فصل دوم

chapter-2

because no one knows

So here’s the thing. A lot of us are anxious. Many of us haven’t been diagnosed as such, or even worked out if our particular flavour of anxiety constitutes a problem. But we know we’re anxious. More anxious than we should be. When I mention I’m writing a book about anxiety, everyone (and I mean every single person) suddenly goes a little wide-eyed. Drops their tone a little. Leans in. And tells me … ‘Everyone these days seems to have it, hey.’ We’re told that globally one in thirteen people suffer an anxiety-­related illness. Some studies tell us that one in six of us in the West will be afflicted with an anxiety disorder at some stage in our lives, making it the most common officially classified mental illness. For men, anxiety is even more common than depression – one in five men will experience anxiety at some point. But of course these are only the stats for those whose anxiety crosses the line to become a diagnosed disorder. There’s no accurate gauge for the number of people who are feeling the frenetic toll of modern life but somehow manage to keep on keeping on without presenting to a doctor, though Google search rates can sometimes give a real-time picture of such things. And, sure enough, searches for anxiety are up 150 per cent in the past eight years. Searches for ‘anxiety at night’ have risen nine-fold.

A growing number of conditions come under the umbrella term of anxiety, in the medical sense of the word. The latest (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the diagnostic handbook used by mental health professionals in most Western countries, lists thirty-seven different disorders under anxiety, including social phobia, specific phobias, panic disorder, generalised anxiety disorder (pervasive and chronic worry about a variety of everyday issues), separation anxiety, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder. (I should note that since 2013 the American Psychiatry Association assigned OCD its own separate category.) Anxiety was first classified as a mental disorder in 1980 in the third edition of the DSM.

Yep, you read right: 1980.

And before then? Were none of us anxious?

For nearly three centuries – pretty much since Descartes separated our heads from our flesh and bones – the idea that our emotions could impact our physical health remained scientific taboo. In 1950 only two books had been written on the topic. Two. In the whole entire world. (Freud wrote about it eighty years ago in The Problem of Anxiety, and Sǿren Kierkegaard ninety years before him in The Concept of Anxiety.) We officially became ‘stressed’ from 1950, when the term was invented by an Austrian–Canadian physician who worked tirelessly to popularise the term with a one-person campaign to get the word into dictionaries around the world. An aetio­logy I just love.

Several dozen more books and academic papers then appeared on the subject. In the main, though, the mind–body split persisted and anxiety was regarded as an everyday condition (we all get anxious, right?) that some of us are just too weak to handle. Women who got anxious were slapped with the hysteria diagnosis. Men self-medicated with drugs or alcohol or went into man caves. And we all got on with things.

Today there are countless theories as to the genesis of anxiety. All of them are worth understanding. Childhood trauma is one. In Sue Gerhardt’s seminal book Why Love Matters: How Affection Shapes a Baby’s Brain, it’s argued that when you grow up in conditions of emotional vulner­ability (anything from extreme abuse to having a parent who was busy with other children – hello, the Anxiety of Being An Eldest Child!) this can shape how you cope emotionally for the rest of your life. British TV clinical psychologist Oliver James (author of the brilliantly titled parenting book They F*** You Up) argues that childhood trauma sees you grow up in a state of permanent ‘red alert’ which deregulates your brain chemistry. It’s firmly nurture, not nature, in his book.

Low levels of certain chemicals in the brain (namely serotonin and norepinephrine) have also been implicated. Our brains process information about what’s happening inside and outside the body via the nervous system – a network of 100 billion neurons that relay information via electro-­chemical signals. Serotonin relays messages related to mood, sexual desire and function, appetite, sleep, memory, learning and social behaviour. The crude theory is that when we don’t have enough serotonin, the information doesn’t get through.

More recently, it’s been found that another neurotransmitter, anandamide (a name that comes from the Sanskrit word ananda for joy or bliss), helps our brain communicate happiness, ease and comfort. Those of us with low levels of this message emitter tend to get nervous. Or so goes the theory.

Even during the writing of this book, I’ve been exposed to fresher explainers.

Recent research has shown that anxiety is more common in people with autoimmune (AI) diseases, illnesses that occur when the immune system gets deranged and attacks different parts of the body. I have Hashimoto’s, an autoimmune disease of the thyroid, a gland in the neck that controls everything that makes you a conscious, sentient being: metabolism, breathing, heart rate, the nervous system, menstrual cycles, body temperature, cholesterol, blood sugar, mood, sleep … No one can explain the connection between AI and anxiety, in part because the genesis of many autoimmune diseases is not known. Some suggest that the uncertainty of living with an autoimmune disease is a possible factor – simply not knowing what the hell is going on with your body would drive anyone to agitated despair.

A more promising, and compelling (to me), explanation is that AI, like other inflammatory diseases, leads to high levels of circulating cytokines which have been shown to affect how our neurotransmitters communicate. Indeed, increasing evidence links anxiety to a bunch of inflammatory diseases such as atherosclerosis, metabolic syndrome and coronary heart disease. Clinical trials have shown that adding anti-­inflammatory medicines to mood medications not only improves symptoms, but also increases response rate. The fact that ‘normal’, healthy people can become temporarily anxious after an inflammatory vaccine – like typhoid – lends further credence to the hypothesis.

Possibly the most exciting work is being conducted on the link between gut health, inflammation and anxiety. As you’ve no doubt heard, we have a whole community of bacteria in our digestive tract – our microbiome – which not only plays an important role in our metabolic and immune systems, but also our nervous system. Recent research suggests that these microbes may influence emotional behaviour, pain perception and how we respond to stress.

When the balance of ‘good’ and ‘bad’ bacteria is out of whack (dysbiosis, caused by such things as poor diet, medications, antibiotics, allergens, parasites, fungal overgrowth), it can trigger a cascade of inflammatory molecular reactions that feed back to the central nervous system, causing inflammation in the brain. And it’s this inflammation that messes with our neurotransmitters, leading to anxiety. Put simply, if you have fire in the gut, you have fire in the brain.

Researchers have found that folk who eat more fermented foods (which contain gut healing probiotics) have fewer symptoms of social anxiety. Another study found that eating a mere yoghurt (I say ‘mere’ because the commercial stuff contains only small amounts of the beneficial bacteria touted on the front of the tub) twice a day for a few weeks changed the makeup of the subjects’ gut microbes, and this led to the production of compounds that modified brain chemistry.

In the final weeks of writing the first draft of this book, I found out that I have a number of genetic issues that likely played a part in my anxious history. I have a defective MTHFR gene, which can affect serotonin availability and uptake. It’s a new area in the debate, so I’m still learning about its implications. My hormone clinician, Leah, suspects that I was also born with an inability to produce enough glutathione, a key antioxidant that helps eliminate heavy metals from the body. As a result, I have mercury levels that are literally off the scale (as in, beyond the graph that the labs provided). High levels of mercury, of course, are directly linked to anxiety. ‘Mad hatters’ went nutty from the mercury used in felting work. Leah reckons these genetic variables may have been ‘switched on’ by epigenetic factors such as stress, illness and environmental pollutants.

Nascent research published in Nature Neuroscience also hypothesises that phobias (an anxious manifestation, as per the DSM) may be genetic ‘memories’ passed down from our ancestors and mediated by epigenetics, which may help to explain why people suffer from seemingly irrational phobias that probably made sense at some point in our evolution (like fear of germs).

But none of the above factors consigns a person to an anxious diagnosis. You can have all of the above and never have an anxious day in your life.

8.

You know what else happened in 1980, just prior to anxiety being formally recognised and diagnosed? The first anti-­anxiety drugs were manufactured. Which begs, was anxiety ‘invented’ in 1980 to fit the drug? Just a question, just a question, people … Oh, and there’s this.

In 1994, as Scott Stossel notes in My Age of Anxiety, the term ‘social anxiety disorder’ had only appeared fifty times in the media. By 2000 it was part of our lexicon and studies were indicating that 10–20 million Americans were afflicted.

What might have triggered such a dramatic switch? Were we are all suddenly being forced to go to more crowded parties in the late ’90s? Or to attend more group workshops involving those awkward trust exercises?

Or could it have been the widespread awareness campaign launched by the Social Anxiety Disorder Coalition (SADC) in 1999, just one year earlier? This particular campaign featured glum-looking folk accompanied by the truly awful tagline, ‘Imagine you were allergic to people’ and got blanket coverage across America, on the backs of buses and on freeway overpasses.

But sit tight! There’s more.

The SADC turns out to have been a partnership with SmithKline Beecham (which later became drug giant GlaxoSmithKline), which – hello! – had just released the world’s first pill, Paxil, approved to treat – you guessed it! – social anxiety disorder. Obsessive-compulsive disorder and bipolar disorder have similar drug-first histories.

Now, let me say very clearly. I’m not suggesting anxiety is a confection. I live it out viscerally, daily. So do the estimated 14 per cent of us whose lives are disrupted by OCD, social anxiety, post-traumatic stress and other anxiety-related illnesses.

Like David Beckham, who gets sent over the edge if things in his life aren’t in a straight line, or in pairs: ‘I’ll put my Pepsi cans in the fridge and if there’s one too many then I’ll put it in another cupboard somewhere … Everything has to be perfect.’ And Whoopi Goldberg, who avoids flying. I’m not sure why I’ve inserted these celebrity anecdotes. Perhaps just to lend colour and weight to the fact that anxiety is the sixth leading cause of disability in the world.

So yes, this stuff is real. And learning about it and carefully considering the various diagnoses and suggested causes and treatments is important. Indeed, it’s vital to the journey. But, I guess my brushwork here is broader. I’m plonking down the above factlets because they pertain to many of the quandaries every anxious person I know has had to face.

Am I really mentally ill? Disordered? Defective?

Or am I just weak of character and just not trying hard enough?

Does taking medication alter who I am? Am I less authentic for it? Is it ‘unnatural’?

And am I clinging to the ‘chemical imbalance’ theory because it absolves me of blame and the science-y-ness promises a neat fix?

Or are my neuroses fair enough given the state of the world today? Is my fear of crowds, confined spaces, financial ruin, being touched etc. a reasonable evolutionary response, albeit one that has got a little bit off kilter?

I’ve asked these questions for years. We have to, we anxious folk. The existing medical theories fail to answer them.

You ask the same? Well, you’re probably just as interested as me to learn that despite grand efforts to classify anxiety as a distinct disorder, there is no diagnostic process that actually works. No technique has been established that can determine the line in the sand where normal stress and fear becomes neurotic anxiety, or at what point your whirring thoughts can be explained as a chemical flaw in the brain instead of a character flaw (the former, of course, being far more ‘forgivable’ and, of course, ‘fixable’).

In fact, studies of the DSM’s diagnostic guidelines have found that when two different psychiatrists used the same edition of the DSM to diagnose the same patient, they get a consistent result only 32–42 per cent of the time.

Again, terribly vague. In Australia, just to confuse matters further, doctors work to both the DSM guidelines and a set of classifications set out by the World Health Organization (WHO), which are, not so conveniently, at odds with each other. To make matters worse, public hospitals work to an outmoded version of the WHO classifications when coding cases. Lost? Yeah, so are most medicos.

I think many of us when we’re young find the chemical imbalance rationale comforting. Which is fair enough. For me it provided a shelf on which I could place things for a bit until I could process them. To be told that we have an illness that is not our ‘fault’ relieves some of the doubt and uncertainty, and absolves us of the guilt we feel that we should be able to cope better. Which in itself turns down the anxiety dial.

Back in my late teens, doctors told me I had a serotonin deficiency in my noggin.

I’d moved out of home not long after my little brother was born and there was chaos all around me in the group house I shared with three older students. One of them loved to vacuum and practise guitar late at night, another self-harmed in her annexed bedroom off the kitchen (she claimed it was the yellow paint on the ceilings that caused it). I was studying law and politics. And working three jobs.

I was not sleeping and I was tapping and I was counting and I went on wild, wailing runs in the bush reservoir nearby at 4am when I couldn’t sleep.

And I’d sing Violent Femmes’ ‘Blister in the Sun’ (da doonk, da doonk) over and over.

I let out a big sigh when the psychiatrist explained my brain in easy to illustrate electrical circuitry terms. Finally, I had a tangible and apparently touch-it-with-a-scalpel reason for this mess in my head! More importantly those around me had a reason. It was hereditary, unavoidable and my parents weren’t to blame (at least not beyond the transferral of their genes).

Certainly it all seemed to be an unavoidable instance of genetic misfortune. My grandmother on Dad’s side was institutionalised for manic depression. She told me on a four-hour bus trip from Canberra to Sydney when I was about fourteen that she’d had electric shock treatment four times against her will. Dad was very young at the time and the details were always kept quiet. Mum’s mum suffered from terrible anxiety and was hospitalised when Mum was young. Again, these things weren’t discussed much and the details are sketchy.

This whole corner of the debate is likely to get a rise from some of you. Rapper and sensationalist Youtube dude Prince Ea waded into this territory recently and, boy, did he cop it in the comments section of his video from anxious thousands around the world tired of being blamed for their condition. Prince Ea said (to a motivational beat) that we are not our anxiety or depression. No, we are the sky, and anxiety and depression are but clouds that pass through us.

I see what he was getting at. I am not my sickness; I have a condition that can wander all lonely and cloud-like into view from time to time. I (the whole me) can choose to sit back and witness the clouds, let them be, let them pass. Pfft.

However, much online outrage ensued with many arguing their illness was most definitely medical and not a passing thing. ‘Would you tell someone who is diabetic, “You are not diabetic, you’re just choosing to focus on insulin and blood sugar levels.”’ Yep, once again, I see what they were getting at. For some of us, it does get to the point where the bloody clouds take over the sky. There is nothing left but black clouds. It becomes medical.

That said, since I was first presented with the ‘chemical imbalance’ explanation, it’s been found to be largely unproven and increasingly regarded as incorrect given how little we actually understand about how the brain works. I was pointed to the UK Royal College of Psychiatrist’s website recently. On the Treatments and Wellbeing page it tells us (bless them for being so frank), ‘We don’t know for certain, but we think that antidepressants work by increasing the activity of certain chemicals in our brains …’ The italics are mine. You have to roll your eyes a little, yes?

Besides, the quandary remains: is a chemical imbalance the cause, or the effect? Did my grandmothers’ anxiety instead cause a drop in her serotonin levels?

I admit I feel nervous about questioning the medical model when I’m not a doctor (although history shows that it’s often lay people who draw attention to gaps in science). I consulted a number of psychiatrists and heads of certified mental health organisations to ensure that my questioning was neither misleading nor harmful. I was told repeatedly over animated coffee chats around the country that it was not. Dr Mark Cross is a psychiatrist and board director of SANE Australia. He flags openly that modern psychiatry at times suffers from over-­medicalisation and often a lack of informed consent when patients are given drugs without being given the full picture, including the fact that drugs are not curative in many instances. ‘We have not cracked the cure, yet patients are often given drugs without being told this.’ He goes as far as to say that the medical model can sometimes cause harm, which goes against the Hippocratic oath (which he took during his medical training).

And so you take all these unanswered questions and deficiencies to your shrink or to the self-help aisle or the internet.

One of the psychiatrists I saw in my early twenties, a grandfatherly man with a snow-white beard, conceded that yes, we’re talking about an inexact science here. He added this warning. ‘Be careful Sarah. You’re very seductive.’ He was effectively telling me that less wary doctors than he might be driven to abandon their treatment plan for me in the face of my robust questioning of the science. Which only fuelled my cynicism.

Ready to roll your eyes again? In 2011, the dude in charge of the DSM was asked by a journalist if the line between normal human response to threat and certifiable ‘disorder’ might not be as distinct as his didactic tome makes out. His response was – you can probably guess it – ‘I don’t know.’ In another interview he confesses that there are no biological markers for anxiety disorders.

And you might scream back, as I did when I reached this point, ‘But we’re not just talking about a bunch of cells and synapses on a screen here; this is my goddamn sense of self, the stuff that makes me, me!! Are we really doing this experiment, people?!’ So my point is this. Take on board all the theories. But given no definitive causes, diagnoses and treatments have been found yet, why not see this as an opportunity? An opportu­nity to define anxiety as something other than a problem or disorder that has to be fixed as such. UK Guardian columnist Oliver Burkeman, who dedicates his column inches to questioning self-help culture, asks whether our focusing so heavily on defining the problem tacitly creates the problem, namely that we’re broken and require fixing. ‘Perhaps the problem, sometimes, is the notion that there’s a problem.’ I must emphasise: learn, learn, learn. And be open to it all. This is pretty much the raison d’être, the joy of this journey.

Dr Mark Cross agrees: ‘Just because you’re diagnosed with anxiety, doesn’t mean you have a problem, one that needs medication.’

So, I ask, could we go our own way? Could we play a little with not having a problem? Could we be so bold?

9.

Although, let me emphasise, pills and shrinks and behavioural therapies each have their place. For sure. So does a medical diagnosis. As I say, even just addressing the issue with an external party is invaluable. It can get you started on the journey. And, again, for those new to their anxiety – especially teens – a diagnosis can be a safe place to plant things until you have the wisdom and learning to take you into deeper understanding.

Nicely, the word diagnosis itself comes from the Greek diagnosi, which means ‘to know through’.

Last year, as I launched into writing this book, my insomnia bottomed out after almost a year of trying to get by while berating myself relentlessly for not coping better. Bugger the root cause of my anxiety! Bugger the vested interests of the drug giants! Bugger whether the chemicals in my brain were awry or not. I. Was. Not. Coping.

The lack of sleep night after night was causing my autoimmune disease to flare up terribly and I was struggling to function most days. I couldn’t hold a thought for longer than a few seconds, I was totally irascible and every nerve ending hurt. I was in pain – an inflamed, aching pain that I describe to those who care to know as someone running their nails down a blackboard and rubbing your nerve endings with a scrubbing brush, simultaneously. I was existing like this five or six days a week. My former business manager kept having to take me aside and explain the impact my frazzled state was having on the team in the office. Every human irritated me. Unlike in the past, when I worked on my own, I couldn’t squirrel myself away from the world, saving them from my sub-human presence. I was now highly accountable.

It was when a friend confided that she couldn’t run her fashion styling business without seeing a therapist every week that I was reminded of a sensible commitment I’d made back when I first went my own way at twenty-seven. I’d promised myself I’d get help if I needed it again. I went back for anti-anxiety tablets, which I took for ten months. And then I went back for psychoanalytic psychotherapy, an old-school style of therapy that focuses on understanding and expressing feelings, which I’d abandoned for many years in favour of the more modern cognitive treatments, which teach techniques that control said feelings.

I saw Dr H for six months before he dismissed me, finding me to have stabilised enough to venture back out on my own.

Like I say, it’s a bumpy journey.

10.

Even today, truth be told, I’m not entirely sure I have an anxiety disorder. As such. Or if I’m just terribly deficient at coping with everyday living. You too? Which leads me to point out the first of many cruel ironies in the anxious struggle. There are a few.

— cruel irony 1

The curious nature of anxiety is such that it defies its own diagnosis and treatment.

Let me explain.

Anxious behaviour is rewarded in our culture. Being highly strung, wound up, frenetic and soooo busy has cachet. I ask someone, ‘How are you?’ and even if they’re kicking back in a caravan park in the outback with a beer watching the sun set, their default response is, ‘Gosh, so busy, out of control, crazy times.’ And they wear it as a badge of honour.

This means that many of us deny we have a problem and keep going and going. Indeed, the more anxious we are, the more we have to convince ourselves we don’t have a problem. This is ironic, or paradoxical. And it seems awfully cruel. I read an interview with a clinical professor of psychology and psychiatry at Weill Cornell Medical College who said it takes 9–12 years for women to get a diagnosis for anxiety. I presume it would be just as long, possibly longer, for men. We suck it up when we feel anxious and soldier on until, well, we tip over the edge and our anxiety turns pathological and medical. Flipside, depressed behaviour – slovenliness, unproductiveness and suck-holey gloom – is something we abhor. Thusly, depression is an issue. And, thusly, we have lots of structures in place to identify it and treat it.

Depression is stigmatised, anxiety is sanctified as propping up modern life, which ironically sees depression treated as a legitimate illness, and the anxious left in a cesspool of self-doubt and self-flagellation for not being better at coping with life. And so we buy each other Keep Calm and Carry On mugs as though that’s something you can just do.

But it gets worse, you see. We then try to cope by revving up the angst, don’t we? We use coffee and fast-speak and sugar and staying back at work longer. We grind harder. Try harder. Think harder. We should be able to work our way through this. We think this is what will fire us up out of our funk and get us back on our game. It’s a self-perpetuating pain – we use anxiety to fight our anxiety.

But we don’t see it, often until it’s too late. I suspect many of you with anxiety who are reading this struggle to see it clearly. And struggle to treat it appropriately, with candle-lit baths and ‘me time’ and cortisol-calming medicinal foods. I do (struggle) and I often don’t (do candle-lit baths when I’m nuttily fast in the noggin).

For years I saw my life as a stacked spiral of dominoes. Until I realised a Jenga stack was probably a better metaphor. I was wholly convinced that if I removed my bull-at-a-gate approach, even just a few struts, the whole structure would topple. I was told to ‘back off’. To ‘just relax’. I dismissed such notions because they only induced further anxiety. I felt I’d be nothing without my anxious drive and when I felt it sag a bit I’d panic. I’d sturdy things again with a stern talking-to. ‘Fire up, Sarah.’ I’d rev up my adrenals with punishing runs and double-­strength long blacks. I could not let this whole game fall over.

I was rewarded for doing so with better jobs and lots of admiring looks. Until a gentle zephyr happened by and knocked the whole rickety structure to the ground. (We’ll get to this in a bit.) We also need to recognise – and many doctors don’t – our anxious behaviours are so often the solution to our problem, not our problem. Take bulimia. I struggled with it in my teens and twenties. I was lucky to have a mum who’d never dieted in her life and loved food. Food was not stigmatised in our house. For me (and I suspect for many others) bulimia wasn’t about food or body image directly (although the fact I expressed my anxiety via my body means I can’t fully escape the connection). It was about controlling my anxiety. I jammed raw oats and Vita-Brits (anything heavy and gluggy) down on top of the flutteriness I felt in my guts. It dampened it for a bit, suffocated it. Guilt, despair, disgust would build, not so much from the gluttony and fear of weight-gain (although, yes, it was connected), but from the anxiety working its way back in again. So I’d purge. I’d purge the anxiety. The bulimia was my solution, in the absence of anything better at the time, and I never, ever spoke about it because I didn’t want anyone to get it into their heads to take it away from me.

And don’t try telling me it was the modelling work I did when I was younger that caused it. It was only while I was modelling that the bulimia backed away, for reasons that had a lot to do with the security that came from my handsome pay-checks, and the fact that it took me away from what was then a turbulent home life.

A BRIEF NOTE ON HIGH-FUNCTIONING ANXIETY

Many of us with anxiety don’t look like we’ve got a problem because outwardly we function ludicrously well. Or so the merry story goes. Our anxiety sees us make industrious lists and plans, run purposefully from one thing to the next, and move fast up stairs and across traffic intersections. We are a picture of efficiency and energy, always on the move, always doing.

We’re Rabbit from Winnie the Pooh, always flitting about convinced everyone depends on us to make things happen and to be there when they do. And to generally attend to happenings.

P.S. ‘Clusterfuck’ is a military term from the 1960s. It refers to a chaotic, complex situation where everything seems to go wrong.

But beneath the veneer we’re being pushed by fear and doubt and a voice that tells us we’re a bad husband, an insufficient sister, we’re wasting time, we’re not producing enough, that we turn everything into a clusterfuck. Sure, we look busy, but mostly we’re busy avoiding things. So we tie ourselves up in stupid paper-shuffling-like tasks that shield us from ever getting around to the important stuff. Or the tough stuff.

And, yep, we’re the ones who send out random texts suggesting we all catch up for dinner next week. We’re also the ones who cancel at the last minute. And who simply do not pick up the phone for days (weeks?) when it gets too much. We go underground. We remain single for decades. And everyone just assumes we’re too busy and high-functioning for such things.

On a blog post entitled ‘When Social Anxiety Looks Like Talking Too Much’ I read about one girl’s battle with the seemingly inconsistent appearance of her anxiety. ‘To everyone, I’m just the girl who talks too much and tries too hard. When really, I’m just trying to quiet this battle in my mind for the hour.’ I’d add that, in such instances, we’d love everyone (someone?) to see that we absolutely do not have our shit together. And to come and tell us they’ve got this one. Even for five minutes.

The more anxious we are, the more we’d really love someone to come and take the load off us and help us cope for a bit. This presents us with another cruel anxious irony, doesn’t it: — cruel irony 2

The more anxious we are, the more high-functioning we will make ourselves appear, which just encourages the world to lean on us more.

Anxiety … it’s befuddling and clusterfucky for everyone involved.

11.

Sometimes, particularly when I give myself a hard time about taking medication to sleep (variously, valerian, melatonin, paracetamol, cold and flu tablets, Valium and Seroquel), I recite to myself the chorus of John Lennon’s ‘Whatever Gets You Through The Night’ (s’alright, s’alright). I find the certain c’est la vie-ness of it brings a lightness, an expansiveness, to things when I get into one of my fretty funks. And we need to find lightness where we can (I think it’s why so many ­comedians make jokes about their neuroses, and even why so many neurotics become comedians). I tend to repeat Lennon’s very forgiving line over and over. This is because I’m really rather, literally, obsessive-compulsive.

12.

Yeah. So. Let’s talk some more about insomnia. I’ve had it, on and off (mostly on) since I was about seven. As a kid, I was super aware that Dad couldn’t sleep and I’d hear him in the middle of the night from down the hall, agitated, freaking out to Mum about how he’d cope in the morning. I took this on, as an eldest daughter just does. I realise I also blamed myself for Dad’s insomnia (something – helpful or otherwise – you learn after a few decades of therapy).

Insomnia is anxiety’s spiteful bedfellow. Anxious people desperately need sleep, yet their condition ensures they are denied it.

— cruel irony 3

The less you sleep, the more anxious you get, the less you sleep … and so on.

Indeed, ironic. And in a not-so-fair kind of way. Yet this is all medical fact. Neuroscientists at University of California Berkeley have found that sleep deprivation fires up the same abnormal neural activity seen in anxiety disorders. Worse, the already-anxious are more affected by this mimicking pattern.

‘These findings help us realise that those people who are anxious by nature are the same people who will suffer the greatest harm from sleep deprivation,’ said Professor Matthew Walker, one of the researchers of the study.

I remember reading Harvard psychologist Daniel Wegner describing this sad spiral in some journal or other a few years back. He gave it a name: Ironic Process Theory. He said that trying to sleep by attempting to eliminate negative thoughts upon hitting the pillow, or trying not to panic about how you haven’t slept in three days, or whatever mind control you’ve been told to try, only succeeds in triggering an internal moni­toring process that watches to see if you’re succeeding. Which keeps you awake.

I’ve worked on my insomnia from all angles. And, yes, I’ve tried chamomile tea. And sleep meditations. And I know some of you are busting right now to suggest I try melatonin, or counting sheep backwards, or earthing mats. To which I would reply that Valium and a pick-axe to the head fails to take the edge off when I’m in one of my sleepless ruts.

But I had some spacious thoughts about it all recently.

When we’re babies the mortal terror of the vast, seemingly unsafe experience of life outside the womb is overwhelming and leaves us on high alert and unable to sleep. Our parents must, night after night, hold us tightly and rock us gently, to get us to drift off. Over time, the holding, the rocking, the reassurance of a full tummy, warmth and everything else the baby books advise our parents to do, makes us feel safe and supported, and we learn to trust life, and to self-settle. Well, most of us do. Some of us, though, do not learn how to self-­settle, or have had reason to unlearn this ability to trust later on down the track (we’re abandoned, abused or a younger sibling rocks up and takes away the attention). We feel unsupported and unsafe and so we must remain hyper-vigilant. At night, we simply can’t shut down our thoughts and fears. We can’t rest easy and trust that the stove is off, that the noisy neighbours will eventually quieten down, that work stresses can be put on a shelf for eight hours. We have to stay ‘on’. We are on our own. We feel this acutely and, oh, it hurts.

Thinking about it this way has helped things a lot. Rather than feeling I have a hopeless, helpless affliction, I can see I just need to find a way to feel held. To feel that everything fits. That everything is going to be okay. That life has this one, my little friend.

I think this is the better journey. What do you think?

13.

Here’s another equally generous and spacious thought. I throw it into the mix because I’m aware we need lots of different takes to work our way through such a complex condition.

Insomnia is a cry from our core to spend reflective time with ourselves. As British philosopher Alain de Botton puts it, ‘It’s an inarticulate, maddening but ultimately healthy plea released by our core self that we confront the issues we’ve put off for too long. Insomnia isn’t really to do with not being able to sleep; it’s about not having given ourselves a chance to think.’ De Botton argues that this need to reflect quietly (to reacquaint our selves with ourselves), without the distraction and obligations of our daylight selves, outweighs the benefits of sleep and so we subliminally make the call: think, not sleep.

I come to deep, hurtful but ultimately growth-creating realisations at night. In daylight I struggle to see my true weaknesses. And I wear masks during the day. The eeriness, the loneliness, the expansiveness, the ‘out-of-sync-ness’ of 4am sees me delve into truths and realisations I wouldn’t otherwise.

It’s always 4am, isn’t it? Indeed there’s a meme doing the interweb rounds that captures all the 4am references in movies, sitcoms and books. There are hundreds. It’s a thing!

When I can’t sleep now, I remind myself that it might just be about a need to reacquaint myself with myself.

Yep, a better journey.