By the way …
Someone has nominated this blog for Bloggers Choice Awards under ‘Best Health Blog’
See?
http://bloggerschoiceawards.com/blogs/show/177188
If you want to vote you need to register though 😦
Pretty cool though, hey?
ps Curiosity was too much – I’ve registered …. and put in a vote (so was temptation)
The Massage Table
I had had it.
I was aching.
It had been a long day at work.
The black dog had been pulling at the lead all week.
My work satchel was dragging down on my shoulder.
I was walking towards Woollies to buy the makings for dinner.
Then I saw it.
The massage therapy place in the shopping centre.
It was clean.
It was respectable.
It was affordable … with minor adjustments
And it was THERE!
And in only a moment so was I.
“Do you have an opening?”
There was an opening.
What did I want?
“Upper back, shoulders & head please.”
Back, shoulders and head I got.
Forty minutes.
I went in with my muscles aching, my shoulders set like concrete and my neck so tight that I’d not been able to comfortably look over my shoulder in days.
I came out uncrimped and able to move.
I happened to be lucky last week. I had a little money that I’d not budgeted on having. I couldn’t always just do that. Besides, I’m not usually the type to let someone I don’t know give me a massage. (Seriously, if you’d heard me coming on Thursday you’d have gotten out the DW40 ready to get rid of the creaky noises when I arrived)
The problem is, however – I have trouble getting a massage at all. Most of the time it doesn’t bother me – but when I say “massage” around my family and friends, they all turn around and say, “yes please!”
Yep, you’ve got it. I’m the one who grew up with the sooky Dad. The one that played sport too hard too far into his 40’s and 50’s and then moaned about the aches and pains all week. I was trained to massage my father’s legs when I was six or seven … and I am not exaggerating. There is no need.
My brother, who had once helped, grew callous and demanded payment at some stage, but I was still too gullible to get out of it – or figured it was easier to put in 5-10 mins of back or head massage than to listen to him grovel until he gave up. In the end I got to be not too bad at it and when I hit Uni and somebody taught me anatomy, I actually became quite good. Now, this was all fine and dandy for the family and the friends – but it did bugger all for me.
I’ve tried to interest some of them in learning, but do you think I’ve had any success?
The thing is – it’s not that hard to give a passable shoulder massage that will make someone very happy that you took a few moments out of your day to share it. There are only a few basic principles that you need to follow – and these are consistent pretty much anywhere you massage.
Here is a rough picture of some of the muscles of the back:
If I were looking to spend five or ten minutes just helping someone to unwind, I might start by finding the bony landmarks on the person’s back and think about where the muscles are in relation to those bones. The spine is usually visible down the centre of a person’s neck and back. The easiest way to locate the shoulder-blade is to start at the tip of the shoulder and to trace it around with your fingers. Notice that the shoulder-blade has two bony borders along the top. This is because it’s not shaped only like the 2 dimensional triangle that you see in drawings, it has another edge – a bit like a fin (but not quite).
So, say a person is sitting in front of me – here I start by running my hands straight up the back to the neck one after the other, avoiding the spine and moving from the centre to the edge – first on one side, then the other.
I then follow this by focusing on the muscles coloured red and green on the left hand side of the illustration – initially the red Trapezius muscle which is large and often carries a lot of tension. I would massage predominantly in the direction of the arrows – in upward strokes along the muscle fibres.
After these muscles have been freed up a bit and feel less tense, then I might move my attention to the deeper muscles. If the muscles are not freeing, I would turn my attention to the blue muscle – Latissimus Dorsi. A person’s lat’s are large and often carry a lot of tension also, so you may need to break up some of this to get anywhere with the Trapezius. When working the Lats, I use a wide surface of my hand or forearm with long firm, upward and oblique strokes and then smooth them down and go back to the Traps again.
By now the person’s muscles are warmed up, so they are also tolerating firmer pressure as I target deeper muscles and the upper muscles are relaxed enough so that the pressure reaches them. The principles for the muscles of the deeper layer muscles are pretty much the same as the ones I use for the upper layer ones. The only exception is that I will often spend some time after warming up the Rhomboids (pink) working them across the grain of the muscle (ie across the muscle fibres, not along them because the Rhomboids get really, really stiff sometimes and need help to free up).
The other muscle to have a good look at that people love having worked is the Levator Scapulae. Again, just work it up the grain of the muscle fibres. It’s also helpful to just press on it at about the base of the neck for a few seconds or so. Also working the muscle inside the triangle at the top of the scapula is easier once the muscles are warmed up.
But if the deeper muscles look too confusing, don’t worry – even if all you do is loosen up the upper layer of the person’s back – most people will thank you.
What part of your hand you use is up to you – I often knead with the flat edge of my thumb while I rest the heel of my hand on the person’s back. I might sometimes use the heel of my hand to massage. Depending on the person and how long I have been massaging for I may gently use my knuckle. You can also use your forearm.
None of the stuff I’ve shared today is particularly scientific or text-book. Simply hands-on learning. But I think that people being able to help each other break up muscle tension is worthwhile. So is nurturing.
When it comes to massage, all I can say is that lots of people like a treat. See if anything that I have learned adds anything to what you know – and please … you’re welcome to share your tips with me.
You know where the comments section is 🙂
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:
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.
Heel, Dog. Heel. I’m onto you.
The alarm clock rings.
Perhaps.
I drool. I roll.
The dog opens an eyelid.
I haven’t moved yet.
The dog opens another.
I am snoring lightly.
His head lifts.
Tilts.
He listens.
I am breathing.
The dog rises on his haunches – quietly – all the while waiting for me to stir.
The song changes on the clock radio.
… and slowly, slowly he rises to his legs and creeps out of the room.
The black dog roams free in the house.
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.
I pull the covers up over my head and try to snuggle back down to sleep.
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.
Today, the dog has finished his day at heel.
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.
One day.
Some people are Summer people. Some people, spring people. Some are winter people. Some love autumn.
No, I’m not talking about people’s colouring or the things that they like to wear (that is something that I, in fact know very little about). I am simply talking about peoples’ favourite times of year. Some people like to soak up the sunshine in summery garb out in the garden, down at the beach or over at the local pool. Others love to curl up by the fire in their favourite jumper under a rug with a good book and a cup of hot chocolate – or put a movie on. Some love the colours of autumn and the beginnings of that lick of ice in the early evening. And some the radiant brightness of spring, its scents, the new life, the slow steady warmth, the magpies diving at you from overhead…
I never settled to a favourite time of year. I really do enjoy almost all of all seasons – and by the time one ends I am ready for the next. I am not fond of the days that exceed 40 degrees celsius with no cool breeze for long stretches at a time. Hot winds are their own breed of evil in Australia for reasons far beyond temperature tolerance. I’m not a great fan of temperatures at the other end of the spectrum either – especially if they come with a wind. Actually – wind bugs me more than temperature. But seasons – apart from the odd bits like getting up in the dark to go to work in winter – seasons are a delight. Full of life. At least, I always used to think so.
My dog pays attention to the seasons too.
Unlike me, the dog has clear preferences for different times of the year. It took me a while to work this out, but its consistent. The dog is stubborn in winter. He moves slow. He needs more time. He takes more time and holds me up whether I plan it or not and he wears me out more easily than he does during the warmer months. I think he’s arthritic. He gives me no trouble if I allow for the arthritis though. A bit more sleep – 1/2 hr or so more than I need in summer and I’m fine. I just need to be patient.
Summer is usually the dog’s best time of year. He still needs discipline, but he’s more content to walk at heel and doesn’t drag and tug away at the lead. Spring and Autumn are strange. Most of the seasons fall in with the winter and summer behaviour for Dog according to temperature and what the light is doing. In each of these season there comes a point where the light changes – and over these few weeks the dog goes nuts. He is unpredictable. I can not afford to let my guard down for more than a few moments at a time. My sleep gets poor – this starts the ball rolling. My energy levels become low, my motivation to maintain routine relapse prevention strategies gets sloppy and I soooo don’t feel like doing anything about it. It at these times that I have frequently relapsed (almost without exception). I made it through autumn this year. So far I have struggled this far through the last few weeks. Another 3 – 4 should see me through the worst of it.
Until then, its keep on keeping on and stick to the programme. Watch for warning signs – the very time of year in and of itself is a trigger – even without the presence of other factors. Light does funny things to my health in other areas too. It’s like the dog becomes delirious. Here is a time when I need my friends and family – my supports more than any other time of the year. I’m struggling to get to work on time at the moment, but so far my boss has let me cover with time in lieu. Still, I’m determined to conquer that one too. I get there on time more often than not – just not as often as I should. Just now – when I least feel like it – discipline becomes oh so important.
I had my last review with my Psychiatrist this week. We agreed that it would also be possibly a beneficial thing to increase one of my medications for 1-2 months during the peak risk zone while I’m wrestling risk factors and wavering – just for that short-term – and then go back to my current dose afterwards as the weather and season stabilises a bit more.
Hopefully the combination of ‘personal medicine’ or monitoring of triggers and early warning signs with the kind of action plans that are outlined in my post “Better Medicine” with the temporary medication adjustment will prove to be a good protective measure. I’ve had a good year. I’d hate to mess it up now. I’m hoping to get to at least a whole year without a relapse this year!
So roll on to the latter end of Spring. Because despite all of this, I really do love spring. There’s a certain level of hope and promise in the air in Spring that’s unique to this time of year.
Come Dog. Heel. Walk. Heel. Walk. Heel …
I have been cleaning out my study over the last couple of days – no small job – I have been putting it off for a long time. I unearthed a lot of rubbish, a tonne of reading, receipts, filing, thankfully nothing that should have been included in my tax (which I have done already this year – yay me!) and my bucket list that I did for my Psychologist earlier in the year.
Why a bucket list?
I had been depressed on and off for years. When I was well I had only just been coping with no room for anything but putting one foot in front of the other. It had been a long time since I had really allowed myself to cast my eyes very far into the future. It was hard to do. My life had become so tied up in looking after the dog and keeping him out of the way so that I could manage walking that it was hard to picture anything else. This is not a healthy way to live!
Maybe not – but everyone knows that we need to get through each day – so what’s the point of looking any further?
My first response to this would be to give you a reason to stick to the fundamentals that feel so arduous when times are tough. The healthy lifestyle, the sleep, the medication, the self management strategies that you’ve chosen to compliment your medical treatment (see my post Beyond Medicine) can feel like such a chore at times, and there are days when you question if your daily struggles are all that important. Things that have some value and potential to motivate you are important.
My second is that a routine is strongly recommended, but often hard to fill out. An exercise like doing a bucket list may give some clues to your interests or things that you could start even now to use time doing something that you are more likely to consider worthwhile.
Thirdly, if you are getting well and your health is stable, but you’re a bit lost about what you want to do – this is a great way to brainstorm ideas that you can later use to figure out what direction you want to work towards and what sort of goals you want to set for yourself. You can also look at the different sort of things you have put on your list and use it to try to make sure you keep some balance to your goals so that you can target a balanced lifestyle that reflects you.
Fourthly, if you are struggling to stay well and all that you are focussing on your health or perhaps your health and keeping your job – perhaps you can use it to choose one thing to help with relaxation and/or re-energising. Often – and I speak from several years of experience here – this is neglected to our detriment when expanding our support network and finding opportunities elsewhere for success would improve our workplace performance and keep the dog in his place much more effectively.
Not sure what you’d put on it? Try meeting up with a friend and do bucket lists together (I met up with a couple of different people). This helps stretch your ideas until you start freeing up your mind. Read past journals if you have some if you used to write about things you’d like to do one day. Be as vague or specific as you like – it’s your list.
Here are some of the things on my list:
Bushwalking
Make a pretty garden
Redo a house
Teach professional practice skills
Overcome Depression and Anxiety to the point where they no longer require any intervention – even meds
Stay well
To make sure I keep up friendships and make new ones
To grow wise but be humble
To be physically fit and able to run without getting puffed out
To get good at being organised and reliable
To learn lots of interesting things eg Ancient Greek, Ancient & modern History, Latin, Languages, Leadlighting, Aromatherapy, Sciences, making things, gardening, writing and publication industry, professional development and research, theology …
Write a book and publish it
Write a children’s book, get it illustrated and publish it
Go to Scotland, Ireland and Canada and see lots of other places too
Learn Piano
Write a song
Learn to play Cello and/or an alto/tenor woodwind instrument
Research and develop useful intervention strategy for use in Mental Health Recovery – meaningful to and valued by consumers – well weighted by evidence
Learn to tap dance
Build a doll house
Act in a stage performance
There’s a tonne of others that I’m not going to share and I’ve simplified a lot of these. But they have made way for goals and routine and positive steps.
There are six major themes among the things in my bucket:
Creativity
Learning
Relationships
Social Responsibility/contributing to others
Travel/adventure
Growth (language, fitness etc)
My challenge is to have something – one thing at a time among my goals that touches on each of these areas. I also try to include something of each – at least most – in my routine.
The steps to some dreams are appealing. The way to others not so much. The keys are choice, balance and timing.
Never let the dog stop you from dreaming. Sure, be careful not to get stuck in them – but be careful not to lose sight of the things that you’d like to do or some day. These are the things that give you a reason to put your next foot forward. These are the things that make it matter that the dog stays out of your path. These are the things that help you choose which direction you walk in. These are the things that make it matter that it’s you and not the dog that does the choosing.
Look where you are going. Move deliberately. Walk one step at a time if you must during the hard times, catching your balance and calling the dog back to heel in between. Don’t let him draw you down to wrestle with him while you walk. When you stop looking where you are going, the dog has the upper paw. Shorten the leash. Keep him close. Don’t give him an inch.
Heel, Dog. Heel!
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.
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.
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.
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livingwithablackdog 
