18 May 2023
By Andrew K Kauffmann @JKaye82
Listen to the piece in full:
Our son has started teething. A little earlier than any paediatrician or YouTube video caused me to expect, he’s familiarising himself with a teething toy. When Sophie the giraffe falls to one side, he seems surprised, confused even. Out stretches his arm, and then in it curls as he tries to also feed on his hand. It’s caused me to ponder what he considers “normal” and what, on the contrary, feels sudden and unwelcome.
I imagine him panicking: ‘what on earth is going on? I’ve never had this awful feeling before.’ Admittedly these are my words; feeling alarmed is a place I go to often. So I start to reason. ‘It’s perfectly normal that he’s teething at such a tender age. Of course he hates his baby teeth.’ What we come to experience as unwelcome or sudden isn’t, as us adults can attest, necessarily “abnormal”. These are the routines of early infancy. Our son’s growing. So far, so “normal”.
Apart from recently becoming a parent, an idea that, as a gay man, I once considered most abnormal, but now feels “normal enough”, challenging events elsewhere have caused me to question the order of things. They’ve caused me to question what, and who, I trust. Something more fundamental still has been causing me concern. Like a baby getting used to their walking feet, I feel the world spinning too fast.
Compared to just a few years ago, I become more easily overwhelmed. I´ve always been easily triggered into intense emotional reactions but I now experience greater depth to these feelings. Time seems to speed by, cliché though it is, in a haze. I rush about. My milky memory seems weaker than before. For most of my life, I’ve taken pride in my powers of recall, but these days, I find it hard to concentrate. Worse still, I experience less balance than in the past. I’m certain I feel this way because the world itself is strange, and not just because of my personality.
I’m 41. I don’t think my chronological age explains my feelings of entropy. People in my age group are positioned somewhere on the bottom bit of the bend in the U-curve measure of life course happiness, but I’m not unhappy. Far from it: I´m very proud of myself, and happy that, at last, I’ve become a Dad. Something else feels amiss, not just for me, but, I’d argue, for all of us.
I´ve been feeling less ‘anchored’ for a few years. It was during the pandemic that this sense of strangeness became more acute, but these feelings of disorientation were taking root before the coronavirus entered our lives. There have been times, like Alice in Wonderland, where I’ve questioned whether I am out of step with the world. More recently, however, I´ve started to conclude that not only am I out of step with a rapidly changing world but, discomfitingly, so are many of the people I know and care about.
‘Down a rabbit-hole’
On January 27th this year, I stepped into Barnet Town Hall to register my grandmother’s death. I’d been at her bedside the day before, alone, holding her hand. Entering the registry office, I began to imagine that I might have been responsible for hastening her death. ‘I released my hand.’ I kept on repeating it over and over in my mind.
Grandma was visibly and audibly dying. I couldn’t bear it, so I asked a nurse to increase her pain relief. I turned away to send an email. Then she passed. Reflecting the next day, I let my mind run wild: had I been too impatient in her hospital room? Am I more impatient now than I was as a kid or as a teen, and if so, why? As someone who has lived with OCD for over 20 years now, noticing my mind goad and bait me feels commonplace, but the ruminative pendulum that swings from one side of my head to the other still destabilises me.
That same day these ruminations intruded, I visited my father’s North London home. His home had been trashed by somebody he knew. The morning’s events at the registrar had left me acting headstrong so I rushed to the house to take photos to pass on to the police. The bedroom cupboards and wardrobes were covered in the graffiti of a red highlighter pen that repeatedly declared that I, not my father, but I, Andrew, have OCD, am ‘mad’, and come from a ‘mad’ family. My mental health condition is hardly a secret, and this person was well aware of my family’s history of mental health problems.
Nevertheless seeing all this smeared all over my Dad’s bedroom came as a shock. Grandma´s mother, my great-grandmother, was ‘mad’, the scrawled abuse screamed – she was forced to have electroconvulsive therapy. I have been taking antidepressants for 20 years, this red-coloured graffiti continued, and, shock horror, I once even needed to see a psychiatrist.
Things got odder. More abnormal, I might say. Shouldn’t I phone the police? ‘No,’ the reply came from someone I trusted. We risked ‘upsetting’ the perpetrator and causing them to act even more egregiously.
In a rush of more adrenaline, I warned friends that the perpetrator was hacking my emails and that if they could graffiti things about me all over Dad’s house, they might soon spread rumours about me online. In a confetti explosion of 20 plus – possibly quite paranoid – messages, I spooked my partner on WhatsApp. He was back at home, in Madrid, caring for our one-month old.
‘I am not myself, you see?’
If I was a car battery, by the end of that Friday, I was precipitously low on acid. I could reach for other metaphors. I was like one of those Duracell Bunnies in the television adverts. I was still running, busying myself, but I was also close to collapse. I know what it’s like to approach burnout. It’s not easy to climb away from.
The desire for a darkened bedroom and a heavy duvet washes over me like a soapy machine rinse. A dusting of self-awareness might, only just, keep things manageable. “Things will eventually get back to normal” flickers as a flabby thought. In these moments, I typically switch off my phone. My OCD reveals its sharpened claws. I retreat, lose confidence. On this occasion, I stayed in a friend’s spare bed and curled up in the foetal position. Like a precious Ming vase, my mental health felt too significant a weight to be burdened with, so I lay down and remained prostrate.
Looking back from a distance, none of this sounds particularly shocking. I was grieving, and dealing with a genuine shock – a crime – the very same week Grandma had died. I was still adjusting to life as a new parent. In the following days and weeks, however, few people appeared to me to be acting at all “normally”. More and more, things seemed to me to be very “abnormal” indeed.
Staying at a relative’s the night before my grandmother’s funeral, they asked if I thought their partner might be suffering from bipolar disorder. The quiet calm I’d appreciated on past visits to their house had disintegrated. Elsewhere, an in-law’s growing unpredictability felt like it was advancing on me during a trip for them to connect with our newborn. What was causing them to swing quite so suddenly from one mood state to another, I wondered?
Closer to home, my father was sending me panicked text messages that centred on one theme: that everything was a disaster. For the first time in his life he was freely choosing the word ‘depressed’ to describe his mood. He hadn’t just lost his mother; severe financial problems were also mounting.
I observed how more people I know are being diagnosed with mental health conditions, and being prescribed prescription drugs, like Fluoxetine Hydrochloride, the ones I have taken since university. More and more people are confiding in me that they are receiving some form of counselling or psychotherapeutic treatment. They know that I’ve been down that road, so they open up, but this isn’t happening once a year, or even once a month, but more and more frequently.
Looking in the mirror, the hardest act of all, I was aware that I was beginning to sound quite “abnormal” as I raged into the night about everybody else and their “strange” behaviour. I too was switching between emotional extremes. Confronted with sleepless nights and new childcare responsibilities, the elevated risks of mental ill health that I faced as a parent with a history of depression started to frighten me.
In the few spare moments I felt lucid enough, I began to reflect. I wanted to try and take a wider perspective. First, it dawned on me that perhaps the common denominator in all these encounters with friends and family was my own fragile mental health. The world isn’t getting stranger, I ventured. Everything else in this world is as it always has been: the Queen of Hearts has always ruled irrationally and supreme in Wonderland. It occurred to me that it could be me who was starting to act strangely – that I might be tumbling.
A week or two later, as I slid further down a mental rabbit-hole, and loved ones seemed to be catapulting all around me, I went a little bit easier on myself. Perhaps I’m simply noticing more people in tune with their mental health, I said to myself. Friends and peers are talking about mental health more openly, and this propensity to ‘share’ is a generational or cohort effect, so of course I´m observing something fairly new.
I find myself surrounded by peers, who, like me, are at a stage in their lives where they’re shouldering the caring responsibilities of supporting ageing (sometimes very elderly) parents, and sandwiched at the same time in assuming many other responsibilities, whether it’s bringing up children, meeting rent or mortgage payments, juggling constant work demands, coping with relationship pressures and anxieties, and a variety of other life challenges that seem to intensify in mid-life.
Pursuing one theory, we might not be witnessing a change in the overall numbers – the prevalence – of people experiencing ill mental health, but the extent to which people feel confident and comfortable sharing their experiences of mental health. One mental health practitioner I’ve spoken to even wonders whether attitudinal shifts to mental health in the workplace have spurred on more people to request mental health support. There was always a latent need, they added, but now the need is manifest, and possibly growing further still as professionals come to see themselves as individuals with mental health rights and entitlements.
An alternative view on worsening mental wellbeing might look for answers in our society´s changing demographics, as we become a society of ‘beanpole families’, stretched out, increasingly unable to offer (or receive) all the in-family care and support that was once taken for granted, and might still be needed. This theory might link greater levels of mental illness with objectively stressful adaptations we have to make in a more atomised world. Let’s also not forget the cost of living crisis as a major factor, intensifying people’s difficulties after a decade or more of stagnating incomes. Centre for Mental Health’s evidence points to the systemic issues driving mental health problems and the many economic and social determinants that can exacerbate mental health.
My intuition, focused on the ‘character’ of our current age, is that we´re all a little out of step, with ourselves as much as anything else. My take is that 2023 may well be an unusual time in history, and that things are genuinely less stable than before – before the pandemic erupted in 2020, in any case. If this world was dreamt up and rendered in story form today, its author might not be a dystopian writer like Aldous Huxley, or a chronicler of bad times such as George Orwell, but rather, a fantasist like Lewis Carroll.
‘Run as fast as we can, just to stay in place’
“We labour at our daily work more ardently and thoughtlessly than is necessary to sustain our life because to us it is even more necessary not to have leisure to stop and think. Haste is universal because everyone is in flight from himself.” Friedrich Nietzsche
‘Everyone is in flight from himself’. The image that comes to mind is of the White Rabbit in Alice in Wonderland, forever singing, ‘I’m late, I’m late, I’m late! For a very important date!’
What I’m curious about is whether this basic sentiment – of being in flight – is an even more precise observation about human behaviour now, 150 years after Nietzsche wrote it. Are we in flight from ourselves – and, if so, is this even more pronounced a phenomenon today, driving even greater levels of mental illness than before?
If people seemed somehow disconnected from themselves in the 19th century, rushing about and resistant to looking at themselves, what does this mean for how we conduct ourselves now, in an age of Instagram, Elon Musk, hyper-capitalism, turbo-charged communications, ChatGPT, ever-growing worries about intelligent AI, and every other 20th or 21st century contrivance and contraption? How does this need to ‘take flight’ affect people in unequal societies such as the UK? Sociologists Kate Pickett and Richard Wilkinson felt they had an answer in their 2018 text, The Inner Level: How More Equal Societies Reduce Stress, Restore Sanity and Improve Everyone’s Wellbeing:
‘Greater inequality heightens social threat and status anxiety, evoking feelings of shame which feed into our instincts for withdrawal, submission and subordination: when the social pyramid gets higher and steeper and status insecurity increases, there are widespread psychological costs.’
Assuming Pickett and Wilkinson are right, and I think they are – and performing a historical somersault by also agreeing with Nietzsche that haste is universal, and has been for a decent amount of history – perhaps in 2023 we can claim that we find ourselves at a moment in history where haste and status insecurity are at their apotheosis.
What can we do with this information? Should we give up? Shrug and curse our mentally unhealthy world? No. Let me try to first understand the current context, however superficially. Towards the end of the essay I’ll then try to offer some positivity and brief notes on seeking enchantment in an anxious age.
‘I fancied that kind of thing never happened’: in the middle of a bad fairy tale
First, what is the Covid age doing to our mental health and wellbeing? I want to begin with some general assumptions.
Let’s assume that in this peculiar period, (the so-called ‘post-pandemic years’), where we’ve been urged by politicians, employers and media commentators to ‘return to normal’, we’re feeling even more perplexed as to what “normal” behaviour even is.
Let’s assume the years 2020-2023 have been instrumental in driving a strange sense of collective flight, and (contrary to popular predictions when the pandemic began that we’d all slow down and take greater appreciation of our world), we are in fact pacing about ever faster, ever more in haste, acting ever more abnormally – trying to forget, despite all the available evidence, that we are mortal beings. Most of us remain as short-termist in our approach to life as ever.
Let’s imagine that population mental health has worsened, not only as a consequence of the social isolation and other major changes engendered by the Covid-19 pandemic, but because we’re all being advised to act as normal, which is a most abnormal thing to do.
There are those, such as academics involved in longitudinal cohort studies examining mental health prior to and during the Covid pandemic, who conclude that there is scant evidence of an inexorable decline in mental health. They argue we can’t paint a picture, at least not yet, that just as a result of the pandemic, mental health has (unalterably) worsened.
No one doubts the research methodologies were sound, but does this idea of (more or less) stable mental health prior to and post the pandemic sound persuasive? Not for me.
In the first year of the Covid-19 pandemic, the World Health Organization (WHO) reports that global prevalence of anxiety and depression increased by 25%. In the longitudinal cohort studies and meta reviews comparing mental health symptoms before and after the pandemic, there were worrying signs that some symptoms did become more pronounced, not least depressive symptoms, which are hardly trivial. The WHO reports a ‘global shortage of mental health resources’ that continues today, even after a pandemic where concerns grew for mental health, and after years of historical underinvestment.
In the domestic context, referrals to NHS mental health services are up 44%, from 4.4 million people in 2016/17 to 6.4 million in 2021/22. The National Audit Office states that, as a result of this growing gap between provision and demand, there are now 1.8 million people on NHS mental health waiting lists and an estimated further 8 million people with a mental health condition not getting any support.
Further, Centre for Mental Health has highlighted how the pandemic has been accompanied by ‘a spike in mental illness presentations’. Referrals to children’s mental health services were up 134% in a year, and emergency crisis care presentations were up 80% in that first year of the coronavirus (Royal College of Psychiatry, 2021). Recent evidence from the Office for National Statistics also suggests anxiety is up from pre-pandemic levels.
As a layperson, all I can deduce from this information is that, first of all, there was an increase in overall prevalence in 2020, and furthermore, that this was from a place where psychological distress and mental ill health was already affecting frighteningly high numbers of people. On top of that, inequalities were already placing certain communities at greater risk of mental ill health, and these risk factors were intensified during the pandemic. Worse still, policy and budgeting decisions in many health care systems still under-value mental health. Just look at the UK government, choosing to abandon its plan for a cross-cutting ten year plan to prevent mental ill health.
If the pandemic did not, in some fundamental way, worsen mental health and wellbeing in some way that continues today, I want to see the evidence. Returning to my general point, arguing as I have that things have steadily felt like they’re getting less stable, less comfortable, less predictable, and that, for me at least, this sense of decline precedes the pandemic, what can we say about mental health problems in pre-Covid times? Were they increasing even before the pandemic started in 2020, and if so, why? What possibly explains that?
‘Is everything queer to-day?’
Multiple organisations have evidence that the rates of people reporting mental health problems has indeed been going up in recent years. The number of people with common mental health problems went up by 20% between 1993 to 2014 in both men and women. I genuinely have to squint when I read this.
‘Common mental disorders’ such as phobias, panic disorder, depression and anxiety, and yes, obsessive-compulsive disorder (OCD) became more widespread between 1993 and 2014, the period in which me and my friends all came of age.
In less time than it took the last babies born to Generation Y to learn to walk, leave school and get jobs, the prevalence of these problems rose by around one-fifth in both men and women. What is happening?
Could it be that we´re all living more fragmented lives? Isn’t that often the explanation? In 2016 to 2017, 1 in 20 (5%) of adults in the UK said they ‘often or always’ felt lonely. This proportion rose to 7.2% of the adult population in February 2021 during the coronavirus pandemic.
If mental health and wellbeing is in decline in countries such as the United Kingdom, and some of these problems have been exacerbated (but cannot solely be explained) by the pandemic, we might wish to consider the abnormal environment that we´ve been conditioned to view as normal and quotidian. More of us say we´re feeling lonely, for longer periods of time. More of us are experiencing common mental health problems. On no account have things returned to normal. They weren’t particularly normal to begin with.
Whatever periods of turbulence and unpredictability predate ours, I think that this period of turbulence is so intense – that the nature and pace of change in the 2020s is so unhinged, and the level of inequality so entrenched – it’s somewhat inevitable many of us will experience worse mental health.
Could we state that we´re better at collecting data on these measures of health and wellbeing than we were in history, and that’s why we appear lonelier, more in need of mental health services? I don’t think so. Or at least, I think that only provides us with part of the answer to what is happening today. Personally, I think more and more of us are conditioned (one might say forced) by this neoliberal age to live on the precipice, precariously hang on, keep on like a Duracell Bunny, running and running just to keep pace as the world keeps on spinning. That surely has to take its toll.
‘Curiouser and Curiouser’
Is there something specific and temporal about this historic moment that’s driving a sense of precarity and insecurity? We live in an age of exponential technological and social change, an age where we face a climate emergency, where ‘doomism’ prevails, and where social scientists argue we´re restless as never before. One might say Covid merely amplified the anxieties.
Johann Hari, Oliver Burkeman, and Benjamin and Jenna Storey (and many other commentators besides) argue there is something specific and unique about this period which is intrinsic to much of the malaise – or the ´lost connections´, as Hari frames it – that people are experiencing.
In Stolen Focus, Hari draws together compelling evidence that there is something grave and possibly even quite dangerous about this current moment in history. We are chronically distracted by harmful interruptions (social media included), and we are now diverted so frequently, and at such a scale, that it’s taking a considerable toll not just on our ability to concentrate, but on our overall sense of happiness and mental health. In Radical Attention, Julia Bell´s polemical on today’s online economy and how it has created an industry out of our distraction, we come to see the personal cost. We only have so much human capacity for processing information, and now we are playing with this.
We carry on, attempting to keep calm despite this patently absurd environment we insist is the ‘new normal’. We all end up looking like those Duracell Bunnies I started aping in my haze after losing Grandma, after I sent emails when I should have been holding her hand, after I acted carelessly and impatiently, when I was in flight, away from myself, from death, from time itself.
‘It would be so nice if something made sense for a change’
If there are greater numbers of us who feel mentally ill in this post-pandemic period, what would be so abnormal about that? What is the currency of the word “abnormal” when there’s so very little in the world to which we can objectively ascribe the meaning ¨normal¨? Isn’t it a breach of historical etiquette to talk about one period being more or less normal than another when the very term “normal” only gained the social significance it carries today in the taxonomy-obsessed 19th century?
Have things ever been “normal”? In the 4th millennium BC, how normal did it feel for the Sumerians to suddenly see solid discs of wood rotate, and, two thousand years after that, to see these turn into wheels, revolutionising everyday life?
When heretics were slaughtered in pre-modern times, and when witchcraft trials in Salem, and later, McCarthyite ‘witch hunts’ in 1950s USA, sought to denounce modern ‘heretics’, how awful must it have been to find yourself cast out by those in power as threateningly abnormal?
Thinking about the contemporary context, there are warnings about where advanced AI is headed, but let’s not forget there were concerns and misgivings about the role the news industry played in presenting and then amplifying a sense of abnormality when television became a mainstay of mid-twentieth century life.
Earlier in the century, Virginia Woolf looked at photographs from the Spanish Civil War and questioned whether the educated classes of which she was a part were lacking in empathy and intelligence to end such scenes – what was driving such extremes in human behaviour, such seeming ‘madness’? It was the availability of these photos, the relative speed in the 1930s, reaching Britain as they did from the beleaguered government in Madrid, that caused one to shiver, and to also feel confused and powerless.
“These are crazy times and even crazier circumstances,” Anne Frank wrote in her diary on 16 March 1944. Who can imagine the incredulity she must have felt, and the terror, on learning that her family´s German heritage mattered not a jot to the Nazis?
Can these historical moments, in any meaningful sense, be described as “normal” periods in history? How can we suppose to know what people’s overall state of mental health was in such periods, and whether societies historically experienced greater or lower levels of contentment, anxiety, or any other feeling, than we do today? Did we measure people’s ‘common mental disorders’ in these periods? I don’t wish to anachronistically suggest that people even spoke of such things as “normality” or “abnormality”. In The Normal and the Pathological Georges Canguilhem analyses the new ways in which health and disease were defined in the early 19th century. He demonstrates that the emerging categories of the normal and the pathological were far from objective scientific concepts.
‘We’re all mad here’
It was September 2001 when I began to experience the world as increasingly abnormal and disruptive. I guess at the time I called it “crazy” or “mad” and I was self-stigmatising. Referred by our family doctor to a psychiatrist, I felt there must be something wrong with me. I had just come out as gay. I was still grieving Mum. 9/11 sent shockwaves. That same week the Twin Towers collapsed, obsessive ruminations began to threaten me.
It was around this time, in the early 2000s, that I was visiting a psychiatrist in Enfield. Nothing seemed especially normal about life anymore, not mine, at least. It’s only now, 20 years later, I can see how in the same way, nothing would have seemed normal when my great-grandmother was subjected to electroconvulsive therapy in the 1950s; or when my Grandma lamented in the ’60s that she feared she had cancer, but the doctors couldn’t find anything wrong; or indeed when my paternal grandfather, Arthur, was sectioned and placed in a straitjacket in the old Friern psychiatric hospital in the mid-1970s. There has been demonstrable progress in how we treat and support people with mental illness today.
If I experience the ‘madness’ of the world as one source of growing distrust and disbelief (that at least in any real sense things are improving around me), it’s equally plausible for others to argue that previous generations had their own fault lines, worse in many respects than anything we are exposed to today, and that life was in many ways more problematic, more disorientating – even if it felt slower, and qualitatively different. The first director of the World Health Organization, Brock Chisholm, a psychiatrist, said about a world he saw as sick, and humans placed within it “…the ills from which it was suffering were mainly due to… his inability to live at peace with himself”. The world had just been at war. Perhaps I’m being ahistorical in suggesting a propensity to flee ourselves is a modern curse. Perhaps it’s long been characteristic of the human condition.
It’s a fool’s errand to compare this age to that, to try to run an intellectual quiz to determine conclusively which historical period was the strangest of all time. All I can say is what I feel. This post-pandemic period does feel odd and uncomfortable. Borrowing a phrase from writer Rachel Aviv, we can become ‘strangers to ourselves’, unsettled in our minds. The world continues to spin far too fast.
What’s more, a psychiatric framework, on its own, which reduces everything to whether we have this or that mental health problem, may estrange us from “the many scales of understanding required” (Rachel Aviv), as we try to maintain a continuous sense of self. In a period of crisis – constant crisis, it feels like – we all need a more open climate within which we can not only talk openly about our mental health problems, but where we can challenge the very conditions causing our problems. That would be a much healthier approach.
‘If you don’t know where you are going, any road can take you there’
In Wonderland, Alice asks The Cheshire Cat, ‘Would you tell me, please, which way I ought to go from here?’ We may not always have a clear destination, let alone a map, and at times in this bewildering world, it can feel like we´re not heading anywhere useful. I believe we all have a purpose, and we all have agency.
In this chaotic world, I can still do things to not feel so overwhelmed, to avoid crashing like a Duracell Bunny.
I need to not feel so impatient, to be so utterly uncentred and distracted, so much a product of my unhealthy environment. We must not give up hope. That is Johann Hari’s conclusion in Stolen Focus, and Julia Bell´s in Radical Attention, and that of the sociologists Pickett and Wilkinson. There are ways we can reorganise our lives, and build better societies.
That said, I do feel some confusion about my own direction. Should I listen to those who argue we need to prioritise the needs of future generations above our own? Could I find common purpose in the new movement of longtermists? In so doing, can I find meaning in sacrificing instant gratification today to help build a better society for tomorrow? We can all go slow, some insist. Others say this is no time to slow down: we must intensify our efforts to save the planet. There are many systemic inequalities and deep-rooted problems that need tackling. We can’t be Eeyores and retreat to the confines of our comfort zone and private spaces. But while collective action is clearly required, I’m a new Dad, and I don’t have spades of energy. I have to start small, as I suspect many of us will.
In the maelstrom, I try to find everyday pleasure in simplicity. In her new book, Katherine May talks about the search for enchantment in an anxious age. I will expand on this theme and how I like to find enchantment when my OCD and anxiety most threaten to hold me down in a future essay, but for now, let me conclude with very brief specifics. I do four things to remain centred – so connected, and feeling like myself.
I like to visit independent bookshops – to feel awe and wonder. I like to write, for writing offers meaning and momentum. It can also help me overcome the feeling of incommunicability. Third, I like to smell the flowers and notice the changing colours of a public garden close to where we live. There I can ground myself and observe what remains constant, and appreciate what doesn’t. If I was being bolder, I could even grow my own veg on our terrace. And in a world that feels so utterly extraordinary, so dizzying, fourth, I like to feel my son grab my hand so he can feed on my forefinger. From time to time, I even try to read him Alice’s Adventures in Wonderland.