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Do You Tell Your Boss? 13/11/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Explaining Depression,Function,Managing Depression,Work — jillnottelten @ 11:28 pm
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If you have a mental illness do you tell your boss?

Are you obliged to tell your boss?  Why or why not?

With discrimination rife in society and difficulty getting friends and family to understand what you are going through, what are your greatest fears in the workplace? Or the study environment?  Or wherever it is you spend most of your productive time?

Does your illness affect your ability to do your job at times?  In what ways?

Does your boss know?  Do any of your colleagues? What led to them finding out?

Whether you are studying or working always consider ahead of time whether you are prepared to disclose your illness.  If your current position is non-disclosure, consider carefully any occasions which might arise which might make it more necessary and under what circumstances you may disclose if at all.

Disclosure is always best done in a planned manner.  You should have some idea what you are going to say, how you want to say it and how you are going to explain its relevance to your work.  If you need some adjustments to your work conditions or some time off, it is best for you to come to your boss with some options that you have considered and reasons for your request.  You need your boss to understand that you wish to be healthy and productive as possible and are trusting them so that they are able to best support you to reach a goal that is in both of your best interests.  A large proportion of ‘Western’ countries, including Australia, provide legislation to support your right to this.

When you plan what to disclose think in terms of how you are affected by your mental illness more than your diagnosis.  You may, in fact decide to disclose only the effects of your illness and not your diagnosis, stating that you have “a condition that affects …”.  You may identify symptoms or you may simply describe what it does to you and how that affects your work eg my condition means that I have less energy than I used to have.  This means that I have to be careful how I plan my time and that I have to take holidays at regular intervals throughout the year to maintain stable health.  I need to be careful to use my meal breaks and leave on time so that I don’t become over-tired.  Or my condition means that I need to take medication.  When I change medications, sometimes I am more sleepy than usual and over-sleep or become very drowsy in the afternoons.  Sometimes my speech even gets slurred and I sound a little intoxicated.  So if I’m changing medications I need to take a week off, otherwise I find that I’m coming to work late all week and I sound as though I’m tipsy for half the afternoon and I don’t get much done and am at risk of making faulty decisions or overlooking things because my head is all foggy – especially in the first few days.  After that I will be fine at work again, but might over-sleep a couple of times in the 2-3 weeks afterwards while my body gets used to the new meds.  It doesn’t happen very often.  I’ve only needed to do it 2 or 3 times, but each time I’ve been glad that I did.

You do not need to disclose specify personal or medical information if you tell them about anything at all.

You should also think about when to disclose.  That is – when you are applying for a job, before a job interview, during the interview, after you have been offered the job and before starting, during the time you are employed after you have worked there for a while, if you become unwell and need to or never.  There are pros and cons of disclosing at each point of the way.  Sometimes your circumstances will have presented you with little choice to prevent awkwardness – you may have become unwell at work and have it become obvious that something was wrong or you may have symptoms that you are aware will soon become obvious if arrangements aren’t made to cater for your needs.  Again, despite prejudice and stigma in some places you have legal rights to have your needs and confidentiality met and protected within your workplace in most western countries.  Further, in Australia at least, if you become unwell because the employer failed to attend to your needs having been made aware of them, you are entitled to compensation under work cover.  It is however, worth serious consideration whether or not you are going to disclose because unfortunately discrimination does still happen and there are people who do fail to respect privacy and you never know where they are until you find them.

Some helpful things to consider at each stage of the employment continuum.

Prior to interview

Why you might …

  • You are able to to discuss the organisations policies and support resources when exploring the prospective position
  • You are able to get an idea about your employer’s predisposition to your needs from the word go.
  • If you have restrictions on any key job criteria due to temporary limitations because of recent relapse/graded hours return to work plans.

Examples of Why you might not …

  • Risk of discrimination influencing whether or not you get an interview.
  • No work related needs arising from your mental illness.
  • You don’t believe that they need to know/believe it irrelevant to job.

At the job interview

Why you might …

  • You are able to address people after creating a positive impression of yourself and demonstrating your capability.
  • You can gauge their understanding of your meaning and clarify appropriate questions about your needs.
  • You are able to discuss with the employer positive traits that you bring to the team that you have learned through your journey of recovery.
  • You are able to discuss your needs and what your potential employer would be able to accommodate or explore during the interview process.
  • You can brief them as to whether your referees are aware of your condition and how it affects your work and offer consent to discuss previous workplace arrangements with other employers if they have gone well.

Why you might not …

  • Risk of discrimination in job selection.
  • You don’t feel that you have needs that require accommodating or can manage them without support from your employer.
  • You might worry about where information gathered by panel members will go and whether people are trustworthy to maintain your privacy.
  • Concern that even if you get this job, opportunities for advancement could be limited by poor understanding of your illness.
  • You might be well and consider it unnecessary at this point in time.
  • You might not want to distract the panel from thinking about your abilities by talking about areas of need.

When contacted with an offer of employment

Why you might …

  • You are able to discuss your needs without risk of missing out on the job due to discrimination.
  • You can arrange to enter the work place with a plan in place that accommodates your employment needs and commence as you mean to continue.
  • If required and with your consent, the employer can arrange appropriate mental health sensitivity workshops for managers or staff by organisations such as Beyond Blue or circulate general anti-stigma/population health information among routine organisation circulars, yet not make it obvious that it was for your benefit.
  • Allow development of appropriate support and mentoring systems.

Why you might not …

  • Fear of stigma, gossip and/or discrimination.
  • Currently well and don’t feel that you are affected at work.
  • Work does not need to know.
  • Protection of positive image and opportunity for advancement.

During the course of your employment

Why you might …

  • You decide that your employer is trustworthy.
  • You become unwell.
  • You encounter difficulties or are not performing to standard because of symptoms or medication side effects and need to offer reasonable explanation or require support, alternate work arrangements or time off for medication reviews etc.
  • You are being harassed or bullied.

Why you might not …

  • It might not be necessary.
  • Protection of positive image and opportunities for advancement.
  • It might result in harassment and discrimination.
  • You are able to manage your needs without workplace support.

Never disclosing

Why you might …

  • Protection from gossip and discrimination.
  • Protection of positive image and opportunity
  • Privacy
  • Stable health
  • Lack of necessity

Why you might not …

  • Difficult to prove entitlement to compensation in case of illness, relapse or deterioration due to failure of workplace to meet needs for psychological health if they were not disclosed.
  • Relapse or need for hospitalisation might put your job at risk.
  • Might discover a positive attitude to mental health issues within workplace.
  • Legal obligations under occupational health and safety act where specific work related tasks are affected resulting in serious risk issues.

What did I do about disclosure to my employer with my job?

For me it was simple.  I told mine.  I disclosed at interview.  I felt that this was necessary because I had taken my previous job without learning to manage my mental health well and my references would have reflected that in the answers to some of the standard questions that interviewers ask referees no matter how careful the referees were.  I chose to take control of this situation at the time of my interview because having reached interview I could present myself as a competent individual in person, demonstrate that I was healthy and create a positive impression before and whilst disclosing.  I also needed to disclose because I wanted to work less hours than the position entailed and needed to offer a good explanation.  I told them that I had depression, how it affected me in terms of energy levels, concentration, seasonal patterns, medication changes and how I managed these things to be able to work.  I spoke of arrangements that I had previously made with my former employer that had been helpful and asked if they would be amenable to such strategies.  I also used the opportunity to tell them things that I had learned and accomplished through the experience of working, the determination and dedication that it entailed and the commitment to my job that resulted so that I could achieve personal satisfaction through working.  In my case this had a positive effect and outcome, although it doesn’t always.  I don’t disclose before I have the chance at interview to sit down and talk with the employer so that I can get a gauge on how they are reading what I am telling them and to avoid preconceived assumptions about what I will be like that are difficult to shift.  There are always risks associated with disclosure, but my reasoning is that if they are going to discriminate when I am well, I would rather not have to deal with them if I were to relapse.

When I am in the workplace I lay low for a while and watch what goes on around me.  As long as they are not untrustworthy, I tell someone if they are closely and directly affected by my health so that they are not left in the dark if I have to take leave at short notice.  That’s usually only one or two people.  Often they are among the first to notice that I am off my game,  so it can work in my favour because when someone who I work closely with starts asking if I’m okay and comments that I’m not myself before I notice anything, it gives me a cue to step back and check my early warning signs and triggers.  Over the course of years there have been a couple of people who have learned how to pick my good and bad days at least as well as I do myself and also to support and accommodate me through the bad ones and to lean on me in return when I’m good.  I’m pretty limited in what I disclose to start with, but with proof of worthiness comes more trust.

My current situation in my new workplace is new to me.  I have always had employers who were fiercely protective of my privacy before.  I have little in the way of evidence about my current manager, only the report of one other worker about two specific occasions of breached privacy.  I have, however worked in a place where it has been possible to work with my information kept private and so I am prepared to stand for my rights in both privacy and in workplace accommodation now.  If I expect the respect of others, there may be times that I need to stand up and remind them what it entails.  This is however new to me and the workplace is one with strange dynamics.

I have included in the Fact Sheets menu this week a document called “Choosing Your Path.  Disclosure: It’s a Personal Decision“.  It’s about disclosure of ‘disability’ (or illness) in education and training after High School and employment and the processes of application, entry and engaging in the roles.  The booklet discusses legal issues, reasons why one may or may not disclose at various stages of training or employment, responsibilities and some of the considerations to ponder in making your decision.  Also have a look around the Beyond Blue website as they have a number of resources for work sites and managers as well as fact sheets about telling your employer about your illness and maintaining good mental health for tertiary education students.  Lastly, I have listed a book called “Tackling Depression at Work” in the Books menu.  I’ve not yet read this one, but it was written by reliable people and has been well reviewed so should be worth a read.  I have listed the book at the publisher’s site, you may or may not be able to find it cheaper elsewhere if it interests you greatly.

 

Arch-Enemies 02/11/2011

Filed under: Depression,Experiencing Depression,Function,Managing Depression,Mindfulness & the Senses,Monitoring early warning signs, triggers & Wellness action Planning,Routine,self-management strategies,Therapies,Work — jillnottelten @ 4:33 pm
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Do you have arch-enemies?

I do.  Mine haunts me.  I can never seem to beat it.

There are the odd occasions when I do really well against it and I win.  It feels great.  I could walk on air.

Sometimes they last for a short stretch of time – a few days, a week – two if I’m lucky.  I could fly.

And then

it all comes

crashing

down

in

a

great

big

thud.

OUCH!

And it’s not just me who is affected.

It’s not a small thing with small consequences.

What happens, you ask?

Okay I’ll ‘fess up.

I don’t wake up.  Or if I do – I drop right off back to sleep before I can haul by backside out of bed.

Then I am late for anything that I have on for the day – visits, appointments, ….work.

And we’re talking regularly 30 – 40 mins late during the mid spring and autumn – and every now and then it’s a couple of hours.  It affects other people when that happens – workers, patients … if I don’t get my work done it slows down the process of referrals going through, information getting to people in hospital and their treating teams for planning, people going home.  It means groups can’t run or other people have to cover me.  I nearly lost my last job over it.  Even when well I’m often 10 – 20 mins behind my start time.  I survive because I start before my boss and I always work back – but I can’t keep it up.

And it doesn’t seem to matter what time I ‘m supposed to start – I’ve adjusted starting times.  It’s simply the process of getting out of bed and waking up in the morning.

Once I’m up, my sensory routines are helpful.  I’ve started to experiment with some mindfulness exercises when I get time – which help a lot.  But actually waking up and getting out of bed is jolly hard work.

The other thing that happens to me is that I lose time in the mornings.  I do.  Even when I’ve gotten up on time and have been running on time something happens – I space out in the shower or getting myself a drink and meds and time just vanishes.

I started a new experiment earlier this week that I think holds promise for the latter issue – I’ve started using a mindfulness breathing meditation exercise as soon as I get up that goes for about 10 mins to raise my level of alertness.  If it keeps working at keeping me focused, I’ll be writing about that in a couple of weeks.  But for it to work – I need to get up in time to have time to do it.  It doesn’t need to be earlier – because I’ve worked out that I do everything else more efficiently when I do it.  But I need to get up.

Sleepy-head

At present I use two alarm clocks set 5 mins apart – one to arouse my attention if I am in deep sleep so that by the time the second goes off I won’t sleep through it even if I sleep through the first.  Part of me wonders whether it’s worth investing in a bed vibrating alarm clock – they make them for deaf people.  It might be uncomfortable enough to help me move out of bed more easily.  Has anybody ever used one?

I know the rules – go to bed early and get up and the same time every day.  I’m awfully undisciplined at doing that.

Take your meds at the same time every day.  I tend to get lazy and just take them on the way to bed – which admittedly is probably half of the problem.  There are some very sleepy meds among my cocktail.

Every day is a new day with no mistakes in it – yet.  Thank you, Anne Shirley – but other people remember and I need to work out the best way to deal with their memories and keep myself focused on the present so that I don’t drown in fright.

So here it is.  My arch-enemy.  The alarm clock.  That moment in time that I’m supposed to get up.  To get moving.  To get started with the day.

Please – anybody with your own ghouls – what helps you haul yourself out of bed every morning?

 

Depression? … No, it’s not just … (sigh) … Forget it … 12/10/2011

Filed under: Experiencing Depression,Explaining Depression,Managing Depression,Medication,My Black Dog,self-management strategies,Social Supports & Networks,Talking About Depression,Therapies,Work — jillnottelten @ 5:30 pm
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If there are around 7 billion people in the world, then I reckon that there are about 7 billion ways to explain depression.   Seriously.  Everyone is so different.  Just when you think you’ve nailed a way to explain what it is and how it affects you, you come across someone for whom that explanation just doesn’t cut it.  Now, I know that it’s not necessary to tell everyone what is going on.  It is not everyone’s business and not everyone even wants to know.  But sometimes it’s necessary – and necessary that they have an understanding of what depression actually is rather than just what they assume it to be.  If someone is going to support you, live with you, take your sickness certificates seriously when they start piling up or you relapse in the work place – they need to understand more than just what they see at surface level.

So how do you get there?

How do you explain that you have this black dog that is constantly with you, even when under your command and at heel?

How do you help someone get past the idea that you could just put mind over matter if you wanted to?

How do you convince your boss that you’re not being lazy? Or taking sickies?

How do you convince your grandfather who is not very aware of mental health issues that you are not a hypochondriac?

Do you find yourself getting into arguments over these things?  Being left feeling guilty and doubting yourself because of the things that people say?  Feeling frustrated and defeated because they just don’t understand? Or just feeling out of your depth explaining the nature of depression, it’s causes, what perpetuates it and what helps to treat it and to support your recovery? You are not alone. Do you struggle to understand these things yourself?

The first step in becoming more confident explaining what is happening to you to someone else is to become more confident in your own understanding. Write down what you know.  Organise your ideas under headings like

My Diagnosis (there are different types of depression):

Definition of diagnosis and Symptoms:

Body chemistry:

Thoughts (ie what it does to them, not necessarily yours although you may include a couple of less risky examples):

Behaviour (ie what people do because of depression):

Effects on function and everyday life:

Treatments that people use (ie medication and therapies):

Treatments I use: How well my treatments are working (and if you are thinking of trying any others some time):

Things recommended to help recovery:

Things that I do/am doing:

Things that are recommended for carers/supporters/workplaces who are supporting people who have depression:

Resources that I have found that might be handy to give people:

How did you go?  Where are the gaps?

The next step is to dig around and fill in some of the gaps in your own mind.  Make a list of the questions that you still have.  You don’t necessarily need to have them all answered before you talk to someone about your depression – but they are there for you to follow up on for your own benefit.  Sometimes you can also make a joint venture out of finding the missing information with the person you plan to talk to if they are someone who you trust.  If anyone would like me to work through a series on these or to post any heading in particular I’d be happy to include something like this in future entries.  Please put any suggestions or requests in the comments section for this post.

When you have thought through these things for yourself and written them down – if you come to a time when you need to pull your thoughts together for an explanation it is so much easier to do. The next thing to think about is this.  What type of person or question are you dealing with?

People like your grandparents and some parents have been brought up in a generation where sickness is seen in form of a disease or medical issue – so with them, I would start by explaining to them the aspect of depression caused by biological factors and that it’s an episodic illness.  Perhaps I would give them some information to read, or would talk to them and describe what happens – maybe draw a diagram of a synapse and show them how my neurotransmitters are out of balance.  Then I would tell them the symptoms that causes and how they affect everything else.  Then I would go back to my drawing and show them how my medication works and talk to them about why I need to keep on taking it.  If they were interested and wanted to know more about my treatment, I might also explain that I go to a psychologist to learn techniques to overcome other symptoms too because they have become fairly stubborn and I get lost in them at times – but that I don’t expect that this will be like the medication, and it’s not like lying on a couch talking.  It’s about learning specific skills and having time limited therapy that has been show in the research to be very effective in strengthening recovery and preventing relapse.  I might then tell them about my goals and what I’ve been working on and how things are going.  Lastly I would talk to them about what kinds of things experts say that family and friends do that help.  If they wanted something to look at for more information, I would try for something from a doctor or official health site, in large print if I could find it.

Your boss might need a medical kind of approach too.  With them I would also look for information for employers on one of the mental health support websites.  BeyondBlue has a good one (http://beyondblue.org.au/index.aspx?link_id=7.980&tmp=FileDownload&fid=1176 ).  It has another one about whether or not to disclose if you are considering the decision (http://beyondblue.org.au/index.aspx?link_id=7.980&http://www.beyondblue.org.au/index.aspx?link_id=6.1068&tmp=FileDownload&fid=356 ).  I would stick to workplace issues only and be clear about how your efforts are going in relation to getting or staying on top of your work.  Make sure that you are clear of your work place rights.  If you are in Australia, BeyondBlue spell them out more specifically or direct you to a source.  I’m not sure where international readers would need to go.  Mr Google would, I’m sure.

For siblings and friends – it probably depends upon how they relate.  Some will understand best if you describe it by its symptoms and numerous courses, some will need a scientific approach, others will need an explanation of the treatments that they see you taking and using as an entry point.  Usually family and close friends want to know what they can do and feel frustrated when they feel helpless.  It’s important to make sure to give them information about your symptoms, your treatment, what your doctor thinks is causing it and what they can do to support you.  Sit down with them and talk about what helps if they are involved in your life.  If they are not talkative people, gradually feed them things to read.

I’m not going to talk about young to school-aged children here because I want to talk to a friend who is a specialist in this area and do a special post specifically on this topic at another time.  However, for adult children my advice is similar to that which I have written for siblings.  Generally they want to feel that Mum or Dad is okay.  Yes, it’s strange and they start hovering as though they were the parents and can get overbearing at times.  Other times they may be so caught up in their own lives that they don’t even seem to notice.  In both cases, it’s important that you are ready to educate.  If you don’t have the energy for the conversation, young adults will respond to websites.  Sending them to http://www.beyondblue.org.au , http://www.blackdoginstitute.org.au and http://www.scottishrecoverynetwork.net will get them well oriented to Depression, treatments and some people’s experiences stories if they look around.  There are also great resources there for family and friends.  Then they can come back and talk to you about what they have learned.

Then of course there are your parents.  All the strategies in the world will not stop their concern at times.  This is part of their world.  For most people, when things are hard – all a parent wants to be able to do is make it better, easier somehow.  It’s the nature of the role and love that they have had no matter how old we get.  I am aware that there are people who are not lucky enough to have families who have cared for them like this – but on the whole, a parent’s response to any perception of threat to your wellbeing is a desire to protect you (remember, that one that’s been driving you nuts since you were at least as young as 14).  When talking to your parents about your depression remember this.  Once a parent – who has considered themselves a carer or a protector throughout your life when you have been unwell or threatened – accepts that you have depression and understands the nature of the illness, they will find it difficult to respond to as well.  It is good to have information designed for families and carers for them if they find watching you struggle hard.  Make sure that you spend time talking with them about what helps and what doesn’t.  Calmly.  Write it down first if you need to.  I share things to read with my family.  They don’t say much, but their education shows in the things that come up when we are talking about my health or my plans for the future.

My observation from working with people who find their parents “too interfering” is that often in by not telling them anything about what they are doing for their depression – is that a lot of the parent’s interference is related to ignorance; and that more, rather than less information about what is going on, better education for the parent and some help to reassure the parent that their son or daughter is making healthy choices goes a long way toward defusing the situation.  I know that this is not true in every case, but frequently it is.  And while some of the parents need to learn better adult boundaries, others are just desperate for the wellbeing of their son or daughter.  It may not be possible to put all of your parent’s concerns to rest.  This is not your job.  Nor is it your job to protect them from ‘finding out’ – because ten to one odds say that they have already noticed that you haven’t been yourself for a while and are already worrying in secret if bothering to hide it.  Explaining the true shape of the issue that you are dealing with and telling them how they can help rather than leaving them to shadow box with the ghosts they imagine is all that you can do.

Sometimes, unfortunately, like we might have been to start with – the people we care about or people we need to know may also remain in denial of depression in someone they know.  This is very hard.  Sometimes a family member might respond if they come to the doctor with you.  Other times it may be a case of letting your treatment and the efforts that you are putting in prove themselves over time.  It is hard to be motivated to do this with someone saying that you are being lazy or playing sick.  It doesn’t help the thoughts.  It can increase anxiety.  It is humiliating even to one’s self.  If the person won’t respond to your attempts to talk to them or to give them information, unfortunately it is difficult to make their choices for them.  However, the best way to deal with them is to prove them wrong.  The best way to prove them wrong is to prove that the treatment that you are undertaking and the effort that you are putting in is having an impact.  Even if it’s a partial impact that goes in fits and starts – change can be a catalyst for more change.  Perhaps seeing a change in you as you progress will convince them that there was something to that information that you tried to give them a few months ago…

 

The Wall with a Hole in it … 30/09/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,Routine,self-management strategies,Work — jillnottelten @ 5:23 pm
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And I’m not talking ATM.
Have you ever felt yourself to be up against that dragon that you were never destined to slay?  That worm you’ll never be early enough to get? The one that leaves you feeling like the Emperor in all his glory when he set out in grand style to show off his ‘new clothes’ just when you think you’ve gotten a hold on it.

My nemesis is time.  Not just any time – although we have a slippery time keeping pace with each other continually.  No, the ultimate battle is drawn around the time of sleep and waking.  Here I am repeatedly mauled by my dragon, eaten by the worm and left with nothing but the Emperor’s new clothes to show for all the effort that I have made to conquer the struggle.  I feel as though I am beating my head against a brick wall.

What happens you ask?

I set an alarm clock.  Actually I set two alarm clocks ten minutes apart.  I do not trust myself with one.  I have been known to turn one off in my sleep!  I set one to raise my level of consciousness and the other to wake me.  For most of the year this is adequate.  But then comes the changing of the guard – it starts to get light earlier or later in the spring or autumn and for several weeks my dog hides the alarm clocks.  He must.  Some nights anyway – because they sure as hell don’t wake me.  But then I also have trouble in getting to sleep – so maybe it’s not all the dog’s fault.  At times I sleep no more than an hour or two a night.  Others I may get to sleep and then wake up at two in the afternoon – ON A WORK DAY!  This year I thought that I was winning at work until the seasonal sleep monster set in.

Right now I feel like I am beating my head against a brick clock.  In getting to sleep.  In waking up.  In getting to work.  My psychiatrist has given me something to try for the short-term (ie 4-6 weeks) as it’s a regular pattern and struggle and part of a bigger picture of short-term seasonal change in my mood.  It’s not a relapse – just a dip.  But oh so disappointing because its been so stable for so long.  In lots of ways I think I could handle it if the sleep didn’t go out the window.  It’s started to affect my work though, so I’m taking the medical option this time.  Maybe next time I’ll be able to have the personal strategies down strongly enough to manage it without boosting my meds for a few weeks – but I need to prioritise keeping my job over my pride for this time.  I may have to wake up and phone in to work in the Emperor’s new clothes.  I do not have to parade through the streets in them.

Bloody Dog.

Damn Clock.

So for now I get my sleep under control.  I keep my mood stable with a little extra help than usual until the season settles.  At least I will be able to keep the dog in his place.  At least I will stop messing things up so badly in getting to work.  It will only be for a few weeks and then its back to the normal cocktail that I’ve accepted will be a part of everyday.  Back to using my ‘personal medicine’ or lifestyle strategies to manage life and its stressors.  Then I get summer to strengthen my other skills and to be ready for autumn when it comes.  Perhaps I will plan a short increase in meds again.  Perhaps I will plan time off work.  Perhaps I will be enough on top of my sleep to manage it with flying colours.

My Dog loves the twilight of the seasons.  He thinks its play time.  He loves the dawn.  He dances while I wake.

Oh to be able to open one eye and say in my firmest voice.

“Sit. Dog.  Sit!”

And have confidence that he’d obey.

One day.  One day he will.  One day I am determined to slay that dragon.

One day.

 

Seasons Come & Seasons Go 29/09/2011

Filed under: Depression,Experiencing Depression,Function,Leisure,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies,Treatment Resistant Depression,Work — jillnottelten @ 10:24 pm
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Some people are Summer people.  Some people, spring people.  Some are winter people.  Some love autumn.

No, I’m not talking about people’s colouring or the things that they like to wear (that is something that I, in fact know very little about).  I am simply talking about peoples’ favourite times of year.  Some people like to soak up the sunshine in summery garb out in the garden, down at the beach or over at the local pool.  Others love to curl up by the fire in their favourite jumper under a rug with a good book and a cup of hot chocolate – or put a movie on.  Some love the colours of autumn and the beginnings of that lick of ice in the early evening.  And some the radiant brightness of spring, its scents, the new life, the slow steady warmth, the magpies diving at you from overhead…

I never settled to a favourite time of year.  I really do enjoy almost all of all seasons – and by the time one ends I am ready for the next.  I am not fond of the days that exceed 40 degrees celsius with no cool breeze for long stretches at a time.  Hot winds are their own breed of evil in Australia for reasons far beyond temperature tolerance.  I’m not a great fan of temperatures at the other end of the spectrum either – especially if they come with a wind.  Actually – wind bugs me more than temperature.  But seasons – apart from the odd bits like getting up in the dark to go to work in winter – seasons are a delight.  Full of life.  At least, I always used to think so.

My dog pays attention to the seasons too.

Unlike me, the dog has clear preferences for different times of the year.  It took me a while to work this out, but its consistent.  The dog is stubborn in winter.  He moves slow.  He needs more time.  He takes more time and holds me up whether I plan it or not and he wears me out more easily than he does during the warmer months.  I think he’s arthritic.  He gives me no trouble if I allow for the arthritis though.  A bit more sleep – 1/2 hr or so more than I need in summer and I’m fine.  I just need to be patient.

Summer is usually the dog’s best time of year.  He still needs discipline, but he’s more content to walk at heel and doesn’t drag and tug away at the lead.  Spring and Autumn are strange.  Most of the seasons fall in with the winter and summer behaviour for Dog according to temperature and what the light is doing.  In each of these season there comes a point where the light changes – and over these few weeks the dog goes nuts.  He is unpredictable.  I can not afford to let my guard down for more than a few moments at a time.  My sleep gets poor – this starts the ball rolling.  My energy levels become low, my motivation to maintain routine relapse prevention strategies gets sloppy and I soooo don’t feel like doing anything about it.  It at these times that I have frequently relapsed (almost without exception).  I made it through autumn this year.  So far I have struggled this far through the last few weeks.  Another 3 – 4 should see me through the worst of it.

Until then, its keep on keeping on and stick to the programme.  Watch for warning signs – the very time of year in and of itself is a trigger – even without the presence of other factors.  Light does funny things to my health in other areas too.  It’s like the dog becomes delirious.  Here is a time when I need my friends and family – my supports more than any other time of the year.  I’m struggling to get to work on time at the moment, but so far my boss has let me cover with time in lieu.  Still, I’m determined to conquer that one too.  I get there on time more often than not – just not as often as I should.  Just now – when I least feel like it – discipline becomes oh so important.

I had my last review with my Psychiatrist this week.  We agreed that it would also be possibly a beneficial thing to increase one of my medications for 1-2 months during the peak risk zone while I’m wrestling risk factors and wavering – just for that short-term – and then go back to my current dose afterwards as the weather and season stabilises a bit more.

Hopefully the combination of ‘personal medicine’ or monitoring of triggers and early warning signs with the kind of action plans that are outlined in my post “Better Medicine”  with the temporary medication adjustment will prove to be a good protective measure.  I’ve had a good year.  I’d hate to mess it up now.  I’m hoping to get to at least a whole year without a relapse this year!

So roll on to the latter end of Spring.  Because despite all of this, I really do love spring.  There’s a certain level of hope and promise in the air in Spring that’s unique to this time of year.

Come Dog.  Heel.  Walk.  Heel.  Walk.  Heel …

 

I wanna be a … 18/09/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Routine,self-management strategies,Work — jillnottelten @ 8:29 pm
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Jetson!

Are you old enough to know The Jetsons, I wonder?  Most are, surely.

I’m not after the groovy little space-sedan.

I’m not even in it so much for the robot house keeper – although I would certainly NOT turn her away …

I want the bed that tips you out when you need to get up, stands you up and puts you on a conveyor belt to the shower and gets you started for the day.

I swear, that has got to be the hardest part of the day!  I’m okay once I’m showered and dressed for the day – but until that point it is all up hill.

On work days I don’t trust myself with less than two alarm clocks.  I’ve been known to turn alarm clocks off in my sleep.  I figure that one will at least bring me out of deep sleep and the second can wake me if the first doesn’t.  I don’t keep at least one near my bed.  I make sure that I need to touch floor to turn it off.  I also make sure it’s a really noxious sound so that I don’t just let it keep going.

One thing that I don’t do that a lot of people say works well for them is put out my clothes the night before.  I have tried it a few times, but tend to finish up thinking that I don’t feel like wearing what I put out and finish up dithering over what I do want to wear.  That said – it would probably work fine on work days if I kept it up – so I should try it again.

I also tend to waste a lot of time putting off getting to the shower (especially in winter) puttering around the house.  Alas! This just makes me late.

Oh for an alarm clock that tipped the mattress 45 degrees and dumped me on the floor with a bang if I reached for a snooze button!

Drat the need for motivation, will power, decent routine & bedtimes, discipline in lights out and organisation in the morning.

But then again, if I have been eating well, doing exercise, working, and going to bed at a decent hour I am likely to have been refreshed by sleep and find it easier (note that the word here is “easier” and NOT necessarily “easy”) to wake and rise.  Perhaps key to my struggle with rising in the mornings is my lack of discipline in other areas – most obviously in getting to bed at a decent hour reliably, but also exercising regularly.  I would also have more energy if my diet included more fruit and vegetables.

So many things to fine tune.

I still envy George Jetson.

 

Attishoo! Attishoo! We All Fall Down 31/08/2011

Filed under: Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,Physical health & wellbeing,Routine,self-management strategies,Work — jillnottelten @ 9:42 pm
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What’s going on?

I’ve got a headache that I’ve had on and off for a few days now.  I’m so tired so much of the time.  I’m disorganised.  My house is a mess and getting less clean than I’d like it to be – it’s not grotty, but without action it could get there without a lot of effort … I’ve spent the last couple of days off loafing in my ever comfy PJs and while I’ve gotten up and done stuff, I’m sure I said ages ago that I was going to stop doing that…

Hang on.  These things are all among my early warning signs.  I’m off my game.  Nothing serious yet – but now is the time to act.  I’ve been going really well for ages.  It’s not even my Depression that’s knocked me off my game – it’s the damn cold that I’ve been fighting.  Yet this I do know.  In the past relapse has often followed physical illness.  The dog acts when he knows I’m not at my best.  He takes advantage of weakness.

So what do I do now?  Give in? Panic?  Book an extra doctor’s appointment?  Nope.  Now is the time to reach for my WRAP – my Wellness Recovery Action Plan – something that I should probably be going over more regularly to remind myself of the daily and weekly/regular things that keep me well.  In my WRAP I found that I’ve been neglecting a lot of these over the last couple of weeks and that I have gotten sloppy with a couple of my routine maintenance markers over the past couple of months.  My work WRAP (my own experiment) shows me that I’ve not been sticking to my wellness goals about leaving on time and planning my day either – no wonder I’ve been feeling like I’ve been run over by a truck.

Now is the time to restart the action plans.  I need to tell someone that I’ve noticed that I’m off my game and that I’m acting on it – that way they can ask me how I am going with my action plan in a couple of days to see if I need some help to get things moving again or if I’ve been able to self-start again solo (often harder than I think it’s going to be).  I’ll wait to see how things progress and talk it over with my friend before I rush into moving any appointments forward.  I think I’m okay if I get reorganised at this point.

So its back to setting alarms and keeping them for going to bed and lights out at night.  I’ve been letting the sleep run thin.

I need to plan my meals rather than look in the fridge and hope that there’s something I feel like eating in there.  And I probably need to start putting more attention towards the balance of what I eat because I don’t think I’m eating enough fresh fruit and vegetables (that’s a new strand to the plan for me).

I need to put away the things that are lying around and creating clutter.

I need to clean the house.  When that goes to my list though it will read room by room and the floors will be separate.  That way I can do it in parts and feel like I’m making headway when I cross things off on my list.

I need to set up a routine for maintaining my housework.

I need to set aside time for doing things that I like to do.

I need to work out how I want to prioritise a couple of things that I have going at the moment so that I can put away what I am not going to finish in the immediate future and finish off what I am doing in my ‘projects’ department.

I need to set aside time for some meditation and prayer.

I need to make sure I leave work on time.

I need to make better use of my diary and go back to keeping a list of things that I need to do to mark off and prioritise – this works well for me

I also really need to put some effort into starting to exercise and to spending more time outdoors.

If I need help with anything, I can and will ask.

I’ve been good with most of my other stuff but things involving routine, and doing things that I’m not instinctively motivated by (like exercise and cooking for anything other than guests) are difficult.  It may get easier.  Who knows?  My goal is to find something that I enjoy in the things that I find difficult to do at some point – but not now.  Now the need is to just do it.

We all fall down.  We all need to know the best way to get up again too.  Take the time to be prepared.  I use the WRAP (http://www.mentalhealthrecovery.com/wrap/ .  You can now download an old edition of this from “Recovery X-Change” http://www.recoveryxchange.org/downloads/RxChange%20WRAP%20WorkBook.pdf  if you want to check it out a bit more closely).  There are a number of different systems people have.  The most important thing is to be ready to be ready.

All I have is a cold.  It does not have to become a relapse.

Right now though it’s approaching bed time.  So rather than editing anything else.  I’m going to post this and head for the sack.  Good night.

 

Planning with Purpose 21/08/2011

Filed under: Depression,Function,Goals & Purpose,Leisure,Managing Depression,Routine,self-management strategies,Social Supports & Networks,Socialisation,Work — jillnottelten @ 1:35 pm
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In my last entry I wrote about going back to work.  I also made brief reference to having a need for some kind of productive activity if I wasn’t.  One of my regular readers made a comment that spoke directly to something really important.  The need for purposeful activity.  Not necessarily work – but activity that is goal directed and meaningful to you.  Activity in which you are setting out to achieve something that you are interested in achieving.  It doesn’t need to be paid activity, but it needs to provide you with a sense of purpose and achievement.  This reader suggested that – but for the expense of living, she would not even care so much about paid work as long as she had purposeful activity.  I have to say that I agree.  Sound odd?  It’s one of the biggest problems people have when they retire.  Not having planned for their need for purposeful activity.
The thing is – people have an innate need to do something.  Preferably something they value and something that is purposeful.  All you have to listen to one of the things that we complain about.
“I’m bored”, “There’s nothing to do”
“What’s the point of this?”, “This is a waste of time!”, “I hate doing this.”, “I’d rather …”, “I’m sick of doing this”, “None of this does anyone any good”
“When am I ever going to use this?”, “No-one’s going to look at it …”, “All I did was sit and look at the …”
Examination of research into the presentation of people with long-term unemployment and people with Depression actually show a lot of similarities.  Things like loss of routine, beginning to neglect personal appearance, poor diet, lack of activity, sedentary lifestyle, poor sleep habits, loss of motivation, social isolation, loss of self-esteem …
Of course for many there are possibly crossover elements of situational depression, however it is interesting to note that the lack of purposeful activity can have such a strong effect.  A study that I heard presented followed up some people some of whom pursued work – some full-time, some part-time; some of whom pursued volunteering.  The outcome – purposeful activity made an enormous difference to quality of life.
But other studies show that it does not even need to be work related.  Simply valued and purposeful – and it will improve quality of life and wellness.  Take up gardening.  Build a doll house for a kid.  Join a gym or walk somewhere every day.  Volunteer at a local charity, Church or club.  Write a book.  Go to a local community centre and check out the programme.  Do a course on something that interests you.  Join a book club.  Start meeting a friend for coffee regularly.  Take up cooking.  Invite a friend over for dinner.  Try that sport you always wanted to try – talk a friend or family member into coming with you if you like.  See if you can find some old friends you’ve lost contact with – you might be surprised how many want to catch up.  Try that hobby you always wanted to take up.  Research your genealogy.
Purposeful activity.  This is what forms the building blocks.  This is where a healthy routine can be built.  This is where a healing routine can be built.  Research says it works.  My training says it works.  My observations of the people I have worked with as a mental health worker say that it works.  My experience of healing says it works.
 

It Works For Me 14/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Routine,self-management strategies,Work — jillnottelten @ 11:59 am
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In every culture there are certain norms.  Rules if you like.  What type of food people eat, the structure of families and social networks, the kinds of things that people do, our attitudes to authority and among other things our attitude to work.  In most western cultures the attitude is that you’re supposed to engage in it – but it’s also something to complain about.  The idea is to have a lot of other things you’d rather be doing.  Work, school all things regarded as ‘compulsory’ are often seen as restrictive.

I returned to work recently after a long absence from the workforce.  The initial period was due to a nasty relapse of depression.  Most of the months were while human resources were getting their act together pushing me through ‘independent’ doctors who were giving clearance for graded return to work plans all the while saying that the doctors had not said that I was not fully fit for duties.  It reeked of them trying to get rid of me.  Alas for HR, they failed.  I got back in.  What is more I got another job which I will start next week  and was offered others while they were stuffing around – with disclosure about my depression.  But enough on that.

Some of the Benefits of Productive Activity and Work

My return to the workforce has brought one thing to my attention in a stunning way.  I love going to work.  Sure there are some tasks that I could do without.  But on the whole, work is something that I need.  While I was off, I had to work hard to manufacture work for myself in the form of projects and I enjoyed them a lot.  But it feels good to be doing something productive.  To see people and say “hello” to them and pass the time of day with them.  And that’s before I’ve even gotten my first pay!  And to be busy.  I am enjoying being busy.

I am really fortunate this time too.  My latest medication regime is leaving me non-drowsy.  My attention is better in the morning than the afternoon – so I will have to gear my day around doing the close work that needs that kind of focus early, but otherwise things are looking good.  I am well.  The dog has gotten the message that he needs to stay at heel and not strain on the lead.  At the moment I am tired at the end of the day.  Very tired, but I am convinced that in the coming weeks this will pass. Some of this has been helped by the fact that I am not starting cold.

I am convinced that my determination to keep busy with projects that required concentration, busyness and maintenance of a routine while off work has helped enormously with this, because in this too the dog was given little space to roam free on my time and thoughts.  He essentially had to stay out of the way.

People, let me say that I am a convert.  I believe that people need work – not necessarily paid work – but productive activity of some description to keep them feeling like they are moving and breathing.  I believe that work brings freedom with it.  Sure there is a need to have support and watch your early warning signs.  Sure there are unpleasant tasks.  Sure there are jobs that you would prefer over others.    But work – work is grand!

 

Black Dog, White Knight 03/08/2011

Filed under: Clinical Depression,Function,Managing Depression,My Black Dog,self-management strategies,Treatment Resistant Depression,Work — jillnottelten @ 4:16 pm
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If there is one thing more frustrating than the battle with the black dog, it’s the battle with the white knight.  The overprotective protector.  Oh to be able to call the white knight to heel along with a well-controlled dog!

Take for instance the plan to return to work.  A sensible return to work plan is graded with appropriate supports according to the nature of the illness or injury.  My most recent absence from the work place involved an epic trial to accomplish reentry.  It took five months to the day from the time my psychiatrist of eight years cleared me for graded reentry to the workplace – and almost two months after he cleared me for full hours – for my employer and independent occupational physicians (not psychiatrists) to clear me for a very slow and protective graded reentry programme, more suited to someone with chronic pain or active symptoms.  I, however, have an episodic illness – certainly, with excessive stress and sudden change as triggers – however having been all but symptom free for some time now, the rate of change laid out was a looooooong way from sudden.

The starting plan was laid out as 4 weeks of 3 days of 4 hour days.  This would be followed by 4 further 3 day weeks where hours increased by an hour a day per week.  Finally, a half day would be added on the ninth week to bring me to full hours.  Such a programme would have been appropriate in at the beginning when I was cleared for graded return to work by my doctor.  But five months later?  I had been stable for some time.  Depression is an episodic illness, not a static one.  I would agree that grading is wise for maintenance purposes, but given the amount of time that I’d been stable for it would have been feasible to start with a 3 day week at 4 hrs, progress from there to 6 hrs, then 8, before returning to full hours.  And that would be conservative.

The key factor that will make or break the return to work will be the provision of personal support within the workplace throughout this and over the coming months.  A clear plan for what to do with symptoms in the workplace.  A way of taking control of the situation when things get difficult.  I speak here both as a clinician with experience in work rehabilitation and as person who has treatment resistant depression.

The white knight needs to step back and stop blocking the path.  There are no dragons.  It’s a dog.  A black dog that is currently walking patiently at heel.  Please don’t let it get so bored that I trip on it.  A worthy helper walks beside, notices when the going is hard or easy and helps me to adjust the burden so that I can continue at a pace with just the right level of challenge and focus.  They are about helping me engage with what is around me without losing track of my dog.  The white knight will ultimately drive my dog crazy with all the attention and fuss.  If I don’t trip over the dog, I’ll trip over the knight – although they’ll default all responsibility and blame the dog.  Get rid of the protective sword, the suit of armour and all the pomp and ceremony.  Rather put on your hiking boots, pick up a pack, bring me a spare map and compass for if I lose my way and throw in my dog handling manual in case I lose mine; then come and walk alongside me.

 

 
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