Mental health triggers

My ADHD seems to have become much worse over the last couple of days. Like this morning I had this episode where I couldn’t decide whether to go back home to get an umbrella, and thus turned around twice while I was in the middle of crossing a road.

In part, I blame this on having just read a book on ADHD – the second such book I’ve read in the last week (I found this book from the bibliography of previous one). While this book told me the impact of ADHD on relationships, and helped me understand what someone married to someone with ADHD goes through, in the course of doing so it reminded me of all the problems that one faces when you have ADHD.

So in some way, as I read through and “revised” the list of problems that one has with ADHD, all these problems have started surfacing (more likely I have noticed these issues every time they’ve come up). And this has led to a positive feedback loop, and thus much shorter attention spans and massive distractions and even mild addiction (to online chess).

This is not an isolated incident. In the past as well, when I’ve read material related to mental health problems that have affected me as well, the precise problem gets triggered. So when I read some stuff about depression, I’m likely to have a depressive episode after that. Similar with anxiety.

Interestingly, there is no impact when I read something related to a problem that I myself have never faced – like I once started reading Siddhartha Mukherjee’s essay on bipolar disorder and it had no effect whatsoever on me.

It wasn’t always this way. Long back, before I got diagnosed, reading stuff about mental health issues which I later got diagnosed with would make me feel hopeful – hopeful perhaps that there was in fact a diagnosis for what I was going through and it wasn’t simply “laziness” or “ineptitude” on my part that was causing me all that I was going through. But once I got the diagnosis, and figured out lifestyle changes to deal with my issues, reading more has only triggered the respective issue.

I guess the solution for this is simple – unless absolutely necessary (say there is a specific issue for which I seek help on) I shouldn’t read stuff about mental health issues that I might be facing.

I won’t spare you, though – here is an essay about ADHD that I had written three years ago (which I dug up after a conversation on ADHD with a friend yesterday).

 

11/13: Support

Careful readers of this blog might remember that things weren’t going very well for me on the health front at the beginning of the decade. Increasing stress from a job that was in hindsight not all that stressful led me to seek help, and I’d gotten diagnosed with anxiety and depression. Soon a diagnosis for ADHD followed. This was immediately after I’d quit my (supposedly stressful) job and was trying to establish myself as a consultant.

As I’ve documented on this blog earlier, I came through this difficult phase of life fairly successfully. I managed to use the medication I was on as some kind of a “stimulus“, and then built upon my later success to pull myself out. I also made necessary changes to my lifestyle and working style to take advantage of my brain being supposedly wired differently.

What I’d failed to mention in that post about coming out of depression was the role that Pinky had played in helping me back then. The biggest impact on her was in terms of my erratic behaviour. The medication I was taking, while helping me get out of depression, was also altering my mood in ways I hadn’t imagined, and she increasingly became the target of a lot of my outbursts.

Moreover, she was also really young at the time, and having yet to see the quarter life crisis, found it hard to empathise with what I was going through. She started with the reaction that most relatives of people with mental health issues start off with – denial followed by accusation that I was using it as an excuse. It’s to her extreme credit that she soon came to understanding things from my perspective, and appreciating what she was going through.

After that, she was a constant pillar of support for me as I battled my depression and ADHD. She helped me talk over any fears I had (it turned out I had a lot of them, mostly irrational). She was nice to me when I wasn’t being nice to her. She put up with my outbursts and fights. She forgave my once frequent transgressions, and took my side in fights where she could’ve easily turned against me.

She even regularly accompanied me to the psychiatrist which was never a particularly pleasant experience for her, and stood by me as I made fairly important decisions about life and mind-altering substances. And finally, when in January 2013, I decided to get off the medication, she made sure she was accommodative in case my old behaviours took off again.

I’m still not “perfectly okay”, and possibly will never be. And there are transgressions and bad behaviour on my part from time to time. Pinky, while not condoning such behaviour, has remained patient with me, and constantly helped me improve myself. She has stayed positive through the process, and made extreme efforts to make sure that our relationship remains intact.

And for all this, I can never thank her enough. If I were the religious sort, I would’ve said that I could never thank her enough either in this life, or in our next seven lives!

1/13: Leaving home

2/13: Motherhood statements

3/13: Stockings

4/13: HM

5/13: Cookers

6/13: Fashion

7/13: Dashing

8/13: Dabba

9/13: UnPC

10/13: Pep

Writing and depression

It is now a well-documented fact (that I’m too lazy to google and provide links) that there exists a relationship between mental illness and creative professions such as writing.

Most pieces that talk about this relationship draw the causality in one way – that the mental illness helped the writer (or painter or filmmaker or whoever) focus and channel emotions into the product.

Having taken treatment for depression in the past, and having just finished a manuscript of a book, I might tend to agree that there exists a relationship between creativity and depression. However, I wonder if the causality runs the other way.

I’ve mentioned here a couple of months back that writing a book is hard because you are working months together with little tangible feedback, and there’s a real possibility that it might flop miserably. Soncequently, you put fight to make the product as good as you can.

In the absence of feedback, you are your greatest critic, and you read, and re-read what you’ve written; you edit, and re-edit your passages until you’re convinced that they’re as good as they can be.

You get obsessed with your product. You start thinking that if it’s not perfect it is all doomed. You downplay the (rather large) random component that might affect the success of the product, and instead focus on making it as perfect as you can.

And this obsession can drive you mad. There are days when you sit with your manuscript and feel useless. There are times when you want to chuck months’ effort down the drain. And that depresses you. And affects other parts of your life, mostly negatively!

Again it’s rather early that I’m writing this blog post now – at a time when I’m yet to start marketing my book to publishers. However, it’s important that I document this relationship and causality now – before either spectacular success or massive failure take me over!

Depression and TARP

When the US Treasury initiated the Troubled Asset Relief Program (TARP) in the aftermath of Lehman Brothers’ collapse, they imposed one condition on banks – banks were forced to borrow money under the scheme irrespective of how they were doing. So you had banks that weren’t doing badly such as Goldman Sachs and JP Morgan taking TARP money, and getting flak for giving fat bonuses (“from TARP money”, as the press claimed) to their employees who had helped them survive the crisis.

The reason even well-to-do banks were forced to take money under TARP was for the signalling effect. If only banks that really needed the money were to take money from TARP, then banks who really needed the money would be loathe to take it, for it would them mark them out as being ‘in trouble’. By making the well-to-do banks take money under TARP, this stigma of borrowing under TARP was removed, and the American banking system was “saved”.

The reason I got reminded of this was this piece on actor Anupam Kher coming out with his depression. This is on the back of actor Deepika Padukone coming out with her depression, which was reported yesterday. From the article on Kher’s “coming out”:

Kher says what Padukone had done is a very brave and wise thing to do. “People look up to her. When they know that she is consulting a therapist, they will understand there is no problem in getting help, and it is an okay thing to do,” he says.

 

The thing with depression is that it affects people from all over the spectrum – some of them are wildly successful despite their depression, like Kher or Padukone, while depression ruins some others. And then there are others who are ravaged by depression, and lead mostly “middling” lives.

Depression is an illness to which much stigma is attached. Especially in India, if you are consulting a therapist, or taking psychiatric drugs, people assume something is “wrong” with you, and discriminate against you. This gives people with depression a strong incentive to hide their illness, and appear to the world as if they’re fine.

The consequence is that people end up not seeking help even when it is prudent for them to seek help, and this leads to their depression possibly consuming them, sometimes even leading to fatal consequences.

In this context, when you have people who have had successful careers despite being ravaged by depression “coming out”, it makes depression a little more “normal”. On the margin, it can lead to the depressed person seeking help, and potentially getting better, rather than letting depression continue to waste them. Thus, successful depressed people owning up to depression makes it easier for less successful people (who might be worried about the stigma attached to mental illness) to come out with their condition and seek help.

In that sense, “coming out” with depression is similar to banks that were not in trouble taking TARP funds! Oh, and while on that topic, here is my “coming out essay”, from almost three years back.

Depression and playing out the overs

There are two ways to bat – you can either seek to score runs or you can seek to play out the overs. Some puritan fans of Test cricket argue that the latter is the more important skill – that you are not a good Test player unless you can play out the overs when required. However, cricket matches are won only when you score more runs than the other team, and so while playing out the overs is important at certain times in the match, the value of run-scoring ability should not be ignored.

Sometimes, however, especially say when you are chasing a big fourth innings target on a nebulous wicket, you could decide to eschew any thoughts on run scoring and instead focus on hanging in there. You decide to devote all your energies to just “staying alive”, and just playing out the overs. In that sense, yes, playing out the overs without necessarily scoring runs can sometimes be a valid strategy.

However, you should notice that it remains a valid strategy only until the end of that particular Test match! Once the stumps are drawn at the end of the fifth day, with you hopefully still unbeaten and your team escaping with a draw, things are reset to zero! The next Test match is a whole new game, and you start off from zero, and you cannot afford to start that Test match batting the same way you did while you were trying to save the earlier match! You need to realize that you should include some run-scoring in your objective function, too!

Sometimes in life, when you are going through a tough phase for whatever reason, you might make a decision to “simply hang in there”. At these points in time, you don’t care whether you really achieve something in that time period – all you seek to do is to prevent further damage to yourself – this is similar to trying to play out the overs in a Test match.

I argue that this can be a viable strategy if and only if you decide to “play out the overs” until a fixed point in time! The difference between game and life is that game has a specified end-point. At four thirty on the final day, if you are still batting, the game is a draw, irrespective of whether you were one down or nine down! The next Test starts on a clean slate. This, however, doesn’t apply to life.

Life doesn’t have clear breakpoints like cricket does. And sometimes when you get yourself “nine down and far behind in terms of runs”, you find that you begin the “next Test match” (if you can divide life into discrete units called Test matches) at a disadvantage, and soon find yourself far behind and unable to cope.

Given that life doesn’t play out the same way as a game of cricket, you should use the strategy of “playing out the overs” only sparingly, and only when you see a clear “gamechanger moment” after which your equation is reset to zero! If you choose to overplay this strategy, however, not much good is going to come out of it.

So, what does depression have to do with all this? I’ve found depression to be a state of mind where you want to play out the overs even in situations where it is not the right thing to do (think, for example, of India’s third Test against the West Indies in Dominica in 2011). And soon you get into the state of mind of just playing out the overs that you lose all ambitions and hopes and desires for run-scoring. And soon you find yourself in a rut. And you decide to “play out” the rut by continuing to dig in. And that makes you sink deeper. It becomes harder to “play out” but now you know no other strategy, and soon get into a bad downward spiral.

If you find yourself “playing out the overs” way too often, it is an indication of trouble. It means that you are possibly exposing yourself to a downward spiral. And it is possible that you need help. The next time you get the desire of wanting to “play out the overs”, check if there is going to be an end to it, and implement the strategy if and only if you see a clear end.

Mental Health: Update

It’s been over six months since I got off my medication for depression (venlafaxine) and ADHD (methylphenidate), so I thought I should just provide an update. The immediate trigger for this post is that I’m reading Nassim Nicholas Taleb’s Antifragile, in which among other things he rants against excess medication, and explicitly picks on medication for depression and ADHD.

Overall, I must mention that I’ve managed pretty well these last six months. Yes, there are depressive bouts. Yes, there are times when I can’t concentrate and I get increasingly restless. Sometimes it is perhaps as bad as it used to be before I started seeing a psychiatrist. But it’s ok. The most important outcome of going to a psychiatrist for a year has been that I’ve gotten diagnosed.

You might have heard this in several places – that ninety percent (or maybe more, or less) of treatment of a disease is diagnosis. And in case of my mental health I find that to be absolutely true. Yes, I took medication for a year. Yes, it helped back then. Yes, as I’ve written before, having those medicines provided me the necessary stimulus to get myself out of the depths I’d gotten into over the last few years. However, I’m certain that I don’t need them any more. But the diagnosis helps.

Two years back my biggest concern was that I wasn’t able to explain my life. There was no story. I had done a lot of things that were seemingly disparate and there were a lot of things that I’d done which I would later regret. So I had a lot of regrets, and I would expend a lot of my idle processor time (in my head) dwelling on these regrets, and wondering why I did certain things the way I did, or why I took the decisions I took. Every time I tried to come up with an explanation for something, I would get the “but everyone deals with that, why can’t you” response.

The biggest advantage of having diagnosed is that it now all fits in. I now know why after getting into IIT with such a good rank I drifted away and completely lost interest. I now know why so many of my initial crushes didn’t work out (ADHD among other things makes you impulsive and blurt out things you aren’t supposed to). I now know why I chose to literally run away from my first job (that’s a long story in itself. Will save it for another day). And I precisely know why I went in and out of three more jobs in the five years after that.

Yes, I might be overfitting in some things (you can see that I’m doing that in the previous paragraph to explain why no relationships worked out). Nevertheless, after a long and ardous search for that one variable or set of variables that would explain a large part of who I am or what I did, when I all I found was noise, I think I’ve found the signal. Till I was close to thirty, I led my life without having fully understood myself. And trying to blame myself for being inferior to other people in certain ways, and constantly regretting my decisions. The diagnosis changed all that. Yes, after a discussion on a mailing list on ADHD some three years back I’d posited that I might have it. Yet, a formal diagnosis from a qualified psychiatrist helped.

So you may ask why I discontinued medication if I know that I have some problems. Two different reasons for the two medicines I was taking. As for Venlafaxine (which I used to take for anxiety and depression), I had a harrowing time in November of last year when I ran out of supplies of the drug and couldn’t find it in any store near my house for a couple of weeks. During this time I would feel weak, have a fever and feel extremely numb in the limbs, but had no clue why that was happening. Later, the psychiatrist told me that these were withdrawal symptoms for failing to take my drugs regularly. I panicked. i didn’t want to get addicted to mind-altering substances. More importantly, around this time I got the feeling that the drug wasn’t doing much help. I would still have the same old bouts of depression. The psychiatrist agreed that I had plateaued in response to the drug. So she recommended a rather slow taper off from the drug (to prevent withdrawal symptoms), which I followed and got off it.

Methylphenidate was useful, and wasn’t addictive (some literature has likened it to wearing spectacles. It affects you only when you’re taking it). Yet, I found that it changed me. Yes, I know that I’m attention deficit and possibly hyperactive, but I  refuse to believe now that it’s a ‘disorder’. The problem with the drug was that it was changing my mind. Yes, it made me concentrate so much better. Long strings of meetings when I would visit the client’s office were a breeze thanks to the drug. My concentration levels shot up. Yet,  I found that it had impaired my creative thinking. I’m extremely proud of my ability to connect disparate things, but I felt that this drug was impairing my ability to do so. I just wasn’t being myself. And I had found that on days when I would forget to take the drug  I would be more capable of creative non-linear thinking. And I figured that with the drug I wasn’t being myself.

So yes, I’ve been off the drugs for a while now and have adjusted to life with it. Yes there are days when I’m constantly fidgety and can’t concentrate to get work done. Yes, nowadays  work that takes long bouts of intense concentration gets delayed. But I’m back to being myself. And I’m back to being good at what I thought I was always good at – big picture thinking and making disparate connections.

Yes, one important factor that has helped me to deal with my condition (no, it’s NOT a disorder) is my work. As a freelance management consultant who mostly works from home (and visits client once every couple of weeks)  I can set my own pace. If i’m feeling particularly fidgety some day, I can take a break till I’m doing better. I don’t have daily or sub-daily deadlines to bother me (this was my biggest issue with most of my jobs). More importantly there’s no one looking over my shoulder to see what I’m doing, so I can freely switch between my work screen and twitter. And trust me, this helps. Immensely.

Since I visit my clients once in 2-3 weeks I end up having lots of meetings during these visits. But I simply draw up on my energy reserves during those times and buckle down and concentrate. Yes, last two or three times after I’ve visited the client I haven’t got much work done for the following three or four days – since I’d be recuperating from that intense expense of mental energy – but again I’m okay with that.

I plan to write on this again in the near future after I finish reading antifragile. I find this to be a rather important concept for me given that I’m prone to making errors (I’ve now accepted that). I think I’ve already started designing my life along antifragile principles. But more on that in another post.

Meanwhile, some other posts I’d written earlier about my mental condition.
1. How ADHD is like being perennially doped
2. On the importance of admitting mental illness and going to a specialist
3. On anti-depressants being like an economic stimulus
4. On mental illness in elite colleges in India
5. On anxiety being like a computer virus
6. On how ADHD can sometimes be advantageous

The fundamental problem with the world economy

… is that wages are sticky.

With increased globalization, it has become significantly cheaper to produce certain goods and services in countries that were hitherto “low income” or “less developed’ or whatever you call it. In the past, in part due to protectionism at various levels and in part due to high transaction costs (transport, communication, etc.) “developed economies” such as the US or Europe had got adjusted to a reasonably high wage structure. In fact, it is possible that in the absence of trade with the rest of the world these countries might still be able to support that structure.

However, with the walls of protectionism and transaction costs falling, these traditionally high wage economies haven’t been able to compete with the up and coming economies where production costs are significantly lower. And because wages are sticky, i.e. it is impossibly hard to cut wages across the board, this has resulted in unemployment. Worse, a lot of other benefits (such as Social Security or Medicare in the US) have been set based on the high wage structure these countries used to enjoy.

And then you have unions, which makes it even tougher for you to cut wages which might make you competitive. It’s a combination of sticky wages and unionism that the various austerity measures in Greece haven’t managed to go through (of course, Greece has another set of problems in terms of law enforcement and tax collection).

And so, in short

1. Wages are sticky. Even though your current wages are not competitive enough, you can’t cut wages

2. That leads to high unemployment

3. That leads to lower economic activity and thus depression

4. The government needs to spend more to “stimulate” the economy, but hasn’t collected enough in good times. And the “level” of the economic cycle itself has gone down now. And the government itself has other obligations linked to the high wage levels

And so it goes. One thing I can think of is “devaluation” (in these times of floating currency rates, that term has lost all meaning), but then now these countries import so much that will again not be a good idea.

Fun!

PS: please note that this post has been filed under “Arbit”