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Making Sense of It All 04/11/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Explaining Depression,Function,Managing Depression,self-management strategies,Social Supports & Networks,Socialisation,Talking About Depression — jillnottelten @ 4:45 am
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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

 

Mmmm … Massage 30/10/2011

Filed under: Depression,Managing Depression,Mindfulness & the Senses,Physical health & wellbeing,self-management strategies — jillnottelten @ 8:30 pm
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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 🙂

 

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

Filed under: Experiencing Depression,Explaining Depression,Managing Depression,Medication,My Black Dog,self-management strategies,Social Supports & Networks,Talking About Depression,Therapies,Work — jillnottelten @ 5:30 pm
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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 Best Bucket For Fishing In 27/08/2011

Filed under: Depression,Function,Goals & Purpose,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies — jillnottelten @ 6:13 pm
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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

Filed under: Depression,Function,Goals & Purpose,Leisure,Managing Depression,Routine,self-management strategies,Social Supports & Networks,Socialisation,Work — jillnottelten @ 1:35 pm
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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.
 

The Jealous Dog 22/07/2011

Filed under: Depression,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,Social Supports & Networks,Socialisation,Talking About Depression — jillnottelten @ 1:02 pm
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If there’s one thing that discourages a jealous dog, it’s competition.

Sounds simple, doesn’t it?

Of course like everything that sounds simple there’s a journey involved in getting to the bit that’s simple.  And at times the times the ‘simple’ bit is anything but easy.

If you were to tell me in the depths of my depression that competition was all that was needed to discourage the dog – that having other, more enjoyable things around me would make life easier to manage I would probably knock you flat.  And I hit ‘like a girl’.  When I am unwell they probably do knock the edges off things, but enjoy … ? Perhaps.  I certainly need help to initiate the diversion and the routine.  Ah … the old ‘r’ word.  Yes, I must admit – it does help.  I just hate it.  I never feel like it and it’s damn hard to do.  Especially when I still lack the sense of enjoyment of anything.

But further on – about eight months ago I gritted my teeth and reestablished contact with a long-lost world.  The friend.  The ones I lost contact with during a couple of years of withdrawing from – well – life in general.  Initially it was very tentative.  After all – who would really want to be friends with me, right?  But no, contrary to my very localised opinion friends welcomed me back with enthusiasm … on-line, phone calls, coffees, visits and finally a trip to see someone who lived a long way away for a few days (I was very nervous about this one) which was lots of fun.  I now have friends who I talk to again regularly and see when our schedules allow it, an old school friend I catch up with regularly, friends kids who are excited when I come to visit and people who miss me if I’m not around.  I never thought I’d see the day.  I’m still not sure I believe it.  By rights I should have black and blue spots up and down my arms from where I have been pinching myself but if it’s not true, I’m not planning to end the dream any time soon.

Today is my first day at home after a couple of weeks on holidays – staying with the same friends that I visited earlier in the year.  I was originally going for a few days, but the family with whom I was staying voted unanimously that I should stay longer – so I did.  I visited with other friends and their families on the way home, including one family not far from home where I stopped in filthy weather with an hour’s notice to drop onto their couch for a night.

Amidst all of this my dog stayed at heel without challenge.  This is amidst ongoing bungles with a return to work plan that has been drawn out for months.

My dog is shy around people who value me.

I need to remember this next time he pulls me in close to home.

A black dog needs a little competition from people who care.  He just wants me to believe that there aren’t any.  I did once and it turned out to be a lie.  I must remember this for another day.

My dog lies.

 

The Stranger 04/07/2011

Filed under: Clinical Depression,Depression,Function,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,My Black Dog,self-management strategies — jillnottelten @ 5:19 pm
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I sat down to do my WRAP a few months ago.  My Wellness Recovery Action Plan.

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

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

“What am I like when I’m well?”

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

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

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

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

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

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

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

 

The Phantom 02/07/2011

Filed under: Clinical Depression,Depression,Experiencing Depression,Managing Depression,Monitoring early warning signs, triggers & Wellness action Planning,self-management strategies,Social Supports & Networks,Talking About Depression — jillnottelten @ 5:20 pm
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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.

 

 
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