If you are one of those odd people who read the Read Me First page, you will know I referred to my mental health. Given that, I feel obliged to make a statement on the subject. Here goes. My mental health status is: almost normal, now I have taken action to improve it.
To explore this subject in more detail, let’s start with this picture of myself with Professor Sir Simon Wessely.
Simon is on the right, laughing like a drain after playing a well executed trick on me. It is taken at a garden party in Westminster Abbey. Not the kind of event I had ever attended before and I was feeling very out of place. This discomfort started on arrival when I found my name was “on the list” and they let me in. Are you sure? I thought. Once “in” everywhere I looked I saw politicians and journalists who I recognised from the telly. I didn’t know anyone. I am hopeless at walking up to people and introducing myself, and anyway what would I say? “Hi, I am Ken Nobody do you mind if I join you?”. But I couldn’t just circle around so I forced myself to do it. The people I joined were polite enough. They introduced themselves back: a think tanker, an academic, a journalist and a Chinese diplomat. As the CEO of a tech startup my status was tenuous. They were talking about Hong Kong and the Chinese diplomat was reeling off impressive statistics about how Hong Kong might look like a successful economy to the UK but these days it was just a bit player in the Chinese miracle so China doesn’t worry about clamping down on its democracy. The others joined in with expert and informed opinion. I stood silently wishing my complimentary Pimms was a pint of bitter. My input was not required even though I am sure it would have got a laugh. After spectating for a decent time, I shuffled off and stumbled into Simon who was standing on his own and didn’t look the least bit bothered about it. I introduced myself. He didn’t waste time telling me his name, he just launched straight into one. It sounded like a prepared speech. “I am a psychiatrist and if we don’t do something to hold back this epidemic of people turning up at their GP asking for help with their mental health, the NHS will be swamped”.
“Blimey”, I thought, “are you out of date”. A few years earlier I had done a fair bit of health research at the Institute of Ageing in Newcastle University, which played a minor role in drawing attention to unrecognised problems related to mental health. More recently, interest had exploded with slebs like Ruby Wax, Stephen Fry, Alistair Campbell (who was milling around somewhere) all raising the profile and making it cool to be a looney. To hear somebody speak so far “off message” shocked me. Simon picked up on my unease and expanded.
“The issue is that too many people with mild conditions want to be medicalised and receive interventions that the NHS doesn’t have the resources to provide. There aren’t enough practitioners and there is no budget”.
Who was this guy? Some kind of heartless fascist? I thought I had better lead him to the safer ground where the rest of us were these days. He needed to take things more seriously. Step one was to refer to a personal experience to support him and then draw him in to see the error of his position. I felt a duty to save his career, his view was so isolated and exposed. I explained how I thought mental health issues were over-hyped and I could see his point. My daughter had suffered very badly from recurring glandular fever for two years but was now recovering. I said how worried I had been that she would read about ME, which has many of the same symptoms and would convince herself she had it and become locked in a lifetime condition, which I believe had now been classified as a mental health condition and not the long term side effects of a virus, which is what ME sufferers would prefer. “Interesting” said Simon and he looked interested. Encouraged by this “interest”, I ventured further. “I read about this in a Royal Inquiry report, the same thing was true of Gulf War syndrome, it wasn’t caused by chemical contamination but when people read about the symptoms they sort of psychologically developed them. From what I remember both reports were by the same author and he suffered abuse from victims who wanted to be classified as physically ill not mentally ill”. “Very interesting” said Simon nodding along. From the cobwebs of my memory I threw in the name of the author. Simon nodded and with a straight face said “And have you ever met this person?”. “No” I said. And Simon said “Well you have now”. We both roared with laughter. Sir Simon was the head of the Royal College of Psychiatrists, a very clever and genuinely nice bloke and in total command of the subject. I should have realised how smart he was when I told him my daughter developed “Yamamoto’s disease” a thyroid condition related to glandular fever. “Wasn’t that a Japanese battleship?”, he said, “I think you mean Hashimoto’s disease”. which I thought spoiled my moment but I brushed it off as a minor detail. At least I had got the gist of his reports right. More or less.
The point Professor Wessely was making is that the mental health epidemic includes many people who are dealing with the rough and tumble of everyday life which they should cope with by using their own personal resources and support from friends and family, and not by demanding tabs or therapy from the NHS. I got that but having only recently been persuaded to see the flaws of a culture that expects people to “man-up”, “don’t complain” and “get on with it”, I found Simon’s position unsettling. One of the reasons for this was that I was in my early sixties and had spent most of my life, from early teenage, self-managing what was these days being classified as a mental health condition. I had sympathy with people who went to the doctor’s with mild depression. I thought that might leave them better off than homespun efforts which consisted of not telling anyone and creating an elaborate deception pretending to have a completely different personality to the one harbouring underlying fears and doubts and, then, occasionally engaging in unhealthy behaviours such as drinking too much, taking big risks and eating an unhealthy diet with too much fat and sugar. In the kind of high pressure work that I did it would be career suicide to admit you had any form of mental vulnerability, even minor. To seek medical help or ask for time off would finish you. I had seen that happen. The macho system disposed of people who “couldn’t hack it”.
The change in my opinion on mental health came about through a research project into income related health inequality where the data and evidence overwhelmed my prejudice. I discovered that people struggling with poverty, entered a mental health spiral of despair and depression. They weren’t “flakes”. They were victims. They were living in sub standard housing, performing low status work and not being paid enough to survive without benefits. Not being able to afford a good diet or participate in a normal social life, they slid into bad habits, smoking, takeout food, not exercising, not socialising, self-neglect leading to withdrawal from society and opening the door to physical diseases such as obesity related type 2 diabetes, cardio-vascular disease, lung cancer, kidney and liver disease all of which had a gateway from poor mental health.
In 2012, with this fresh in my mind I started a “turnaround project” in which a software system had been developed very late and over budget. The buyer was happy with the quality and wanted to continue but the supplier was getting ready to pull out as it was in the penalty zone of a contract and making no money. I was engaged as an outside expert to recommend changes. I renegotiated the contract. The project was genuinely more complex than either side had realised and the team needed to be paid for the fair value it was creating. That was the easy bit but I also insisted on much healthier working conditions. I removed the fixed price and fixed date terms that led to working around the clock and through weekends to the edge of exhaustion. This was harder to pull off than a price increase but the project was breaking people. But we got this approved as well and then found that productivity and quality improved and the speed of delivery got faster. Everyone was much happier. Tada.
I thought this was such an important breakthrough that I wanted it to be adopted more widely. I had exploratory academic conversations about it with the Chief Medical Officers of Unilever, BT and Babcock’s. All highly qualified and conscientious doctors. Two of them ex Royal Navy and one from Harvard Medical School. My point was that we (global business) worked to strict health and safety standards in physical environments with hard hats, high viz clothing, guards on machines, restrictions on the use of dangerous chemicals etc but in the professional white collar environment, especially on high profile IT projects we offered no protection even though we knew that project management systems imposed serious and avoidable stress that led to breakdowns, unhealthy behaviour and human tragedy. I wanted us to view projects as hazardous environments where companies should seek out and help people who were under too much pressure and at risk of harming their mental wellbeing. Nobody disagreed but back then (ten years ago) it was seen as difficult to confront. These days things have improved but even with the raised profile of mental health and many companies offering hotlines and local mental health support, I don’t believe the fundamentals for IT projects have truly changed. When it boils down to it projects are still set up with impossible budgets, deadlines and objectives and the human variable becomes the compensating factor. It is squeezed to chase the impossible target and people break.
In my case, I carried on working like this until aged 66 when in the last year, the last month, the last week, the last day, the last hour and at the last minute, I sort of snapped. I didn’t breakdown in tears or get carted out in a straightjacket. I just stood up told everyone to [blank] off and walked out of an important meeting. Mind you I then had to walk back in it and ask an exec I had just cussed to use his electronic key to let me out the building but that didn’t bother me. I had reached that moment. I didn’t want to play any more. By then I was only getting two hours sleep a night, and waking up every night with intensely realistic nightmares where I was trapped and couldn’t escape. When you wake up like that you don’t go back to sleep. Sleep deprivation on this scale over months is a form or torture. It’s banned under the Geneva convention. This was clinically bad and not from the “look at me I’ve got depression” fashion cult that Simon is concerned about. By that point I was already having therapy. I had been through a very thorough clinical psychiatric assessment at the Priory and a physical health assessment that revealed worryingly high blood pressure, a racing heart and high cholesterol. But treatment has its limits. It couldn’t change my working environment. My job wasn’t high pressure like a brain surgeon or soldier but it could no longer be tolerated. Like someone who had absorbed their lifetime limit of radiation I had reached the point where I could not endure another moment of corporate bollocks. In that moment I gave up trying to do that corporate dance thing with my legs tied together.
Since then I have made a good recovery. Recovery to what? Good question. I am as normal as anyone else. Only a couple of nightmares a month and way less disturbing. I get five hours sleep a night, I’d like more but that’s enough to function. I am far less likely to seek confrontation when I see behaviours I don’t like, which is good for my personal safety and greatly reduces the chance of being stabbed in London. My blood pressure, heart rate and even cholesterol are back within a healthy range (or better) for my age. But I am still benefitting from therapy that allows me to manage stress more healthily and is unwinding the effects of fifty plus years of managing it with amateurish and flawed methods. My only worry is how I will get on in retirement without the stimulation and purpose of a high pressure job, but I cover that elsewhere.
I am not entirely on board with Simon. I think he is right that way too many people seek medical help for personal challenges that their family, friends and colleagues can far more effectively support them with. If I could go back fifty years and talk to my younger self I would advise against projecting a false image that other people come to depend on. I would advise that it’s ok to admit you are tired, worried, have doubts, need help etc. I would say that alcohol and other forms of negative dependency starts at a much lower level than people think. An “unhealthy relationship” with alcohol starts well before drinking in the morning and getting through a couple of bottles of vodka a day. I never got anywhere near that but if you “need” a beer to relax, or to enter that room full of strangers and be the convivial host or guest, watch out. And, also watch out for putting pressure on your close family. Ask them for help but don’t use them as your infinite shock absorber. I am glad that mine did, but they do not have to put up with you. And, if it all still gets on top of you and you can’t shake it off, it is ok to ask for professional help, and I am sure Professor Sir Simon Wessely agrees with that.
