I really can't be bothered (part of a 'Uses for a maths teacher' cartoon by Miriam Slechter

Do you ever have days when nothing feels worth starting and everything is shades of grey? Days when the sun doesn’t shine, and getting out of bed is the hardest thing you’ve ever done? Periods when the smallest chore becomes an impossible task?

Well of course you do. You’re human.

I remember someone telling me that as a youngster he worried he’d inherited chronic depression from his Mum. Later at university he discovered that everyone feels down for a few days at a time, now and then. It’s normal.

Actually feeling like this in adolescence (call that ages 12-25 ) is common. The hormones are rampantly badly mixed, the challenges of life are to be faced without as yet the desired rewards. Who am I? What do I believe? What will I do with my life? How do I succeed? Am I happy? Do people like me? Does she love me?

I get this feeling of lethargy and inertia far more often, and sometimes far more severely, than people without clinical depression. But it’s basically the same feeling. Over forty five years I’ve had many tricks suggested to me. I’ve tried them out, and discovered other possibilities too. This series will be the things I have found work. For me. Often enough to be worth trying.

Imagine you are at the top of a hill and the enemy approaches. You need to roll that boulder down onto them. But at first it won’t shift. These will be tricks you can try that might get the boulder started rolling.

Miriam’s picture? Yes we know verticals should look vertical even in a cartoon, but it makes sense when you see the whole picture.

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the old-fashioned type

So there I was cleaning my teeth with the trusty old electric brush when quite naturally my thoughts fell to sleeping tablets.

Sometimes I collect Jenny’s prescription from the Doctors’ surgery and fetch the medication. Last time the duty pharmacist, trying to be helpful, warned me about the number of sleeping pills included.

“She’s being given rather a lot. You need to be aware that clinical trials show this medication ceases to have any effect if you take it for more than three weeks.” (I think he said three weeks – thereabouts anyway).

“That’s okay,” I said, “that’s just clinical research. She gets them on repeat prescription and they work for her.”

He looked at me oddly. You’re not supposed to question the findings of clinical research, just take the raw findings as fact. “She may think they’re helping but they’re not. She really should stop taking them.” he said.

I smiled, hopefully in a warm rather than condescending way. “Actually research is limited in various ways. The tablets definitely help her sleep because if she doesn’t have any she doesn’t sleep at all.”

He seemed an intelligent guy and was clearly educated in some senses of the word, yet looked at me first blankly and then with mild annoyance. He, after all, was the qualified pharmacist.

The trouble is that research into the effects of medication is bound to be limited. Usually the number of people in the test sample is small. Also the people devising the test are handicapped by the limits of their own experience and imagination. I could ramble on about research into use of sleeping tablets but that’s a rather obscure area.

So let’s think about whether electric toothbrushes are more effective than non electric. Now all of us I hope use a toothbrush of some sort.

The electric ones were marketed in part as being more efficient than hand brushing. This claim has been tested, up to a point. The conclusion I’ve encountered several times is that they are not more effective. Common sense, and natural laziness, baulks at this outcome. As I brushed my teeth I’d been thinking up possible reasons why the research might have been flawed. And this applies to research into the use of sleeping tablets as well as (for a later post) whether or not tranquillisers are addictive.

So you take a random group of people and split them into three groups. One group must use electric brushes for the next, what, six months. One must brush by hand. The third carry on as normal. At the beginning and end of the period experts check everyone’s teeth. Surprise: no significant difference between the first two groups. In fact in one study the electric group showed more deterioration.

What happened?

As I brushed my own teeth I got to thinking about what I was physically doing, and what my attitudes to cleaning my teeth have been at various ages.

The brush has a timer. If you spend long enough on each tooth then shortly before you finish the motor stutters. If you don’t spend long enough then the brushing is far less effective.

Add this to one of the great advantages of the electric brush – it does most of the work and half the thinking for you. With a hand brush you not only must consider which part of your teeth to brush first, but also how you brush them. Brushing horizontally will miss a lot of enamel, so you need to use some sort of up and down motion. I was taught to start with edge of bristles on gum and roll so they sweep the whole length of the teeth, then repeat a couple of times before moving on – spend at least a second on each side of each tooth.

Now imagine a normal person being given an electric brush by the researchers. This requires a completely different technique. Were they taught how to use the brush effectively? I don’t know. I wasn’t. I just bought it and away we went till the first time the motor stuttered and I thought it must have broken. Then I read the instructions.

So people in the first group may not have been using their brushes correctly, but there’s a more compelling problem. We’re lazy. Given a dish washer, who hand washes the dishes? Given a car, who walks? You can feel how much faster the electric toothbrush is working. The busy buzzing tells you it’s more efficient. You can get carried away and just move it slowly across the line of teeth, but it also needs to move up and down in order to clean each tooth from gum to tip. It is so easy to halve the time with electric and actually leave your teeth inadequately cleaned.

And this had to be a long term project. The researchers were not observing their test subjects every time they brushed – simply not practical. How many of the electric people lapsed into lazy habits? We’ll never know. But it could dramatically affect the conclusions.

The only valid way to draw conclusions from scientific research is to read the full report, not just a summary. This is not easy, but unless you know exactly how the research was designed, how the data was processed, and what the exact statistical values were, you’re too likely to draw false conclusions. We trust experts to do this for us, but what if the ‘expert’ is a journalist in a hurry, or a scientist who doesn’t really understand the limitations of research?

Mr Leech in the library with the sleeping tablets, obviously

sleeping tablets in fiction lol

In fiction, especially murder mysteries, sleeping tablets receive their own dose of poetic licence. How many times has the villain mixed powdered sleeping pill into someone’s bedtime drinking chocolate and the target has not only dozed off as quickly as if hit over the head with a railway sleeper but also stayed dead to the world for eight hours while noisy events happened round them? The pills don’t work like that.

A general anaesthetic does because it is more powerful and is injected straight into the main blood stream so it reaches the brain in seconds. Sleeping pills first have to be absorbed by the stomach lining. This is a slow process. There is a significant time lag while the concentration in the blood stream rises, and the person who took the tablets gradually feels more sleepy. Effectiveness of the medication is also influenced by whether or not you’ve used it recently, and what frame of mind you’re in – which can be affected by mental illness. Taking a dose does not force you to sleep. With luck it should make it easier to sleep.

Never mind, there are so many other factual inaccuracies in murder mysteries but we still enjoy them. Which real police force would allocate just an Inspector and his trusty Sergeant to investigating a murder? But we love the Morse books and films. Mind you I don’t think Colin Dexter ever has his characters supping a nightcap of drinking chocolate.

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Yes, I was traumatised for many years. The abuse was merely emotional, but it hurt. Like it or not memories of those days dogged me for years. They simmered just below the surface and distorted my thinking and my behaviour. They made it far harder to learn how to cope with my own depression. They made it less likely I’d make a good parent myself.

I was exceedingly fortunate. Over the years I made a number of friends who listened attentively as I rambled on about how bad things had been. Some experiences I recounted again and again. Gradually I got used to them and they lost their power.

We all have painful memories. By and large they can be left alone because we’ve grown beyond them, but sometimes there’s one worth dealing with because it’s having a damaging effect now. In a previous post I described some NLP work I did with a student which enabled him to recreate an alternate version of a true memory. In the alternate version he handled an embarrassing situation as he would now with his increased maturity and understanding. If the bad memory surfaces he has the option of switching to the modified version. Which version is true? In a sense neither. The actual events happened, but they do not describe who he is now. He is able to relax and shrug off the embarrassment because he knows he has now used that experience, he has grown up.

Some memories are like feuds between families or nations. What triggered things happened long ago and we should move on, but somehow we can’t. Someone, perhaps a parent, treated us in some unfair way which has crippled us, and we continue to resent what they did and suffer the after effects. This is frighteningly normal, but hardly rational and certainly not helpful.

The trouble is that we may need more than friends loving enough to listen to our memories. We may need the skills and expertise of a counsellor trained and experienced in working with destructive memories.

Psychodynamic counselling does far more than just deal with memories, but it is one approach that might prove useful. I suspect Post-Trauma counselling could also be useful, though I’ve not experienced that kind. A competent NLP practitioner should also be able to help.

A triplet of warnings:

• You need to let go of destructive memories, yet if you’ve been hanging on to them grimly for decades that will not be easy. Approach this with your eyes open: it will be hard work, and it may prove very painful for a short time. It is worth it.
• There is evidence that some hidden memories which are affecting you now may best be left alone. Dragging them to the surface and experiencing them again can make matters worse. I suspect whether or not this happens has a lot to do with the relationship you and your counsellor have with each other.
• There are examples of counsellors looking for repressed memories, and phrasing their questions so badly that false memories are created in the client. Beware of a counsellor who asks closed questions such as “did your father abuse you” when they should be asking open questions like “thinking back, do you think any part of your childhood might have been worse than it should have been?”. Police are increasingly being trained to interview witnesses using only open questions and non emotive words because otherwise they run a high risk of altering the witness’s memories just by how they phrase the question. Loftus and Palmer did a neat experiment on this in 1974. Google ‘Loftus and Palmer 1974′ or check out this site which describes the research.

If you know of any other types of counselling which includes constructive reprocessing of bad memories please let me know. Thank you.

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There’s a well-known saying about how to help people in poor countries: give a man a fish and you feed him for today, give him a fishing rod and he’s set for life. 

Of course if he’s too weak with hunger to fish for himself then a fish to eat first makes sense, but after that it’s wise to show him how you use the fishing rod to catch more fish, and then give him the rod.

In the previous post I described how I was helped after my first breakdown. I was referred to a doctor who specialised in student mental health problems. He first of all established a suitable relationship. Then he prescribed something to help with the immediate symptoms. After that he told me to try one possible strategy which should help, and it did. Since then I’ve been learning how to resolve many subsequent problems, and sometimes I’ve had guidance from counsellors – some of them doctors – on how to set about doing this.

The long-term target has been that I become someone who knows how to set about solving his own problems.

Arguably this should be a part of any type of counselling. It may not be an obvious part; if it’s there it may be hidden. Sometimes I’ve only realised afterwards that I’ve learned something by simply paying attention, observing the counsellor at work. This facet of their work might have been more effective if it had been conscious.

Everyone has problems; they’re a part of life. We start by passively letting someone else solve each problem for us. As we grow up we begin to understand how they have helped us. We begin to listen and to try things out for ourselves. Gradually we develop a stock of possible strategies to look through and experiment with. At this point we’re still immature. We need to learn how to deal with a fresh problem for which we currently have no solution: we need to learn how to solve problems ourselves. We need to move from being entirely dependent on other people like a baby to being independent.

Warning: independence is not the final goal. Adolescence is about becoming independent of our parents, finding out who we are. Full maturity requires us to move even further and to recognise the need to be interdependent, a member of society who helps and is helped by other people, a member of the family.

If you suffer the crippling effects of depression, or are human in any other way and face problems which appear insoluble, look for people who can help you. But don’t be passive. Do not look just for help with the most obvious current problem. Look beyond today and find out more about how you may be able to help yourself. Gradually begin to accept some responsibility for your own treatment. And if you are receiving counselling from someone who wants to do it all for you …

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I was 21 when I had my first breakdown. I’d been suffering teenage depression on and off for six years but not known what it was, never questioned it. Suddenly I was too ill to go to lectures. In those days there was no specialist student health care, but a local GP (family doctor) had become increasingly concerned by the mental health problems he saw in his student patients. A year or two earlier he had decided to specialise in treating this epidemic. I was lucky enough to be referred to him by my own GP.

I don’t know what he prescribed me. Almost certainly a tricyclic antidepressant (this was autumn of 1970). I’ve just looked them up on the net and I certainly gained several recognised side effects: increased heart rate, drowsiness, blurred vision, dizziness, confusion. Mind you I was pretty confused when he first saw me.

The first consultation was weird. Okay so he sat behind a large desk and I had a traditional upright surgery chair. But he offered me a coffee, which was shrewd. It worked in much the same way as being given a drink when you arrive at a party. I had something to hold on to, something to take sips from as if I felt confident and purposeful.

His overall approach was way ahead of its time, perhaps because he had not been trained as a psychiatrist so came at the problem with fresh eyes. The starting point was medication, but he made it clear that the antidepressant was only to give me the opportunity to work hard at learning to cope with depression. So that’s what this was. Depression. Hmmm.

“The trouble is that when you feel down you have only the one escape route: running.”

I was a keen member of the university cross-country and athletics teams, and hell I enjoyed running. Best of all was ten or fifteen miles at relaxed pace through the beautiful countryside around Durham. That’s Durham England. If I felt a bit rough I went for a run. But if I felt seriously rough any attempt to run would be frustrating because the energy was gone. Clinical depression affects you physically. I would try to train and fail. The harder I worked at it the worse I got, which was absurd. Races were a waste of time.

“You try to escape by running and find that route is closed to you. What do you do? Nothing. You do nothing because you have no other escape routes set up apart from friends who are usually not available because they’re working or having a life of their own.”

I must have looked blank.

“When I get home from work I’m often feeling pretty rough. What do I do? I knock hell out of the garden. Do I like gardening? Sometimes. Not always. But I do it anyway, and it helps me feel better even when I don’t think I’m enjoying it. But some evenings it’s too dark or it’s raining heavily.”

What did he do then? Sorry, I can’t remember.

“Now you’re too depressed to run what other hobbies do you have?”

- I write.

“When was the last time you wrote?”

- well, er, I wrote a novel two years ago …

“Are you well enough to write?”

- er … well … I read a lot. I listen to music.

“You just told me you’re picking up books, trying to read them, and giving up after just a page or two. You said music isn’t doing anything for you anymore. In fact you have nothing but friends to fall back on when you’re this ill.”

I doubt I nodded, but he was right.

He told me I must find at least one new hobby. How? Well I could try browsing the local bookshop to see if anything caught my eye.

“This is your homework. You find one new activity to try. I don’t care what it is so long as you try it. No matter whether you find a new hobby first time off, the key thing is to try something. And then something else. And we keep going till you have a battery of escape routes to fall back on when you’re depressed. See you next week. Good luck.” He smiled and shook my hand firmly.

I went to the local bookshop (these days a Waterstones but not then). It was an Aladdin’s cave, but cold and dark and grey with the air like treacle. I kept wanting to cry but I made myself work through every single shelf of non-fiction. I read every title. I took some books off the shelf for a browse.

I have no idea what activity I picked, but I do remember the faint glimmer of light that doing something, anything, left me feeling ever so slightly better. No, I didn’t feel happy. No, I still couldn’t think straight. No, the future was still black. But something eased just a tiny bit, barely enough to notice. I had made a crucial discovery: when you’re depressed doing anything is better than just sitting around thinking about how bad you feel.

Actually there were two other long-term results: a lifelong love of browsing bookshops (which fortunately my wife shares, though it’s cost a lot of money over the years), and a tremendous variety of interests. To focus enough on writing to produce the next book for my agent to try and sell I’ve had to be brutal in sidelining many hobbies.

The doctor cum counsellor I saw in Durham from 1970 through 1972 used a range of techniques. The one I’ve described above would probably now be called solution-focused therapy. It was exactly what I needed at the time, and has benefited me ever since. I’ve sometimes used it with people I’ve tried to help, but rarely as forcefully as it was used on me: once I had a really bad weekend and made an appointment to see this doctor. What was I supposed to do when I realised I was getting worse? Anything but sit around moping. What had I done over the weekend? Sat around moping. There’s your answer so next weekend have stuff planned and do it no matter how you feel. Just do it. He then warned me that if I ever came back complaining of being worse yet had not followed this strategy then he’d not see me again. Hard words, but spoken forcefully at exactly the right time. The next weekend I had planned in detail, and I stuck with the plan. I didn’t feel okay. But I didn’t feel worse. Success! Often success for a depressive is entering a bad situation and simply not feeling worse than before.

If your counsellor proposes some action on your part then you have only two rational choices: you can give it a go, or you can stop seeing that therapist. And what harm is it going to do trying out their suggestion? After all, it might work. You’ll be sure it won’t, but give it a go. Give it a serious go, and in so far as you can when ill be open minded. Not every suggestion will work, but you can be almost certain that when you first hear of something that can help you’ll try to reject it; that is part of depression.

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The rawest form of this approach is often referred to as person-centred counselling. The guy who started it was Carl Rogers, a remarkably able therapist. He believed that we each already have the resources to solve our personal problems, and the counsellor shouldn’t interfere by telling the client what to do. In his book ‘On Becoming A Person’ he says this (I rephrase slightly) :

If the counsellor works at our relationship in such a way that I experience his genuineness, transparency, and warm acceptance of me as an individual, and in such a way that I realise he is sensitively seeing my world as I see it then I will become more of a person, understand myself better, function more effectively, gain confidence, be more understanding and accepting of myself and others, be more able to cope with life, and move closer to being who I want to be.

(The book was first published in 1961 and is still readily available.)

Rogers’ theory is: that’s all the counsellor does, although it has to be genuine. If it is then in my experience this really does make a difference. One problem is that even given this rare type of support I still may not be able to sort out the mess my head is in. Another problem is that many counsellors find they are unable to accept clients as they are. I’ve tried working with at least one student who I simply could not accept or prize as he was – and I failed to be of any real help.

Some counsellors confuse the need to be ‘professional’ with the need to show none of these feelings, and as a result their work is far less effective.

The founders of NLP (Richard Bandler and John Grinder) included Carl Rogers in a small group of highly effective counsellors they chose to study. They were ignoring how each therapist claimed to be achieving their results and instead observed with great care what each person was actually doing. Apparently Rogers was seen to be doing more than he said. For instance when clarifying for someone what their options were his body language indicated a preference – even though he was not aware of it.

Rogers’ basic approach, his underpinning attitude to each client, is incredibly powerful on its own. My own feeling, though, is that it should be the background against which other techniques can be used as and when appropriate.

On the other hand I’ve worked with two psycho-dynamic counsellors, and by far the most effective was the one showing very little emotion but having by far the greater training and experience in the method. She came across as caring but professional. Not cold. The other was warm and accepting but not all that helpful.

Conclusions

I aim to be genuine with everyone I meet. For instance if I have nothing good to say I keep quiet, and only when I identify something I believe is worth complimenting do I comment. I try to accept everyone warmly – we each have a hard battle to fight, we each make mistakes. This can be difficult, so I work at seeing the other person’s world through their eyes. I seem to enjoy life much more as a result.

I would prefer a counsellor to be able to communicate at least some of this to the client. But sometimes the nature of the problem requires an expert in some particular approach, and you may have to take what you can get.

An anecdote

Some time back I heard of an experienced senior medical doctor who was taken ill and admitted to hospital for tests. He describes his feelings and thoughts when his consultant surgeon sat down beside the bed and told him he had terminal cancer. I quote his approximate words from memory:

“At that moment the one thing I wanted more than anything else was human contact. I looked at him wishing he would grip my shoulder or hold my hand, but he just sat there. He was behaving in the professional way Doctors are trained to behave: don’t get emotionally involved, never touch the patient except for clear professional purposes.

“But I longed for him to reach out and make human contact. And in that instant I looked back at my entire career behaving professionally and knew that sometimes I should have stretched the boundaries.”

It means a lot to a homeless person when someone pauses, smiles, says hello, and makes even the faintest attempt to understand what it feels like to be homeless.

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It's time to talk to someone, but who?

What types of counselling are there?

Here’s a list of what I’ve come across.

My questions are: How does the counsellor expect to achieve results, what do they see as the source of my problems, and what approach do they believe is likely to help? Most formal methods of counselling will include two or more of these facets.

1. The Relationship: you already have the resources within you to sort things out. All that is needed is that I create the right relationship between us.
2. The Solutions: your problems have practical solutions which I will teach you. Some of this will include you learning new skills.
3. Finding solutions: you need to develop problem-solving skills of your own.
4. Memories: it’s all in your memories, especially the ones of your childhood.
5. Repressed feelings: you’re lying to yourself about how you really feel.
6. Consciously controlling thoughts: your natural way of creating and processing thoughts is damaging, so lets help you make some changes.
7. Mental reprogramming: there’s a range of mental tricks other people just use naturally to modify how they think and react. You can learn their tricks.
8. Mindfulness: the problem is your attitude to experiencing life from moment to moment.
9. Hypnotherapy.
10. Classic conditioning.

We’ll take these one at a time – which I guess will take nine ten posts, but you never know.

(A tenth facet added 4 April 2010 as a result of working on facet 4.)

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