Yes, I am still here. Still living, breathing and blogging. Just fell victim to a couple of very shocking weeks (interspersed with some lovely moments, but very few and far between).
This week I’ve barely been able to tolerate daylight, let alone the computer screen – migraine like I have not had in a long time since my medication includes migraine voodoo concoctions … but … amidst my Barry Crocker of a week the week before and the ensuing weekend I became a bit disoriented and missed a couple of doses of my meds, hence the hole in the firewall (just to mix some more metaphors). Yesterday I went to the GP to get a medical certificate for work and stopped at the shopping centre on the way home. Talk about sensory overload! My world had not yet totally stopped spinning so I had this strange spacey kind of sensation as I was walking, the noises were louder and more jarring, lights and colours still bright, smells still sharp. I couldn’t get out of there fast enough!
Work has been crazy and exhausting trying to manage the politics and dynamics within the office. Don’t get me wrong – I like my job. If only work could just be about going and doing your job and coming home again, what a relief it would be! But there are systems and other people that one has to navigate to do one’s job. Equipment that one and space one has to somehow get adequate access to do it. Preferably in a way that lets you stay well without creating more stress than is necessary – which is where the battle lies at present for me. At present it seems that I am destined to bang my head against a brick wall and progress nowhere and to endure life in the office that gets claimed by miscellaneous team members to serve as their staff room – while my office buddy and I are trying to work in it!!!
But alas! These are not healthy things to dwell upon. The goal is to work out how to attack and push through. I had thought that we had had a strategy for the work one, but it is back to the drawing board on that one next week as it looks like this is rapidly fading into embers.
At present I am struggling not to dwell on the difficulties of the last few weeks. I grew frustrated that my usual seasonal dip in mood was dragging on longer than usual, but didn’t really look beyond it for other triggers until much too late. Sitting down with a friend a couple of weeks ago to go over what had been happening clarified things a lot more for me. One of the reasons that I am so focussed on work issues over the past couple of weeks has come about because through sitting down and working through my usual triggers and warning signs with my friend revealed that my workplace is simply loaded with triggers. There is little wonder that I have been struggling to emerge from my usual brief decline and regathering of mood.
It’s so easy to forget to go back to the basics when one gets busy. I can sort of see why Mary Ellen Copeland, the woman who designed the WRAP suggested that going over triggers and warning signs should be something that someone should do daily to prevent relapse. I’m not sure that I would ever go to daily, but I do know that I need to be going over my WRAP a lot more frequently than I do. The whole point of knowing one’s triggers and warning signs is so that you can be alert to them. It’s one thing to know them – but so easy to miss them unless you’re really watching.
So – What do you do with the shockers? Do you beat yourself up over them? There’s no point in that. To me, it seems you need to do is stand back and detach a little. Stand in the moment. Not the future. Not the past. Just the moment. Examine – and for me, it helps if I can find someone to help me stay in perspective … at least to get me going – and learn. This helps me to see cause and effect relationships; it helps me to learn and relearn trip hazards; it helps me see things specifically rather than looming ghouls and it leaves room to remember that there were a couple of good moments in the last fortnight too.
From there I can start with a plan. If the plan needs adjusting, then so-be-it, but perhaps – just, perhaps … next week can be a bit better …
If you have a mental illness do you tell your boss?
Are you obliged to tell your boss? Why or why not?
With discrimination rife in society and difficulty getting friends and family to understand what you are going through, what are your greatest fears in the workplace? Or the study environment? Or wherever it is you spend most of your productive time?
Does your illness affect your ability to do your job at times? In what ways?
Does your boss know? Do any of your colleagues? What led to them finding out?
Whether you are studying or working always consider ahead of time whether you are prepared to disclose your illness. If your current position is non-disclosure, consider carefully any occasions which might arise which might make it more necessary and under what circumstances you may disclose if at all.
Disclosure is always best done in a planned manner. You should have some idea what you are going to say, how you want to say it and how you are going to explain its relevance to your work. If you need some adjustments to your work conditions or some time off, it is best for you to come to your boss with some options that you have considered and reasons for your request. You need your boss to understand that you wish to be healthy and productive as possible and are trusting them so that they are able to best support you to reach a goal that is in both of your best interests. A large proportion of ‘Western’ countries, including Australia, provide legislation to support your right to this.
When you plan what to disclose think in terms of how you are affected by your mental illness more than your diagnosis. You may, in fact decide to disclose only the effects of your illness and not your diagnosis, stating that you have “a condition that affects …”. You may identify symptoms or you may simply describe what it does to you and how that affects your work eg my condition means that I have less energy than I used to have. This means that I have to be careful how I plan my time and that I have to take holidays at regular intervals throughout the year to maintain stable health. I need to be careful to use my meal breaks and leave on time so that I don’t become over-tired. Or my condition means that I need to take medication. When I change medications, sometimes I am more sleepy than usual and over-sleep or become very drowsy in the afternoons. Sometimes my speech even gets slurred and I sound a little intoxicated. So if I’m changing medications I need to take a week off, otherwise I find that I’m coming to work late all week and I sound as though I’m tipsy for half the afternoon and I don’t get much done and am at risk of making faulty decisions or overlooking things because my head is all foggy – especially in the first few days. After that I will be fine at work again, but might over-sleep a couple of times in the 2-3 weeks afterwards while my body gets used to the new meds. It doesn’t happen very often. I’ve only needed to do it 2 or 3 times, but each time I’ve been glad that I did.
You do not need to disclose specify personal or medical information if you tell them about anything at all.
You should also think about when to disclose. That is – when you are applying for a job, before a job interview, during the interview, after you have been offered the job and before starting, during the time you are employed after you have worked there for a while, if you become unwell and need to or never. There are pros and cons of disclosing at each point of the way. Sometimes your circumstances will have presented you with little choice to prevent awkwardness – you may have become unwell at work and have it become obvious that something was wrong or you may have symptoms that you are aware will soon become obvious if arrangements aren’t made to cater for your needs. Again, despite prejudice and stigma in some places you have legal rights to have your needs and confidentiality met and protected within your workplace in most western countries. Further, in Australia at least, if you become unwell because the employer failed to attend to your needs having been made aware of them, you are entitled to compensation under work cover. It is however, worth serious consideration whether or not you are going to disclose because unfortunately discrimination does still happen and there are people who do fail to respect privacy and you never know where they are until you find them.
Some helpful things to consider at each stage of the employment continuum.
Prior to interview
Why you might …
You are able to to discuss the organisations policies and support resources when exploring the prospective position
You are able to get an idea about your employer’s predisposition to your needs from the word go.
If you have restrictions on any key job criteria due to temporary limitations because of recent relapse/graded hours return to work plans.
Examples of Why you might not …
Risk of discrimination influencing whether or not you get an interview.
No work related needs arising from your mental illness.
You don’t believe that they need to know/believe it irrelevant to job.
At the job interview
Why you might …
You are able to address people after creating a positive impression of yourself and demonstrating your capability.
You can gauge their understanding of your meaning and clarify appropriate questions about your needs.
You are able to discuss with the employer positive traits that you bring to the team that you have learned through your journey of recovery.
You are able to discuss your needs and what your potential employer would be able to accommodate or explore during the interview process.
You can brief them as to whether your referees are aware of your condition and how it affects your work and offer consent to discuss previous workplace arrangements with other employers if they have gone well.
Why you might not …
Risk of discrimination in job selection.
You don’t feel that you have needs that require accommodating or can manage them without support from your employer.
You might worry about where information gathered by panel members will go and whether people are trustworthy to maintain your privacy.
Concern that even if you get this job, opportunities for advancement could be limited by poor understanding of your illness.
You might be well and consider it unnecessary at this point in time.
You might not want to distract the panel from thinking about your abilities by talking about areas of need.
When contacted with an offer of employment
Why you might …
You are able to discuss your needs without risk of missing out on the job due to discrimination.
You can arrange to enter the work place with a plan in place that accommodates your employment needs and commence as you mean to continue.
If required and with your consent, the employer can arrange appropriate mental health sensitivity workshops for managers or staff by organisations such as Beyond Blue or circulate general anti-stigma/population health information among routine organisation circulars, yet not make it obvious that it was for your benefit.
Allow development of appropriate support and mentoring systems.
Why you might not …
Fear of stigma, gossip and/or discrimination.
Currently well and don’t feel that you are affected at work.
Work does not need to know.
Protection of positive image and opportunity for advancement.
During the course of your employment
Why you might …
You decide that your employer is trustworthy.
You become unwell.
You encounter difficulties or are not performing to standard because of symptoms or medication side effects and need to offer reasonable explanation or require support, alternate work arrangements or time off for medication reviews etc.
You are being harassed or bullied.
Why you might not …
It might not be necessary.
Protection of positive image and opportunities for advancement.
It might result in harassment and discrimination.
You are able to manage your needs without workplace support.
Never disclosing
Why you might …
Protection from gossip and discrimination.
Protection of positive image and opportunity
Privacy
Stable health
Lack of necessity
Why you might not …
Difficult to prove entitlement to compensation in case of illness, relapse or deterioration due to failure of workplace to meet needs for psychological health if they were not disclosed.
Relapse or need for hospitalisation might put your job at risk.
Might discover a positive attitude to mental health issues within workplace.
Legal obligations under occupational health and safety act where specific work related tasks are affected resulting in serious risk issues.
What did I do about disclosure to my employer with my job?
For me it was simple. I told mine. I disclosed at interview. I felt that this was necessary because I had taken my previous job without learning to manage my mental health well and my references would have reflected that in the answers to some of the standard questions that interviewers ask referees no matter how careful the referees were. I chose to take control of this situation at the time of my interview because having reached interview I could present myself as a competent individual in person, demonstrate that I was healthy and create a positive impression before and whilst disclosing. I also needed to disclose because I wanted to work less hours than the position entailed and needed to offer a good explanation. I told them that I had depression, how it affected me in terms of energy levels, concentration, seasonal patterns, medication changes and how I managed these things to be able to work. I spoke of arrangements that I had previously made with my former employer that had been helpful and asked if they would be amenable to such strategies. I also used the opportunity to tell them things that I had learned and accomplished through the experience of working, the determination and dedication that it entailed and the commitment to my job that resulted so that I could achieve personal satisfaction through working. In my case this had a positive effect and outcome, although it doesn’t always. I don’t disclose before I have the chance at interview to sit down and talk with the employer so that I can get a gauge on how they are reading what I am telling them and to avoid preconceived assumptions about what I will be like that are difficult to shift. There are always risks associated with disclosure, but my reasoning is that if they are going to discriminate when I am well, I would rather not have to deal with them if I were to relapse.
When I am in the workplace I lay low for a while and watch what goes on around me. As long as they are not untrustworthy, I tell someone if they are closely and directly affected by my health so that they are not left in the dark if I have to take leave at short notice. That’s usually only one or two people. Often they are among the first to notice that I am off my game, so it can work in my favour because when someone who I work closely with starts asking if I’m okay and comments that I’m not myself before I notice anything, it gives me a cue to step back and check my early warning signs and triggers. Over the course of years there have been a couple of people who have learned how to pick my good and bad days at least as well as I do myself and also to support and accommodate me through the bad ones and to lean on me in return when I’m good. I’m pretty limited in what I disclose to start with, but with proof of worthiness comes more trust.
My current situation in my new workplace is new to me. I have always had employers who were fiercely protective of my privacy before. I have little in the way of evidence about my current manager, only the report of one other worker about two specific occasions of breached privacy. I have, however worked in a place where it has been possible to work with my information kept private and so I am prepared to stand for my rights in both privacy and in workplace accommodation now. If I expect the respect of others, there may be times that I need to stand up and remind them what it entails. This is however new to me and the workplace is one with strange dynamics.
I have included in the Fact Sheets menu this week a document called “Choosing Your Path. Disclosure: It’s a Personal Decision“. It’s about disclosure of ‘disability’ (or illness) in education and training after High School and employment and the processes of application, entry and engaging in the roles. The booklet discusses legal issues, reasons why one may or may not disclose at various stages of training or employment, responsibilities and some of the considerations to ponder in making your decision. Also have a look around the Beyond Blue website as they have a number of resources for work sites and managersas well as fact sheets about telling your employer about your illness and maintaining good mental health for tertiary education students. Lastly, I have listed a book called “Tackling Depression at Work” in the Books menu. I’ve not yet read this one, but it was written by reliable people and has been well reviewed so should be worth a read. I have listed the book at the publisher’s site, you may or may not be able to find it cheaper elsewhere if it interests you greatly.
Habits. My life is full of them. Good ones. Bad ones. Helpful ones. Ones that I have resolved to end a hundred times over, yet continue with. I have things that I do because I like to. Things that I do because I have to. Things that I do because that’s just what I’ve always done. Some I maintain consciously, some unconsciously; and some are maintained by failing to maintain others. Habits.
I spent yesterday afternoon pottering in the garden. Among my many little chores I spent lifted bulbs from some pots.
Now, I am very new to gardening. My once black thumbs are currently oscillating between a brown and occasionally get a very slight hint of green (until I forget to water the garden for a few days in a row). There is no science going on – it’s all experimentation … almost. I do occasionally look things up on the net. After I write this post I will be looking up what you do with bulbs after you lift them.
Which brings me to the some of the reflections that I had yesterday as I waxed poetical in my head and got very grotty at the same time.
I have never grown plants that were bulbs before. So this year was certainly an experiment. Some grew and some did not. I believe that I probably planted some upside down, but can’t confirm that. I probably over-watered some … they rotted in the soil. Others grew and didn’t bloom. I am not keeping bulbs of plants that did not bloom. Some grew and missed a few days water and got hot wind and died while others did quite well. Some even made it to bouquets for friends.
Yesterday came to the beginning of stage two of my experiment with bulbs. I went to the pots that held the plants that had bloomed that I had liked and decided to lift the bulbs. Not quite sure of the correct procedure I began to burrow. Now the first pot was not so difficult. They were tulips. The second pot I did just to get rid of the bulbs because I still wanted to keep the pot, but needed to get the bulbs out. They too, were easy to find. The daffodils gave me no trouble. And then I came to these other plants – whose name I do not recall – but the bulbs were in little nests that were distributed unevenly around the planter box and while the upper couple of bulbs in the nest were of reasonable size there were also bundles of little balls – I assume new bulbs – that would often fall free and needed fishing for. It took a lot of work to sift through this pot to lift the bulbs.
While I was doing this it struck me that If I were this thorough with everything, much of my life would be a lot simpler. I would not have forgotten to take my medication yesterday morning had I refilled my dosette box when I emptied it. I would not get weary looking at the mess in the kitchen as often if I were in the habit of cleaning up after myself as I went more regularly. I would be exercising regularly by now instead of simply planning to start within the next month. I would not grow weary from lack of sleep. In short, I would be more scrupulous about my habits. Certainly it’s laborious. Yet, there is a purpose to these habits the same as there is a purpose to my clearing the pot. I am seeking to be in the best of health so that I can get on with living and doing other things. Just as I was clearing the pot so that I could plant something new in it that would grow over the summer months. There is a purpose to maintaining habits that are mundane that is anything but.
The second reflection came to me while I was battling one-handed with my bush rose whilst watering it. I was attempting to remove the spent blooms – I’ve been taught to do that, but don’t do it regularly enough so there are lots at present. They’re all over the bush. Some of them were impossible to get to without doing battle with thorns while working one-handed. Others, within reach while able to be grasped and eventually detached, were not easy to remove. I also managed to get spiked by the tree regardless. Ouch. How different the bush rose was from the geraniums which simply slip off the plant with the slightest pull.
I am much more like the bush rose than the geranium when it comes to surrendering my bad habits. How much simpler life would be if when I noticed that I needed to change I were able to simply let go of the old ways like my geraniums. But, no. For me it is work. It requires effort and often shakes up the petals of some of the other flowers during the process. Occasionally, not just the dead rose came off with the pulling, but some of the good ones beside as well. I think my roses are very much like my habits. They grow without effort and bloom. Often they serve a good purpose, but then are no longer needed. Other times they just are. But when they are past their usefulness and deadweight, burdensome – they do need removing. Sometimes it can be done while I’m doing other maintenance like the watering, but I think that I am going to have to go out soon and pull them off myself deliberately. One at a time. Not a job that I see as stimulating, but to encourage the bush to be productive and to keep it looking healthy it needs to be done. Now I just need to take the same path with my troublesome habits and learn to tackle them one at a time and replace them with helpful ones.
Will I be as meticulous in dealing with my dead habits that are no longer blooming as I work at being with my flowers? Will I dig and sift as thoroughly as I looked for my bulbs when it comes to removing them?
Again I set my resolve to commit to tackle my environment and not let it get out of control (The kitchen, living area and study are cluttered again and the floors are past cleaning time). My dosette box should never be left empty – I used to be good with that. There are a number of other things that I need to sit down and map out.
Which plant holds the flowers that are hardest to remove in your garden? Just how carefully are you prepared to dig out your bulbs?
I think I still have black thumbs in the habit garden and it’s time to green up. What colour are your thumbs?
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.
I do. Mine haunts me. I can never seem to beat it.
There are the odd occasions when I do really well against it and I win. It feels great. I could walk on air.
Sometimes they last for a short stretch of time – a few days, a week – two if I’m lucky. I could fly.
And then
it all comes
crashing
down
in
a
great
big
thud.
OUCH!
And it’s not just me who is affected.
It’s not a small thing with small consequences.
What happens, you ask?
Okay I’ll ‘fess up.
I don’t wake up. Or if I do – I drop right off back to sleep before I can haul by backside out of bed.
Then I am late for anything that I have on for the day – visits, appointments, ….work.
And we’re talking regularly 30 – 40 mins late during the mid spring and autumn – and every now and then it’s a couple of hours. It affects other people when that happens – workers, patients … if I don’t get my work done it slows down the process of referrals going through, information getting to people in hospital and their treating teams for planning, people going home. It means groups can’t run or other people have to cover me. I nearly lost my last job over it. Even when well I’m often 10 – 20 mins behind my start time. I survive because I start before my boss and I always work back – but I can’t keep it up.
And it doesn’t seem to matter what time I ‘m supposed to start – I’ve adjusted starting times. It’s simply the process of getting out of bed and waking up in the morning.
Once I’m up, my sensory routines are helpful. I’ve started to experiment with some mindfulness exercises when I get time – which help a lot. But actually waking up and getting out of bed is jolly hard work.
The other thing that happens to me is that I lose time in the mornings. I do. Even when I’ve gotten up on time and have been running on time something happens – I space out in the shower or getting myself a drink and meds and time just vanishes.
I started a new experiment earlier this week that I think holds promise for the latter issue – I’ve started using a mindfulness breathing meditation exercise as soon as I get up that goes for about 10 mins to raise my level of alertness. If it keeps working at keeping me focused, I’ll be writing about that in a couple of weeks. But for it to work – I need to get up in time to have time to do it. It doesn’t need to be earlier – because I’ve worked out that I do everything else more efficiently when I do it. But I need to get up.
Sleepy-head
At present I use two alarm clocks set 5 mins apart – one to arouse my attention if I am in deep sleep so that by the time the second goes off I won’t sleep through it even if I sleep through the first. Part of me wonders whether it’s worth investing in a bed vibrating alarm clock – they make them for deaf people. It might be uncomfortable enough to help me move out of bed more easily. Has anybody ever used one?
I know the rules – go to bed early and get up and the same time every day. I’m awfully undisciplined at doing that.
Take your meds at the same time every day. I tend to get lazy and just take them on the way to bed – which admittedly is probably half of the problem. There are some very sleepy meds among my cocktail.
Every day is a new day with no mistakes in it – yet. Thank you, Anne Shirley – but other people remember and I need to work out the best way to deal with their memories and keep myself focused on the present so that I don’t drown in fright.
So here it is. My arch-enemy. The alarm clock. That moment in time that I’m supposed to get up. To get moving. To get started with the day.
Please – anybody with your own ghouls – what helps you haul yourself out of bed every morning?
An area that is starting to grow in mental health is an intervention called Sensory Modulation. It is used in a number of different ways and some people use it only in part. Some people may have come across ‘grounding techniques’ and ‘self-soothing techniques’. There is a cross-over between Sensory Modulation and distraction as a technique to deal with difficulties. It is a sub-branch within the world of Mindfulness and involves use of activity and engagement of the senses for therapeutic purposes. It is a big area for Occupational Therapists, Diversional Therapists and is starting to feature in Nursing literature, particularly for use in hospitals to try to find ways to reduce people’s levels of distress without having to resort to extra medication and seclusion. Studies are showing promising results.
The Senses
Despite the way that we usually talk about five senses, we have actually have seven senses. We are used to thinking of our senses in terms of taste, touch, sight, smell and sound. However there are two more that we very rarely talk about.
The first of these is called proprioception. Proprioception is communication between your muscles and your brain. This is how your brain knows what your muscles are doing – when they are stretching, flexing and where your body is in space. It is proprioception that enables you to match the position of one arm to the position of the other with your eyes shut.
The second is a vestibular sensation. This is what gives us our sense of balance and the sense that we are moving in space like when we are in a car. It is also the sensation that gives us the feeling of dizziness and nausea when it is out of kilter.
Some people also differentiate between deep touch and light touch when working with the senses because your body often responds differently to the different types of touch. Think of the difference between being massaged and being tickled.
What is Sensory Modulation & how does it work?
Sensory Modulation involves using different types of activity or stimuli to calm or alert one or more of the seven senses. This in turn can feed into the way that a person is feeling or reacting to a situation, a stressor or the environment. So if feeling anxious and having anxious thoughts churning over through ones head someone might choose to do something that they know will engage the senses in a soothing way for them eg using a rocking chair, listening to music that they like that has a tempo of approx 60 beats per min whilst being mindful of the sensations; or they may choose to ground and/or distract themselves with something that alerts the senses and redirects their attention, perhaps using the tension in their muscles by going for a run or walk, again engaging awareness of the movement of the muscle groups and the engagement of the senses with the environment around.
Essentially, you take control of your senses and use them to serve your advantage.
Mindfulness & the Senses
Some of the ways that you can use your senses with mindfulness include:
Grounding
Grounding techniques are active techniques to help you to orient and focus on the present and to distract or self-soothe when you’re feeling distressed. When you are feeling ‘out of sync’ they can help emotionally, physically, mentally and spiritually. If you know what you respond to best – you can even be prepared for times of crisis or for prevention if you are feeling triggered.
Some activities that people use to help ground themselves include
A hot or cold shower
Eating hot balls or sour balls, chilli, lemon – alerting tastes
Breathing exercises
Yoga
Using a balance ball
Cleaning
Yard work
Wearing weighted item eg back pack, ankle weights
Petting dog or cat
Warm or cold flannel to the face and neck
playing with a stress ball
Aromatherapy
Moving furniture
Holding or chewing ice
Jumping rope or doing star jumps
Stretching
Running or walking
Lifting weights
Push-ups
clenching and unclenching muscles (isometric exercises)
playing drums or other musical instruments
Pottery
Rocking in a rocking chair
Dancing
Listening to music
Waxing
Journaling
Other activities that can be used for self-soothing or for orienting and alerting oneself capitalise on the calming and alerting features of the stimuli. Some examples of these include:
Calming Sensations Alerting Sensations
Hot shower/bath Cold or cool shower/bath
Holding/petting a pet Holding ice in hand or to face
Warmth of fireplace Being in a cool room
Wrapping in a heavy blanket Wrapping in cool bed sheets
Soft materials/textures Rough or prickly materials/fabrics
Rocking in a rocking chair A bumpy car ride
Swinging on a swing Spinning on a swing
Slow rhythmic motions Fast and/or jerky movements
soft/low lighting Bright or flashing lights
Decaf herbal teas Drinking coffee
Chewing gum Biting into an icy-pole
Chewy or crunchy foods/ lollies Sour or hot foods/ lollies
What to do with these activities – A bigger picture
The idea then is to consider the primary areas of difficulty that you encounter. Do you
get overwhelmed
get voices
Get angry
Get anxious
Depressed
Struggle with negative thoughts
Feel disconnected
feel triggered by something …?
Think about a) things that you can use to alert or distract yourself;
b) things that you can use to do to calm or comfort yourself;
c) things that you can do to help improve the moment; (something you enjoy, a treat, something to make you feel better)
Often you may need to do all three in that order – but not always. Regulating your reaction, however, may be more than a single step process.
What senses do you respond to most strongly?
Different people are more responsive to different senses. Some people love touch. Others squirm. Some love movement. Others enjoy scents. We’re all wired differently. How do you think you are ‘wired’? What are your preferred senses for comforting and alerting yourself?
Think about what kind of movement you enjoy (eg exercise, rocking chair, doodling, shopping, cleaning, theme park rides, skating, building, sports activities)
What kind of Touch & Temperature do you like (eg massage, sitting by fire, shower/bath, knitting, sunshine/shade, lotions, playing instruments, art, fiddling with things, doing your hair, heavy blankets/quilts)
What kind of auditory/listening stimuli you like (eg silence, running water, music, rain, relaxation soundtracks, wind chimes, theatre, a purring cat, people talking)?
What kind of visual stimuli you like to look at (eg scenery, photos, lava lamp, movies, window shopping, reading, fish in a tank, art)?
What kind of scents do you like or respond to (eg scented candles and oils, coffee, perfumes and aftershaves, flowers, fruit, herbal tea, fabric after being hung out to dry, chopped wood, forests)?
Think also about what kind of gustatory, tastes and chewing sensations you respond to (eg chewing gum, crunchy food, sour food, sucking a thickshake through a straw, yawning, deep breathing, listerine, blowing bubbles, hot balls, drinking coffee or hot chocolate, fizzy drinks, sucking a lollypop)
Making a Plan
When you have thought about the types of activities that you respond to. Make a note of half a dozen things that you think would be most helpful when you are distressed.
Why not set aside a place or a kit where you have some if not all of those things ready to go and on hand when and if you need them?
Knowing how your senses work can help you tap into them better for relaxation, recreation and for giving yourself a jolt if you need one. I have found ideas from studying this stuff that are great for my recreation, rest as well as helping me when I am worked up or struggling to focus. I hope that it’s useful to you also.
If you are interested in more information, information about making a sensory kit or a questionnaire about your sensory profile, please leave me a message in the comments and I will get something back to you.
(Credit to a lot of the lists goes to a combination of published resources that I have referred to, some of which have no author attached, majority of examples listed resourced from Tina Champaign’s website)
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.
And if climbing back on aft’ one spill weren’t enough –
Alas – staying on top is an art!
For most of us who have passed though one episode of depression – or other forms of mental illness and come out the other side, a common concern draws us. We don’t want to go back there.
Some have a harder battle ahead of them than others. Some have different forms of depression; different forms of anxiety; different forms of mental illness that are more or less responsive to the things that we do to treat them. Some are more vigilant than others – often this makes a big difference … and sometimes life’s not fair. Some do all the ‘wrong’ things and yet never have another episode – but that’s unusual.
What’s usual is hard work with a need to use a range of strategies to stay well. Things like good sleep, exercise, a nutritious diet, keeping up social support networks and getting out of the house, exposure to sunlight and fresh air, use of medications and talking therapies are just some examples of these.
But how do we know that we’re winning? What can we do at the times when we’re worried about how our mood is going to try to prevent it from tipping over the edge into something we can’t manage? How do we know if that new medication is doing anything to change anything at all?
One of the things that is helpful to do at times is to track your mood. How do you do this? You use a mood diary. Ever done it?
The purpose of a mood diary is essentially to get a profile of what pattern your mood is following on a day-to-day basis. At their most basic level, a mood diary will ask you to rate your mood on a numerical or incremental scale every day while you keep it. Some will additionally ask you to record other information such as your anxiety levels, your irritability levels, how much sleep you had the night before, significant events and triggers throughout the day and/or the medication that you took. The good thing about doing some of these other things is that they provide a much fuller picture of what is going on.
If you don’t already know what they are – this process can help you to work out what your early warning signs are as well as your triggers. If you know your triggers and early warning signs, this can help you to monitor them. For that reason, I recommend choosing a mood diary that records significant events in the day. I would also recommend one that includes the amount of sleep that you had the night before as this tends to be pretty universal and fairly influential.
Talk to someone close and ask for their help if you have trouble working out if you were irritable or if they noticed anything in particular that seemed to set you off if you are having trouble identifying these kinds of things – but the object of the exercise is to make observations about yourself – so do what you can on your own as well.
However, asking someone close to you whom you trust to help monitor your mood and to help you get to know your warning signs and triggers is a good strategy. They sometimes see things that you are not in the right place to see or notice when you’re not well because your self-awareness can get a bit skewed. They also see the ways that you differ from the way that you would normally be – so they can measure you against you and not somebody else. Yes, it might be their perception – but it will still be your behaviour and actions and the things that you say and the responses and facial expressions that they are used to that are part of you. Choose someone who you trust and talk with them and let them tell you about what they noticed changing last time and as you have been working through your recovery.
Do I use a mood diary and self monitoring systems all of the time?
Not on a daily basis. When I am well I keep regular tabs on how I am going by talking about it with a good friend and checking over my early warning signs and triggers list regularly to ensure that my awareness of them is good and that I am alert to high risk periods. I use what is called a WRAP – a Wellness Recovery Action Plan where I have identified what I am like when well, what my triggers are, what things are hints that I’m not as good as I could be, my early warning signs and so on …. I go through this regularly. Some people do monitor their mood daily and find that it works well for them. People with things like rapid cycling Bipolar disorder often find that they need to until it slows down and is brought under control. At first I needed to chart my mood a lot more than I do now.
When I am in a high risk period I watch things more closely and have recently resolved to keep a mood diary through high risk periods because I still find myself at sea sometimes and feeling like I’m losing my grip. I am particularly vigilant about my warning signs and triggers as well as their corresponding action plans during periods of high risk. I have to be. Recently I let things go at home and let the dishes and the housework pile up around me – a sign that things are getting away from me and didn’t act and it triggered me (it becomes a cycle). I couldn’t face getting up to look at the house. I didn’t want to go into the kitchen to prepare a decent meal because it was a mess and I didn’t feel up to cleaning it up – so of course my nutrition level went down, my budget blew out and thus the cycle continued. In the end it took a cleaning weekend to put me back on track, followed by a week of very early nights and a lot of discipline. It’s too easy. So I have decided that I need to do something to catch myself more quickly before it gets away from me. Not simply cleaning, just lots of little things. This time of year I need to be very careful about relapse prevention. It sounds minor when I talk about dishes – but when it snowballs, I just keep sleeping and if I sleep through work or go in late consistently and am still going around in circles while I’m at work and don’t have energy or concentration to work – I could lose my job.
I’ve attached today some links to some self monitoring resources and different mood diary sites. I know there’s a lot, but different things suit different people and I think these are important tools. Most mood diaries have room for the full spectrum of mood disorders – both mania and depression.
Warning signs and triggers are important. Monitoring your mood is tedious sometimes – but there are times when it is necessary.
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…
Some people are Summer people. Some people, spring people. Some are winter people. Some love autumn.
No, I’m not talking about people’s colouring or the things that they like to wear (that is something that I, in fact know very little about). I am simply talking about peoples’ favourite times of year. Some people like to soak up the sunshine in summery garb out in the garden, down at the beach or over at the local pool. Others love to curl up by the fire in their favourite jumper under a rug with a good book and a cup of hot chocolate – or put a movie on. Some love the colours of autumn and the beginnings of that lick of ice in the early evening. And some the radiant brightness of spring, its scents, the new life, the slow steady warmth, the magpies diving at you from overhead…
I never settled to a favourite time of year. I really do enjoy almost all of all seasons – and by the time one ends I am ready for the next. I am not fond of the days that exceed 40 degrees celsius with no cool breeze for long stretches at a time. Hot winds are their own breed of evil in Australia for reasons far beyond temperature tolerance. I’m not a great fan of temperatures at the other end of the spectrum either – especially if they come with a wind. Actually – wind bugs me more than temperature. But seasons – apart from the odd bits like getting up in the dark to go to work in winter – seasons are a delight. Full of life. At least, I always used to think so.
My dog pays attention to the seasons too.
Unlike me, the dog has clear preferences for different times of the year. It took me a while to work this out, but its consistent. The dog is stubborn in winter. He moves slow. He needs more time. He takes more time and holds me up whether I plan it or not and he wears me out more easily than he does during the warmer months. I think he’s arthritic. He gives me no trouble if I allow for the arthritis though. A bit more sleep – 1/2 hr or so more than I need in summer and I’m fine. I just need to be patient.
Summer is usually the dog’s best time of year. He still needs discipline, but he’s more content to walk at heel and doesn’t drag and tug away at the lead. Spring and Autumn are strange. Most of the seasons fall in with the winter and summer behaviour for Dog according to temperature and what the light is doing. In each of these season there comes a point where the light changes – and over these few weeks the dog goes nuts. He is unpredictable. I can not afford to let my guard down for more than a few moments at a time. My sleep gets poor – this starts the ball rolling. My energy levels become low, my motivation to maintain routine relapse prevention strategies gets sloppy and I soooo don’t feel like doing anything about it. It at these times that I have frequently relapsed (almost without exception). I made it through autumn this year. So far I have struggled this far through the last few weeks. Another 3 – 4 should see me through the worst of it.
Until then, its keep on keeping on and stick to the programme. Watch for warning signs – the very time of year in and of itself is a trigger – even without the presence of other factors. Light does funny things to my health in other areas too. It’s like the dog becomes delirious. Here is a time when I need my friends and family – my supports more than any other time of the year. I’m struggling to get to work on time at the moment, but so far my boss has let me cover with time in lieu. Still, I’m determined to conquer that one too. I get there on time more often than not – just not as often as I should. Just now – when I least feel like it – discipline becomes oh so important.
I had my last review with my Psychiatrist this week. We agreed that it would also be possibly a beneficial thing to increase one of my medications for 1-2 months during the peak risk zone while I’m wrestling risk factors and wavering – just for that short-term – and then go back to my current dose afterwards as the weather and season stabilises a bit more.
Hopefully the combination of ‘personal medicine’ or monitoring of triggers and early warning signs with the kind of action plans that are outlined in my post “Better Medicine” with the temporary medication adjustment will prove to be a good protective measure. I’ve had a good year. I’d hate to mess it up now. I’m hoping to get to at least a whole year without a relapse this year!
So roll on to the latter end of Spring. Because despite all of this, I really do love spring. There’s a certain level of hope and promise in the air in Spring that’s unique to this time of year.
I live with a black dog. It follows me everywhere. My philosophy now is that I need to plan for its needs when I plan for my own. I also need time out and restful places to enjoy the warmth of the sunshine on my shoulders.
livingwithablackdog 
