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What do you do with the Shockers? 25/11/2011

Filed under: Depression,Experiencing Depression,Function,Goals & Purpose,Managing Depression,Medication,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks — jillnottelten @ 12:34 pm
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Yes, I am still here.  Still living, breathing and blogging.  Just fell victim to a couple of very shocking weeks (interspersed with some lovely moments, but very few and far between).

This week I’ve barely been able to tolerate daylight, let alone the computer screen – migraine like I have not had in a long time since my medication includes migraine voodoo concoctions … but … amidst my Barry Crocker of a week the week before and the ensuing weekend I became a bit disoriented and missed a couple of doses of my meds, hence the hole in the firewall (just to mix some more metaphors).  Yesterday I went to the GP to get a medical certificate for work and stopped at the shopping centre on the way home.  Talk about sensory overload!  My world had not yet totally stopped spinning so I had this strange spacey kind of sensation as I was walking, the noises were louder and more jarring, lights and colours still bright, smells still sharp.  I couldn’t get out of there fast enough!

Work has been crazy and exhausting trying to manage the politics and dynamics within the office.  Don’t get me wrong – I like my job.  If only work could just be about going and doing your job and coming home again, what a relief it would be!  But there are systems and other people that one has to navigate to do one’s job.  Equipment that one and space one has to somehow get adequate access to do it.  Preferably in a way that lets you stay well without creating more stress than is necessary – which is where the battle lies at present for me.  At present it seems that I am destined to bang my head against a brick wall and progress nowhere and to endure life in the office that gets claimed by miscellaneous team members to serve as their staff room – while my office buddy and I are trying to work in it!!!

But alas!  These are not healthy things to dwell upon.  The goal is to work out how to attack and push through.  I had thought that we had had a strategy for the work one, but it is back to the drawing board on that one next week as it looks like this is rapidly fading into embers.

At present I am struggling not to dwell on the difficulties of the last few weeks.  I grew frustrated that my usual seasonal dip in mood was dragging on longer than usual, but didn’t really look beyond it for other triggers until much too late.  Sitting down with a friend a couple of weeks ago to go over what had been happening clarified things a lot more for me.  One of the reasons that I am so focussed on work issues over the past couple of weeks has come about because through sitting down and working through my usual triggers and warning signs with my friend revealed that my workplace is simply loaded with triggers.  There is little wonder that I have been struggling to emerge from my usual brief decline and regathering of mood.

It’s so easy to forget to go back to the basics when one gets busy.  I can sort of see why Mary Ellen Copeland, the woman who designed the WRAP suggested that going over triggers and warning signs should be something that someone should do daily to prevent relapse.  I’m not sure that I would ever go to daily, but I do know that I need to be going over my WRAP a lot more frequently than I do.  The whole point of knowing one’s triggers and warning signs is so that you can be alert to them.  It’s one thing to know them – but so easy to miss them unless you’re really watching.

So – What do you do with the shockers?  Do you beat yourself up over them?  There’s no point in that.  To me, it seems you need to do is stand back and detach a little.  Stand in the moment.  Not the future.  Not the past.  Just the moment.  Examine – and for me, it helps if I can find someone to help me stay in perspective … at least to get me going – and learn.  This helps me to see cause and effect relationships; it helps me to learn and relearn trip hazards; it helps me see things specifically rather than looming ghouls and it leaves room to remember that there were a couple of good moments in the last fortnight too.

From there I can start with a plan.  If the plan needs adjusting, then so-be-it, but perhaps – just, perhaps … next week can be a bit better …

Please.

 

Making Sense of It All 04/11/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Explaining Depression,Function,Managing Depression,self-management strategies,Social Supports & Networks,Socialisation,Talking About Depression — jillnottelten @ 4:45 am
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A while ago I spent some time blogging about how we can talk to people about Depression – or about mental health issues in general.  But I left out a very important group of people.  Kids.

How do you talk to kids about mental illness?  How am I going to explain my Depression to the important children in my life?  How do you explain it to those in your own?  While people often worry about upsetting kids or frightening them by talking about mental illness – and I’m talking about the kids in your family or very close to you here; the facts indicate that most of the time children worry less about something if they understand it.  Providing them with opportunities to talk and to find out what they think is happening is important.  So is clearly and simply explaining what is actually happening in a way that they can understand.

But finding the right words to explain what needs to be said in kid language is a tough business.  Plus, adults struggle to share their feelings.  Again, accurate and age appropriate information are the best way to go – and this usually goes down best coming from a parent or another adult family member or close friend of the family.

So – how do you know when and how to do it?

If they ask questions about your or  the other person’s health – this is a good opportunity.  A number of resources suggest strategies like asking the child how they are feeling at the moment, if there has been an incident recently then perhaps ask them how they felt when such-and-such did this-or-that; or even if they thought you or the person were acting differently lately – depending on the age of the child.  But whenever you do – pick a time and place where you’re all most likely to be comfortable and feel safe and where you won’t be interrupted.

It’s suggested that you explore the child’s understanding of what’s going on – not just accept their first reply because they could easily just repeat someone’s words without clearly them.  Plus it’s important to know how they learned what they do know.  Also, make sure that you’ve understood properly what they have told you.

Ask questions that are open – that is, they require the child to do more than say ‘yes’ or ‘no’.  Try to get them to say what they think in their own words.

Be ready to reassure them.  They might feel awkward.  They might feel distressed or disloyal or angry or be afraid of causing worry or getting into trouble.  Make sure they know that this is okay.

Now when you come to the explaining part:

There are lots of good resources take a look through some of them to prepare yourself for the talk or use them with the child.  (Please see links at end of post).

Keep some coloured pencils or pens and paper or some play dough handy.  Something that you can use to illustrate what you are telling them about or that you can ask them to draw something to help illustrate a point or  a feeling.  You may also write down thoughts or questions or plans together later (or draw their understanding of things for you when you are exploring what they know).

Think about examples of illnesses that children are familiar with that could be helpful in your explanation eg asthma, diabetes, broken bones, colds, chicken pox (some will depend on what they or their friends/family have had).  Be specific in the comparison that you make  eg asthma and depression both have triggers and physical signs even though they happen in parts of the body, both can seem to come out of nowhere … ; it is not like a cold because you can’t ‘catch’ it.

Or a common example is to compare the body to a car with different parts – different things work together to make the whole car work, but if something goes wrong then it can make the whole car run badly or not start.  In the case of Depression … (a good example of such an explanation can be found in Talking to Children and Young People )

The big ideas to communicate no matter what are:

  • Mental illness is nobody’s fault
  • It’s not YOUR (the kid’s) fault
  • It doesn’t mean that the person doesn’t love you or care about you anymore
  • It is not your responsibility to make the person better.
  • You can’t “catch” it
  • Just because someone else in your family has it doesn’t mean you’ll get it
  • It happens to lots of people, in lots of families – not just this person
  • The person won’t be like this all the time
  • There are treatments like medicine and people to go to for special conversations and doctors who know about this illness
  • It’s not just about the person thinking or feeling differently.  What is happening to the chemicals in their brain is different.

Here is a summary of an outline that I found about how to explain Depression to a child in an Australian COPMI program booklet.

Children can sometimes understand the impact of your illness more easily than they can its cause.  This means that it may be best to describe what the depression does to you rather than what depression is.

So you might tell them that Depression can cause:

  • no energy (making it harder to play)
  • difficulty sleeping or sleeping too much (making it harder to get out of bed or keeping you up late at night)
  • crying a lot (sometimes when there is no apparent reason)
  • losing or gaining weight (because you don’t feel like eating or you eat too much)
  • not enjoying the things that you used to (means that sport or dancing or cooking or whatever it is doesn’t make you smile anymore)
  • make you tired and cranky (can make you get grumpy at the children for no real reason)

What does your depression make you do?

Depression is an illness.  It’s like having a cold or having asthma except it affects your brain.  Your brain controls the things you feel, think and do.

Everybody feels sad sometimes.

Everybody thinks bad things sometimes.

Everybody has things that they wish they could do, but can’t.

What makes your/this child(ren) sad?

What sort of things do they think about?

What do they wish they could do but can’t?

When someone has the illness called Depression, they can feel sad for a long time and not know how to feel better.

Depression can stop people being able to do things that they used to do and enjoy.

I hope that this gives you some ideas for some starting off points.  Seriously – do take the time to check out some of these links.  The first three have really informative and detailed guidelines in them.  The resource lists include children’s storybooks, links and all kinds of things and the other links have some wonderful things in them too.

I have found some other FANTASTIC resources for parents, siblings, extended family and close friends of children who have parents (or family members) with a mental illness.  Even one about babies for those with bubs or planning pregnancy.  There are more out there just waiting to be discovered.

COPMI stands for Children Of Parents with a Mental Illness.  It’s Australia’s national project over this area.

Piecing the Puzzle Together: Raising a Family When Mental Illness is Part of Your Life

Family Talk

Best for Me & My Baby

Talking to Children and Young People

 

 

Resources for Children aged up to 6yrs

Resources for Children aged 7 – 12 yrs

Resources for young people aged 13-18 yrs

Resources for Parents

Care Planning for a Family

Links for young people

 

Australian programmes offering support for children and young people with a parent or sibling with Mental Illness

Family to Family project booklets

When Things Are Sad And Gloomy : Understanding Mental Illness in your Family

 

Watching Wellth 16/10/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Function,Managing Depression,Medication,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks,Therapies — jillnottelten @ 10:30 am
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The journey’s oft’ rough as one travels the road

with one’s mood apt to upset the cart;

And if climbing back on aft’ one spill weren’t enough –

Alas – staying on top is an art!

For most of us who have passed though one episode of depression – or other forms of mental illness and come out the other side, a common concern draws us.  We don’t want to go back there.

Some have a harder battle ahead of them than others.  Some have different forms of depression; different forms of anxiety; different forms of mental illness that are more or less responsive to the things that we do to treat them.  Some are more vigilant than others – often this makes a big difference … and sometimes life’s not fair.  Some do all the ‘wrong’ things and yet never have another episode – but that’s unusual.

What’s usual is hard work with a need to use a range of strategies to stay well.  Things like good sleep, exercise, a nutritious diet, keeping up social support networks and getting out of the house, exposure to sunlight and fresh air, use of medications and talking therapies are just some examples of these.

But how do we know that we’re winning?  What can we do at the times when we’re worried about how our mood is going to try to prevent it from tipping over the edge into something we can’t manage?  How do we know if that new medication is doing anything to change anything at all?

One of the things that is helpful to do at times is to track your mood.  How do you do this?  You use a mood diary.  Ever done it?

The purpose of a mood diary is essentially to get a profile of what pattern your mood is following on a day-to-day basis.  At their most basic level, a mood diary will ask you to rate your mood on a numerical or incremental scale every day while you keep it.  Some will additionally ask you to record other information such as your anxiety levels, your irritability levels, how much sleep you had the night before, significant events and triggers throughout the day and/or the medication that you took.  The good thing about doing some of these other things is that they provide a much fuller picture of what is going on.

If you don’t already know what they are – this process can help you to work out what your early warning signs are as well as your triggers.  If you know your triggers and early warning signs, this can help you to monitor them. For that reason, I recommend choosing a mood diary that records significant events in the day.  I would also recommend one that includes the amount of sleep that you had the night before as this tends to be pretty universal and fairly influential.

Talk to someone close and ask for their help if you have trouble working out if you were irritable or if they noticed anything in particular that seemed to set you off if you are having trouble identifying these kinds of things – but the object of the exercise is to make observations about yourself – so do what you can on your own as well.

However, asking someone close to you whom you trust to help monitor your mood and to help you get to know your warning signs and triggers is a good strategy.  They sometimes see things that you are not in the right place to see or notice when you’re not well because your self-awareness can get a bit skewed.  They also see the ways that you differ from the way that you would normally be – so they can measure you against you and not somebody else.  Yes, it might be their perception – but it will still be your behaviour and actions and the things that you say and the responses and facial expressions that they are used to that are part of you.  Choose someone who you trust and talk with them and let them tell you about what they noticed changing last time and as you have been working through your recovery.

Do I use a mood diary and self monitoring systems all of the time?

Not on a daily basis.  When I am well I keep regular tabs on how I am going by talking about it with a good friend and checking over my early warning signs and triggers list regularly to ensure that my awareness of them is good and that I am alert to high risk periods.  I use what is called a WRAP – a Wellness Recovery Action Plan where I have identified what I am like when well, what my triggers are, what things are hints that I’m not as good as I could be, my early warning signs and so on …. I go through this regularly.  Some people do monitor their mood daily and find that it works well for them.  People with things like rapid cycling Bipolar disorder often find that they need to until it slows down and is brought under control.  At first I needed to chart my mood a lot more than I do now.

When I am in a high risk period I watch things more closely and have recently resolved to keep a mood diary through high risk periods because I still find myself at sea sometimes and feeling like I’m losing my grip.  I am particularly vigilant about my warning signs and triggers as well as their corresponding action plans during periods of high risk.  I have to be.  Recently I let things go at home and let the dishes and the housework pile up around me – a sign that things are getting away from me and didn’t act and it triggered me (it becomes a cycle).  I couldn’t face getting up to look at the house.  I didn’t want to go into the kitchen to prepare a decent meal because it was a mess and I didn’t feel up to cleaning it up – so of course my nutrition level went down, my budget blew out and thus the cycle continued.  In the end it took a cleaning weekend to put me back on track, followed by a week of very early nights and a lot  of discipline.  It’s too easy.  So I have decided that I need to do something to catch myself more quickly before it gets away from me.  Not simply cleaning, just lots of little things.  This time of year I need to be very careful about relapse prevention.  It sounds minor when I talk about dishes – but when it snowballs, I just keep sleeping and if I sleep through work or go in late consistently and am still going around in circles while I’m at work and don’t have energy or concentration to work – I could lose my job.

I’ve attached today some links to some self monitoring resources and different mood diary sites.  I know there’s a lot, but different things suit different people and I think these are important tools.  Most mood diaries have room for the full spectrum of mood disorders – both mania and depression.

Warning signs and triggers are important.  Monitoring your mood is tedious sometimes – but there are times when it is necessary.

General

http://breeze.blackdoginstitute.org.au/keepingwell/

Mood Diaries

http://www.bipolar.com.au/common/pdf/mood-diary.pdf

http://www.blackdoginstitute.org.au/docs/MoodChartforDepressionandhowtomonitoryourprogress.pdf

http://www.blackdoginstitute.org.au/docs/DailyRatingScale.pdf
http://www.psychiatry24x7.com/bgdisplay.jhtml?itemname=mooddiary

http://www.moodscope.com/ for those who like online resources

https://www.moodtracker.com/ another online resource

http://itunes.apple.com/au/app/moody-me-mood-diary-tracker/id411567371?mt=8 for those who like apps

Mood Monitoring & Relapse Prevention Programmes

http://www.cci.health.wa.gov.au/docs/KYB-3-Self%20Monitoring.pdf

http://www.idamaecampbell.org/files/40263519.pdf (WRAP personal workbook)

Early Warning Signs

http://www.health.qld.gov.au/rbwh/docs/early_warming_signs.pdf

http://www.blackdoginstitute.org.au/docs/20.WellbeingPlanforBipolarDisorder.pdf (can be used for depression too)

Healthy Lifestyle

https://www.mindbodylife.com.au/Downloads/index.cfm

 

 

 

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…

 

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.
 

Beyond Medicine 06/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Mindfulness & the Senses,Monitoring early warning signs, triggers & Wellness action Planning,Physical health & wellbeing,Routine,self-management strategies,Social Supports & Networks,Talking About Depression — jillnottelten @ 4:01 pm
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Personal Medicine

What's missing from your treatment regime?

Taking a dog to obedience school can be a challenge.  The thing is – it’s you that get’s stuck with the homework.  You that has to reinforce the training and know that the dog understands what you are telling it to do.  You that has to maintain all that new knowledge. (Just who is being trained anyway?)  Tiresome? Yes, while the dog is learning.  Worth it?  When the dog does what it’s told and behaves?  Certainly.

There are “medicines” beyond the pills and potions that I take that serve to keep my black dog in check.  “Personal medicines” if you like.  But to me these are the things that have made the difference between ‘a life half lived’ and the journey of recovery.  Let me share some of these with you now:

Routine:  Keeping up some kind of regular pattern of activity helps to keep the dog at bay.  It’s hard to start with to fill up when there is ‘nothing’ to put in it.  I start by setting meal times and trying to put one thing in the slots of time between meals, perhaps a short walk, washing dishes, putting a load of washing on, having a shower, reading – it doesn’t have to be big.  Then I build up from there as I work on other things on the personal medicine list.

Sleep:  Work out how much sleep you need to have and make sure you get it.  I need to make sure I have at least 8 hrs consistently.  That also means I need to allow time for falling asleep when I go to bed.  Now I have a bed time and a getting up time.  This means that I shouldn’t over-sleep (although sometimes I stay up too late and still do) and that I shouldn’t lie around in bed all day either.  Bed becomes a sleeping place.  I will often allow myself 10 hrs sleep on weekends and 8 hrs through the week.  This suits my work schedule.

Nutritious Diet:  I can’t tell you what a difference it makes to my mood when I am eating a well-balanced, appropriately spaced and portioned diet compared to when I am not.  My energy levels are consistently better.  My concentration is better.  My mood is brighter.  Check out basic dietary guidelines for a balanced, healthy diet and plan your diet around them.  It will take a while to get used to doing – but you will notice the difference in your mood, wellbeing and possibly your weight.

Exercise:  There is research that shows that exercise has an antidepressant effect on the body.  Get into a regular exercise pattern.  It can be as simple as walking most days in a week, or you may choose to do different activities on different days to save yourself from boredom.  My advice – start simple.  Again – start with the recommendation made on general health sites about exercise.  I aim for approx 30 mins about 5 days per week.  At the moment I’m being slack because it’s winter here and I’m just getting over a nasty cold – but I need to get back into it.

Early Warning Signs & Trigger Watch:  Learn to spot the early signs that your mental state is slipping so that you can catch it early!  Make sure you have a plan for what you will do when you notice them – even if it is as simple as call your doctor, counsellor or case worker for help and ask them to teach you some strategies so that you can do it yourself next time.  Also, get to know the things that trigger you, that way you can either plan for them or do something about the effects of the trigger before you become symptomatic (eg relaxation, pleasant events, talk to someone, visit a friend etc).

Pleasant activities:  Plan to include things you enjoy among the things that you do.  Enjoyment is a great way to remind that dog that he’s not wanted.  If you’re not well and not enjoying things – you may find it neutral or relaxing even if it doesn’t give you the same buzz that you usually get.  Sometimes you will also find you like things more than you think you will.  I enjoy reading, getting a massage from a friend – or if I have money I used to go to someone who made me feel comfortable for a back, shoulders and head massage; seeing a movie, going to bookshops and the local wool shop.  I love spending time with my family and playing with my niece.  Doing these things – even when depressed – often leaves me feeling better.

Looking after myself:  Making sure that I shower daily and clean my teeth when I should makes a huge difference to how I feel.  Clean and trimmed nails.  Clean and presentable hair (preferably at a length I like without an inch of grey roots showing), the hair in places that it’s not wanted removed, without wax in my ears … and its nice to use a soap that feels good on my skin and some moisturiser; perhaps a face mask here and there – after all some of those medications do yucky things to my skin.  I also like to make the effort to wear clothes that make me feel nice these days.  I used to be very happy dressing very daggily – and still am often; but it helps me feel better when I’m wearing something that I like.

Social supports:  Having people who care intimidates the dog.  Essentially, he’s a shy creature when the depression’s not at its more aggressive stages or I’m not on a self-pity kick.  Take the time when things are going well – or even just okay – to “screw your courage to the sticking place” (Shakespeare) and build a network of people who will stand by you.  It doesn’t need to be a large one, just people who are friends or family and willing to stand by you.  Even better if they will help you to see when your early warning signs come and to deal with those before you sink right into depression.  Last time I was emerging from a nasty episode of depression, with the encouragement of my psychologist I gritted my teeth and started looking up old friends who I had lost contact with.  I was very surprised to find them pleased to hear from me and have rebuilt a good network from those with some more current contacts who are now more aware of how and why I vanish and are less likely to let me do so again.  They ask questions if they don’t hear from me for a while.  This is helpful.  My family is also great.

Regular Social Contact:  Make sure that you plan regular contact with people.  Coffee with a friend on a regular basis; attend a group, a club or church – something together with others; talk to family or a person who supports you a lot often.  Sometimes you will feel like it, sometimes you won’t.  If you have trouble getting started, ask them to come to you or to pick you up on the way.  Different things work for different people.  I speak to family a couple of times a week and try to make sure I see my brother and his family at least once a fortnight.  I try to cultivate a couple of friendships with people who I have met at work.  There are people who I call once every 2-3 weeks because they are friends that I want to keep close contact with who live a fair way away from me.  I open up my Facebook every day or two to just make a conscious passing by into a handful of people’s screens for the day and join a joke or post some comment about my day.  A couple of people notice if I vanish for  a while and ring me to see where I am.  I try to invite friends around for dinner about once or twice a month and have someone by for a cuppa regularly.  Of course – sometimes I go to their place or we meet elsewhere, but when I make the effort it does help.  Who I spend time with will depends on my mood – people who accept me as they find me and who just don’t see the mess or will help me with it are all I can manage at times; but these are the kind of people I like to cultivate as friends anyway.  If I never spend time with people, I never reach that level of comfort with them.  Remember – the dog does not like competition.  As I’ve pointed out before, he’s a jealous creature when all is said and done.

Mindfulness:  This is a skill that I learned with my Clinical Psychologist.  Its big at the moment and a lot of counsellors are teaching it.  There are also a number of books around and  – I haven’t explored this – you may even be able to find online tutorials (?).  A really useful skill for noticing what is happening in the moment as well as slowing things down so that you can deal with things as they are.    A couple of sites that might be helpful include http://www.bemindful.co.uk/,

http://www.blackdoginstitute.org.au/docs/10.MindfulnessinEverydayLife.pdf,

http://www.mindfulness.org.au/MINDFULNESS%20SOUNDTRACKS.htm,

http://www.dayonepublishing.com/VMC/Exercises/Exercises.html

Reality testing:  This skill is something I picked up through doing Cognitive Behavioural Therapy (CBT) with my Clinical Psychologist.  It’s about checking the evidence for those intrusive negative thoughts.  Don’t just accept them at face value.  Getting into the habit of doing so involves discipline just like everything else – and sure there are days when I don’t do it and the thoughts win out – but over all the effort is worthwhile and gets easier with practice.  If you want to know more about CBT give it a ‘google’.  The research holds up really well.  On the occasions when the reality is tough, then I follow through with a question about whether I am affected by the thought, if it matters and if I need to do anything about it and if so – ‘what?’.  If you can’t afford a therapist, I believe that some places have tried short CBT courses online – there was one in Australia pitched at Uni students a couple of years ago.  Here’s a more recent version of it that seems to have a broader audience in mind along with another I found that seems to have a good reputation:

http://moodgym.anu.edu.au/welcome, http://www.llttf.com/

Mental stimulation:  Keeping my mind active helps me to keep the dog in check.  When there is nothing else happening in a day to stimulate my brain (eg work, other activities, people to talk to) I do puzzles – simple ones when down and more variety most of the time.  I think it just helps to keep my mind busy so that there is less room for it to ruminate on negative thoughts.  It also gets pleasantly tired so that I sleep more soundly and don’t lie awake with my mind churning for hours.

Maintaining the space around me:  I need to keep my home in some kind of order.  I’m often known to say that you can get a good idea of my mental state by looking at the state of my house!  I find that if I stay on top of my housework and the place is orderly and clean it is easier to feel on top of my game.  When the place is looking like a bomb hit it, I need to hunt for things and everything is in the wash I’m more likely to get flustered, stressed and have a blah day.

Goals & Plans:  I hate doing it, but setting goals and making plans helps to keep me on track and walking on days when I don’t feel like making a decision.  It means that I have a sense of direction and a sense of future and that I can tick things off as I achieve them.  Always make sure you have some short-term goals people!  They can be very simple, but it helps to have a map when you have a dog that wants to take over and steer a different course.  You then have a reminder why you might not want to just let it take over and be done with it.  You’re not out to live the dog’s life.  It’s yours.

Bucket list:  I lost all sense of direction during the last few years of depression.  I had long series of bombed goals and really had no idea of what I wanted to do.  My Clinical Psychologist sent me away to write a ‘bucket list’.  Now mine wasn’t a particularly daring one and there’s a lot of room on it for change; but it was permission to start dreaming again.  What we did come up with through that was that there were six main areas that I liked to be doing something in.  The end result was that we sorted the things I would like to do into those categories and I now aim to have something going from each category at a time.  I will probably never do everything on the list and will do things that aren’t there – but it was a good way to find somewhere to start ‘doing’ again.

Projects:  These come off my Bucket list.  I have only a couple on the go at once so that it doesn’t explode on me – but they give me something other than work, eat, sleep to do and be interested in.  I’m quite proud of my projects.  Engaging your interests is an important part of recovery.  Yet another way that you stay in the front seat and the dog must sit at heel while you do your own thing.

Faith:  I am a Christian and turn to God and I pray for him to support me also.  I believe that this makes an enormous difference.  I also believe that there will come a day where heaven and earth will be restored and I will be given a new, whole mind and body with no illness in it because I am one of God’s people.  I am destined for heaven.  There is hope in this.  Although I become fearful when I am depressed about my acceptability to God, I have now learned enough scripture to know that my worth has nothing to do with what qualifies me for salvation.  This helps.

A couple that I don’t use that are also highly recommended include

Relaxation Exercises:  Excellent for managing stress or unwinding enough that you have a chance of getting to sleep.

Sport:  I’ve never been able to connect well with a ball, I’m not overly coördinated and I don’t move quickly and things that you’re not good at are not lots of fun unless they’re back-yard variety with friends – so no I don’t do much sport.  BUT for those who are into it, it’s a great option not only for exercise, but for social activity and networking and hopefully a bit of fun.

And these are not the only ones there are more … all the best as you try some out if you’ve not tried them before.

 

The Jealous Dog 22/07/2011

Filed under: Depression,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,Social Supports & Networks,Socialisation,Talking About Depression — jillnottelten @ 1:02 pm
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If there’s one thing that discourages a jealous dog, it’s competition.

Sounds simple, doesn’t it?

Of course like everything that sounds simple there’s a journey involved in getting to the bit that’s simple.  And at times the times the ‘simple’ bit is anything but easy.

If you were to tell me in the depths of my depression that competition was all that was needed to discourage the dog – that having other, more enjoyable things around me would make life easier to manage I would probably knock you flat.  And I hit ‘like a girl’.  When I am unwell they probably do knock the edges off things, but enjoy … ? Perhaps.  I certainly need help to initiate the diversion and the routine.  Ah … the old ‘r’ word.  Yes, I must admit – it does help.  I just hate it.  I never feel like it and it’s damn hard to do.  Especially when I still lack the sense of enjoyment of anything.

But further on – about eight months ago I gritted my teeth and reestablished contact with a long-lost world.  The friend.  The ones I lost contact with during a couple of years of withdrawing from – well – life in general.  Initially it was very tentative.  After all – who would really want to be friends with me, right?  But no, contrary to my very localised opinion friends welcomed me back with enthusiasm … on-line, phone calls, coffees, visits and finally a trip to see someone who lived a long way away for a few days (I was very nervous about this one) which was lots of fun.  I now have friends who I talk to again regularly and see when our schedules allow it, an old school friend I catch up with regularly, friends kids who are excited when I come to visit and people who miss me if I’m not around.  I never thought I’d see the day.  I’m still not sure I believe it.  By rights I should have black and blue spots up and down my arms from where I have been pinching myself but if it’s not true, I’m not planning to end the dream any time soon.

Today is my first day at home after a couple of weeks on holidays – staying with the same friends that I visited earlier in the year.  I was originally going for a few days, but the family with whom I was staying voted unanimously that I should stay longer – so I did.  I visited with other friends and their families on the way home, including one family not far from home where I stopped in filthy weather with an hour’s notice to drop onto their couch for a night.

Amidst all of this my dog stayed at heel without challenge.  This is amidst ongoing bungles with a return to work plan that has been drawn out for months.

My dog is shy around people who value me.

I need to remember this next time he pulls me in close to home.

A black dog needs a little competition from people who care.  He just wants me to believe that there aren’t any.  I did once and it turned out to be a lie.  I must remember this for another day.

My dog lies.

 

The Phantom 02/07/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks,Talking About Depression — jillnottelten @ 5:20 pm
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I have a secret identity.  Not just a pseudonym.

She appears when the black dog prowls.  But she’s not a superhero.

Her superpower? She melts into the weave of the sheets and the very mattress on my bed like 3 day old macaroni cheese sauce on the lounge of a bachelor pad in summertime.  She can barely roll over and will do anything not to.  Almost anything.  She won’t wet the bed.  She will tell you the most atrocious lies in the universe.  Anything to make you go away and leave her alone there.  She barely eats or drinks – far too much effort.  She stinks – goes for days at a time without a shower or cleaning her teeth.  The thing she does do is sleep.  She excels at that … except when she needs to.

And she can never tell you how she got to that state.

I am pleased to say that she has only taken a firm hold on my space a couple of times, but cleaning up after she has even attempted to gain entrance is a nightmare.   It’s hard work chasing her out when she’s just passing through and catches me out.  Next thing I know, there she is sitting there.  She’s not looking like moving anywhere.  She looks like she knows she’s not welcome, but can’t bring herself to move.  A lazy visitor.  In the way.  Impeding the things that need to be done.  And looking like she’s stay the year out given the opportunity.  She has no sense of time.  Little sense of purpose.  And little sense of the ‘other’.

And then I look over my shoulder and see my dog pacing.  He’s never still when she’s around.  They feed off each other.  Stalker and sidekick.

I am learning that the secret identity has more pitfalls than safeguards.

Superman.  Batman (without Robin).  Spiderman had pretty lonely existences – and they were the good guys.   Secrecy is isolating.

Maybe just one or two people need to know about my secret identity.  Need to know now while she’s not around – so that they know to come looking before too long if I disappear; so that they know what to do with my secret identity before she takes over again completely.  So that they know when to say “Bulldust!” and when to be gentle.  So that they know that I am also vulnerable to her bullying ways for short bursts while I am physically sick.  Not everyone – just a couple of people.  Perhaps then one or two will know to come not call.  To peek in the fridge.  To offer a lift rather than remind me.  To ring just that little while after I say I’m planning to be up in the morning for a chat – til I sound like I’m awake and alert and up for the day (and to try again in ten minutes if I don’t answer in case I was in the shower or just missed the phone).

It’s hard to disappear when there are a carefully selected few making constant contact and stripping away the secret identity.

Soothing the dog.

Because everyone needs someone who will come looking.  The biggest question is – is there anyone I trust enough for that task?

Do I want to share the ugly signs that show that my black dog is starting to pace?  That the secret identity is moving into play?  How do I decide who to share with?  How much can I ask of people who put up with so much from me anyway?

But if it means avoiding the black dog at his worst …

If it means I can keep a job ….

If it means keeping a friend …

If it means not exhausting my family through another painful and exhausting regathering process …

If it means keeping some perspective on life …

Perhaps I am asking less of people than I am by struggling on alone.  If only I can bear to share the secrets with those close to me …

… in exchange for those that they have already discovered that I have been too blind to see.