Apologies to all for a long absence. I have been running around in circles.
Miserable circles.
Busy circles.
Changing circles.
Family circles.
Circles of decision.
Circles of despair.
Circles of relief.
Circles of exhaustion.
Circles for lack of direction.
But I think that I have finally found where I am going.
The dog is back on his leash.
This is merely a short entry to promise more and that I will be back – probably later today and will catch up with the people I regularly visit and have been neglecting shortly. I have been very short of energy for anything over the course of the last few weeks.
One of the factors that I have spoken of recently that has affected my mental state is the change of season. I become more vulnerable to symptoms of Depression and need to be careful not to be taken captive by them and dragged back under the control of the black dog as he strains upon the lead. October this year has been fraught with tension as the dog hauls away at the lead while I wrestle endlessly to bring him to heel and keep him there. While each time he strains, I have brought him back – it takes a lot out of me and he knows it as he waits impatiently at heel for the next opportunity to pull away. I have had a tiring month.
How do I know when things are starting to get too much?
One of the things that I have decided to work on is paying closer attention to the cues that my body gives. It’s very easy not to be aware of these until I have a nasty headache, my shoulders ache, my muscles are all sore, I have a noticeably palpitating heart rate that makes my chest feel hollow and heavy or I feel exhausted.
I commented in my last post in closing about Mindfulness that one of the areas that I need to work on is that of noticing what is happening in the moment. This is what I am working on at the moment. To start with – to notice the cues that my body is giving me. For instance, when is there a change in the level of tension at key points in my body like my neck, shoulders and jaw? Am I breathing deep, medium or shallow breaths, what kind of rate am I breathing at? Am I aching anywhere? What is my heart rate like?
Now I don’t do this as a checklist and step through it or try to determine these things in a specific way. What I am learning to do is to try to do what is called – in Mindfulness language – a ‘body scan’ at regular intervals.
What does a body scan involve?
Essentially all I do is start out by observing my breathing until I am into the mindset of observe – not control. I then move my attention to my heart and notice and feel the rhythm of my heart beating inside me and the sensations that arise from that and enjoy that for a little bit. From there, I start by noticing the feel of the clothes on my skin, the shoes on my feet if I’m wearing any and then move my attention to my muscles. To scan my muscle I start by placing my attention on my toes of one foot and paying attention to them, noticing any tension or pain or other sensation, acknowledging it and – if it is tension, consciously releasing it from the muscles by either picturing it draining away or stretching and/or wiggling them. I then do the same for the other foot and move on to the next section of my leg and do the same thing. And doing this throughout I might move through the body in a pattern something like:
Toes
Feet
Lower legs
Thighs
Butt
Abdomen
Lower back
Upper back
Shoulders
Chest
Upper arms
Lower arms and wrists
Hands
Fingers
Head
Forehead
Eyes
Nose
Cheeks
Mouth
Jaw
Tongue
Neck
Shoulders
I figure that since the shoulders bunch up so easily, it doesn’t hurt to check them again. It doesn’t really matter what order you do it in though, nor how big or small the groups you break them up into are to a certain extent.
After scanning and relaxing all of the muscle groups, I then observe my breathing again for a moment or three before drawing my attention back to what is in front of me to do. It doesn’t take very long, and with practice it should take perhaps a minute – maybe less. If I try to do it when the little ‘beep’ goes on my watch on the hour (when I hear it), I should get lots of practice and stay well on top of these cues.
The goal is to be able to notice the tension before it becomes problematic and to be able to question whether I am becoming stressed before I get there. A lot of people who do this regularly swear by it. I guess it’s a bit like paying attention to when there is tension growing on the dog’s lead when walking a dog. As it grows, it cues us in to the idea that the dog is growing more likely to want to get away from us. Thus it is living with my black dog. I must be wary of tension.
So – here’s to my next excursion into the world of mindfulness. Noticing physiological changes and discomfort and either accepting them or letting them go without blame for their getting there.
Here’s to the next step into managing my Depression. Noticing the cues that early warning signs are present so that I can act. Perhaps October will improve from here on in.
The dog rises on his haunches – quietly – all the while waiting for me to stir.
The song changes on the clock radio.
The dog waits.
But I don’t move …
… and slowly, slowly he rises to his legs and creeps out of the room.
The black dog roams free in the house.
And I sleep on.
Eventually, much later I wake.
I look at the clock.
%##@@
And then I see the empty patch on the floor …
and I know that something worse seems to be afoot. I haven’t just slept through an alarm this morning.
The dog is at large in the house.
I fall back on the bed and close my eyes in dread.
What awaits me?
How awful will this become?
Can I face it again?
I pull the covers up over my head and try to snuggle back down to sleep.
It’s not really happening.
But I can’t do that anymore.
I’m not the same person that I was last time I found myself like this.
Bloody Dog!
Now I have to go and clean up this mess.
The mess. Can I face the mess?
Sooner or later I have to. I’m really just putting it off lying here in dread and imagining.
He’s only been loose a little while. How bad can it be?
Bad. It’s been bad quickly before.
Come on. This is getting us nowhere – time to move.
So eventually. Eventually. Eventually – I do.
I was right.
He’s been everywhere.
But unlike before, I can catch him and rein him in reasonably quickly.
Sure, this leaves me tired. But not defeated.
There are muddy prints where the dog has been – but all they are are the traces of his lies upon my consciousness. I can clean those.
Tonight the dog is back on his leash.
Tonight is evidence of what gains I have made with the help of my psychologist in learning to be conscious of my thoughts, emotions, my actions and how my body is responding to situations and to be deliberate in how I respond to this. Tonight I remember how these things used to crush me. How encouragement was drowned out by self-derision.
Today my dog got off the lead. Today I caught him again.
Yes, it made a mess of my morning.
Yes, it upset me.
But today, I could hear encouragement when it was offered by someone supportive.
Today Mindfulness skills allowed me to feel and experience the emotions of the moment and yet use the CBT strategies that I have learned to right my perspective and reorient my day so that I could finish it feeling like I had accomplished something useful.
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…
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.
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.
In recent years I have developed a fierce respect for my health. Not only my mental health – but my physical health. Whereas before I had little patience for the times when I was sick, there are times now when I fear it. When I am sick I just use more sick days at work – which raises more questions and more suspicion: “what is really going on?”. I feel disgusting. I break all of my carefully laid down routines and maintenance plans. I have to take more tablets. And all too often it drags on for too long thanks to poor immunity and a system that’s already struggling with every day and brings me – if not to relapse, then certainly to the brink.
When I am sick, the dog often thinks he is allowed to play.
It makes sense. There is less energy to be on top of my game with my thinking, so if I’m not ultra careful I do forget to reality test my thoughts. I get lazy and don’t practice mindfulness. My appetite is lacking, so unless there is someone else cooking for me and serving up nutritious food, I’m not eating well. I’m exhausted and sleeping all the time and not maintaining my routine. I’m too sick to exercise. My medication is going in – but that’s about the only maintenance activity that is actually happening – and if I have a gastro bug even that gets out of kilter.
Short term bugs aren’t so bad. A day or two and I get back on top of my game without too many problems. No, the one that I hate most of all is surprising to some people. The thing I dread most is the common cold. It drags on forever. It saps my energy. It robs me of the desire to prepare decent food, to look after the house, to keep much of a routine. Sound like anything else you know? I live in fear that the head cold will go to my chest and then I will finish up coughing for weeks on end which leads to fear of aggravation of an old back injury – and so my thoughts become dominated by dismal and negative themes and the black dog leaves his rightful position at heel and begins to circle again. Thus it is that I find that a cold, if I can’t get rid of it quickly can be a trigger for relapse.
So – what do I do? I stay rested. I eat well. I have my flu shots – which I know some find controversial – and that there are also people who are not convinced that this helps, but as a health worker I find that it has left me less vulnerable and in Australia health workers get them for free. I wash my hands regularly and use hand disinfectant. I dress to the climate. I’ve given up rain walks in cold weather. Some people use vitamins, but to be honest I couldn’t face taking any more pills and don’t want to spend the money and would rather just eat the vegetables. I try to avoid spending a lot of time with people who are sick. If you look back a couple of posts to ‘Beyond Medicine‘, you will find that these are the things that will keep you physically healthy as well as mentally healthy. If you want to keep the bugs at bay these are the things you go to. Some I have already mentioned, but lifestyle habits and strategies that reduce stress are also important. Support is important. Hope is important. Sunshine is important. Recognising the early warning signs and triggers of physical illness is important. Our mental health and physical health are inextricably linked.
If I get a cold, I do start taking cold and flu tablets early when I get symptoms of a cold – particularly at night, and I use airway clearing aromatherapy oil before I go to sleep so that I can breathe clearly. I also sleep propped up slightly. Usually these things stop the cold from getting to my chest. Usually.
This year has gone well so far. I’ve stayed mentally well enough while I’ve been sick that I’ve still been able to use my mindfulness and cognitive behavioural techniques to keep the dog in line, so he hasn’t really challenged – even when some of the other important stuff has fallen by the wayside. It’s still going to involve work to get the rest back in place, but hopefully not as much as usual. So just for the moment while I get a bit better…
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.
I live with a black dog. It follows me everywhere. My philosophy now is that I need to plan for its needs when I plan for my own. I also need time out and restful places to enjoy the warmth of the sunshine on my shoulders.
livingwithablackdog 
