer and depressed person are interesting things. Words don’t get written unless you’re at the computer (or typewriter, or even with a notepad and pencil), and totals don’t wait for holidays. I suppose all self-employed people have the same problem – can we afford to take a break? It is though I think more challenging for writers facing a deadline. My current plan is never to stop writing, and write even in holidays and on Christmas day.

I suppose there is with every task a point at which it sometime becomes a chore, no matter how important the job and no matter how enjoyable it usually is. We just have to push on through.

A long time ago, Apelles the painter said:

Nulla dies sine linea.

Not a day without a line. The same applies to writers too. Even depressed writers. And setting some task for the day ahead, however small, and if possible doing it is of great help to depressed people in general.

The daily schedule of a depressed writer

 

wood pigeon

It’s not easy being depressed, and it’s not easy being a writer. Being a depressed writer is worse than the sum of the parts. I often wonder why I bother; why not just go for the easy life of staying in bed all day long, which is often what I most often most want to do? Instead I struggle to make time for my writing.
It does mean that for depressed writers there is the question of how can we best arrange our time to facilitate writing? Of course it’s a problem all writers and creative people share. One of the best books I have read recently is Daily Rituals: How Great Minds Make Time, Find Inspiration, and Get to Work by Mason Currey (2013). Unusual creativity comes from unusual people living unusual lives. It is quite difficult to discern a pattern in the most creative lives. Have a look at this nice graphical representation of the daily routines of a sample of creative people (including creative scientists):

https://podio.com/site/creative-routines

With all sorts of caveats, and with many exceptions, the pattern seems to be get started early, exercise, relax. I’m not being prescriptive: until I cut down my quetiapine medication I was incapable of getting started early. And when I was Dean I had countless 8.30 and 9.00 am meetings, which really got in the way of getting deep work done (see my earlier blog on “Deep work”). There is robust evidence that some people are morning types and some evening, and if I were going to be prescriptive about anything, it would be to work out when you have most energy and feel best, and do your most creative work then. So of course there are many exceptions to this general pattern of writing first thing: some writers can only really get going at night after a few martinis. (Amazingly though Ernest Hemingway always started writing at six in the morning, even if he had been up late the night before with hard drinking, and worked until about noon.)
For me it ‘s good though to get the writing out of the way. I can never relax until I’ve completed my writing goal for the day. Another problem with starting late is that I never know how a writing task is going to take until I’ve done it. I’m writing a book on consciousness at the moment and I’ve set myself the target of a thousand words a day. It preys on my mind until the target bar in Scrivener (my currently preferred book writing software) reaches 100% for the day.
It is worth spending time on working out what is the perfect day for living the perfect life, in the sense of maximising quality time to get what we want to get done, done. It’s obvious that routine is important; routine crystallised to the point of ritual in many cases, as the title of Currey’s book suggests. Routine does bring its own problems for living – routine is the enemy of spontaneity, unless we schedule some hours in which to be spontaneous, which almost defies the purpose. But when on a creative burst, writing a book with a deadline, I need routine. A rigid routine or else I will not get it done. This routine means being tough on myself as well as other people. No exceptions.
I do wonder how some people manage to get so much more than me. I struggle at the moment with work, let alone writing. I try and free up as much quality time (for reading, writing, and thinking) as possible by outsourcing things like cleaning and mowing the lawn. I’m lucky that I can. How do people with children manage? But there are some days when I am so depressed that I just want to sit and cry and stare into space. Fortunately these days are much rarer when I’m writing; perhaps the sense of purpose writing provides helps us lift my mood. But one of the most depressing things about being depressed is how much time is lost to being ill. It is tragic.