Vincent Deary is a clinical and academic specialist in fatigue, in the ways in which we can spend life mentally and physically. Part memoir of his practice, part exploration of the ways in which mental health is undermined, this book follows on from an earlier volume, How we are, published in 2015. The chronology is relevant. The journey of those who lived through nine years of austerity, pandemics and uncertainty makes this book both inevitable and urgent. Insomnia and anxiety were among the few growth sectors of that decade. If Deary’s previous book was pretty much a meditation on how we might thrive in the world, this is a subtle catalog of the ways we fail to do so. One of his colleagues has a phrase for our prevailing psychological moment: “It’s as if we’re always one step ahead of the dogs.”
There is a rawness to Deary’s analysis that lends a compelling human touch to his theorizing. Some of that stems from his allusions to a breakdown he himself suffered in recent years. Otherwise, he dwells on case studies of people he has met in his work, individuals whose ‘allostatic load’ of tensions (the camel waiting for one too many) becomes overwhelming. Some of these case studies are composite patients, combining jobs and debt, caring responsibilities, trauma and regret; The two important stories to which he returns are those of his mother, Isobelle, a life force in the world who fell into the darkest of depressions in her final years, and of his former partner, here called Sami, an NHS nurse, who has the crisis overcome. childhood sexual abuse was then unraveled through the precarious shifts and unfair bureaucracies of his job. (After staying up all night with a mental patient who committed suicide, Sami panics when he’s reprimanded for drinking a mug of coffee in a staff room he doesn’t qualify for.)
It is the book’s compelling claim that we are somehow born “trembling,” three or twenty-three times away from breaking in our own particular way, more or less temperamentally at odds with where we fall on the earth. A creative and volatile spirit, Deary’s mother became a mother at the age of 19 in working-class Scotland to escape the “fools in old-fashioned hats and coats” who had restricted her own childhood, and found herself in a different kind of compromise. She characterized that struggle in a favorite phrase, an inversion of the usual platitude: “What doesn’t kill you makes you vile.”
Aiming to avoid becoming ‘stunned’ – bitter, hopeless – Deary punctuates his book with a series of health checks: ‘How insecure are you, in your work, in your family life, in yourself?’ In doing so, he makes a powerful argument against some of today’s factors that undermine safety: the ‘audit culture’ of the working world that continually tries to measure our performance against vague targets; the shift in focus in the welfare state, away from a culture of care and towards preaching about ‘resilience’; the erosion of a healthy perspective in the “ambient buzz” of social media; and the fact that as a society we have “lost the skill of recovery,” the space and capacity for deep rest that could accelerate recovery.
Deary is clearly an eclectic reader and through his studies he turns to quotes from Terry Pratchett and George Eliot as often as from the Diagnostic and Statistical Manual of Mental Disorders. He describes the “way in which events and revelations enter our bodies, hearts, and minds” as “a still emerging area of research,” but of course the science of internal commentary has been the domain of the greatest novelists for at least a year. a few centuries. Reading this book had me turning again to F. Scott Fitzgerald’s seminal essays on his own ‘crack-up’, not least because the speculative cadences of some of Deary’s metaphors are reminiscent of those pieces; Fitzgerald was a reluctant expert on allostatic loads: “In a true dark night of the soul it is always three o’clock in the morning, day after day.”
At the heart of Deary’s analysis – like Fitzgerald’s – is the idea of our minds as storytelling machines, going haywire in “our periods of trembling and breaking,” fueling delusions, addiction, compulsion, and paranoia. The second half of his book is devoted to the strategies that could protect us from these deceptive internal narratives. In particular, here is ‘the third wave’ of cognitive behavioral therapy, known as ‘acceptance and commitment therapy’, a process that begins with the idea that your mind – essentially ‘more of a problem finder than a problem solver’ – is not always your friend . The self-help wisdom here is quite under-discussed and hard-won, but there’s still enough for the odd inspirational Post-it note. Here is one: “The work of well-being is not to change the piece, but to change it be the theater… hold your self-narratives lightly and let them hold you lightly.” Happy new year.