livingwithablackdog

sit. stay. good boy.

The Best Bucket For Fishing In 27/08/2011

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!

 

Planning with Purpose 21/08/2011

In my last entry I wrote about going back to work.  I also made brief reference to having a need for some kind of productive activity if I wasn’t.  One of my regular readers made a comment that spoke directly to something really important.  The need for purposeful activity.  Not necessarily work – but activity that is goal directed and meaningful to you.  Activity in which you are setting out to achieve something that you are interested in achieving.  It doesn’t need to be paid activity, but it needs to provide you with a sense of purpose and achievement.  This reader suggested that – but for the expense of living, she would not even care so much about paid work as long as she had purposeful activity.  I have to say that I agree.  Sound odd?  It’s one of the biggest problems people have when they retire.  Not having planned for their need for purposeful activity.
The thing is – people have an innate need to do something.  Preferably something they value and something that is purposeful.  All you have to listen to one of the things that we complain about.
“I’m bored”, “There’s nothing to do”
“What’s the point of this?”, “This is a waste of time!”, “I hate doing this.”, “I’d rather …”, “I’m sick of doing this”, “None of this does anyone any good”
“When am I ever going to use this?”, “No-one’s going to look at it …”, “All I did was sit and look at the …”
Examination of research into the presentation of people with long-term unemployment and people with Depression actually show a lot of similarities.  Things like loss of routine, beginning to neglect personal appearance, poor diet, lack of activity, sedentary lifestyle, poor sleep habits, loss of motivation, social isolation, loss of self-esteem …
Of course for many there are possibly crossover elements of situational depression, however it is interesting to note that the lack of purposeful activity can have such a strong effect.  A study that I heard presented followed up some people some of whom pursued work – some full-time, some part-time; some of whom pursued volunteering.  The outcome – purposeful activity made an enormous difference to quality of life.
But other studies show that it does not even need to be work related.  Simply valued and purposeful – and it will improve quality of life and wellness.  Take up gardening.  Build a doll house for a kid.  Join a gym or walk somewhere every day.  Volunteer at a local charity, Church or club.  Write a book.  Go to a local community centre and check out the programme.  Do a course on something that interests you.  Join a book club.  Start meeting a friend for coffee regularly.  Take up cooking.  Invite a friend over for dinner.  Try that sport you always wanted to try – talk a friend or family member into coming with you if you like.  See if you can find some old friends you’ve lost contact with – you might be surprised how many want to catch up.  Try that hobby you always wanted to take up.  Research your genealogy.
Purposeful activity.  This is what forms the building blocks.  This is where a healthy routine can be built.  This is where a healing routine can be built.  Research says it works.  My training says it works.  My observations of the people I have worked with as a mental health worker say that it works.  My experience of healing says it works.
 

Black Dog, White Knight 03/08/2011

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

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 Phantom 02/07/2011

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

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.

 

Vanishing Days 28/06/2011

This was written six months after major brain surgery.  I now know that this is a major risk factor for depression.  At this time I took it that my body was reacting with exhaustion to trauma.  Retrospectively, the truth is that what I was probably experiencing was a combination of both.  It’s amazing how long a black dog can circle you unnoticed despite impeding your walk and causing you to stumble.  One thing that strikes me as a shame is that there was then, perhaps there is now – no active follow-up of people who had major brain surgery to screen for depression.  The statistics for it are actually quite high and warrant it – I will have to look them up again to add them in here.

Anyway, this is Vanishing Days
I’d pack up all I have to disappear

I’d run a thousand miles away from here

To abandon this life with all its confusion

To flee reality and resist the illusion –

I long to be free from all complications

From all of those everyday expectations

Where nobody has any knowledge of me

How I long from this everyday life just to flee.

But where would I go?

And how would I know –

That I’d run far enough to be free?

For no matter where I’d begun –

No matter where I might run –

Every place I could go I’d find me.

 

Inertia 27/06/2011

Filed under: Poetry — jillnottelten @ 10:00 am
Tags: , ,

Here is a poem written freestyle at a time when I was struggling immensely. Again this was in the early days and I had thought myself to be merely exhausted due to the amount of big things that had been happening that year – including the brain surgery that led to my depression.

Straining forward, forward

Pulling hard against the tide of inertia

pulling me back, and back to some place

as I slice through the gelatinous mass

of my existence in which I swim

Never moving anywhere.

Kick.

Stroke.

Kick.

Stroke.

Kick.

Stroke.

Breathe.

Breathing the same air.

Suffocating as the oxygen thins.

Less to breathe.

More of the same.

Kick.

Stroke.

Kick.

Stroke.

Kick.

Stroke.

Breathe the same –

More of less to breathe.

Suffocating and dying of Inertia.

 

Groundhog Days 26/06/2011

Filed under: Poetry — jillnottelten @ 4:11 pm
Tags: , ,

Groundhog days was written in 2000 at a time before I recognised the black dog for who he was, yet at this point I was being towed along more influenced by his direction than my own.

Oh to revel in this breath

and not ignore the pain

To go to sleep and not wake up

to live this day again

To laugh aloud so free – so free

from the belly of my soul

And spill the tears that dwell inside

before they rot, erode and mould;

To wear my face, asleep, awake –

whe’er joyed, mad, jealous, bored –

To smash to shards that cursed jar

that stands there by the door;

To place my feet upon the path

not doomed to circle back

After climbing hill and valley

to the same place, same damn track.

To walk the path with someone else

with feet beside my own.

To find the strength of someone’s gut

to bolster and press on;

To soar the heights on laughter’s wings,

to bathe in salt of tears

To be still in someone’s stillness,

to bring arms for someone’s fears;

To have somehow made some difference

in some small unimportant way

And to be made somewhat different

by the passing of a day.