No, not a post about the grumpiest rock genius ever Lou Reed, but about a short film we just made at the Guardian, based on interviews with dozens of people on antidepressants. Love to hear your thoughts
No, not a post about the grumpiest rock genius ever Lou Reed, but about a short film we just made at the Guardian, based on interviews with dozens of people on antidepressants. Love to hear your thoughts
Brilliant piece of writing in Pat Barker’s ‘Regeneration’. I must confess, I’m only half enjoying the book – but the bits on mental health are convincing.
At risk of breaching copyright, I’ll copy right down the paragraph:
Not that one could despair of recovery. Rivers knew only too well how often the early stages of change or cure may mimic deterioration. Cut a chrysalis open and you fill find a rotting caterpillar. What you will never find it that mythical creature, half caterpillar, half butterfly, a fit emblem of the human soul, for those whose cast of mind leads them to seek such emblems. No, the process of transformation consists almost entirely of decay.
Recovery from depression is like that. The darkest hour really is just before the dawn. It’s a process of transformation that is all decay until it’s done, and you emerge, new, from the dark, sticky mess. So if you feel you’re on the mend, don’t despair at sudden relapses which can leave you feeling as bad as ever. Restoration may be just around the corner. You’ll look good as a butterfly. Just mind the birds…
At the mo, I’m interviewing cricketers about what it’s like to play while suffering from depression. Pretty rotten by all accounts. Spent an engaging hour at Lord’s with Marcus Trescothick, who’s a nice fellow, like me not totally out of the woods (are you ever?) but looking well. His ‘thing’ was not so dissimilar to my own. We both hate zopiclone when it doesn’t work (I don’t use it any more).
Iain O’Brien was a totally different case, describing what it’s like to love the on-field stuff but HATE the off-field antics, touring, dressing room japes, long hours and days fiddling away time. He’s retired now to have a family, and I think found the transition pretty tough. Let’s see: playing for your country, snaring opening batsmen, staying in fancy venues all over the world, versus wiping snot off a 15month old. I know what I’d prefer.
Anyway, this for a magazine piece to appear this autumn. Watch this space. And if you know of any depressed cricketers, send them my way.
Angela Merkel gave a wide-ranging interview to the Guardian and five other European newspapers. A transcript follows.
Question: You have suddenly discovered youth unemployment 90 days before the elections. Why now and not sooner? Are you up to something?
Merkel: Youth unemployment in Europe has been on my mind for a long time. I discussed the matter last year with trade unionists and employers, and when we were deciding the EU financial framework for the coming years at the European Council early this year, we managed to get 6 billion euros earmarked specifically for combating joblessness among the young. Furthermore, President Hollande and I have talked to representatives of major European businesses about what they can do to help. I have also repeatedly spoken to German industry about what options it has available – measures that the German-Greek Chamber of Commerce might undertake, for example, or German companies operating in Portugal. When the European Parliament passes the budget, as it is due to do soon, we will finally have extra, targeted funds as well.
Question: And as a side-effect of the initiative, Germany’s image gets a boost. Is that the actual reason for doing this?
Merkel: Youth unemployment is perhaps the most pressing problem facing Europe at the present time. We in Germany have learned a lot from successfully reducing unemployment by means of structural reform since reunification, and we can now bring that experience to bear.
Question: There was money available before too – but the labour market problem has deeper roots than that.
Merkel: It certainly has, and money alone won’t be enough to solve it; we will need intelligent reform. It’s not intelligent, for example, for some countries to make labour law more flexible just for the young and not for older people who have been employed for a long time. In difficult economic times, that will generate youth unemployment. We also need greater mobility in Europe. Employment Minister Ursula von der Leyen has been pushing for a significantly stronger EURES, the cooperative network linking the European Commission and the public employment services. As a European employment agency, it can help many people look for vocational training or jobs in other countries.
Question: Two obstacles remain: funds are often left unused, and labour market reform is stagnating in many countries. What makes you so optimistic that this time will be different?
Merkel: With the major conference being held in Berlin, we are starting to very specifically share our actual experience of measures that work. In bringing together the Employment Ministers and the heads of the national employment services, a gathering of precisely those people who have practical experience. Quite apart from that, the EU has learned lessons. We have been using the Structural Funds more flexibly for two years now, targeting projects that have high priority for growth and jobs. You can see how intensively the money is now being used by the fact that the EU is expecting supplementary budgets totalling more than ten billion euros for 2013. Another thing that the EU ought to have is a start-up procedure for new businesses, in IT for example, that is the same everywhere, instead of having 27 – and now 28 – different sets of rules. That would make it much easier for investors around the world to decide to come to Europe.
Question: Pep Guardiola is joined by thousands of young Spaniards coming to Germany, but they are ending up in mini-jobs or working under unfavourable conditions. Surely that’s not something to take as a model.
Merkel: It’s true enough that young people who want to work in other EU countries find themselves in a broad range of different situations, some with places on good training programmes or in jobs with fine prospects, while others find work in more basic positions. But they too can switch to better jobs in due course, assuming they know German. At any rate, we have no intention of expanding the low-wage sector, as there is a great demand for skilled workers, which cannot always be met by Germans, although they remain of course our first priority. To reiterate, Europe needs a more mobile labour market. To that end, the way students and academics move around the single market as a matter of course could be better reflected among skilled workers. Language barriers are part of what is preventing this, which is why we want to open up the Erasmus exchange programme to include vocational training.
Question: Are you afraid of the lost generation’s potential for political protest?
Merkel: When things start to become dysfunctional, it is the job of politicians to remedy the situation. Youth unemployment has been much too high in some countries for many years, and now the crisis has driven it even higher. That is unsustainable in a continent with an aging population. We must not allow there to be a lost generation.
Question: Is there a specifically German model for combating youth unemployment?
Merkel: In spite of having halved youth unemployment since 2005, we do still have problems when, for example, not all of our school leavers are actually ready for training. We need to help them, and our best tool for doing so, as ever, is our dual system of vocation training, which combines school-based and on-the-job training. We are now in a position to offer a place on such a training programme to every young person who wants one. That wasn’t always the case, and we had to have inter-company training, run in training centres for several businesses which lacked their own facilities. One thing that experience taught us is that there is of course no need for any country to introduce the whole dual system straight away. Inter-company vocational training can be an alternative. Another thing we have learnt is that we should not just try to make our young people more academic. Germany is seeing the positive effects of skilled workers and master craftsmen having an excellent reputation too.
Question: But the labour markets and the form that unemployment is taking in the South are hardly comparable to Germany. Can one country’s solution really be applied elsewhere?
Merkel: There is nowhere that youth unemployment can be solved in one fell swoop. After Germany’s unification, for instance, I hoped for a while that a major investor would move into my constituency and promptly solve our problem of 25% unemployment. None came, of course, and I realized that the foundations had to be laid one step at a time – ten jobs here, six jobs there, another five there. The crucial thing is for there to be experienced advisors in the area who know the young people and see them regularly. They need both to be given hope and to be pushed into investing their own energies. How best to do that is something we can learn from sharing practical experience. It won’t be achieved by anything that Madrid, for example, or Berlin, can do centrally.
Question: Have you ever had to fear that you might become unemployed?
Merkel: No, fortunately. In the first few years when I became a politician, I did sometimes think about what I would do if politics suddenly ended for me. I could have imagined running a job centre; it’s a pleasant duty to help people find work.
Question: And now you’re looking to run a job centre for Europe…
Merkel: No, my task is a different one. My job is to set the right political course, in Germany and alongside my colleagues in Europe.
Question: … with major difficulties. Just look at the Greek brewer who has lowered his unit labour costs by 20% but pays two and a half times as much for his loan as it would cost in Germany. How is he supposed to become more competitive; how can he be expected to employ more people?
Merkel: The high refinancing costs facing businesses has indeed materialized as a more stubborn problem than we in Europe had anticipated. The European Investment Bank and/or Germany’s Reconstruction Loan Corporation KfW can help for a while, as Finance Minister Schäuble is negotiating with Spain and Portugal and will soon also be discussing with Greece. I also support Greece’s Prime Minister Samaras’ plans to set up a Greek development bank as a partner for the KfW. What a lasting solution to this problem will require is better regulation in the banking sector, and credible central banking supervision above all. That will be able to regenerate investor confidence and help lower interest rates in the long term.
Question: Why didn’t you anticipate the problem of interest rates for normal loan financing?
Merkel: Because we had never known such a massive loss of confidence in banks and even financial supervisors. European banking supervision and rigorous stress tests will enable us to regain that confidence.
Question: In Spain, the state development bank is simply not working. Don’t we need this banking union to move more quickly?
Merkel: We are making progress on all banking supervision issues, but it won’t help to be quick without being thorough. The supervision arrangements are entering into force next year. The European Central Bank needs to hire hundreds of highly qualified personnel and then conduct strict stress tests to secure its reputation as a supervisory authority. We are working to harmonize the various national deposit-guarantee systems, while Germany’s protection systems for deposit guarantees must and will continue to remain in place in Germany. What is more, the Finance Ministers have now agreed on an EU Directive which will allow for the resolution of banks. One principle is important to Germany on that score, namely that control and liability need to be held at the same level. Certain intervention options will be impossible without treaty change.
Question: The very thought of treaty change makes some of your counterparts’ hair stand on end.
Merkel: As the years go by, we will not get around the need for more treaty change – but even so, we should now do everything we can that does not require treaty change. It would otherwise take too long to get anything done at all. We are states run on the rule of law; what we do has to rest on statutes and legislation and treaties. That applied to the European Stability Mechanism, for example, for which we had to insist on a limited treaty change, and it applies to all banking supervision issues just the same.
Question: Germany is suddenly supporting labour market programmes. Deficit ceilings are being made less strict. Are the years of austerity over?
Merkel: In everything that I do, I see no dichotomy between sound budgeting and growth. How did the debt crisis come about in the first place? Debt was so high in some countries that investors lost confidence in them and stopped buying their bonds. Interest rates shot up, and those countries found they could only finance themselves at ruinously high rates. In such a situation, accumulating yet more debt cannot provide the solution. No, the deficits need to be reduced to allow investors around the world to regain confidence and to generate financial room for manoeuvre so that we can invest in the future. And we in Europe have made a good bit of progress in that direction.
Question: … but investors won’t just be looking at levels of debt…
Merkel: That’s right – how competitive a country is, how much industry it has and how efficient its administration is will be equally crucial. You need to watch out for excessive gaps between pay and productivity. All that was made painfully clear to us in Europe by the shock of the crisis. After that, everyone should really have known that things couldn’t go on as they were. The road we have now started along is therefore the right one – with budget consolidation on one side and fundamental structural reform on the other. That is what will bring sustainable growth. And then, each country has to ask itself a direct question about how it wants to make its money, which industries and services it wants to have. The construction industry won’t be able to drive the economy all by itself – as we discovered in Germany, when the post-reunification housing boom died down after a while.
Question: It is noticeable though, that you change tone and talk more about programmes and investment than about cuts…
Merkel: The two things do go together. I have always said that we need to move forwards one step at a time. We have managed quite a bit. Deficits in Europe are roughly half what they were. We mustn’t now lose patience.
Question: The euro zone is the only region in the world that is still in recession. What’s the problem?
Merkel: When you have bloated public sectors shrinking as they need to in the crisis countries, and the over-inflated construction industry subsiding too, then it is hardly surprising that those countries cannot generate growth right now. But if we look at the Baltic countries, which are doing much better and all recording growth again after some tough, difficult years of thoroughgoing reform, the clear lesson is that making your structures more competitive will return you to growth in the medium term. I have the impression that people in many countries know exactly where things went wrong in the past. I am sorry that it is often those who had absolutely nothing to do with those wrong turnings, the young or the poor, who bear the brunt of the hardship today. Many of the people with capital have long since left the country or have other ways of protecting themselves. In the countries worst affected by the crisis, more active engagement on the part of the wealthy people living there could make a big difference. It is highly regrettable that parts of the economic elite assume so little responsibility for the deplorable situation.
Question: Why did you want to have the IMF on board to fight debt? Wouldn’t the Europeans have managed alone?
Merkel: The International Monetary Fund has more experience dealing with overly indebted states than any other institution on the planet. We Europeans benefited a great deal from its reputation and its expertise when we were negotiating the rescue packages with the affected countries.
Question: The IMF has been getting particularly nervous in the last few weeks about the viability of Greece’s debts. The statutes could force it to pull out. Does that mean that, if it comes to it, Europe might have to fund a debt programme for Greece without the IMF?
Merkel: Greece has made progress thanks to the Samaras Government and its dedication to reform. I am working on the assumption that the debt will remain viable.
Question: So there’s not going to be another haircut?
Merkel: I don’t think so.
Question: The people of southern Europe find it worrying that Germany has so much influence on these existential questions. They fear they are going to lose their familiar economic order. Do they all need to conform to the German model?
Merkel: But it’s absolutely fine for a country to want to structure its economy completely unlike Germany’s; I am always pleased to see different roads leading to success. What nobody can negate is the need to be competitive and to work for and earn prosperity. When I look at Italy, Spain or Greece, I do see very different, successful industries.
Question: … but just not any large industries.
Merkel: Size is not what determines success. What is crucial is that we all realize how much the world has changed. China, India, Brazil, South Korea and many other countries have been competing with us quite some time in areas that we used to dominate. We need to respond to that and change ourselves. The World Trade Organization tells us that the vast majority of global growth today is taking place outside our continent. We either offer those parts of the world attractive and innovative products, or we resign ourselves to losing market shares and therefore prosperity – which is precisely what I do not want, neither for Germany nor for Europe.
Question: At a 2011 party conference in Leipzig, you were still calling for an even more closely integrated Europe. The message in this election manifesto is quite a different one. What kind of a Europe is it that you want in the end?
Merkel: As I say, the EU will need more treaty change in the medium term. For now though, we have urgent problems that we need to address swiftly, at least more swiftly than we can change treaties. We will be looking at the big institutional questions in more detail than we are now in our manifesto for the European elections. Our manifesto for the Bundestag election sets out what steps are needed next.
Question: You have already dropped the idea of a directly elected Commission President.
Merkel: I personally am more sceptical about that than my party, which spoke in favour of direct election in 2011. I think the office of a directly elected Commission President could be problematic for the way the European institutions fit together.
Question: How surprised were you at the extent of the surveillance scandal in Britain and the United States? And why do you criticize the bugging when Germany’s security has benefited from it?
Merkel: Like most Germans, I am well aware that other countries’ services have helped identify terrorist groups in Germany, and prevent their attacks, on a number of occasions. That said, the need to protect privacy also has to be respected alongside security interests. There has to be balance between the two. Our services and our ministries are working at all levels – at the European level too – to clear up what has happened, including the new issues that came to light at the weekend. If these reports are confirmed in the course of our investigations, we will be looking at an extremely serious incident. Using bugs to listen in on friends in our embassies and EU representations is not on. The Cold War is over. There is no doubt whatsoever that the fight against terrorism is essential, and it needs to harness intelligence about what happens online, but nor is there any doubt that things have to be kept proportionate. That is what guides Germany in talks with our partners.
Question: Following the events of the last few weeks, what is Turkey’s place in Europe?
Merkel: We in Europe see Turkey as a very important and close partner. We are engaged in accessions negotiations with Turkey which have no predetermined outcome. The EU has not just carried on with the agenda as normal after the events of recent weeks, because human rights are non-negotiable. The compromise that has now been reached, that we will be able to open the next chapter in the accession negotiations in October, once the European Commission has submitted its progress report, addresses both concerns.
Everyone warned me before I had surgery on my knee: it’s a big deal, they said. Pain. Rehab. More pain. Swelling. Scars. Pain. Frustration. Tears. Oh, and then there’s the pain as well.
Well, three days on, there are a number of things I can say. Yes, surgery of any sort is a serious undertaking. But compared to discomfort of the mind, discomfort of the body is EASY. OK, it hasn’t been very long and things could still drag. But indulge me in this comparison: what would you rather have, broken bones or a broken brain?
I ruptured my anterior cruciate ligament playing football last year. Stupid 43-year-old man pretending to be 8. Serve me right. Tried physio, but it was clear this needed repair. So in I went on Friday. 24 hours later I was on crutches. 48 hours later doing my exercises and relatively pain free. No serious painkillers or meds at all in fact. Just me and my improving knee. Not quite a knee’s up, not just yet. But a full-throated expectation that it will get better. My grandmother broke her leg at 103 and even that knitted together quite satisfactorily. We do heal. And while we do, we can read, play, dream, watch TV, work. Write blogs, for example.
Now compare that to depression. I ruptured my mental equilibrium in 2009. Stupid 40-year-old man trying to be a superhero and burning out. Served me right. I presented on Friday. Six months later, it was still agony. Not pain or discomfort, but worse: that horrid sense of just not being able to get comfortable in your own skin. So unable to do anything with any relish: read, play, dream, watch TV, work. Write blogs.
Now I understand: ruptured knee ligaments aren’t the same as cancer or heart disease. True. I am comparing apples and pears. But I still maintain: I would break every bone in my body rather than succumb to depression again. When the body fails, we still have the mind to enjoy. But when the mind fails, we may have the body intact. But it will be well nigh impossible to enjoy it.
I have just been sacked as a customer. I think it’s the first time in my life that it has happened. The incident is arcane. But the behaviour of the service provider to whom we paid £120 a year is instructive.
If you hire a nanny, you have to pay their taxes and NI contributions. To do this, you will need a payroll company. They sort out how much you pay and let you know. So far so good. Recently, we had a request from HMRC for an outstanding amount. We asked for clarification from the payroll company. Only to receive an astonishing outburst of petulant, hostile ranting from Nannywage ltd.
I’ll paste some examples.
We asked for additional payslips to be sent so we could check any outstanding amounts.
They said: “As you have had all Tax & NIC due notices for each quarter sent to you at the time each quarter was due we find your request redundant and an insult to Nannywage Ltd as you are clearly saying you do not trust Nannywage Ltd to process your payroll.”
We said we were worried that HMRC were demanding a payment we knew nothing of
They said: “Unfortunately as a payroll provider we cannot be held responsible for where another body in this case HMRC send correspondence so we find your first comment redundant.”
We said we would like to work in partnership with them, not be treated as a nuisance
They said: “We would not like to discuss any of this with you or your husband as you kindly offer and do not really wish to continue to act on your behalf.”
So there you go. We have been sacked. Have you ever been sacked as a customer?
Another week, another fallen sporting icon. Though in truth we have known for years that all was not well with Paul Gascoigne. I feel for Gascoigne and wish him a speedy recovery. But his case has me wondering again – is it the intensity of top flight sport that breaks people? Or the other way round? I suspect the latter – that’s to say it is edgy, uncomfortable, vulnerable people who tend to be attracted to the limelight to compensate for the difficult emotions they have to contend with. Sport is a theatre in which people with depressive tendencies can forget it all, focus on something simple, albeit demanding, and use the rush of success and achievement to compensate for any low self-esteem lurking from their upbringing.
And not just sport. How many tortured geniuses have come and gone in performing arts over the years? I suspect it’s the same in business and politics too: that it is people with a restless, unquiet mind who tend to keep bashing away at their thing until they break through. Sooner or later the past catches up with them. And then it’s a long long way down.
The hard thing then is to realise that even if you’ve scored 100 for England, or run a government ministry, even if you were CEO of a FTSE 100 company or danced Swan Lake to a full house at the Royal Ballet, you won’t get well again until you accept that you’re no longer special. In fact, you were never special, just another of the seven billion who enjoyed a brief moment of glory. Until you can teach yourself that you’re OK even without the adulation of the fans, that there is much to live for beyond the braying of the crowd; until you understand that you don’t need the affirmation of others to enhance your own feelings of self-worth, you will struggle to be comfortable in your own skin. Actually the breakthrough realisation is this: that self-esteem is a pointless exercise, a futile, counterproductive judgment of the self which is by definition subjective, and thus almost always skewed, wrong, harsh and often poisonous. The opposite of low self-esteem isn’t high self-esteem, it’s not estimating oneself at all. Stop judging. Observe instead.
I hope someone is telling Paul Gascoigne that.
Reading helps. That’s reading as in books, not Reading the football team.
I know this not just because reading helped me to understand what was happening to me when I had a breakdown three years ago. But because dozens of fellow sufferers have told me the same thing: books help you make sense of the most baffling of illnesses.
In fact, the medical profession already knows this. Psychiatrists and psychotherapists have told me that they regularly recommend books to their patients, depending on the nature and severity of their condition. It gets trickier of course when people are too ill to read, as I was for several months, but even then there are books like Matthew Johnstone’s wonderfully illustrated “I had a Black Dog” that can soothe even the weariest of eyes.
So a reading list makes good sense – on a number of levels. Firstly, because a great many first-time sufferers might not suspect that relief can come from books as well as boxes of pills. Secondly, because it gives GP another option other than just reaching for the prescription pad. Availability of talking therapies on the NHS is still woefully patchy; there is concern that GPs end up overprescribing anti-depressants as a result.
But the reading list they are suggesting for GPs to prescribe to patients seems quite narrow. Self-help books come in many guises. Depression is not something, in my experience, that can be “overcome” in “five easy steps”. I wonder if memoir (and there are no shortage of titles out there – see below) and even fiction (Silvia Plath’s The Bell Jar, Sarah Waters’ Affinity) might not be equally as helpful. The three titles listed to help sufferers cope with depression all centre on Cognitive Behavioural Therapy, which may help resolve some of the more straightforward cases of depression and anxiety but won’t work for everyone.
GPs might equally usefully steer patients towards the healthtalk websites, where fellow sufferers tell their stories. It’s a powerful moment of insight and relief to understand that you are not alone, that others have been through what you are enduring — and survived to tell the tale.
We must also be careful that prescribing a book doesn’t take the place of proper therapy. People with mental health problems really need specialists to help them work through what is wrong with them. Until we do better at providing this (and I’ll warn you now – it’s not cheap) we won’t get to grips with the fastest-growing illness of our times.
In fact, it may make more sense to prescribe reading lists to the healthy, not the sick.
Prevention is better than the cure, particularly when it comes to mental health. Understanding why some people like me fall over will help people like you avoid doing so.
My own reading list? Tim Cantopher’s Depressive Illness: Curse of the Strong. Sally Brampton’s Shoot the damn dog. And Gwyneth Lewis’ Sunbathing in the Rain.
A version of this blogpost appears on the Guardian’s website at http://www.guardian.co.uk/society/2013/jan/31/self-help-books-many-guises
I mean, I don’t think it is. But then again…
When I was ill, we were very conscious that if we weren’t careful I might drag others down into the hollow with me. Particularly my wife. She had her job, the family, me, so much pressure, so much stress. I think if she wasn’t as tough and straight as she is, it might have got to her. She took sensible precautionary steps: talking, talking, talking, to friends, her mum, my mum, even a counsellor. She was a good nurse, but refused to climb down in there with me. She maintained the broad contours of her life. She admits now it was a relief to leave the house and close the front door on the misery behind her.
But now I’m wondering about more subliminal reactions in my children. At the time, one had quite bad abdominal pains for several months. Growing pains said the doctor, but I wondered – anxiety? Another had problems sleeping. The insomnia seemed to come and go, broadly in line with my own fluctuating wretchedness.
Is it possible that people, children, can pick up on stress, anxiety, depression in adults and develop sympathetic symptoms? Would love to hear from clinicians on this.