E73 - Why Do We Fall Apart? (with Vincent Deary)

Vincent Deary is a practitioner health psychologist and professor of health psychology at Northumbria University, where his research focuses on the development of new psychosocial interventions for people with a variety of health issues, including cancer survivors and the elderly. Vincent worked as a clinician in the UK's first transdiagnostic Fatigue Clinic, he worked as part of a multidisciplinary team to help people with disabling fatigue.

He is the author of How We Are and How we Break, the first two books in a planned trilogy.

In this episode we discuss his in particular his second book How We Break, all about chronic stress and what causes people to become fatigued and exhausted. We also discuss the different demands people face particularly in modern life, the different between real rest and distraction, the problem with caffeine, how people can form new habits, the importance of self-acceptance and self-understanding, and much more

Interviewed by Dr. Alex Curmi - Give feedback here - thinkingmindpodcast@gmail.com Follow us here: Twitter @thinkingmindpod Instagram @thinkingmindpodcast

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Transcript

 Welcome back to the Thinking Mind podcast. My name is Alex. I'm a consultant psychiatrist. Today I'm in conversation with Vincent Deary. Vincent Deary is a practitioner, health psychologist and professor of health psychology at Northumbria University, where his research focuses on the development of new psychosocial interventions for people with a variety of health issues, including cancer survivors and the elderly. Vincent worked as a clinician in the UK's First Chance Diagnostic Fatigue Clinic, where he worked as part of a multidisciplinary team to help people with disabling fatigue. He's the author of How We Are and How We Break, the first two books in a planned trilogy. In this episode, we discuss in particular his second book, How We Break, which just came out all about chronic stress and what causes people to become fatigued and exhausted. We also discuss the different demands people face, particularly in modern life, the difference between real rest and distraction, the problem with caffeine, how people can form new habits, the importance of self-acceptance and self understanding, and much more. This is the Thinking Mind Podcast, a podcast all about psychiatry, psychology, psychotherapy, self-development and related topics. If you like it, there are a few ways you can support it. You can share it with a friend. Follow us on social media. Give us a rating wherever you happen to listen or if you want to support us further, you can check out the Buy Me a Coffee link in the description. If you like, you can also give us feedback emailing us at Thinking Minds podcast at gmail.com. Thank you for listening. 12s Welcome back, everyone. Today I'm here with Vincent Deery. Vincent, thank you so much for coming on the podcast today. A pleasure, Alex, thanks for asking. We're going to talk about your new book today, How We Break, but we're going to talk about a few other topics as well. One thing I'm curious about you. Quit your job or at least paused your job. I believe when you are 40 years old, to start writing full time, you know it's many people's dream, I think, to give up their 9 to 5, at least temporarily, to pursue a creative project. But for many people kind of remains a dream. And it never happens. It never actually rises. What was that like for you? What was your motivation? Where were you at at the time? So. 2s If I look back over. I just turned 60 a few months ago, and if I look back over the last few decades, it more by accident than by design. I tend to have had quite large life changes at each of the the big markers 30, 40, 50. So the big marker for me at 40, God, 20 years ago indeed, was that I had been working as a clinician at the, uh. Maudsley and at King's College Hospital in south London. 2s And I just felt it was time for me to end that chapter of life and to sort of consolidate what I'd seen and what I'd learned, because I'd been training as a psychiatric nurse and then as a CBT therapist. I had been reading a lot of theory, philosophy, but also novels, all roughly around the subject of. Who we are and how life can get to us and and how we can cover, uh, recover from that. And so. 1s I decided, yeah, I'm going to take some time out just to focus on seeing if I can collect everything I've done over the last, uh, or the decades prior to that, into some kind of form that might be coherent because. Because I've been writing all my life, like, uh, just behind me or kind of underneath the desk there, just kind of stacks of notebooks that I've been keeping since I was in my late teens. And, uh, I probably have to burn them before I die because there's nothing particularly coherent or great in there. But I have been writing and thinking for a long time, so I thought, let's see if I can actually find a structure that would work. So that's what I spent, um, almost two years doing, is actually thinking, okay, how how can I begin to collect this? And then I started working on it and I went back into, uh, full time employment. And I, uh, also kind of transitioned from being a, uh, full time clinician into being a full time academic. So I kind of changed that focus of my career as well. And, and yeah, just kept working on the project for the next, uh, ten know, 20 years. Goodness gracious, Alex and really old. It's, uh. Yeah, yeah, it's funny looking back because at the time I never feel I made any big decisions, but looking back, it feels very purposeful. But I think one of the things I've learned from looking at my own and other people's lives is the role of accident and and just chance. And, you know, I think we've I don't know if we have to mention economics, but I do think it's important. And I was just lucky enough to be part of that ridiculous London housing bubble where we bought a house in the 90s and sold it in the early 2000, and that enabled me to buy myself some time out. I do think I had to make that decision. I had to go, okay, I'm going to invest in my own creativity. But I did have the money to invest. Yeah. It's interesting that you mentioned chance and the role that chance plays in the trajectory of our lives. I in an essay I just put out last week, which was kind of about focus and selective attention. I thought of it as when you're trying to get somewhere in life, there's going to be a mixture of intention and serendipity. And generally speaking, I think you need both because you need to set a broad intention, a broad direction. As to where you're going, so as to allow for serendipity to happen. For to allow chance, to allow fate to take its course. And then you need to be have your eyes open for serendipity so that you don't miss certain windows of opportunity. And so I think there are a lot of people in the career advice world would say it's all about intention, and a lot of people would say it's all about serendipity and following your passion and your impulses. But I found personally, and I don't know if this resonates with your experience, is that it's the combination of the two is kind of unstoppable. You set an intention and then allow for luck to happen, and it will seem like it might seem more like luck in retrospect, but I'm sure, like in your case, if you had stacks of notes, you know writing was a practice for you. Clearly you had set an intention at some point to write, or perhaps writing came very easily for you, or maybe it was more of an urge that you had, like, what was it like for you? I think that's lovely balance of serendipity and intention because I. You know, one of the. 1s Kind of meta level realizations I think I've come to. And thinking about the books is that life is rarely either or. It's often those dichotomies. They're usually working together. And I think it's definitely true of intention and serendipity, and I think it is one allows you to capitalize on the other. Uh, and. 1s It's something I've seen. 1s One of the cases in the in the book how we break is is Sammy a and I've changed his name. But the story is true and it's about his struggles as a person of color working through the pandemic. Zero hours contract agency worker only as good as his last moment. So we see him really struggling under multiple assaults. But one of the things that keeps him going, like you said, is he has a clear intention. He kind of he has a North Star is the way I would put it. He's got something that is helping him steer through the turbulence of his life. And he's and and still does. I was just talking to him yesterday. He still has a very clear idea of, okay, I can endure this because I can see that I'm still heading there. And I think going back to your question about the writing. 1s I certainly know that even in the most difficult parts of the last few decades, that I've gone through some. 1s UPS and downs, as we all do. The fact that I had this project running in the background. Uh. 2s It somehow helps somehow. It kind of acted as a container for everything. Everything else that was going on, it's like even the worst stuff that happened. And this sounds kind of maybe a bit instrumental or told, but it isn't. But I knew I could use whatever was happening to me or other people in need for material. It became stuff that could be transformed through through writing. And. Yeah, and writing's just always something I've done, I think from a very early age, and I had a lot of trouble coming to terms with who I am and kind of understanding myself. And I think writing has always been part of the practice of me doing that. I've always found writing very helpful, and I. 1s Advocates writing as a kind of very powerful form of introspection. And I obviously advocate psychotherapy as well. And that's a lot of what this podcast is about, is trying to explain some of the nuances of psychotherapy and the psychotherapy process to people who aren't privy to it, because it's a very mysterious field in a lot of ways. If you don't take the time to read about it. And I always advertise journaling as a free therapy, because a lot of what happens in therapy, you can get out of journaling. Obviously there are disadvantages, but you can get a lot done by getting some of your most troubling ruminations just out of you externalizing them. And I think we have an a reasonable understanding of what's going on in the brain. That's where processing things in different parts of our brain, when we're conceiving them in words, and whether we're speaking them out loud or whether we're writing them down. I've become 1s going more to your book, How We Break. Which, you know, as soon as I read the cover, as soon as I read the title, I was like. I breathed a sigh of relief. 1s Because I had been going through a difficult few months right before reading that book, and I've always found it extremely cathartic to have someone else. 1s Just mentioned the fact that life is hard. I remember the first time I. Read about Buddhism and rule. One of Buddhism is life is suffering. And I breathed a sigh of relief then as well. And I think one of the things that particularly my generation and maybe generations younger than me, one of the problems we're laboring on there is a lot of us work on the delusion that life is supposed to be easy, and that we're supposed to get everything that we want, because in many ways. We live in such a prosperous time. And self-actualization, I think, is more possible for many of us than ever before, for more of us than ever before. And that's an amazing that brings with it an amazing set of possibilities. But it also can become very quickly, can become a burden when it's apparent that life is going to be way harder than you expect. And although self actualization can be. So revitalizing self-actualization is hard work, and it's like it's requires a lot of. Dedication. 1s How have you found? Navigating the ups and downs of your life. You mentioned that having a project, having a way helps you navigate the vicissitudes of life. What are some of the other ways that you found, maybe for yourself or for your clients, have helped you get through those ups and downs? I think one of the things that relates back to the writing project and the under more general goal of. Psychotherapy, but also of spiritual practices and of a lot of the more practical philosophies like stoicism is that basic idea of knowing yourself and knowing the kind of creature that you are and. 2s That for me is often where. 2s Healing can start. Is having a real. 2s In therapy terms, I guess a real formulation almost of actually, this is what I'm currently dealing with and this is who I currently am. 1s And I think we can perhaps come on to this later. I think we need to equally be aware of getting to fix the narrative about ourselves, because I think that is also a potential source of suffering. We've become over identified with a limited version of ourselves, but I think getting a real sense of who we are. So I've got much better as I've got older, uh, just owning various different, uh, bits of me that I used to be locked in a battle with. Like, for instance, my social anxiety might, uh, quite extreme enter introversion. The fact that after social stuff, I need quite a lot of time to recover. I think I used to either hide that or try and make it go away. And I think one of the things the younger generation has taught us is it's okay to say, that's just who I am, and this is what I need to do to manage that. So I think that self understanding and that self-acceptance. 1s It's something I've learned the hard way. 1s And. I think the other thing that has really helped me actually is working with other people. Having patience, having clients and you learn so much from that, and very simply so it's often much easier to say to someone else, essentially, look, be kind to yourself. You're already working at capacity. How can you lighten some of your load? It's really easy to say that someone else. It's much more difficult culturally to say to yourself, but I think I've learned again the hard way 2s in some ways, to be able to to be gentler and kinder with myself. 1s I think that the third thing that springs to mind is having come up against my own physiological, emotional and, uh, cognitive limits, uh, over the last few years, you know, going through, uh, profound exhaustion, hopelessness and going through a real low point myself and. 1s Coming out of it by doing a lot of the things that I encourage my clients to do. You know, pacing myself, being gentle, figuring out what worked for me, what didn't, what nourished me or depleted me. And that that in itself was a long journey. But I think that has helped me have more respect from my own limits, I think. Yeah. And I read that while you were writing How We Break while you're in the middle of it, you actually got to a point where you were very exhausted and fatigued yourself. And how did that come about? Was that strange to you? Was it does this come on quite insidiously, or was it almost predictable? I think to some degree predictable, because if I look at the. 1s The people I work with in the clinic. I worked in an NHS trans diagnostic fatigue clinic. So by trans diagnostic, meaning that we saw people who primary diagnosis that might be an autoimmune condition like Sjogren's syndrome, or it could be they had fatigue, uh, following cancer treatments or. Yeah, and liver disease, any number of reasons. But if they had fatigue as a symptom, they could come to us for help us being a multidisciplinary team. And one of the things that I saw there is it was rarely one thing that pushed people to the edge of their mental and physical limits. It was and it was. It was rarely one big trauma. It was often the accumulation of. Physical illness, difficult relationships, difficult work situations, getting embroiled in a difficult relationship with money or the benefit system. It was usually multiple factors on different levels that just became too much for too long. And if I look back over the the year leading up to my own, uh, collapse, however we want to talk about it, I can see there was a lot going on in my life. There was an accumulation of branches. It just meant I was getting more tired more quickly. And and then. 2s Developing a couple of physical problems that I'm not going to go into in detail, but the physical stuff kind of is the bit that just pulled the rug out from under my feet. And but I think if I hadn't already been, as it were, tenderized by the bludgeoning of life events, I would have got over the physical stuff quicker. But I was already kind of, uh, yeah, a bit bruised. Uh, so yeah, I saw what happened to me, uh, really mirrored, uh, in the clinic and vice versa. And, and and in a way that ended up being useful because it was something I could say from the inside as well as from, uh, clinical experiences. It is often the accumulation of small things that that, uh, undermines us. Yeah. And if you're an ambitious person and you want to accomplish things, if you want to accomplish a certain life goal, 1s you're always trying to figure out how you can get more out of your time. Time is the ultimate currency, perhaps time and your own energy, and you're always trying to figure out. Do I have the capacity? What exactly is my capacity? And it's, I think one people, one thing high achieving people don't talk about enough is that it's very hard to predict. You can think something's manageable. And then when you're in the midst of a very busy week or a busy month or a busy year, right out of nowhere, you can go from I'm quite busy to I'm exhausted. Or as you mentioned, obviously unpredictable things happen. And one of the really hard things about life is, of course, the unpredictability. You know, most of the things that people would probably say were the worst things that happened to them were probably things that they never really saw coming in the first place. Is that something you've seen with your with your clients as well? Yeah, totally. It makes me and not just clients, research participants as well and but friends, colleagues, myself. And in all of them we we see what the sociologists call biographical disruption, which is a term that resonates. There's quite a lot of people because although it's it sounds technical, I think it has a real felt sense of it's exactly what happens to us sometimes. We're going along in our story about how life is, and then something just hits us sideways. That biography of who we are and what we think our life is about gets knocked sideways and takes us on a different trajectory and goes back to what we were saying earlier about the role of chance and life. You know, those biographical disruptions can be they can be good as well as bad. So when I finished the first book, I left in a drawer for a few years because I thought it was too old. I liked it, but I didn't think it had a market. But then when I did put it out there, people actually responded and I had my own kind of unexpected biographical disruption. But being the kind of creature that I am, which is by nature quite a threat. Sensitive. Uh. 1s I also find that process quite exhausting. You know, that was part of what got folded in to those years of exhausting is the, uh, that suddenly there was a level of exposure and expectation. So. Yeah, I think that. That we can be. Not sideways by life in ways that can be both good and bad. But they both become work. They both become more for us to do. And that's one of the themes in the book, is that when we're already at capacity, like you said, having to deal with. Extra stuff. It's all coming from the same finite resource, i.e. us and our mental and emotional capacity at the time. So one of the things I've seen is that we're all only 1 or 2 life events, sometimes away from, you know, serious. Uh, I don't know, collapse is too dramatic, but yeah, being pushed to our limits being. And I see it in colleagues. I see it in friends. Um, one, I might push back against that a little bit. And that is obviously we are a finite resource. But one thing I do think people don't appreciate enough is even though we are finite, we are incredibly dynamic. And we can and we most people can and should try to improve their capacity. And they might find if, in fact, even if they do. Basic self-care like if they exercise, if they eat the right things, and very importantly, if they don't eat the wrong things, if they minimize drugs and alcohol. That can all vastly expand your your range and your energy and your capacity to do important things as well. Yeah. No, I think that's really key insight. And. And one. 1s I think a lot of people struggle with. I've. Said this a few times in a few different contexts, but working in a fatigue killing, one of the things that I came to appreciate is that. People are not struggling, or some people are not struggling so much with being active as they are with recovering and revitalizing themselves. I think as a culture, we're very good at emphasizing activity and productivity. And those are skills that we all become fairly well versed in. But we seem to be less secure. Is like you were just saying, how do we revitalize our capacity? And not just through physical intervention, but through spiritual through connections, through joyousness, through. Yeah, just the stuff that recharges us. And I saw a lot of people in the clinic and again, myself, my friends, my colleagues struggle with that side of life. And so, yeah, I think you're absolutely right. It's not just about decreasing demand. It's about increasing capacity. That's really important. And. On the subject of recharging, I agree with you. It's definitely under emphasized. And also what we think of as recharging isn't recharging. I think for a lot of people, when they're not working, not being productive, they're not really resting, actively caring for themselves, they're often either distracting themselves or further depleting themselves with devices, say, going out late or watching Netflix on the couch, or they're in this kind of gray area, often of procrastination. Say you want to take a break. From work. When you're in the office, you might spend 15 20 minutes of watching videos on YouTube or on TikTok, say on your phone, and it will take you to take your mind away from the burden of work. But it actually is another form of stimulation. It's often not very restful, and a lot of people, I think, spend their leisure time in this weird gray area where it's not particularly making them happy or rested, but neither is it being productive. Um. Recently I've gotten the opportunity to work more from home, and what I really like about that is I've found that gray area has largely gone away, and instead it's either actual work accomplishing something, or it's depressed in some form, whether that's. Or exercising or it's like ten, 15 minutes of of rests of closing your eyes. So that's kind of gray area has gone. And I feel that I've managed to get to this point of feeling both productive but not as stressed. Not as frenetic. 1s Yeah, that's really lovely. Uh, because, yeah, something I talk about in the book towards the end, I get, uh. 1s Both me and the reader to a self-assessment of various dimensions of our life and. And one of them is talking about genuine highs of productivity and achievement and genuine lows of recovery and refreshment, because I think there's a nice physiological version of that. If you look at highly trained athletes, they have really high heart rate variability, so they're able to gear up for the performance, but they're also then able to really gear down for the recovery and what you see in people who are. 1s Variously anxious or in pain. It shows up in lots of different conditions, is very low heart rate variability. They're not really able to properly switch on to gear up, but neither are they able to switch off. They're just kind of stopped in that gray area that you were talking about. So one of the yeah, I just yeah, I just loved the way you talked about it because I think it's a skill as worth mastering as our kind of productive skills is. Our non productivity is those moments of rest and recovery. But it's it's also a personal project. One of the things I've seen is that what depletes one person nourishes another and vice versa. It's so I think it is a something worth experimenting in because I've. I get what you mean about, uh, 2s watching stuff on screens, but a lovely counter example was. I was talking to a group of therapists recently doing a kind of group supervision session with someone we were talking about. This how do we how do we genuinely switch off? And one of the therapists was reflecting that they find it really difficult. Even when a client didn't turn up, they still felt they had to be doing something with that time. And they they had walked into the room of a colleague who was had their feet up and was watching Coronation Street when the client didn't turn up. And they said, well, why wouldn't I? And they were using that in a way that was genuinely actually, I'm just going to forget about other people's stuff for a while and do something genuinely non-work. So yeah, I think it it depends on what works for you. But I do think we often said, I think the way I put it in the book is we're we're stopped, but we're not really off. We have just ceased labour, but we're but we're not genuinely in that kind of parasympathetic rest and recovery mode that we need to go into. Yes. And often the engine of your mind is still revving and you're still thinking and ruminating. And, you know, for all intents and purposes, if you're as you think your body will follow, if you're thinking about stressful thoughts, even if your body is under no threat, and even if your body is static, it feels very much under stress. And people pay the physiological toll of that, perhaps even more than if their body was at least moving and felt like it was engaging with the process instead, I think absolutely, I think people end up feeling quite helpless a lot of the time. We've been doing, uh, a launch, randomised controlled trial of. 1s Working with GP's to help them. 2s Engage clients who have got common regarding persistent physical symptoms like, uh, like fatigue or, uh, headaches or chronic pain, stuff that they see a lot of but can't necessarily do anything, uh, in terms of prescribing a clear medication or course of treatment. But one of the things or two of the things that they did that really seem to help in this trial, which should be coming out soon, the results of it is actually listening to people spending time getting a sense of why they were where they were, and then doing very simple. Almost. There are very simple behavioral interventions, like one of my GPS called prescribing Joy, which was literally talking to people in the clinic. Okay. What gives you a genuine sense of joy? And I think often when we've got a little fund of energy, we we often conserve it and use it just for duty for the stuff that we really feel we have to do. And in a way, that's a false economy of our energy. If you actually if you put it into stuff that brings you joy, it gives you more energy to then do the duty. But I think we need to learn that the hard way. I think I had to learn that the hard way. People just don't talk really about energy management. Much at all. And also we have all of these things in society which give us the deception of energy to give us the illusion of energy. But actually it's a trick and you get robbed on the back end. And I think probably the biggest example of this is caffeine. Where caffeine. Obviously if you ingest it, you immediately feel a sense of energy and concentration and focus. Currently, me and my whole podcast team are taking a month break from caffeine, and we're going to record a podcast about what it's like. We're all caffeine addicts, and we're gonna see what it's like to not have it for a few months. Have you had experience with caffeine? Do you drink it? Have you had have you seen clients having a caffeine addiction in clinic? Oh, totally. Yeah. And I've gone through periods of myself of uh, of yeah, just not doing it. Detoxing from caffeine and. 1s I think my current partner and he drinks a lot more coffee than I do, and I've kind of got into a slightly bad habit from him of drinking too much coffee and using it to manage my energy, so you know it is what is. It's 2:30 in the afternoon and I'm going through the post-lunch energy dip. And so of course I have a cup of coffee because, uh, I'm talking to you and I'm going to be talking to someone else after I'm talking to you. So I am using it as a kind of quick and dirty fix. But I've also found that when I've come off it. 1s Uh, my energy is much more even. And and and not doesn't tend to be an issue. Uh, but I think once you get into the cycle of relying on it, it does take a while to get into the cycle of not relying on it. But what's your experience been on this? How is it going not doing caffeine? I I've had the same experience of you so far that my energy levels. Certainly feel a lot more even. And I have drank probably way too much coffee for too long. And eventually I came to a kind of stark realization, which is why I made my whole team quit for a month. And that is, caffeine doesn't give you energy. It unlocks energy that your brain already has faster than it ordinarily would. You have the energy your brain has. The neural chemistry has the energy. And the same is true in much more serious ways for drugs like ecstasy, cocaine, heroin. So if you look at cocaine, you have drive. You have the ability to have joy and motivation. And cocaine unlocks that by increasing your dopamine levels. Ecstasy causes a flood of serotonin, and you feel extremely compassionate and empathic. You have the ability to to be compassionate, to feel safe, to be empathic. It's within you. You have to figure out how to unlock it. Uh, sometimes drug experiences can be useful just because they can give you that insight, because they can make you realize what you have within you. But obviously, as we know of oftentimes. We fall under this pretense that it's the drug that's giving me the thing. But the drug is just unlocking the thing. And so the dominant realization I've had so far with caffeine is you have the ability to concentrate and focus. You're just you're kind of a deal with the devil. It's always good up front. And then it hits you on the back end. 2s Yeah, I think that's a really nice insight. And how is your team? Get the normals that have they all complied. You know, are you monitoring their caffeine intake. So we've just started but I'm going to be using the trust system. They've just started. I wish them well. And then we're going to be checking in on them in a few weeks and see how it goes. Because we don't. Again, caffeine is like the most common drug. People don't think of it as a drug. It's the most common drug people are addicted to. And I think it does affect people. And it really ties in to what we've been talking about in terms of energy management and burnout and trying to find these ways to fit more stuff in less this time. Um, I'd like to talk a bit about your first book, How We Are, which was a lovely book. And I remember, as I told you before we started recording, I randomly picked it up in a bookstore in Glasgow when I was still considering psychiatry training. I wasn't 100% sure, and I picked up this book. And can you tell us a little bit, what's the what's the thesis of the book? What did you want to convey with that book? It was always. 1s I was when I first started writing it. I just thought I was going to write one book, which was in the first act of the book. I wanted to set up just how we are as creatures, and particularly the role of habit and change in daily life. And then in the second part of that book, it was, okay, what happens when that system gets pushed to its limits? And then in the third part of the book, how do we recover from being pushed to the elements? So I saw it as one big book. And of course, when I started writing the the first book group. So essentially how we are is it's kind of habit and change in normal life is the way I would put it. And I'm just going to 2s have a sip of coffee, because the other thing that always happens when I talk is that my voice starts to go. 2s It's funny, I did my PhD on functional dysphonia, which is where people lose their voice in the absence of any clear stuff happening with their vocal cords. And actually, I developed I developed it in the middle of doing my PhD, which was, uh, both illuminating and a bit embarrassing when, uh, when the lovely ENT consultant actually said, yep. So, uh, it's become one of the signs for me, though I know that I'm reaching my limit when, uh, my voice goes, uh uh, but also I just talk too much. But anyway, back to your question, which is the. Yeah, the find speaks about normal life. Uh, the first part of it is showing how habit isn't just a matter of, um. Excuse me. Alex. Uh. 1s Our ways of thinking, feeling and acting, though it is the, uh, it is, uh, you know, we lay down learned responses to the things that we commonly come into contact with. So we don't need to think about how to drink, how to make a cup of tea. I don't even really need to think about how to write anymore. If I put myself in the position of writing was an intention, the writing will happen and a lot of that is happening. There's a bit of consciousness, but there's a lot of it is also automatic. So I was trying to, uh, portray that, uh, that large, automatic underbelly of everyday activities that we take for granted and showing that it's not just embodied in us, it's also embedded in our environment. So if you look around, uh, I'm in my study at the moment, and so behind me we can see wall charts and ideas that are out there. And there's the computer, there's my notebooks, and my thinking is happening in this embedded, embodied, enacted, extended context. And I really wanted to portray that as well, that we're not these isolated islands of cognition, that our habits become embodied in routine and people, places and things. So that's the first half of the book. And in the second half it's like, okay, what happens when we have to change? But again, sort of normal change, moving house, uh, new relationship, ending an old relationship, grief, losing something, gaining something. What happens when we have to step out of habit and deliberate and think and establish new habits? And how do we go through that sort of high noon of deliberation into the sort of the twilight of, actually, we don't need to think about this anymore. So that that was what I was trying to track in the book is that the move from this is how things are to we're going to have to adjust, uh, to, to establishing a new normal. And I like signals. So the new normal is one of the themes, the themes and the phrases I use a lot in that book. And it was kind of weird subsequently to see us talk over the last ten years, we have so many new normals in terms of what's happening to us collectively. Uh, so yeah, that was the the basic thesis of the book. Um, and of course, it's not even just about developing new habits. People often find they have to let old habits go. And there's a pain in that. It's kind of a little death that people have to experience when they're letting go of a new habit. What what general advice would you give someone who's either trying to start a new habit because they recognize that they need to, or trying to let go of an old habit? 1s Persistence. Uh, 1s it's something that I see in myself. Although I think of myself as. 1s Not that ambitious and and quite difficult to manage, and sometimes and sometimes quite averse to doing the hard work. I've always persisted. I've always had, uh, the vision, uh, in mind at the end of it, but I think. 2s It's something I think I've learned from working a lot and training a lot and acceptance and commitment therapy. It is before you embark on something is really tuning in to white matters to you is really tuning into to what value does this serve for you? And and then I think if you have that, like I said earlier when we were talking about Sammy, the agency care worker who is just working really hard to improve his situation, he has this constant Northstar in his in his sight that keeps on going through turbulence. So I think that's a key part of it. Identifying why it matters and keeping it in mind. 1s And. 1s There are so many books about habit these days, but I think. The the wisest ones often realized that habit isn't just an internal matter, it is embodied in people, places, and things. So get your environment on your site. Set up the environment so that what you want to do becomes easier, and what you don't want to do becomes more difficult. What they call and how. Psychology the nudges. So set up your environment so it nudges you to do the right thing. So for instance, if you want to give up coffee, get rid of the coffee around you. You know, actually get rid of the cues to coffee, drink and find other things you can do at that time. Find habit substitution. I think it's I think it's often the case. As a health psychologist in my field, we're often trying to essentially get people to do more good stuff and stop the bad stuff. And it's rarely lack of knowledge. We all kind of know what we should be doing, but it is. 2s Difficult for us to change our habits. So I think I would go back to that notion of persistence that we just need to remember why we're doing it and stick with it. It's really easy to tell other people to do it, but doing it yourself, it's not always that easy. Yes. No, I heard that I heard the definition of wisdom recently. That wisdom is having the courage to take your own advice. I really like that. What about you, Alex? It sounds like you are fairly good at doing the self management stuff. What has helped you kind of persist and stay on track and it's established good habits. I'm a I'm a big believer in making habits and really being conscious of what your habits are, because I do think habits are the micro building blocks of your life and and your outcomes. Now obviously there's. Many influences to your habit, and you can go in all the way into the depths of your psychology, and you can go into the layout of your study, as you've mentioned. So there's lots of inputs that might be feeding in to what you'd happen to be doing on a Tuesday at 9:30 a.m.. And so I'm kind of a big fan of teasing all that apart. And then, much like you suggested, seeing what you can change and that could be examining in a very in a, not in a pejorative sense, but more superficial way, what can be changed. So as you mentioned, changing the architecture of your room, for instance, or changing the objects that happen to be around you. Um, one of the most powerful things I've learned, and something that I tend to talk about with clients a lot, is micro habits. So if, for example, someone wanted to start an exercise routine, I would encourage them to start with five push ups and call five push ups or workouts and let yourself feel the success of five push ups. And it sounds silly and it sounds like it wouldn't work. But funnily enough, our brains are sensitive enough that even if you did something trivial like that, you'd get you'd feel motivated at the end. If you're someone who hasn't done any exercise in five years and you do five push ups, your brain would register that as, okay, this is different. And even functionally five push ups is vastly superior to zero push ups. And so, uh, generally I would when someone wants to start a new habit, I would advise them to break that habit down into the smallest possible unit of action that they would even consider doing. 1s And then doing that every day for a long time, and then slowly and then slowly, slowly increase it. And then, as we've suggested, you know, the whole goal of habits is they're automatic. You don't have to think about them. And then they start to become a part of you, and they'll start to produce their own rewards. So you might start to feel better if you were exercising every day, or you might start to be proud of your work. If you're doing five minutes of writing every day and then it becomes a little engine. That's your building in your mind. Um, it takes it's very much takes on a life of its own. And often enough, when you grow good habits, it kind of allows bad habits to wither away. Like plants you don't want in your garden, plants you don't feed. And. And then I find, like I said, it's kind of a self-reinforcing process. So that's kind of how I think about it. That's lovely. And and yeah, the research banks that that good and bad habits, they both tend to cluster. So the more you do one good habit, you're more likely to do other good ones. And similarly for bad habits. So I think yeah just tending your habit garden as it were. I think that's a nice way to look at it. And, and I really like that gentle beginnings thing as well because. 1s So, for instance, working with fatigue, you often see people who are really, uh, used to being very productive and being able to do a lot. And so the idea of just doing a little can feel really insignificant. And if they do see the five push ups, the discount it because it's like, well, I used to be able to do 50. And so actually reframing that from the beginning as achievement that that's a really nice move. It's rather than making 52 standard making things the standard thing. That's a really nice idea. Yeah. Even viewing starting as success. Like if you know, I mean I'm curious, do you find that people in your fatigue clinic generally, were they of a particular personality type where they quite perfectionistic, ambitious, that kind of person? Was it more of a mix, do you think? It's hard to tell? Uh, because I think these days almost everyone I know is heavily invested in work. I think we've become very good, uh, at being good for the institutions that we're involved in. And so I was seeing that a lot in the clinic I was seeing people were certainly the. 1s For some of them, their degree of conscientiousness, their ability to, and their desire to give as much as they could to work was part of the factor of why they ended up seeing me in the first place. So I am seeing a fairly by sample, but I do think at the more general level, people's embroiled with a with a work culture that was trying to get them to do as much as possible is part of the issue. I think it is for a lot of us. Yeah, yeah. So your first book was called How We Are, your second book, which just came out, How We Break and your third book is going to be How We Mend, is that you're working on that now? Yeah. And and again, it's a bit like the. 1s What we're saying about the first couple of books I've been writing notes for the the third one for years, so that I've kind of simultaneously working in all three. But the the not the issue, but the work that the actual work is arranging those notes into a coherent story and framework, which is which is where the big wall chunks come in. So before I start a before I start the next book, which I'll be, uh, doing over the next couple of months, because I'm going to be on sabbatical. Before I do that, I will actually chart out the chapters chapter by chapter. I often find if I have the structure first, that that's really key for me. So, uh, yeah, how we mean and I'm hoping it will be a slightly cheerier task than the last one, because for the last ten years, I've had this perceptual bias of not only looking at, but asking people about, you know, tell me about the worst times of your life. It'd be quite nice to do the opposite and, uh, get more of a sense of, uh, thriving. Yeah. And do you have a sense of what the thrust is going to of the book is going to be? Yes, I think so. Uh, but I think one of the nice things about writing when it's going, what I would consider well, is you're often surprised yourself, uh, because it is that sort of dialogue with the unknown, uh, where, uh, genuinely different stuff come out, uh, and new stuff comes out. 1s But I think. 2s The current book. Ends, and this is not particularly a spoiler for people who are going to read it, but the current book ends. 1s By addressing some of the stuff we've been talking about in terms of. 2s As all being embroiled in a culture where we're kind of encouraged to value. Our cells in terms of our productivity, in terms of our output, in terms of how much we can get done. 1s And. And so I end the book by asking, what would it be like to start from the position that we're fine as we are and that we're actually sufficient as we are? And being someone who is very threat sensitive. Also asking what would it be like if, rather than the avoidance of threat, the kind of the. 1s The seeking of peace was more a goal. So I'm thinking in terms of, uh, this was the book of war. The next book will be the Book of Peace. So I am thinking about peace, uh, sufficiency being enough in and of ourselves. That's the kind of the general trend of it. Um, and I'm really interested in the way that different schools of therapy and different spiritual schools think about. 1s Peace and sufficiency and and how we get there. So yeah, I kind of know roughly where it's going, and I know the sources I'm going to draw on. And uh, and then it's just a matter of writing it. Alex. Yeah, yeah. And in terms of how that's I really like that mindset, you know, starting with. You're fine as you are. Actually. You're sufficient. Your value. You belong. And I really like how starting with that frame, it can influence actually what work you do choose to do, because I don't really believe. 1s In the main, I think people like to give and they like to produce. And I'm always curious about the question, what would you do if you had £1 million? You know, what would you do? What kind of work would you do? If you didn't have to work. Because all of a sudden now, when you start along that question, you're very much on the path to your value system, because generally, the work you would choose to do if you didn't have to work, if you didn't have to work, would be work that's reflective of what you really care about. You know what's important to you. What questions do you want answered? What do you want changed about yourself? Or do you want change about the world? And a lot of people make the argument that to work hard, you need a certain sense of insufficiency. 1s And I. And I think maybe that's true in some sense. Maybe a sense, a sense of insufficiency in your competence. And you'd like to get more competent in something and you'd like to be more confident in something. But I think where a lot of people go wrong in this, and I know a lot of success for people with very low self-esteem. So I know a lot of people who are very competent and can do a lot, but their self-worth is rock bottom. And I think what's happening is rather than having a more kind of benign sense of insufficiency, incompetence, they have a deep sense of lack of self-worth. And it's that lack of self-worth that's driving you. And fair enough, it can be a really powerful engine. Not having self-worth can get you, can motivate you, I think, to do a lot of things and even a lot of great things, but you can very importantly warp your path. And what I've seen again in people I know. But even if you look at certain celebrities, certain very famous people who are enormously successful when they get to that. 1s Often they've gone towards the wrong goal, or they misuse their success, or they're more easily corrupted by their success, or it's more obvious that they have something to prove. You see it as a strange kind of perversion there, because what was driving them wasn't a sense of I necessarily just want to give back. But I had something to prove, and perhaps they still have the hole inside them because. You can achieve a lot, as I've mentioned, and still feel a very deep sense of insufficiency. 3s Yet. I would totally anchor that that. I think I think it's tea and Sally talks about doing the right deed for the wrong reason. And 1s and you know, I like to think if I did get the million pounds, I'm fairly sure I would still write the next book because it's just it's something that I want to do for me because part of the overall trilogy is called How to Live, which sounds incredibly arrogant, but it's actually me trying to figure it out by writing it. And and that's an ongoing project. You know, I'm still figuring it out 60, but I kind of like that. I think I am not a finished project and this is not a finished project, so I'd like to think I would still do that. And yeah, it really resonated when you talked about people being productive from a sense of insufficiency. Uh, not not a deficit of skills, but a deficit of self. And I but I do think that work cultures often capitalize on that. I think they actually exploit that vulnerability in many of us. There was this notion a few years back that what workplaces really need are insecure overachievers, because if you have someone in post who is exactly as you described, you'll get a ton of work out of them, and they'll feel and they'll never feel like they can give enough. So I do. I do think we need to think about how those personal traits get exploited by the systems in which they get embedded, uh, in something that often benefits work but doesn't benefit the individual, or it might benefit them in ways they don't really want, like it might benefit you in salary and stock options. But it won't be the hunger for something deeper than that you have. 2s Absolutely. And kind of parallel to the, the what would you do if you won £1 million in exercise? What some extensions and commitment therapists get their clients to do is imagine the obituary exercise. So you get to the end of your life and you overhear, uh, your obituary, or you somehow manage to hear your own funeral and you imagine what would you actually like people to be saying about you? And that can be a good way for people to tune in to. 2s The fact that we often value ourselves very differently from we value those around us. So if I think of the people that I'm close to and that I love, I for me kind of talk to values of sort of kindness and humor and, you know, that is 1s wouldn't be my automatic valuation of myself because it's like, well, you should have written the book. It should be producing this grant. You should have finished this paper by now. We often value ourselves very differently than we do those around us. So I think those kind of lottery winning or imagine you're reaching the end of your life, uh, ways of getting us to tune into a bigger values can be really useful. Yeah, absolutely. And in keeping with what you said, people often talk to themselves in ways they would never speak to anyone else. 1s And it's if totally. If it's one thing I wish more people get into the habit of doing, it's writing down their self-talk. And again, it feels like a very contrived exercise. But you write down your self-talk and then you realize that actually, because you talk to yourself, you must in fact be in a relationship with yourself, which most people don't really think that because we think of ourselves as one entity, 1s just like you have a relationship with other people, which you need to cultivate and you need to maintain its quality, you need to maintain a good quality relationship with yourself as well. I totally agree with that. And it's it's one one of the themes in the book is that it's something we don't talk about enough. It's the fact that your only lifelong relationship is your relationship with yourself and that. And for some people, that relationship is deeply problematic. I know that when I, when I was younger, uh, because I didn't really fit in with the culture in which I grew up, I was very much an outsider, and I was forced to encounter really difficult emotions really early on, like shame and fear and and really anxious, uh, threat sensitive mind. So. 1s One way I've come to think about that is I was forced into a relationship with myself and difficulty really early on, and the part of my life's work is learning to manage that and is learning to manage my relationship with myself. And I think we all do. I think it's something like we don't talk about enough, but it's really key to our both our breaking and our mending. I think it's the quality of that relationship. Mhm. 1s What do you think has surprised you the most about human nature? As you've worked with different people across your career, you've seen people in trouble. You've seen you've seen people grow and overcome things. What surprised you the most about our nature? 1s I don't know about. Surprised Laura is in there, but I think the first thing that sprang to mind when you said that was. 2s Our ability to laugh. Humor. 1s It's really difficult to efface that, even in the the grimmest of circumstances, that often there will be a connection in the client, with the client or with the friend when we can both not laugh at the awkwardness, but there is still that freedom. That is not defined by the awfulness which is often expressed in humor. And I even saw that in my mom, who had a really difficult struggle with depression, particularly in the last few years of her life. But one of the things we could still connect over was laughter. If if we could get her out of her very bitter story about how awful her life was, there was still an ability to laugh. And that's where the connection would come. So. Yeah, that's the first thing that sprung to mind when you when you said surprise, there is something there that I think is really key. Mhm mhm mhm. Well Vincent it's been lovely to speak to you. Your two books how we are, how we break. I'd encourage everyone to go out and read those. I'll put some links in the description and we're greatly looking forward to your next book, How We Mend. When can we expect that book? Oh, I'm not going to. What's it called, a hostage to fortune. I would like to get it done in. I've just turned 60. I'd like to get it finished before I'm 62. I think I can see me getting it done in the next year or so. But you can play this clip back to me when I'm 70 and go, remember you saying that, but hopefully not that long. No, it's perfect. You're putting it into practice. You're going going easy on yourself. That's you're actually, uh, taking your own advice, which is good to see. I really enjoyed this conversation. It's been lovely. Thank you for asking me. Thank you. Me too. 8s Thanks so much for listening this week. If you've got any feedback, as always, do get in touch. If you enjoyed the episode, why not give us a rating on Spotify or Apple Podcasts? Because it really helps other people to find us. If you want to get in touch, you can find us on Instagram or Twitter, or you can drop us an email. And if you value the show more generally, why not bias coffee? Thanks so much.