Depression and spiritual awakening -- two sides of one door

Depression and spiritual awakening -- two sides of one door  Lisa Miller 

Lessons from the Mental Hospital -- Glennon Doyle Melton  

Psychosis or Spiritual Awakening 

Sick of this market-driven world? You should be

The self-serving con of neoliberalism is that it has eroded the human values the market was supposed to emancipate

• 
• • George Monbiot
  • The Guardian, Tuesday 5 August 2014 21.05 BST

‘The workplace has been overwhelmed by a mad, Kafkaesque infrastructure ... whose purpose is to reward the winners and punish the losers.’ Photograph: REX/High Level

To be at peace with a troubled world: this is not a reasonable aim. It can be achieved only through a disavowal of what surrounds you. To be at peace with yourself within a troubled world: that, by contrast, is an honourable aspiration. This column is for those who feel at odds with life. It calls on you not to be ashamed.

I was prompted to write it by a remarkable book, just published in English, by a Belgian professor of psychoanalysis, Paul Verhaeghe. What About Me? The Struggle for Identity in a Market-Based Society is one of those books that, by making connections between apparently distinct phenomena, permits sudden new insights into what is happening to us and why.

We are social animals, Verhaeghe argues, and our identities are shaped by the norms and values we absorb from other people. Every society defines and shapes its own normality – and its own abnormality – according to dominant narratives, and seeks either to make people comply or to exclude them if they don’t.

Today the dominant narrative is that of market fundamentalism, widely known in Europe as neoliberalism. The story it tells is that the market can resolve almost all social, economic and political problems. The less the state regulates and taxes us, the better off we will be. Public services should be privatised, public spending should be cut, and business should be freed from social control. In countries such as the UK and the US, this story has shaped our norms and values for around 35 years: since Thatcher and Reagan came to power. It is rapidly colonising the rest of the world.

Verhaeghe points out that neoliberalism draws on the ancient Greek idea that our ethics are innate (and governed by a state of nature it calls the market) and on the Christian idea that humankind is inherently selfish and acquisitive. Rather than seeking to suppress these characteristics, neoliberalism celebrates them: it claims that unrestricted competition, driven by self-interest, leads to innovation and economic growth, enhancing the welfare of all.

At the heart of this story is the notion of merit. Untrammelled competition rewards people who have talent, work hard, and innovate. It breaks down hierarchies and creates a world of opportunity and mobility.

The reality is rather different. Even at the beginning of the process, when markets are first deregulated, we do not start with equal opportunities. Some people are a long way down the track before the starting gun is fired. This is how the Russian oligarchs managed to acquire such wealth when the Soviet Union broke up. They weren’t, on the whole, the most talented, hardworking or innovative people, but those with the fewest scruples, the most thugs, and the best contacts – often in the KGB.

Even when outcomes are based on talent and hard work, they don’t stay that way for long. Once the first generation of liberated entrepreneurs has made its money, the initial meritocracy is replaced by a new elite, which insulates its children from competition by inheritance and the best education money can buy. Where market fundamentalism has been most fiercely applied – in countries like the US and UK – social mobility has greatly declined.

If neoliberalism was anything other than a self-serving con, whose gurus and thinktanks were financed from the beginning by some of the world’s richest people (the US multimillionaires Coors, Olin, Scaife, Pew and others), its apostles would have demanded, as a precondition for a society based on merit, that no one should start life with the unfair advantage of inherited wealth or economically determined education. But they never believed in their own doctrine. Enterprise, as a result, quickly gave way to rent.

All this is ignored, and success or failure in the market economy are ascribed solely to the efforts of the individual. The rich are the new righteous; the poor are the new deviants, who have failed both economically and morally and are now classified as social parasites.

The market was meant to emancipate us, offering autonomy and freedom. Instead it has delivered atomisation and loneliness.

The workplace has been overwhelmed by a mad, Kafkaesque infrastructure of assessments, monitoring, measuring, surveillance and audits, centrally directed and rigidly planned, whose purpose is to reward the winners and punish the losers. It destroys autonomy, enterprise, innovation and loyalty, and breeds frustration, envy and fear. Through a magnificent paradox, it has led to the revival of a grand old Soviet tradition known in Russian as tufta. It means falsification of statistics to meet the diktats of unaccountable power.

The same forces afflict those who can’t find work. They must now contend, alongside the other humiliations of unemployment, with a whole new level of snooping and monitoring. All this, Verhaeghe points out, is fundamental to the neoliberal model, which everywhere insists on comparison, evaluation and quantification. We find ourselves technically free but powerless. Whether in work or out of work, we must live by the same rules or perish. All the major political parties promote them, so we have no political power either. In the name of autonomy and freedom we have ended up controlled by a grinding, faceless bureaucracy.

These shifts have been accompanied, Verhaeghe writes, by a spectacular rise in certain psychiatric conditions: self-harm, eating disorders, depression and personality disorders.

Of the personality disorders, the most common are performance anxiety and social phobia: both of which reflect a fear of other people, who are perceived as both evaluators and competitors – the only roles for society that market fundamentalism admits. Depression and loneliness plague us.

The infantilising diktats of the workplace destroy our self-respect. Those who end up at the bottom of the pile are assailed by guilt and shame. The self-attribution fallacy cuts both ways: just as we congratulate ourselves for our success, we blame ourselves for our failure, even if we have little to do with it.

So, if you don’t fit in, if you feel at odds with the world, if your identity is troubled and frayed, if you feel lost and ashamed – it could be because you have retained the human values you were supposed to have discarded. You are a deviant. Be proud.

Loneliness is one thing. A happy loner quite another

Britain may well be 'Europe's loneliness capital', but being happily alone by choice is quite another matter

• 
• • Barbara Ellen
  • The Observer, Sunday 22 June 2014

Isolated… or just enjoying her own company? Photograph: Pierre Desrosiers/Getty Images

There used to be a fashion for scaremongering surveys about single women, saying things like: "Eight out of 10 women are going to die alone, surrounded by 17 cats." But to that I would mentally add: "Or it could all go horribly wrong." To my mind, aloneness never necessarily equated with loneliness. It wasn't a negative, something to be avoided, feared or endured.

Now a survey from the Office for National Statistics says that "Britain is the loneliness capital of Europe". Overall, Britons are less likely to have people they can turn to in a crisis or to feel close to neighbours. On this last point, we came 26th out of 28 European countries – beating Denmark and France (but they scored higher in other areas).

However, Britain was better than average in areas such as feeling that life was generally worthwhile. And though we did come near bottom on having people to turn to in a crisis, there were still 88.7% who could turn to someone. Slovakia's score was nearly 100%, but that's just showing off. Joking apart, if the truly lonely in Britain are to be identified and helped, then the first step would be to stop lazily lumping them in with the contented-alone.

I sometimes think of myself as a natural loner, though, in my case, this could just be a cover for being a sullen, unsociable, misanthropic cow who was warped by reading too much as a child. The upshot is that "alone" doesn't bother me much. But, then, there are two types of solitude – voluntary and enforced, the latter being a killer.

Past studies have reported the debilitating impact of loneliness, one stating that, for older people, it could be more deadly a factor than obesity. Such loneliness is caused by myriad factors – disability, unemployment, economic stress, mental illness, family breakdown, relocation and so on. Few would want to suffer it.

Then there is the other type of "alone". This study could just as well be interpreted as saying that many Britons are self-reliant problem-solvers, respectful of others people's privacy – and what's wrong with that? Isn't this the modern British definition of neighbourliness: not over-chummy and intrusive, but friendly, considerate and, most importantly, happy to sign for your Amazon parcels?

Now I'm being flippant. Of course you'd hope that people would help each other out in a crisis. However, generally, things such as "neighbourliness" seem defined by personality types. That's why some people go to London, are shocked by its standoffish ways and leave, while others like myself (escapees from villages) relish the freeing anonymity.

Likewise, while these days social media et al provides a sense of ersatz "community" without human interaction for those who want it (the equivalent of the television left on "for company"?), some people don't even want or need this.

Odd, then, that it's usually loners who are viewed with pity, condescension or suspicion. But why? Britain is an overstuffed, teeming little rock. It makes sense that, just as some people will be sociable, others will adopt the "island mentality" of standing alone and neither is right or wrong.

Still, the feeling persists that sociability is a skill, while the opposite casts a person as a loser or a weirdo – someone who's going to end up walking down a high street wearing a bandana, firing guns at those who've "wronged" them.

Personally, I'd be more likely to distrust people who can't bear time with themselves. What's wrong with them that they can't abide their own company – what are they trying to hide in the crowd?

This is what I take from these kinds of surveys – that there are the lonely, and there are the alone. Seemingly the trick is to reach out to the group who truly need help, rather than getting them mixed up. 

Materialism: a system that eats us from the inside out

Buying more stuff is associated with depression, anxiety and broken relationships. It is socially destructive and self-destructive 

• • George Monbiot
  • The Guardian, Monday 9 December 2013 20.30 GMT

Owning more doesn't bring happiness: 'the material pursuit of self-esteem reduces self-esteem.' Photograph: Dominic Lipinski/PA

That they are crass, brash and trashy goes without saying. But there is something in the pictures posted on Rich Kids of Instagram (and highlighted by the Guardian last week) that inspires more than the usual revulsion towards crude displays of opulence. There is a shadow in these photos – photos of a young man wearing all four of his Rolex watches, a youth posing in front of his helicopter, endless pictures of cars, yachts, shoes, mansions, swimming pools and spoilt white boys throwing gangster poses in private jets – of something worse: something that, after you have seen a few dozen, becomes disorienting, even distressing.

The pictures are, of course, intended to incite envy. They reek instead of desperation. The young men and women seem lost in their designer clothes, dwarfed and dehumanised by their possessions, as if ownership has gone into reverse. A girl's head barely emerges from the haul of Chanel, Dior and Hermes shopping bags she has piled on her vast bed. It's captioned "shoppy shoppy" and "#goldrush", but a photograph whose purpose is to illustrate plenty seems instead to depict a void. She's alone with her bags and her image in the mirror, in a scene that seems saturated with despair.

Perhaps I'm projecting my prejudices. But an impressive body of psychological research seems to support these feelings. It suggests that materialism, a trait that can afflict both rich and poor, and which the researchers define as "a value system that is preoccupied with possessions and the social image they project", is both socially destructive and self-destructive. It smashes the happiness and peace of mind of those who succumb to it. It's associated with anxiety, depression and broken relationships.

There has long been a correlation observed between materialism, a lack of empathy and engagement with others, and unhappiness. But research conducted over the past few years seems to show causation. For example, a series of studies published in the journal Motivation and Emotion in July showed that as people become more materialistic, their wellbeing (good relationships, autonomy, sense of purpose and the rest) diminishes. As they become less materialistic, it rises.

In one study, the researchers tested a group of 18-year-olds, then re-tested them 12 years later. They were asked to rank the importance of different goals – jobs, money and status on one side, and self-acceptance, fellow feeling and belonging on the other. They were then given a standard diagnostic test to identify mental health problems. At the ages of both 18 and 30, materialistic people were more susceptible to disorders. But if in that period they became less materialistic, they became happier.

In another study, the psychologists followed Icelanders weathering their country's economic collapse. Some people became more focused on materialism, in the hope of regaining lost ground. Others responded by becoming less interested in money and turning their attention to family and community life. The first group reported lower levels of wellbeing, the second group higher levels.

These studies, while suggestive, demonstrate only correlation. But the researchers then put a group of adolescents through a church programme designed to steer children away from spending and towards sharing and saving. The self-esteem of materialistic children on the programme rose significantly, while that of materialistic children in the control group fell. Those who had little interest in materialism before the programme experienced no change in self-esteem.

Another paper, published in Psychological Science, found that people in a controlled experiment who were repeatedly exposed to images of luxury goods, to messages that cast them as consumers rather than citizens and to words associated with materialism (such as buy, status, asset and expensive), experienced immediate but temporary increases in material aspirations, anxiety and depression. They also became more competitive and more selfish, had a reduced sense of social responsibility and were less inclined to join in demanding social activities. The researchers point out that, as we are repeatedly bombarded with such images through advertisements, and constantly described by the media as consumers, these temporary effects could be triggered more or less continuously.

A third paper, published (paradoxically) in the Journal of Consumer Research, studied 2,500 people for six years. It found a two-way relationship between materialism and loneliness: materialism fosters social isolation; isolation fosters materialism. People who are cut off from others attach themselves to possessions. This attachment in turn crowds out social relationships.

The two varieties of materialism that have this effect – using possessions as a yardstick of success and seeking happiness through acquisition – are the varieties that seem to be on display on Rich Kids of Instagram. It was only after reading this paper that I understood why those photos distressed me: they look like a kind of social self-mutilation.

Perhaps this is one of the reasons an economic model based on perpetual growth continues on its own terms to succeed, though it may leave a trail of unpayable debts, mental illness and smashed relationships. Social atomisation may be the best sales strategy ever devised, and continuous marketing looks like an unbeatable programme for atomisation.

Materialism forces us into comparison with the possessions of others, a race both cruelly illustrated and crudely propelled by that toxic website. There is no end to it. If you have four Rolexes while another has five, you are a Rolex short of contentment. The material pursuit of self-esteem reduces your self-esteem.

I should emphasise that this is not about differences between rich and poor: the poor can be as susceptible to materialism as the rich. It is a general social affliction, visited upon us by government policy, corporate strategy, the collapse of communities and civic life, and our acquiescence in a system that is eating us from the inside out.

This is the dreadful mistake we are making: allowing ourselves to believe that having more money and more stuff enhances our wellbeing, a belief possessed not only by those poor deluded people in the pictures, but by almost every member of almost every government. Worldly ambition, material aspiration, perpetual growth: these are a formula for mass unhappiness.

The drugs do work, but they can't cure unhappiness

Antidepressants are sometimes prescribed when they aren't needed, but never to use them is to miss an opportunity

• Tim Cantopher
• theguardian.com, Wednesday 20 November 2013 16.20 GMT

Antidepressants buy you time to sort out the issues that caused the depression in the first place. Photograph: Cultura/Rex Features

I can't stand zealots. Unfortunately, the literature on antidepressants is full of them. I'm not impressed by the protagonists in the polarised argument over the efficacy or otherwise of these drugs, whose positions are firmly held and loudly proclaimed. Many researchers appear to have written the conclusion of their study before the protocol.

At the one pole are the pharmaceutical industry and academic psychopharmacologists. I'll call them the pros. They urge us to practise only evidence-based medicine, by which they mean following rigid protocols based on treatments that have achieved positive results either in double-blind placebo-controlled drug trials, or meta-analyses (a method for grouping together results from several trials). Most of these studies focus on antidepressants because their effects are easy to measure.

The pros despise any practice not based on this narrow definition of evidence. One of them once told me: "Employing clinical experience to decide how to treat patients means continuing to make the same mistakes and never learning from them." So much for the lessons I've learned from treating about 3,000 people with this illness.

At the other pole are a group of naysayers who assert that antidepressants don't work any better than placebo. I'll call them the cons. They use the available statistics in the way best suited to their argument and are equally dismissive of any contrary view.

It's part of our culture to take up polarised positions. Our political and legal systems are based on this premise and our media rely on it. The middle ground isn't interesting and is rarely aired. It is this environment in which the pros and cons dominate the literature on antidepressants. Meanwhile, sufferers from the depressive illness don't know which way to turn.

The root of the problem is that good research is difficult and limited. Research is good at showing big effects in large groups of people. It's not so good at showing more subtle, or difficult to define, effects in subgroups of people. The results of your study will depend on whom you study, what you measure, what you define as an effect and what you do with your data.

The cons say that the pros have suppressed some findings that didn't suit them. If you compare two identical groups 20 times, you will find an apparently significant difference between them once. Test your ineffective antidepressant 20 times and you'll be able to publish a positive result, so long as you suppress the other 19. We clinicians knew this was happening years ago. One particular antidepressant was known by everyone to lack efficacy, yet the studies appeared to show that it worked as well as all the rest. Something was wrong with the published research and it seems we may now know what it was. Recent research seems to under-report some side-effects and withdrawal effects of antidepressants.

The cons are equally selective. They point to meta-analyses showing that antidepressants don't out-perform placebo sufficiently to reach this arbitrary level of significance. They conclude that antidepressants don't work. This is the oldest misuse of statistics in the book. An insignificant difference doesn't mean that you've proven no difference; it just means that you haven't proved that there is one.

Another issue is failing to exclude the outlier. As I've already pointed out, one expects occasional misleading results from research. A meta-analysis should deal with this problem by excluding from the analysis any study with results wildly different from all the others. The pros say that this hasn't always happened in the cons' analyses, potentially producing misleadingly negative results.

So research is failing us in this field. Unfashionable though this is in the environment currently existing in medicine, it means we clinicians need to use our experience, powers of observation and common sense, bearing in mind the experience of other clinicians.

We need to take note of the available research, while also taking a critical view of it. Here is the upshot, accepted by most of us on the ground: antidepressants usually work, but only for real clinical depression, the type involving a chemical disturbance in the brain, with a full range of characteristic physical symptoms. They don't work for unhappiness, grief or chemically induced depression and if you take them irregularly or for too short a period, the depression comes back.

Prescription numbers are rising mainly because doctors are getting better at identifying depression, though antidepressants are sometimes prescribed when they aren't needed and won't work. Except for people suffering from recurrent depression they are only first aid, buying you time to sort out the issues that caused the depression in the first place, but never to use them is to miss an opportunity to provide relief from this horrible illness.

Dr Tim Cantopher, consultant psychiatrist, Priory Hospitals Group, author of Depressive Illness – the Curse of the Strong (Sheldon)

The Psychological Price of Entrepreneurship

INC. 5000

BY JESSICA BRUDER in inc

No one said building a company was easy. But it's time to be honest about how brutal it really is--and the price so many founders secretly pay.

 

By all counts and measures, Bradley Smith is an unequivocal business success. He's CEO of Rescue One Financial, an Irvine, California-based financial services company that had sales of nearly $32 million last year. Smith's company has grown some 1,400 percent in the last three years, landing it at No. 310 on this year's Inc. 500. So you might never guess that just five years ago, Smith was on the brink of financial ruin--and mental collapse.

Back in 2008, Smith was working long hours counseling nervous clients about getting out of debt. But his calm demeanor masked a secret: He shared their fears. Like them, Smith was sinking deeper and deeper into debt. He had driven himself far into the red starting--of all things--a debt-settlement company. "I was hearing how depressed and strung out my clients were, but in the back of my mind I was thinking to myself, I've got twice as much debt as you do," Smith recalls.

He had cashed in his 401(k) and maxed out a $60,000 line of credit. He had sold the Rolex he bought with his first-ever paycheck during an earlier career as a stockbroker. And he had humbled himself before his father--the man who raised him on maxims such as "money doesn't grow on trees" and "never do business with family"--by asking for $10,000, which he received at 5 percent interest after signing a promissory note.

Smith projected optimism to his co-founders and 10 employees, but his nerves were shot. "My wife and I would share a bottle of $5 wine for dinner and just kind of look at each other," Smith says. "We knew we were close to the edge." Then the pressure got worse: The couple learned they were expecting their first child. "There were sleepless nights, staring at the ceiling," Smith recalls. "I'd wake up at 4 in the morning with my mind racing, thinking about this and that, not being able to shut it off, wondering, When is this thing going to turn?" After eight months of constant anxiety, Smith's company finally began making money.

Successful entrepreneurs achieve hero status in our culture. We idolize the Mark Zuckerbergs and the Elon Musks. And we celebrate the blazingly fast growth of the Inc. 500 companies. But many of those entrepreneurs, like Smith, harbor secret demons: Before they made it big, they struggled through moments of near-debilitating anxiety and despair--times when it seemed everything might crumble.

"It's like a man riding a lion. People think, 'This guy's brave.' And he's thinking, 'How the hell did I get on a lion, and how do I keep from getting eaten?"

Until recently, admitting such sentiments was taboo. Rather than showing vulnerability, business leaders have practiced what social psychiatrists call impression management--also known as "fake it till you make it." Toby Thomas, CEO of EnSite Solutions (No. 188 on the Inc. 500), explains the phenomenon with his favorite analogy: a man riding a lion. "People look at him and think, This guy's really got it together! He's brave!" says Thomas. "And the man riding the lion is thinking, How the hell did I get on a lion, and how do I keep from getting eaten?"

Not everyone who walks through darkness makes it out. In January, well-known founder Jody Sherman, 47, of the e-commerce site Ecomom took his own life. His death shook the start-up community. It also reignited a discussion about entrepreneurship and mental health that began two years earlier after the suicide of Ilya Zhitomirskiy, the 22-year-old co-founder of Diaspora, a social networking site.

Lately, more entrepreneurs have begun speaking out about their internal struggles in an attempt to combat the stigma on depression and anxiety that makes it hard for sufferers to seek help. In a deeply personal post called "When Death Feels Like a Good Option," Ben Huh, the CEO of the Cheezburger Network humor websites, wrote about his suicidal thoughts following a failed start-up in 2001. Sean Percival, a former MySpace vice president and co-founder of the children's clothing start-up Wittlebee, penned a piece called "When It's Not All Good, Ask for Help" on his website. "I was to the edge and back a few times this past year with my business and own depression," he wrote. "If you're about to lose it, please contact me." 

Brad Feld, a managing director of the Foundry Group, started blogging in October about his latest episode of depression. The problem wasn't new--the prominent venture capitalist had struggled with mood disorders throughout his adult life--and he didn't expect much of a response. But then came the emails. Hundreds of them. Many were from entrepreneurs who had also wrestled with anxiety and despair. (For more of Feld's thoughts on depression, see his column, "Surviving the Dark Nights of the Soul," in Inc.'s July/August issue.)"If you saw the list of names, it would surprise you a great deal," says Feld. "They are very successful people, very visible, very charismatic-;yet they've struggled with this silently. There's a sense that they can't talk about it, that it's a weakness or a shame or something. They feel like they're hiding, which makes the whole thing worse."

If you run a business, that probably all sounds familiar. It's a stressful job that can create emotional turbulence. For starters, there's the high risk of failure. Three out of four venture-backed start-ups fail, according to research by Shikhar Ghosh, a Harvard Business School lecturer. Ghosh also found that more than 95 percent of start-ups fall short of their initial projections.

Entrepreneurs often juggle many roles and face countless setbacks--lost customers, disputes with partners, increased competition, staffing problems--all while struggling to make payroll. "There are traumatic events all the way along the line," says psychiatrist and former entrepreneur Michael A. Freeman, who is researching mental health and entrepreneurship.

Complicating matters, new entrepreneurs often make themselves less resilient by neglecting their health. They eat too much or too little. They don't get enough sleep. They fail to exercise. "You can get into a start-up mode, where you push yourself and abuse your body," Freeman says. "That can trigger mood vulnerability."

So it should come as little surprise that entrepreneurs experience more anxiety than employees. In the latest Gallup-Healthways Well-Being Index, 34 percent of entrepreneurs--4 percentage points more than other workers--reported they were worried. And 45 percent of entrepreneurs said they were stressed, 3 percentage points more than other workers.

But it may be more than a stressful job that pushes some founders over the edge. According to researchers, many entrepreneurs share innate character traits that make them more vulnerable to mood swings. "People who are on the energetic, motivated, and creative side are both more likely to be entrepreneurial and more likely to have strong emotional states," says Freeman. Those states may include depression, despair, hopelessness, worthlessness, loss of motivation, and suicidal thinking.

Call it the downside of being up. The same passionate dispositions that drive founders heedlessly toward success can sometimes consume them. Business owners are "vulnerable to the dark side of obsession," suggest researchers from the Swinburne University of Technology in Melbourne, Australia. They conducted interviews with founders for a study about entrepreneurial passion. The researchers found that many subjects displayed signs of clinical obsession, including strong feelings of distress and anxiety, which have "the potential to lead to impaired functioning," they wrote in a paper published in the Entrepreneurship Research Journal in April.

Reinforcing that message is John Gartner, a practicing psychologist who teaches at Johns Hopkins University Medical School. In his book The Hypomanic Edge: The Link Between (a Little) Craziness and (a Lot of) Success in America, Gartner argues that an often-overlooked temperament--hypomania--may be responsible for some entrepreneurs' strengths as well as their flaws.

A milder version of mania, hypomania often occurs in the relatives of manic-depressives and affects an estimated 5 percent to 10 percent of Americans. "If you're manic, you think you're Jesus," says Gartner. "If you're hypomanic, you think you're God's gift to technology investing. We're talking about different levels of grandiosity but the same symptoms."

Gartner theorizes that there are so many hypomanics--and so many entrepreneurs--in the U.S. because our country's national character rose on waves of immigration. "We're a self-selected population," he says. "Immigrants have unusual ambition, energy, drive, and risk tolerance, which lets them take a chance on moving for a better opportunity. These are biologically based temperament traits. If you seed an entire continent with them, you're going to get a nation of entrepreneurs."

Though driven and innovative, hypomanics are at much higher risk for depression than the general population, notes Gartner. Failure can spark these depressive episodes, of course, but so can anything that slows a hypomanic's momentum. "They're like border collies--they have to run," says Gartner. "If you keep them inside, they chew up the furniture. They go crazy; they just pace around. That's what hypomanics do. They need to be busy, active, overworking."

"Entrepreneurs have struggled silently. There's a sense that they can't talk about it, that it's a weakness."

No matter what your psychological makeup, big setbacks in your business can knock you flat. Even experienced entrepreneurs have had the rug pulled out from under them. Mark Woeppel launched Pinnacle Strategies, a management consulting firm, in 1992. In 2009, his phone stopped ringing.

Caught in the global financial crisis, his customers were suddenly more concerned with survival than with boosting their output. Sales plummeted 75 percent. Woeppel laid off his half-dozen employees. Before long, he had exhausted his assets: cars, jewelry, anything that could go. His supply of confidence was dwindling, too. "As CEO, you have this self-image--you're the master of the universe," he says. "Then all of a sudden, you are not."

Woeppel stopped leaving his house. Anxious and low on self-esteem, he started eating too much--and put on 50 pounds. Sometimes he sought temporary relief in an old addiction: playing the guitar. Locked in a room, he practiced solos by Stevie Ray Vaughan and Chet Atkins. "It was something I could do just for the love of doing it," he recalls. "Then there was nothing but me, the guitar, and the peace."

Through it all, he kept working to develop new services. He just hoped his company would hang on long enough to sell them. In 2010, customers started to return. Pinnacle scored its biggest-ever contract, with an aerospace manufacturer, on the basis of a white paper Woeppel had written during the downturn. Last year, Pinnacle's revenue hit $7 million. Sales are up more than 5,000 percent since 2009, earning the company a spot at No. 57 on this year's Inc. 500.

Woeppel says he's more resilient now, tempered by tough times. "I used to be like, 'My work is me,' " he says. "Then you fail. And you find out that your kids still love you. Your wife still loves you. Your dog still loves you."

But for many entrepreneurs, the battle wounds never fully heal. That was the case for John Pope, CEO of WellDog, a Laramie, Wyoming-based energy technology firm. On Dec. 11, 2002, Pope had exactly $8.42 in the bank. He was 90 days late on his car payment. He was 75 days behind on the mortgage. The IRS had filed a lien against him. His home phone, cell phone, and cable TV had all been turned off. In less than a week, the natural-gas company was scheduled to suspend service to the house he shared with his wife and daughters. Then there would be no heat. His company was expecting a wire transfer from the oil company Shell, a strategic investor, after months of negotiations had ended with a signed 380-page contract. So Pope waited.

The wire arrived the next day. Pope--along with his company--was saved. Afterward, he made a list of all the ways in which he had financially overreached. "I'm going to remember this," he recalls thinking. "It's the farthest I'm willing to go."

Since then, WellDog has taken off: In the past three years, sales grew more than 3,700 percent, to $8 million, making the company No. 89 on the Inc. 500. But emotional residue from the years of tumult still lingers. "There's always that feeling of being overextended, of never being able to relax," says Pope. "You end up with a serious confidence problem. You feel like every time you build up security, something happens to take it away."

Pope sometimes catches himself emotionally overreacting to small things. It's a behavior pattern that reminds him of posttraumatic stress disorder. "Something happens, and you freak out about it," he says. "But the scale of the problem is a lot less than the scale of your emotional reaction. That just comes with the scar tissue of going through these things."

"If you're manic, you think you're Jesus. If you're hypomanic, you think you're God's gift to technology investing."John Gartner

Though launching a company will always be a wild ride, full of ups and downs, there are things entrepreneurs can do to help keep their lives from spiraling out of control, say experts. Most important, make time for your loved ones, suggests Freeman. "Don't let your business squeeze out your connections with human beings," he says. When it comes to fighting off depression, relationships with friends and family can be powerful weapons. And don't be afraid to ask for help--see a mental health professional if you are experiencing symptoms of significant anxiety, posttraumatic stress disorder, or depression.

Freeman also advises that entrepreneurs limit their financial exposure. When it comes to assessing risk, entrepreneurs' blind spots are often big enough to drive a Mack truck through, he says. The consequences can rock not only your bank account but also your stress levels. So set a limit for how much of your own money you're prepared to invest. And don't let friends and family kick in more than they can afford to lose.

Cardiovascular exercise, a healthful diet, and adequate sleep all help, too. So does cultivating an identity apart from your company. "Build a life centered on the belief that self-worth is not the same as net worth," says Freeman. "Other dimensions of your life should be part of your identity." Whether you're raising a family, sitting on the board of a local charity, building model rockets in the backyard, or going swing dancing on weekends, it's important to feel successful in areas unrelated to work.

The ability to reframe failure and loss can also help leaders maintain good mental health. "Instead of telling yourself, 'I failed, the business failed, I'm a loser,' " says Freeman, "look at the data from a different perspective: Nothing ventured, nothing gained. Life is a constant process of trial and error. Don't exaggerate the experience."

Last, be open about your feelings--don't mask your emotions, even at the office, suggests Brad Feld. When you are willing to be emotionally honest, he says, you can connect more deeply with the people around you. "When you deny yourself and you deny what you're about, people can see through that," says Feld. "Willingness to be vulnerable is very powerful for a leader."

Depression and physical decline: why retirement can seriously damage your health

Retirement can cause a drastic decline in health, according to a study released today.

Research found that both mental and physical health can suffer, said the Institute of Economic Affairs and the Age Endeavour Fellowship, who claim the Government should help people work longer and raise the state pension ages.

The study - Work Longer, Live Healthier: The Relationship Between Economic Activity, Health And Government Policy - shows there is a small boost in health immediately after retirement but that, over the longer term, there is a significant deterioration.

It suggests retirement increases the likelihood of suffering from clinical depression by 40% and the chance of having at least one diagnosed physical condition by about 60%. The probability of taking medication for such a condition rises by about 60% as well, according to the findings. People who are retired are 40% less likely than others to describe themselves as being in very good or excellent health.

The length of time spent in retirement can also cause further disadvantages, the study found.

It concluded that, for men and women alike, "there seem to exist longer-term health benefits of employment among older people".

Its authors said: "This, in turn, indicates that politicians do not face a trade-off between improving the health of the older population, increasing economic growth, decreasing health spending among the elderly and producing solvent pension systems.

"The policy implication is that impediments to continuing paid word in old age should be decreased. This does not necessarily mean that people should be expected to work full-time until they die, but rather that public policy should remove the strong financial incentives to retire at earlier ages."

Philip Booth, editorial and programme director at the Institute of Economic Affairs, said: "Over several decades, governments have failed to deal with the 'demographic time bomb'.

"There is now general agreement that state pension ages should be raised. The Government should take firmer action here and also deregulate labour markets. Working longer will not only be an economic necessity, it also helps people to live healthier lives."

Edward Datnow, chairman of the Age Endeavour Fellowship, said: "In highlighting the positive link between work and health in old age, this research is a wake-up call for the UK's extensive and well-funded retirement lobbies.

"More emphasis needs to be given to ways of enabling a work-life balance beyond today's normal retirement age with legislative discouragements to extending working life being replaced with incentives. There should be no 'normal' retirement age in future.

"More employers need to consider how they will capitalise on Britain's untapped grey potential and those seeking to retire should think very hard about whether it is their best option."

The injury that has no quick fix. Brearley on Depression

by Mike Brearley in Cricinfo

	"Snapping out" of depression isn't an option © Getty Images

 

Depression is a terrible thing. People struggle to describe it to those who aren't subject to it: darkness, pointlessness, worthlessness; a black dog, perhaps, or a nuclear winter of the soul. There are often suicidal thoughts, which can dominate consciousness. Depressed people can't concentrate, can't think, feel lethargic, guilty, worthless and irritable. There may well be disturbance in sleep, and in eating and digestion. Some turn to drugs or drink. Those in its grip often seem addicted to suffering, helpless and hopeless. There is inadequate understanding of what it is about, why it has taken such a hold. 

And, of course, there's no reason why cricketers more than anyone else should be immune: the image of Marcus Trescothick hunched up in a corner of an electronic-goods shop at Heathrow while his Somerset team-mates prepared to board a flight to Abu Dhabi for a pre-season tournament remains a haunting one even four years later.

For sportsmen and women - but in particular men - depression has often been a badge of shame, especially in a world that values confidence, courage and the supposedly manly virtues of strength and assertiveness. When Trescothick's return home from England's tour of India in early 2006 was first explained, it was put down to a virus, which later changed to a "stress-related illness", still the terminology often used when his condition is discussed today. By the time Mike Yardy left the World Cup in 2011, the ECB did feel able to cite depression as the reason. This was a step in the right direction, but the reluctance to be open in the first place about Trescothick's plight stems, I believe, from a long-held idea that we should be thick-skinned and resilient; that to admit fear or unhappiness would be to lay oneself open not only to ridicule but to being dropped from the side (the very word "dropped" hints at the link to early-life anxieties and the insecurities of the baby). We are not supposed to be vulnerable, certainly not to show vulnerability. We don't wear our hearts on our sleeves - particularly not we English.

The proliferation of coaches and backroom staff over recent years may, paradoxically, risk making the situation harder. In the old days, it would be one's closest team-mates to whom one might admit anxiety; they are, after all, in the same boat, and may have a less judgmental or executive response. But the willingness of players such as Trescothick, Yardy, the outwardly chipper Matthew Hoggard, the former Derbyshire captain Luke Sutton, and even that tremendous competitor Andrew Flintoff to admit to their feelings may suggest change at a societal level: depression is not quite the taboo it once was. And, unlike Trescothick and Yardy - who both felt compelled to explain their departures from tours - the others were under no obligation to talk about their emotions.

There are two separable things here: the reluctance to admit to feeling low; and the increasing willingness of players to overcome that reluctance. On the one hand, in order to be a good sportsman one must be tough, a quality which can be weakened by self-doubt and fear. Players may therefore rightly be apprehensive about too much self-doubt. On top of this, there may be a reinforcement of such apprehension from the macho attitude of those who mock ordinary doubt. It is this that leads to the shame. However, self-doubt can be a necessary resource leading to work, improvement and, in the end, greater strength, both technically and emotionally.

Keeping things bottled up can be disastrous. The New Zealand seamer Iain O'Brien, another sufferer who has felt able to go public about his condition, alluded to this process when he admitted that the potential consequences of saying nothing were far worse than the supposed shame of opening up. "I don't want to be one of those statistics," he said, referring to those cricketers - and there have been too many - who have ended up killing themselves.

Several have now risked this feared ridicule and come out as depressed. O'Brien himself was encouraged to do so after listening to a radio programme on the subject, hosted by Michael Vaughan in 2011, in which Hoggard said he felt like crying as he reached the end of his run-up during his final Test appearance, in Hamilton. The revelation was a poignant one: Vaughan was Hoggard's captain in that game. Not long before my time as a player, bowlers were reluctant to show emotion even when they took a wicket; Hoggard's openness was an encouraging sign of the times. Equally refreshing has been the respect accorded by the press to both Trescothick and Yardy. Despite inevitable pressure from their editors to get the story, journalists have been sensitive enough to allow the players to tell it in their own time. And admitting the extent of the problem may be the first step towards healing and repair.

So why the apparently growing need for healing and repair? Has depression become more prevalent for cricketers? It may be that the speeding up of life, the demand for quick fixes, the "taking the waiting out of wanting" - as the 1980s credit-card advertisement so pithily put it - make for more depression, not less. Such a culture seems to require happiness, briskness, a capacity to succeed early, and in overtly measurable ways. So cricket, with its waiting around, its lonely trudge back to the pavilion, its longueurs, its rain-breaks, may offer a testing task to the modern young man or woman.

But there must be more to it than that. For depression often arises in relation to loss, especially loss that the person cannot, for whatever reason, successfully mourn. It may be of a significant other; it may be more a matter of long separations and loneliness; or it may be of prestige, position or power, such as comes with loss of form, or decline with age, or from a realisation that one is not the only pebble on the beach. Cricket is no exception. Careers are short - few go on beyond their late thirties, unless offered a juicy contract by a Twenty20 franchise. Since most professional cricketers are in it primarily because they love the game, and since it has such intensities of effort, elation and disappointment, the loss related to retirement is bound to be painful. By the time you retire, your contemporaries in other fields will have moved onwards and upwards, while you have to start afresh. 

Most ex-professional cricketers will never again be so directly involved in doing what they are passionate about. Even jobs which involve the skills and knowledge of the sport - umpiring, coaching, commentating or writing - may seem less intensely vocational than playing at a high level, and few go into second careers which involve them as cricket did. Shakespeare, naturally, had a phrase for this general truth about life: "And every fair from fair sometime declines, by chance or nature's changing course untrimmed." For the cricketer, nature's change of course can be too early, too fast, and too damaging. Hoggard, remember, was discarded by England's Test team virtually overnight during that tour of New Zealand.

	Depression is an arrangement by which we keep from ourselves the degree of hostility we feel, turning it on ourselves, but in a way inflicting it on others indirectly

Loss is harder to bear and more likely to turn into depression if one is full of hatred. All losses evoke some anger: how dare you leave me! But for some it is particularly strong; loss and separation may evoke bitterness and anger such that in the imagination there are murderous impulses to the person one misses. New Zealand's Lou Vincent, who was dropped on more than one occasion, told the Independent: "I was passionate about playing for New Zealand. But how many times can you be let down by something that you love? It's like the love of your life, she takes you back and she drops you. How many times can you have your heart broken?" Since that person - or, in the case of Vincent, that organisation - is often the very person one would turn to in a crisis, the hostility towards them, and the ensuing guilt, leaves the subject doubly alone. It is harder in such cases to mourn and move on.

Closely related to letting go of one's passionate activity is decline in form. Failure is stark and public. Like a king deposed, the dismissed batsman has to leave the arena; the bowler is merely taken off. The batsman may have to wait days for another chance. One little error, one good delivery, can result in total exclusion. And such outcomes are reported instantly to the public. The starkness of a scorecard that reads "Gatting b Warne 4" tells the casual observer nothing about the drama of the moment. Luck plays a big part. What's more, failures which may be a result of bad luck eat away at one's confidence, making form not only mercurial and uncontrollable, but self-fulfilling, the outcome of self-denigration. There can so easily be a vicious circle.

One type of such destructiveness happens when the person is prone to grievance: the glass is always half empty. Such a person is addicted to suffering and to inflicting suffering; he focuses on what he doesn't have, rather than what he does. He even prefers suffering - perhaps in dramatic or histrionic ways - to making the best of a bad job, and appreciating what he has. Depressed people feel passive, have no energy, a damaged sense of self. They may trade on this, stoking up the role of victim and, without realising, choose it over the ordinary struggle involved in getting on with things. As Iain O'Brien perceptively put it: "Wrapped up in it is how you value and see yourself."

Depression is more likely, too, for someone who at heart feels fraudulent, which itself is related to the weight of expectation felt by international sportsmen. Then - because that fraudulence may have been repressed - the depression can be experienced as something alien to the conscious self, a black dog, something that comes from outer space, or from a blue sky. Reflecting on his swift demise, Hoggard told Vaughan: "I was just thinking that the world was against me, that I'm rubbish, that I can't do this anymore. It just got on top of me. The self-doubt was huge."

People may be depressed at failure, but also at success. How often do we see a tennis player lose his serve immediately after breaking his opponent's? I think this is to do with guilt at triumph, at superiority. We may, in hidden ways, gloat over our defeated opponent or upstaged rival, and this may be so hard to bear that we contrive to fail rather than risk it. We may also discover that success isn't the panacea we have expected. No doubt post-natal depression has many causes, but one might be: this is not a bed of roses!

This may be hard to see in sport, partly because, as spectators, journalists and readers, our attention is so fixed on success; and those who are consistently successful are better able to accept their aggression and manage it well. But I am convinced, partly from my own experience, that we often do draw back from success, reluctant to risk gloating over a defeated rival who in the depths of our minds evokes a father or a sibling. We may also identify with that part of the other which wishes to knock the successful off their pedestals.

Depression, then, is an arrangement by which we keep from ourselves the degree of hostility we feel, turning it on ourselves, but in a way inflicting it on others indirectly. The depressed person is savaged by a judgmental inner voice, whose punitiveness mirrors the often unconscious wish to hurt the person felt to have let him down. He may also displace his bitterness and anger from the lost person on to an available target (an umpire, for example), like someone who comes home from a humiliating day at work and kicks the cat.

So the cricketer has to tolerate loss of form - and with it, perhaps, his place in the team, even his career - and the early ending of at least one of the loves of his life. It can, as Lou Vincent implied, feel like the end of a love affair, or like a sticky patch in a marriage; loss of, or decline in, bodily skill can, like later mental decline, be experienced as the surrender of the essential self. No wonder some find it unbearable. As David Frith catalogued in Silence of the Heart, published in 2001, no fewer than 150 professional cricketers had by then committed suicide. And this must have been the tip of a much larger iceberg of players who had been depressed but not gone to this ultimate. During his career, the successful cricketer also spends a lot of time travelling. Some find this separation from loved ones, especially at great distances, troublesome. One reason why, on the whole, teams do so much better at home lies here. The depression suffered by both Trescothick and Yardy was exacerbated by being far away from the people who knew them best and by the lack of a comparable support network on tour.

Of course, it can be hard to know what is going on in people's minds. But I was occasionally aware of a player being in difficulties, perhaps depressed, especially on tour. And loneliness was often at the heart of it. Some found big hotels in large cities anonymous and not conducive to feeling safe and at home. By contrast, the communal experience of staying in circuit houses or small hotels in India or Pakistan back in the 1970s, usually outside the main cities, could create a feeling of togetherness, humour and sociability that was much harder to find in the five-star luxury of a modern big-city hotel; some would stay in their rooms evening after evening, eating dinner on their own. Such patterns could be hard to notice when there was no place of focus once we were away from the dressing room, the manager's room, or the team bus, and the habit could become more addictive if morale dropped lower. A vicious circle of alienation and loneliness could ensue if no one became aware of it.

Such scenarios also happen in England. There are county cricketers who find it hard to be away even from their home town. One county captain I knew made himself available for dinner with a team member who was prone to depression during every away match. For some, loneliness is an outcome of the sheer routine of socialising on a cricket tour. A certain sameness can become limiting. Such people need other, perhaps more culturally varied, stimuli. Sometimes, one needs to get away from the close cricketing family.

During my playing days, tactful help and awareness of the problem prevented it from getting a grip on a few individuals. Captains and managers vary greatly in this important ability to be sensitive to people when they become unhappy, or aggrieved, or bored. One of Doug Insole's many assets as England manager was in this area. It would be hard to write "sensitivity to potential depression" into the job description of today's England coach. But ordinary human consideration, concern for everyone in the party, and tact should be. And occasionally that would extend to recognising that something more than ordinary friendly management is required, that a player needs to get specialist treatment, and may even have to leave the team for the time being.

	Iain O'Brien felt bottling up what he felt inside would have had far worse consequences than opening up about his condition would © Getty Images Enlarge

Despite all this, the sporting arena itself can provide an antidote, since sport does permit aggression. Many people give the impression that only on the field can they be thoroughly and spontaneously themselves, though here again, this can make retirement, or absence through injury or poor form, feel like a loss of the true self. But at least the sportsman might be helped to avoid depression by the fact that sport has aggression built in. What is not so readily permitted in its ethos is envious rivalry with one's own team-mates. I think it's impossible not to feel some envy at the successes of a colleague who is vying with you for a place, and this can arouse guilt and shame. So aggression can be a problem when one can't enlist it, and also when one can but with too much or inappropriate venom or force.

Sporting teams are, as I've suggested, tough social groups, and the effect can be amplified in cricket, where the participants spend so much time with each other. Vulnerability may not be respected. Professional cricketers can be quick and perceptive, often cruelly so. The dressing room is not an easy place in which to hide. The rough and tumble, the sarcasm and mockery, are mostly friendly, but can also become bullying, the stuff of small boys in school playgrounds. In short, for some cricketers, aggression causes problems rather than provides a safety valve.

Perhaps what I have suggested in relation to both loss and aggression could be summed up thus: what doesn't kill you - or make you depressed - leaves you stronger. The tipping point can be hard to predict, perhaps the outcome of chance and the presence or absence of the right person, or the right piece of good luck, at the right time. Sport can indeed be an antidote to depression. I remember a time when I was in turmoil in my personal life; batting and playing, however difficult to do well, provided an arena in which life's aims and objectives were for a while simplified. It is not easy to hit a hard ball delivered with speed and skill by a fellow professional, but facing it does, like imminent execution, concentrate the mind.

And yet there is no escaping the profundity of depression - nor, as I noted at the beginning, the difficulty among non-sufferers of grasping it. As Trescothick said: "There's so much to it. People say: 'Pull yourself together, move on.' I wish it was that simple. You try to forget, but it takes over your whole life." Our understanding of this crippling condition, especially in the sporting arena, may merely have scratched the surface. And even when something is recognised and acknowledged, it is still hard to know what's best for the sufferer. Sportsmen want, above all, quick fixes, as with physical injury. The trouble is, established patterns can take a long time to shift. 

Mike Brearley played in 39 Tests for England between 1977 and 1981, captaining them in 31, of which 18 were won and only four lost. He is a practising psychoanalyst