How to self-publish a work of non-fiction; pitfalls and handy tips

This year 2015 is the year I wrote my first book - a work of non-fiction entitled Stress, Trauma and Unresolved Emotion in Chronic Disease. It was, to my knowledge, the first time that someone has addressed the biochemistry, physiology and psychology together in one book reflecting my personal interests. I started research formally last September, and completed a 'how to write a book course' which , although giving me some useful tips, turned out to be a bit out of date and more geared towards those who want to get a publisher, whereas I wanted to self-publish as I knew I could get it out quicker.

1. Writing the manuscript
   I used Word which I know is not what professional writers use, but once you set up a Styles template makes producing an index (aka Table of contents or TOC) much, much easier. You can also move parts of your document around by looking in Outline view so you don't have to scroll through thousands of words.
   
   I was told that around 30 - 70,000 words was ideal - in the end mine was over 80,000 but as it was quite technical in places and needed a lot of explanation I deemed that ok. There is an important payoff between length and cost so this is important.
2. Proof reading
   I got a friend who specialises in this to do the proof-reading - don't attempt to do it yourself as you will not notice errors. Even after this was done there were still some that escaped so I would say get it proof-read professionally and then maybe read by someone you trust to see if they understand it and it makes sense.They can also point out anything that they notice that may have been  missed.
3. Kindle version
   I then went on to the Kindle self-publishing website and found a template which enabled me to copy and paste into which made the kindle pages the right size (6" x 9")is industry standard and paginated accordingly. After that it was simple to check the layout and make any necessary changes using their tools.
4. Print version
   For the print version I knew I'd have to do a lot more work; I chose to use CreateSpace which is an amazon company dedicated to self-publishing print to order books. Now, some of you may grown but it has been invaluable in the help they give you and the easy interface with amazon, which, after all is the biggest bookseller in the world. I did some research on alternatives, which work out slightly cheaper per print copy but then you had to pay more up front print costs which, since I had no idea how many I'd want, seemed not a good idea. The point after all, is not to have to order loads of books that you then have to store. Print to order is exactly what it says. They're only printed when someone orders a book and then you get your royalty payments accordingly.
   
   This proved to be quite tricky and took almost as long as the proof-reading as the system has to be re-published too each time you make an alteration to the text. So make sure your manuscript is finalised before publishing to the online tool.
5. Images
   These proved very tricky indeed - getting royalty free images is vital so either your own or ones which are clearly marked as such. you may need to search for these online and check. Also size is an issue here as in order to print well, some of the images I'd used in my kindle edition were not good enough for the printed version as the resolution must be much higher for print than for the web. In the end where I couldn't find a better quality image I had to reduce the size of the images - and keep re--publishing an proofing til the online tool accepted my version (it has some inbuilt checks here).
6. Printing
   The issue of colour or black and white is crucial - I wanted a colour print but it turned out that the cost to make a profit would have meant the retail cost to the buyer would have to be around £25 - not likely to sell well for a first-time author no-one has heard of!! So I chose to go for a colour cover (using my own artwork and again their handy design tools) and a b/w interior. It's come out fine, very clear and although I would have preferred colour of course, it still makes sense as the greyscale is quite well-defined for some of the more complex diagrams that require you to map to a key.
   
   Anyhow when I had to judge what a good sale price would be and determined £5.99 for a Kindle version £7.99 for a 300 printed page book was ok (actally this is cheap but as an unknown author I didn't want to price myself out the market). Each author needs to make this choice for themselves. you will also need to judge whether you want to give Kindle unlimimted rights to the digital version which gives you more royalties but means you can't advertise it anywhere else e.g another bookseller or on your own website.  you can reassess this after 90 days and change your mind.

The gut brain - strangely true

The gut is not just the site of your digestion it is also a key part of your immune system and the site of a good deal of the information relayed to and from your brain. It has even been called the ‘second brain’ or ‘enteric brain’ as it contains 100 million neurons i.e. more neurons than the spinal cord or peripheral nervous system combined[i]. It is responsible in no small part for how you feel; your mental state, mood and health. For instance, 95% of the feel-good chemical serotonin in your body is found in your gut. This fact has been suggested as the reason why many mental diseases have correlates in the gut e.g. autism and depression often have gut symptoms associated with them.

Vitally, via the roughly 100 trillion bacteria that it contains[1], called the gut microbiome, it contains enough bacterial DNA to produce a vast array of the metabolic products (vitamins, neurotransmitters, enzymes, and signaling proteins called neuropeptides) that our body needs to function. It has been said the human being is simply a highly evolved, complex host for bacteria  In fact, evolution has shown us that bacteria have often been instrumental to the development of the organism, as they have developed in symbiosis with us[ii]. Babies born via Caesarian section often have poor gut function as they have not been properly inoculated with their mother’s gut flora via a vaginal birth[iii]. This may cause the children to have more allergies and health issues than children born normally, including mental health problems. Given the increasing use of C-section in hospitals, and the likelihood of deficiencies being passed on from  that child when she too has baby, this has health implications for us as a society not just as individuals.

The importance of the gut in general health is often ignored. Nutrition is mostly ignored when you engage with conventional medicine. How often has your doctor asked you about your diet when discussing your mental  – or even your physical - health[2]? Having a good balance of gut flora is vital – I am not looking at purely psychological factors here as I am only too aware that the balance of your gut microbes is crucial to your mental functioning. Your gut microbiome balance is vital to functioning. Unfortunately as your microbes get more out of balance, your digestion becomes poorer, you intake less vital nutrients and your gut gets further depleted and imbalanced. Opportunistic bacteria and resident yeasts begin to take hold. Symptoms are gas, bloating, itchy, flaky skin, cravings for sweet foods, and ‘foggy’ brain. You can see it is a cycle: poorer digestion – less nutrients and higher yeasts – poorer digestion.

Figure 1 Digestive tract and immunity

 

Let’s look at one example of how this works. The gut is one of the most important sites of  your immune system – the gut wall is, after all, a form of modified skin and as such is an entry point of pathological microbes (i.e. the unfriendly type!). Hence it’s not surprising that the most evolutionarily ancient immune function (called the ‘innate immune system’), is based here. It is the essential non-specific first-line defence to invasion controlled by the release of inflammatory molecules called cytokines. These are peptides (small proteins) produced in the body which control inflammation. Continuous stimulation by bacterial structural cell wall sugars called lipo-polysaccharides activate the immune system to be in a state of constant alert, helping to keep it activated. Bacteria keep us primed!

The release of cytokines is controlled by the balance of these polysaccharides and it helps the body maintain its immunity and, via their or its interaction with the stress response, even its normal sleep pattern (they are involved with the transition to Rapid Eye Movement sleep from non-REM sleep). This is important for dreaming and restful sleep. So, the balance of your gut flora influences your immunity and the quality of your sleep; therefore both directly and indirectly affecting your health using bi-products of their metabolism. This leads to the perhaps surprising conclusion that bacteria are essential to our physical wellbeing.

However, they also govern the balance in your mood and anxiety levels via the serotonin and other neurotransmitter levels they produce. Surprisingly most of the serotonin in your body is found in your gut. This is why when we increase levels via anti-depressants (the SSRIs like Prozac reduce re-uptake) you often get gut problems as a side-effect; oo much serotonin is just as much of a problem. So gut flora are vital for mental health too.

Another factor influenced by your gut bacteria is the permeability of your gut. With a standard western diet (also called the ‘standard American diet’  (SAD) in the US), your ‘bad’ bacteria are encouraged to overgrow which can cause the cells in your gut to become ‘leaky’ i.e. the gaps between the cells instead of having ‘tight junctions’ as normal, develop gaps. If you were unlucky enough to have childhood infections and were then prescribed extensive antibiotics these can affect gut flora for life too and exacerbate the problem. Antibiotics are non-selective about which bacteria they kill – the same is true of ‘anti-bacterial’ handwashes which are highly damaging to the gut.

Toxic bacterial overgrowth can encourage auto-immunity as undigested protein fragments (peptides) and toxins are able to penetrate through the gut wall causing the body to react with an immune response to food as if it were an invader. The cells in the gut are meant to be a semi-permeable barrier, finely controlled so as to only allow certain things in. When this control fails by the cells being permanently open, the barrier is broken and disease may result. Excessive permeability has been implicated in such definitive auto-immune conditions as diverse as coeliac disease, multiple sclerosis and chronic fatigue syndromes.

So, leaky gut syndrome is a precursor to many diseases as the gut is key in regulating so many bodily functions. In addition to the direct effects on immunity and inflammation, there are more factors in gut functioning that impinge on your health. The short-chain fatty acids (breakdown products of indigestible carbohydrate in your diet produced by your gut bacteria) are epigenetic regulators[3]; that is they help to control what genes are expressed in the cells. These epigenetic effects of the gut flora help to explain why each of us reacts differently to our environment – since each of us has an individual gut flora we have a unique response to the external environment. Those with a healthy gut not only have a healthier immune system but digestion and metabolism work better, with more nutrient availability, more accurate genetic regulation and intercellular communication. It can’t be overstated how important this is for brain function, especially in the area of pain response.

Although we are all familiar with the idea of ‘gut feelings as a source of information, we are seldom aware how vital the gut is in central nervous system (CNS) function. The enteric (gut) brain really does exist and it is just as important as the brain in your head. Stress (whether conscious and acute, or unconscious and chronic) alters the balance of your gut flora via the release of hormones like adrenaline and cortisol (from the adrenals) and cytokines produced by bacteria. The self-regulating system is sent haywire and the results are systemic (i.e. throughout your body). These findings are so important, the study of these interactions now has its own field

This is an extract from my book Stress, Trauma and Unresolved Emotion in Chronic Disease.

 

See here to purchase copies (digital or paperback)

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[1]10 times the amount of cells in your body! The combined gut flora has been called the ‘third brain’. Gut and brain start off as the same tissue embryologically. They then differentiate into central and enteric nervous systems. The enteric nerve cells are considered part of the autonomic nervous system in some newer definitions, see polyvagal theory later in the book. Brain, Gut, Microbes; First Second and Third brain.

[2] While writing this book I had a free GP health check organised by the NHS. The nurse did not physically assess me (apart from to weigh me and take a blood test). She asked a little about my diet and exercise but it was very general and no advice was given to reverse my hormone imbalance.. What an opportunity missed to educate people about health.

[3] ‘Above genetics’. It means there is another layer of control above what DNA you have. It is a very exciting development in biology. See the epigenetics section for more information.

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[i]Hadhazy, Adam.(2010). Think Twice: How the Gut's "Second Brain" Influences Mood and Well-Being. Scientific American. February 12

[ii] Yatsunenko, et al. (2012). Human gut microbiome viewed across age and geography. Nature, 48 6(7402), 222–227. doi:10.1038/nature11053

[iii]The Human Microbiome: considerations for pregnancy, birth and early mothering. January 2015 http://midwifethinking.com/2014/01/15

Bowlby's Attachment theory, trauma and scientific dogma

Was very honoured to attend a lecture yesterday organised by the Hampshire Association of Counselling and Psychotherapists (HACP) featuring Sir Richard Bowlby the son of the eminent psychiatrist and researcher who, together with Mary Ainsworth, developed attachment theory of human development. I cover the significance of this theory in my new book but it was great to hear it 'from the horses mouth' so to speak via his son. It's interesting that his theory was so radical at the time (and very contrary to the current understandings of human mind of his supervisor and senior colleagues) that he almost failed to pass his psychiatry exams! Until then it was though that any behavioural problems with children were due entirely to failings in the brain of that child rather than as a direct response to their environment (and specifically their bond with mother). It was a radical departure to suggest that the infant brain was affected in its development by the degree of attachment to the mother (and later the father).

Mary Ainsworth, (who, typically, is often missed out in the official record), developed a practical test called the 'Strange Situation' to monitor the behaviour of very young children (typically less than a year old) when a stranger enters the room, and later the mother leaves. They identified 2 distinct patterns (later expanded) - securely and insecurely attached. We watched videos of these experiments and close-ups of the children's faces which would search their mothers eyes for clues to whether this was safe or unsafe. Children who are securely attached (i.e. have bonded with their mother who is attuned to their needs) will seek close proximity and refuse to be comforted by a stranger. Those insecurely attached will dissociate (show by a wide eyed look of pain but numbing) and play disconsolately with their toys instead and show no relief when mother comes back. It is a telling moment because these bonds and their behavioural adaptations remain with us for life.

We can become avoidant of close relationships because we are not sure we will be rewarded/comforted or clingy where we feel imminent abandonment so ask for constant reassurance.
I was so interested to see the neurological consequences are being considered finally.

In the afternoon Richard presented the results of a pilot study conducted by another researcher Jane Sherwood who has proposed that early trauma across the generations of the maternal line may predispose to Alzheimer's Disease (AD) and dementia generally. It was fascinating stuff. She's written a book called  'In the shadow of Loss'. Richard was careful to say there were flaws in the study as it was small and privately funded but nevertheless with 120 participants and a clear pattern of association, not to be dismissed. Indeed I think we may be able to point to a  method of transmission. Mitochondrial DNA is passed from the maternal line and is intimately linked with the cell danger response when stress (environmental including attachment trauma) is present. This switches off the efficient energy production cycle of the mito's into a low energy pathway. We know that AD results in protein tangle accumulation in the brain but not everyone who has these gets the disease. Could it be that trauma is at the heart of this disease too.?

Richard was clearly in the shadow of his father but sensibly has decided to dedicate his life to further promulgating his ideas while not taking any money for doing so (remarkably his career has been designing racing cars!). So we were privileged to hear the latest research and without having a/ travel to London or b/ pay a fortune. Thank you Sir Richard and the HACP.

Human Givens

Read an article written by the Human Givens originators Ivan Tyrell and Joe Griffin on depression - was really interesting - I realised 3 of my human needs are not being met right now with the problems I've been having with my clinic not being watertight (= secure) despite being busy:

• Security - safe territory in the home (read home AND work here)
• Volition - a sense of autonomy and control over what is happening (I have no control whatsoever - unless it's over my response)
• Competence - a sense of achievement (although met in other ways i.e. professionally I feel really incompetent when it comes to looking after the building. I can't solve it and I spend all day and night worrying about it.

So, my sleep is permeated by awful dreams which leave me exhausted. Human Givens have a theory for this too which is that dreaming is a necessary discharge of the Autonomic Nervous System (ANS) in order to balance what has been denied during the day. Too much REM sleep and not enough slow wave which is responsible to restoring the immune system and cellular health. How interesting.. That explains why I wake exhausted and still 'wired' despite loads of dream sleep.

They have developed an 'expectation theory of dreaming; "dreams, as we shall see, is nature’s way of metaphorically discharging the autonomic nervous system (ANS)  of accumulated expectations we got worked up about during the day and did not deactivate by taking action in the real world. Emotions, we know are both motivators to DO something (from the verb emovare 'to move') and our greatest intuitive connection to our own truth. The problem is when they get stuck, as in depression, and we feel powerless to change them, our innate needs are not being met and the ANS gets set into fight, flight or freeze which sends us into a downward spiral of rumination and fear. This is the essence of depression and anxiety and it explains why it feels so physical; there are very few physiological processes that aren't affected by the ANS: immunity, metabolism and digestion being just some.

In some ways the Human Givens ideas are very much in parallel with my own that I detail in my book: Stress, Trauma and unresolved emotion in Chronic Disease. But my approach is probably more geared towards the body than this purely psychological framework would have it.

Great British Bake off - a multicultural phenomenon

Well we're nearing the final of this incredibly popular TV show.. how to explain it's popularity? Sure, it's a competition and the nerves are jangling as you watch the highs and lows of the various challenges. But, I think, more appealing, is the ability of 'ordinary' people (albeit superb bakers) to raise themselves and their art week after week with humour and emotional honesty. Of course, it's great TV, and edited no doubt to keep us hooked, but I for one think it's done more for tolerance and understanding of what it means to be an immigrant to this country (2 of the 3 remaining have families from other countries) including a British born Muslim woman who wears a headscarf and a 'hearthrob' man of Indian extraction.

Here's the phenomenon - we can identify with people as people regardless of race and see their common humanity - through the medium of cakes! Riveting stuff.

http://www.bbc.co.uk/news/entertainment-arts-34423035..

The scar that won't heal

Today is a very important day. It's the day after I uploaded my book to Kindle - a year's work and a very intense year it's been. Not only did it take a year's writing to get the 85K words, but then there's the proofing (thanks to the stalwart efforts of a friend), references and booklists to compile, getting someone to write the forward and so on. The book was actually written about 2 months ago but all the rest took a long time to complete.

During this time of writing and fretting, I've also been struggling with some personal issues which has entailed me getting quite anxious in a way that hasn't occurred since my last bout of depression 15 years ago. Initially all was going well but sometime around August my clinic (which is a conservatory at the back of my house) developed a leak. After heavy rain a stain would slowly make its way from the corner of the room and fill the air with the smell of damp plaster until it dried out again with the sun. Now, under normal conditions I would just call in the builder who erected it and demand reparations. But he is not to be found.. And I have no written guarantee despite months of requesting it. Beware a builder who can't/won't respond to your requests for things in writing!

So I called in another builder who has painstakingly worked backwards from the most likely cause to the least, repairing and making 'good' various badly done bits from flashing to the roof. After each repair comes the hope, then dashed after the next rainstorm. Finally this last weekend I admitted to myself my reaction has been so extreme, that I need therapy. I can't sleep when rain is due, my guts churn, my chest feels tight. I can't sit still, or eat for worry - and it feels like a personal attack when that stain comes back time after time..

So, of course it's no co-incidence then that my book is called The Scar the won't Heal; Stress Trauma and Unresolved Emotion in Chronic Disease'. Perhaps in the writing of it, I have touched upon some of my most painful memories, including the death of my father at 19. In EMDR (Eye movement desensitisation and reprocessing) therapy this week, it was this that came up. My feelings of abandonment when he died, and that I was somehow responsible. How strange! I know logically this isn't true but my emotional brain believes it, and the issue of fixing the leak has become a cipher for what I couldn't achieve 30 years ago. I had no control then and I have none now.  And both things seem to threaten my sense of self in a way that sounds ridiculous but nevertheless that's how my body is reading it.

So, it's really been a case of 'healer heal thyself' and I have tried to see this time as an important reminder of how illogical emotional memory formation is and how it affects us in later life if triggered. Which is exactly what my book is about - and how this can translate into anxiety, depression and chronic pain, IBS, TMJ, etc. So the universe has given me another swift kick up the backside to look at myself and deal with my stuff so I am in a better position to help others deal with theirs. Onwards people. Oh and please god I get the leak mended soon. Driving me crazy. Literally.

Highly Sensitive People and Business

As I've nearly finished reading the Highly Sensitive Person by Elaine Aron (and what  a great book it is!) I thought I'd put my thoughts down about how this relates to me (definitely an HSP) and those of us who are working as therapists, counsellors, health workers, etc. It seems to me that most of us are that category of easily over-aroused people who therefore prefer to be our own boss, having quiet time away from the hubbub, and avoiding the strident dominant types who tend to run corporations and, increasingly these days, public life (including service sector and local government, education, etc), According to Elaine, about 20% of people are born this way, and the only way they can survive and thrive is to create an environment that fits this personality style. Well, I seem to have done that.
Working with clients is a very introspective process, but as we need people it is also a chance to contribute and make a difference in life without the over-stimulation that high pressure sales, or self-promotion that entails.

However the downside to this I've found is  though we're very good at the therapy bit, we're less confident around marketing and promotion which we largely leave to others or completely. Hence there are a lot of us out there seeing maybe 3-10 clients a week, making do. If, like me you're also running a small therapy business then maybe you'll recognise the following scenario:
You know you're rubbish at the marketing. you want more clients but you hope they'll just come to you. You see an ad for 'how to market your therapy business/ conquer social media/ find your inner salesperson and you sign up. you do the study for a while, you apply a few of the ideas (which are usually sound) but, because they put you in the uncomfortable position of being 'out there' selling yourself, you soon lapse and fall back into your own routine. Another course wasted. And of course there is no shortage of courses...

It seems to me that there are lots of 'A-type' driven people out there selling courses for how to be more like them to those of us sensitives who know we can't do it. After my last course (about the 8th!) I vowed to do no more. It's not that I don't think it's a good idea to focus more on marketing myself. I just struggle because it's not 'me'. It feels all wrong. I try but it  comes over as inauthentic and that's how I am perceived. So, I've decided I'm not going to do it their way. I'm going to write a book, do my PhD and develop myself steadily, with focus but no rush. It saddens me to think there's so many of us therapists out there doing good work but most of us feel inadequate in some way cos were not out there selling our latest juicing package or social media marketing techniques. And yet, we do ok. Truth to tell, we don't want to be seeing 40 clients a week like the courses tell us we should be. We want to do what we do but not to overstimulate ourselves with sales targets and radio interviews and accolades. I say that knowing that there are some therapists out there who do and good luck to them. I see them making great headway, helping more people, that's great. But I have to accept who I am, not because I don't want to get better or improve my lot, but I don't want to do it their way. I want to do it mine. Slow but steady.