Golgi stained neurons in the dentate gyrus of an epilepsy patient. Image: WikiCommons
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Self-awareness by numbers

What is consciousness? In the past, this question was the preserve of theologians, psychologists and philosophers. Scientists seemed unable to find a way to probe the grey matter between our ears. Now that has changed. The study of the brain has experienced a renaissance.

We are in a moment similar to that when the telescope provided a way for the likes of Galileo to explore the outer reaches of the solar system. The development of the fMRI (functional magnetic resonance imaging) scanner, techniques of transcranial magnetic stimulation (TMS) and EEGs (electroencephalograms) has given scientists a way to ask the brain new questions. One of the most intriguing proposals to emerge is that mathematics might hold the key to unlocking the mystery of consciousness.

To understand what makes something conscious, one can look at the converse question of what contributes to things being unconscious. Every night, when we fall into dreamless sleep, our consciousness disappears. So what is happening in the brain that causes us to lose our sense of self until we wake or dream?

In the past, it was impossible to ask the sleeping, dreamless brain questions. New TMS techniques allow us to infiltrate the brain and artificially make neurons fire. By applying a rapidly fluctuating magnetic field to the brain, we can activate specific regions when people are awake and, more excitingly, when they are asleep. So how do the conscious and sleeping brains respond to this stimulation of neurons?

Experiments conducted by Giulio Tononi and his team at the Centre for Sleep and Consciousness at the University of Wisconsin-Madison have shown that the brain’s reaction to TMS when it is awake is strikingly different from when it is dreamlessly sleeping. The first part of the experiment involves applying TMS to a small region of the participants’ brains when they are awake or conscious. Electrodes attached to the head record the effect using EEG. The results show that different areas far away from the stimulated site respond to the stimulation at different times in a complex pattern that then feeds back to the original site of the stimulation. The brain is interacting as a complex, integrated network.

Participants are then required to fall asleep and, once in deep, “stage-four” sleep, TMS is again applied to the brain in the same location, stimulating the same region. Unlike in the conscious state, the electrical activity does not propagate through the brain. It’s as if the network is down. The tide has come up, cutting off connections. The implication is that consciousness has to do with the complex integration in the brain.

Our gut has as many neurons as our brain, yet we don’t believe it is conscious. Is this because the neurons are not wired to have this integrated feedback behaviour? Tononi has even developed a mathematical coefficient of consciousness that measures the amount of integration present in a network. Called “phi”, it is a measure that can be applied to machines as well as the human brain and offers a quantitative mathematical approach to what makes me “me”.

Could Tononi’s phi help us understand if a computer, the internet or even a city can achieve consciousness? Perhaps the internet or a computer, once it hits a certain threshold, might recognise itself at some point in the future. Consciousness could correspond to a phase change in this coefficient, rather like the way water can change state when its temperature passes the threshold for boiling or freezing.

If consciousness is a spectrum encoded by this coefficient, measuring from the consciousness of a stone to the consciousness of the human mind, who are we to say there might not be consciousness beyond where evolution has taken the brain? The fMRI scans that have been done on Tibetan monks as they meditate seem to show that the act of meditation takes them into an altered brain state that might well be an increased level of consciousness. The brain appears to be organised into two networks: the extrinsic network and the intrinsic – or default – network.

When people are performing tasks external to themselves, such as playing a musical instrument or filling the kettle, it is the extrinsic portion of their brain that is active. When individuals are reflecting more on themselves and their emotions, it the default network that appears to be more dominant.

The interesting observation is that these two networks are rarely fully active at the same time. One side of the see-saw needs to be down in order to allow the other side to play its part in enabling an individual to concentrate on whatever task is at hand. Yet evidence from scanning the Buddhist monks during periods of meditation indicates that they seem to be able to raise both sides of this neural see-saw at the same time.

The research opens up the thrilling possibility that there are ways to increase your levels of consciousness. And so, on 2 March, as part of the Barbican’s and the Wellcome Trust’s season “Wonder: Art and Science on the Brain”, I will be collaborating with the musician James Holden to see whether we can use music to take the collective phi of our audience and turn it up to 11.

Marcus du Sautoy is the Simonyi Professor for the Public Understanding of Science at the University of Oxford. “Wonder: Art and Science on the Brain” will run at the Barbican Centre, London EC2, from 2 March to 10 April

This article first appeared in the 04 March 2013 issue of the New Statesman, The fall of Pistorius

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“I felt so frantic I couldn’t see my screen”: why aren’t we taking mental health sick days?

Some employees with mental health problems fake reasons for taking days off, or struggle in regardless. What should companies be doing differently?

“I would go to the loo and just cry my eyes out. And sometimes colleagues could hear me. Then I would just go back to my desk as if nothing had happened. And, of course, no one would say anything because I would hide it as well as I could.”

How many times have you heard sobbing through a work toilet door – or been the person in the cubicle?

Jaabir Ramlugon is a 31-year-old living in north London. He worked in IT for four years, and began having to take time off for depressive episodes after starting at his company in 2012. He was eventually diagnosed with borderline personality disorder last January.

At first, he would not tell his employers or colleagues why he was taking time off.

“I was at the point where I was in tears going to work on the train, and in tears coming back,” he recalls. “Some days, I just felt such a feeling of dread about going into work that I just physically couldn’t get up ... I wouldn’t mention my mental health; I would just say that my asthma was flaring up initially.”

It wasn’t until Ramlugon was signed off for a couple of months after a suicide attempt that he told his company what he was going through. Before that, a “culture of presenteeism” at his work – and his feeling that he was “bunking off” because there was “nothing physically wrong” – made him reluctant to tell the truth about his condition.

“I already felt pretty low in my self-esteem; the way they treated me amplified that”

Eventually, he was dismissed by his company via a letter describing him as a “huge burden” and accusing him of “affecting” its business. He was given a dismissal package, but feels an alternative role or working hours – a plan for a gradual return to work – would have been more supportive.

“I already felt pretty low in my self-esteem. The way they treated me definitely amplified that, especially with the language that they used. The letter was quite nasty because it talked about me being a huge burden to the company.”

Ramlugon is not alone. Over three in ten employees say they have experienced mental health problems while in employment, according to the Chartered Institute of Personnel and Development. Under half (43 per cent) disclose their problem to their employer, and under half (46 per cent) say their organisation supports staff with mental health problems well.

I’ve spoken to a number of employees in different workplaces who have had varying experiences of suffering from mental ill health at work.

***

Taking mental health days off sick hit the headlines after an encouraging message from a CEO to his employee went viral. Madalyn Parker, a web developer, informed her colleagues in an out-of-office message that she would be taking “today and tomorrow to focus on my mental health – hopefully I’ll be back next week refreshed and back to 100 per cent”.

Her boss Ben Congleton’s reply, which was shared tens of thousands of times, personally thanked her – saying it’s “an example to us all” to “cut through the stigma so we can bring our whole selves to work”.

“Thank you for sending emails like this,” he wrote. “Every time you do, I use it as a reminder of the importance of using sick days for mental health – I can’t believe this is not standard practice at all organisations.”


Congleton went on to to write an article entitled “It’s 2017 and Mental Health is still an issue in the workplace”, arguing that organisations need to catch up:

“It’s 2017. We are in a knowledge economy. Our jobs require us to execute at peak mental performance. When an athlete is injured they sit on the bench and recover. Let’s get rid of the idea that somehow the brain is different.”

But not all companies are as understanding.

In an investigation published last week, Channel 5 News found that the number of police officers taking sick days for poor mental health has doubled in six years. “When I did disclose that I was unwell, I had some dreadful experiences,” one retired detective constable said in the report. “On one occasion, I was told, ‘When you’re feeling down, just think of your daughters’. My colleagues were brilliant; the force was not.”

“One day I felt so frantic I couldn’t see my screen”

One twenty-something who works at a newspaper echoes this frustration at the lack of support from the top. “There is absolutely no mental health provision here,” they tell me. “HR are worse than useless. It all depends on your personal relationships with colleagues.”

“I was friends with my boss so I felt I could tell him,” they add. “I took a day off because of anxiety and explained what it was to my boss afterwards. But that wouldn’t be my blanket approach to it – I don’t think I’d tell my new boss [at the same company], for instance. I have definitely been to work feeling awful because if I didn’t, it wouldn’t get done.”

Presenteeism is a rising problem in the UK. Last year, British workers took an average of 4.3 days off work due to illness – the lowest number since records began. I hear from many interviewees that they feel guilty taking a day off for a physical illness, which makes it much harder to take a mental health day off.

“I felt a definite pressure to be always keen as a young high-flyer and there were a lot of big personalities and a lot of bitchiness about colleagues,” one woman in her twenties who works in media tells me. “We were only a small team and my colleague was always being reprimanded for being workshy and late, so I didn’t want to drag the side down.”

Diagnosed with borderline personality disorder, which was then changed to anxiety and depression, she didn’t tell her work about her illness. “Sometimes I struggled to go to work when I was really sick. And my performance was fine. I remember constantly sitting there sort of eyeballing everyone in mild amusement that I was hiding in plain sight. This was, at the time, vaguely funny for me. Not much else was.

“One day I just felt so frantic I couldn’t see my screen so I locked myself in the bathroom for a bit then went home, telling everyone I had a stomach bug so had to miss half the day,” she tells me. “I didn’t go in the next day either and concocted some elaborate story when I came back.”

Although she has had treatment and moved jobs successfully since, she has never told her work the real reason for her time off.

“In a small company you don’t have a confidential person to turn to; everyone knows everyone.”

“We want employers to treat physical and mental health problems as equally valid reasons for time off sick,” says Emma Mamo, head of workplace wellbeing at the mental health charity Mind. “Staff who need to take time off work because of stress and depression should be treated the same as those who take days off for physical health problems, such as back or neck pain.”

She says that categorising a day off as a “mental health sick day” is unhelpful, because it could “undermine the severity and impact a mental health problem can have on someone’s day-to-day activities, and creates an artificial separation between mental and physical health.”

Instead, employers should take advice from charities like Mind on how to make the mental health of their employees an organisational priority. They can offer workplace initiatives like Employee Assistance Programmes (which help staff with personal and work-related problems affecting their wellbeing), flexible working hours, and clear and supportive line management.

“I returned to work gradually, under the guidance of my head of department, doctors and HR,” one journalist from Hertfordshire, who had to take three months off for her second anorexia inpatient admission, tells me. “I was immensely lucky in that my line manager, head of department and HR department were extremely understanding and told me to take as much time as I needed.”

“They didnt make me feel embarrassed or ashamed – such feelings came from myself”

“They knew that mental health – along with my anorexia I had severe depression – was the real reason I was off work ... I felt that my workplace handled my case in an exemplary manner. It was organised and professional and I wasn’t made to feel embarrassed or ashamed from them – such feelings came from myself.”

But she still at times felt “flaky”, “pathetic” and “inefficient”, despite her organisation’s good attitude. Indeed, many I speak to say general attitudes have to change in order for people to feel comfortable about disclosing conditions to even the closest friends and family, let alone a boss.

“There are levels of pride,” says one man in his thirties who hid his addiction while at work. “You know you’re a mess, but society dictates you should be functioning.” He says this makes it hard to have “the mental courage” to broach this with your employer. “Especially in a small company – you don’t have a confidential person to turn to. Everyone knows everyone.”

“But you can’t expect companies to deal with it properly when it’s dealt with so poorly in society as it is,” he adds. “It’s massively stigmatised, so of course it’s going to be within companies as well. I think there has to be a lot more done generally to make it not seem like it’s such a big personal failing to become mentally ill. Companies need direction; it’s not an easy thing to deal with.”

Until we live in a society where it feels as natural taking a day off for feeling mentally unwell as it does for the flu, companies will have to step up. It is, after all, in their interest to have their staff performing well. When around one in four people in Britain experience mental ill health each year, it’s not a problem they can afford to ignore.

If your manager doesn’t create the space for you to be able to talk about wellbeing, it can be more difficult to start this dialogue. It depends on the relationship you have with your manager, but if you have a good relationship and trust them, then you could meet them one-to-one to discuss what’s going on.

Having someone from HR present will make the meeting more formal, and normally wouldn’t be necessary in the first instance. But if you didn’t get anywhere with the first meeting then it might be a sensible next step.

If you still feel as though you’re not getting the support you need, contact Acas or Mind's legal line on 0300 466 6463.

Anoosh Chakelian is senior writer at the New Statesman.

This article first appeared in the 04 March 2013 issue of the New Statesman, The fall of Pistorius