Anhedonia

I’ve been going through a phase of depression. I’m familiar with the signs and symptoms, and how they manifest for me specifically. (I keep a checklist of my idiosyncrasies that don’t get covered on the standard lists. I get disproportionately sensitive to and upset by bad smells, for example.) It has happened before, and it will happen again. Until now I have always managed to deal with it by working with a therapist, focused on cognitive behavioural therapy (CBT).

This year it has been different, and worse. It kinda snuck up on me. (Or rather: it probably always sneaks up on me. This time it just came from an unfamiliar angle.) April was when one piece of realization clicked into place. I read Cate Huston’s blog entry Whose Expectations are Those, Anyway?, in which she talked about Gretchen Rubin’s Four Tendencies framework. It’s an understatement to say that I’m not a fan of reductive personality summaries, and I should withhold judgement until I’ve actually read the book. But the brief description of the “obliger” type fit me distressingly well. I was distressed.

Obligers respond to expectations from other people. They struggle meeting their own expectations.

Expectations is something I have always struggled with, specifically: living up to what I imagine other people’s expectations are for me. It’s a key point I keep coming back to in therapy, year after year. At its worst, it chases me out of jobs: over time I become so terrified that people will expect me to be knowledgeable, that I can’t open my inbox for fear of what my colleagues might ask of me. I get scared of being visible on chat, and of receiving text messages, in case a friend wants to meet up for lunch. My value system associates being a good person with helping other people, and being generous with my time and attention. But I’m not very good at setting limits to how much of myself I give away, or at telling when I’m all used up.

Looking back, I’ve been in a constant state of “used up” for quite a while. There are reasons I got into in that state. The hard emotional work of the last couple of years was necessary, and I don’t begrudge it. But I’m in my mid-40s now, and I don’t have the energy of a 20 year-old. I also didn’t (don’t) have the boundaries and emotional defences in place to deal with saying “no” to requests that are perfectly reasonable for the people asking them, but are more than I feel I can handle. I’m very good at concealing my feelings, and putting on a show of being just fine: Of course I’ll help. I may be stressed, but I’m dealing with it. I’m working hard, but staying cheerful.

Pretending to be me.

2018 was all about stumbling on, feeling ever more burned out. The negative thoughts piled up and up, and made it hard to concentrate on everyday tasks. Interruptions would upset me, and irritations would quickly grow into simmering anger. Keeping a lid on my feelings, and putting on a brave face — both in person, and on chat — kept taking more effort, until it felt like that was all I was doing. Just like when you repeat a word over and over again until it loses meaning, the smiles I faked and the cheer I portrayed became disconnected from actual emotions, and associated with mere pretense.

If I watched a movie, I could say that I enjoyed it, but what did I mean by that? Did I actually feel anything resembling pleasure? No. I was making a robotic assessment of its qualities, and translating that into what Martin would have said. When I visited Edinburgh, I would go to familiar restaurants and cafés. I would order my “favourites”, because that’s what Martin does, and wonder if this blend of sweet and umami is what “tasty” felt like. I went to concerts because Martin already had a ticket and I shouldn’t waste it, not because I wanted to go. (What does “want” feel like, anyway?) And then I stood there seething whenever someone inevitably came and stood right in my sight line.

And then lying about it. Was I looking forward to this or that? Yes. (What does “looking forward” even mean? I don’t understand.) Do I love you? What does love mean? Am I feeling anything right now? I don’t want to be hurtful, but I don’t want to say something I’m not sure is true. For months, the only emotions I genuinely felt were fear, dread, disgust, and “do not want”, and these are exactly the things I don’t generally talk about. So I didn’t talk. I kept myself flat, and I shut down.

(This is probably why I found the TV show Travelers so compelling. The theme of sudden personality change, and how the people around them react to it.)

When Scott Hutchison, and Anthony Bourdain committed suicide in May and June, their deaths hit me hard. I don’t have suicidal thoughts. There are so many things out in the world to do and see and hear (even though I might not “want” to do them right now), that I’d be really annoyed if I died before I got to them. But during depressive episodes I do want things to go away, or to end. I go to bed abnormally early, just so I can stop being conscious. And I wonder what it would be like to walk away from this life, leaving everything behind. Even though I don’t act on it, realistically I have that freedom. I wonder if Scott Hutchison and Anthony Bourdain acted the way they did because they felt like they didn’t have that freedom. I’m sad for them.

Abi eventually introduced me to the term “anhedonia”:

Anhedonia is a diverse array of deficits in hedonic function, including reduced motivation or ability to experience pleasure. While earlier definitions of anhedonia emphasized the inability to experience pleasure, anhedonia is used by researchers to refer to reduced motivation, reduced anticipatory pleasure (wanting), reduced consummatory pleasure (liking), and deficits in reinforcement learning. In the DSM-V, anhedonia is a component of depressive disorders, substance related disorders, psychotic disorders, and personality disorders, where it is defined by either a reduced ability to experience pleasure, or a diminished interest in engaging in pleasurable activities. While the ICD-10 does not explicitly mention anhedonia, the depressive symptom analogous to anhedonia as described in the DSM-V is a loss of interest or pleasure.

It’s a symptom, not a condition in itself — there’s no drug or treatment for it, but it is characteristic of depression. Like when I read Cate’s article in April, this was a very “it me” moment.

In June and July I also interviewed for a couple of jobs, and one of them came through with an offer. In 2010 I left my job at Skyscanner partly because I was in a trough of depression. Even though in the long term that worked out okay, I had long told myself that I shouldn’t do that again. Leaving a job is a way to break out of a depressive cycle at work, but that’s also when my sense of self-worth is at its worst. So that’s not a great time to be interviewing. Especially when the anhedonia was making it impossible for me to really say if I genuinely wanted any of the opportunities I was pursuing.

July was a crisis time at work, a crisis time between me and Abi, and a crisis time for myself and my own identity. During one of the interviews I got asked the question: what would you do if you won the lottery and didn’t have to work any more? I found this hard to answer honestly, because the whole concept of wanting something felt utterly alien to me. I used to think that I would go back university and study some more, but I’m not that person any more. In fact, I’m not even sure what kind of person I am now. I don’t know what I want or like in something as simple as a movie or a meal, let alone in my future career. So the answer I ultimately gave was: I would take some time to deliberately not do things, so that I could re-learn what I enjoy in life, and to rebuild myself from the ground up.

I didn’t get that job, but the question and my answer stuck with me. For the first time in a long while I had discovered something I actually wanted, even needed: some time free of obligations and expectations. Time in which I didn’t have to regularly do anything in particular, with the inevitable anhedonic realization that — no matter what it is — I don’t actively “want” to do it. (Which dovetails with the depressive spiral in which I feel trapped by having to do things I don’t want to do.) Having gone through a similar thing with Fiona last year, I’m very aware of how time plays a part in recovering from mental health problems.

We already had some holiday time scheduled over the summer, and we had consciously chosen not to go anywhere this year. But even holiday time comes with expectation that it’s limited and precious. I needed to break out of that. I’m fortunate to work for a company that cares a lot about the mental health of its staff. I talked to my manager and tried to explain what was going on in my head. I felt there were three paths open to me: quit and move to the new job I had been offered (taking some time off before starting there), take some unpaid leave from my current job, or the Hard Brexit option of just quitting entirely and figuring things out later. My manager was extremely supportive, and immediately paved the way for me to take some sabbatical leave, right after my holiday. I’ll be staying with FanDuel when I return.

So that’s where I am now. I’m tackling the depression from three angles: therapy, medication (the first time I’ve tried that), and time off work. The term “sabbatical” brings to mind the idea of undertaking projects I wouldn’t have time for otherwise. I suppose that’s true, in the sense that the project I’m working on is me. As I’ve alluded to in recent posts, my strategy is to pay close attention to my own feelings (mindfulness) and to learn to recognize when there is a glimpse of something I enjoy, or want to do. And then pursue that feeling and see where it leads. I started out by calling it “finding my joy”, but Abi coined the phrase “chasing Tinkerbell”, which is much more evocative.

Sometimes it’s taking a walk to watch the crows and magpies defend their roosts. One day, I felt like browsing second-hand furniture shops, and I came home with a lovely comfortable chair I spotted for €35 that feels rewarding every time I sit in it. I’m starting to play the bass guitar. When I wake up in the morning, after going to the toilet I crawl back under a warm duvet for a while and savour the contrast of a cool breeze from the open window. I’m trying to resist the idea that all of this is selfish and self-indulgent, and that I should be working and should be using my time more productively. With the help of my family and friends and therapist I’m succeeding at least some of the time.

New chair in my office
My new old chair. €35 👌

I still feel numb to most things. But I’m in a place right now where the potential for negative emotions has been reduced to the point where I can at least detect moments of positive emotion, and try to encourage them. I’ve changed the signal-to-noise ratio in my favour. I’m not “better”. But I think it’s helping.

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6 Replies to “Anhedonia”

  1. Sabaticals have been a big help to me over the past number of years. I describe the first period (which for me seems to take about two weeks, YMMV) as “decompression”: it takes a while to adjust back to ambient pressure. What I’m reading in your last couple of paragraphs certainly resonates with my experience of this process.

    Also: I have chair envy.

    1. When I was contracting, one of the best things about it was that contracts end, and give you a natural break point for taking some time off before the next gig. As a permie, if you want time off, you generally have to rely on limited holidays, or leaving your job. I feel like I’ve just rediscovered the wheel here, but I reckon that companies could deploy sabbaticals (or stigma-free unpaid leave) as an effective retention mechanism.

  2. There’s a fundamental disconnect between knowledge workers – who are employed for what they know, not what they do – and having a spreadsheet of fungible resources that can be reshuffled between business units to achieve 100% utilisation like some form of assembly line. It’s easy to measure and it looks good to have that 100% utilisation, but what you really want is high efficiency – and that’s hard to measure.

  3. I don’t know what to say. I’m crying at my desk.

    I could have written 90% of this. I’ve been suffering with depression for just over a year and now have a very personal relationship with nearly everything you described in this article. It isn’t quite as bad as it was, say, 8 months ago, but I cannot seem to shake the insidious stuff. The feeling that nothing matters. That I’ll never feel better, so why continue working, and eating, and caring. The fact that I annihilate myself from the inside out endlessly via my critical inner voice.

    I, too, am just going through the motions. Everything I do is done with muscle memory. But one major problem is that I can’t remember much of anything. Words especially, but even programming. I look at code I wrote last week and can’t understand it, even with comments and documentation. So I relearn it. But sometimes I forget what I was relearning. I often can’t finish sentences, usually just awkwardly stopping halfway and changing the subject.

    Throughout this entire process I’ve asked one question over and over: “What do I do?”

    I’ve been in therapy for 6 years. I’ve been on antidepressants and mood stabilizers for even longer. So how did this happen? How did I fall so far under the care of mental health professionals, and why do I feel like I’m now irreparably damaged?

    In the early stages I was truly lost. I remember collapsing a few times and just saying, “What do I do? What do I do?” until I couldn’t say it anymore. I tried a hospital and let’s just say that didn’t go very well. I was already seeing a therapist, and I was already on medication. What was I supposed to do to feel better? I just need someone to tell me and I’ll do it.

    I’m signed up to try Ketamine Injection Therapy soon. Very hard not to get my hopes up, but it doesn’t work for everyone.

    Please keep us up-to-date. I want to know how it goes for you, but I would also love to know if you find anything that helps at all. Good luck with everything, and thank you for such an open post.

    1. Hey Brandon – I’m sorry you’re going through this. I recognize what you’re saying about concentration and memory. I was having trouble with that, too. Trying to grasp new concepts that I felt I should be able to handle, and feeling like a failure and a fraud when they just wouldn’t stick.

      I hear that ketamine can help with anhedonia. I haven’t tried it myself – I’m taking paroxetine for now.

      I consider myself enormously fortunate and privileged that I can afford to take this time off work right now. My has been suffering from severe depression for the last two years. It’s only now that it seems like she is back to normal. For her, we started with therapy and medication, but eventually we had to take her out of school completely. It was a scary thing at the time for us as parents, and there were times when we despaired that she would ever turn the corner. But the medical professionals helping us were united in the message: look, this is going to take time.

      Time away from school (about six months, followed by a six-month gradual re-introduction at a different school) helped Fiona to grow back to herself. It can get better. Having seen it first hand, I’m hoping that the same technique works for me. If Tinkerbell strikes in the middle of a work day, I can’t just up and leave. But while I’m on leave, I can. I don’t think I can get away with six months off, but I’m hoping that three will get me on my way.

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