livingwithablackdog

sit. stay. good boy.

It Works For Me 14/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Routine,self-management strategies,Work — jillnottelten @ 11:59 am
Tags: , , , , , , , , , ,

In every culture there are certain norms.  Rules if you like.  What type of food people eat, the structure of families and social networks, the kinds of things that people do, our attitudes to authority and among other things our attitude to work.  In most western cultures the attitude is that you’re supposed to engage in it – but it’s also something to complain about.  The idea is to have a lot of other things you’d rather be doing.  Work, school all things regarded as ‘compulsory’ are often seen as restrictive.

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

Some of the Benefits of Productive Activity and Work

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

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

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

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

 

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
Tags: , , , , , ,
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.

 

Black Dog, White Knight 03/08/2011

Filed under: Clinical Depression,Function,Managing Depression,My Black Dog,self-management strategies,Treatment Resistant Depression,Work — jillnottelten @ 4:16 pm
Tags: , , , , , , , , , , ,

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.

 

The Dog in The Fog 27/07/2011

Filed under: Clinical Depression,Cognitive,Depression,Function,Managing Depression,Medication,My Black Dog — jillnottelten @ 7:43 pm
Tags: , , , , , , , , , , , , , , , ,

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.

 

Marionette 26/07/2011

Filed under: Poetry — jillnottelten @ 8:24 pm
Tags: , , , , ,

This was written at a time when I was feeling exhausted and spent; dangling as though on a string like a marionette.

Some laugh at the world – but what’s to laugh at?

It used to be so easy – but I can’t remember how.

A ghostly chuckle in my ears –

A relaxed, contented smile before my eyes:

My voice. My smile. My ears. My joy.

They seem so distant to me now; plunged in the depths

of self-pity, loneliness, frustration and depression.

The wells of my eyes are barren.

There is no relief for the dryness of my heart

as it cracks and I dangle from a string.

If I refuse the string, I could live a life

of sheer and utter relief;

Relief from the barrage of emotions that storm me

from minute to minute…

hour to hour…

day to day.

In the depths of the gully I would gladly surrender

the thrill of soaring the heights.

At the heights I would wish me more string.

In the middle – I pause and wish for moderation –

But what the cost?

 

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
Tags: , , , , , , , , , , , , ,

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.

 

Reality? 05/07/2011

Filed under: Poetry — jillnottelten @ 9:54 pm
Tags: , ,

This poem was written during a time when I was exhausted, but not depressed – long before my initial encounter with Depression.  I was disenchanted with many things and felt like I was being torn in a lot of different directions by the demands in the household I was living in, my work, my Church and my own emotions.  I was in phase of experimenting with free verse as well as some old English language.  The reference to beauty and truth draws back to Ode on a Grecian Urn by Keats which I studied for my HSC.

The poem reflects the way I have often felt in more recent times when progressing toward becoming unwell.

Reality bites?

Bites?  Nay – it gnaws.

It grinds me away with its powerful jaws.

There is breaking and tearing –

Yet taste, yet flavour.

Mastication, taste, digestion, excretion –

Where is reality?

Where is truth?

Is beauty all truth?  Or truth beauty?

Which portion –

Which fragment

of that which is truth…

is reality?

 

The Stranger 04/07/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies — jillnottelten @ 5:19 pm
Tags: , , , , , , , , , , , , , , , ,

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.

 

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
Tags: , , , , , , , , , ,

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.

 

Who Walks Whom? 29/06/2011

Filed under: Depression,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies — jillnottelten @ 3:56 pm
Tags: , , , , , , , ,

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.