Vincent Deary, psychologist, fatigue specialist and author, has been telling me what an “anxious creature” he is. He barely slept last night. The hotel room was unfamiliar and noisy. Worse, the prospect of an interview and of meeting someone new made his arrhythmic heart race.
It’s racing now as we sit together in a London hotel. We’re here to discuss his new book, How We Break: Navigating the Wear and Tear of Living, an exploration of our varying responses to the corrosive pressures of daily life, especially work, and an assertion of the vital necessity of rest, recovery and the lost art of convalescence. The book is the second in a trilogy by Deary, a professor of psychology at Northumbria University and a clinical fatigue specialist at the Cresta Fatigue Clinic, a role from which he has just retired. The NHS clinic, which is closing later this year was unique in the UK for its trans-diagnostic multi-disciplinary approach to disabling fatigue in patients with various diagnoses such as auto-immune conditions, liver disease or post-cancer fatigue. It excluded people with a primary diagnosis of CFS/ME as there were existing clinics for them. Deary goes on to share something else with me: he dreads the intimacy of dinner parties and hates surprises, before adding that his partner of 10 years recently threw a surprise party for his 60th birthday – and he loved it. Proof, it seems, that people can change.
Well yes and no. Deary believes we can make changes, if circumstances allow, and we can adapt, but we can’t fundamentally change the self we were born with. First, there’s our genetic makeup. Then, he says, there’s our constitution, which is encoded with memories of previous generations and sometimes by intergenerational trauma; the body remembers, it keeps score. Deary offers himself up as a good example of this, and there are three other case histories in the book, including that of his late mother.
When he hit 40, long since amicably divorced, Deary left his job as an NHS therapist, sold up in London, moved back to Scotland, and corralled material for the first book. Five years later, he became a single parent when his 16-year-old daughter came to live with him. The finished book cowered in a drawer, Deary lacking the confidence to seek publication. How to Live, the first book in the trilogy, was finally published when he was 50. Now he was an author, too, an acclaimed one. Lots of changes there then.
But who he is, fundamentally, has not changed, he says. “I still have social anxiety.” What he has managed to change is his relationship with this anxiety: “I recognise that it is part of me, that it’s going to show up, so I now literally bring it along with me as a companion. And that’s OK. It might mean I am hyper and talk a lot, but that can be quite useful.”
For Deary, arriving at this place of self-acceptance and self-love has been a project, it’s been work and that’s also OK, because we each have to work on the self we are born with in order to survive, or thrive. Some, like Deary, won’t be a good fit for their environment, which means “some of us are harder work for ourselves than others”. We “tremble” as we encounter the turbulence of life, including the changes we have to navigate but, again, some of us tremble more than others. In turn, holding steady in the face of change, what’s known as the allostatic load, becomes too much, “There’s no wriggle room and we break,” as Deary himself did while writing his new book.
As part of his work on himself, Deary has traced the reach and roots of his anxiety, as he does for his patients in the fatigue clinic. Early on, he “meets” an effeminate child growing up in a working-class culture on the west coast of Scotland and sees what “a misfit” he was. He ran with the “rejects and the freaks”.
“I was visibly different from my peers,” he tells me, “very gentle, soft-spoken. I was little and timorous by nature. That’s not necessarily great in a working-class comprehensive in the 70s in Scotland. There was bullying. I was called either snobby or poofy. I was neither.” He had a big nose and was called Concorde. “My body remembers the early threats; I am still easily frightened.”
So was his mother. Gentle and open-minded, she had a punitive upbringing and, like her son, had an “anxious constitution”. Deary was an “unexpected pregnancy,” he writes, his mother already dealing with a large family and the wear and tear of poverty and a difficult marriage. “I was born alarmed,” he writes. But home was good. “I had quite an exceptional mother,” he says, “and an exceptional home life. We were enculturated into art, literature, theatre very early on and so that marked us out as different. I did not come from a typical west coast Scottish family.”
He shares his story in the book, not “to say I had a really difficult time, but because I wanted people to find resonance – I wanted them to see that when you don’t fit in, you’re given back to yourself as work because you need to learn to manage that not fitting. You need to learn to manage the difficult feelings coming out of that and you need to learn to manage yourself.”
Key to that self-management is not only understanding and self-love, but rest. Deary has a mantra: work needs rest and rest takes work. We need to take time out to rest in order to heal from extreme exhaustion, chronic illness, or unexpected life events, what Deary terms “biographical disruption”. We also need to take a rest from work and free ourselves from an “audit culture” that pushes us, sometimes to breaking point. But first, we need to learn how to rest. “It’s a skill,” he says, one that nowadays has to be acquired.
“One of the things I noticed in the fatigue clinic is that tired people can often do the things they need to do, but a lot of them really struggle with switching off. We often associate our worth and our value in terms of productivity and output. Both within academia and the NHS there are whole mini-industries dedicated to evaluating your productivity and your output, often telling you that you could do better and, actually, could you do better with less, please. It’s very easy to buy into that narrative that your work equals your productivity. So, for people who are exhausted and can’t be productive, it’s very easy to go, I don’t deserve to rest, I am worthless, I have done nothing to earn this.
“But we need to allow ourselves to rest, to nap, to enjoy, to deliberately switch on to joy and nourishment and the stuff that actually fills the tank. I wrote this book to understand myself, but also because, in the last few years, I saw friends, family, colleagues, society, to an extent, just become overwhelmed, or exhausted, or hopeless or joyless. Ordinary people going through ordinary suffering. Some of them crossed the clinical line into physical or mental health systems, but most of them were just struggling to get on with life. Often the first casualty of stress is joy. Deliberately leaning into that joy and finding out the stuff that restores you is really key to recovery.”
Some GPs have started handing out joy as a “social prescription”. But how do we identify what brings us joy? “The clue is in our everyday language: ‘That really lifted my spirits,’ or ‘I got a lot out of that.’ It’s the stuff that cheers us up or energises us.” A meal with loved ones is often high up on the list. Deary’s academic research looks at the challenges faced by head and neck cancer survivors. “It’s not the food they miss,” he says, “it’s the sharing. They were mourning the connection. It’s what we call commensality: that social magic which comes when you’re sharing food. Our research with food and head and neck cancer and other conditions highlighted that pleasure is a necessity; being deprived of it is literally depressing and demoralising.”
One day, halfway through writing How We Break, Deary discovered this for himself. He woke up “in a state of exhaustion. I had no real ability to get out of bed. When I finally took myself for a walk, I was wiped out the next day. I was in a state of hopeless exhaustion. My mood went down as well. I was completely disengaged from life. It was a very difficult time.”
To recover he did “what I help people in the fatigue clinic do, which is, gradually get back into things at my own pace and do a combination of physical and emotional rehab. Incremental engagement with life. I think that is what true convalescence is. It’s not just rest and it’s not just activity, it’s that mixture of both: it’s acknowledging that there is a deep need for rest and recovery. It’s like Thomas Mann’s Magic Mountain where they are all sitting about in the sanatorium: there’s the beauty, there’s the connection, there’s the food. There’s the joy” – even in an interview. “A joyful encounter!” was Deary’s verdict, glad that he came, proud of himself and proof that a little self-love goes a long way to ease the wear and tear of life.
• This article was amended on 29 January 2024 to add details about the transdiagnostic approach of the Cresta Fatigue Clinic and to make it clear that it did not include patients with a primary diagnosis of CFS/ME.
How We Break: Navigating the Wear and Tear of Living by Vincent Deary is published by Allen Lane on 25 January at £25. Buy a copy from guardianbookshop.com for £21.25
