Vincent Deary is a clinical and academic specialist in fatigue, in the ways in which we might be mentally and physically spent by life. This book, part memoir of his working practice, part inquiry into the ways in which mental health is undone, is a sequel to an earlier volume, How We Are, published in 2015. The chronology is pertinent. The trajectory of those intervening nine years of austerity, and pandemic, and precarity, serve to make this volume both inevitable and urgent. Sleeplessness and anxiety have been among the few growth sectors in that decade. If Deary’s previous book was, just about, a meditation on how we might thrive in the world, this one is a subtle catalogue of the ways in which we fail to do so. One of his colleagues has a phrase for our prevailing psychological moment: “It’s like we are always one step ahead of the hounds.”
There is a rawness to Deary’s analysis that gives a compelling human edge to his theorising. Some of that comes from his allusions to a breakdown he himself suffered in recent years. Otherwise, he dwells on case studies of people he has met in his work, individuals whose “allostatic load” of stresses – the camel’s-back-of-straws waiting for one too many – become overwhelming. Some of these case studies are composites of patients, juggling jobs and debts and caring responsibilities and trauma and regret; two significant stories he returns to are those of his mother, Isobelle, a force of life in the world who descended in her final years into the blackest of depressions, and of his former partner, here called Sami, an NHS nurse, who has overcome sexual abuse in his childhood only to be unravelled by the uncertain shift patterns and unfair bureaucracies of his job. (Having been up all night with one psychiatric patient on suicide watch, Sami cracks when reprimanded for drinking a mug of coffee in a staff room to which he is ineligible.)
