Friday, 5 June 2020

I was happy in the haze of a drunken hour......

Just a quick reminder that self-medicating with alcohol (or drugs) is probably not a good plan.

Copyright Matthew Johnstone

Alcohol is a depressant - so if you're already depressed it's not good to depress yourself further. Obviously, while you're drinking you will normally experience a short-term, feel-good factor but the day after you are likely to feel more lethargic and unmotivated than normal. Alcohol can also affect the effectiveness of antidepressants which, again, can leave you feeling worse than normal the morning after.

These days, I have the odd beer or glass of wine in the evening - but never to excess.

You know it makes sense, Rodney.


Wednesday, 3 June 2020

Change and decay in all around I see

Death is a fact of life. As Philip Larkin said: 'Most things may never happen: this one will.' Death unfortunately is unavoidable: we all die (sometime) and so do all our friends and family. It's not a very happy state of affairs - but such is life.




Most people, in the face of death, just try to get on with their lives. In fact, in some ways the prospect of death can actually enhance life. If we are going to die, then we might as well live now. We need to experience, to love and to be happy (if possible). In fact, the Romans used to have a skull at their feasts to remind themselves that life was short and should be enjoyed wherever possible.

Prior to being depressed I was, like most people, aware of my own mortality - but I didn't feel it breathing down my neck. To misquote Beckett: 'I didn't have a bone to pick with graveyards'. But depression seemed to open up a new relationship with death. It seemed to bring my slightly muted sense of mortality into sharp focus. What had hitherto not troubled me suddenly troubled me quite a lot. (Ironic for someone with suicidal depression, I know.) Death was suddenly everywhere. It was beneath the skin of every person I passed. Change and decay was all around.

I was wondering whether it is because depression drains all of the joy out of our lives that we are suddenly left with the stark reality of death. Pleasure undoubtedly distracts us from mortality: classically sex - but also food and drink, and then pretty much anything else we enjoy from scuba diving to ball room dancing. So when you strip these away - as happens when you experience anhedonia - you probably can't help noticing the big tombstone at the end of your life. So, yet again, this is another trick that depression plays on you. If you feel that you have woken up as Philip Larkin - don't despair because it may just be your depression which has made you 'death-suited'.



One Flew Over the Cuckoo's Nest

In July 2015, I was voluntarily admitted to the Thurne Ward at Hellesdon Psychiatric Hospital, Norwich for a period of 10 days. I haven't written anything about this episode so far because, to be honest, it still traumatises me five years on. However, I feel that I need to set down my experiences in order to hopefully move on. So here goes.


After several weeks of home visits by the Crisis Team - I remember one morning that the guy in front of me suddenly asked me: 'Would I like to go into hospital for a while?' The question stopped me in my tracks. Up to that point nobody had really mentioned hospital. We had done medication and talking therapies but the possiblity of a psychiatric ward had not arisen. However, he asked in such a matter of fact way that the enormity of what he was suggesting seemed to pass me by. I was fully aware of how ill I was and was desperate for something to alleviate my pain but was this it? I was suicidal, anxious, depressed and having delusions that I would be homeless. Nicki had patiently dealt with all my daily ravings for several months now and I was conscious, even in my distressed state, that she needed a break. (She was also running the house and looking after our daughters.) So, I found myself saying yes. To be honest, I didn't really know what else to do. Phone calls were subsequently made and remarkably (based on the normal poor provision of mental health beds in Norfolk) a place was found for me that afternoon.

I will always remember my arrival at the hospital - limping in with my blue holdall and Nicki by my side. I remember being buzzed through the prison-like double doors and into the reception area. I remember my bag being searched and my razor and nail clippers being removed. I remember being taken to my room (cell) which had a single bed with rough blue sheets, a small sink with push-button taps, a window that opened a crack only and which had no ligature points.

Even now, it's hard to explain the effect of being on the ward. If you were in a good place, it would be still be a disturbing experience. But, if like me, you were going through the circles of hell, it can became completetly nightmarish. The first thing that struck me were my fellow patients. They came in various shapes and sizes. There were the slow ones and the fast ones. The slow ones were often too depressed to move out of chairs or who walked in slow motion across the day room. Then there were the agitated ones, like me, who paced quickly back and forth. There was one guy with Borderline Personality Disorder who shouted a lot, a guy with long hair and a black cape (like an extra from The Lord of the Rings) who lay on the floor and talked to himself. He seemed to have lost all his teeth. There was a tall guy with Bipolar who bizarrely was allowed out to drive his car. (One day I noticed that the car had returned with a huge dent down one side.) One patient with incredibly bad depression stayed in his room for most of the time I was there and only appeared at meal times. The depression had so incapacited him that he had to be helped to the table and once there could barely lift his knife and fork.

But there was worse to come. My first night was like something out of The Shawshank Redemption. My room happened to be next to the entrance to the bedroom area and every time anyone went through the door it banged loudly shut - vibrating my whole room. Therefore I couldn't sleep - even with the help of the aptly named Zopiclone. Not sleeping, as it turned out, was the least of my worries that night. At some point I decided that I needed a wee so I tried to get up, but infortunately I fainted. (I had fainted earlier in the day while bringing tea upstairs at home - spilling it over myself and the carpet.) I can't remember if I called for help as I fell but a muscular female nurse suddenly appeared and immediately started to do a blood sugar test on me. I remember that there was blood all over the sheets. I think she concluded that I didn't have low blood sugar but called in another nurse to double check. They discussed me as though I wasn't there - then finally left. The rest of the night I fell in and out of sleep - interrupted hourly by torchlight shining through the door glass to check I was still there.

For me, the whole experience on the ward was like being in a latter-day Bedlam. During the day there would be periodic alarms go off when the SWAT team, as I called them, would suddenly appear mob-handed to subdue some patient who was kicking off. The team were always decked out with latex rubber gloves.

At other times there were surreal moments - like when the then Health Minister Norman Lamb turned up with a small entourage of suits to inspect the ward. I have a lot of respect for Norman Lamb and his campaigning to bring parity for mental and physial health - but when the party arrived I felt like an exihibit in a freak show.

After a couple of days though I settled into a nightmarish routine. Breakfast at eight with fellow patients in dining room hands shaking terribly; day-time TV in day room - pacing the small garden or attempting to read EDP; mid-day med run; lunch in dining room; trying to write something on my iPad in my room but hardly managing to string a sentence together; Pointless (which I still can't watch today); tea; evening med session in meds area; evening sandwiches and then sleep.

The evening med session was a sinister affair. It was coordinated by a black nurse who kept calling me Mr Cameron. I would sit in the large black chair which I noticed had arm restraints while he put tablets into little paper pots. At that time I was on antidepressants, anti-pyschotics and anti-anxieties. I also had to take a daily laxative. This was completely bizarre for in the seven years prior to being ill I must have had the loosest bowels in the UK. However, now I was going for three days without a poo and literally had to work it out with a pencil. The nurse would hand me the little paper pots and also a paper cup of water and watch me swallow them - one after another. My hands shook badly. I didn't like the room as it was packed with medication and needles. One of my biggest fears while on the ward was that I would end up, like my mother, having ECT. There was also a thing call a depot injection which sounded horrendous which I didn't want to experience.

My time was also punctuated by visits. In this respect, I was very lucky. Nicki, who happened to work on the Hellesdon site, would visit me every lunch time and every evening. My friends David and Nigel came to see me - as did my parents. I was aware that some patients had next to no visitors. This may have been because they weren't local. This is one of the most iniquitous things about mental health bed provision. Often there are no beds available locally and patients are sent out of county. This means that at a time of crisis it can be difficult for their family and friends to visit them. Seeing a familiar face in the nightmare of the ward is hugely important. A local EDP journallist called Steven Downes, who was on the ward shortly before me, was sent to a Priory Hospital in London when no provision was available in Norfolk.

I was also allowed out on a visit with Nicki and the girls. I remember she took me to the cafe at Reepham Station. I remember sitting there - agitated and slightly freaked out by the other customers. I was also acutely conscious that my daughters were seeing me in this terrible state. I remember the drive back to the ward - I couldn't keep my legs still. Reepham is on the Marriotts Way and was one of my favourite MTB cycling destinations but, on that day, it seemed a long way away from that.

The other punctuation was my meetings with the psychiatrist - of which I had two or three while I was on the ward - usually accompanied by Nicki. These were not really exploratory but were about reviewing my medication. As I was not really responding to the various meds, he just kept upping the dosage or transferring me onto a different medication. I couldn't help thinking that he must have been on a big salary and what he did could have been peformed by a prescribing nurse. He did at one point ask me if I had had a happy childhood and he also seemed to be concerned as to whether I could touch the end of my nose with my hands. The meetings were also full of other people so there was no sense of privavcy. There were note takers and trainee psychiatrists and various nurses from the ward. Obviously privacy was a thing of the past.

One misconception I had about psychiatric hospitals was that they offered long term care. In fact, they are mostly about short-term crisis intervention. I assumed that I would be kept in for longer or transferred to another ward - particularly as I still felt distressed in every possble way. But by day 10, I was introduced to my Community Care Co-ordinator. He would, apparently, look after me once I was back at home. This came as a shock to me as I didn't think I would ever be discharged - let alone in two day's time. I didn't want to stay on the ward - but I wasn't sure how I would manage at home either. I was still depressed and anxious and psychotic.

But the day of my discharge arrived and I was given back my razor and my nail clippers and a bottle of drink that my friend David had brought me. Nicki thanked the ward staff and gave them a card and a box of chocolates. I was discharged with a huge paper bag full of meds - largely laxatives (:-)). I was buzzed out of the double doors.

If I had to write a trip advisor review for the ward what would I say?  Well, I would be the first to admit that I was very ill and needed some kind of intervention. Something clearly needed to be done. Nicki needed a break; I needed help.  But was going onto the ward the answer? In retrospect, I think not. As I said earlier, the whole experince of being on the ward is traumatising particularly for those of a sensitive dispostion. I'm sure that I have had elements of PTSD over the past five years. Some of the things I saw were the stuff of nightmare and will haunt me forever. I'll never forget that first night on the ward or the SWAT team or the shit on the walls or the screams in the night or the flash of the torchlight at the door. Some of the staff were empathetic but others were intimidating. Has care for the mentally ill advanced all that much? I'm not so sure. Obviously we have all the medications these days which undoudtedly helps in many cases - but not in all. Essentially a lot of it is about containment and preventing suicide. Curing the problems is the hard part.

Above all, I think it's the stigma of having been on a pysch ward that is the hardest thing to bear. I wasn't sectioned but I was there. Forever more I will have the 'loony bin' label round my neck. I know I shouldn't see it like this - but I do. It's so completely different to going into hospital for a physical complaint. There is a massive stigma/embarrassment. I know that many famous people have been on psych wards at various times and have returned to normalish lives again - including the actors David Harewood and Christopher Eccleston and a cyclist called Tim McKenna who I follow on Twitter. Good old William Styron was too.

Anyway, by writing this blog, I'm hoping that I may be able to put some distance between me and Nurse Ratched.
:-)




Sunday, 31 May 2020

Congratulations and Celebrations

When you're struggling with depression even the smallest of tasks can seem insurmountable. Hoovering, going to the shop, booking the car in for MOT, collecting your prescription from the pharmacy or just getting out of bed in the first place. That's why it's important to congratulate yourself on completing any task - no matter how small.

The crucial time is just after you have completed the task. Let me give you an example. Imagine that you are struggling to get out of the house and you set yourself a goal of walking round the block. You have worked yourself up for this and you have achieved your goal and you return to the house. You might imagine that there would be a sudden sense of achievement and release of feel-good endorphins. However, often the exact opposite occurs. The voice of depression is likely to kick in to try and discourage you by undermining your achievement. After all, it doesn't want you to start getting any ideas. As a result, you will normally get the:

'How far did you walk? 400 yards? Is that all?

'If you can't walk further than that, how are you ever going to lead a proper life?'

'You might as well stay in bed, if that's the best you can do.'


You need to be kind to yourself. You need to congratulate yourself for what you have done and you need to try and keep the voice out.

SAY NO TO THE VOICE.







Comfort Break (Happisburgh Norfolk)

Just thought I would relieve the doom and gloom for a moment and say that today I drove myself  to Happisburgh with my bike in the boot. When I got there I cycled along the cliff top from Cart Gap to Walcott (nearly) and back through HB and down into the Bush Estate. It was a beautiful sunny day: the sea sparkled and the trails were bone dry.



Have Bike Will Travel

There were a few people about but it was OK and everyone was social distancing properly (more or less).

The light was very good so I stopped for a few photographs along the way. I felt good (for me) and tried to connect again with my previous MTB life: the joy of following a trail, the joy of knobbly tyres on dust, the spring in my legs and the suspension in my forks.


Happisburgh Lighthouse Etal

The other bonus was that Smallsticks Cafe had reopened for takeaways and I bagged myself a veggie burger. I sat in their car park of a shiny metal chair and enjoyed my snack in the sunshine. 


Smallsticks Cafe, Cart Gap

Without wishing to overstate things, Happisburgh is my most favourite place in the whole world (Rodney). I have been coming here since I was child and have watched its ongoing battle with the sea. Each year, on average, a couple of metres are lost.  In some ways, it is a metaphor for my own battle with depression - the sea being the depression and the soft, friable land being me. The sea seems to have all the cards but, at the end of the day, the land does have some resilience too. The land is shaped by the sea here - not the other way round. If we're being positive about it and today is a positive kinda day - we can say that the land resists the sea. It clings to itself; its glacial clays are sticky. The pub and the church are still standing and occasionally the council bungs in the odd massive rock to take some of the sting out of the waves. 

Long live the land! Hurrah!


Aripiprazole

I need to set the record straight regarding medication. Previously I stated that nothing had really worked for me - but I was being a bit disingenuous - for I have had some success with Aripiprazole. This barely pronounceable second generation anti-psychotic is used for various things - including as an adjunct to standard antidepressants in cases of major depression. This is how I was prescribed it originally - but then later dropped the antidepressant. It balances levels of serotonin and dopamine in the brain. (In the States it's known as Abilify.)



Aripiprazole is very fast acting and is the only thing I've come across that reduces the intensity of my negative rumination. You don't need to wait for 6 weeks - in fact, I find that it works almost immediately.  It doesn't do away with the rumination entirely but it does dial it down from about 11 to 6. This does bring me a modicum of peace and increases my chances of engaging in mindfulness. At volume 11 - mindfulness stands no chance. Imagine trying to recite poetry in a tornado.

I take 5mg in the morning and have never had a problem with side effects. The down side is that I need to have a blood test and ECG before they will issue anymore. (I'm needle phobic as well as all my other things. :-))

PS My gingko biloba still hasn't turned up from Holland and Barrett.



Hindsight

Hindsight, as they say, is a wonderful thing. Looking back I can clearly see where I went wrong. In fact, it's now glaringly obvious.

I can see that my mental health issues were far more serious than I thought; I can see that I was far more socially isolated than I should have been; I can see that my coping strategies were not good enough; I can see that I persisted for far too long in a job that was causing me serious stress.


Rowing backwards into the future

However, it's very easy to say that now. At the time I was just doing my best - rowing backwards (like we all do) into the future. I was trying to look after myself as best I could with exercise and counselling - while continuing to earn and be there for my family. 

To be fair, there is no way that I could have predicted the storm I was heading into. At that time, I still had my mountain biking and my mates to go for a drink with; I still had my literary websites and my photography. Life was a bit stressful but it had compensations. I wouldn't have described myself as happy but I was OK - I was getting by. 

If only I'd quit my work and found another job. If only I hadn't fallen out with my best mate Mark. If only I'd been more of a family man. If only I'd started another literary project. All these  things seem blindingly obvious now. But, to be fair to myself, there's no way I could have known the scale of the storm that I was heading into. It wasn't just a mid-life crisis. It wasn't just a case of moderate anxiety and depression - it was a full-on, life changing wrestle with madness. In the short space of a few months I became suicidal, psychotic, with off the scale depression and anxiety. How all this unraveled from where I was will probably never be entirely clear. But unravel it did with frightening intensity. The whole experience was like being hit by a train. And despite my best efforts, there has been no road back towards the old me. It was like a psychic death (and very nearly a physical one too). The new me was a poor shadow of my former self: brain-fogged, leaden, anhedonic. All my former avenues seemed closed to me. I could no longer concentrate to write and I was too dizzy to walk or cycle. My brain was on fire with terrible rumination.  I was a broken man - alive but not alive.

Five years on, I am still limping. I work - which I never thought I would do. My partner and children have stood by me - so I am not homeless which I so desperately feared at the time. I drive the car - albeit slowly. But I am dizzy and agoraphobia. I am anxious. I have a very small social life and my life is essentially joyless. 

Warning! 

Carpe Diem. Make the best of any life that you have now because you don't know what's round the corner. It may not be perfect - you may have worries and issues - but if things are reasonably OK then celebrate that now. Grasp it while you can. Be good to your family and friends.