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 …
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.
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’ve got a headache that I’ve had on and off for a few days now. I’m so tired so much of the time. I’m disorganised. My house is a mess and getting less clean than I’d like it to be – it’s not grotty, but without action it could get there without a lot of effort … I’ve spent the last couple of days off loafing in my ever comfy PJs and while I’ve gotten up and done stuff, I’m sure I said ages ago that I was going to stop doing that…
Hang on. These things are all among my early warning signs. I’m off my game. Nothing serious yet – but now is the time to act. I’ve been going really well for ages. It’s not even my Depression that’s knocked me off my game – it’s the damn cold that I’ve been fighting. Yet this I do know. In the past relapse has often followed physical illness. The dog acts when he knows I’m not at my best. He takes advantage of weakness.
So what do I do now? Give in? Panic? Book an extra doctor’s appointment? Nope. Now is the time to reach for my WRAP – my Wellness Recovery Action Plan – something that I should probably be going over more regularly to remind myself of the daily and weekly/regular things that keep me well. In my WRAP I found that I’ve been neglecting a lot of these over the last couple of weeks and that I have gotten sloppy with a couple of my routine maintenance markers over the past couple of months. My work WRAP (my own experiment) shows me that I’ve not been sticking to my wellness goals about leaving on time and planning my day either – no wonder I’ve been feeling like I’ve been run over by a truck.
Now is the time to restart the action plans. I need to tell someone that I’ve noticed that I’m off my game and that I’m acting on it – that way they can ask me how I am going with my action plan in a couple of days to see if I need some help to get things moving again or if I’ve been able to self-start again solo (often harder than I think it’s going to be). I’ll wait to see how things progress and talk it over with my friend before I rush into moving any appointments forward. I think I’m okay if I get reorganised at this point.
So its back to setting alarms and keeping them for going to bed and lights out at night. I’ve been letting the sleep run thin.
I need to plan my meals rather than look in the fridge and hope that there’s something I feel like eating in there. And I probably need to start putting more attention towards the balance of what I eat because I don’t think I’m eating enough fresh fruit and vegetables (that’s a new strand to the plan for me).
I need to put away the things that are lying around and creating clutter.
I need to clean the house. When that goes to my list though it will read room by room and the floors will be separate. That way I can do it in parts and feel like I’m making headway when I cross things off on my list.
I need to set up a routine for maintaining my housework.
I need to set aside time for doing things that I like to do.
I need to work out how I want to prioritise a couple of things that I have going at the moment so that I can put away what I am not going to finish in the immediate future and finish off what I am doing in my ‘projects’ department.
I need to set aside time for some meditation and prayer.
I need to make sure I leave work on time.
I need to make better use of my diary and go back to keeping a list of things that I need to do to mark off and prioritise – this works well for me
I also really need to put some effort into starting to exercise and to spending more time outdoors.
If I need help with anything, I can and will ask.
I’ve been good with most of my other stuff but things involving routine, and doing things that I’m not instinctively motivated by (like exercise and cooking for anything other than guests) are difficult. It may get easier. Who knows? My goal is to find something that I enjoy in the things that I find difficult to do at some point – but not now. Now the need is to just do it.
We all fall down. We all need to know the best way to get up again too. Take the time to be prepared. I use the WRAP (http://www.mentalhealthrecovery.com/wrap/ . You can now download an old edition of this from “Recovery X-Change” http://www.recoveryxchange.org/downloads/RxChange%20WRAP%20WorkBook.pdf if you want to check it out a bit more closely). There are a number of different systems people have. The most important thing is to be ready to be ready.
All I have is a cold. It does not have to become a relapse.
Right now though it’s approaching bed time. So rather than editing anything else. I’m going to post this and head for the sack. Good night.
In every culture there are certain norms. Rules if you like. What type of food people eat, the structure of families and social networks, the kinds of things that people do, our attitudes to authority and among other things our attitude to work. In most western cultures the attitude is that you’re supposed to engage in it – but it’s also something to complain about. The idea is to have a lot of other things you’d rather be doing. Work, school all things regarded as ‘compulsory’ are often seen as restrictive.
I returned to work recently after a long absence from the workforce. The initial period was due to a nasty relapse of depression. Most of the months were while human resources were getting their act together pushing me through ‘independent’ doctors who were giving clearance for graded return to work plans all the while saying that the doctors had not said that I was not fully fit for duties. It reeked of them trying to get rid of me. Alas for HR, they failed. I got back in. What is more I got another job which I will start next week and was offered others while they were stuffing around – with disclosure about my depression. But enough on that.
Some of the Benefits of Productive Activity and Work
My return to the workforce has brought one thing to my attention in a stunning way. I love going to work. Sure there are some tasks that I could do without. But on the whole, work is something that I need. While I was off, I had to work hard to manufacture work for myself in the form of projects and I enjoyed them a lot. But it feels good to be doing something productive. To see people and say “hello” to them and pass the time of day with them. And that’s before I’ve even gotten my first pay! And to be busy. I am enjoying being busy.
I am really fortunate this time too. My latest medication regime is leaving me non-drowsy. My attention is better in the morning than the afternoon – so I will have to gear my day around doing the close work that needs that kind of focus early, but otherwise things are looking good. I am well. The dog has gotten the message that he needs to stay at heel and not strain on the lead. At the moment I am tired at the end of the day. Very tired, but I am convinced that in the coming weeks this will pass. Some of this has been helped by the fact that I am not starting cold.
I am convinced that my determination to keep busy with projects that required concentration, busyness and maintenance of a routine while off work has helped enormously with this, because in this too the dog was given little space to roam free on my time and thoughts. He essentially had to stay out of the way.
People, let me say that I am a convert. I believe that people need work – not necessarily paid work – but productive activity of some description to keep them feeling like they are moving and breathing. I believe that work brings freedom with it. Sure there is a need to have support and watch your early warning signs. Sure there are unpleasant tasks. Sure there are jobs that you would prefer over others. But work – work is grand!
If there’s one thing that discourages a jealous dog, it’s competition.
Sounds simple, doesn’t it?
Of course like everything that sounds simple there’s a journey involved in getting to the bit that’s simple. And at times the times the ‘simple’ bit is anything but easy.
If you were to tell me in the depths of my depression that competition was all that was needed to discourage the dog – that having other, more enjoyable things around me would make life easier to manage I would probably knock you flat. And I hit ‘like a girl’. When I am unwell they probably do knock the edges off things, but enjoy … ? Perhaps. I certainly need help to initiate the diversion and the routine. Ah … the old ‘r’ word. Yes, I must admit – it does help. I just hate it. I never feel like it and it’s damn hard to do. Especially when I still lack the sense of enjoyment of anything.
But further on – about eight months ago I gritted my teeth and reestablished contact with a long-lost world. The friend. The ones I lost contact with during a couple of years of withdrawing from – well – life in general. Initially it was very tentative. After all – who would really want to be friends with me, right? But no, contrary to my very localised opinion friends welcomed me back with enthusiasm … on-line, phone calls, coffees, visits and finally a trip to see someone who lived a long way away for a few days (I was very nervous about this one) which was lots of fun. I now have friends who I talk to again regularly and see when our schedules allow it, an old school friend I catch up with regularly, friends kids who are excited when I come to visit and people who miss me if I’m not around. I never thought I’d see the day. I’m still not sure I believe it. By rights I should have black and blue spots up and down my arms from where I have been pinching myself but if it’s not true, I’m not planning to end the dream any time soon.
Today is my first day at home after a couple of weeks on holidays – staying with the same friends that I visited earlier in the year. I was originally going for a few days, but the family with whom I was staying voted unanimously that I should stay longer – so I did. I visited with other friends and their families on the way home, including one family not far from home where I stopped in filthy weather with an hour’s notice to drop onto their couch for a night.
Amidst all of this my dog stayed at heel without challenge. This is amidst ongoing bungles with a return to work plan that has been drawn out for months.
My dog is shy around people who value me.
I need to remember this next time he pulls me in close to home.
A black dog needs a little competition from people who care. He just wants me to believe that there aren’t any. I did once and it turned out to be a lie. I must remember this for another day.
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.
livingwithablackdog 
