Thursday, 21 July 2016

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.

Friday, 17 June 2016

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 ...


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.

Monday, 13 June 2016

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.


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.
“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.
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.

Thursday, 24 March 2016

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...?

Saturday, 19 March 2016

More and more diagnoses… finally!

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

Monday, 25 January 2016

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.

Thursday, 14 January 2016

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.
BRAIN: Dorothy. Doooooooorothyyyyyyyy. DOROTHY!
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.
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: 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?