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. 


Thursday, 28 May 2020

Is there a point to depression?

Some people (Dorothy Rowe included) think that there is a purpose to depression - in that it teaches us lessons about ourselves and the world; and that if we can learn those lessons and act upon them then we can move forward and actually end up being grateful for it.



This is indeed a lovely thought - especially when one is stuck in the middle of the unspeakable hell. I agree that depression highlights things that need changing. For me, it was my job. For others it might be their partner or their home.

The problem is that while it may flag up problems that need solving - it simultaneously strips you of the skills you need to bring about change. Change normally requires foresight, planning, energy and confidence. It also requires resilience to deal with the almost inevitable knock backs. If I can indulge in a metaphor - depression may show you the marathon that needs to be run but then breaks both your legs.

Turning your life around when you are at your lowest ebb is a tall order. I'm not saying it's impossible but it's certainly a challenge.  As I have documented before, anxiety and depression left me with brain fog, dizziness, leaden paralysis and suicidal thoughts. I lost the ability (virtually) to hand write; computers suddenly became alien technology; I even lost my driving licence for 3 months.  So there I was - a virtual 55 year old zombie - saying, hey mate, give us a job.


Clumsiness

In my previous post about dizziness, I mentioned how clumsy I had become. I assumed that this was due to my depression but I recently came across a very interesting article that suggests it's far more likely to be about my anxiety.



What particularly caught my attention was the idea that anxiety somehow blocks the brain and therefore it can't perform automatic things like ensuring that you don't bump into the furniture. This feels like a spot-on explanation for all the clumsy things that happen to me these days. Most of the time I exist in 'fight or flight mode'. My head is going full-steam with nasty thoughts and my heart is beating twenty to the dozen. No doubt my body is awash with cortisol. Therefore, I bump my head on car doors, I get entangled in clothes driers, snag my pockets on chair tops and tread on all manner of objects.

Another fascinating part of the article was the suggestion that anxiety causes one to hesitate before doing things and that this causes you to be slightly out of sync with your surroundings. As I mentioned before, one of my classic problems is getting a tea bag out of the caddy. Not an earth shattering problem, I hear you say but it is symptomatic of a wider issue. Technically, you just take the lid off - put your hand in and pull out the tea bag. Not in my case. It often takes me two or three tries in order to grab the tea bag. Sometimes I knock the caddy lid off by mistake. If I could just let go of the rocket levels of anxiety then I might be able to perform these tasks first time around.

Another factor at pay here is almost certainly my shaking hands. I've always had shaky hands. My mother had them, her father had them. They run (or shake) in our family. They also make it hard to be in sync with the world - especially when things require delicate adjustment. The more anxious I become the worse my hands shake.

Finally, the article suggests that overthinking may also cause the clumsiness - another classic symptom of anxiety.

Comparing Ourselves to Others

'Every time I crawl past your door, 
I been wishin’ I was somebody else instead'

Idiot Wind, Bob Dylan


When you fall into the black hole of anxiety and depression, it's very easy to start comparing your life (unfavorably) to others. When I fell into the pit, I started looking around at my friends and wishing I was them. Suddenly their lives - which previously had been fairly unremarkable - were now prodigiously successful and happy. I resented their careers and children and holidays. In fact, I became envious of anyone who was able to lead a reasonably normal life without the incessant pain that I was going through.  As the ice and fire raged in my head, I longed to be almost anyone else in the world. I remember at the time that the migrant crisis was happening in Europe. The news was full of  footage of refugees packed into precarious inflatable dinghies - crossing the Mediterranean - of orphaned children - or of desperate men trying to break into containers to gain access to the UK. I was at home watching the TV with plenty of food and clothing and with no external danger. But, because of my illness I secretly wanted to be one of the migrants because, rightly or wrongly, I assumed their suffering to be less than mine.





Obviously, you cannot know what others are suffering. Suffering is mostly on the inside - mostly invisible. People might look at me and say - 'Look at him, I wish I could have his life'.  I even got to the stage where I was envious of people who were terminally ill. My crooked reasoning being that - although they might endure terrible suffering - at least it would only be for a short period of time - whereas my suffering would be endless.

The advice, here, is to try not to compare your life to others. But when you feel you've descended to the lowest rung of purgatory - it's hard not to. Remember also that this is closely linked into those feelings of low self-esteem which we mentioned earlier - a classic feature of depression. The illness wants you to see yourself as the lowest form of human life in order to keep you under control. 

Wednesday, 27 May 2020

Ginkgo Biloba

Is Ginkgo the answer to all my problems? I was Googling dizziness remedies yesterday and Ginkgo Biloba came up.



Ginkgo Biloba  has been around for hundreds of years as a herbal remedy and is derived from the Ginkgo tree. It is particularly used for the treatment for poor memory, vertigo, circulation issues, anxiety, brain function, eye health, tinnitus, headaches, asthma, sexual dysfunction etc.

Some people claim that it is an anti-inflammatory. (It certainly has antioxidants.) Some people take it to combat brain fog. I have just done a quick trawl of the internet and some people even claim that it helps with depression.

Obviously herbal remedies are looked down upon by the medical profession - as unscientific/not medically tested. But are they completely ineffective? We will see. Speaking as someone who gained nothing from conventional anti-depressants, I am willing to give it a try.  I recently tried CBD capsules for anxiety and the next day I awoke and was literally punch-drunk. It took me about three hours to get it out of my system - so that I could finally return to my normal chronic dizziness. So, I won't be buying anymore of them.

I've just ordered a bottle of Ginkgo Biloba from Holland and Barrett - so I will keep you posted.

I'm primarily interested in its effect upon dizziness/vertigo. There is one clinical study online which states that it can be more effective than betahistine dihydochloride for vertigo sufferers.

But I will also assess its effectiveness on my depression, anxiety, brain fog, poor memory, stiff fingers and deteriorated eyesight. However, I was reading the list of side effects and was quite alarmed to see that it can actually cause dizziness. It always used to make me laugh when I read the side effects of anti-depressants which can, in some circumstances, cause 'depression'.  Great. Brave new world.

Wednesday, 20 May 2020

Mousehold Heath

Some days I walk the
Criss-cross trails here and let
The heath heal me.

Mousehold Heath is an area of woodland and heathland in north Norwich. Over the years it has been my go-to place when I needed some de-stressing. When things got bad at work I used to walk the trails here or take my mountain bike. There were certain places where I used to stop and absorb the healing vibes of nature. There was one particular hill where I used to crouch down - hidden from passers-by and just reground myself. The trails thread back and forth under the oak, silver birch and rowan trees and up over the heathery heathland sections. There is also a shallow pond that was once used by farmers as a watering hole for cattle they were bringing to market. Gnarled roots intrude on the footpaths; birds sing in the canopy and in summer the gorse is yellow with flowers. In the past, forty minutes over Mousehold was enough to fix me.

Mousehold Heath


Obviously, these days - it's more of a challenge. I went over this morning for a long walk. The sun was dappled through the leaves and the trails were dusty and dry. The chiffchaffs were singing and I even startled a green woodpecker. Being in nature does seem to improve my dizziness.


Gorse and Heather

My walking was fairly assured too. Depression acts as a kind of restricter on the speed one walks and the steepness one can tackle. It's like it's always trying to dial you back down to nothing. And the solution may be just to punch your way through the restriction. It doesn't like it when you stride ahead.

Now, I'm back at home typing this I can feel the effects of having walked. I actually feel more relaxed (which is unheard of for me) and my dark thoughts have slowed down too. Going back tomorrow for another fix.

Studies have shown that walking can be beneficial even for clinical depression.

Sunday, 17 May 2020

A Journey of a Thousand Miles Begins With a Single Step

The other day I was thinking to myself: what would recovery look like if it ever happened?

And the first thing I thought of was walking. I've always liked walking. The quiet rhythm of steps has been good for many depressives. It's a very simple and mindful activity. It doesn't require any specialist kit and it can be accessed from your front door in any direction for free. I always remember that Tennyson used to take therapeutic walks on the downs on the Isle of Wight.



However, my big problem with walking is dizziness. I normally find walking unsettling - so I tend to drive everywhere and keep walking to a bare minimum. But I would love to walk again. It doesn't necessarily have to be the Munros of Scotland - flat footpaths in Norfolk would be fine.

So last week, on Friday night, I went for a short walk round the block. That morning at work I had had a moment of non-dizziness and I wanted to see if I could recreate it. And, in fairness, the walk was better than I expected. After a while, I got into a rhythm and the steps on the pavement were actually reassuring.

I had a major dip this morning (see previous post)  - but I thought I would try another walk this afternoon. As I've mentioned before my dizziness has also made me agoraphobic - so when I step outside the front door there are a few things going on at once. I live in an area of terraced houses in Norwich. The sun was shining and due to Coranavirus restrictions the streets were quiet. I only thought I would do the short block but as I got going I was inspired to walk further and further. I kept adding on extra sections - so in the end I was out for about 30 mins. As I went round I distracted myself by naming plants and shrubs in gardens: nandina, fig, salix, camellia, euonymous.  With many phobias - it's actually good to expose yourself to what frightens you. In this way, you can naturally bring down your anxiety level. After a while I did find that I was feeling more relaxed about being out in the great outdoors which undoubtedly helped with the dizziness.

The other good thing about this walk is that it was a walk for me. It wasn't a walk to take the dog - nor was it a walk to Co-op to get food; it was a walk purely for the purpose of walking. And I came back feeling pleased with myself. I probably did over a mile. (I also executed a stylish U turn at one point when I spotted an ex-colleague who I didn't want to bump into.)

So, as Loa Tzu says: a journey of a thousand miles can begin with a single step. Let's see shall we?
   

Everyday is Like Sunday

This morning I went round to a bungalow that my mother-in-law is selling in order to do a bit of weeding etc. I was in the grip of depression big time - so I just thought I would write down some of the things that happened to highlight the way that depression can undermine you at every turn.



I'm a reasonably fit person for my age - but depression has a way of loading on a couple of bags of stone - so that even the simplest task becomes difficult. This can make you clumsy and disorientated. This in turn makes you feel more weary and incompetent. My chronic dizziness was also dialed up to 10 this morning. Even getting through the garden gate was a challenge. Does it open inwards or outwards? Everyone of these little snafus undermined me and made me believe that I was hopeless. I was there for about 45 minutes and here are some of the things depression said to me:

'Surely you can pull up a small weed like that - a child could do that.'

'Why can't you handle the spade properly anymore?'

'Don't bother hoeing all those weeds out because you'll be a basket case soon - so it doesn't really matter.'

'Why can't you get the tools in the boot properly so the lid fits down - idiot!'

'You only have to walk down this path to the compost heap and you're swaying like you've had 10 pints.'

'Why is Nicki so much better at weeding than you are? Aren't you supposed to work in a garden centre? How incompetent can one person be?'

'You shouldn't be sweating like this - you haven't even done anything yet.'

The louder the voice got - the more the fog descended and the dizzier and more clumsy I became - which in turn made the fog even thicker. By the time I got back in the car I was ready to give up entirely and resign myself to sitting on a chair in a darkened room for ever more - like some character from a Samuel Beckett novel.

Thursday, 14 May 2020

Getting Through the Next Minute

Sorry but I need to put one down for the record here:



When I'm under the cosh, which is most of the time, it can be hard to get through the next minute. I know this sounds a bit melodramatic - but only those who've experienced acute depression/anxiety will really understand. It's an intensely desperate feeling: a mixture of panic, despair and numbness - all rolled together. There is literally no relief from it. No distraction can dispel it. No pleasant thought will pierce it. It feels like a tightness in the chest; a hurricane in the skull - a claustrophobic, impossible unease. When I feel like this there is no comfort to be had from any chair. I stand up, I sit down, I pace around. And the worst thing of all is that there is no end in sight. I know that tomorrow will be the same as today (or worse). I sometimes resort to prayer. I have lived like this for five years now. Most major depressions last 6 months to 1 year. I know that the only relief will be when I go to bed at night. But then I know I will wake up tomorrow morning and the whole dreadful ordeal will start again. I try to stay strong for Nicki and the girls. But how much suffering can one person endure?

I pray that William Styron's experience is correct: 'Mysterious in its coming, mysterious in its going, the affliction runs its course and one finds peace.'

Dark Thoughts

I have to confess that I've always been a thinker. I don't necessarily mean in the manner of a great philosopher but just in terms of internalising or deliberating. Being inside my head has been a kind of refuge from the world; a place I could escape into  - like a wood. It was also a creative place where poems came from. I enjoyed thinking about things.



But, when I became ill, my place of refuge became a place of torment. It was as though the wood had been set on fire. What had previously been a sun-dappled quiet place - became an inferno - acrid and charred. Depression made my thoughts turn toxic through a combination of feeling  worthless, guilty and hopeless. I think my anxiety also added some panic and dread. The thoughts  were so powerful that they made me physically uncomfortable - inducing cold sweats or shakiness. To give you an example, I might think: I'm going mad - therefore I won't be able to work and I won't be able to earn any money, so I won't be able to pay my way. I'll be stuck at home forever, or worse still I'll lose my home.

But as I've said before thoughts are not facts. They may seem like facts. They may seem logical and inescapable. But really they are insubstantial things.

What we all need when we're assailed by the dark thoughts is to create a kind of cordon - a Patronus charm, if you like. The only way I have found of doing this is through mindfulness. Being in the present can definitely slow down (and potentially stop) the thoughts. Let us try a quick exercise now. Start by looking around you. You don't have to be in a beautiful natural place: anywhere will do. (If you're in Coronavirus lockdown then the chances are you'll be in a room.) Try and concentrate on your surroundings. Use your eyes and your ears and your sense of smell and touch. Absorb all the information that you can about the room - the colours - the shapes - the textures - the sounds. How does the light enter the room? When the dark thoughts come back, as they will, just draw your attention back to the present moment. See how long you can keep the thoughts at bay for. Another thing to try is just to be vigilant of your thoughts. Stand back a little and try and observe them as they arrive. (That's that one about not being able to work again.) Don't judge them. Instead of fighting them or trying to block them - just gently draw yourself back to the room. If you can stay in the present - then the thoughts will find it hard to get a grip. They will lose some of their stickiness. If you can keep out the thoughts - even for a short while - you will find that your body will relax a little. This, will then allow you to breathe. Getting in tune with your breathing will also help to keep the thoughts at bay. 



Wednesday, 13 May 2020

Classic Symptoms of Depression

Despite all the advances of modern science, there is still no blood test, MRI scan or biopsy that can determine whether someone is depressed or not. The system for determining depression is still down to a list that was devised back in the 19th Century - interpreted by a doctor or psychiatrist.



If you have five or more of the symptoms below and they have persisted for at least two weeks then you will be deemed to have depression:

  • low mood 
  • loss of pleasure in life/daily activities (anhedonia)
  • loss of interest in food or overeating
  • inability to sleep of over sleeping 
  • psychomotor retardation (slowing down) or agitation
  • fatigue, loss of energy
  • feelings of worthlessness/inappropriate guilt
  • inability to concentrate/make decisions 
  • suicidal ideation/plan/ attempted suicide

When I was ill, I had virtually all of these. Mine was an agitated depression so I had trouble keeping my body still. I used to pace a lot. The only thing that I didn't have was the inability to sleep. Some people with depression lay awake all night tormented by negative thoughts. Fortunately I was always able to get off to sleep. 

If you're ticking all the boxes here, then you need to speak to someone fast. Your GP is probably the best place to start. However, if you feel that you're in imminent danger then ring Samaritans 116 123.

Remember, there are many other people who have experienced this. You are not alone. 


Babylon's Burning

I know this blog is primarily about depression but, as I mentioned earlier, depression often comes together with anxiety. They are partners in crime. Anxiety can tip into depression and depression can cause anxiety. In some ways they are like the yin and yang of mental health - with each containing the seed of the other. In fact, 50% of people with anxiety or depression are likely to have the other.



Throughout my life I have oscillated between the two. I always had social anxiety - though in my day it was just known as shyness. I also always had mild depression. When I became seriously ill in 2015 the two things seemed to merge together to create a monster. As I mentioned before, I actually experience my depression as anxiety. I have a tightness in the chest and a semi-permanent headache. And I simply can't relax. No matter how much deep breathing I do or how much mindfulness or vizualisation - the sense of dread/panic remains. My depression was of the agitated variety - so maybe this explains the similarities with anxiety. Some days I wonder if it is actually more anxiety than depression. After all, anxiety is a key cause of dizziness. Anxiety also causes a tape-loop of thoughts - not dissimilar from rumination. 

The treatments for anxiety and depression can also be interchangeable. Strangely, antidepressants are often prescribed for people with anxiety. Mindfulness can be effective for both illnesses. Being calm is also a way of combating both.

Sometimes I find it's helpful not to compartmentalise the two illnesses. Just try and deal with how it feels. 

Inflammation

Some research (conducted by the University of Science and Technology in Wuhan, China) has suggested that anti-inflammatory drugs like aspirin or ibuprofen can be effective against major depression. There is evidence that inflammation is more common in people with depression and that inflammation may cause a reduction in serotonin, dopamine and norepinephrine levels. As I am not currently on any other medication, I thought I would trial this and see.



When I first became ill I also developed rheumatism in both my hands almost overnight. Rheumatism is caused by inflammation. Dizziness can also be the result of an inflammation of the inner ear.

I will monitor any progress and report back.  I am one of the 30% of people who do not respond to antidepressants. Wouldn't it be amazing if something as simple and as cheap as ibuprofen could make a difference?

Monday, 11 May 2020

In Your Corner

When depression strikes - it's our nearest and dearest who often bare the brunt of the care. If you are lucky you will find that certain people will be there for you in the dark days. For Matt Haig it was his girlfriend Andrea, for William Styron his wife, for Andrew Solomon it was his father. For me it was my partner Nicki and my sister Caroline.



When you're depressed, you don't always appreciate what other people are doing for you. You are too wrapped up in the pain. But, at the end of the day, it is often love that gets you through.

I hadn't been in contact with my sister very much over the years - but when I became ill I found that she was a life raft for me. She listened to hours of my most desperate ramblings on the phone. This provided a safety valve for me at the worst times. But it was Nicki who had to live with me through those years. She was stoic and resourceful and did so much for me. I just wanted to write a list of some of those things:

  • accompanied me to GP appointments
  • sat in with Crisis Team visits
  • visited me in hospital twice a day
  • reminded me to take my medication
  • gave me lists of things to do so I got moving
  • bought me self-help books
  • made sure I didn't miss my appointments
  • encouraged me to walk/cycle/volunteer/work
  • kept the house running 
  • took me to Happisburgh
  • took me on holiday
  • researched different therapies
  • rescued a dog
  • never gave up on me 


Thank you so much.
x

Sunday, 10 May 2020

Dizziness

What has dizziness got to do with depression? Well, to tell you the truth, I'm not sure. All I know is that for me it began right slap bang in the middle of my clinical depression. I remember one morning in particular: I was bringing two mugs of tea up to the bedroom when I suddenly fainted and the tea went all over me and the carpet. From that moment to the present day I have remained chronically dizzy.



Everyone understands what it's like to be dizzy. You get up from a chair too quickly and your head spins. Things feel out of kilter: the world is 'on the huh' as they say in Norfolk. However, most dizzy spells are short lived and normality soon resumes. But what if normality doesn't resume? People who feel dizzy all the time are often diagnosed as having chronic subjective dizziness. This is what I have. Dizziness can be caused by anxiety and depression but is more commonly thought to be the result of a  problem with the inner ear. The problem is that neither of these things can be verified very easily. I have been for a full range of tests at the hospital and the conclusion was that there might be a problem with my inner ear. The treatment for this is a range of vestibular exercises designed to re-correct the imbalance. Typically it involves moving the head while staring at a fixed object on the wall or standing on a cushion and repeating the exercise. I practiced these manoeuvres for several weeks but nothing seemed to change.

I have had to accept, barring a miracle, that dizziness is now a part of my life. It affects everything I do from the moment my feet touch the ground when I get out of bed in the morning till the moment  I return to bed in the evening. It affects all movements throughout the day. It affects my spatial orientation. It affects my hand-eye coordination. As a result, I have become clumsy. My trouser pocket snags on cupboard handles, my trailing hand knocks over things, my feet trip over doorsteps.  Making a simple cup of tea is no longer simple. The tea caddy is never quite where I think it is. Picking out a tea bag from the caddy often involves a number of tries. All my life I've done these things automatically. I've taken them for granted. Things have always been where they are supposed to be. Not any more. As a result, I now have to concentrate very hard on things which previously were purely instinctive.

One of the worst things is my spatial orientation in relation to my head. The clothes line in the back garden, for instance, is a constant danger for me now. In the past, I just instinctively knew where it was even if I wasn't looking at it. It was just there. Now I'm never sure whether it's to my right or left and, as a result, I often get caught by it.

But, by far the worst thing is when I get outside the house and garden. Walking the short distance to the Co-op is now a major expedition. As I proceed down the pavement - the whole street feels out of sync - like I've been drinking. The terrace houses seem to tilt slightly and the sky spins. There is a slight hill that I have to go down and this causes the dizziness to increase. But the worst bit is when I get to the road junction near the shop. At this point, four roads converge and traffic can appear from any road. The Co-op is on the other side - so I have to cross.  This simple manouevre, that a young child could perform, throws me into a panic. Because I can no longer judge distance and speed - cars frequently catch me out. Sometimes I get half way across and have to suddenly retrace my steps. Or I end up standing in the middle of the road with cars buzzing me on either side. Because I feel anxious the spinning sensation increases which makes my disorientation worse. The whole thing makes me want to cry.

As a result of my dizziness, I am now agoraphobic. I used to love walking and hiking and cycling - but now, apart from work and short outings, I'm fairly housebound. It's a horrible thing. If anyone has any suggestions about dizziness, I would love to hear them.

Medication

So far I haven't touched upon the subject of medication. If you have severe depression, you will almost certainly be recommended to take antidepressants. It is thought that these work by increasing the level of chemicals in the brain known as neurotransmitters. Serotonin and noradrenaline are particularly linked to mood and emotion.

There are several types of antidepressants:

  • Selective serotonin reuptake inhibitors (SSRIs)
  • Serontonin-noradrenaline reuptake inhibitors (SNRIs)
  • Noradrenaline and specific serotonergic antidepressants (NASSAs)
  • Tricyclic antidepressants (TCAs) 
When you read the above list, you can't fail to be impressed by the scientific sounding terminology. However, the situation is far more mysterious than you might imagine. Serotonin, for example, is very hard to measure. It is possible that having more serotonin in the brain may lift your mood - but there is no evidence to suggest that having a deficiency of it causes depression in the first place. Furthermore, there are some antidepressants that have no effect on serotonin and some that actually reduce it which have also been shown to be effective. The bottom line is that the brain is a very complicated organ and nobody knows how it works exactly. When you add the mystery of the brain to the mystery of depression - you end up with a very inexact science.



However, antidepressants do seem to work for some people. They may not, as critics point out, solve the causes of depression but they can alleviate the symptoms long enough to allow people to look more rationally at the causes. Classically, clinical depression is treated with a combination of medication and talking therapies.

I have to say that antidepressants didn't seem to work for me. I tried several different types but neither the panic nor the gloom lifted. It has to be pointed out also that there is a long lag time before antidepressants become effective. They can take up to 4-6 weeks to kick in. Often GPs will start with low doses and gradually increase them if there is no effect. If one type is ineffective they will swap you to another and the 4-6 weeks lag time will begin again. They also have a myriad of side effects. When you're on antidepressants it's sometimes difficult to know what is the depression and what is the side effects. Things can get very confused.

During my illness I also took anti-psychotics, anti-anxieties and anti-inflammatories. I once made a list of all the different tablets that I took. The only thing that gave me any relief was diazepam - which is addictive and shouldn't be taken too often. Here are some of the others:

  • citalopram
  • pericyazine
  • venlafaxin
  • vortioxetine
  • risperidone
  • aripiprazole
  • amiltriptyline
  • beta blockers
  • lithium
  • sertraline

At the moment I don't take anything. I'm not proud of this - it is just how it is. I was recently reading an article about Leonard Cohen and his approach to medication. He, too, gained little relief from it and had this to say: ' These things don't even begin to confront my predicament. I figured, if I am going to go down I would rather go down with my eyes wide open.'

:-)

Saturday, 9 May 2020

The Writing Cure

At the end of her book Out of the Blue Jan Wong writes:

'For me, writing about depression was not therapeutic. It made me relive the worst days again and again. But the creative act of setting down words eventually created a certain distance from the source of despair. Once the record is there, written down in full, I'm finally free to purge this terrible period from my brain. I can now stop ruminating about it, over and over again.'

Ever since I was first ill, I have tried to write about my depression. Writing had always been my raison d'etre. Even when I was in the hellish environment of the psychiatric ward I felt that I wanted to record something - to preserve something. At that stage though - I could barely write my own name - let alone say anything meaningful about anything as mysterious as depression. But all through the long and painful process of my illness I could never quite shake off the feeling that I had to find words for it. I had to somehow identify my opponent - pin it down.



In the early days, this was simply impossible. Like other writers who have developed clinical depression, I found I could no longer write. This was both a physical and a mental issue. During the onset of my illness I actually experienced a stiffening in my hands. I remember waking up each morning with my fingers locked. I'm not sure if this was arthritis or poor circulation or inflammation  but I literally could not operate a pen anymore. But obviously I could still type. Or could I? Depression had also overwhelmed me with dizziness - so when I went to my trusty keyboard - the one I had been using for over ten years - I now felt disorientated and helpless. The spatial disorientation that it brought on meant that I couldn't seem to find the keys anymore. They were not quite where they should have been. Furthermore, the screen seemed to move and distort. This may have been due to the deterioration in my eyesight - which also occurred at that time. In any case, typing was now a real challenge for me.

On top of this, I was also wrestling with a general decline in my cognitive abilities. As depression overcame me, my brain literally fogged up. It was as though the metaphorical fog had percolated in through my ears. I could no longer think straight. My spelling and vocabulary had gone to pot. My sentence construction fell off a cliff. To find words for depression is hard at the best of times - but to do it with a brain that is fogged up like a valley in the Lake District - while simultaneously on fire - is an almost impossible task. I remember that it was about this time that I set up an anonymous Twitter  account - to try and communicate some of my 'shit' but it was just that - a mess of suicidal imaginings  - offering no insight whatsoever. Even in my frantic state I could see that it was bad and deleted it.

Over the next few years I tried over and over again to write about what had happened to me. But, like Jan Wong, it was not therapeutic. Retracing my steps was terribly traumatic. By this stage I had read a few depression memoirs and knew how important it was to share information about the illness and how important it was to know that other people had experienced the hell that you were going through. Deep down, I wanted to use my experience to help other people but, time and again, I kept coming up against the fact that I didn't want to share everything that had happened to me. It was too painful, too personal. The memoir format was not working for me.

But I still had this desire to write about depression. I thought (maybe naively) that if I could just pin it down then I could possibly expunge it. If I could expose all its tricks then I might be able to break it's power over me. I had a lot of information to share and I genuinely hoped that I might be able to spare some people the full hideousness of what had happened to me. So, finally, after about 30 attempts at memoir and half a dozen attempts at self-help manuals - it occurred to me that I could write a blog. In this way I could mix up the factual information with the personal information. I didn't have to plod through the full nightmare of my own story; I could cherry pick.

When I finally started this blog another unexpected thing happened: I noticed that my brain started to  re-engage. I'm not saying that the light came shining through and the fog lifted - but I found that  for the first time in five years my brain was helping rather than hindering. Perhaps it was simply that I had finally found something to say and a way in which to say it?  I also found that my spatial issues with the keyboard lessened. I found that I could type faster than before and that I was making fewer mistakes. Suddenly, the words that had sustained me all my life started to come back. Now I am following them to see where they lead.

No Future?

One of the most pernicious things about severe/suicidal depression is that it tells you that you have no future. It tells you that you will never work again, never experience any happiness again, never love again, never leave you bed or hospital ward again and that you might as well get it over with now and kill yourself. But amid this catastrophic racket - there may be another quieter voice which tells a different story - if you can only hear it.


At the Garden Centre

Let me tell you a little story about garden centres.  In Spring 2017, I was in a bad way. I had just given up work at the college after returning for 10 months after my initial breakdown in 2015. It wasn't working out. The college was a toxic place for my mental health and despite huge efforts on my part, I literally couldn't summon up the energy to move anymore. I was suicidally depressed, had chronic dizziness, brain fog, leaden paralysis and anhedonia. I was also extremely socially anxious.

One day, in an uncharacteristic energetic moment, I decided to go to my local garden centre to buy some bark chippings for the front garden. How I managed to concentrate on such a mundane activity with everything else that was going on I have no idea. But I managed to drive the mile up the road to the centre and ordered a bag of bark chips. While I was there a lady mistook me for one of the staff and asked if I could carry some compost to her car. I explained that I didn't work there and she apologised  - but the incident planted a seed in my mind. If one of the customers could mistake me for a member of staff - maybe the owner might do the same. So a week later, despite my mental anguish,  I went in again and spoke to the owner - a man in his 60s with a long grey ponytail - and enquired whether he needed any staff. To my amazement he said that he would give me a trial and could I start tomorrow.

So there I was, the next day on the end of a yellow hose pipe watering the perennials and earning £7 per hour in a garden centre.  My duties included potting on plants to bigger pots in a ramshackle potting shed, watering, sweeping the paths, carrying out compost to cars and assisting the customers with enquiries. The last duty was altogether laughable as I knew next to nothing about gardening and, in any case, found any interaction with people difficult. I remember one day a customer asked me about patio roses and I had no idea.  However, no one seemed to be too bothered by my lack of knowledge and by the end of the week I went home with some cash in my pocket. I returned the next week and gradually fell into a routine of watering and potting on. I remember that the weather that year was very fine and that the garden centre was something of an oasis - albeit located on the Norwich ring road. The plants and trees seemed to muffle the noise of the traffic. I would move slowly round with my hose - hiding from time to time in the bamboo or behind the fruit trees. At lunch time I would eat my sandwiches in a cramped room above the shop surrounded by boxes of Tomorite and weedkiller. But I don't want to give the impression here that things were good - because they weren't. Most days I was suicidal and spent hours wrestling with various different plans to kill myself. This usually went on all day until about four in the afternoon when, for some reason, the voices lessened. But despite feeling horrendous - I could still perform my duties. I also started to try and memorize plant names in an attempt to distract myself from the self-destructive voices. In the evening I also started to jot them down in a note book. So the weeks past, and despite my various issues I started to absorb some knowledge. My brain was still clogged with anxiety and depression but by repeatedly going over things - some of it started to seep in. I learnt for instance that fruit trees are grafted onto root stocks; I learnt that foxgloves were OK in the shade and that clematis like to have cool roots and that you can split bamboo. I learned the difference between bedding plants and perennials and between evergreen and non-evergreen. I started to know what type of compost we sold : multi-purpose, ericaceous, tub and basket etc. But as the summer rolled on it became clear that this conveniently located temporary job would come to an end and that I would need to look elsewhere.

But once again, the universe bizarrely came up trumps - this time with a job at a tree nursery 10 miles north of Norwich. The nursery was located in a glade among the trees and was fenced in on all sides to prevent rabbits and deer. I worked here throughout that winter of 2017 and boy did I work. I planted trees and dug up trees; I unloaded root-ball laurels from lorries, I moved leylandii about and I dug in thousands of bare-root hedging plants and then dug them up again for customers. I remember that most of the time it was cold and muddy and the only shelter we had was a polytunnel where we did the potting. The site had no facilities like toilets or washrooms. I was still suicidal on and off, and although working was hard it was better than sitting at home staring at my phone. Then in the spring of 2018, I had a bit of a blitz and circulated my CV to some garden centres in and around Norwich. I didn't expect to hear anything but surprisingly I got two calls - went for two interviews and was offered two jobs. I subsequently left the tree nursery and began working part time at the two garden centres. By now, I was fairly well-versed in garden centre procedures - so simply got on with dealing with plant arrivals, putting them out, reorganising them, sweeping down the benches, watering, carrying compost etc. This time I also had a few colleagues and I started to interact more. I would actually come home in the evening with some conversation: Bob did such and such today - Paul told me something interesting. That Christmas I actually went on two staff Christmas dinners - one in a pub and one in a smart hotel in Norwich.

Unfortunately, one of the jobs didn't work out long time - but the other one did. I have now been there over two years and have become part of the team. Everyone knows me now and I'm sure that they think I am good at my job. My plant knowledge has increased and my customer care has improved. I now use my own initiative rather than waiting to be told what to do. I'm also involved in helping new Horti members of staff. Perhaps the most surprising thing of all was that I passed my forklift truck licence. To be honest, I'm not sure how I manged to do this with my dizziness and other issues but I did it. I sat a short multiple choice test and did a 40 minute task moving and stacking palettes in a tight area. Using the forklift is now the best part of my job. I love unloading palettes of compost from articulated lorries or moving stuff around the loading yard.

During the Coronavirus period, I was kept on as a caretaker at the centre to water the plants and look after things generally. As the centre has slowly opened up again I have been closely involved in the company's emerging delivery service and click and collect service. I still struggle with concentration but I've been checking and collecting orders and telephoning customers and taking card payments. My life is still very hard - but I hope that this story illustrates that the voice of depression is not necessarily a fact. Even in the most adverse circumstances things can still happen and potentially change. There can be a future out there - even when the voice of doom in your head is telling you to abandon hope. If somebody had said to me in 2015 - as I was pacing the psych ward in an agitated fashion  - that I would be driving a forklift truck at a garden centre in the sunshine four years later I would never have believed them.




Friday, 8 May 2020

Anhedonia

Anhedonia is the technical term for a loss of pleasure in life or, to be more precise, a loss of pleasure in previously enjoyable activities. It's one of the classic symptoms of clinical depression. In reality, anhedonia sucks the joy out of your life. In many ways it's similar to a Dementor's kiss in Harry Potter. Anhedonia may be related to a part of the brain called the basal ganglia aka the 'pleasure centre' - but it might also have something to do with the amygdala, the striatum, the insula or the prefrontal cortex.



People who develop clinical depression can suddenly find that all their hobbies and pastimes provide them with little or no pleasure. Hamlet may have been experiencing anhedonia when he said:

'I have of late - but wherefore I know not - lost all my mirth, forgone all custom of exercises, and indeed it goes so heavily with my disposition that this goody frame, the earth, seems to me a sterile promontory; this most excellent canopy, the air - look you, this brave o'erhanging firmanent, this majestical roof fretted with golden fire - why, it appears no other thing to me than a foul and pestilent congregation of vapors.'

Anhedonia can be devastating. When I became ill, I lost interest in the following activities at a stroke :

  • mountain biking
  • walking
  • church crawling 
  • being on the beach
  • reading
  • writing 
  • poetry
  • photography
  • films
  • comedy (stand ups/sitcoms)
  • music
  • social life
  • nature
It was as as though my soul had literally been sucked out. (To be fair, some of these activities were also impacted by my chronic dizziness and my brain fog.) Getting them back has been a painfully slow process and they have only partially returned. These days I do take photographs on my phone and post them on Flickr or Twitter. I sometimes enjoy listening to music on my ipod in the car and I can concentrate a bit better on films. I laugh at Have I got News For You and I can read self-help books about depression. But I no longer read for pleasure; my writing has been severely restricted (with the possible exception of this blog); my social life has stalled; all physical activity feels leaden and unrewarding and my enjoyment of nature has not returned. Even food and drink has lost some of it's flavour.

However, anhedonia can go away. It is tied in very tightly with depression and if you can shift one then you can potentially shift the other. One of the best approaches is to try to rediscover a child-like innocence and interest in the world. Try to learn new things or new ways of doing things. Do your best to keep you brain active. Neuroplasticity may be our best hope.

Thursday, 7 May 2020

Getting a Diagnosis

Getting a diagnosis can be an important step in your recovery. It can help you to identify what you're dealing with and lead to possible medications or therapies. However, getting a correct diagnosis can sometimes be a problem. Sometimes your GP can make a diagnosis but at other times you might require more specialist mental health advice e.g. from a psychiatrist. Mental health issues can be complicated and often there may be more than one illness involved. Classically, anxiety and depression work as a team.

In 2015, I was diagnosed with psychotic depression. This was a correct diagnosis but it didn't take into account the severe anxiety which had led to the depression in the first place. For seven years prior to my breakdown, I had been suffering from increasing levels of anxiety. In the Spring of 2015 this anxiety literally went off-the-scale. It felt like someone had turned the dial up to 11 and then the dial had snapped off. Faced with this acute level of anxiety my body/mind had little choice but to nose-dive into depression. I crashed down big time. But the anxiety which caused the crash remained as a kind of background radiation. Even today I experience my depression as a kind of anxiety in the chest. As a result, my actual diagnosis only tells half the story.

Another problem, as I have already highlighted in this blog, is that depression is a mysterious illness. Even if someone tells you you have depression. What does this mean exactly? Depression, as we know, comes in all shapes and sizes and can be a tricky customer. However, a diagnosis may be a starting point for understanding your illness. But, at the same time, we also need to be a bit cautious with labels.


Wednesday, 6 May 2020

Up Day (Shock, Horror, Probe!)

So far this blog has been rather downbeat. But today I wanted to record a slightly different day. I mentioned before that I normally only have three types of day: bad, very bad and suicidal. Well today was different; I actually had a good day. It didn't start well though. I woke up about 5.30 am and was beset by the usual terrors of a new day. I couldn't settle my mind and adopted various contorted positions in bed in order to resettle. Nothing seemed to work. Then suddenly I just remember thinking that the pain should go and miraculously it left me. ( I remembered something from Eckhart Tolle about how you drop pain - like a hot brick.) I dozed happily for an hour - which is unheard of. I even got out of bed at seven with something approximating a spring and didn't feel as dizzy as usual. I kept focusing on the pain departing and tried to see how long I could keep it out for.


Photo by me

I managed to keep it out during my dog walk over the park and on my journey to work. Fortunately, it was a busy day at the garden centre. Despite still being closed for the Coronavirus - the centre was buzzing. We had the guys who do the landscaping in to mow the grass - the carpenters were working on the new till area, the carpet man returned to do a doormat and we had some guys came to dismantle one of our old conservatories  -  all observing social distancing of course. The company had also introduced a new click and collect service and we started to get orders. I was buzzing back and forth on the forklift - bringing down compost for customers or garden chairs from the containers for the shop. I even phoned two customers to check their orders and to give them a time for collection. Obviously the thoughts returned periodically and I wrestled with the normal dizziness but I can honestly say that there were times today when I forgot that I was ill. It was amazing to just be doing something without the background voice of doom. I suppose this is what mindfulness is in many ways; just the absorption in a task. It doesn't have to be cultural or 'significant' work - anything will do. Chop that wood and carry water. The sun was shining, which helped, and there was the normal banter between me and the garden centre guys.

Today may have been a one-off - who knows. Tomorrow I may sink back under the blanket - but it is important for me to record this good day. If nothing else, it shows that it is possible. In the weeks ahead it may help me to remember it when I'm under the cosh again. And if I can't remember it - I can click back on this blog and re-read and realise that it did happen.

:-)

Tuesday, 5 May 2020

Standing Up to the Bully

This morning at work I was completely under the cosh. The bully voice of depression was giving me a good seeing to and, as usual, I was taking all the punches. By mid morning I was battered and bruised and ready to give up.

(Drawing by Matthew Johnstone)


But, then, around midday I had an interesting thought. It suddenly struck me as odd why I let depression talk to me the way I do. I wouldn't expect anyone else to be talk to me like this. At the same time, I also wondered why I was such a bad person - as to deserve being spoken to in this way. What had I done to be attacked and criticised and made to feel guilty in this hideous way? Had I killed someone? Had I robbed a bank? Had I deserted my family? Was I an international terrorist? Yet deep down I still felt like a bad person.

I questioned myself further: where had this sense of being a bad person come from? Where had this acceptance of it as a fact come from? And I realised that there was a tacit acceptance on my part that I was a bad person. I realised that I was complicit in what was going on. I scrolled back through my life and tried to be objective about things. I was reminded of Thomas Hardy's phrase: 'neutral tinted haps and such' but, again, no heinous crimes. So how had I reached the conclusion that I was bad? Had it been instilled when I was a child? If I was bad then obviously I deserved to be beaten up. But what if I wasn't actually bad at all. I suppose this is where low self-esteem comes in or, indeed, it's big brother self-loathing. And I realised that I am extremely self critical. It's almost as though I do it on purpose just to beat myself up. But what if I stopped being self-critical?

Then I had another thought. To face depression every day requires an almost superhuman strength. This continuing battle should be recognised as heroic and difficult. Therefore, I am not a bad person at all but a heroic one. So, when you're under the cosh, remember to congratulate yourself. Say 'no' to the bully.