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Making Sense of It All 04/11/2011

A while ago I spent some time blogging about how we can talk to people about Depression – or about mental health issues in general. But I left out a very important group of people. Kids.

How do you talk to kids about mental illness? How am I going to explain my Depression to the important children in my life? How do you explain it to those in your own? While people often worry about upsetting kids or frightening them by talking about mental illness – and I’m talking about the kids in your family or very close to you here; the facts indicate that most of the time children worry less about something if they understand it. Providing them with opportunities to talk and to find out what they think is happening is important. So is clearly and simply explaining what is actually happening in a way that they can understand.

But finding the right words to explain what needs to be said in kid language is a tough business. Plus, adults struggle to share their feelings. Again, accurate and age appropriate information are the best way to go – and this usually goes down best coming from a parent or another adult family member or close friend of the family.

So – how do you know when and how to do it?

If they ask questions about your or the other person’s health – this is a good opportunity. A number of resources suggest strategies like asking the child how they are feeling at the moment, if there has been an incident recently then perhaps ask them how they felt when such-and-such did this-or-that; or even if they thought you or the person were acting differently lately – depending on the age of the child. But whenever you do – pick a time and place where you’re all most likely to be comfortable and feel safe and where you won’t be interrupted.

It’s suggested that you explore the child’s understanding of what’s going on – not just accept their first reply because they could easily just repeat someone’s words without clearly them. Plus it’s important to know how they learned what they do know. Also, make sure that you’ve understood properly what they have told you.

Ask questions that are open – that is, they require the child to do more than say ‘yes’ or ‘no’. Try to get them to say what they think in their own words.

Be ready to reassure them. They might feel awkward. They might feel distressed or disloyal or angry or be afraid of causing worry or getting into trouble. Make sure they know that this is okay.

Now when you come to the explaining part:

There are lots of good resources take a look through some of them to prepare yourself for the talk or use them with the child. (Please see links at end of post).

Keep some coloured pencils or pens and paper or some play dough handy. Something that you can use to illustrate what you are telling them about or that you can ask them to draw something to help illustrate a point or a feeling. You may also write down thoughts or questions or plans together later (or draw their understanding of things for you when you are exploring what they know).

Think about examples of illnesses that children are familiar with that could be helpful in your explanation eg asthma, diabetes, broken bones, colds, chicken pox (some will depend on what they or their friends/family have had). Be specific in the comparison that you make eg asthma and depression both have triggers and physical signs even though they happen in parts of the body, both can seem to come out of nowhere … ; it is not like a cold because you can’t ‘catch’ it.

Or a common example is to compare the body to a car with different parts – different things work together to make the whole car work, but if something goes wrong then it can make the whole car run badly or not start. In the case of Depression … (a good example of such an explanation can be found in Talking to Children and Young People )

The big ideas to communicate no matter what are:

Mental illness is nobody’s fault
It’s not YOUR (the kid’s) fault
It doesn’t mean that the person doesn’t love you or care about you anymore
It is not your responsibility to make the person better.
You can’t “catch” it
Just because someone else in your family has it doesn’t mean you’ll get it
It happens to lots of people, in lots of families – not just this person
The person won’t be like this all the time
There are treatments like medicine and people to go to for special conversations and doctors who know about this illness
It’s not just about the person thinking or feeling differently. What is happening to the chemicals in their brain is different.

Here is a summary of an outline that I found about how to explain Depression to a child in an Australian COPMI program booklet.

Children can sometimes understand the impact of your illness more easily than they can its cause. This means that it may be best to describe what the depression does to you rather than what depression is.

So you might tell them that Depression can cause:

no energy (making it harder to play)
difficulty sleeping or sleeping too much (making it harder to get out of bed or keeping you up late at night)
crying a lot (sometimes when there is no apparent reason)
losing or gaining weight (because you don’t feel like eating or you eat too much)
not enjoying the things that you used to (means that sport or dancing or cooking or whatever it is doesn’t make you smile anymore)
make you tired and cranky (can make you get grumpy at the children for no real reason)

What does your depression make you do?

Depression is an illness. It’s like having a cold or having asthma except it affects your brain. Your brain controls the things you feel, think and do.

Everybody feels sad sometimes.

Everybody thinks bad things sometimes.

Everybody has things that they wish they could do, but can’t.

What makes your/this child(ren) sad?

What sort of things do they think about?

What do they wish they could do but can’t?

When someone has the illness called Depression, they can feel sad for a long time and not know how to feel better.

Depression can stop people being able to do things that they used to do and enjoy.

I hope that this gives you some ideas for some starting off points. Seriously – do take the time to check out some of these links. The first three have really informative and detailed guidelines in them. The resource lists include children’s storybooks, links and all kinds of things and the other links have some wonderful things in them too.

I have found some other FANTASTIC resources for parents, siblings, extended family and close friends of children who have parents (or family members) with a mental illness. Even one about babies for those with bubs or planning pregnancy. There are more out there just waiting to be discovered.

COPMI stands for Children Of Parents with a Mental Illness. It’s Australia’s national project over this area.

Piecing the Puzzle Together: Raising a Family When Mental Illness is Part of Your Life

Family Talk

Best for Me & My Baby

Talking to Children and Young People

Resources for Children aged up to 6yrs

Resources for Children aged 7 – 12 yrs

Resources for young people aged 13-18 yrs

Resources for Parents

Care Planning for a Family

Links for young people

Australian programmes offering support for children and young people with a parent or sibling with Mental Illness

Family to Family project booklets

When Things Are Sad And Gloomy : Understanding Mental Illness in your Family

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Mmmm … Massage 30/10/2011

Filed under: Depression,Managing Depression,Mindfulness & the Senses,Physical health & wellbeing,self-management strategies — jillnottelten @ 8:30 pm
Tags: awareness, black dog, Depression, early warning signs, family, friends, Health, Massage, Mental Health, self-management

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.

Apply pressure in long, slow, firm strokes.
Start light and increase pressure slowly over time.
If you’re worried about whether you’re working your strokes to quickly – slow them down, just keep your pressure even.
Except with specific muscle groups, plan to work the muscle along the grain of the muscle fibres ie the direction that the muscle goes.
Work from the surface muscles toward the deeper ones.
Always stay away from the spine, throat and other sensitive areas.
If it causes pain – stop.

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 🙂

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Hair Raising Therapy 23/10/2011

Filed under: Depression,Experiencing Depression,Function,Leisure,Managing Depression,self-management strategies,Socialisation,Therapies — jillnottelten @ 2:25 pm
Tags: awareness, Depression, early warning signs, family, Health, Mental Health, Mindfulness, niece, self-management

I had only two posts for this weekend.

I had finished and scheduled them by Thursday.

My parents have come to visit – so I didn’t think I’d have time to blog.

But here’s the thing …

I’m too interested in the things I blog about to leave it alone.

I’ve enjoyed sharing some of my early experiences of Mindfulness. I hope that some people have found it valuable and that it has helped some to grasp a little more clearly the concepts behind it.

Being present in the moment, self-aware and able to be aware of your environment or choose to filter what you attend to. Being able to focus your attention, your thoughts and meditate on or observe things. To be deliberate in all of this.

It is a refreshing experience and helpful for many things from distraction to relaxation, to stress management and through to managing early warning signs and symptoms. If you’ve not had the chance to learn it, I would highly recommend it. It is a more concrete skill than it sounds at times.

I have had fun today. I enjoyed having my 5 and 3/4 year-old niece do my hair for me this morning (one must not leave out the three-quarters!). When I got home (after driving for a quite a distance and stopping to get out of the car and fill up with petrol) I believe that I pulled 7 elastics and 2 clips out of my not-so-very-long hair (ie it had bunches sticking out in all directions).

I don’t think that she believed that I was really going to leave it all in until I actually left.

Playing hairdressers with one’s niece is a lot like a dare. She knew I looked silly, and didn’t really think I’d leave her handiwork in – but wanted to see if I would.

What she doesn’t know is the kind of things I did to my own hair for the hell of it when I was in my teens and went out with still in just because I was bored.

My niece is good therapy for me. When I am with her I forget to be anything but open to what she wants to do (except if it involves running too far or something against the rules). I lose most of my inhibitions and allow myself to play like a kid again. She lets me enjoy the moment in her company for just that little while – and while I am with her I feel whole.

She is my favourite anti-depressant.

What’s yours?

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The Banshees 20/10/2011

Filed under: Function,Managing Depression — jillnottelten @ 12:28 am
Tags: Depression, family, housework, planning

It’s official.

My house has been raided.

There has been a hoarde of banshees run through, pick everything up, carry it into another room and throw it willy-nilly anywhere they pleased. They each then had three glasses of something out of my refrigerator, dumped the glasses in the sink, dirtied another sundry dish, killed a plant and left.

And just to make amends for all of their trouble, as a parting gesture – they planted a weed each.

My parents come to visit this weekend.

Somehow the house will be fit to be seen.

Maybe I will be too.

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Five things to be Grateful for 19/10/2011

Filed under: Depression,Managing Depression,Mindfulness & the Senses,self-management strategies — jillnottelten @ 4:30 pm
Tags: Depression, faith, family, gratitude, managing depression, meditation, Mindfulness, readers, sunshine, work

I was reading from a collection of blogs not long ago about becoming mindful of gratitude and how positive this is for your health and well-being. Now I’m not a big one for karma or positive and negative energies or things like this – but with gratitude this is true. It has you thinking positively about things and when you reflect upon what it is you are thankful for there is a physiological response. Your body reacts to gratitude too. So helpful are the effects of your gratitude on your mind and your body upon you that experts beyond religious and philosophical teachers are now convinced that time spent meditating upon those things that you are grateful for and allowing yourself to reflect upon your gratitude is enormously worthwhile.

Now meditation does not have to involve any special costume, or ceremony. Simply a place where you can sit in peace for a few minutes in an alert posture and reflect in a focused way. If you find your thoughts straying – that’s okay too – all you do is bring them back to focus. If sitting doesn’t work for you try a slow walk or standing – but the goal is that you can be alert and not distracted from thought.

To begin with thinking of things they’re grateful for might – to some – feel a bit like Pollyanna’s ‘Glad game’. But it becomes easier if you are not used to it and will feel less of a reach with practice. To others it’s a bit hard to focus oneself on a manageable amount of things to meditate on instead of just churning out a list – either out of a genuine or obliged sense of gratitude. But the point is to reflect on them also. If you need something to help you limit your choices – pick a theme for a day and work with 5 things within that theme.

And so on that note:

5 Things that I am grateful for today:

1. My family. I have a really helpful and supportive family and even though they live all over the place we are in constant contact and any one of them would drop everything if they thought one needed the other. There is trust amongst us and love and fun and we like each other. That’s pretty awesome. My family has seen me through some pretty tough times and I’m extremely grateful for that. It’s not something they expect anything in return for. It’s just family to them. I have a lot to be grateful for in my family.

2. Faith. I have a faith that is new every morning and even though I don’t deserve it I have confidence that there will be peace for me in the end in heaven with God because of Jesus. Even in my darkest hours when I doubt myself I can believe this. For this I am grateful.

3. Sunshine. Today is gorgeous. The sky is beautiful and blue and the sun is bathing my yard all lovely and warm – getting ready for the summer to come. It’s been raining for a lot of the week so with the sun out my flowers are blooming and looking spectacular. When I go outside it will feel beautiful against my skin too. There is so much life sustained and nurtured by the sun. It always puts a life on my mood. I am thankful for a beautiful day.

4. Work. I have a job to go to. After the last 12 months I wasn’t sure that I would. I actually enjoy working. Sure there are parts of my job that I don’t like – but I like the job most of the time. I like to go and earn my own keep. I am grateful that I am able to work in a job that I enjoy and earn the money that I need. I like working with people. I am thankful for the opportunity to make a difference in people’s lives and also for the things that I learn from them.

5. You – my readers. You keep me thinking and looking into what I think about things. I am grateful to you for keeping me on my toes and exploring what is out there for people with depression around the globe. You remind me that I am lucky to live in a country where the government subsidises health care heavily and the standard of education of most of our health workers is good – as is the access to ongoing education. (Not saying that it’s not elsewhere – but grateful that it is here). I am grateful for the interested or curious minds that keep turning up to read what I have to say. You remind me that we can never get too comfortable in what we know and that we should always keep searching to understand more. You, by reading hold me to account to my opinions and knowledge. Because of you, I take my own advice and my health improves as well. This is something to be grateful for.

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Todays post was inspired by a post that I found by Katherine http://inspiredeverymoment.wordpress.com/2011/10/14/growing-through-gratitude/

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Depression? … No, it’s not just … (sigh) … Forget it … 12/10/2011

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…

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.

Comments (1)

The Stranger 04/07/2011

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

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

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

“What am I like when I’m well?”

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

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

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

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

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

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

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

Comments (9)

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: awareness, black dog, Clinical Depression, early warning signs, family, friends, planning, Relapse prevention plan, self-management, Social supports, Wellness Recovery Action Plan

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.

Comments (2)

I have a Dog 23/06/2011

Filed under: Depression,Managing Depression,My Black Dog,self-management strategies — jillnottelten @ 11:13 pm
Tags: black dog, Clinical Depression, Clinical Psychologist, family, GP, medication, Mental Health, mental health workers, planning, Psychiatrist, recovery, responsibility, Social supports

I have a dog.

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

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

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

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

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

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

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

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

He is my black dog.

livingwithablackdog