Just The Same But Brand New

This is another guest post by Dorothy Donald.

In 2016 ... 

Despite several goes at it, I never quite made the transition from ‘shortlisted’ to ‘given the damn job’. I’ve sobbed long and loud over this. I’m still trying.

I noticed that people are asking me for help and advice more and more. And half the time I don’t even panic before I respond. They even seem to find it helpful quite a lot of the time.

I spent a whole weekend with my mother for the first time in I don’t even know how many years. We actually both enjoyed it.

I published N papers (where N is a number I’d describe as ‘impressive’ if I were talking about anyone other than me), and I can tell you in a heartbeat how each and every one of those ‘doesn’t really count’. They’re still there on my CV, though.

My friends - the new ones, the old ones, and the re-discovered ones – just kept making my heart swell with love.

I noticed that, when someone treats me like I’m an idiot, I now tend to feel angry instead of assuming I must actually be stupid or wrong. I’ve even started arguing my case from time to time. (See also: when people assume I’m not busy.)

I had a couple of flings. They were fun. They ended with no hard feelings.

My doctor handed me a prescription for Sertraline on a Friday. He then asked if I’d be at home alone all weekend, looked worried until I assured him I’d see at least one friend, and instructed me to make an appointment for the following Monday before leaving the surgery.

My anxiety dreams remained really fucking weird.

I had a holiday. A real one. Not a few days tagged onto a conference. I didn’t check my email once. I know, right?

I had kind colleagues who supported me.

Something happened to me at a conference. When I described it to someone else later, they said “But isn’t that assault? Was anyone else there? Did anyone do anything about it?” Yes, yes, and no.

My physiotherapist did very painful things to my upper back and told me I work too much.

I took up a new hobby. It tires me out physically and makes it impossible to think about work for a while. Also, I’m getting better at it already.

I told a few people something that’s quite important to me about my sexuality. Only one of them was an arsehole about it.

I felt joyful and content and furious and terrified and proud and despairing and tired and sad and anxious and excited and this was, for the most part, OK.

I am in a much better state than I would usually be this close to Christmas.

I am making tremendous progress.

Well that was an effective hour.

I had a free hour and I want to chip away on a paper I have been working on for two years. I've just started writing an introduction. If I keep chipping away at it I might finish it.

I spent an hour and all I did was edit two sentences and add five references after the second.

For the first sentence I couldn't find a paper I wanted to check something about. This was particularly frustrating because I was looking at it on this exact same computer two days ago. It's like not being able to find your keys even though you know they are on your bed.

Anyway the point of this is that maybe this was an effective hour working on a paper. Or maybe it wasn't. I really don't know.

Since I had my nervous breakdown two years ago I really have felt that I am very ineffective at work, not being as productive as I feel I should be. But I really have no idea if that is imposter syndrome or if I really have been less effective than I used to be.

It's always the small things…

I always meltdown over the small things. Really small things. I can crash out emotionally over misunderstanding how waitlists work at a really busy Alphabet City bar. Or over a facial expression, a tone of voice, of forgetting an appointment, packing or planning to move…

And when I crash out, I crash hard. Curl up into a ball. Cannot stand physical contact -- and simultaneously crave it, and crave comfort, like I do air itself. Cry inconsolably.

But it is always the small things.



The big things don't do this to me. A relative dies, and I'll barely react. At funerals I am more puzzled over my own lack of reaction than I am feeling anything similar to how people describe sorrow. News of relatives being ill are concerning, but seldom bring me out of balance.

The Trump election horrifies me, and I have many many friends whose freedoms, lives, existences are in immediate and concrete danger.
And my emotions are (I think, I have some medication titration going on that confounds ,my results) … non-responsive.



It is always the small things.
The big things seldom faze me, but the small things can annihilate me completely.

Hi Ian, I'm Anxiety, Remember Me?

A few weeks ago I had an appointment with my cognitive behavioural therapist.  I had been feeling very good although even then he made me look inside myself in an uncomfortable way - asking me not if my world view that I am a bad person was wrong (which I am used to) but asking me if it was "helpful". Which of course it is not even if I am, and so that was not a conversation I wanted.

Anyway the point of this is that for the first time after maybe a year of visiting him, I have not made a followup appointment because we agreed I was doing well.

And indeed for the first time in many years I had found that whole days will go by without me thinking "I am the worst person in the world" or "I want to kill myself", two internal mantras that have been my constant friends.  I mean the kind of friends where they are people I hang around with all the time even if they are constantly hassling me and making me unhappy.

Things were going well.

Yayy.

Then a few weeks ago my related but different old friend came back. The one called Anxiety, who caused me to have months off work a couple of years ago.

I don't like to ascribe causes but I think this was related to a work project which I was working very hard on and which was not going as well as I had hoped. And I have been worrying a lot about recent political events (which you will not need to to be told about if you are reading this here and now, and if you are reading from the future I don't want to remind you except to say, goodness, well done for reading this, I am glad that the world hasn't ended which is my main worry to be completely honest with you.)

This whole long rambly post is to bring one ray of light into the situation. Despite having much more anxiety than I have had for months, I have been able to do a couple of things. And this has come about despite them being the kind of things that my anxiety doesn't like. And it has partly from the conscious experience of recognising that just because I am anxious about something doesn't mean it will come out badly.

The two things I mean are that I have made some arrangements for the family involving lots of small decisions about what to do, where to stay etc. This is exactly the kind of thing that I find difficult so it is good I was able to do it.  And the second - which sounds almost laughably trivial - is to arrange a car service. That was tricky because I had got fed up with my main dealer so wanted to find somewhere else, then used somebody's web form to book it which didn't work so (wait for it) I had to ring them up and talk to a person.  Yeeeucch.  But again, from experience (and I assume to most people this sounds ridiculously obvious) people who are wanting your money are usually pretty good on the phone so obviously it was indeed no problem and I booked it. But actually making that phone call despite the fact it was anxiety inducing is something I am fairly proud of doing.

You might note that neither of these two things relate to the two things I have been worrying about, but at least I think it's a healthy sign that I could do things which in the past I would not have done when I was feeling anxious.

So it's not all gloom and doom.

Maybe it was ok to be not so very good at everything as I wanted to be

Today has been a hard day. And it's not even a hard day really.

It just reminded me of what many many days were like until recently.

It's not that I can't do anything. I drove my kids around to various appointments. I went shopping. I wrote a couple of things I needed to write for work.

But when I wasn't doing anything particular I was down all day today (still am but pleased to be writing this as a distraction from that and because I wanted to capture the mood I am in.)

Suddenly distractions are too tempting to avoid.

It's been very hard to make decisions (which soft drink to buy?)

I've felt anxious for no reason several times (have I bought the wrong kind of cheese?)

I've been reminded of tiny things from my life which make me feel bad.

I've got round most of these things and coped, but it's not fun. In fact I've done ok in realising that it's just a bad day and been able to cope at the meta-level ok, realising that ok it's just a bad day and things are not as bad as they seem.

But I've been doing very well for a couple of months I think, really significantly less anxious and not perpetually in a low mood. And starting to feel like I know how to get things done again. Those are all things I didn't feel for more than 2 years before that.

This is a reminder of where I was and why life was hard and maybe it was ok to be not so very good at everything as I wanted to be. Which is not what I was telling myself at the time.

Friends aren't like "Friends"

Yesterday one of the twitter people I follow made me cry.

I'd seen in previous days that somebody I didn't know, Graeme Mathieson, had died.  This had deeply affected people, and in particular Philip Roberts, @philip_roberts. Philip tweeted out a memorial post. I followed the link to http://latentflip.com/mathie. It has trigger warnings about suicide and depression.  But it's an excellent read and I recommend it (it made me cry, I mean that's praise). Feel free to read it now.  It's also fine to stay here and read how it affected me - so I won't do that thing of saying "read it now, it's ok, I'll wait" because it's cute the the first time you see it but it gets old fast.

The part that really hit me was this:

Not long after that I saw this tweet from Graeme in my timeline.

This morning’s art class turned into a mind map of “depression: a personal perspective”: pic.twitter.com/DUuFNUQEbs
— Graeme Mathieson (@mathie) February 6, 2014

One phrase stood out: "no friends".

This was a phrase I was saying to my therapist almost every week at that time.

This was a phrase that I would never have applied to Graeme.

And so, I guess, our true friendship began

There was something about "Can we be friends please?", something about the loneliness and pain on both sides, and of course with no happy ending since Graham is no longer with us. 

But I'm not here to share my tears, but to say something about friends. 

There's so much we don't get educated well about, or at least I wasn't. For example one of them is the joy of running. I love running and for several years it's been a serious hobby and one I love. But at my school it was basically a cross between a punishment and the PE teachers not having an idea what to do if it was raining and the playing fields were too wet. "Go for a run to the Ketch and back", which was a perhaps 5-6 km run, or in fact in this case a short jog followed by long slow walk (almost by definition in the rain) and being teased by the people who could actually run a 5km as they passed on their return trips - the good runners being those who by good luck were good at it instead of all of us taught to run well even if slowly by a PE staff who should have been instilling love of physical activity. Nowadays I love long runs (a 5km run is a short one for me, I prefer longer ones), so somehow this strikes me as one of the most glorious failures any teacher could achieve: making their students hate something that it turns out they can actually love when out of the clutches of the teacher.

Wow that came out a bit rantier than I expected. 

Anyway another thing I didn't get well educated about is friends. I mean, this one is much more understandable for a school to fail in, because nobody is educated about friends.

I don't think of myself as somebody who has no friends. As a teenager I might have written down "no friends", but not for some years. 

But that doesn't mean I understood friendship. Of course I don't now either but I understand it a bit better.  Without doubt being an open and out depressed academic has helped me understand friends a bit better. Maybe a lot better. 

The thing is that friends (in real life) aren't like "Friends" (in the tv show). And I don't just mean in the sense that in real life you don't inevitably have to end up sleeping with somebody you've been friends with for the last 10 years in an implausibly good apartment in New York. 

I mean that friends aren't all the same and you don't have to have the same friends for all things and interact with them all in the same way. Somehow I picture the simplistic world view that culture - like "Friends" - gives us as being that a friend can be somebody who helps you out of trouble, but the same person has to be a good drinking buddy, enjoy movies with you, the sports you like, and especially be a party animal just like you. It's just about OK to have a friend group of mixed gender, but then they have to split up into groups of men who like the same sports and women who like the same clothes shops. 

Life isn't like that.

And friends can be very very different. 

I have friends who I have never met. Because we are friends on facebook for example, perhaps because of a shared interest. And somehow you start to get a connection. If I was culling my facebook friend list some of these would be the last to go.

I have friends I have met but only after becoming friends. 

I've got friends I met only before coming friends, and hardly or not at all thereafter. 


I have lots of friends from depressed academics, or who just know about my mental health generally. And maybe who reach out to me, or come into my office and close the door and say "me too". 

And when I'm talking about these people, some of them are not just friends but some of my most inspirational friends whose example I try to live up to. 

I don't have a lot of drinking buddy friends because I don't go drinking a lot. I do have sports friends, where we have a shared interest (usually cricket). 

I have a lot of work friends where we share a love and interest in some intellectual pursuit. 

I have friends who have different roles in different parts of my life. Maybe we have one kind of friendship on facebook and another at work.

I have - tragically - lost good friends to (a felicitous phrase) "terminal mental illness". But they were still good friends. And I've made good friends because of our shared loss of somebody to mental illness.

And often the people who reach out to you when you need it you don't think of as your friends. But they reach out to you and you realise they are and they are very good friends. 

And the people who don't reach out to you when you need it? They can still be good friends. Maybe not the reaching-out kind of friend, but still a good friend for many other aspects of friendship. 

I thought this post was going somewhere but it's got lost - my point is that yes, I am desperately sad for Graeme and Philip in thinking they have no friends. And I want to pass on such huge kudos to Philip for reaching out to Graham in that way.

Because I still don't know how to make friends. But I realise more and more that it's easier than you think. Because I have never thought of myself as somebody with lots of friends. But I was wrong. 

I have lots of friends.

If you want to donate in Graham Mathieson's memory go to this fundraising page for 
Mind: The Mental Health Charity

So very much better when I know why

I am moving. Cross an ocean, to a new city, a new life.
I am moving. To a tenure track job, finally getting out of the postdoctoral grind.

I am moving. This never goes well for me. Questioning why I keep the things I keep, handling complex logistics that consumes large amounts of money — these things hit me straight in my mental sore spots.
I am moving. My brain caught up with this when I cleared out my old office last week of May. Since then, I have been an emotional wreck, crashing out several times a week — often daily.

And yet… even if this is one of the worse periods I've had in a long time, even if I keep crashing out constantly, keep lashing out, keep breaking into pieces, crying over nothing, a labil emotional wreck, this is better than it has been.
Even if it is bad, I know where this is coming from: moving is stressing me out, more than most things do. Stressing me out aggravates everything else.

It's bad right now. But it is not arbitrarily bad. It is not unexplainably bad. I have a causal chain, and with that there is an end in sight.
Eventually the move is done, and I will have settled in, and the stress will calm down again.
Eventually it will be good again.
Eventually the medication combination I have now, the combination that gave me several quiet months during the spring, will win over the moving stress and I will be back to stability.

This too will pass.

It doesn't make it better if Jo Cox's killer was mentally ill

Yesterday one of our MPs was murdered, as everybody in Britain knows.

Jo Cox, MP, 1974-2016

There's been reports that the presumed murderer had mental health problems. For example, as I write, the Wikipedia page on her murder states "A 52-year-old former psychiatric patient was arrested in connection with Cox's death."

And the tone of a lot of the reaction to that is kind of "well that's ok then." I mean sadness about the loss but relief that it's not terrorism or racism or sectarianism or ...

No.

An oft quoted statistic is that about 25% of the population has a serious mental health problem sometime. So it's ok to paint a quarter of the population as potential murderers?

And just because somebody has had mental health problems, who says their actions yesterday were in any way related to their mental health? The police have - quite rightly - said nothing to indicate that, just as they have not indicated that it was related to the words the murderer supposedly shouted. We simply don't know the motive.

Let's say for a minute that the murder was in some way related to mental health. That is certainly a possibility.

Then what does that say about our society?

It says that we are completely failing to care for the mental health of our population, to the extent that they become murderers. Yes, there could always be an isolated incident where somebody snaps from nowhere, but then the rumour is that this person has had mental health problems. So where was the right drug treatment, the right talking therapy, the right care in the community, or if absolutely necessary the right hospitalisation? It wasn't there, was it?

So if it was mental health related, it doesn't make it better.

It makes it worse.

The sheer terror of self worth

My therapist and I have discovered that a good project for the rest of my life might be to get myself to … well … not love myself, necessarily, but like myself. See my own value. See me like my friends do.

Become a good friend to myself.

The mere concept fills me with terror: when we first talked about it, I started crying just trying to think about it as an abstract idea. Returning to it, I start crying as soon as we skirt near the idea of building up my sense of self-worth.

I have a suggestion to work with, have had for a week and a half now, and probably will carry for quite a bit longer before anything happens: make two lists.
One with all the things that have hurt me. All the hurtful slurs, shouts, names, attacks from my school mates.
One with all the things everyone tells me and show me now. All the things that I am, that are valuable, that make me as loved as I am.

The idea is to build up an alternative narrative, that can take up place in parallel to the one cemented through years and years of school harassment.

…

only

…

I didn't get as far as to writing, but trying to get to sleep tonight, I found myself thinking of document titles for the first list. “Sticks and stones” is a favorite, or reading it out further “Sticks and stones break bones that heal, but words tear me down and leave eternal scars”
And then thinking of things that go into the bad list.
Fat.
Disgusting.
“Micke Toansson” — something vaguely like Mike the Toilet, sounds silly now, hurt incredibly much back then. I still don't like the (incredibly common) nickname “Micke” to this day.
My classmate screaming and running away rather than open a door she had seen me touch.

And as I think about these things, not much happens. I'm comparably euthymic, so these ideas don't spin up a self-hating spiral right now — so not much happens. I'm indifferent to these old, ugly, hurtful words and thoughts.

Then I try to think of the second list. The one about me being good, me being lovable.
Lovable.
The very word brings me to tears. This is a word that terrifies me. I can't understand why, but even trying to think of myself as someone deserving of love sends me crashing down.
I'm surrounded, daily, by evidence to the contrary. People seek me out to spend time with me, to do research with me. I have friends that I love. I have a wonderful wife, whom I love. I love my family.

But the very idea that I could be lovable has me crying in front of the computer. Utterly terrified.

“You carry that bright blue really well — not everyone can do that, you really can.”
«The singer for Shpongle running up to give me a hug before their latest concert»
“We should find a new research project to continue with — I'll bribe you with daily St Louis frozen custard if I have to.”
«My survey article has gotten assigned as introductory reading for people getting into my field of research. At Oxford.»





I write down ways in which I was hurt as a child.
And I feel nothing.
I write down ways in which I am loved right now.
And I am crying onto my keyboard, my head is screaming on the inside.

New Year Blues

I've been low for four months now. Reactive, I think: a new course involving 8-9 hours preparation for every hour delivered, leaving me drained after each session, plus anxiety over persistent unwellness awaiting diagnosis, on top of winter and the general sense of getting older. So it goes...

Anyway, yesterday afternoon one of my undergraduate students came to see me about late coursework. I knew they'd been having difficulties but not the details. Unprompted, they hesitantly told me that they were chronically depressed, so I told them in outline of my 40 years of episodes. They immediately relaxed and said that I was the first grown up who'd ever come out as depressed: at last they had some sense that someone else knew what they were talking about.

I said that I thought depression was just another illness and that acknowledging it helped make it more ordinary and less stigmatising. And I said that because it's an illness, it's not an excuse, it's something that deserves support and compensation.

So, dear reader, why don't I generally tell my colleagues about my condition...?

More and more diagnoses… finally!

 140 characters don't really contain more complex ideas. Neither does 280 characters.

Srsly. "Used to not be a diagnosis" is not an argument against helping people now.

At best, it says we should try not to repeat history.

— michiexile (@michiexile) March 19, 2016

There is this prevalent idea that the rise in mental health and neurodiversity diagnoses is … about coddling kids, about replacing parenting or teaching with pill popping, …
And the more I think about these arguments, the more they anger me.

Media: where arguments enter the memosphere

One of the great classics in this genre is Why French Kids Don't Have ADHD in Psychology Today:

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children's focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child's brain but in the child's social context.

This is taken as supporting evidence that instead of being a neurological difference, ADHD is a manifestation of the environment somehow being off, and thus the US medical culture is medicating where they should counsel. Only … it's not actually true. Also in Psychology Today, the psychiatrist Dr Elias Sarkis is interviewed, pointing out that

[The french model] is "at the price of the child experiencing increased anxiety and internalizing problems". For those children who are not able to receive excellent parenting and high structure, ADHD behaviors can be extremely impairing.
In France it is difficult for parents to get an evaluation and treatment for their ADHD child.  It takes 8 months for a child to get an appointment with a specialist, and it can take another 8 months before a child is prescribed medication (Getin, 2011). 

Or, take The Atlantic arguing that ADHD is in fact “normal narcissistic personality traits”.

Facebook: people pick it up and run with it

From a Facebook thread discussing the article from The Atlantic:

Or here, from a Facebook thread discussing ADHD in French kids:


A big theme out there is how Back In The Day, the things now getting diagnosed were just boys being boys; just a fact of life; and the hardy and good ol' people were just sucking it up — just like these spoiled kids should.

And it makes me furious.

So, the diagnosis didn't exist…

…but that does not mean that the diagnosis is wrong.
That does not mean we shouldn't do anything about it.

If anything it means it is a tragedy we haven't picked up on it earlier.

One red thread running through my own journey, through my contacts with mental health professionals, is how the fundamental criterion is Does this cause suffering? The one thing that keeps returning is whether it degrades my quality of life.

If it does, it is worth trying to alleviate.
If it doesn't, there isn't really a problem.

And this is pretty much an invariant. Even if you fit cleanly into diagnostic criteria in the psychiatric diagnostic manuals, it all stands or falls with this fundamental question: is it a problem?
If it is a problem, you should get help — even if you are not easy to diagnose.
If it is not a problem, there's nothing to fix — even if you are a good diagnosis fit.

The fact that it didn't use to be a problem is in no way an argument against help now.
It might be an illustration of how suffering might have been both widespread and repressed in the past, but it is not an argument against doing anything about the problem now.

But… but… overdiagnosis! overprescription!

Sure, these things might be overdiagnosed.
Treatment through medication and medication only might be way too common.

It still doesn't mean diagnosis and treatment are bad ideas.
We need more funding, better health care, so that even more labor intensive treatments are an option.
We need more research, so we can get better at recognizing and distinguishing possible issues.

What we really, really, really, don't need is shaming and repression of the problems that do exist. That leads pretty straight to more suffering.

Besides, “more diagnoses” is far from the same thing as “over-diagnosed”.
Why do we see more ADHD and autism diagnoses? More depression and anxiety diagnoses? How about:

1. Better diagnostic criteria, research advances, so we can tell what's going on better than we used to.
2. (Slowly) decreasing stigma, so more people even try to seek help instead of just sucking it up and suffering on their own.
3. More diagnosed adults of hereditary issues that have been viewed as childhood issues, like ADHD, leading parents to consider it as a possibility for their children, and allowing them to be diagnosed.

By all means, it might have been that people weren't diagnosed depressed, ADHD, autistic, bipolar, anxious, phobic, … when you were a kid.

It is a tragedy that they weren't. And it is not a reason not to diagnose and help today.

I Think You'll Find It's More Complicated Than That

This is another guest post by Dorothy Donald.

The old CBT-vs-psychotherapy argument will, I suspect, never die. Particularly not while people think that when you go to see someone about your depression, you will either get one kind of therapy or the other. That you can either talk about how your thoughts operate day-to-day right now, or the events of your childhood.

Would you rather learn some new mental habits, or understand yourself? Do you want your therapy to be practical, or empathic? Formula-driven or intuitive? Quick and surface-level, or slow slow slow… and life-changing? Do you want it to work, or feel good? Do you want to be fixed, or cared about? Do you want your therapist to be your coach, or your friend?

Funnily enough, most of the therapists I’ve worked with  [*] have drawn on a veritable pick’n’mix of approaches. (It’s almost as if the dichotomous view of therapy is bullshit or something.)

Neil is a CBT counsellor. We ‘do’ CBT. CBT is what I wanted.

And there we were, on Friday, talking about my mother (we are not going there today) and shame (no no no). He invited me to take a moment to be with my emotions and describe how they felt in my body (it felt as if my throat had developed a will of its own and was closing itself up in a bid to choke me to death, in case you’re wondering). In short, it was not flow-chart thoughts-by-numbers control-your-mental-bad-habits training that ignores underlying causes in favour of thinking happy thoughts. This was about making peace with the past events that had been motivating me to do damaging things to myself for years. It was difficult. I cried buckets. I was exhausted afterwards. I have a new perspective on something that happened a long time ago. And, yes, I feel better.

Which I guess is a long way of saying: If you want to avoid talking about your mother, seeking out a CBT practitioner instead of a psychoanalyst is a lousy strategy.

---

[*] I can’t remember how many there have been over the years. Maybe eight or ten? This is a topic for another post. Maybe next week.

Me And My Brain: A Play In Three Acts

This is another guest post by Dorothy Donald.

Act One

Scene - A woman’s bedroom

BRAIN: Hey, Dorothy.

DOROTHY: …

BRAIN: Dorothy. Doooooooorothyyyyyyyy. DOROTHY!

DOROTHY: Wh’?

BRAIN: I’ve made a list of all the things you’ve done wrong recently and I would like to go over it with you in detail.

DOROTHY: What?

BRAIN: I’ve made a list. Of all the things you’ve done wrong recently. And I would like to go over it with you. In detail.

DOROTHY: It’s 4am!

BRAIN: You didn’t look busy.

DOROTHY: I was sleeping!

BRAIN: Yeah. So here’s my list. One…

Act Two

Scene - An office

DOROTHY: Hey, Brain?

BRAIN: …

DOROTHY: Brain?

BRAIN: …

DOROTHY:  BRAIN!

BRAIN: Um. Yeah. So, your query is, like, in a queue or something.

DOROTHY: What? I need you!

BRAIN: Would you like to hear the same few bars of ‘Ashes to Ashes’ over and over?

DOROTHY: No. I want you to help me. I want you to help me to not screw up. What is this? Are you angry with me because I didn’t like your 4am shit-list?

BRAIN: I am not available at this time. Please try again later.

Act Three

Scene - A woman’s bedroom

BRAIN: You didn’t do much today, did you?