Arts, Books, Psychology

Book Review: ‘How We Break’

LITERARY REVIEW

Intro: How to survive when you’re at breaking point

THERE are various idioms containing the word break. One friend moans, “I feel just broken”, meaning she’s very tired. Another says, “It’s heart-breaking,” which is referring to something rather sad.

We can “break even”, where neither profit or loss is made and is seen as good practice, but when lovers “break up” it’s bad emotionally for all concerned. When the waves break on the shore, the meaning is not in question: they smash down and are changed. Similarly, a truly “broken-hearted” person will feel – in body, mind, and spirit – that life can never be the same again. And they are right.

And, so, what of the journey towards the breaking point? What stress must be applied to an elastic band, say, before it will snap?

In How We Break, health psychologist Vincent Deary suggests some answers for “navigating the wear and tear of living”. He shows how social circumstances can combine with individual genetics and unexpected external shifts to make each individual’s experience of stress unique.

Nobody – not even the most confident and strong among us – should think of themselves as invulnerable or immune. Events can combine to overwhelm you. A sudden shock can make almost anyone teeter on the edge and then fall.

How We Break is the second in a proposed trilogy series: How To Live. The first volume, How We Are, was published a decade ago. For publishing, that’s an unusual and significant gap: for the author himself suffered a sort of breakdown during the writing of this volume.

Since his subject matter is exhaustion, the physiology of stress and how so many of us seem to be permanently set in “fight or flight” mode, it should come as no surprise that Deary’s writing style becomes increasingly fraught as the book progresses.

There are times during the second part of the narrative when it becomes unclear whether he is writing “shrink-speak” for professional colleagues or providing information for the general reader. There is no doubt, though, depths of pain are quietly plumbed within these pages.

How We Are was about the acute difficulty of facing change, and the first part of How We Break continues the analysis of how “allostatis” can put such a strain on our minds, bodies, and spirits, that we face “trembling” before the point of “breaking”. Allostatis refers to the work of maintaining stability in the face of change. Parts one and two of this book explores the territories of what happens when we are pushed past our limits.

Deary draws on his extensive experience in an NHS clinic specialising in fatigue and uses case studies to show how people can suddenly be pushed over the edge.

We are introduced to “Sami”, a young care assistant (who also used to be his partner); “Anna”, a middle-aged woman who suddenly ceases to make sense of her life; and his own mother, Isobelle, whose emotional strength was eroded and sapped by frustration, bitterness, and regret.

Throughout, Deary provides an open invitation for the reader to ask questions about his or her own life. Yet, at times, he also seems to warn against overthinking – when we can “become hard work for ourselves”. There is convolution in the argument.

For his mother, listening to a ruinous inner “chorus” of recrimination and doubt proved disastrous. Rumination and withdrawal contributed to her depression, the downward negative spiral amplifying the other, in a process that increasingly had a momentum and a mind of its own. More rumination and withdrawal followed. The downward pressure was relentless.

That process – of plunging depression – can happen to anybody. Alarmingly, Deary points out that there are a staggering 16,400 accepted profiles “that qualify for a diagnosis of [a] major depressive disorder”. No wonder, then, that “thinking has become its own self-perpetuating problem”.

The author is painfully honest about his own psychological struggles as an effeminate child growing up in a working-class area on the west coast of Scotland. He was mercilessly teased at his comprehensive school, mocked for his appearance, turned into a “misfit”, and easily frightened as a child.

Such essential self-exploration and introspection underlines the deeply human plea which is the heartbeat of the book: more self-compassion is needed.

There is a depth of wisdom in Deary’s regret that society has neglected the idea of convalescence. Rest and recuperation are essential, yet increasingly (it seems), withheld. No time is allowed for the recovery of strength after childbirth, illness, family problems, and so on.

For all the modern emphasis on “mental health”, not enough is really known about the points at which people “tremble” then “break” (to use Deary’s own terms).

Some fortunate, and better-adapted souls are resilient and can cope, but others fall apart, at great cost to themselves, their families, and society. Our fast-moving, hyper-active, over-connected, multi-platform, anxious way of life and existence cuts people no slack.

What we can do about all this will be the subject of the third and final book in this series, How We Mend. Until then, Deary offers some pointers: “Beware mirrors. Which is to say, beware of becoming too entranced with your own opinions, stories, and concerns.

“Beware of becoming too preoccupied with yourself to the exclusion of the world. To prepare for life by looking in a mirror is to lose sight of who we really are and what we are preparing for.”

How We Break by Vincent Deary is published by Allen Lane, 304pp

 

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Health, Medical, Research, Science

Blood test that can detect Alzheimer’s 15 years before onset

ALZHEIMER’S DISEASE

A SIMPLE blood test can detect Alzheimer’s disease up to 15 years before symptoms begin, a major trial has found. It paves the way for a national screening programme.

The trial found that the test was as accurate as the current gold standard for diagnosing the condition.

For the first time, doctors were able to say if a person had a high, medium, or low chance, of having the disease – ruling out further invasive procedures.

Experts have said it would “revolutionise” diagnosis, making Alzheimer’s as easy to test and detect as for other routine health conditions such as high cholesterol.

Patients could expect results within days of visiting their GP, rather than the years it currently takes to get a diagnosis. This could have huge implications for future treatments, removing the barriers for a diagnosis – such as long waits for spinal taps or brain scans – and speeding up trials.

It could also pave the way for screening over-50s once more effective treatments become available.

Made by diagnostics company ALZpath, it was found to be 97 per cent accurate at detecting traces of the “tau” protein, which was linked to developing Alzheimer’s disease during the eight-year trials. These proteins start to build up on the brain 10 to 15 years before symptoms start showing.

Researchers in Sweden found high levels of the “tau” protein in the blood test corresponded to high levels of Alzheimer markers seen in expensive diagnostic brain scans and painful lumbar punctures.

The more of this leaked “tau” brain protein in the blood, the more likely or advanced the Alzheimer’s disease was in the tests involving 786 people. Growing evidence suggests biomarker changes like these can be detected in the blood years before other signs of the disease appear in the brain.

It means if scientists can find a way to stop these protein levels from rising, they could effectively halt Alzheimer’s in its tracks.

With breakthrough treatments such as donanemab and lecanemab on the horizon, experts say it is vital to have quick and reliable diagnoses. Professor David Curtis of University College London Genetics Institute said this was “one half of the solution”, while we await effective treatments.

He added: “This potentially could have huge implications. Everybody over 50 could be routinely screened every few years, in much the same way as they are now screened for high cholesterol.”

Around 900,000 people in the UK live with dementia – with Alzheimer’s the most common form. The growing ageing population means numbers are expected to rise to 1.6million by 2040, making a cheap screening tool vital to get to grips with the challenge.

Alzheimer’s Research UK analysis found 74,261 people died from dementia in 2022 compared with 69,178 a year earlier, making it the country’s biggest killer. While previous blood tests have shown promise, these findings have caused particular excitement given the high accuracy levels, large study size, and because the test already exists commercially.

It is also the first time a blood test has been found to be at least as good as a painful lumbar puncture or spinal tap for detecting elevated levels of the tau protein, according to the research team at the University of Gothenburg, Sweden.

Lumbar punctures involve taking fluid from the patient’s spinal cord. The inexpensive tests – priced at around £150 – could also be used to monitor a patient’s condition, allowing more tailored trials or treatment in future.

Dr Richard Oakley, of the Alzheimer’s Society, urged that more research would be needed, but said: “This study is a huge welcome step in the right direction as it shows that blood tests can be just as accurate as more invasive and expensive tests.

“It suggests results from these tests could be clear enough to not require follow-up investigations for some people living with Alzheimer’s disease, which could speed up diagnosis.”

The tests would need regulatory approval before widespread use. But they could form part of NHS trials starting imminently and looking to roll out blood tests for Alzheimer’s within the next five years.

The scientists’ findings were first published in JAMA Neurology.

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Arts, Bible, Christianity, Culture

James urges Christians to live out their beliefs

NEW TESTAMENT

A narrative on James 1–5

IN a circular letter addressed to Jewish Christians scattered by persecution across the Roman empire, the apostle James has called for a faith that is visibly demonstrated by good works, controlled language, and steadiness under pressure. Writing in forthright terms, James warns rich landowners that they will pay dearly for hoarding their wealth and refusing to pay labourers.

He begins by encouraging faithfulness in the face of difficulty. He reminds his readers that the unchangeable God who gives wisdom to all is never the source of temptation. “The crown of life” awaits all who press on, he asserts.

Every Christian should listen carefully to, and consider, God’s truth – and then put it into practice, he says. Such practice includes treating people equally whatever their economic situation.

Wishing someone well who needs practical help is no help at all, he claims. Abraham was commended not just for believing God’s promise but for doing what God asked, and preparing to sacrifice his son Isaac.

A person’s speech is also a test of their faithfulness to God, says James. The tongue can be like a spark that sets a forest ablaze; one word out of place can do immense damage. And curses on people have no place in the mouths of those who praise God.

The root cause of all sin is selfishness and greed, he argues. Humility before God is the only safe way to live. God will judge others, and he will determine the number of someone’s days. So he urges his readers to bear in mind that Christ will return soon and not to boast, argue, or slander each other.

James concludes his letter with some practical instructions on praying for the sick and turning people back to God.

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