livingwithablackdog

sit. stay. good boy.

The Dog in The Fog 27/07/2011

There are a lot of things I hate about Depression.  Take your pick – the effect it has on your self-worth, your energy levels, your mood, how sociable you feel and act, your self-image and presentation, that non-expression on your face … or the medication – weight gain, constipation, tremors, medication for the tremors … the constant need to micromanage your life to prevent relapse routine, exercise, diet, sleep, early warning signs, triggers, medications, appointments and to cap it all off there’s the increased incidence of things like diabetes and heart disease in people with depression.  Some of these are direct results of depression.  Some are spin-off effects from symptoms played out in the lifestyle.  Some are medication related.  But by far the effect that I loathe the most is the ‘fog’.

Thinking in ‘The Fog’ is like those movies where a character moves across a misty set barely able to see what is in front of them, working to make out the shadowy forms in the haze before them until the mist folds away just before they meet it to reveal what is there – yet the objective never quite within sight.  When I am not well my mind is in stupor.  Gears creak.  Cogs struggle to turn.  I forget things constantly.  I lose my place in what I am trying to communicate to someone.  These are things I was once very good at.  As I get better I can do all of the things that I used to do – but many of them I do more slowly than I once did.  It now takes me longer to process things in my head – arithmetic, deciding how to express something carefully, making a decision, figuring something out.  Some of this is because of medication – but not all of it.  Some is the Depression itself.  It has slowed my once quick mind.  Recent changes to medications have freed it up a little, but it is still not what it once was.

It is not obvious to everyone.  Mostly only to people who have known me for a long time before and after the Depression left its mark.  When talking with a friend and therapist with whom I once worked once told me that the difference had made her cry.  It was such a relief to know that another person was grieving too.

I had an ongoing dilemma with medications until recently that centred around a Lithium fog.  After years on a tricyclic that kept me well in tandem with Lithium, I eventually had to stop the Lithium so that I could use anti-inflammatory meds for chronic back pain that wasn’t responding to any other form of treatment.  The result was that the back pain settled reasonably quickly, but it was difficult to keep my mood stable on the tricyclic alone.  In the end, my Doctor suggested that a medication change was the way to go and I finished up on a combination of Lexapro and Edronax.  Beautiful.  I could think.  However, like the tricyclic (which I’d been on because SSRIs on their own didn’t work), in reality my mental state was still not really robust.  Finally, after much resistance on my part, I restarted Lithium as an augmenting medication to bolster the main ones – and, for stability I did need it.  But it really stank.  The fog was back.  Lithium, I find does slow me down – preferable to relapse and job loss – but still unpleasant.  My best news has come with the release of Valdoxan.  Given how much I hate and object to the use of Lithium, my doctor has trialled me on this in place of the Lithium as my augmenting drug and it is working beautifully and without fog.  So what is now left that is attributable to medication is as low as we can get it.

What has been affected is what I will call my ‘working memory’.  The part of the brain that is operating and pulling everything together at any moment so that I can think, move, find information that I know, solve problems, come up with ideas and take action of any kind.  It is where what is needed from my short & long-term memory, senses, visual-spatial understanding, communication and organisational understanding and my level and focus of attention are is pulled together and used to observe or interact with the cues, instructions or things in the environment around me to guide my actions in a certain way.  It is where, to a large extent I can regulate the speed of my actions also.  BUT here’s the thing.  When I’m not well my level of attention is affected so I miss information from the environment and not all of the information that my mind needs makes it in.  The speed of the working memory slows down, my memory is fuzzier and less accessible, I lose the flow of operations I am doing.  It’s like if there is a little man inside my memory coordinating all the information, he ages 100 years and can’t manage all of the information when I’m depressed.  When I’m well he returns to almost his original age and moves reasonably well; but he’s been left now with some injuries – back strains and a touch of arthritis that slow him down just a little on the fine and detailed work or when handling really heavy stuff.  He can handle it, but he’s not as fast as he was before the injuries that the sudden aging episode left on him.  And nor am I.

At times I think walking with a black dog is like walking through the high mountains where there is rarely a day unaffected by mist – not necessarily always pea-soup fog; yet always just a light haze.  Not enough to hamper most of the time, but enough to dampen the spirits and frustrate – especially one who is unaccustomed to fog.  But the moments when the fog lifts and the sun shines through – Oh my! They are glorious.

 

The Jealous Dog 22/07/2011

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 Stranger 04/07/2011

I sat down to do my WRAP a few months ago.  My Wellness Recovery Action Plan.

The idea is that you describe what you’re like when you’re well, what helps you stay that way, what your triggers are and what you plan to do when you encounter triggers to prevent spin-off effects; then what your early warning signs with an action plan for what to do if you notice them emerging; also what happens when you’re feeling much worse and again what helps in those instances.  You also make a crisis plan, identify supporters and how you agree that they will support you/what you would like them to do for you, identify people who you don’t want involved in your care/treatment and people who need to be notified, your current meds etc.  There are a whole bunch of different ways of a similar process.  Mary Ellen Copeland’s Wellness Recovery Action Plan is the one that I have been using – and hence describing (see link to website).  The point is then to read it regularly – she recommends daily and to stay on top of your management plan and to know yourself, to recognise when you are not yourself; to be watchful and vigilant for triggers, warning signs and symptoms and to act immediately, instinctively.  Also she recommends to have a couple of others who check in with you regularly to help out and give you their perspective or who will tell you if they notice that things don’t seem right.

I think that almost the hardest part of the process to complete was the first question.

“What am I like when I’m well?”

It had been a long time since I had been well for longer than a few months at a time.  What’s more, I have changed.  I am not the same as I once was.  This battle – this relationship with my dog has changed me.  What am I like?

I was in my mid twenties when I had surgery for a massive aneurysm.  Somewhere over the period of the next five years came the prodromal and early symptoms of Depression without being diagnosed until I was almost 30.  I have been wrestling to learn self-management skills until reasonably recently.  It has been a long time since I was truly healthy, although between brief periods of mood change or minor undiagnosed episodes in my twenties until my eventual breakdown with depression I’m sure I was fine.

My point?  What am I like when I’m well?  I don’t know anymore.  What’s more, it always feels like such a silly question to ask other people.  I mean – asking people to help me to identify what I’m are like when I’m not well … that makes sense because I know that my insight is not at its sharpest.  But well?  Shouldn’t I already know that?

Not that I was ever good at describing myself.  Always self-critical, I was never particularly sure why people wanted to be friends with me after leaving school when I had hadn’t had many friends at school.  But that’s school for you – start school somewhere awkwardly and the perception sticks with you til you leave.  Even as an adult I struggle to have a clear picture of what I am like.

What am I like when I am unwell?  What helps when I am unwell?  These questions I can answer reasonably these days.  I have even thought to discuss some of this with others or take notice of comments that they make.

But to know myself well.  To know the self that has been changed by this dog of an illness, by periods of chronic pain, by a swollen blood vessel in my brain waiting as a time bomb for its final burst – but found before it could; the self that has been altered by periods of self-imposed hermit style living apart from the workplace.  This is a person that I must relearn.  This is a person whom I have lost and who has changed while she has been away.  She is a stranger.

I need help to know this person.  Friends.  Family.  Memories.  Time to explore the things that interest me again, to develop new ones.  To reflect.  To do.  To explore.  To discover. To learn.  To grow.  To live.

 

Who Walks Whom? 29/06/2011

I was talking with a friend yesterday who commented on the extraordinary difficulty of the last few years.  She asked about how I’d coped with my depression at different times, what kind of treatments I’d had, the other health problems that had intruded – because there have been significant episodes of those also – just to poke bruises into bruises and how I felt that all of this had affected me.  None of these things are new topics.  They are things that I have had a lot of time to reflect on over the past eight months in particular and to use to build into my Wellness Recovery Action Plan.  But here’s a question it raises for different periods of my life over the last eight – no, realistically the last thirteen years – if I count back to my surgery:

Who walks whom? Was I walking my black dog? … or was he walking me?

For large proportions of that time, my black dog walked me.  How I responded to that varied.  Sometimes I trundled aimlessly along behind him without the energy or fight to do anything else.  Sometimes I would simply sit down and refuse to be moved anywhere and let him pull and tug away at me or haul me along as I sat.  Other times we would do battle – although the amount of energy I had to put into the fight would at times be outweighed by the dog’s.

For example, I injured my back and had chronic pain for months.  Months I fought the pain and the black dog became just another thing to fight, but my fight was strong.  However by the time the back was better, my fight was gone.  My energy was gone.  Before I knew it, my black dog was taking the lead as we walked and I had simply fallen in step with him without the wherewithal to reclaim authority.

Exhaustion does that.

Walking does that.  Especially uphill battles.

How does one keep on walking day by day without getting exhausted?  By walking.  By familiarity.  By over-familiarity with the scenery.  Boredom.  Work.  Idiots.  Medications.  Side effects.  Doctors.  The same stuff as everybody else.  The bloody dog.

I don’t know how to answer that.  All I know is that I can’t afford to let the dog lead when I am exhausted.  I need to stay the one who is the walker and the dog needs to stay at heel.

I think the answer is more related to ‘how do I know how far I can walk?’

I think the answer is related to ‘how do I know when my dog is getting ready to challenge my authority?’

Perhaps the answer is more about pace than distance.  More about awareness than knowledge.

You take a puppy to puppy school and you learn nothing – your puppy doesn’t get trained.  I think that this is also true of depression.  You don’t train black dogs, you teach their custodians how to keep them in check.  Some are easier to keep in check than others.  Mine’s resistant – a mongrel of a thing – but others have worse.  At least I can work with mine.

My black dog needs a leash.  It should not have a halter.  It is not a guide dog.

It must walk at heel.

I must keep my black dog at heel.  I must be alert to his movements.  Too often I have let him have his head and too often I have paid the price.

Heel dog.  Heel!  Good boy.

 

I have a Dog 23/06/2011

I have a dog.

Lots of people have dogs.  Most of them are called things like Spot, or King or “Here, Boy”.  They’re spotty Dalmatians, flat-faced Rotties, alert Alsatians,  perky Jack Russells, yappy little floor mops, podgy Pig dogs, loyal Labradors and trusty Heelers.  Or so we say.  Most of them are bitzers.  But the average household dog is loved.

My dog is a black dog.  He is with me everywhere I go.  I have what  is known as treatment resistant Depression.

My journey has been a strange one.  I find myself standing amidst two different worlds on a regular basis.  In one world I stand with my black dog, visiting a doctor.  In the other I stand with the doctors and other health workers trying to keep my dog out of the way while I see others who come to me, some trailing their own black dogs.  I am also a Mental Health worker.  In fact, I was a mental health worker before my black dog came to join me.  While I had been an empathic one before this, the shift in perspective gave a lot of insight to the way that I worked.

I will always be glad not to have been in the workforce at the point in my journey when my symptoms of depression became so severe that I couldn’t function.  It was a spectacular crash.  I was – it seemed – irretrievably tangled in this black dog’s unsecured lead to a point where I had tripped and was unable to get up again.  Mongrel dog.  As it was with a lot of time, hard work, patience and medication I was able to get untangled – but I’m stuck with the dog and the lead.

More time, more and more review and adjustments to medications by my Psychiatrist, a lot of work with a Clinical Psychologist, an excellent GP, a supportive supervisor and manager at work, a couple of great friends and a magnificently supportive family behind me and eight years later I have my black dog much better trained.

With a lot of time, effort, meds, bucks, sweat and tears I have trained my dog to walk at heel.  He does not run riot anymore.  He is not a puppy.  He is still a challenge and will always need a close eye.  There will always be times when he moves unexpectedly and I stumble on his lead or get pulled in a different direction.  There will always be places that are not as dog-friendly as others, even if it’s not deliberate.   When making plans I must plan not only for my needs, but for those of my dog.  They can be costly in all senses of the word.  They can be inconvenient.  They can seem impossible.

But if I plan for him, I can plan for me.  And I can do all manner of things.

He is not my pet.  He is my responsibility.  I am never without him.

He is my black dog.

 

 
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