Today is a blah day. It isn’t that there is anything terribly wrong today. There are issues looming, yes, but there are always issues of late. There is nothing pressing, though.
It is just a blah day, a day where I lay in bed, struggling to find a reason to get up. I’ve had to pee for a couple hours now. Yet, the dull ache in my bladder is not enough to pull me from under my covers. I should probably brush my teeth. Maybe get dressed and get a bite to eat. I have been awake for more than five hours now, even before the sun rose. Yet, here I still lay.
I feel blah. While the world around me continues with its hustle and bustle, I have no motivation, no desire to do anything. Nothing seems interesting or important. Nothing is pressing enough to pull me from this funk.
I would go back to sleep if I could, call in sick from life itself. I feel like nothing, not myself. I feel numb.
Days like this are common with depression. Those who have never struggled often assume that depression is all bouts of random sadness and tears. Yes, I have those days, too, and it is draining when everything and anything feels heart-wrenching and makes me want to cry. Yet, even worse, perhaps, than the days when I feel everything too strongly are the days I feel nothing at all.
On these days, I have trouble pulling myself up or doing anything. I’m not being lazy. I just don’t see the point. I am pulled into a gray abyss, where there’s no purpose, no joy, no motivation, no will to live. It isn’t that I’m suicidal and actively want to die, either. I just have no will to live. The emptiness is all-consuming.
People suggest I should just “try” to be happy or to be positive. If only it were this simple. Again and again, the “should be” and “could be” options roll around in my mind but I’m numb to them all. Deep down, I know I should be getting up, doing something, living life.
Yet, my brain has me in a death lock. “What’s the sense?” and “Why bother?” it parrots to me again and again. Its voice is booming and deafening. I can hear nothing else. I would love to just smile, think a happy thought and have it vanish away like a puff of smoke but it’s solid and real to me. It takes the form of four solid walls, caging me in, holding me hostage, refusing to budge or listen to reason.
Those blah days are the worst because I feel trapped in this numbness. I cannot escape. I never know whether it will last one day or one week. There is never an end in sight, never a scheduled sweet release.
Blah days drag on and on until at some point I begin to feel everything too strongly again. On blah days, I would welcome the tears, the anguish, the pain and the struggling just to feel anything at all.
It has been more than hours now, and I’ve barely managed to write a few paragraphs. Yet, those feel like a tremendous accomplishment. I call it a victory. I have done something, which is more than I am able to achieve on most blah days. I still have to pee, though the dull ache has grown into a steady cramp. Breakfast time has come and gone, and lunch time has arrived. Yet, I still don’t have any desire to eat anything, let alone get up.
There are calls I should make and things I should be doing. Yet, my depression still echoes in my head that I shouldn’t bother, that nothing is worth the effort. It tells me to stay in bed, just let this day drift on by, that it doesn’t matter.
Nothing matters. It is all I can hear. It is deafening. I am adrift in a sea of hopelessness and emptiness. I feel paralyzed.
I swear I am not being lazy. I’m just trapped in a battle with my own mind. I feel lost and alone. I feel trapped in this emptiness. I feel nothing. I feel numb. I feel blah. This is what depression feels like.
The first sign that something is happening is Angelina’s hands. As she chats to the nurse in Italian, she begins to gesticulate, jabbing, moulding and circling the air with her fingers. As the minutes pass and Angelina becomes increasingly animated, I notice a musicality to her voice that I’m sure wasn’t there earlier. The lines in her forehead seem to be softening, and the pursing and stretching of her lips and the crinkling of her eyes tell me as much about her mental state as any interpreter could.Angelina is coming to life, precisely as my body is beginning to shut down. It’s 2am, and we’re sat in the brightly lit kitchen of a Milanese psychiatric ward, eating spaghetti. There’s a dull ache behind my eyes, and I keep on zoning out, but Angelina won’t be going to bed for at least another 17 hours, so I’m steeling myself for a long night. In case I doubted her resolve, Angelina removes her glasses, looks directly at me, and uses her thumbs and forefingers to pull open the wrinkled, grey-tinged skin around her eyes. “Occhi aperti,” she says. Eyes open.This is the second night in three that Angelina has been deliberately deprived of sleep. For a person with bipolar disorder who has spent the past two years in a deep and crippling depression, it may sound like the last thing she needs, but Angelina – and the doctors treating her – hope it will be her salvation. For two decades, Francesco Benedetti, who heads the psychiatry and clinical psychobiology unit at San Raffaele Hospital in Milan, has been investigating so-called wake therapy, in combination with bright light exposure and lithium, as a means of treating depression where drugs have often failed. As a result, psychiatrists in the USA, the UK and other European countries are starting to take notice, launching variations of it in their own clinics. These ‘chronotherapies’ seem to work by kick-starting a sluggish biological clock; in doing so, they’re also shedding new light on the underlying pathology of depression, and on the function of sleep more generally.“Sleep deprivation really has opposite effects in healthy people and those with depression,” says Benedetti. If you’re healthy and you don’t sleep, you’ll feel in a bad mood. But if you’re depressed, it can prompt an immediate improvement in mood, and in cognitive abilities. But, Benedetti adds, there’s a catch: once you go to sleep and catch up on those missed hours of sleep, you’ll have a 95 per cent chance of relapse.The antidepressant effect of sleep deprivation was first published in a report in Germany in 1959. This captured the imagination of a young researcher from Tübingen in Germany, Burkhard Pflug, who investigated the effect in his doctoral thesis and in subsequent studies during the 1970s. By systematically depriving depressed people of sleep, he confirmed that spending a single night awake could jolt them out of depression.
Benedetti became interested in this idea as a young psychiatrist in the early 1990s. Prozac had been launched just a few years earlier, hailing a revolution in the treatment of depression. But such drugs were rarely tested on people with bipolar disorder. Bitter experience has since taught Benedetti that antidepressants are largely ineffective for people with bipolar depression anyway.
His patients were in desperate need of an alternative, and his supervisor, Enrico Smeraldi, had an idea up his sleeve. Having read some of the early papers on wake therapy, he tested their theories on his own patients, with positive results. “We knew it worked,” says Benedetti. “Patients with these terrible histories were getting well immediately. My task was finding a way of making them stay well.”
So he and his colleagues turned to the scientific literature for ideas. A handful of American studies had suggested that lithium might prolong the effect of sleep deprivation, so they investigated that. They found that 65 per cent of patients taking lithium showed a sustained response to sleep deprivation when assessed after three months, compared to just 10 per cent of those not taking the drug.
Since even a short nap could undermine the efficacy of the treatment, they also started searching for new ways of keeping patients awake at night, and drew inspiration from aviation medicine, where bright light was being used to keep pilots alert. This too extended the effects of sleep deprivation, to a similar extent as lithium.
“We decided to give them the whole package, and the effect was brilliant,” says Benedetti. By the late 1990s, they were routinely treating patients with triple chronotherapy: sleep deprivation, lithium and light. The sleep deprivations would occur every other night for a week, and bright light exposure for 30 minutes each morning would be continued for a further two weeks – a protocol they continue to use to this day. “We can think of it not as sleep-depriving people, but as modifying or enlarging the period of the sleep–wake cycle from 24 to 48 hours,” says Benedetti. “People go to bed every two nights, but when they go to bed, they can sleep for as long as they want.”
San Raffaele Hospital first introduced triple chronotherapy in 1996. Since then, it has treated close to a thousand patients with bipolar depression – many of whom had failed to respond to antidepressant drugs. The results speak for themselves: according to the most recent data, 70 per cent of people with drug-resistant bipolar depression responded to triple chronotherapy within the first week, and 55 per cent had a sustained improvement in their depression one month later.
And whereas antidepressants – if they work – can take over a month to have an effect, and can increase the risk of suicide in the meantime, chronotherapy usually produces an immediate and persistent decrease in suicidal thoughts, even after just one night of sleep deprivation.
Angelina was first diagnosed with bipolar disorder 30 years ago, when she was in her late 30s. The diagnosis followed a period of intense stress: her husband was facing a tribunal at work, and they were worried about having enough money to support themselves and the kids. Angelina fell into a depression that lasted nearly three years. Since then, her mood has oscillated, but she’s down more often than not. She takes an arsenal of drugs – antidepressants, mood stabilisers, anti-anxiety drugs and sleeping tablets – which she dislikes because they make her feel like a patient, even though she acknowledges this is what she is.
If I’d met her three days ago, she says, it’s unlikely I would have recognised her. She didn’t want to do anything, she’d stopped washing her hair or wearing make-up, and she stank. She also felt very pessimistic about the future. After her first night of sleep deprivation, she’d felt more energetic, but this largely subsided after her recovery sleep. Even so, today she felt motivated enough to visit a hairdresser in anticipation of my visit. I compliment her appearance, and she pats her dyed, golden waves, thanking me for noticing.
At 3am, we move to the light room, and entering is like being transported forward to midday. Bright sunlight streams in through the skylights overhead, falling on five armchairs, which are lined up against the wall. This is an illusion, of course – the blue sky and brilliant sun are nothing more than coloured plastic and a very bright light – but the effect is exhilarating nonetheless. I could be sitting on a sun lounger at midday; the only thing missing is the heat.
When I’d interviewed her seven hours earlier, with the help of an interpreter, Angelina’s face had remained expressionless as she’d replied. Now, at 3.20am, she is smiling, and even beginning to initiate a conversation with me in English, which she’d claimed not to speak. By dawn, Angelina’s telling me about the family history she’s started writing, which she’d like to pick up again, and inviting me to stay with her in Sicily.
How could something as simple as staying awake overnight bring about such a transformation? Unpicking the mechanism isn’t straightforward: we still don’t fully understand the nature of depression or the function of sleep, both of which involve multiple areas of the brain. But recent studies have started to yield some insights.
The brain activity of people with depression looks different during sleep and wakefulness than that of healthy people. During the day, wake-promoting signals coming from the circadian system – our internal 24-hour biological clock – are thought to help us resist sleep, with these signals being replaced by sleep-promoting ones at night. Our brain cells work in cycles too, becoming increasingly excitable in response to stimuli during wakefulness, with this excitability dissipating when we sleep. But in people with depression and bipolar disorder, these fluctuations appear dampened or absent.
Depression is also associated with altered daily rhythms of hormone secretion and body temperature, and the more severe the illness, the greater the degree of disruption. Like the sleep signals, these rhythms are also driven by the body’s circadian system, which itself is driven by a set of interacting proteins, encoded by ‘clock genes’ that are expressed in a rhythmic pattern throughout the day. They drive hundreds of different cellular processes, enabling them to keep time with one another and turn on and off. A circadian clock ticks in every cell of your body, including your brain cells, and they are coordinated by an area of the brain called the suprachiasmatic nucleus, which responds to light.
“When people are seriously depressed, their circadian rhythms tend to be very flat; they don’t get the usual response of melatonin rising in the evening, and the cortisol levels are consistently high rather than falling in the evening and the night,” says Steinn Steingrimsson, a psychiatrist at Sahlgrenska University Hospital in Gothenburg, Sweden, who is currently running a trial of wake therapy.
Recovery from depression is associated with a normalisation of these cycles. “I think depression may be one of the consequences of this basic flattening of circadian rhythms and homeostasis in the brain,” says Benedetti. “When we sleep-deprive depressed people, we restore this cyclical process.”
But how does this restoration come about? One possibility is that depressed people simply need added sleep pressure to jump-start a sluggish system. Sleep pressure – our urge to sleep – is thought to arise because of the gradual release of adenosine in the brain. It builds up throughout the day and attaches to adenosine receptors on neurons, making us feel drowsy. Drugs that trigger these receptors have the same effect, whereas drugs that block them – such as caffeine – make us feel more awake.
To investigate whether this process might underpin the antidepressant effects of prolonged wakefulness, researchers at Tufts University in Massachusetts took mice with depression-like symptoms and administered high doses of a compound that triggers adenosine receptors, mimicking what happens during sleep deprivation. After 12 hours, the mice had improved, measured by how long they spent trying to escape when forced to swim or when suspended by their tails.
We also know sleep deprivation does other things to the depressed brain. It prompts changes in the balance of neurotransmitters in areas that help to regulate mood, and it restores normal activity in emotion-processing areas of the brain, strengthening connections between them.
And as Benedetti and his team discovered, if wake therapy kick-starts a sluggish circadian rhythm, lithium and light therapy seem to help maintain it. Lithium has been used as a mood stabiliser for years without anyone really understanding how it works, but we know it boosts the expression of a protein, called Per2, that drives the molecular clock in cells.
Bright light, meanwhile, is known to alter the rhythms of the suprachiasmatic nucleus, as well as boosting activity in emotion-processing areas of the brain more directly. Indeed, the American Psychiatric Association states that light therapy is as effective as most antidepressants in treating non-seasonal depression.
In spite of its promising results against bipolar disorder, wake therapy has been slow to catch on in other countries. “You could be cynical and say it’s because you can’t patent it,” says David Veale, a consultant psychiatrist at the South London and Maudsley NHS Foundation Trust.
Certainly, Benedetti has never been offered pharmaceutical funding to carry out his trials of chronotherapy. Instead, he has – until recently – been reliant on government funding, which is often in short supply. His current research is being funded by the EU. Had he followed the conventional route of accepting industry money to run drug trials with his patients, he quips, he probably wouldn’t be living in a two-bedroom apartment and driving a 1998 Honda Civic.
The bias towards pharmaceutical solutions has kept chronotherapy below the radar for many psychiatrists. “A lot of people just don’t know about it,” says Veale.
It’s also difficult to find a suitable placebo for sleep deprivation or bright light exposure, which means that large, randomised placebo-controlled trials of chronotherapy haven’t been done. Because of this, there’s some scepticism about how well it really works. “While there is increasing interest, I don’t think many treatments based on this approach are yet routinely used – the evidence needs to be better and there are some practical difficulties in implementing things like sleep deprivation,” says John Geddes, a professor of epidemiological psychiatry at the University of Oxford.
Even so, interest in the processes underpinning chronotherapy is beginning to spread. “Insights into the biology of sleep and circadian systems are now providing promising targets for treatment development,” says Geddes. “It goes beyond pharmaceuticals – targeting sleep with psychological treatments might also help or even prevent mental disorders.”
In the UK, the USA, Denmark and Sweden, psychiatrists are investigating chronotherapy as a treatment for general depression. “A lot of the studies that have been done so far have been very small,” says Veale, who is currently planning a feasibility study at Maudsley Hospital in London. “We need to demonstrate that it is feasible and that people can adhere to it.”
So far, what studies there have been have produced mixed results. Klaus Martiny, who researches non-drug methods for treating depression at the University of Copenhagen in Denmark, has published two trials looking at the effects of sleep deprivation, together with daily morning bright light and regular bedtimes, on general depression. In the first study, 75 patients were given the antidepressant duloxetine, in combination with either chronotherapy or daily exercise. After the first week, 41 per cent of the chronotherapy group had experienced a halving of their symptoms, compared to 13 per cent of the exercise group. And at 29 weeks, 62 per cent of the wake therapy patients were symptom-free, compared to 38 per cent of those in the exercise group.
In Martiny’s second study, severely depressed hospital inpatients who had failed to respond to antidepressant drugs were offered the same chronotherapy package as an add-on to the drugs and psychotherapy they were undergoing. After one week, those in the chronotherapy group improved significantly more than the group receiving standard treatment, although in subsequent weeks the control group caught up.
No one has yet compared wake therapy head-to-head with antidepressants; neither has it been tested against bright light therapy and lithium alone. But even if it’s only effective for a minority, many people with depression – and indeed psychiatrists – may find the idea of a drug-free treatment attractive.
“I’m a pill pusher for a living, and it still appeals to me to do something that doesn’t involve pills,” says Jonathan Stewart, a professor of clinical psychiatry at Columbia University in New York, who is currently running a wake therapy trial at New York State Psychiatric Institute.
Unlike Benedetti, Stewart only keeps patients awake for one night: “I couldn’t see a lot of people agreeing to stay in hospital for three nights, and it also requires a lot of nursing and resources,” he says. Instead, he uses something called sleep phase advance, where on the days after a night of sleep deprivation, the time the patient goes to sleep and wakes up is systematically brought forward. So far, Stewart has treated around 20 patients with this protocol, and 12 have shown a response – most of them during the first week.
It may also work as a prophylactic: recent studies suggest that teenagers whose parents set – and manage to enforce – earlier bedtimes are less at risk of depression and suicidal thinking. Like light therapy and sleep deprivation, the precise mechanism is unclear, but researchers suspect a closer fit between sleep time and the natural light–dark cycle is important.
But sleep phase advance has so far failed to hit the mainstream. And, Stewart accepts, it’s not for everybody. “For those for whom it works, it’s a miracle cure. But just as Prozac doesn’t get everyone better who takes it, neither does this,” he says. “My problem is that I have no idea ahead of time who it’s going to help.”
Depression can strike anyone, but there’s mounting evidence that genetic variations can disrupt the circadian system to make certain people more vulnerable. Several clock gene variations have been associated with an elevated risk of developing mood disorders.
Stress can then compound the problem. Our response to it is largely mediated through the hormone cortisol, which is under strong circadian control, but cortisol itself also directly influences the timing of our circadian clocks. So if you have a weak clock, the added burden of stress could be enough to tip your system over the edge.
Indeed, you can trigger depressive symptoms in mice by repeatedly exposing them to a noxious stimulus, such as an electric shock, from which they can’t escape – a phenomenon called learned helplessness. In the face of this ongoing stress, the animals eventually just give up and exhibit depression-like behaviours. When David Welsh, a psychiatrist at the University of California, San Diego, analysed the brains of mice that had depressive symptoms, he found disrupted circadian rhythms in two critical areas of the brain’s reward circuit – a system that’s strongly implicated in depression.
But Welsh has also shown that a disturbed circadian system itself can cause depression-like symptoms. When he took healthy mice and knocked out a key clock gene in the brain’s master clock, they looked just like the depressed mice he’d been studying earlier. “They don’t need to learn to be helpless, they are already helpless,” Welsh says.
So if disrupted circadian rhythms are a likely cause of depression, what can be done to prevent rather than treat them? Is it possible to strengthen your circadian clock to increase psychological resilience, rather than remedy depressive symptoms by forgoing sleep?
Martiny thinks so. He is currently testing whether keeping a more regular daily schedule could prevent his depressed inpatients from relapsing once they’ve recovered and are released from the psychiatric ward. “That’s when the trouble usually comes,” he says. “Once they’re discharged their depression gets worse again.”
Peter is a 45-year-old care assistant from Copenhagen who has battled with depression since his early teens. Like Angelina and many others with depression, his first episode followed a period of intense stress and upheaval. His sister, who more or less brought him up, left home when he was 13, leaving him with an uninterested mother and a father who also suffered from severe depression. Soon after that, his father died of cancer – another shock, as he’d kept his prognosis hidden until the week before his death.
Peter’s depression has seen him hospitalised six times, including for a month last April. “In some ways being in hospital is a relief,” he says. However, he feels guilty about the effect it has on his sons, aged seven and nine. “My youngest boy said he cried every night I was in hospital, because I wasn’t there to hug him.”
So when Martiny told Peter about the study he had just started recruiting for, he readily agreed to participate. Dubbed ‘circadian-reinforcement therapy’, the idea is to strengthen people’s circadian rhythms by encouraging regularity in their sleep, wake, meal and exercise times, and pushing them to spend more time outdoors, exposed to daylight.
For four weeks after leaving the psychiatric ward in May, Peter wore a device that tracked his activity and sleep, and he completed regular mood questionnaires. If there was any deviation in his routine, he would receive a phone call to find out what had happened.
When I meet Peter, we joke about the tan lines around his eyes; obviously, he’s been taking the advice seriously. He laughs: “Yes, I’m getting outdoors to the park, and if it’s nice weather, I take my children to the beach, for walks, or to the playground, because then I will get some light, and that improves my mood.”
Those aren’t the only changes he’s made. He now gets up at 6 every morning to help his wife with the children. Even if he’s not hungry he eats breakfast: typically, yoghurt with muesli. He doesn’t take naps and tries to be in bed by 10pm. If Peter does wake up at night, he practises mindfulness – a technique he picked up in hospital.
Martiny pulls up Peter’s data on his computer. It confirms the shift towards earlier sleep and wake times, and shows an improvement in the quality of his sleep, which is mirrored by his mood scores. Immediately after his release from hospital, these averaged around 6 out of 10. But after two weeks they’d risen to consistent 8s or 9s, and one day, he even managed a 10. At the beginning of June, he returned to his job at the care home, where he works 35 hours a week. “Having a routine has really helped me,” he says.
So far, Martiny has recruited 20 patients to his trial, but his target is 120; it’s therefore too soon to know how many will respond the same way as Peter, or indeed, if his psychological health will be maintained. Even so, there’s mounting evidence that good sleep routine can help our mental wellbeing. According to a study published in Lancet Psychiatry in September 2017 – the largest randomised trial of a psychological intervention to date – insomniacs who underwent a ten-week course of cognitive behavioural therapy to address their sleep problems showed sustained reductions in paranoia and hallucinatory experiences as a result. They also experienced improvements in symptoms of depression and anxiety, fewer nightmares, better psychological wellbeing and day-to-day functioning, and they were less likely to experience a depressive episode or anxiety disorder during the course of the trial.
Sleep, routine and daylight. It’s a simple formula, and easy to take for granted. But imagine if it really could reduce the incidence of depression and help people to recover from it more quickly. Not only would it improve the quality of countless lives, it would save health systems money.
In the case of wake therapy, Benedetti cautions that it isn’t something people should try to administer to themselves at home. Particularly for anyone who has bipolar disorder, there’s a risk of it triggering a switch into mania – although in his experience, the risk is smaller than that posed by taking antidepressants. Keeping yourself awake overnight is also difficult, and some patients temporarily slip back into depression or enter a mixed mood state, which can be dangerous. “I want to be there to speak about it to them when it happens,” Benedetti says. Mixed states often precede suicide attempts.
A week after spending the night awake with Angelina, I call Benedetti to check her progress. He tells me that after the third sleep deprivation, she experienced a full remission in her symptoms and returned to Sicily with her husband. That week, they were due to be marking their 50th wedding anniversary. When I’d asked her if she thought her husband would notice any change in her symptoms, she’d said she hoped he’d notice the change in her physical appearance.
Hope. After she has spent more than half her life without it, I suspect its return is the most precious golden anniversary gift of all.
This article first appeared on Mosaic and is republished here under a Creative Commons licence.
Amanda Leventhal who is an undergraduate student at the University of Missouri has recently explained in an article how depression is underdiagnosed and overlooked in high functioning individuals. Her article has inspired a host of online discussions regarding the complex nature of depression and why it is so important to talk about this epidemic problem. Even in today’s societies, the causes of depression remain unknown and mental disorders such as manic-depression (bipolar disorder) are still unfairly stigmatized making mental health still a taboo topic that needs to be clarified and brought to light.
What is Depression?
Most guidelines today define depression as a mental disorder marked by low mood, aversion to activity and that also affects a person’s thoughts, behavior, and well-being. The exact causes of depression are unknown but possible triggers are stress, trauma, low self-esteem, chemical imbalances in the brain, prolonged illness, loneliness, and lack of light. Brain scans of depressed persons show that certain regions of the brain such as the frontal and temporal cortex, the insula, and the cerebellum are hypoactive. Furthermore, a growing number of studies have found a link between illness-caused inflammation and the development of depressive symptoms. What this means is that depression can no longer be considered an invisible illness but a very much palpable disorder that definitely requires treatment.
Depression in High-Functioning Individuals
Depression, just like the majority of all illnesses manifests with many symptoms. The most common symptoms of depression are low mood, apathy, a lack of motivation, troubles concentrating, problems with memory, sleepdisturbances, etc. The symptoms of depression tend to affect almost every aspect of a person’s life making this illness quite debilitating. An article published in the Canadian Journal of Psychiatry found that 79% of people with depression report that their illness has interfered with their ability to function at work. Since depression is considered a disorder that affects a person’s ability to function in life, we have to wonder if it is possible for people to be high-functioning and depressed at the same time? The short answer is yes as there are different types of depression. According to Harvard Health Publications, there is such a thing called dysthymia which is low-grade depression that lasts five years on average. The disorder is not as crippling as major depression but is a risk factor for episodes of major depression and it is probably under diagnosed in the general population.
The Stigma of Mental Illness and Why It Is a Problem
The stigma of mental illness causes a great deal of suffering and missed opportunities for those afflicted. Unfortunately, the invisibility of mental illness makes it harder for people to emphasize with a person suffering from mental disorders such as schizophrenia, major depression or manic-depression, and many often see the illness as made up or all in their head. The stigma may make it harder for people with mental illness to find employment, housing, and build secure relationships. People struggling with depression are very well aware of the stigma that surrounds mental illness and those going through depression may ignore their symptoms believing they have everything under control. This creates a problem that could lead to depression becoming worse with time and leading to poor health and even suicide if left untreated.
What You Can Do
Knowing the nature of depression can help friends and family recognized atypical symptoms in loved ones. High functioning depressed persons may be better at hiding their symptoms, but behavioral and personality changes are usually good indicators something is going on. Irritability, anger, and a morose attitude is a good sign a person is depressed. Another sign could be increased sleepiness, weight gain, moodiness, and excessive fatigue. Asking the person that you believe is depressed about how they feel may help them understand that their behavior and mood is not normal but a result of depression. We have to understand that depression tends to skew a person’s view of themselves and the world and they may not recognize this as a sign of illness but rather as a normal reaction to a seemingly gloomy reality.
Although we tend to associate depression with low levels of functioning, some people may develop atypical symptoms of depression that can make it harder for them to believe they need help. The problem with mental illnesses such as major depressive disorder and manic-depression is that they often go unrecognized until a person develops severe symptoms that interfere with everyday functioning. The stigma attached to mental illness complicated matters further by making people already struggling with their mental disorder deal with feelings of shame and guilt. The result is often missed opportunities and low quality of life. Recognizing the symptoms of depression even in high-functioning individuals is something we need to take notice of today.
Unfortunately, a lot of people still believe that those claiming to have mental illnesses just make them up and it’s “all in their head.” However, a new study in the journal Current Biology might finally put the stigma to rest. Researchers found that people who have anxiety perceive the world differently because of differences in their brain. Therefore, the sufferer doesn’t choose to have anxiety; it just happens to them based on genetics and past experiences.
Researchers from the Weizmann Institute of Science in Israel discovered that it boils down to the brain’s plasticity, or its ability to change and form new connections based on exposure to different stimuli. This will determine how a person reacts to that stimuli. In their study, researchers found that people diagnosed with anxiety can’t distinguish between safe and threatening stimuli as well as people who do not have anxiety.
Scientists found that those suffering from anxiety had lasting plasticity in their brains long after coming into contact with a stimulus, meaning that the brain couldn’t differentiate between new, non-threatening situations and familiar ones. The inability to distinguish between the two stimuli, in turn, causes anxiety. Anxious people tend to put all experiences in one category, in other words, due to their inability to distinguish between safe and unsafe situations.
Researchers noted that people with anxiety cannot control this reaction to stimuli since it’s due to a fundamental difference in their brain.
For the study, the participants were trained to associate three specific sounds with one of three outcomes: money loss, money gain, or no consequence. In the next part of the study, participants listened to approximately 15 tones and researchers asked if they had heard them before or not.
To “win” the tone-identifying game, participants would have to differentiate between the old and new sounds, and not overgeneralize them. The study authors found that anxious participants had a higher likelihood than non-anxious individuals of confusing the new sounds with the old ones.
This didn’t happen due to a learning disability or hearing problem, but rather a misperception in the tones they heard. They simply linked the sounds associated with money loss or gain to the new sounds, resulting in confusion.
Researchers also found that, during the exercise, people with anxiety showed differences in the amygdala, a part of the brain that governs our response to fear. According to the authors, the results of the study may explain why some people develop anxiety disorders and others don’t.
“Anxiety traits can be completely normal, and even beneficial evolutionarily. Yet an emotional event, even minor sometimes, can induce brain changes that might lead to full-blown anxiety,” lead researcher Rony Paz said.
The new research provides further proof that no one asks for mental illness, and people shouldn’t have to apologize for having them. Mounting evidence shows that mental illnesses have genetic and psychological causes, and that those suffering have dramatic differences in their brains.
Despite all the research continuing to show the mechanics behind mental illness, the stigma is still very much alive. According to the U.S. Centers for Disease Control and Prevention, only 25 percent of people with a mental health disorder feel like others understand what they go through on a daily basis.
HERE ARE SOME OTHER WAYS PEOPLE WITH ANXIETY LOOK AT THE WORLD DIFFERENTLY:
SOCIAL SITUATIONS SEEM DAUNTING.
People with anxiety disorders tend to have a hard time with social cues and might misinterpret facial expressions or body language. Here are just a few ways that people with anxiety perceive social situations differently:
They might think that people are talking about them behind their back (even if they aren’t).
They may have a difficult time reading facial expressions.
Starting and keeping a conversation going may seem impossible.
Social situations can feel downright draining.
They will judge themselves too harshly most of the time. You might hear them say things like, “I’m not funny/smart/interesting enough to hang out with these people.”
They may avoid social outings as a result.
THEY ENJOY STAYING INDOORS ALONE RATHER THAN BEING OUT WITH FRIENDS.
For a lot of people with anxiety, the world can feel overwhelming. With so many people to see and places to go, the choices seem endless. For people without anxiety, this fact might seem exciting. However, those with the disorder would rather keep their choices slim and stay inside. Too much stimuli can quickly overwhelm someone suffering from anxiety, especially if they also identify as an introvert.
Many people with anxiety greatly benefit from a calm environment. A relaxing night curled up on the couch with some hot tea and a good book will often suffice.
THEY OFTEN FEEL LIKE THEY CAN’T RELAX.
For someone with anxiety, it can feel like having energy locked up in your body with nowhere to go. This pent-up energy can wreak havoc on the body, causing symptoms such as heart palpitations, sweaty palms and feet, stuttering, and difficulty focusing. Exercise and/or meditation can help a lot of people, but others benefit from therapy as well.
People without anxiety might come home from work and shut their brains off from the day behind them, but the mind of the anxious never stops. People with anxiety may feel like their brain controls them, and often look forward to bedtime when they can finally catch a break.
THEY FEAR THAT PEOPLE HAVE BAD INTENTIONS.
Those with anxiety often have a hard time trusting people. Even for those without social anxiety, starting and maintaining friendships doesn’t happen easily for anxiety sufferers. Some of them might feel like people have bad intentions for them and will take advantage of them if they get too close. Their brains are always on the lookout for the next threat, and this includes people as well.
If they do have friends, it will take a long time for them to feel comfortable getting close to them.
THEY HAVE AN OBSESSION WITH BEING PERFECT.
People with anxiety have a tendency to hold themselves and others to impossible standards. They are vulnerable to both internal and external pressures and will try endlessly to achieve perfection. Of course, some stress and anxiety can help us achieve goals, but too much can cause our plans to backfire. If an anxious person doesn’t reach their goal, they might give up entirely. Or they may fail to see their own limits and push themselves past their comfort zone.
Perfectionism is a dangerous characteristic of anxiety; though it might seem harmless, it can cause people to develop distorted and obsessive thinking patterns. Those with anxiety have a hard time accepting defeat and will stop at nothing to reach their self-imposed goals.
EVERYTHING IS STRESSFUL.
Because people with anxiety have an overactive fear response, they may react as if the world hangs in the balance of a decision they’ve been asked to make. In other words, they may seem highly frazzled or stressed out when doing something as simple as talking; they’re just reacting based on their perception of the world. Since those with anxiety have a hard time relaxing, the world can seem overwhelming with all of the stimuli and triggers.
Loud sounds, bright lights, or chaotic environments might stress out some people with anxiety. Others might respond negatively to conversations, while the decision of what to eat might trigger someone else. In other words, people with anxiety already feel on edge, so the slightest thing might set them off. They have a very thin emotional skin, if you will, so they can get wounded quite easily.
THEY NEVER FEEL GOOD ENOUGH.
No matter if it’s their job, relationship, friends, or a social event, they never feel good enough for the life they lead. They will be overly critical of their job performance and might constantly feel like they’re being scrutinized by their coworkers. They might feel like they’re failing their partner due to self-perceived flaws and a distorted self-image. Friendships may seem unstable due to feeling inadequate in their social life.
In the eyes of someone with anxiety, what they do and say will never measure up. They’re on a constant quest for perfection. This incessant need to become better might stem from a verbally abusive parent or bullies at school. Likewise, similar experiences may have molded their image of themselves. No matter where the feeling comes from, people with anxiety have a hard time changing their view of themselves. They tend to have a negative self-image, and likely need more encouragement and support due to this.
For those with anxiety disorders, daily life can feel like hell on Earth. They have to try to make it through the day with their brains on overdrive. Additionally, they must constantly defend themselves to people who have no idea what they deal with. We hope this article shed some light on the battles that people with anxiety disorders face. The world needs a better understanding of this potentially debilitating disorder.
When we hear someone is psychotic, we automatically think of psychopaths and cold-blooded criminals. We automatically think “Oh wow, they’re really crazy!” And we automatically think of plenty of other myths and misconceptions that only further the stigma surrounding psychosis.
In other words, the reality is that we get psychosis very wrong.
For starters, psychosis consists of hallucinations and/or delusions. “You can have one or both at the same time,” said Devon MacDermott, Ph.D, a psychologist who previously worked in psychiatric hospitals and outpatient centers, treating individuals experiencing psychosis in various forms.
“Hallucinations are sensory perceptions in the absence of external triggers,” MacDermott said. That is, “the trigger comes from inside [the person’s] own mind,” and involves one of their five senses. The most common is hearing voices, she said. People also can “see or feel things that aren’t there.”
“Delusions are persistent beliefs without sufficient evidence to back up those beliefs—and often with substantial evidence to refute the belief,” said MacDermott, who’s now in private practice where she specializes in trauma and OCD.
Psychologist Jessica Arenella, Ph.D, describes psychosis as a disruption in meaning-making: “The person may be finding meaning in otherwise random or inconsequential things (e.g., license plate numbers, TV ads), while minimizing or failing to grasp the importance of basic needs (e.g., showing up for work, changing one’s clothes).”
The signs of a psychotic episode differ depending on the person, because the symptoms are “an extension of each person’s unique thinking patterns,” MacDermott said.
Generally, people’s speech can be tough to follow or not make sense (because the person’s thoughts are disorganized); they might mutter or talk to themselves; say extraordinary, often unlikely things (e.g., “An actor is in love with me”), she said.
During a psychotic episode, it’s common for individuals to act in ways that are strange or out of character for them, MacDermott said. “This can range from something small like wearing more layers of clothes than is appropriate for the temperature all the way to sudden bursts of emotion that seem to come out of nowhere.”
What Psychotic Episodes Feel Like
“[During a psychotic episode], I zone out. I’m gone. I leave reality,” said Michelle Hammer, who has schizophrenia. She’s the co-host of Psych Central’s A Bipolar, a Schizophrenic, and a Podcast and founder of Schizophrenic.NYC, a clothing line with the mission of reducing stigma by starting conversations about mental health. “I can be thinking of anything. A past conversation. A made-up conversation. A weird dreamlike situation. I lose reality of where I actually physically am.”
“I mainly just feel ‘off,’ Things just aren’t right,” said Rachel Star Withers, who has schizophrenia and is an entertainer, speaker and video producer. She creates videos documenting her schizophrenia and ways to manage it, and aims to let others like her know they are not alone and can still live an amazing life.
“The biggest tell for me is that I start talking to myself and thinking in third person,” Withers said. She’ll tell herself things like:”OK Rachel, just walk; be normal.”
A patient once described psychosis in this way to MacDermott: “Imagine that you summon a picture in your mind like, say, a baseball. Imagine a baseball. Now imagine what it would be like to have the knowledge that you put that image in your mind taken away. Now, all you are left with is a thought having no idea how it got there. That’s what it’s like to be psychotic.”
MacDermott’s patients also have told her that they struggle with interpreting situations and see special meaning in everyday things. “That same patient once saw a family member put a knife down while they were cooking and had the thought that the family member was trying to send the patient a message that they were going to be killed because a knife represents death.”
In this piece on The Mighty individuals shared what it’s like to experience psychosis. One person wrote, “For me, it felt like I was watching a movie that was my life. I knew bad things were happening and I couldn’t stop it.” Another person described having an “out of body experience,” along with “excruciating sensations amplified by 1,000 at the tip of every sensor in my body.”
Someone else explained it in this way: “Every sense is heightened and colors are especially bright. The world is on a giant flat screen TV. Everything seems more crystal clear than you ever knew, but then it all becomes confused and muddled. You make your own realities, constantly decoding messages that seem extremely important, but are ultimately meaningless. They further the storyline in your head that seems so real.”
Arenella’s clients have described their psychotic episodes as “disorienting, overwhelming, frightening and isolating. They often describe heightened sensitivity, believing that there are no boundaries, that everything is related and transparent, and there is no privacy.”
Some might believe that they’re part of, or at the center of, a critical life-altering mission or plan, Arenella said. Which might lead to intense activity or the complete opposite: a feeling of paralysis.
Myths about Psychotic Episodes
One of the biggest and most harmful myths about psychosis is that people are dangerous and violent. Both MacDermott and Arenella emphasized that individuals in the throes of psychosis are much more likely to be victimized than to victimize.
Similarly, psychosis is not the same as psychopathy, MacDermott said. “Psychopaths are people who don’t feel empathy, are thrill seeking, and often are parasitic, aggressive, or manipulative to others. Psychosis is completely different and unrelated.”
Another misconception is that psychosis is always indicative of schizophrenia. Sometimes, psychotic episodes occur on their own, or as part of a different mental illness, such as depression, Arenella said. Most people only experience one or a handful of psychotic episodes in their lifetime, she said. (“Only approximately one third of people who experience psychotic episodes go on to have persistent psychotic states.”)
And if someone’s psychotic episodes are part of schizophrenia, it’s important to understand that people can and do recover from this illness, Arenella said.
Arenella, a founding board member of Hearing Voices NYC, also noted that eliminating voice hearing isn’t an essential part of treatment. “How a person interprets and interacts with their voices is more important for recovery than hearing them or not hearing them.” (This TED talk from Eleanor Longden, who has schizophrenia, provides more insight.)
Moreover, even many mental health professionals believe the widespread myth that medication successfully treats psychosis, said Arenella, the president of the United States chapter of the International Society for Psychological and Social Approaches to Psychosis. While medication can decrease the intensity of symptoms, many people still hear voices and have difficulty in social relating, she said. Many also experience bothersome or serious side effects.
“Medication works for some people, some of the time, but it is not a cure all.” Psychosocial treatments, such as cognitive behavioraltherapy for psychosis (CBT-p), have been shown to be effective in treating psychosis.
What Causes Psychotic Episodes
MacDermott noted that there’s a lot we still don’t know about psychosis, and that includes its causes. Genetics likely plays a role. “People with an immediate family member with schizophrenia are much more likely to have schizophrenia themselves than someone who doesn’t have an immediate family member with the disorder,” she said.
Adverse childhood events and trauma can contribute to psychosis, as well, even though the episode can occur years later, Arenella said. She also identified other common factors: loss, social rejection, insomnia, illegal and prescribed drugs and hormonal changes.
“A lot of antipsychotic medication reduces the amount of certain neurotransmitters, like dopamine, in the brain,” MacDermott said. This suggests that too much dopamine (and other neurotransmitters) might be involved in psychosis. But, as MacDermott noted, “People and brains are so complicated that we can’t know for sure exactly what triggers psychosis in each person.”
A big reason psychosis scares and confuses us is because it seems so out of the realm of “normal.” But in actuality, “psychosis is part of the normal range of human experience,” Arenella said. “While it is unusual, it is not fundamentally different from other human experience.”
That is, she said, “people who hear voices actually hear them and they sound just as real as all of the other voices of people. Imagine if someone were talking to you all day long while you’re trying to have a conversation with someone else; you might be distracted, confused, irritable, and want to avoid conversations. This is a normal response, albeit to an unusual stimuli.”
Also, many people hear voices, and aren’t having a psychotic episode. Arenella noted that after a loved one dies, some people report hearing the person talking to them. “Musicians and poets often hear tunes and verses in their heads and may not feel as if they created them, but more like they received them somehow.” Many people also talk about hearing the voice of God or Jesus during pivotal moments in their lives.
We tend to be taught, both implicitly and explicitly, that psychosis is unlike any other mental health issue—such as anxiety or depression, and “is not amenable to regular therapeutic techniques,” Arenella said. “This fosters a profound othering and harmful stigma toward people who experience psychosis.”
And such teachings simply couldn’t be further from the truth.
Good Reasons for Bad Feelings: Insights From the Frontier of Evolutionary PsychiatryRandolph M. Nesse Dutton (2019)
Globally, the burden of depression and other mental-health conditions is on the rise. In North America and Europe alone, mental illness accounts for up to 40% of all years lost to disability. And molecular medicine, which has seen huge success in treating diseases such as cancer, has failed to stem the tide. Into that alarming context enters the thought-provoking Good Reasons for Bad Feelings, in which evolutionary psychiatrist Randolph Nesse offers insights that radically reframe psychiatric conditions.
In his view, the roots of mental illnesses, such as anxiety and depression, lie in essential functions that evolved as building blocks of adaptive behavioural and cognitive function. Furthermore, like the legs of thoroughbred racehorses — selected for length, but tending towards weakness — some dysfunctional aspects of mental function might have originated with selection for unrelated traits, such as cognitive capacity. Intrinsic vulnerabilities in the human mind could be a trade-off for optimizing unrelated features.
Similar ideas have surfaced before, in different contexts. Evolutionary biologists Stephen Jay Gould and Richard Lewontin, for example, critically examined the blind faith of ‘adaptationist’ evolutionary theorizing. Their classic 1979 paper ‘The spandrels of San Marco and the Panglossian paradigm’ challenged the idea that every aspect of an organism has been perfected by natural selection (S. J. Gould et al. Proc. R. Soc. Lond. B205, 581–598; 1979). Instead, like the curved triangles of masonry between arches supporting domes in medieval and Renaissance architecture, some parts are contingent structural by-products. These might have no discernible adaptive advantage, or might even be maladaptive. Gould and Lewontin’s intuition has, to some extent, been vindicated by molecular genetics. Certain versions of the primitive immune-system protein complement 4A, for instance, evolved for reasons unrelated to mental function, and yet are associated with an increased risk of schizophrenia.
Decades earlier, the evolutionary theorist George C. Williams explored perhaps the most perplexing aspect of human biology: our inconvenient tendency to age and die. He suggested in 1957 that some of the genes that cause ageing evolved because they enhanced fitness early in life (G. C. Williams Evolution11, 398–411; 1957). Such ‘antagonistic pleiotropy’ — in which a single gene controls at least one beneficial and one detrimental trait — suggests that the design of biological structures is a complex optimization problem involving multiple trade-offs. Emotions and other aspects of mental function are not like machine components, each with a set function; instead, they are embedded in complex overlapping biochemical pathways.
In 1994, Nesse teamed up with Williams for Why We Get Sick, a manifesto for “Darwinian medicine”. Their insights opened up new perspectives on the origins of diseases, arguing for ‘proximate’ causes (driven by anatomy, biochemistry and physiology) and higher-level ‘ultimate’ (evolutionary) causes. They noted that evolution selects for reproductive success rather than for health and happiness; hence, the existence of human diseases and disorders. They also detailed the contingent and sometimes ‘irrational’ nature of biological legacies, such as the nerves and blood vessels that run across the human eye’s retinal surface. Cephalopod eyes don’t have this ‘flaw’.
Good Reasons for Bad Feelings builds on these insights. Adopting an “engineers’ point of view” on mental illnesses, Nesse suggests that anxiety, although apparently undesirable, is a design component with utility in certain situations — for instance, as a “smoke detector” for potentially life-threatening events. Depression might also perform adaptive functions. The psychiatrist Aubrey Lewis argued that by signalling distress, depression could prompt others into providing assistance through foraging and other activities. It has even been suggested that depressive behaviour in vervet monkeys (Chlorocebus pygerythrus) evolved to signal loss of status, deflecting attacks from dominant males.
Yet, however functional its components when appropriately regulated, mental illnesses cause suffering, and evidence-based treatments are sparse. Indeed, the field has seen no significant pharmaceutical breakthroughs for many years. Biological causes remain elusive, and biomarkers non-existent.
Psychiatry as a field, meanwhile, quivers with theoretical uncertainty. It has not become a sub-speciality of neurology, as one might have expected if mental illness mapped directly to neural behaviour. And common genetic variations with large effects on mental disorders are elusive. The various incarnations of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders(DSM) have enabled diagnostic consistency and the objectification of mental illnesses. But the DSM has resulted in overlapping diagnoses, and contrived symptom-cluster checklists. At times, it impinges on the territory of healthy mental function. Allen Frances, chair of the task force that wrote the manual’s fourth edition in 1994, revolted against out-of-control mental diagnosis in his 2013 book DSM: Saving Normal.
From adaptive to maladaptive
Nesse argues that evolutionary theory could foster therapeutic breakthroughs by providing a robust theoretical foundation for psychiatry. He posits that it might also help to prevent people from equating psychiatric symptoms with diseases and viewing extremes of emotion such as anxiety as disorders. Nesse also suggests that mental illnesses might result from the disruption of regulators that maintain equilibrium in the body, such as the endocrine system. The normally adaptive function of thoughts and emotions could, in such instances, become maladaptive.
The future success of clinical psychiatry might depend on an evolutionary framework being integrated with whole-genome sequence-data analysis; this could help to identify mutations predisposing people to mental illness. Given the small contributions of individual genes and the diverse mechanisms involved, this will demand analysis of the genomes of hundreds of thousands of people. As a result of the extensive and often paradoxical entanglement of genetic networks, future treatments might, by necessity, require mental circuits to be engineered to release them from hard-wired evolutionary constraints.
In Theodicy (1710), German philosopher Gottfried Leibniz argued that God, being omniscient, must have created the best of all possible worlds. (Fifty years later, in his novel Candide, Voltaire lampooned Leibniz as Doctor Pangloss, who opined that faults in the world are necessary, like contrasting shadows in a painting.)
Ironic readings aside, the philosopher’s optimism might now be shown to have rational echoes in contemporary science. As Good Reasons for Bad Feelings boldly posits, many of the core dysfunctional components of mental illness ultimately help to make us human.
There are times in our lives when we feel down, and we can’t figure out what the source of the problem is. There’s a difference between feeling sad and being depressed. When you don’t want to do anything – not even simple things that you enjoy – there’s a problem. When you find yourself with no motivation, it’s time to seek help because you may be depressed. When you’re thinking “I don’t want to do anything,” there’s something inside of you that’s telling you that life isn’t worth enjoying or pursuing, and that’s not true. You have individual interests and motivation, and there’s inside you. You have things that make you happy, but you can’t see them at the moment. That’s the problem; when you feel stagnant and lack positive emotion. It’s a symptom that shouldn’t be ignored, and it’s important to know that you can get through this time.
Pushing past the “I don’t want to do anything” feeling
One way to push past this feeling is to pursue therapy, but getting to that point is difficult because your brain is telling you that there’s no point in doing anything; including going to therapy. It’s essential that you work past those feelings of stagnancy. It’s vital to remember that what your brain is telling you isn’t true; there is a point to live, and you do have things that you enjoy. It’s about pushing through and remembering that the thoughts going through your mind are attributed to depression; they aren’t a reflection of who you are as a person.
Depression isn’t who you are. Depression is a mental illness that has symptoms such as lacking motivation, sleeping too much or not sleeping enough, changes in appetite, thoughts of emptiness or hopelessness, and thoughts of suicide or a plan to end one’s life. If you’re having thoughts of suicide, please call 911 or go to the emergency room. Contact a mental health professional and get medical attention immediately. Depression is a legitimate illness, and it needs to be addressed. If you’re feeling an emptiness inside, it could be because of this mental illness. It is treatable, it isn’t your fault, and there’s nothing wrong with you.
There is nothing wrong with you
Hear this now: there is nothing wrong with you. If you have depression, you are not alone. You’re struggling with a medical condition that many people, in fact, millions of people in the US alone, battle every single day. If you look at it that way, you’ll be more apt to seek help. It’s okay to acknowledge that you feel hopeless, as long as you pursue something that’ll help you move past this feeling. You’ve got this. Things will not be this way forever, and you will be able to move forward, no matter how hard it seems. Remember a time when you felt emptiness or sadness and were able to push past it and keep going. If you’re reading this article, you are alive. If you’re reading these words, you are strong, and you deserve to seek help.
Online counseling is an excellent place to seek help for feelings of emptiness and that “I don’t want to do anything” feeling. You are allowed to feel lost, but your online counselor is there to help you push through these feelings and find a way to cope. You might feel helpless, but your online counselor believes in you. Don’t be afraid to reach out for help.
This is a featured post by site sponsor Better Help.
It’s not easy being an introvert, because our society seems designed for extroverts. Job interviews favor those who are personable, smooth-talking, and quick-thinking. Classrooms are noisy, busy places that reward the students who raise their hands frequently and dive into group work. The social scene lauds those who are confident, outgoing, and quick to make small talk.
How can an introvert live a happy, fulfilling life in an “extroverted” world? In my book, The Secret Lives of Introverts: Inside Our Hidden World, I explore how introverts can work with their introversion rather than fight against it. Here are 10 ways introverts can do just that.
1. Get over your guilt of leaving the social event early. Have you ever started saying your goodbyes at a social event only to have someone incredulously exclaim, “You’re leaving already? We’re just getting started!” These types of comments used to fill me with guilt. Why was I the only one getting drained and wanting to leave? Was there something wrong with me? Thankfully, I later learned that I’m an introvert, and introverts get worn out by socializing because they respond to rewards differently than extroverts (you can learn more about the science behind introversion in my book). Now, I have no problem calling it an early night and heading for the door.
2. Have more meaningful conversations. Introverts tend to loathe small talk because it feels pointless and inauthentic, but we feel energized by talking about meaningful topics and big ideas. And there’s good news for introverts: research suggests that the happiest people have twice as many meaningful conversations — and do less surface-level chitchat — than the unhappiest. You may even find that big talk doesn’t drain you the way small talk does.
3. Be okay with turning down social invitations that promise little meaningful interaction. We’ve all been there. An acquaintance invites you to such-and-such event. You feel obligated to attend because you don’t want to hurt that person’s feelings or seem rude. But you know that the birthday party for your friend’s niece’s toddler or the guys’ night out won’t be fulfilling. In fact, it will not only lack meaningful interaction but also leave you with an introvert hangover, which is when you feel physically unwell from overextending yourself socially. If you’re anything like me, you’ve spent a good chunk of your life saying yes to social invitations out of guilt — then you paid for it later with exhaustion and overstimulation. Of course, there are some things you probably shouldn’t skip, like your good friend’s wedding or your spouse’s birthday dinner with the family. Bottom line, to live a happier life, pass on any unnecessary get-togethers you feel will drain your introvert battery, not energize it.
4. Schedule your alone time to avoid hurt feelings. I had the pleasure of sitting down with introverted Indie rocker jeremy messersmith to interview him for my book. He told me about a smart practice he’s been doing for quite some time: He makes sure he gets enough alone time by scheduling it once a week on the family calendar. That way his extroverted wife won’t feel hurt when he says he wants to be alone, and they can both work together to protect his restorative solitude by not scheduling other obligations at that time.
5. Don’t force yourself to live the “extroverted” life. Researchfrom the University of Maryland suggests that acting falsely extroverted can lead to burnout, stress, and cardiovascular disease. Turns out, embracing your introverted nature isn’t just a feel-good axiom — it’s actually good for your health.
6. Back away from one-sided relationships. Sadly, because introverts listen well and are often content to take the back seat, we can be targets for toxic or emotionally needy people. These relationships — in which one person is taking more than they give — drain our already limited social energy. If there are people in your life who continually exhaust you, consider spending less time with them. You’ll get the bonus of freeing up more time and energy for the people who do fill you up.
7. Stop beating yourself up for that awkward thing you said…3 years ago. Perhaps because introverts have more electrical activity in their brains than extroverts, they tend to ruminate. Our overthinking may take the form of playing embarrassing mistakes over and over in our minds. Sadly, rumination can give way to anxiety and depression — and it rarely helps you solve the problem you’re chewing on. To break free from the rumination cycle, do something to get the powerful engine of your mind chugging down a different track. Try calling to mind a positive memory, putting on music, going for a walk, or doing any different activity than the one you’re currently doing.
8. Give yourself permission to not do it all. I have an extroverted friend who always has her hand in something. If she’s not organizing a get-together with our friends, she’s volunteering at her son’s pre-school or taking on an extra project at work. I’ll admit that I’ve wished for her energy because she really does seem like she’s doing it all. But I have to remind myself that my talents lie in deep analysis, reflective thinking, and quality over quantity — not in running around doing all the things.
9. Occasionally push yourself out of your comfort zone. To my absolute horror, after writing a book about introversion, I learned that people wanted to talk to me about said book. They even wanted me to give interviews, go on podcasts, and give speeches! Let’s just say it was a very real lesson in pushing myself out of my stay-at-home-and-watch-Netflix comfort zone. Honestly, I hated almost every minute of it (I really did!), but I did those things because I knew it would be good for me. Taking the occasional jaunt out of your comfort zone can help you grow, too.
10. Protect your needs. Because introverts tend to be conscientious people who keep their thoughts to themselves, they may find their needs getting overlooked. Most people probably aren’t purposely trying to burden you or take advantage of you — it may be that they simply aren’t aware of what you need! Do you need a few hours to yourself to recharge from a busy week? Say it! Do you need someone to stop talking to you for a few minutes so you can concentrate? Tell them! Your needs matter just as much as everyone else’s.
If you’re a night owl, you might want to consider trying to make the switch to getting up earlier.
Researchers recently took a look genomic data from 700,000 people, all of whom had completed a DNA analysis from the company 23andMe and opted into the study. Participants were asked to complete a health survey, which asked whether or not they considered themselves a morning person or a night owl.
While the study didn’t find any difference between being a morning or night person and a person’s risk of obesity of diabetes, it did find a connection between night owls and being prone to depression, anxiety, and schizophrenia. The results of the study were published this week.
That said, the reason for the link is currently unknown, and instead points out a need for further research in the area.
Some theories include the genes in early risers potentially offering some sort of protection against mental health issues, the amount of light early risers are exposed to, and perhaps the societal advantages of feeling more awake in a 9-5 world.
In the study, both groups of people ultimately got around the same amount of sleep at night, and that’s important. Another recent study found that not getting enough sleep at night can ultimately lead to coronary artery disease or even a stroke.
In recent decades, economists studying life satisfaction have noticed a pattern – one that is remarkably persistent across different countries and cultures. Most people’s happiness levels begin dipping in adulthood, bottoming out when they reach their forties and fifties, before rising again.
This link between age and life satisfaction is known as the happiness curve. For discontented Generation Xers, it may provide relief to know that the midlife crisis is real but temporary, and that things will most likely get better. Young people might think rather differently, however. Could they feel any worse?
In both the US and the UK there has been a disquieting rise in depression, anxiety and other forms of distress among young people. Last April, a survey of more than 2,000 Britons aged 16-25 conducted by the youth charity the Prince’s Trust found that half had experienced a mental health problem, one in four said they felt “hopeless” and almost half felt they could not cope well with setbacks in life. The number of students dropping out of British universities because of mental health problems, and the number of campus suicides, have reached record highs. Similarly, a 2017 survey of 63,500 US college students found that 39 per cent had felt “so depressed it was difficult to function”. Between 2008 and 2015, the number of hospitalisations of suicidal teens doubled in America.
There are many economic and structural reasons why American and British teens might be struggling to cope. Inequality is rising, social mobility is stalling, competition for high-ranking universities and well-paid jobs is becoming fiercer. Yet this remains an insufficient explanation.
Last year, the Nordic Council of Ministers, an inter-parliamentary group comprised of representatives from Denmark, Finland, Iceland, Norway, Sweden, as well as several autonomous islands, released a report titled In the Shadow of Happiness. The Nordic countries consistently top the United Nations’ world happiness rankings, which is often attributed to their egalitarianism, extensive welfare states and work-life balance. But the Council wanted to examine a population that is overlooked in glowing UN reports: in the happiest countries in the world, who is sad?
It transpired that the populations most likely to be suffering or struggling emotionally were the very old (those over 80) and the young. The report found that 13.5 per cent of 18- to 23-year-olds in the Nordic states rated their life satisfaction as less than six out of ten, which means they are either struggling or suffering. The primary cause of this discontent, the authors concluded, was the rising rate of youth mental illness. In Norway, the number of young people seeking help for mental illness increased 40 per cent in five years. In Finland, named the happiest country in the world for 2018, suicide is responsible for a third of all deaths among 15- to 24-year-olds.
In her 2017 book iGen, Jean Twenge, an American psychologist, attributed the sharp increase in mental illness among young people to the proliferation of smartphones and the rise of social media. She noted that in the US, youth mental illness rose steeply from 2012 onwards, the year that more than half the population gained access to a smartphone. Perhaps the use of smartphones helps explain the similar trends observed among Nordic teens.
Twenge’s research found that the more time teenagers spend on social media, the more likely they are to report feeling unhappy or depressed. One of her studies found that teens who spend more than three hours a day using electronic devices were 35 per cent more likely to present a risk factor for suicide (such as having made plans to end their life). If modern technology is a prime culprit, then researchers should be worrying about teens in poorer countries too, where smartphone use is spreading but people are often less likely to report mental illness.
Mental illness is complex and there is unlikely to be merely one reason so many young people worldwide are miserable – or any simple solutions. Banning smartphones and social media would be neither practical nor effective: research shows that social media can also increase happiness. Yet finding ways to protect young people from the harmful effects of digital culture could save lives – and might benefit miserable middle-aged people too.