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.
Why you might …
Protection from gossip and discrimination.
Protection of positive image and opportunity
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.
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?
I don’t know about you, but I was very sceptical about relaxation exercises for a long time. I would always think back to school days when guidance counsellors would take us through guided imagery sequences featuring a calm blue ocean or some such scenic place and tell us how we relaxed we were while the class clown made farting noises, his followers giggled, the teachers reacted and everyone else just rolled their eyes and waited for the session to finish. At other times, attempting to relax has been more stressful than relaxing because the facilitator just wasn’t on the same wavelength as me. I find it annoying when that happens.
It took a long time to realise that relaxation was a skill that required practice. It has taken longer still to discover that there are many different types of relaxation exercises that you can do. Recently while looking for a site for someone, I found one that had a variety of sound tracks for relaxation exercises ( http://www.allaboutdepression.com/relax/index.html ). I decided that I would sample all of the relaxation exercises on this site to see what I thought of each of them – to give each a chance. Today, I’d like to share with you a little about the exercises that I did and my thoughts on each.
I thought that these were very useful. Each of them was effective, and they were particularly effective when used in series. The educators recommended that for those with anxiety disorders, your levels of anxiety will reduce by doing breathing exercises regularly as maintenance – and I can believe this given the difference that it made in the amount of tension in my body.
For those who do not have anxiety – like me … I did my mood diary scoring after I did relaxation exercises and my scores were significantly higher than they had been on any of the recent days leading up to these times. I have been experimenting recently with http://www.moodscope.com which is a computer based system – so I was not simply giving myself a better score out of 10.
Progressive Muscle Relaxation
Progressive Muscle Relaxation is a favourite of mine. It essentially involves tightening a group of muscles, holding them tight and noticing the tightness, then releasing the tension entirely and noticing the absence of muscle tension. You then systematically work through to the next group of muscles and do the same thing.
I will usually start with my toes, progress to the soles of my feet and calves, the upper foot and shins, my thighs, my butt, then my hands, wrists and arms, elbows and biceps then shoulders; then I go back to my trunk and tighten and release my abdomen, then lower back, upper back, chest, shoulders (again), front of neck, back of neck, tilt neck left then right, then I work through my face so my forehead, nose, cheeks, mouth, jaw and tongue (pressed against the roof of my mouth). Then I finish by either breathing exercises for a while or by standing and shaking out my arms and legs and stretching. But that’s me and that takes anything from 10 to 20 mins depending on how many repetitions you do of each muscle group. Sometimes for really tight groups, I’ll repeat the actions a couple of times eg shoulders.
The progressive muscle relaxation sequence on the All About Depression site goes for 8mins40sec and is nice and efficient while still covering what needs to be covered (http://www.allaboutdepression.com/relax/pmr/pmr1QT.html ). I found it satisfying and was pleased with the result at the end of the session.
I need to be frank here and admit that I am not someone who is a great fan of guided imagery sequences. I find someone else’s descriptions of a place that they think should be relaxing for me to be kind of distracting. I’d much rather be left to breathe or if there needs to be an image, then I’ve done sequences where the person guiding the sequence has left room for the person relaxing to select a place they like and guided by asking questions like “what can you see?”, “What can you smell?”, “Look around you and explore the colours.” I found that kind of guided imagery more engaging.
I came to this exercise expecting it to be grossly annoying and to loathe it. It was actually one of my favourites. I’m not sure whether it was because of the sequencing of the exercise, or the conscious repetition of phrases (I repeated most of them in my head because I found that doing it out loud made it difficult to breathe deeply and evenly), but this exercise really worked for me. I want to go back and learn the phrases and the sequence to use at any time. http://www.allaboutdepression.com/relax/phrases/phrases1QT.html
Mindfulness Oriented Relaxation Exercises
Mindfulness is about being ‘just in the moment’. In this context, the relaxation exercise is about focusing oneself on relaxing just into the moment. A lot of the rationale for this is that a lot of distress occurs surrounding things that have already happened or have not happened yet and that sometimes the sadness, anxiety, pain or negative feelings are easier to bear in the immediate moment if we are not contemplating past or future at that point in time.
This is one of my favourite relaxation exercises. It starts out with breathing, then gradually asks you to notice things with your other senses, in particular where your body has contact with other surfaces, the feel of your clothes and the sense of the weight of your arms and legs as you’re supported by your chair (in my case) or where ever you are resting. I loved the sensation of my clothes on my skin as I was breathing – I was wearing a particularly soft shirt the day that I did the exercise for review. A definite must in my books (http://www.allaboutdepression.com/relax/mindfulness/mm21QT.html ) although regulars will know that I’m a fan of mindfulness as a strategy in general.
Mindfulness with Guided Imagery
Remember what I wrote earlier about guided imagery? Well it’s no less true where the imagery is attached to mindfulness strategies. That said – in the first exercise Sending Thoughts Away on Clouds (http://www.allaboutdepression.com/relax/mindfulness/mm31QT.html ) I found the clouds a great way to dismiss unwanted or intrusive thoughts – the idea being that where a thought that was a distraction from the scene or your breathing came into your consciousness, you were to send it away on a cloud. I could picture this as though just blowing the thought away. Sending Thoughts Away on Leaves (http://www.allaboutdepression.com/relax/mindfulness/mm41QT.html ) didn’t feel as natural, although it kind of worked. In this guided image I was taken to a clear forest stream to enjoy it.
The final image was quite different in what it did with distracting thoughts. In this the idea was to be Sorting Into Boxes (http://www.allaboutdepression.com/relax/mindfulness/mm51QT.html ) thoughts that intruded, the boxes being one for thoughts, one for emotions and one for sensations eg aches and itches. This was more bizarre to start with and I found myself distracted by the boxes – but after a while I settled down and just focused on my breathing again and that helped. For a while however, I think I was almost inventing itches and filing the thought ‘this is stupid’ over and over again. Once I went back to breathing and visualisation the boxes became background scenery – a bit like a picnic basket when you’re not actually eating. I can imagine this being helpful though if you were being flooded by intruding thoughts and feelings – you could just label them without processing them and put them to the side by the rules of the exercise without it being an intrusion on what you’re supposed to be doing – which is staying in the moment, just breathing and picturing a scene.
MY TOP 3
My favourite three out of these audio tracks in no particular order would have to be:
Progressive Muscle Relaxation
Why not take the time to try a few? What were your favourites?
One of the factors that I have spoken of recently that has affected my mental state is the change of season. I become more vulnerable to symptoms of Depression and need to be careful not to be taken captive by them and dragged back under the control of the black dog as he strains upon the lead. October this year has been fraught with tension as the dog hauls away at the lead while I wrestle endlessly to bring him to heel and keep him there. While each time he strains, I have brought him back – it takes a lot out of me and he knows it as he waits impatiently at heel for the next opportunity to pull away. I have had a tiring month.
How do I know when things are starting to get too much?
One of the things that I have decided to work on is paying closer attention to the cues that my body gives. It’s very easy not to be aware of these until I have a nasty headache, my shoulders ache, my muscles are all sore, I have a noticeably palpitating heart rate that makes my chest feel hollow and heavy or I feel exhausted.
I commented in my last post in closing about Mindfulness that one of the areas that I need to work on is that of noticing what is happening in the moment. This is what I am working on at the moment. To start with – to notice the cues that my body is giving me. For instance, when is there a change in the level of tension at key points in my body like my neck, shoulders and jaw? Am I breathing deep, medium or shallow breaths, what kind of rate am I breathing at? Am I aching anywhere? What is my heart rate like?
Now I don’t do this as a checklist and step through it or try to determine these things in a specific way. What I am learning to do is to try to do what is called – in Mindfulness language – a ‘body scan’ at regular intervals.
What does a body scan involve?
Essentially all I do is start out by observing my breathing until I am into the mindset of observe – not control. I then move my attention to my heart and notice and feel the rhythm of my heart beating inside me and the sensations that arise from that and enjoy that for a little bit. From there, I start by noticing the feel of the clothes on my skin, the shoes on my feet if I’m wearing any and then move my attention to my muscles. To scan my muscle I start by placing my attention on my toes of one foot and paying attention to them, noticing any tension or pain or other sensation, acknowledging it and – if it is tension, consciously releasing it from the muscles by either picturing it draining away or stretching and/or wiggling them. I then do the same for the other foot and move on to the next section of my leg and do the same thing. And doing this throughout I might move through the body in a pattern something like:
Lower arms and wrists
I figure that since the shoulders bunch up so easily, it doesn’t hurt to check them again. It doesn’t really matter what order you do it in though, nor how big or small the groups you break them up into are to a certain extent.
After scanning and relaxing all of the muscle groups, I then observe my breathing again for a moment or three before drawing my attention back to what is in front of me to do. It doesn’t take very long, and with practice it should take perhaps a minute – maybe less. If I try to do it when the little ‘beep’ goes on my watch on the hour (when I hear it), I should get lots of practice and stay well on top of these cues.
The goal is to be able to notice the tension before it becomes problematic and to be able to question whether I am becoming stressed before I get there. A lot of people who do this regularly swear by it. I guess it’s a bit like paying attention to when there is tension growing on the dog’s lead when walking a dog. As it grows, it cues us in to the idea that the dog is growing more likely to want to get away from us. Thus it is living with my black dog. I must be wary of tension.
So – here’s to my next excursion into the world of mindfulness. Noticing physiological changes and discomfort and either accepting them or letting them go without blame for their getting there.
Here’s to the next step into managing my Depression. Noticing the cues that early warning signs are present so that I can act. Perhaps October will improve from here on in.
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.
Fruit. Vegetables. Meat. Protein. Dairy. Iron. Carbohydrates. Breads. Cereals. Rice. Pasta. Vitamin E. Vitamin C. Vitamin D. Vitamin B. Fats. Sugar. Cholesterol.
Hormones. Blood Sugar levels. Chocolate. Shortbread…
How we eat makes a big difference to how we feel. It affects how much energy we have. It affects how efficiently our system processes what we do eat and how easily it will break down and prevent or minimise constipation. For some it can affect them at a more vital level – for those with diabetes it is even more important to monitor food intake, as for those with particular allergies.
Recent studies indicated that people with depression have a high (anything up to a one in two) risk of developing diabetes. That is an enormously scarily high statistic. You might ask, “Why? Why this on top of everything else?”
A large part of the answer is thought to be tied up in lifestyle issues. They actually think that for most people this is preventable! Risk factors for development of type 2 diabetes include lack of exercise and sedentary lifestyle (ie sitting around a lot and inactive), obesity especially if your weight distribution is more around your stomach than your hips and thighs, eating unhealthily is a major cause of type 2 diabetes – too much fat, too many simple carbohydrates and not enough fibre in particular; also high blood pressure, high cholesterol levels, high cortisol (stress hormone) levels, smoking, family history, gestational diabetes and aging (over age 45 becomes higher risk).
A lot of these risk factors overlap with issues that occur regularly in people with depression. It is common for people with depression to have little physical exercise and very sedentary lifestyles, poor diet and become overweight due to a combination of this and at times side effects of medications – and the lovely little belly that the medication leaves is usually a tummy rather than hips and thighs. Stress level hormone levels may be high due to anxiety levels; depression, like diabetes often has genetic links, many of the high levels can be secondary to diet and lack of exercise and statistics indicate that a high proportion of people with depression also smoke. Oh – and yes, we might say that we’re 39 for a while, but everybody ages.
The good news is that the majority of the factors identified as risks are preventable. They are also helpful ways to improve the prognosis of the course of our mental health.
Look for ways to become more active. Start small and build up a little at a time. Sooner or later you will feel like you are exercising. In the meantime, you will be stretching out those muscles and getting them ready for a challenge. One of the biggest weight loss programmes in the world was started by a woman who started out by walking around her clothesline.
Research what needs to go into a balanced diet. Plan what you will eat ahead of time and stick to it. I find this really hard, but it really is worth it. I have more energy when I do and it helps keep a lot of other things more balanced. Try cutting up your veggies when you get them and storing them ready to use – that way you don’t have as much to do to prepare food when you have to cook. Same with your meat and everything else. It takes longer to store – but half the time (at least for me) a large part of the battle in getting the energy together to get something healthy and wholesome to eat is in overcoming that ‘I don’t feel like all the preparation’ feeling. At worst keep a couple of pre-cooked healthy meals stored in the freezer for when you don’t feel like cooking.
Talk to your doctor about a Quit smoking programme. It is possible. People do it all the time.
See someone about some anxiety management strategies. If you already see a case worker, therapist or doctor ask them for advice about what to do or where to go. Look around for local programmes through community health resources. If you get stuck and are not sure where to start, check out the mindfulness and CBT pages on this site or post me a comment and let me know. If you’re in Australia, ask your GP to write you a referral under “Better Health” to see a psychologist or clinical psychologist.
Just to start off, this week I had a really simple meal of a piece of steak about the size of the palm of my hand. I had a couple of mushrooms that I chopped up and cooked with it in the pan. I then steamed in the microwave generous serves of broccoli, cauliflower, both green beans and yellow ones and some snow peas that I grew in my garden. It was filling, plain and simple.
Why not share something healthy that you cook/prepare or plan to cook/prepare after reading this in the comments. Maybe we can collect some recipes and ideas?
Are you old enough to know The Jetsons, I wonder? Most are, surely.
I’m not after the groovy little space-sedan.
I’m not even in it so much for the robot house keeper – although I would certainly NOT turn her away …
I want the bed that tips you out when you need to get up, stands you up and puts you on a conveyor belt to the shower and gets you started for the day.
I swear, that has got to be the hardest part of the day! I’m okay once I’m showered and dressed for the day – but until that point it is all up hill.
On work days I don’t trust myself with less than two alarm clocks. I’ve been known to turn alarm clocks off in my sleep. I figure that one will at least bring me out of deep sleep and the second can wake me if the first doesn’t. I don’t keep at least one near my bed. I make sure that I need to touch floor to turn it off. I also make sure it’s a really noxious sound so that I don’t just let it keep going.
One thing that I don’t do that a lot of people say works well for them is put out my clothes the night before. I have tried it a few times, but tend to finish up thinking that I don’t feel like wearing what I put out and finish up dithering over what I do want to wear. That said – it would probably work fine on work days if I kept it up – so I should try it again.
I also tend to waste a lot of time putting off getting to the shower (especially in winter) puttering around the house. Alas! This just makes me late.
Oh for an alarm clock that tipped the mattress 45 degrees and dumped me on the floor with a bang if I reached for a snooze button!
Drat the need for motivation, will power, decent routine & bedtimes, discipline in lights out and organisation in the morning.
But then again, if I have been eating well, doing exercise, working, and going to bed at a decent hour I am likely to have been refreshed by sleep and find it easier (note that the word here is “easier” and NOT necessarily “easy”) to wake and rise. Perhaps key to my struggle with rising in the mornings is my lack of discipline in other areas – most obviously in getting to bed at a decent hour reliably, but also exercising regularly. I would also have more energy if my diet included more fruit and vegetables.
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.
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.
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.