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Dr Nerina


Once you realise we are all mad, life starts to make sense.
This statement is on the front of a card that a friend gave to me several years ago and I loved it so much that I’ve kept it in my office where I can look at it and chuckle on a regular basis. In fact, I’ve actually been given this same card a few times by perceptive friends. Hmmm…what are they trying to tell me?
I was running my patient group yesterday at the psychiatric clinic and a thought struck me; there were 16 people in the room and more than three quarters came from City firms. So the majority of people in the room had been working in corporate environments before they were signed off work with exhaustion, nervous breakdowns, depression, anxiety and whatever other labels had been used to describe their eventual collapse. I’ve been working pretty hard for the last month or so – in and out of all sorts of professional services firms running programmes on resilience, stress, energy, wellness, but I’ve been thinking that I should rebrand my sessions with the simple title of ‘Stop the Madness!’ And it occurred to me that the ‘patients’ I was working with were the sanest human beings I’ve seen in weeks! At least they know things are ‘not right’.
So let’s talk about what’s really mad…
For the past twenty years, my consulting work has taken me into places where people wake up every morning feeling afraid because of what might have landed in their inbox or on their desk overnight, they choose to ignore their body’s cries for food and water because to put fuel in the tank takes too much time or their stomachs are simply too knotted up with dread and anxiety, they stay rooted to the same spot all day staring at a screen, forgetting to move or breathe because (yes you’ve guessed it) they have to deal with what’s in the inbox, they daren’t leave their desks at lunch time because their leaders don’t, toilet breaks are usually taken with their BlackBerries or iPhones in tow, sleep (if it happens) is punctuated by several email checks during the night (easier if you just put your phone on ‘vibrate’ and tuck it into your pillow case), holiday locations are chosen with a good WiFi connection in mind because replying to emails on holiday really is more important than gazing at an aquamarine sea, smelling the flowers or playing with your children, they run on a constant level of adrenalized, caffeinated jet lag from spending all their time inhabiting the wrong time zone - worrying about the future and what could go wrong…
Let me remind you, these aren’t my patients. These are my ‘mentally well’ clients!
This has started to enrage me because it’s not right. It enrages me when a young trainee at a law firm tells me she’s exhausted and on the verge of collapse but doesn’t know how to break the cycle because ‘it’s what everyone does.’ This could be my daughter in years to come. Last year I spoke at a City Mental Health Forum about mental health at work. I was pretty vocal about all of the above but I think it’s time for me to raise the volume. We need to stop the madness in its tracks and at the source. We need to get clear about what we’re calling weakness, or mental illness when it’s simply someone’s mind, body and spirit saying ‘enough!’ We need to stop admiring and rewarding behaviours which fuel this madness and it needs to start at the top with our leaders and their behaviours.
My work with individuals and organisations is about helping to get them to what’s really important. It’s about showing them that it’s safe to stop, to pay attention to their body’s needs, to become more conscious about the choices they are making in their daily lives at work and at home. It’s about the small things that really do make a big difference. Over the coming months I will be writing about these small things that restore our energy and motivation, help us to reconnect with safety and keep us sane.
It’s time to stop the madness. What do you think?


My father passed away in Guyana a month ago aged 81 years. This is not the first time I’ve had to cope with losing a member of my immediate family; my sister Nirvana died suddenly over a decade ago and that was hard. And my father? Well most of my life my father had infuriated me but nonetheless we were close and I was expecting that his death might hit me hard.
But something has happened since dad’s death. It started when Nirvana died but I have experienced the most profound shift in this last month. The morning after he died, I felt strangely vulnerable and alone as if I had lost my most important source of protection. Who’s going to look out for me now? But very quickly these feelings started to transform…
I have never been afraid of dying and in fact, have often felt some fascination with understanding the ‘what next?’ Many years ago I read ‘The Tibetan Book of Living and Dying’ and this was the initial catalyst. As I read I felt as if I was coming home, as if what I’d always known was being validated. I’m now reading Anita Moorjani’s ‘Dying to be me’ which is further validation of that inner knowing.
So what has brought about this shift? I believe that much of it is to do with the way in which death (at least my father’s death) was treated. My father was a Hindu so he was cremated but his Guyanese cremation was nothing like I’d experienced with my sister. Hers was a sanitised process in a crematorium in Surrey, the coffin disappearing into a hole in a wall, ashes (whose? Was it really her?) delivered to my doorstep in an urn a few days later. Being born and brought up in England for most of my life this is what I had expected. But when dad died, the ‘rawness’ of the ensuing cremation process was a shock. Everything was out in the open. His body was placed on a pallet and carried up to the crematorium foreshore while mantras were chanted. Death was out there for everyone to see. We could see his body. It wasn’t hidden in a box. My brother helped to build the pyre and lay my father’s body onto it. The fire was lit and we stood under the baking tropical sun and watched the flames engulf his body. His body continued to burn for the rest of the day and into the night. The next morning, my brother and I returned to the foreshore and chanted mantras while we scooped up his ashes (and even some of his intact bones which the crematorium priest later ground up!) to take to the sea.
This process affected me profoundly. Back in the UK, when I recounted this story to some of my friends they recoiled in horror and offered sympathy for the ‘trauma’ I’d been through. I almost bought into this story myself until I stopped and realised that it hadn’t affected me in any way traumatically. In fact, what I had witnessed and engaged in had felt indescribably poignant and absolutely right. It had felt like the best way to express gratitude and respect to this body, this container that had faithfully housed my father’s spirit throughout his life.
It also greatly affected my ability to let go of my father– I have been able to let go of his physical ‘container’ almost as if he has moved house and I now am able to visit him in another place. In this ‘other’ place, I’m getting to know him afresh and without the baggage that inevitably clouds all of our relationships (especially those with our family). Without the ‘he said this’ and ‘he did that‘ stories.
We returned home after the cremation and I lay on my bed exhausted and drifted into a deep, dreamy sleep in which I told him how much I loved and missed him. I was woken by something fluttering against my face as a tiny passport sized picture of him that I’d placed on my bedside table drifted onto my pillow.
My first inkling that dad is still very much with me came as I ran along the sea front two days after his death. As the sun rose, I felt his presence strongly as it was the place that he loved to run and then walk as he got older and his joints began protesting. Even at 5am it was hot and humid and felt like breathing butter but he was there with me and I had a huge smile on my face as I ran into the rising sun with his voice whispering in the wind, urging me on.
I know he is with me. I feel it everywhere – when I work I do so with renewed conviction, when I run I feel stronger, fear is easier to confront, love is stronger, I feel a stronger sense of who I am, my father’s daughter, me.
In 1969 Elizabeth Kubler-Ross introduced the 5-step theory of grief and loss in which acceptance is the final stage. Maybe we would be better placed to reach this final stage of acceptance much more quickly if we learn to let go lightly which I have done by using my own 5 steps. Maybe they might offer you some guidance and solace if you have just lost someone you love
1. Continue a dialogue with your loved one – speak to them, write to them. Can you get to know them again and without the stories and baggage? In doing this you will begin to explore the sacred legacy that they have left you.

2. Cultivate inner stillness and quiet – allow yourself time to be quiet and avoid the tendency of well-meaning friends and family to constantly ‘keep you distracted’. It is in this inner stillness and quiet that you will hear the ‘voice’ of your loved one.

3. Sit with the emotions and grief – don’t be afraid of them, they come in waves and pass. When you’re riding a storm just say to yourself ‘this too will pass’.

4. Don’t feel guilty about the surges of joy that you may experience. It is possible for joy and sadness to occupy the same space – I used to feel surprised when I would feel this when I saw or did something that reminded me of my sister. It took me a while to realise that what I was feeling was joy and to allow myself to feel the emotion.

5. Be kind to yourself – support yourself well. Don’t spend time with people who are uncomfortable with death and who you have to spend time reassuring. Do things that nourish your spirit and remind you that you are allowed to enjoy life. Read books that make you laugh, listen to music that makes you want to dance, take afternoon naps, meditate and pray. Read or watch things that help you to understand your grief process. I love this particular clip:
Most of all, know what makes you happy and do it without guilt – that’s what our loved ones would want for us after all.
Nerina Ramlakhan (28 May 2013)

February 2013 blog - TECHNOLOGY ON THE TRAIN

There’s no doubt that technology can make our lives easier. Just this morning it brought a huge smile to my face when I picked up my email and saw that I’d been contacted by a friend now living in Australia who I’d lost touch with and hadn’t heard from for over 15years. A lovely start to my week.
But are we in danger of getting too addicted or at least unhealthily dependent on technology? I recently read with interest the global report commissioned by Nokia which claims that, on average, people check their phones about 150 times per day.
The New York Times reports that the average computer user checks 40 web sites a day and switches programmes up to 36 times an hour.
This doesn’t surprise me at all.
Just last week I boarded the 7.49 to Waterloo and it was packed. I didn’t get a seat so I stood there; people watched and gathered my own data…during the course of the 35 minute journey, more than 90% of the people in my carriage were using iPads, lap tops, Kindles or their ‘phones. One chap close by me checked his phone 26 times throughout the journey! He didn’t seem particularly stressed, just bored.
This is a pretty accurate representation of what I have been observing for the past two decades in my clinical practice and corporate work. Years ago in a dismal basement health screening clinic in Moorgate, I noticed that many of my clients were complaining of insomnia, fatigue, difficulties concentrating and switching off which I then termed ‘Tired But Wired’ (the title of the book I went on to write two years ago). I noticed that these problems seemed to worsen as technology continued to develop and we spent more time immersed in it. At my weekly Sleep and Energy group at the Capio Nightingale clinic I’m now seeing more and more people who have become ill as a result of over-exposure to technology from City bankers to stressed out multitasking mums. The most worrying part of all of this is the number of adolescents who are turning up at my clinic with problems relating to insomnia which can then be tracked back to how they are using – or abusing – technology. Recently, I saw this starkly (and terrifyingly) with a fifteen year old who said she couldn’t sleep unless she was holding her iPad.
We need more studies like the Nokia report. We need more awareness of just how severely technology is eating into our lives and eroding the boundaries. Boundaries that enable us to compartmentalise our lives and behaviours in a way that is vital to our relationships and sanity. And I’m just as guilty as the next person because it’s so insidious, so easy to get caught up in the blurring of boundaries.
For example:

But the question is why have we become addicted or overly dependent on technology? Some of my clients say that they are so caught up in the vicious cycle that they are too tired to think or behave in another way.
I think the root of the problem is more profound than this and maybe it’s related to a simple loss of connection and meaning. Every time you experience a mini rush of anticipation at the sight of that red flashing light the brain produces a small dollop of dopamine – the feel-good hormone. This wakes us up, makes us feel good, even momentarily. This is partly what feeds the compulsion to keep picking up your phone and checking. Not just a fear of missing out on something but an inability to find ways of making ourselves in happy in a real and sustainable way.
So maybe we are looking for something but looking in the wrong place. Technology helps to fill a void but at the same time fuels the fear and loneliness and absence of true connection. We’re afraid to stop, afraid to daydream or, dare I say it, do nothing for even a few seconds. We feel this constant need to be in ‘doing’ mode, justifying our existence, forgetting that we are human beings and not human doings. We need to re-establish boundaries. We need to start thinking about regulation. While we question what we eat or drink on a regular basis, we have only now started to question what this constant immersion in technology is doing to us and most importantly, to our children’s minds, bodies and spirits.

Dr Nerina Ramlakhan
11 Feb 2013

January 2013 blog


“It’s not the mountain that we conquer but ourselves”
Edmund Hillary
I have done a lot of sport over the years having competed in over 30 triathlons and 7 marathons and every training session, every race I’ve competed in has taught me something about myself.
I thought I’d learnt everything I needed to learn about sport and the ‘inner game’ and then I fell in love with climbing…
I’ve now been climbing for more than a year, both indoor and outdoors. It was my 8 year old daughter who got me into it when we had a go at a climbing wall at a fun fair. I immediately found that years of hard physical training, yoga and dance and a decent power/ weight ratio stood me good stead. It also helped that it doesn’t really occur to me to be afraid of heights. There are, after all, so many other gremlins to overcome in life. So within a week I’d committed to climbing regularly at a climbing centre with a club called Iota Climbing with regular camping/climbing trips to Swanage, Portland, Kent and the Peak District. I loved it and couldn’t get enough of it. Not least, spending time outdoors with my daughter and like-minded people of all ages felt good.
Initially I progressed quite rapidly through the grades then things went pear shaped as my naturally competitive nature kicked in and I strove to improve. Week after week I pushed myself harder at the climbing wall, but my progress just seemed to decline. I vented my frustration somewhat impotently on the wall but the only reward for my efforts was strained muscles and ligaments, and umpteen bruises on my knees and shins. The harder I tried and the more I focused and obsessed on the goal, the worse I got. I even embarked on the infamous INSANITY workout programme in an effort to improve my strength and flexibility in the hope that it would somehow make me a better climber. This only made things worse and my climbing became jerky, less fluid and more labour intensive as I tried to bully my way up the walls
In disgust, I took a sabbatical from climbing and decided to reassess my ‘relationship with the wall’. To my great surprise and amusement I then discovered exactly what I have been teaching my patients and clients for the past two decades.
So here are some of the lessons I have learnt from climbing:
1. LESS IS MORE – I found that the more I relaxed, the better I climbed and the less I wasted energy.

In life we often apply too much effort to getting things done. This might sound odd when we live in a ‘try harder’ culture. All of my chronically exhausted clients, for example, have ended up in front of me because of they are perfectionists, trying too hard, nothing’s ever good enough. They present with bruxism (nocturnal teeth grinding), neck and shoulder tightness, stress and exhaustion which often tips into chronic fatigue. My work with them is often, ironically, about how learning how to apply less effort to achieve more. I show them how to stop, become aware of when they are getting into a state of ‘contractedness’, how to back off, breathe, release the tension and then move forward. In doing so, they begin to build intermittent rest and recovery into previously relentless days. And the end result? Greater productivity, zero burnout.

2. ANALYSIS VS INTUITION – In climbing (and I accept I’m still very much a novice), there’s a balance to be struck between analysing how you are going to climb a route and intuitively ‘feeling’ the route and finding a rhythm and flow so that it becomes a dance.

In life, and certainly in running my own consultancy for 13 years I’ve had to learn how to navigate between creating goals and trusting my intuition. Letting go and feeling the flow. Relinquishing control or at least, accepting that we don’t always have control of how we’ll achieve our goals or whether we’ll even get there

3. DON’T FORGET TO LAUGH – I’m still learning that when it becomes all about just achieving perfection, I forget to laugh. It becomes less joyful. For a while, climbing became yet another stick to beat myself up with. I am constantly learning how to laugh at my mistakes, how to embrace imperfection.

4. A LEAP OF FAITH – umpteen times the climbing wall has shown me that I can achieve what I might have thought was impossible. Just daring to reach a bit further, the impossible becomes possible. In climbing it helps to have a strong core. In life too it helps to have a strong inner core of safety, call it faith or an inner sanctuary. A reserve that we can draw on when our limits are being stretched.

5. EMBRACE THE FEMININE – my inspirational climbing instructor uses the words ‘grace, poise and elegance’ to describe how he would like me to climb (vs. the aforementioned ‘bullying my way up the wall’ technique). Most of the sports I’ve ever done have required a strong masculine approach so it felt natural to apply this to climbing. How astonishing to learn that a softer touch, letting go of over-controlling the desire to achieve, relying on feel, and, dare I say it, climbing with love versus a macho idea of ‘being the best’ could actually enhance my climbing.

6. STAY IN THE PRESENT – to climb well you have to be 100% in the present and that’s one of the things I love about it. I can’t think of anything else but the next move and my monkey mind is finally quiet.

Someone once said ‘The past is history, the future is a mystery and the present is a gift, which is why it’s called the present.’ Maybe a bit cheesy but so true. It’s so easy in these chaotic times we live in, especially in the run-up to Christmas, to constantly live in the wrong time zone (ie the future). Much of my work with stress, anxiety, depression and insomnia comes from exactly this – living in the past or the future. All we can do is remain in the present because the reality is this is all we truly have any control over. Be here NOW.

For many, 2012 has been a year of highs and lows. WIth the economic downturn, many people have found themselves facing tough challenges and uncertainty. Could climbing offer us some metaphors for how we could choose to live in 2013?


Creativity and Sleep: Things that go bump in the night

Welcome to my August newsletter.

This month I have felt compelled to look at ‘creativity and sleep’ and for at least a couple of reasons. For starters, I seem to have been going through a particular type of bad patch with my sleep over the last few months and I’ve been able to pinpoint my creative process as being the villain and secondly, I’m going to be involved in a ‘Cutting Edge’ documentary with Channel 4 about a group of sleep problems called the ‘parasomnias’ (which I think can be caused by a disruption in the creative process). More about this later.

But first, what’s going on with my sleep? Almost 2 years after publishing Tired But Wired and I’m ready to write Book 2. All the familiar rituals when I’m getting ready to write seriously kick in; finding the right journal (always a Moleskin), my favourite pen and ink cartridges. And that’s it really. All I need to do now is to show up and write. Easier said than done. Everything else gets in the way and takes precedence – well it is the summer holidays after all and the Olympics are on. But it’s as if the decision really isn’t up to me. Something has decided that it is time for me to write and write I must. Only I don’t. Day after day I ignore The Voice until eventually it chooses the route I will surely listen to and I stop sleeping. I lie there at night and the noise kicks off in my head and I can’t sleep. Well I do sleep but it’s like being stuck in an in-between world of mad music and conversations, the opening ceremony for Olympics played in reverse. I open my eyes in the morning knowing I have slept but it hasn’t felt like I’ve slept at all – just spent the whole night doing battle in my dreams.

Many of my dreams are just plain ridiculous but just occasionally, I have a gem of a dream and I wake up excited, energised and inspired. Often my dream has helped me find that elusive idea or insight that I’ve had a vague sense of but has been lodged in my subconscious.

There is a well-documented link between sleep, dreaming and creativity and in fact, many important scientific discoveries were ‘intuited’ in the highly creative dream state of REM sleep – Einstein’s theory of Relativity, Kekule’s structure of benzene. In his book ‘On Writing’, Stephen King describes how he dreams about the plot of a story which he writes, for lack of anything else to scribble on, on an American Airlines napkin. This forms the basis for his best-selling book ‘Misery’. Apparently the tune for ‘Yesterday’ came to Paul McCartney in a dream and Mary Shelley’s ‘Frankenstein’ came to her in a dream. So it seems our dreams can be very powerful problem-solving tools and sources of inspiration and creativity.

But what happens if we choose not to act on our dreams or give them the attention they ask for? Does not expressing creativity give rise to enhanced dreaming and disrupted sleep?

Well it’s always been this way for me ever since my childhood. If I don’t express, I don’t sleep and it’s really as simple as that. I also see this at my clinic and in my corporate work. At the clinic I see patients who are literally being driven mad by their creativity which is bursting to get out. It manifests as nightmares, night terrors, vivid and maddening dreams. Sadly they may end up turning to drugs and alcohol to block out the noise. Equally sadly, they may end up being prescribed medication and drugs that disrupt their dream process and health and they can end up feeling even worse. In companies I see people who are being suffocated in their ‘little boxes’ whose creative spirits are desperate to get out (I see a lot of this with lawyers, strangely enough).

I believe that creativity, if internalised, can literally make you ill, drive you mad.

Back to the Channel 4 documentary. I’m going to be working with someone who, for a number of years, has suffered from disturbing and vivid night terrors. So vivid in fact that he has ended up acting them out and throwing himself off a balcony in his sleep. His frustration is that he has seen a number of doctors who have told him he can’t be treated other than by drugs and that his condition is ‘nothing to do with his psychology’. He hates being on drugs as he doesn’t feel like himself and just feels like a ‘zombie’. We’ve spoken on the ‘phone and what immediately became clear is that here is a very bright and creative individual who needs some help. But can we do it without drugs? I think so and I am looking forward to working with him.

Sleep problems, and the parasomnias, can be caused and exacerbated by all sorts of factors from lifestyle, stimulants (eg caffeine), life events and stressors, over exposure to technology and many more. However, in some cases, I believe it can be viewed as a cry for creative expression, a simple need to sing your song. Just last week I spoke to a journalist who was interviewing me about parasomnias in children. She herself had suffered from them as a child and her 5-year-old daughter now has them too. We talked about how she can help her daughter to express through art, singing, drama or even yoga. All of these strategies have helped my younger clients particularly when they are at the ages where they are struggling to find words to express what is going on in their inner world. Getting them to do the lion posture and roaring is particularly effective for ‘getting it all out’!

I am very excited about being involved in this documentary because I know it will have important messages for so many people. I am encountering more issues with parasomnias in my work and I think it’s no coincidence that, at the same time, the world is going fast and faster and so many people are struggling to find the time and space to just be. We are locked into a world of doing, doing doing. There’s no stillness. No silence. Nowhere to stop and listen to your inner world – until it gets louder and louder and you are forced to stop and listen. At 2am this morning I got up and started writing. I’m hoping for a good night tonight…I think I’ll get it somehow.

In the meantime, here are a few strategies for you to try if you are battling with your own dreams or nightmares or if you simply want to nourish your creative spirit:

Find time and space to regularly listen to your inner world whether through meditation, journaling, painting, cooking, singing – in fact whatever creative outlet takes your fancy. You don’t need to spend 3 hours a day meditating. Regularly, throughout the day, just stop for a few minutes, breathe, come back to yourself, be mindful, be here.

Avoid thinking of your vivid dreams and nightmares as enemies. The question is ’what are they trying to tell you?’ Think of them as a friend who is on you side and just trying to offer a little guidance.

To manage noisy sleep (the simplest way of putting it), try Julia Cameron’s ‘stream of consciousness’ journaling. Taken from her book ‘The Artist’s Way’ you aim to write 3 pages every morning as soon as you wake up and before you do anything else. Over the years I have adapted the process and I don’t use it all the time – only when my sleep is really ‘noisy’. This morning I spent 5 minutes furiously writing 1 page and that cleared enough mental space for me to sit and write this newsletter.

To calm your mind and spirit, try a little pre-sleep yoga before you get into bed. I describe this in my book ‘Tired But Wired’ and it simply consists of ‘child’s pose’ to ‘legs up the wall’ pose to ‘corpse pose’. The whole thing need only take 5 minutes and you do it before you get into bed. Your sleep will be quieter and deeper.

I hope you’ve enjoyed reading this and learning more about the wonderful and mysterious process of sleep. More next month…


Six months ago Phil Smith, the CEO for Cisco in UK and Ireland, asked me to join him and 23 other CEO's in the City to form a group called the LeaderBoard. We have amongst our members Kevin Cahill (CEO for Comic Relief), Sir Roger Black and Austin Healey and our aim is to raise money for Sports Relief by taking part in various sporting events. Our first event is the Blenheim Triathlon on June 9.


As you may know, I have competed in many marathons and triathlons over the years, but for me this is an opportunity to really make a difference with my energy and efforts. I would be very grateful if you would consider sponsoring me. I'm hoping to raise at least 5K so I've got some way to go yet.

Please click on my Just Giving page to make a donation:


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