Posts on mental illness in general

Do not suffer in silence (7 April 2024)

A version of this blog appeared in early February on the "Trevors together" website:

https://www.trevorstogether.com

I have never liked the name Trevor. I don’t know why my mother chose it; she was always a bit shifty about her reasons when asked. I think of it as a Welsh name, and Welsh I am not. In the USA some years ago I was ordering a Philly cheesesteak when the server asked me for my name; “Trevor”, he said, “gee, that’s not a very American name, is it?”. “Call me Carl”, I said, and he did.

I suppose I could have changed my name. I know many people who didn’t stick to their birth name; a Fiona who became a Fhionna, a Ruth who became a Pendragon, and actors are able to be anyone. I know several people who have used their middle names. That wouldn’t have helped me because my middle name is Andrew, and Scottish I am not. No, I don’t like Trevor, but instead of doing anything about it, I moan to myself and suffer in silence.

Suffering in silence is something we are very good at. Indeed we view patient suffering as part of our reserved, stoical British nature, and consider it to be a thoroughly good thing. If you ask someone how they are and they reply “oh not so good, I have a bit of a headache and some arthritis in my left middle finger and my bowels haven’t been quite normal the last few days”, we look at them oddly, and turn off mentally. We ask out they are out of politeness, and we want to hear in response “very well thank you - never been better!”, even if we can see blood spurting from their ears we expect them to say “it’s just a scratch”.

But is it good to bottle up our true feelings, our anger, our physical pain and our mental anguish? Freud certainly didn’t think so. For Freud repression of past events led to mental illness. The Rat Man developed obsessive-compulsive thoughts that something bad involving rats was going to happen to his father’s bottom because of his father had long ago punished the Rat Man for childhood masturbation. Freud considered the treatment of bringing these repressed thoughts out into the open as one of the early successes of psychoanalysis.

We do not now view repression favourably as an explanation for much of mental illness. There is though a great deal in the idea that we do not talk enough about what pains us, particularly mentally. We tend to suffer in silence, even though much of this suffering is in fact unnecessary; unhelpful and unhealthy, even.

I think there are two reasons for our silence. The first is that there is still a considerable stigma associated with mental illness. My mother suffered all her life from terrible depression, anxiety, and obsessive-compulsive disorder (and probably more), as did her mother before her, and probably her mother before her, yet she didn’t do anything about it until she was over 70. In contrast she would happily go to her doctor and expect a pill for the slightest physical disturbance. Mental troubles though were different: they were in some way her fault in a way that her “allergic rhinitis” (hay fever) wasn’t. If only she tried hard enough, she would be able to conquer her symptoms by sheer force of will. Of course, she never could, and as a result was deeply unhappy most of her life. Society often treats people with mental illness as weak people, perhaps even bad people, blaming them for their troubles. Broadsheets periodically publish letters to the effect that “mentally ill people need to pull themselves together and snap out of it”. I have even had a psychologist say to me at work “I know you’ve had mental health issues BUT …” - they would never have dared say to someone in a wheelchair “I know you are paralysed from the waist down, but you do seem to have a bit of trouble with the stairs”. People don't say "the cancer diagnoses are increasing - it can't be because the science is getting better, they must be faking it". In the face of such hostility it isn't surprising that too many are afraid to talk, particularly the most vulnerable groups, including men.

Second, very closely related to this idea that we are responsible for our mental woes is a sense of shame that amplifies our belief that these things are best not talked about except reluctantly and apologetically. People remain quiet about their drink problems or debt problems or gambling problems because they worry, quite rightly, that others will blame, accuse, and shame them instead of trying to help them. The sense of shame often exacerbates the original problems such that often there seems to be no way out, and when people feel completely hopeless, they might take their own lives.

We need not suffer so much because being depressed or addicted to gambling is not our fault. We are a product of our genes and environments. Gamblers have different reward systems from the rest of us. People need help and understanding, not condemnation. Mental illness is just as real as physical illness.

Usually the first step towards treatment is to talk about our worries, concerns, and illnesses. People should seek help, of which there are many sources out there, including the NHS, Samaritans, Citizens Advice, and probably, your friends. I have been amazed how many apparently normal, happy people are, in fact, deeply troubled in some way or another, and are relieved to hear that ill and unhappy they might be, bad people they are not. Normal is a myth.

And if you do consider yourself normal, and think you are a perfectly content, happy soul, you can spread some of that joy around by occasionally listening to others, and encouraging them to get help.

Full disclosure: I am completely mad. I suffer from depression, anxiety, OCD, ADHD, and am on the autistic spectrum. Some treatments have helped, but I am still pretty unwell (mentally) most of the time. And yes, for many years I denied it, making things much worse.

I am Emeritus Professor of Psychology at the University of Dundee. I write about mental illness, the weather, consciousness, and language. My website is www.trevorharley.com.

Things people say (5 May 2023)

There are many things people say to me about my mental health – and that of others – that annoy me. I am sure they may have the best intentions in mind. They usually mean well. They think they’re helping. Speaking to others, I know that I am not alone in feeling that normal, healthy, happy people should be more guarded. All my life people have been saying things like the following to me.

“You should stop wallowing in your misery and snap out of it and pull yourself together.” As though I have a choice. I find this the most annoying thing people sometimes say.

“But you are so successful …”. I am often told that and it is clearly given as a reason as to why I can’t be mad, or be on the spectrum, or have ADHD. I don’t think it’s unreasonable to say that by most measures I have been relatively successful in my career, but that doesn’t mean it hasn’t been very hard work, or that I haven’t just been very lucky. (Yes, I have “impostor syndrome” too.) Or that I couldn’t have done even better with a more normal brain.

“You should just go for a run.” It helps, I know, but when you are severely depressed you just can’t. And it will not cure a seriously depressed person.

“I know you’ve had mental health problems but …” People have actually said this to me. Bring on the equality, diversity, and discrimination training in the workplace! Would they have said something similar to someone in a wheelchair?

If only people would stop before they say anything personal to someone struggling with mental health problems and ask themselves “would I say this thing to someone with cancer?”. Of course the person might think that mental illness and physical illness are different, and that the former is a person’s fault, while the latter isn’t. Changing that outlook is the most important task in the fight against stigmatising mental illness.

Don’t let people say any old rubbish to you.

(I am sorry about the brevity of this post, but a post is better than no post. I have been “wallowing” a great deal lately.)

Weird (8 February 2023)

All my life, people have been calling me weird, so many that I have at last accepted that they are probably right.

“Weird” is a statistical label; people are weird if they’re out there on the extreme of some behavioural dimension, or more likely dimensions. A dictionary definition is:

“Very strange and unusual, unexpected, or not natural.”

That definition doesn’t capture the usually pejorative way in which “weird” is used as a label. Also, it’s not simply being extreme on any behavioural measure. You can be very clever, or very extravert, and I doubt anyone would call you weird. No, weirdness implies a special sort of unusualness. It’s thinking or behaving in some unusual way that catches the attention of most people and makes them want to pass some slightly negative judgement. Looking odd, having an unusual hobby that is considered esoteric (or “boring”, as though the activities of most people have some inherent meaning that makes them worthwhile), saying inappropriate things, or repeatedly breaking social norms, are all likely to get you called a weirdo.

Being weird obviously troubles many individuals because the internet is awash with worried weird people looking for reassurance. My favourite question is “Is being weird normal?” – to which the answer was, surprisingly, “yes”. There is apparently, no normal. But while no one might be exactly average, I don’t think that really lets me off the weird hook.

There are even apparently benefits to being weird. Weird people tend to be more creative. Many scientists and mathematicians are distinctly odd. This finding shouldn’t be too surprising because people who achieve great things must be very unusual in some way.

I think my weirdness is a consequence of my neurodivergence, one of those increasingly fashionable terms that I think does have some value.

Neurodivergent people think and behave in atypical ways, and go against social norms, because our brains are different, either through genetics or upbringing or most likely both.

I have previously listed all my psychological symptoms, and here is a recap: depression, anxiety, obsessive-compulsive disorder, phobias, general phonological disorder, and autistic spectrum disorder (not to mention noise sensitivity, task avoidance disorder and completion anxiety). Is it likely I have all of these independently? Of course not. They all stem from an underlying brain that’s significantly different from normal; my brain is sufficiently different from others to warrant a label.

You can be neurodivergent without it being a problem for anyone. It’s only difficult if it causes you pain or distress: in my case the depression, anxiety, and occasionally OCD do. I hesitate about adding “or if it causes other people distress” because people are sometimes upset by the behaviour of another when it is questionable whether they should be. A psychopath might not suffer but can hurt others, but is the naked rambler recalling doing anyone any harm?

There are even some people who seem weird to me. There is a chap who wanders around town with no shoes on, whatever the weather. But doubtless he has his reasons, and it’s none of my business. The world would be a happier place if people stopped telling others what to do so much.

So to all you self-confessed weirdos and freaks out there, with the caveat about being or causing psychological or physical pain: be free, be yourself, indeed rejoice in your weirdness. And if you don’t think that you’re weird, please don’t judge anyone else.

Sometimes I almost feel sorry for all you neurotypicals out there.

Sing if you're glad to be mad, sing if you're happy that way (October 2022)

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? (September 2022)

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.

Further reading

Allsopp, Kate, John Read, Rhiannon Corcoran, and Peter Kinderman. (2019). Heterogeneity in Psychiatric Diagnostic Classification. Psychiatry Research, 279, 15–22.

https://doi.org/10.1016/j.psychres.2019.07.005.

Fear of death (April 2021)

When I was three or four I was afraid of television aerials, dogs (particularly black ones), electrical plugs, outdoors painters, thunder, and pneumatic drills. As I grew up these specific fears resolved into more general anxiety disorders, but I still have mild arachnophobia (I bear spiders no ill will, but they have far too many legs and move much too quickly for their size) and thanatophobia, a profound fear of death.

Most people don’t want to die, but I am surprised how casual most people are about their eventual demise. Why isn’t everyone raging against the dying of the light from the moment they first realise that the light will some day die? I think that in twenty-five years or so I could well be dead, and I think back twenty-five years from now and that doesn’t seem to be any time at all. Even if I die peacefully in my sleep, which seems to be most people’s goal, I won’t be happy. When I reflect on my fear I’m particularly afraid of not being conscious ever again. The universe will roll on perfectly well without me. A few people will grieve, but that will fade, and the ripples of the effects of my life will soon die down and I will be forgotten. Just writing that makes me very, very miserable. And angry, as does thinking about the unfairness of having to get old.

Mental illness requires consciousness. Your computer can’t be depressed, but a dog can be; we know from Martin Seligman’s studies on learned helplessness that dogs can show symptoms akin to depression, and of course other animals can suffer mentally too. Social outcasts in groups of social primates also give the appearance of being depressed. But can a wasp be depressed? We can’t know for sure, but it doesn’t seem likely. A wasp has very little consciousness, not enough to feel depressed. I explore animal consciousness in my new book, The Science of Consciousness.

Some forms of mental illness require more than consciousness: they require self-consciousness: thanatophobia is one example, and illnesses to do with the meaning of life are another. I am pretty certain Beau, my poodle, is not afraid of his death. Of course (non-human) animals are capable of fear and other negative emotions, but not of concepts that require self-reflection. I don’t think he has any concept of death, so he can’t be afraid of it. I’m not saying that if something happened to me he wouldn’t be very upset, but that he can no more appreciate the meaning of mortality than he can understand quantum mechanics. These concepts are utterly beyond his comprehension because he doesn’t have the mental capacity for them. It isn’t simply that the concepts are too complicated for him, it’s that reflecting on the death of his self requires a complex concept of his self, and for that he requires self-awareness. Awareness and self-awareness are very different things. Many animals are (probably) aware, but few are self-aware. I’m not sure it’s right to talk about awareness and self-awareness as if they are a dichotomy – he might possess a bit of self-awareness, but not enough to worry about his death.

Can we learn anything useful from all this? On the whole I’d say Beau is much happier than me, and he doesn’t spend his life reflecting on canine existential concerns. I think his happiness and restricted self-obsession are related; sometimes humans reflect too much. Of course some thinking is good: it’s good to be aware of our situation; it’s important to prepare for our deaths and leave our affairs in order, and I wouldn’t want to put existential philosophers out of a job, but for many of us too much reflection can be a bad thing. We should look at Beau and realise that it is good to live in the moment, which is essentially what studies of mindfulness and mental illness tell us to do. This obsession with death is also utterly futile because there is nothing I can do to prevent my impending obliteration. And maybe that’s true of much mental illness: we need to learn to stop thinking. Easier said than done of course.

Psychologists occasionally reflect on what makes humans unique. To the list of language, a highly convoluted cortex, and opposable thumbs, I think we should add the ability to suffer mentally in particular ways. Our uniqueness has given us unique ways of being tormented.

I wish March (2019)

I wish I had brilliant blue eyes.

I wish I had a smaller nose.

I wish my thigh bones were two inches longer.

I wish I didn’t have a psycho tummy.

I wish I had had a better relationship with my mother.

I wish I had just 10 more IQ points.

I wish I had children.

I wish I had a strong jaw.

I wish I had been to Australia.

I wish I had just a bit more money.

I wish I wasn’t pigeon chested.

I wish I had tracked down my friend Carl before he died.

I wish I wasn’t crippled by anxiety.

I wish I had known my father.

I wish my mother hadn’t died last year.

I wish I had more friends.

I wish I hadn’t messed everything up

I wish I could go outside.

I wish my mind wasn’t mud.

I wish I wasn’t depressed.

I wish quite often that I was dead.

Christmas comes but once a year (December 2017)

I am no grinch who wants to steal your Christmas. In fact I love many aspects of it; I love the lights, the colours, a nicely decorated tree, an opportunity to drink champagne before lunch, and thinking about the turning of the seasons as the winter solstice at last arrives. But I don’t feel the joy of anticipation and the frenzy that many people, perhaps most people, apparently feel. It is one of many events, like parties and family gatherings, where I feel like an alien.

Why do people get so worked up about Christmas? Maybe I’m very lucky in having such a good life that I don’t need special days; maybe it’s because I don’t have children; maybe because I’m not so conditioned by the insane advertising that tries to force us to think the event is the most important thing ever. Or maybe it is because I’m an insane alien. Sure, it’s nice, but the reaction of nearly everyone else seems so over the top  to me, particularly given that most ignore the religious aspect. (Indeed usually the more religious people are, the more restrained they are about the commercial aspects.)

It is seen as opportunity for many to “let their hair down”, and have fun, a good “blow out” for a day or two. But why just one day? Why can’t our lives be full of meaning and pleasure all year round? Why can’t it be Christmas every day?

I know of several people of whom it is said “they live for their holidays”, among which I am including Christmas. I find that sad: the remainder of their lives is so unpleasant and has so little meaning that they’d rather they didn’t happen, but instead would pass as quickly as possible until the next special day. At this time of year it is almost impossible to get into Marks and Spencer’s food hall, and that’s assuming that you can park within ten miles to get in; what are you doing the rest of the year, shoppers? Where are you? What do you do the rest of the time? And why are you such bad drivers? I am supposed to be antisocial and depressed, yet I think your situation is the sad one. One day of joy and gluttony, three hundred and sixty four of misery. At least in good years I can manage five days of joy and only three hundred and sixty of misery. (Bugger leap years.)

Is it really that “work” you have to do really so unpleasant? It is clear that many people have really unpleasant jobs. It’s manual labour and repetitive, boring jobs that would get to me. Being an academic was good; working on a checkout sounds dreadful to me. Most jobs are in between. Yet the people who do them don’t seem that unhappy; they have friends, they chat, the time appears to fly by for them, although I would hate it. I am left confused. It doesn’t make much sense to me, but I am the unhappy one who is depressed. Is there some causal relationship here that I’m missing?

Is the experience of Christmas much worse if you are very depressed? I have been alone a few times on Christmas Day and it’s not nice. There are several good sites (here is another) talking about how Christmas and depression “don’t go” together. It is hardly surprising, because there are few things more depressing when you’re depressed than happy people.

If you are crazy about Christmas, good for you. I’m not trying to demean or cirticise you; I sometimes wish I could join in more easily. I’m simply saying that there are some of us who are cut off from normal life. I wish I could, if only once a year, let my hair down, as they used to say, but probably no longer do. But a very Merry Christmas to you!

What does a psychiatric diagnosis mean? (June 2017)

I have a new psychiatrist and a new tentative diagnosis. Or rather, a new additional diagnosis. So at the moment I have been diagnosed at some time by somebody with: severe depression, bipolar disorder, obsessive-compulsiveness disorder, obsessive thinking, anxiety disorder, social anxiety disorder, panic disorder, dissociative disorder, autistic spectrum disorder, narcissistic personality disorder, borderline personality disorder, and now adult attention deficit disorder. I have might forgotten one or two. Although I am certain I have depression and a batch of severe anxiety disorders, parts of all these diagnoses seem right, but none of them alone fits perfectly. I don’t think I’m special in feeling confused, even frustrated, about the problems in getting a clear diagnosis.

When you have a problem with your gallbladder or spleen, the diagnosis and treatment are comparatively obvious. Your just look at the spleen and you can usually see what’s wrong with it, and if that doesn’t work (I’m no spleen specialist) you run a few simple tests, like a blood test, and look at those results. But looking at the brain won’t help for mental illness. You can see a brain tumour easily enough, but you can’t see depression or anxiety. (I admit that this claim isn’t quite true, as there are some correlations between some structural changes to the brain and some mental illnesses some of the time, but the correlations are complex and not perfect predictors – yet – so I think my statement is essentially true.)

And then there is the pathologising of the extremes of normal behaviour. It is perfectly normal to grieve when a loved one dies, or to be upset when something important goes wrong. When does grief edge over into depression? It isn’t easy to say. When is a child abnormally hyperactive and not just rather boisterous? When is a person manic and bipolar rather than just lively and extraverted?

So at the moment mental illness is different from physical illness. Things might change in the future, with more sophisticated imaging and the means of visualising neural circuits and neurotransmitter system in real-time action. But even then we are left with the fact that the brain is a hugely complicated organ and the relation between what it does and its structure is also extremely complicated, and mental illness results from the interaction of developmental, situational, and genetic structures to the whole brain. Although we obviously have many working hypotheses, we don’t have any good complete models of mental illnesses and how exactly they arise, and how changes to the brain and its neurochemistry changes behaviour. I think this difficulty in seeing what is wrong contributes to the stigma of mental illness: with a physical illness, you can see, and therefore point to, your problem – look at my swollen spleen! – but people with mental illness look the same on the outside and on the inside.

Simple diagnoses make life easier for clinicians. You have a label, and then you also have a range of possible treatments: the label will determine that treatment. If you are diagnosed with depression and are given anti-depressants, and you respond to anti-depressants, then you must have had depression. Everything else, like poor concentration, tiredness, anger, lack of empathy, and inability to sit still, or whatever, must have been caused by the depression. But why should disorders of a very complex organ that we barely understand map nicely on to simple linguistic categories devised by clinicians in order to enable them to classify and treat people? I doubt if they do.

I don’t see that for mental illness we are in any better situation than physicians at the time of the Black Death who thought that the plague was caused by a miasma rising from the ground. But at least they could see the buboes. Just look at the mess the idea that depression is caused by a lack of serotonin is in.

In practice there is no point going in to see your doctor, psychologist, or psychiatrist, saying that their diagnosis is rubbish and unscientific. They have busy, difficult lives and can’t know everything. Do though make sure that every symptom that troubles you is taken seriously, and that you receive appropriate treatment for these symptoms. And if after a while things don’t get better you need more or a different sort of help. If your mood improves a lot but your concentration doesn’t, then you shouldn’t feel bad about trying to find out why. Good luck.

Dream a little dream (May 2017)

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

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

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

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

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

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

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

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

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

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

Stay well, and dream on.

Loneliness (April 2017)

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.

The future is bleak (September 2016)

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.

Big baby: Taking responsibility for our lives (September 2016)

t’s not my fault my blood pressure is too high, manufacturers put too much salt in processed food. Let’s sue the food multinationals! It’s not my fault I tripped up, the council should have put more effort into levelling the pavement. Let’s sue the council! It’s not my fault that I’m fat because I stuff my face with chips, it’s the shops for selling them. Let’s sue the shops! Let’s appoint a government chip tsar to tell me to eat fewer chips! And a salt tsar, and a council tsar, and chip tsar, and a tsar tsar to look after them! And when anything goes wrong, let’s sue the tsar tsar!

I’ve read a lot of life coaching sites and books, and there’s a strong belief that taking responsibility for your life, mistakes, and happiness is essential for personal growth and mental health. It certainly sounds plausible, and there’s plenty of anecdotal evidence, but I’ve found experimental data hard to come by. It’s the sort of idea that would be very difficult to test in practice. We do know from the work of Victor Frankl that the people who found purpose and meaning in their lives, who accepted their situation and who took responsibility for their lives, were those who were most likely to survive in concentration camps. So taking responsibility and accepting the situation can save our lives.

Then there is the well-known related result that when we are successful, we think that it is due to our efforts, and when we fail in some way, we have been unlucky; but when other people  are successful, they’re lucky, and when they fail, it’s because they didn’t try hard enough. [If you want to find out more, the original source is Jones and Nisbett’s (1971) work on the actor-observer bias. In terms of attribution theory we generally prefer external attribution to facing the possibility that we are at fault (that is, internal attribution); this work dates back to Fritz Heider in the late fifties. The fundamental attribution error is the name given to the cognitive bias that we overestimate internal factors in explaining the behaviour of others, while underestimating their role in our own behaviour.]

The other side of responsibility is blame. It is YOUR fault that I didn’t succeed at doing this or never even tried doing that in the first place. The UK is now starting to resemble the USA in being a blame culture, full of lawyers and ambulance chasers and people taking out insurance without reading the small print and then blaming the banks, and people eating too much and blaming the food manufacturers and supermarkets and advertisers. In researching this blog I came across the following, unattributed, quotation: “When you blame others, you give up your power to change”. That rings very true to me.

It’s not a healthy situation, either for society or for ourselves.

Self-employed creatives have it harder than most. Although being self-employed as a writer (or retired, depending on your perspective) is liberating, it is also frightening. Writers are wholly responsible for their own work. If anything goes wrong, they only have themselves to blame. Employees do as they’re told, however high-level their job: in the end they have tasks they have to do, and places they have to be – and if they don’t do them, or if they’re not there, ultimately they get fired. But if I don’t write my two thousand words today I can’t fire myself or sue the council. Being responsible for your own time is also dangerous because it’s so easy to misuse it. Procrastination must surely be the writer’s biggest enemy – why do today what can be put off until tomorrow? Writers must take responsibility for their time.

When however we apply the idea of responsibility to mental illness the issues are less clear. I’m not saying we should blame ourselves for our illness. Why am I mad? The reasons are complex; it’s not one’s person’s fault, it’s just the way it is. But there’s no point feeling sorry for ourselves either – in fact wallowing will just make things worse. If we can’t blame others for our predicament, we can at least take responsibility for our mental health and trying to get better. Yes, I know there are times when you’re unable to get out of bed, or move from the chair – I’ve been there. But most of us have some better days, and then we can make a plan to live by.

The first step, which surprisingly many don’t take, is to acknowledge to yourself that you’re ill. Or, if you’d rather, that you have a particular set of problems. Life isn’t going to be as easy for you as the cheery soul at the next desk who is never faced by self doubt, never wants to spend a week in bed in tears, and who has never thought about suicide. We are, I’m afraid, different. We have it harder.

The second step is to implement the plan. I’ve talked in another blog about what we can do to improve our mental health, and how physical health is an important part of mental health.

The final step, which even fewer take, is to come out; perhaps we don’t quite have to go so dare as  to say we’re glad to be mad, but we can at least announce that we’re mad.

How are we ever going to remove the stigma of mental illness if we ourselves are embarrassed about it, or if we try to hide our problems from others? Would you hide cancer or a heart attack? Are people ashamed about having arthritis? Of course not. Unless we decide there is no shame in being depressed, or obsessive-compulsive, or schizophrenic, how can we expect other people to think any differently?

Jones, E. & Nisbett, R. (1971). The actor and the observer: Divergent perceptions of the causes of behavior. New York: General Learning Press.

Note: The title of this blog is a nod to Michael Bywater’s excellent book Big babies, arguing that that is what we’ve all turned into.

Removing the stigma of mental illness (April 2016)

Last week was UK Depression Awareness Week.

I used to be sceptical about these special days and weeks, but now I think there is a great deal of benefit to having a concerted surge of activity because at the very least it generates publicity.

There used to be a great deal of stigma and shame associated with any kind of mental illness. People felt forced to hide their suffering. They were discriminated against, made fun of, and even bullied – things that of course just made people even worse. At our school, many years ago, boys who were slightly odd were given nicknames based on the local mental hospital. People found it more difficult to get and keep jobs. I remember an employee, a long time ago and in a place far away from here, feeling forced to tell me that he had been off work for some weeks with a “very bad cold in the head” – whereas there were rumours that he had had a “nervous breakdown”. There was very little advice available in the NHS, and there was a much more restricted choice of drugs. Prozac only became widely available in 1988.

Things are by no means perfect even now, but every time a celebrity “comes out” as mad, there’s another step forward. Every time someone is honest at work or with their friends all of us are a little more liberated. Those of us who can owe it to the others to stand up and say we’re GLAD TO BE MAD. Well, maybe not glad, but we are, and there’s nothing to be ashamed of. Stop the stigma now.

The afterlife (March 2016)

I would love to be able to believe in God. I can see the advantages of the promise of an afterlife, the lure of goodies for ever as long as I obey a few simple rules in this life, we provided a way of living without having to think about myself, and meaning on a plate. I envy the faithful.

It is of course more difficult trying to live a good life if you have to work out what good is yourself from scratch. The Bible tells us what is good, and we just have to follow the good book. To be fair the Ten Commandments largely provide a short cut for a moral system, as stripped of their religiosity they are good sound ways of being good to others, or at least not harming them, based on the golden rule do unto others as you would like to be done by.

But it’s the meaning I envy religious people most. Meaning on a plate; ready meal meaning. The rest of us have to make do with having no meaning. But because I think there is no ultimate meaning, it doesn’t follow I think that there is no purpose. We could, for example, give ourselves maximum pleasure in life. The Greek philosopher Epicurus advocated finding pleasure in life, although his pleasures were rather more modest than stuffing ourselves with champagne and caviar; he sought the pleasures of friendship, freedom from fear, and peace. And we have to titrate short-term gain with long-term pain: I could rob a bank tomorrow, and in the unlikely event that I succeeded in coming away with a few pounds, blow them on a first-class flight to Sydney. Any pleasure gained from this escapade would be more than outweighed by the grimness of the inevitable twenty years or whatever in prison afterwards. In any case robbing a bank would violate my ethical system of trying to do unto others as I would be done by; if we all robbed banks we would soon be in a pretty pickle (and all in prison).

I often think psychopaths have been dealt a lucky hand in life. The ability to put themselves first and not worry about must be pretty wonderful. I on the other hand fret about every action and how it’s going to affect others. I’m still a pretty selfish person, but I worry. And how I worry about retribution.

The loss of God (to many of us) has of course led to some well known consequences. The existentialists in particular have thought and written about how we should think and live in a godless world where the only certainty is death, sooner or later. Like many other depressed and anxious people I am obsessed with death. If you have no hope of an afterlife then what we experience now and in our remaining days is all we can hope for. The philosopher Kierkegaard said that anxiety, angst, comes from within us, and our dread at the existential choices we have to make in the face of our fear of death. He said that confronting this fear expands the soul and fulfils the self – assuming we can resolve the fear and accept the ultimate meaninglessness of life.

“Learning to know anxiety is an adventure which every man has to affront if he would not go to perdition either by not having known anxiety or by sinking under it.” – Kierkegaard.

We have to accept that we will die, and that will be it. I find that idea very hard to accept. It’s unfair, but it seems that there’s nothing I can do about it. And although the idea of not existing is so incredibly painful, perhaps it’s only when I feel that pain that I feel truly alive.

Emptying the minds (December 2016)

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.

     1     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.

     2     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.)

     3     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.

     4     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.)

     5     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.

     6     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.

Oh to be an optimist (August 2016)

There are a number of ways of dividing up the spectrum of personality types; the Big Five model is the most popular, but there are others. Some people are born lucky: they’re optimists. How I envy them! Their glass is half full rather than half empty – when I look at my glass, I’ve just had a sip and it is already a third empty.

Although optimism-pessimism is an important personality construct in its own right, it’s unsurprising that optimism correlates with other aspects of personality. I consult my favourite book on individual differences, Maltby et al.’s (2013) text Personality, Individual Differences and Intelligence, to confirm what we might have expected: that in terms of the “Big Five” personality factors, optimism is significantly positively correlated with extraversion, agreeableness, and conscientiousness, and negatively correlated with neuroticism (see in particular Sharp et al., 2011). I’m surprised there isn’t a negative correlation with openness; how can you be open to new experiences if you expect everything to turn out badly? Better the devil you know.

Needless to say optimism is correlated with good health and well-being. Optimistic people enjoy better physical and mental health, and they age better too. It didn’t take long to find a study suggesting that optimistic people might be less prone to Alzheimer’s disease later in life. They are a number of reasons for these findings: optimism seems to have a positive effect on the immune system, provides people with better coping strategies, enabling them to deal better with stress, leads to more positive health and life habits, and to an absence of negative mood (which we also know is bad for health). One has of course to be careful about inferring causality from a correlation (of course you’re likely to be more optimistic if you’re not suffering from chronic ill health, or more pessimistic if you’re under great stress), but the evidence suggests that optimism does indeed play a role in driving well being.

Pessimism can have a serious and negative impact on our lives (beyond simply our being more likely to die tomorrow). As academics carrying out research we are obliged to submit grant applications to get funding for our research and to write papers reporting that research when we’ve done it. There’s a great deal of rejection in academic life (some of it nastier than most people imagine), and if you’re pessimistic about your chances of success you’re going to be less likely to submit something in the first place. So your career suffers.

As you might expect, in general I am not usually an optimistic person, although I am trying to be more so. Here is an example of one recent chain of thought. As frequent readers of my blog will know, I’m now no longer working for The Man and am self-employed as a writer, consultant, and journalist: a professor with a licence to roam on whatever he is interested in. What good be better? (Except being paid more for it; all decent offers of paid work considered!) But it so happens that Monday 15th is my birthday. I’m 58. (Yes, I know you thought I was much, much younger.) To me that sounds unbelievably ancient, even though in my head I’m still only 19. 58 is uncomfortably close to 60, which is getting on for 70. Women in the UK until recently used to have to retire at 60, and men at 65. When I was growing up the life expectancy of a man was around 69. ****! I’m nearly that age! And after 70 it’s not too long until 80, which sounds really, really old to me now, and I think most people who are alive 80 have some kind of infirmity. I already have a touch of arthritis in my left little finger. And many people don’t make 80. And at 80 the life expectancy for a man is just over another 8 years. If I make 80, a big IF, I’m likely to die in September 2046. That’s not far away at all; I’m as good as dead. And we’re supposed to celebrate birthdays?

This line of reasoning isn’t just pessimism, it’s a mode of thought, called catastrophic thinking, which characterises depression. Minor difficulties or obstacles are turned into insurmountable hurdles. I’d heard of it before of course, but it was only recently that my therapist pointed out how often I think catastrophically. I am currently single; therefore I am destined to die alone. I will never find love again. I will never even touch anyone again. I’m too old to change, and too old to find a new partner. After all, I’m getting on for a 100. Except I’ll be dead before then.

Another example, one which happened while I was writing this blog: I spent ages (well, a few minutes) cleaning the cooker hob, and I’ve just dropped a piece of mushroom on it. All that time and effort was completely wasted, I thought. What is the point of ever cleaning anything? Let it rot.

Catastrophic thinking is one of the most insidious and pervasive yet least well-known features of severe depression. And one of the most annoying.

I seriously worry sometimes about the death of the universe. Everything is pointless. I don’t worry too much (it’s a Lesser Worry rather than one of my many Great Worries) but I admit it’s odd that I worry about it at all. I ask other people and most of them don’t give a damn about the End of the World let alone the End of the Universe. If you don’t worry about the end of the Universe and your place in the great scheme of things, I recommend you don’t try the Total Perspective Vortex, a creation in Douglas Adams’ Hitchhiker’s Guide to the Galaxy trilogy of five. It shows you that you are a microscopic dot on a microscopic dot, with an arrowing indicating YOU ARE HERE. Such realisation drives (almost) everyone mad.

I don’t know why I’m bothering to write this; I doubt if anyone will read it.

References

Maltby, J., Day, L., & Macaskill, A. (2013). Personality, individual differences and intelligence (3rd ed.). Harlow: Pearson.

Sharpe, J.P., Martin, N.R., & Roth, K.A. (2011) Optimism and the Big Five factors of personality: Beyond Neuroticism and Extraversion. Personality and Individual Differences, 51, 946-951.

Making big changes the small way (April 2016)

If you want to change yourself for ever, make the change in tiny steps. We’re all familiar with people who make big resolutions at New Year (I’m just as guilty as anyone else), who then take out gym membership on 1 January but who have stopped going by the 10th. When I reflect I’m ashamed by the number of times I have resolved to eat less, drink less, exercise more, work more, travel more, go out more, and so on, and so on, and so on.

A few years ago the book Nudge by Cass Sunstein and Richard Thaler (2009) was very popular; apparently politicians were taking it on holiday as beach reading. I see that there is a forthcoming book (2015) by David Halpern called Inside the Nudge Unit; its Amazon description starts:

“Behavioural scientist Dr David Halpern heads up Number 10’s ‘Nudge Unit’, the world’s first government institution that uses behavioural economics to examine and influence human behaviour, to ‘nudge’ us into making better decisions. Seemingly small and subtle solutions have led to huge improvements across tax, healthcare, pensions, employment, crime reduction, energy conservation and economic growth.”

The much debated “sugar tax” is presumably a recent application of the nudge principle: a small increase in the price of sugar-containing goods will (or might) change behaviour by stopping some people eating quite as much sugar as they have, leading to a reduction in obesity levels. With millions of people you don’t need to make a big change to make a big difference.

Nudging means changing behaviour by making small changes. We know dramatic diets are often ineffective; indeed people often end up weighing more than they before dieting. When people fall off the diet wagon they think “what the heck”, and binge. Small changes to lifestyles are more likely to persist and have long-lasting effects than dramatic resolutions.

So I am reducing my medication, and doing it gradually. (A caveat: always discuss it with your healthcare professional before you change medication in any way. I did with mine, and they’re monitoring me in case I go downhill without appreciating it.) I’ve cut quetiapine from four to one a day, very gradually. I don’t feel so good after going down to just one but I’m hoping it’s just a blip.

And of course only change one thing at once, and give that change a chance to bed in and observe its effects. There are still many more things I want to change about my life so that I can find more time for writing, reading, and thinking, but this change is the big one for now. It will mean I need to sleep less and am more alert in the day.

This technique should work for everyone – including depressed non-writers and non-depressed writers and even non-depressed non-writers. Look at your life. Decide what is the most important thing you have to change. Decide upon a small step towards that change. Implement the change. Give it time until what you’ve changed is now habit, then repeat. The technique is good for diet, exercise, working more, working less, and so on.

One thing I am not so sure about is whether gradual change is better for making a permanent change in areas such as smoking and alcohol and drug addiction. In these areas many people appear to have success with going cold turkey. Whether nudging would be even more successful for these sorts of things I don’t know, and I don’t know of any figures either way.

So vow to make one small change today.

Changing my life (April 2016)

In my last blog I described how I had decided to take the leap from being employed to self-employed, and become a full-time writer. I’ve done this in part because of course I want to spend more time writing, and in part because I think being wholly responsible for my life will help my battle with depression and anxiety. So far – and I’m aware that it’s very early days – I’m optimistic; mostly, at the moment, I feel remarkably happy and anxiety free. Taking complete control of my life has almost been an instant cure. I still have some bad days when I feel a bit depressed, but the bad is now nowhere near as bad as it has been. Of course the days are getting longer as well, and the perpetual gloom of the Scottish winter has started to lift; I’m sure that helps, but I don’t think the weather is the main reason for my improvement. Being free is I think the major factor. I’m sure the feeling won’t last for ever – people soon adapt to changes in their circumstances – but I think it’s a good and important change.

So I have decided to reduce my medication. I have gone down to only two quetiapine a day. Quetiapine is an atypical anti-anxiety drug that is very effective against anxiety. It worked great for me, but made me extremely sleepy. I was worried that this reduction in dosage might interfere with my ability to sleep: I love the instant unconsciousness quetiapine gives you at night; I like the way I put my head on the pillow and I am asleep. In the morning I don’t even remember switching the light out the night before. I was afraid that I would lose this instantaneity of falling asleep, but I haven’t (so far). I don’t sleep quite as deeply later in the night, but I do find it easier to wake up in the morning. I hate the way quetiapine makes it so difficult for me to wake, and leaves me feeling like I just need to go back to sleep for the first couple of hours of the day. Reducing the dose has greatly reduced this zoned out feeling. So far, so good. And I’ve had no rebound in anxiety levels, which I also feared might happen.

I’ve decided I need to make other changes too. Now the general advice when changing your medication and life when mentally ill is only to change one thing at a time. So I’ll give the reduction in quetiapine some time to bed down. My previous “big change” was to try to get fit and go to the gym. This change has more or less worked out, and I’m now fitter than I have ever been. I still can’t say I particularly enjoy the gym or exercise though; I find cardio painful – literally and metaphorically. I hope to reduce the dose of quetiapine to one a day soon.

But it is also time to rethink my daily schedule to see how I can maximise writing time. The research shows that many great writers start early in the morning and get going with those words. I would need at least a cup of tea before I could do anything, but I could make writing the number one priority of the morning. No checking of email or Facebook until those thousand or whatever the target number of words are out. At the moment I go to the gym some mornings, and as the anxiety builds up, take quetiapine. Although it calms me down I feel a bit sedated as well, and I don’t like that feeling. Often (and of course it’s not always possible to do so) I fall asleep. I then feel good and perky for the later afternoon, evening, and early night. Of course at the moment the writing time is naturally heavily constrained by the day job; I won’t be able to change my life fully until I actually finish. At this time of the academic year student project work and marking more than fills the day. For now though, work comes first. The writer’s life is not an easy one. And being depressed is not easy. Being an employed depressed writer is very difficult indeed.

The cycle of consumerism (March 2016)

Anyone who knows me well knows that I love my stuff. I love the latest gadgets, particularly if they’re from Apple. I like my car and big TV. I like my stereo and home cinema. I love buying books and music.

And yet, I know there’s a hollowness at the heart of all this consumerism. I know stuff shouldn’t make me happy (but it does, a bit, at least, and at least for a while). I think in addition to all my other problems, including OCD, I have a slight shopping disorder. If I see something I want I get it; waiting is not a word I know. It’s not bad enough to ruin me, and I don’t have a cupboard full of shoes (books maybe), but it’s at the boundary of normal and pathological. In part there’s this completeness obsession – the idea that I might be missing something. Or even worse, that one book in a series might have a different kind of cover.

Yet in the end, totally predictably, stuff doesn’t make me happy (well, just a bit). Shopping doesn’t make me happy. Owning stuff doesn’t make me happy. Or if it does, I only feel happy for a short while. In the end, it makes no difference. If anything I feel a little encumbered by all this stuff.

But not encumbered enough to do anything. Money can’t buy you love, but I’m sure it helps. All the research shows that if you give someone a lot of money, eventually their happiness reverts to the previous level. I’m sure that most people who struggle with debt or to pay the mortgage or even just who want to live in a better house will find that very difficult to believe. I do. I’m sure that if I just had a bit more of everything, I would be much happier for ever. Really happy. If I won the lottery my depression would lift at once and permanently. But surely everyone knows this joke:

“There is this guy who’s always been poor, and one day he decides to pray to God that he could win the lottery. He prays and prays, but doesn’t win. Every day, he prays to God that he could win the lottery, and it never happens.

One day, when he’s very old and frustrated, he gets on his knees and says, “Look, God. This is the last time I’m going to pray. PLEASE let me win the lottery, or at least tell me why you aren’t letting me win.”

Suddenly, an angel appears before the man and says, “Look, sir, could you do God a favour and at least BUY A LOTTERY TICKET???!!!”

Let me finish with some quotes from that master of pith, Tyler Durden in Fight Club.

“Advertising has us chasing cars and clothes, working jobs we hate so we can buy shit we don’t need. We’re the middle children of history, man. No purpose or place. We have no Great War. No Great Depression. Our Great War’s a spiritual war… our Great Depression is our lives. We’ve all been raised on television to believe that one day we’d all be millionaires, and movie gods, and rock stars. But we won’t. And we’re slowly learning that fact. And we’re very, very pissed off.”

“You’re not your job. You’re not how much money you have in the bank. You’re not the car you drive. You’re not the contents of your wallet. You’re not your fucking khakis.”

The afterlife (March 2016)

I would love to be able to believe in God. I can see the advantages of the promise of an afterlife, the lure of goodies for ever as long as I obey a few simple rules in this life, we provided a way of living without having to think about myself, and meaning on a plate. I envy the faithful.

It is of course more difficult trying to live a good life if you have to work out what good is yourself from scratch. The Bible tells us what is good, and we just have to follow the good book. To be fair the Ten Commandments largely provide a short cut for a moral system, as stripped of their religiosity they are good sound ways of being good to others, or at least not harming them, based on the golden rule do unto others as you would like to be done by.

But it’s the meaning I envy religious people most. Meaning on a plate; ready meal meaning. The rest of us have to make do with having no meaning. But because I think there is no ultimate meaning, it doesn’t follow I think that there is no purpose. We could, for example, give ourselves maximum pleasure in life. The Greek philosopher Epicurus advocated finding pleasure in life, although his pleasures were rather more modest than stuffing ourselves with champagne and caviar; he sought the pleasures of friendship, freedom from fear, and peace. And we have to titrate short-term gain with long-term pain: I could rob a bank tomorrow, and in the unlikely event that I succeeded in coming away with a few pounds, blow them on a first-class flight to Sydney. Any pleasure gained from this escapade would be more than outweighed by the grimness of the inevitable twenty years or whatever in prison afterwards. In any case robbing a bank would violate my ethical system of trying to do unto others as I would be done by; if we all robbed banks we would soon be in a pretty pickle (and all in prison).

I often think psychopaths have been dealt a lucky hand in life. The ability to put themselves first and not worry about must be pretty wonderful. I on the other hand fret about every action and how it’s going to affect others. I’m still a pretty selfish person, but I worry. And how I worry about retribution.

The loss of God (to many of us) has of course led to some well known consequences. The existentialists in particular have thought and written about how we should think and live in a godless world where the only certainty is death, sooner or later. Like many other depressed and anxious people I am obsessed with death. If you have no hope of an afterlife then what we experience now and in our remaining days is all we can hope for. The philosopher Kierkegaard said that anxiety, angst, comes from within us, and our dread at the existential choices we have to make in the face of our fear of death. He said that confronting this fear expands the soul and fulfils the self – assuming we can resolve the fear and accept the ultimate meaninglessness of life.

“Learning to know anxiety is an adventure which every man has to affront if he would not go to perdition either by not having known anxiety or by sinking under it.” – Kierkegaard.

We have to accept that we will die, and that will be it. I find that idea very hard to accept. It’s unfair, but it seems that there’s nothing I can do about it. And although the idea of not existing is so incredibly painful, perhaps it’s only when I feel that pain that I feel truly alive.

The war against sleep (February 2016)

I worry I sleep too much, particularly being depressed and having been so ill. I would like to get up cheerful and alert at 7.15 every day, but rarely manage to do so. If at all possible, I nap in the afternoon. I need at least eight and a half hours a day, and preferably nine, or even more. That’s a lot of my life asleep. And as I struggle out of bed, my first thoughts are wondering when I can next get back to it again.

When I was much younger, with two scientifically minded friends I tried a sleep deprivation experiment. We went for 40 hours without sleep – missing one night. The going is hardest in the few hours before the time you would naturally wake up. So come 5 am we felt pretty rotten. The worst symptom I remember was nausea, which fortunately seemed to be cured by a good old-fashioned fry-up at the normal time for breakfast. I don’t think I could get past 1 am now, I need my sleep so much.

A few years ago I came across the obituary of the British writer Colin Wilson in the Daily Telegraph. I was both slightly surprised, as though I had expected a greater fuss to be made of his death than a short obituary a few days after the event, and sad, because in spite of some of his strange musings on Atlantis and the paranormal, I thought he was an inspirational thinker and writer. He called himself a “new existentialist”, and wrote about how humans routinely underachieved in failing to fulfil their potential.

Wilson introduced me to the ideas of the Russian mystic and philosopher George Gurdjieff (d. 1949, birth date uncertain). Gurdjieff sported a Dali-esque moustache and had apparently perfected the useful technique of being able to give a woman an orgasm just by looking at her in the right way. He also argued that we spent much of our time “asleep” . By this he meant not just that we were in bed dozing away much of our lives, like me, but that we we living automatically, reacting to life without being fully aware (also like me). Colin Wilson talks of “the robot taking over” our lives.

These words strike a chord, and I know exactly what they mean by living automatically and the robot taking over. I am in this automatic, non-reflective state much of the time. I wake up, have breakfast, start work, have lunch, a rest, do yet more work, have a bath, have a glass of champagne, watch a movie, listen to music, read, go to bed, and then invariably have vivid violent dreams. And I repeat the next day. The robot lives my day; I am in a sense asleep even when I am awake. I am less clear what the alternative to being asleep is though. Of course it’s being awake, but what does being awake feel like? I do have moments of what are called in the literature “epiphany”, when I feel a surge of happiness and almost mystical oneness with the world. Being awake is I think being aware, and being aware of being aware. You’re aware of being alive and aware of being awake. You can place yourself in a context. Living properly is a war against sleep.

I remember a story told by Gurdjieff’s follower John G. Bennett. I have tried to find the exact quote, but have failed, so if you know where it came from (and perhaps can tell it more accurately), please let me know. Bennett describes how he had spoken to Gurdjieff, and then carried on with his life. The robot took over. Then a few weeks later something prompts him, and he comes to his senses again. He says something like “I realised that I had been asleep for two weeks, and then I woke up”. I know exactly what he means.

A brush with death (January 2016)

Just before Christmas I nearly died.

One Saturday I was feeling fine – rather stressed, but physically fine. Sunday morning I couldn’t urinate. Sunday evening I was in hospital. Monday evening my temperature was soaring, my pulse racing, my blood pressure falling through the floor, and I wasn’t breathing well. I was in a stae of severe sepsis – what my mother calls “blood poisoning”. Although I didn’t know it at the time, the stage I reached has a mortality rate of 50%. Fortunately I recovered; my infection responded to the antibiotics, and I had wonderful care at Ninewells Hospital in Dundee. Recovery was slow, and I still don’t feel completely well.

It turns out that there is nothing like nearly dying to focus the mind on what you should do while you’re living. We’re all going to die sometime; if I’m lucky I might have another 40 years or so, although how many of those will be quality years is unclear. What should I do in the next 20 – 30 years? What do I need to do now so that when in the future I am on my death bed I will be able to lie back satisfied and think “yes, that was a worthwhile life”?

It wasn’t just this near death experience that made me think about the meaning of life, although it has focussed my mind on it. I’ve always been a bit obsessed with how I should live my life, and how I should spend my time.

Someone once said something like “No one ever said on their death bed ’I wish I had spent more time at the office’.” (I think it was the American rabbi Harold Kushner.) I suppose though it depends what sort of office you’re talking about. Hillary Clinton might well end up saying “I wish I’d spent more time in the Oval Office”. It depends on your job in having an extremely good job: I am an academic, a Professor of Psychology.

For many years I even said “I don’t make any distinction between my work and my life”. My reasoning was that (most) academics are pretty much working all the time. You go on vacation (or “take annual leave” as it has now become) and you read a psychology book – are you now working on holiday? You think about a problem in the bath, answer a student email while sipping a glass of wine at midnight, you read a short article Christmas Day while waiting for the turkey to cook – you see the problem about defining work, holiday, and non-work.

Unfortunately some of fun, for me at least, has gone out of the job, caused by increasing bureaucracy and attempts to quantify academics’ time with the noble aim of ensuring that the public aren’t being ripped off. Of course the public should be able to sleep safe in the knowledge that university dons are earning their pay, but you, the public, can rest asure that there isn’t a widespread problem: we aren’t on holiday for half the year, because there’s always research to do, new teaching to prepare, PhD students to supervise, and administration to catch up on. A recent article suggests that many academics work considerably more than 50 hours a week. And now we have to account for our time, by filling in forms and keeping track of what we do. Mechanisms with names like TRAC determine how government money is allocated on the basis of these timesheets. Workload models proliferate, mostly giving us 1768 hours a year to account for – even though we might work more than 2500 hours! And they all suffer from the problems above: what exactly is an academic’s work?

For these sorts of reasons I no longer think that my work is my life. And certainly my job isn’t. The life of an academic has changed over the last 30 years, largely for the worse I think, and it is now full of countless meetings, evaluation, meetings, and forms to fill out. I don’t find that part of the job much fun (and I doubt if I am alone).

So now I do distinguish between my job and my life. It’s still a great job and better than most others. And there are still many parts of the job I love (writing and teaching enthusiastic students, for example). But after a brush with death I cannot find meaning in my job alone.

The mortgage has to be paid, but is it possible to do so while living a meaningful life? And where is this meaning to be found?