Monday, 29 June 2020

Neuroplasticity

Neuroplasticity is the process whereby the brain changes its neural pathways and synapses over time.


Surprisingly the brain doesn't stop changing when we are young but continues to adapt itself into old age. It is true that the brain grows fastest when we are young - but it's ability to transform itself continues all through our lives. Basically the brain is not set in stone. Just like the hard drive of a computer  - it fills up or empties depending upon what is saved or deleted. The brain works out what is most relevent and can delete irrelevant pathways/information. The brain can respond to injury and illness by creating new pathways and learning new tricks.

Neuroplasticity is particularly important for depression sufferers because it means that the negative effects of depression on the brain can be reversed. In some ways the brain is just like a stomach in that it digests/absorbs what it experiences: thoughts, happenings and attitudes. If you feed it negative thoughts then it will become negative. If you feed it postive thoughts then it can become postive. (So maybe good old-fashioned positive thinking may work after all.) The brain can also respond positively to exercise.

One classic study looked at the brains of London taxi drivers who were doing the 'knowledge'. The study concluded that the hippocampus increased in size while they studied and was largest in those who had been driving for the longest. So, using our brains is crucial. Use it or lose it.

The bottom line about neuroplasticity is that we aren't necesarily stuck with our old broken mind but can build a new one. So that brain-fogged, forgetful, indecisive old organ between our ears can be retuned and rewired to turn it into a cognitive powerhouse. All we have to do is feed it the right food. 

Sunday, 28 June 2020

Medication

If you have major depressive disorder - then sooner or later you'll be recommended medication. Medication is not a panacea and doesn't work for all people. It is reckoned that only 50% of people respond to antidepressants. Medication can also be accompanied by a myriad of side-effects. Furthermore, critics argue that medication does nothing to address the underlying causes of depression.



However, medication can open a window for you. It can buy you time. When your brain is on fire - it can be impossible to concentrate on any other therapies or strategies. All you are doing is trying to get through the next minute.

I went through a lot of medication. I was on antidepressants, anti-psychotics, anti-anxieties and anti-inflammatories. Nothing seemed to work for me. I went through endless dosage increases and seemingly endless switches from one type of medication to another. Then after about five years and on the third time of trying I found that Aripiprazole was actually starting to work for me. Without it my days were a blood-bath of negative thoughts. (Ever tried living inside a  hurricane?) With it there was a chance to breathe - a chance to grab a modicum of mindfulness. I'm not saying it was Nirvana, because it wasn't. But it bought me time. It allowed my head to clear somewhat. It enabled me to concentrate more on what I was supposed to be doing - like work or being with my family. I could remember what day of the week it was. It also rekindled the vestiges of my sense of humour.

If, like Matt Haig, you can get by without medication - then great. But if you can't - don't be ashamed to use it. If you were diabetic you would take insulin.

Furthermore, depression doesn't like medication - so that may be another good reason to take it.

Saturday, 27 June 2020

Brain Training

One of the other classic ways that depression has of wrong-footing you is through brain-fog.

Use it or lose it!

When I was ill, I found that the fog of depression quite literally entered my brain. What had previously been a perfectly adequate (and in some ways high-functioning) organ suddenly became indistinct, muddled and befuddled. I suddenly became confused by the simplest thing - like how to open a car door with an electronic key or how to tie my shoe laces. I also became chronically indecisive. If somebody in a shop asked me if I wanted a receipt - I would be glued to the spot in an agony of choice.  Furthermore, I didn't always know what day of the week it was and I couldn't remember the birthdays of my nearest and dearest. As for the geography of Norfolk - that had all become a blur.

Many people simply don't understand how much impact clinical depression can have on cognitive ability. At one stage I was so worried I went to my GP who peformed an Alzheimer's test on me. I managed to pass but struggled. I only knew the date because it was on my appoitment card. I was OK on the current Prime Minister and telling the time on a clock face but I couldn't remember the three names that were given to me at the start of the test. I passed but I was far from being an A grade student. 

But brain-fog is another of depression's little tricks - so don't panic. The brain fog just makes you feel even more desperate and plunges you further into the depression.

So, what I tried to do in the early days was to try and use the brain for brain-type things. I couldn't solve my depression but I could try to recite the alphabet backwards. I learnt our car registration numbers (and still know them); I tried to remember Led Zeppelin albums; I tried to remember churches I had visited in Norfolk. At work I tried to remember plant names. Gradually the fog began to clear. I was still struggling with depression but the purely admin function of the brain started to come back.

Friday, 26 June 2020

Acceptance

One of  depression's biggest fears is that you will learn to accept it. By accepting it you intrinsically weaken it. Acceptance is a way of embracing and transforming depression. It is not easy to do and in many ways it feels counter-intuitive. Why would you want to accept this malevolent intruder? Well the truth is that by accepting it you stop fighting with it. And by stopping fighting with it you diminish its power to hurt you. 

I should point out that acceptance is not the same thing as giving up or surrendering. It is not about capitulating to depression but about actively coming to terms with the enemy within. It is about learning to live with the malevolent intruder - about seeing through all of its tricks. In some cases it is even about being grateful for it. I know this might sound bizarre when you are engaged in a life and death struggle - but try it.



Some people believe that depression happens for a reason and that it comes to us in order to teach us a lesson about ourselves and life. It is true that depression can bring about change. However, as an agent for change it is certainly a peculiar one - as it simultaneously strips us of the normal tools that we need to bring about change  - such as energy and perseverance and resilience.

But depression does change people's lives. It certainly changed mine. It got me out of a job that I should have left years earlier. It didn't do it in a congenial or professional way; in fact, it very nearly killed me. But it did it. It made it literally impossible for me to continue. As a result I now have a new job that I enjoy. I have no more stressful meetings, virtually no staff development, no formal sit-down appraisals and no corporate bull-shit. Instead I have plants to move and water, deliveries to take in and palettes to forklift. I get up in the morning and go in and I work and I come home feeling tired - but tired in a good way. I listen to the birds singing in the trees while I'm there and I talk to customers about bamboo and hydrangeas and runner beans.

Many people ultimately find that depression brings something new into their lives (assuming they can get through the horrors.). Depression is a brutal teacher and forces us to re-evaluate our lives. In some cases this re-evaluation is literally a matter of life and death. If you don't change then you get sucked down into the black hole.  But after the darkness subsides - and it does subside - there can be new adaptations. Many people say that after depression they talk to everyone they meet - whereas before they kept themselves to themselves. For others it might mean more exercise or more time spent in nature or more connection with family and friends. Or more love.

For some the acceptance is that depression will always be there - but maybe in a quieter less adversarial kind of way. For others, acceptance can be the final stage before complete recovery.

Thursday, 25 June 2020

Exercise and Nature

Exercise is one of the best ways to beat depression. The poet Alfred Tennyson used to take daily walks on the Downs near his home at Freshwater on the Isle of Wight. Alastair Campbell and Matt Haig are runners and Winston Churchill used to lay bricks. Exercise makes you feel fitter and more alive and also releases feel-good endorphins into your system. 

Depression Hates Exercise

Predictably depression doesn't like exercise. In fact, depression will do whatever it can to prevent you from exercising. To start with depression makes you feel tired and weary - so that you will feel less inclined to want to exercise. Doing anything when you have depression can feel like hard work - very hard work. If you have leaden paralysis (which is the feeling that your arms and legs are very heavy) then even going up the stairs in your home can feel like Mount Everest.

To start with you may need to re-calibrate your perception of exercise. You may have to start very modestly. However, it is very important that you congratulate yourself for whatever you manage to do - no matter how small. Remember that the negative voice of depression will try to undermine anything that you do. After you've finished your exercise is often the time when the voice kicks in. If you've been for a short run, for instance, it might say:

'How far did you run? A mile? Is that all?'

'You used to be able to run that route so much faster before.'

'Why do you feel so tired when you're only managed a mile?'

 Remember that to exercise with depression is doubly difficult. It's like carrying another person round with you.

But you need to be aware that depression can also play other tricks on you. It can make you agoraphobic or, in my case, dizzy. It can also make you feel anxious about joining a gym or self conscious about wearing Lycra, or make you worry unnecessarily that your bike will break down.

One of the other benefits of exercise is that it can get you out into nature. Research has shown that being in the countryside can create serotonin and dopamine in our brains and/or reduce cortisol. Hence nature is very good for mental health. All natural places can boost our sense of well-being: woods, hills, moors, marshes, beaches, fields and lakes. In particular, it has been shown that being near water is good for mental health. It slows our heart beat and calms us down. In his book Bird Therapy Joe Harkness details how a love of bird watching and nature helped him recover after a nervous breakdown. He started a blog about his bird watching experiences and then secured crowd funding to publish his book in 2019. it has since gone on to become a bestseller - thanks to endorsements from the likes of Chris Packham.

I have to admit that since becoming ill five years ago I have failed to establish a regular exercise regime. I used to be a keen walker/hill-walker and a proficient mountain bike. However, clinical depression clobbered me with both dizziness and leaden paralysis. Since then I have managed to climb a few mountains: Great Gable, Blencathra and Haystacks in the Lake District and Cadair Idris in Wales - but on every occasion my body felt like concrete. It was as though gravity had increased ten fold or that I was hauling a rucksack full of bricks. The dizziness also made every step disorientating - as though all the horizons were out of sync.



Wednesday, 24 June 2020

It's Good to Talk

Depression doesn't like being talked about. It doesn't like it because it dispels some of the secrecy and mystery surrounding it. Every time someone talks about depression then depression can become a little less powerful. 

As I've said before depression thrives on secrecy and invisibility. If you suddenly develop depression and have no knowledge of the illness - then it is likely to hit you harder than necessary. Men are particularly prone to suicide - more than three times more likely than women and so it is particularly important for men to talk about depression.

If you have no knowledge of depression then you are more likely to blame yourself for it. You are more likely to internalise it and, as a result, more likely to kill yourself. I always think of the football manager Gary Speed - who after appearing on the BBC's Football Focus and after watching a Newcastle V Manchester united game with his friend Alan Shearer in 2011 - apparently in good spirits - came home and killed himself.

What needs to happen is that the world needs to start having more conversations about depression. But how do we talk about depression? There is still a large stigma surrounding the illness. Many people are ashamed of having it and even more ashamed of talking about it.

Imagine that workplace water-cooler moment where somebody asks: 'How are you?' Even if you are depressed you're very unlikely to say 'You know what, I'm depressed.' Why doesn't that conversation normally happen? Well, owning up to depression is difficult. People feel ashamed that they feel depressed - even to somebody they know quite well. We are conditioned to think that depression is somehow unacceptable - somehow a weakness - even though it is a real illness. For some reason, mental health is seen as problematic - wheres physical health is OK.

We may have concerns for the other person. What if they are not OK with people talking about depression. Maybe it will find it uncomfortable? Maybe it will make them depressed? But in an ideal world we should be able to say we are depressed and in an ideal world we should get the response: 'Sorry to hear that. Anything I can do? Do you want to talk about it?' Just that acknowledgement lets in some oxygen. It breaks the seal on the bell jar; it lets in some light. 

But we need to build the confidence for people world-wide to have these conversations. We need to live in a world where it is OK to be open about depression - where it is OK to be not OK. Not talking about depression simply plays straight into its hand. Ultimately it only increases the death toll and the suffering.  If you had heart disease or diabetes or cancer there wouldn't be any stigma about talking about it. People would (normally) be sympathetic and that's where we need there to be with depression. Mental and physical health should be treated similarly; there should be no divide. It should be just health. Full stop.

So we all need to encourage dialogue about this illness - whether it is spoken or in books, or on blogs or on social media or on TV - it doesn't matter. So when that average guy - like Gary Speed maybe - who is suddenly beset by those terrible dark thoughts - doesn't think: 'Shit what's wrong with me; I feel like ending it all'  but instead: 'Hold on, isn't this depression?' I heard about it the other day and I know that it can make you think bad things.' We need to dispel the mystery and the invisibility surrounding depression.

Some of us are lucky and can open up to friends. But for others this isn't possible. If you can't talk to friends or family then try your GP or the HR where you work, or local clergy, or community workers. If necessary, pay money to have counseling. These days many many people have counseling for a whole range of issues. CBT can be a real game-changer.

But remember that you can also read about depression too. For me - reading depression memoirs was an important way of finding out about the illness. It gave me a reference point in the darkness. When I was having a particularly bad day - I knew that I wasn't alone. I knew that William Styron, and Matt Haig and Mark Rice -Oxley had been there before. That is ultimately why I wanted to write this book - to share some information - in the hope that it might help others. When you're down in the depths, it's vital to know that other people have been there too and come out the other side. That knowledge can be life saving.

Tuesday, 23 June 2020

Know Your Enemy

 'If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.'

Sun Tzu


Depression has been around for a long time - possibly since the first cave man became disenchanted with the hunt and retired to the back of his cave. Yet, despite all the advances of modern medicine it is still with us today. Not only is it still with us today but it is on the increase. The World Health Organisation estimate that there are now a staggering 364 million sufferers world wide.



Its success as an illness (and it has been hugely succesful) is partly down to the fact that it is both mysterious and often invisible. These qualities have helped it to spread with impunity. Depression is a stealthy opponent. It has the ability to single out those who are susceptible to its propaganda. It has many tricks up its sleeve. It is malign and artful. In it's extreme form - it is also a killer. (More deadly than both cancer and heart disease to men under 50.) If we take the personification further - we could even say that it has a malevolent intelligence. Not only does it know how to survive - but it knows how to thrive. 

But whatever shape it adopts - and that can be anything from a mild inconvenience to catatonia - it has always benefited from silence and isolation. The less we know about it - the better it likes it. It doesn't like being talked about and it certainly doesn't like having books written about it.

That is essentially why I decided to write this book. I wanted to expose depression for the trickster that I think it is. Don't get me wrong - I'm not saying that depression isn't real - far from it. When you are in its grip it seems the most hideously real thing imaginable. But - depression does play tricks on the mind and on the body and it makes us believe things which are patently untrue. It is also susceptible to treatment and can be beaten. It has both weaknesses and flaws.

Ever since I was a child, I have suffered from mild-moderate depression - but in 2015 major depressive disorder caught up with me and I experienced a nervous breakdown followed by clinical depression. Since then I have literally been fighting for my life. But ever since that day in 2015 - I have also been trying to identify my enemy. I've tried to understand it and to get inside it - to work out what makes it tick. In fact, I started the first draft of this book when I was in hospital. At the time, I could barely hold a pen and my head was exploding with the perfect storm. I've been trying to write it ever since but with limited success. But then it dawned on me that the best way to undermine a stealthy opponent like depression would be to divulge its secrets. So that, then, is what this book is about. The information in it has been hard-won; I hope that it will be helpful to others.

Monday, 22 June 2020

Come and tell me some lies

Depression is a liar - a very good liar - but a liar nonetheless. It tries to convince you that certain terrible things are true (or will happen).

Liar, liar

When I was first ill, I was overwhelmed by catastrophic thoughts. Depression bombarded me with terrifying visions about my future. I was quite literally going to end up homeless, penniless, friendless and insane. These thoughts were the most real I have ever experienced - almost as though they were projected onto a huge screen inside my head - with HD and surround sound. Here is a full list of the things that depression said would happen to me:

  • I would become homeless and end up sleeping rough
  • I would never be able to work again
  • I would not have enough money to feed myself
  • I would not be able to live with my partner 
  • My children would disown me
  • I would have to kill myself to end the pain

The images were so convincing that I used to check out shop doorways in Norwich where I could sleep rough. I also researched soups kitchens in the City and considered buying myself a trolley to transport my sleeping bag and gear around on. Despite owning my own home, I was convinced that homelessness was my destiny. At the time, no one could reason with me.

Five years on and none of these things have come true. I'm not saying that life has been easy for me in the last five years because it hasn't - but I wanted to write this post to highlight just how convincing the agitprop of depression can be.  But depression isn't incontrovertible truth. The truth lies elsewhere - quieter and less dramatic.

Friday, 19 June 2020

Had we but world enough and time

One of the very worst things about clinical depression is the fact that, when it strikes, you literally have no idea how long it will last.


It might stick around for a few days or a few weeks or a few months. However, major depressive disorder can last for years. 

This is what makes the pain of depression so hard to bear and explains why depression is such a killer. If you knew that you just had to endure a few weeks or a few months then the whole thing might be doable - but you don't. As you struggle to get through the next ten minutes - with your head literally on fire - you are continually faced with the prospect that this torment could be unending. In fact, the ultimate nightmare of clinical depression is that it could last until you die.

However, in most cases depression does run its course and I think that is a message that needs to be trumpeted. But when you are in the middle of it, you have no way of knowing this - especially if you have no knowledge of the illness. All you can see is what lies directly in front of you: the ultimate death sentence or, rather, life sentence.

Obviously depression is not a competitive sport - so I try not to compare myself to others or indeed minimise the suffering that they have been through. However, in most depression memoirs that I read - the illness only lasts for a year or so; two years max. Mine has now been running since 2015. In fact I spent my 53rd birthday on the ward at Hellesdon Hospital. Next month I will be 58. However, in the last week or so I have been seeing some signs that there could, after five years of intense suffering, be a change happening. 

Thursday, 18 June 2020

Laughing at Depression

Our sense of humour (assuming we had one in the first place) is one of  the first things to go when depression strikes. If you have depression then it can seem like one of the most unfunny things ever. It is remorseless, hideous and painful. It doesn't do one liners, double entendres or puns. But in reality humour can be found literally anywhere - even in depression.


I know for a fact that depression doesn't like you laughing at it. Laughter sends a shudder through its dark heart. Why is that? Well, humour can relieve us - it can liberate us - it can allow us to see things that are ludicrous. It can satirise and make fun of things and it can give us some relief from monsters. And God knows depression is a monster.

Try giving your depression a silly voice: Donald Duck, Homer Simpson, or Boris Johnson on helium. Let it speak in an outrageous French accent; let it do silly walks like John Cleese or wear a funny hat; let it slip on banana skins. 

PS I also collect good jokes about depression. Some of these may be in bad taste but what the hell?

Q: How many depressives does it take to change a lighbulb?

A: (In monotone) It doesn't really matter because the darkness will always win.

If you know of any good ones, please send them to me.

Letting Yourself Go

by Matthew Johnstone
When you're in the grip of the horrors of depression it can be very hard to concentrate on mundane things like personal hygiene. Family and friends may start to notice that your appearance may be deteriorating or that flies are starting to follow you around.

I remember that when I was under the cosh I often forgot to use antiperspirant. I also stopped buying clothes. This was partly due to the thought I wouldn't be around for much longer. What use are underpants to a dead man? In three years, I think, I only bought a pair of trainers, a shirt and a fleece.

I also stopped shaving and grew a beard. This wasn't because I was going all hispster but merely because I didn't have the energy to shave anymore. I did manage to buy a beard trimmer however which, with the guard removed, I would use to hack off as much as possible every month or so. I also struggled (for various reasons) to make it to the hairdresser and the dentist.

In fact, everything becomes a struggle with depression. Even getting into the shower - a normally pleasureable activity - becomes a chore. Fortunately I had a partner and two daughters who tactfully reminded me when I needed to reacquaint myself with some soap.

But depression extends its malaise to all things that need sorting: lawns that need mowing, cars that need MOTing, hedges that need cutting and bins that need putting out. Everything weighs you down.

One of the best ways to deal with this never ending list of requirements is to try and break things down into manageable chunks. Just do one thing a day if you can. (And if you can, congratulate yourself.) Pesonal hygiene is particularly important though and should be a way to boost your self-esteem. It's good to be a sharp dressed man from time to time. While you're at it -  smile at yourself in the mirror too.

CBT

Cognitive Behavioral Therapy or CBT is one of the most popular talking therapies for anxiety and depression. It is predicated on the assumption that our thoughts affect our feelings and our actions and that, in turn, our feelings and actions affect our thoughts.


CBT seeks to challenge, change or modify our thought processes in order to change our feelings and our behaviour. It is often about creating virtuous circles and breaking vicious ones.

This can be a particularly effective treatment for depression because, as we know, depression can lead us into false patterns of negative thinking and trap us in viscious circles.

To give you an example - a person with depression may have lots of negative thoughts about their workplace and, in particular, about times when they think they have failed to perform. These bad thoughts may be impacting on their self-esteem which, in turn, may be making them feel more negative about work and leading to them to become even more ineffective. A CBT therapist might help the person to focus on times when they have been effective at work e.g. times when they have succeeded or where they have received positive feedback from clients or managers. This might then boost the person's self-esteem - so that the next time the person is in the workplace they feel more positive about their work and can be more effective. This in turn promotes more feelings of well being which boosts their self-esteem. In this way the viscious circle is transformed into a virtuous circle.

This is just a simple example - but hopefully demonstrates how CBT can change thoughts, feelings and behaviour. CBT can, sometimes, be available on the NHS.

Things Not to Say to a Depressed Person!

If you're caring for a depressed person, or have a friend who is depressed, it can sometimes be hard to know what to say. Even if you're well-intentioned, it can be easy to say the wrong thing. People with depression often have low self-esteem and profound feelings of guilt and hopelessness and can take, what you consider to be well meaning advice, the wrong way. But obviously, for them it is the wrong way.

Don't Say It!

Sometimes it's easier to list things that you should try to avoid saying - so here goes:

Pull Yourself Together - this is the old classic 'man-up', 'get a grip', 'snap out of it' sort of comment. However, depression is a real illness and has seldom, if ever, been resolved by 'pulling yourself together'. Often, depression is the result of a chemical inbalance in the brain - not of someone who is malingering. You wouldn't say to a diabetic 'man-up' because their body can't produce enough insulin.
It's all in the mind - this is another common thing that people say when they are trying to help. In many ways, depression is 'all in the mind' but that doesn't mean that it isn't a serious and difficult illness to overcome. When a depressed person hears this comment it can come acrosss as very patronising. It can also prompt feelings of guilt because it suggests that it's all their own fault. Or worse that it's purely an imaginary condition in the first place.
Worse things happen at sea - when you feel depressed it can feel truly awful - so to be told that there are many people who are worse off than you is not helpful. Obviously there are many people in the world who endure terrible illness and suffering - but it doesn't lessen someone's depression to hear that. In fact, it is likely to increase someone's depression to realise that the world is full of suffering. There is also an implied suggestion here that the depressed person may be over-acting or milking the situation
Count your blessings - as I have mentioned before depression can affect anyone. It can affect those who, on the surface, are very lucky. It can affect the rich, the happily married, the successful. But that doesn't mean that their suffering is any the less because of these things. As Matthew Johnstone says depression is an 'equal opportunity mutt'.

Other unhelpful comments include:
  • Look on the bright side
    • Just get off the sofa and go and do some exercise
    • You don't look depressed
    • It's a lovely day outside
    • Cheer up
      • You're just looking for attention
      • Have you taken your tablets today?

      Instead, try being thoughtful and empathetic. Sometimes just being there is probably the most important thing that you can do - because having depression can feel very lonely. You may have heard it all before - but listening is very important too. Try to be encouraging if the depressed person is thinking of seeking support via their GP or is about to try counselling or medication etc. Helping them to do practical things for them like cooking a meal can be good - but try not to do too much for them as this can take away their sense of self reliance. Asking if they would like to go for a walk or a coffee can be good. Bringing them useful books can be thoughtful - but try not to force them to read them. (Just leave them in the bag for later.) Talking about people who have been through the same thing they are going through can be good. Unconditional love goes a long way too.

      Psychomotor Retardation or Agitation

      This is another symptom of depression as identified in The Diagnostic and Statistical Manual of Mental Disorders - first published in the 1860s.

      Psychomotor retardation is a condition where both thinking and physical responses slow down. It is a symptom of major depression and can manifest itself in both movements and speech patterns. Many symptoms of depression are invisible but psychomotor retardation can actually be observed. Those affected can start to move, speak and react slowly. The amount of speech that sufferers engage in can also diminsh. PR can affect coordination too.

      However, as we know by now, depression is always contrary so in some sufferers - instead of a slowing down there is a speeding up and this is known as psychomotor agitation. This is characterised by unecessary, fast movements such as pacing or toe-tapping. In these sufferers, talking can also be accelerated. I suffered from agitated depression and I used to pace the house - completely unable to settle in a chair; I wasn't a great talker though.

      Wednesday, 17 June 2020

      Appointing a Mentor

      There are many famous, high-functioning people out there who are suffering from (or have suffered from) major depressive disorder.

      Walt Whitman
      It's a good exercise to appoint yourself some mentors. Remember that having depression doesn't necessarily prevent you from doing great things. Some of the world's greatest writers, artists, poets, songwriters and politicians have been depressed. Here is my list of top depressives (mainly selected from Wikipedia's list):

      • Caroline Ahern
      • Woody Allen
      • Richard Ashcroft
      • Charles Baudelaire
      • Samuel Beckett
      • Marlon Brando
      • Charles Bukowski
      • Robert Burton
      • Kate Bush
      • Geezer Butler
      • Alastair Campbell
      • Jim Carrey
      • Johnny Cash
      • Winston Churchill
      • Eric Clapton
      • Kurt Kobabin
      • Leonard Cohen
      • Phil Collins
      • Joseph Conrad
      • Ian Curtis
      • Charles Darwin
      • John Denver
      • Charles Dickens
      • Emily Dickinson
      • Monty Don
      • Nick Drake
      • Bob Dylan 
      • Christopher Eccleston
      • Keith Emmerson
      • F. Scott Fitzgerald
      • Robert Frost
      • Stephen Fry
      • Tyson Fury
      • Peter Gabriel
      • Cary Grant
      • Graham Greene
      • Tony Hancock
      • Ernest Hemmingway
      • Anthony Hopkins
      • Janice Ian
      • Billy Joel
      • Samuel Johnson
      • Franz Kafka
      • John Keats
      • Jack Kerouac
      • Stanley Kubrick
      • Hugh Lawrie
      • John Lennon
      • Abraham Lincoln
      • Henri Matisse
      • Paul McCartney
      • Ewan McGregor
      • Paul Merton
      • Spike Milligan
      • Morissey
      • Edvard Munch
      • Les Murray
      • Isaac Newton
      • Bill Oddie
      • Al Pacino
      • Gwyneth Paltrow
      • Charlie Parker
      • Sylvia Plath
      • Edgar Allan Poe
      • Keanu Reeves
      • Mark Rothko
      • J.K. Rowling
      • Bertrand Russell
      • Siegfried Sassoon
      • Martin Scorsese 
      • Peter Sellers
      • Anne Sexton
      • Frank Sinatra
      • Elliott Smith
      • Robert Smith
      • Andrew Solomon
      • Bruce Springsteen
      • Michael Stipe
      • William Styron
      • Quentin Tarantino
      • Catherine Tate
      • James Taylor
      • Hunter S. Thompson
      • Greta Thunberg
      • Leo Tolstoy
      • Vincent Van Gogh
      • Kurt Vonnegut
      • Tom Waits
      • Roger Waters
      • Evelyn Waugh
      • Ruby Wax
      • Walt Whitman
      • Robbie Williams
      • William Carlos Williams
      • Brian Wilson
      • Virginia Woolf
      • Thom Yorke

      Tuesday, 16 June 2020

      Not waving but drowning

      If you're caring for (or know of) a suicidal person who suddenly cheers up - beware! This may be a sign that they have decided to kill themselves. 



      Sometimes when a suicidal person decides to end it all - they may experience a sudden wave of relief which may manifest itself as unexpected cheerfulness. You need to be particularly concerned if this new-found cheerfulness is accompanied by any of the following activities:
      • giving away clothes or possessions
      • moving money or paying off debts
      • thanking people via letters or social media 
      • generally putting things in order
      • writing notes
      A list of helplines can be found here if required:

       https://www.nhs.uk/conditions/suicide/


      I don't remember, I can't recall.....

      One topic I haven't touched upon yet is memory. Probably because I've forgotten. (Ha, ha.) People with depression have notoriously poor memories.  Furthermore, it's not just a question of remembering silly things like where you've put the car keys but more serious issues like how we make and store long-term memories.

      Forgotten?


      Storing good memories is very imortant for our well-being. Memories are pictures of the world that we carry around with us in our heads. That holiday in Spain, that walk with the dog by the sea, that party with our friends. If we can store good memories like these then we have something to fall back upon during hard times. In fact, good memories are like a Harry Potter Patronus Charm; they protect is from encroaching darkness. However, if you're depressed and have been for a long time then you may have problems making and remembering good memories.

      Depression has a habit of changing our landscape. What may once have been a beautiful sunlit alpine valley can soon become a flat, featureless, field. If  your world is constantly like the Fens on a rainy afternoon in November - then you may be less likely to think of it as memorable. Black Dog days can become indistinguisable from each other. The eskimos may have had 50 words for snow but how many people have 50 words for fog? As a result you tend to remember less. The less positive things you can remember then more likely you are to become depressed and then the more depressed you become the less you can remember. This then becomes a vicious circle. Depressed people can also suffer from brain fog and/or cognitive impairment - which also negatively impacts upon the creation of memories.

      I've always been mildly depressed so my past is a bit of a blur - but when I became seriously ill I lost track of  days, weeks and even months. Over the last 5 years I struggle to remember where I've been and what I've done. This is not age-related forgetfulness; this is the black dog screwing with my memory.

      We also know that anxiety and depression can reduce our sense of being in the present. Anxiety often make us worry about the future and depression makes us ruminate about the past. As such, less of our brain is actually available for being in the present - of engaging with the world around us. This lack of grounding in the here and now also prevents us from making and storing memories. It's like we're a computer but the RAM is already taken up running other programmes.

      But depression also affects short term memory. I am constantly forgetting where my glasses are or where my cup of tea is or where my wallet is. I know that I am 57 - but my forgetfulness is more than just getting old. In her book Out of the Blue Jan Wong describes how she kept forgetting to attend meetings that were booked. She also kept mislaying her purse. I've never missed an appointment in my life but when I was ill I missed dental appointments. Even now I sometimes can't remember the day of the week, the date or even the month. As for the year, well.......

      PS Happy Birthday Beth and Jo.


      Sunday, 14 June 2020

      Side Effects of Antidepressants

      It can be quite hard to disentangle the side effects of antidepressants from the symptoms of anxiety/depression.



      Here are some of the common side effects of antidepressants:
      • nausea
      • increased appetite
      • decreased appetite
      • fatigue or drowsiness
      • insomnia
      • oversleeping
      • dry mouth
      • constipation
      • blurred vision
      • agitation
      • anxiety
      • suicidal thoughts
      • irritability
      • erectile dysfunction
      • amnesia
      • cognitive impairment
      • indecision
      • dizziness 
      • shaking
      • tingling
      • numbness
      • ringing in ears
      • stomach pain
      • muscle pain
      • weight gain
      • weight loss
      • sweating
      • wind
      • rash
      • seizures
      • diarrhoea 
      • edema
      • headaches
      • vomiting
      • altered heart beat
      • depression

      As you can see several of these: insomnia, decreased appetite, increased appetite, indecision, fatigue, cognitive impairment and suicidal thoughts are all classic symptoms of depression. I remember when I was on antidepressants that I had trouble knowing whether I was coming or going. Part of me wanted to come off them again in order to work out which of my symptoms were really depression related and which were antidepressant related.

      Depression and Fatigue (Vicious Circles Abound)

      Fatigue is another classic symptom of depression. However the relationship between depression and fatigue is complicated. In fact, it is another vicious circle. People with fatigue are more likely to become depressed and people with depression are more likely to experience feelings of fatigue. For example, people with chronic fatigue syndrome (or ME) often develop depression.



      As I mentioned in a previous post, depression can also cause the inability to sleep. Loss of sleep can then lead to increased fatigue.

      Exercise is good for depression - but if you feel fatigued then you are less likely to exercise. This is another vicious circle - as lack of exercise will also make you feel more depressed. Lack of exercise may also negatively impact upon your sleep.

      Lack of motivation, another symptom of depression, can also exacerbate feelings of fatigue.

      The solution here is to break the circle wherever you can. This may be easier said than done. Try walking: it's low impact - not too strenous and gets you out in the fresh air. See if you can build up your distance. One of them new fangled step counters might be good. See my earlier post A journey of a thousand miles begins with a single step.

      I feel sullied and unusual....

      Just wanted to break off from the more didactic side of the blog for a moment to do another personal post.  As I've mentioned a few times already anxiety/and depression caused me to become chronically dizzy. Today is Sunday and I'm sitting at home in the back room with the lap-top typing this blog and I'm acutely aware of feeling not OK spatially. While I'm on the sofa and my head is relatively still things are reasonably OK - but as soon I get up or even do anything from a sitting position - then I experience strange sensations. For example, I have a cup of coffee and a Twiz on the table in front of me. Reaching for it immediately sends my faulty gyroscope into a spin. The cup is not quite where I think it should be. It's weight is also unexpected. Similarly when I pick up the Twiz; the packet is sealed and therefore needs opening. Opening a Twiz wrapper shouldn't be rocket science but somehow it is. I can't quite co-ordinate the required hand movements necessary to open it smoothly. I can do it - but the whole exercise feels unnatural and out of kilter - like I'm on a sloping roof or a child's merry-go-round or in a high wind.




      OK, I have now drunk the coffee and eaten the Twiz. I stand up - which always unsettles me. I have two mugs on the table and can't quite pick up both of them with one hand. They slip as I am holding them and I have to re-grasp them. Then there is a side plate with the Twiz wrapper on it. As I stand up it blows off the plate onto the floor. I bend and pick it up - feeling a bit wooshy - and put it back on the plate. I step forward again and it blows off again so I repeat the exercise. These little things craze me. I know this could be normal stuff in action - but my impaired balance/co-ordination just seems to reinforce feelings of hoplessnenes which then kick starts my depression. The problem is that I can't get away from these physical snaffus these days. In fact, I am just like one of those old silent comedians who perpetually have problems with objects. Everything for me is now a bar of soap, a banana skin or a pot of glue. Everything seems to have a mind of its own.

      These days - I'm also acutely aware of the transition from sitting still to moving. It's something that previously I would have taken for granted. I appreciate that age may have a part to play in this as getting up is now accompanied by an habitual groan. However, moving or being still was just a natural thing and the alternation between the two was also natural. But not any more. Hey ho.

      The picture above was taken at Bacton a couple of years before I became ill. I would have extreme problems doing this now :-).


      The Black Dog

      One of the best ways to combat the Black Dog is to actually get yourself a black dog (or, in fact, a dog of any colour). Having an actual dog around can be extremely good for your well-being - whether you are depressed or not.

      Photo by Beth Self

      Here is a list of the advantages of having a  dog if you're depressed:
      • stroking dogs can lower your blood pressure and heart rate
      • being around dogs can release dopamine and serotonin in your brain
      • they provide company when you're alone
      • they give you a reason to go out and exercise 
      • they allow you to interact with other dog owners who are always keen to talk
      • if you're agoraphobic - they can help to get you out of the house
      • feeding them is a good feel-good/caring activity
      • having them in the bedroom or on the bed at night may help you to sleep
      • they do funny things which can make you laugh
      • they are non-judgemental
      • they can boost your low self-esteem
      Here is another picture of our dog - this time at the beach at Happisburgh:



      While I'm on the subject of black dogs - there is a fabulous illustrated book by Matthew Johnstone called I Had a Black Dog - His Name was Depression.

      If I had to recommend one book about depression above all others then this would be the one. Pictures can be so much more effective than words in capturing the essence of depression - and they even inject some much-needed humour into proceedings. This book helps to explain with words and pictures what depression feels like. It's also a great book to give to friends and relatives to help them to understand what you're going through. You may have noticed that I have used some of Matthew's illustrtaions on this blog. That is because I think they are magnificent. Of the book, Stephen Fry said: 'I Had a Black Dog says with wit, insight, economy and complete understanding what other books take 300 pages to say. Brilliant and indispensable.'

      Saturday, 13 June 2020

      To sleep, perchance to dream....

      Just as over-eating and under-eating can be symptoms of depression - then so too can over sleeping and under sleeping.



      In his book Underneath the Lemon Tree, Mark Rice-Oxley describes vividly how his clinical depression robbed him of the ability to sleep. He would spend the night pacing the room downstairs while simultaneously locked into a cycle of terrible rumination. Many depression sufferers resort to sleeping tablets and MRO was on the wonderfully named Zopiclone. I, too, took Zopliclone to help me sleep in the early days of my illness. I, too, had to sleep in another room to prevent disturbing my partner.

      However, depression can also have the opposite effect on your sleep pattern - i.e. making you sleep for much longer than normal. It can also make it dreadfully hard for you to get up in the morning. In some ways, this seems to be a more understandable feature of depression as many of us associate the illness with lethargy and demotivation. After my initial problems with sleep, I flipped over into 'sleeping for England' mode. I could (still can) sleep solidly for 10 hours at a stretch. Sleep also has the added advantage of providing an escape from negative thoughts and can be a welcome refuge. Even today I look forward to bedtime and the oblivion it provides. Waking up on the other hand can be a distressing experience - once you slowly regain consciousness and realise that you are still the same person stuck in the same world.

      As I also suffer from chronic dizzinesss - sleep provides a double relief and I do find that after a good night's sleep I do feel slightly better the next morning.

      'Sleep that puts each day to rest. Sleep that relieves the weary laborer and heals hurt minds. Sleep, the main course in life's feast, and the most nourishing.'

      Macbeth -William Shakespeare

      Friday, 12 June 2020

      Food, glorious food

      Over-eating or under-eating is another classic symptom of depression. I know this sounds a bit contradictory - but depression can tip you in either direction - or indeed in both.




      Just as people with depression lose their appetite for life - they can also lose their appetite for food. This may be due to fatigue or lack of motivation or, in some cases, an unconscious attempt to starve themselves to death. This can result in rapid weight loss. I know that when I was first ill, I lost over two stones in about a month . My face became thin and my trousers became baggy. My situation was also complicated, however, by severe constipation and the fear that I wasn't  sure how food was going to pass through me anyway. I remember going to my local favourite curry restaurant one night and not being able to eat even half of my meal.

      On the other hand, when depression strikes it can also make us head directly to the kitchen. Food can provide comfort when we're feeling down. A depressed person sitting on the sofa eating ice cream is an actual thing! Clinical depression can leave you feeling flat and demotivated and food may be the only thing that gives you a boost - albeit for a short period of time. After my initial weight loss - I started to crave food to boost my feelings of well-being. I used to crave doughnuts, egg mayonnaise and french bread, ambrosia creamed rice and croissants. As a result my weight started to go back on. The only up-side of this craving was that it made me leave the house to go to Tesco's.

      Food may also have a role to play in combating depression. Certain diets are claimed to be effective in fighting the Black Dog. There is, for instance, some evidence that countries with high levels of fish oils (Omega 3) in their diet (like Norway and Sweden for example) may have lower incidences of depression. However, similar claims are made for foods containing antioxidants, or mushrooms, or dark chocolate, or walnuts, or turmeric, or blueberries, or rosemary or chillis. And then there are the herbal remedies/supplements which may (or may not) help depression - such as St John's Wort or Ginkgo Biloba. I would, however, urge you to approach these claims with caution. I have tried a variety of diets and supplements and none have made any difference. (But they may do for you.)

      Thursday, 11 June 2020

      Low Mood

      Low mood, that persists for over two weeks, is one of the classic symptoms of depression. However, low mood is very different from sadness. Sadness is a natural emotion which arises due to loss or rejection or disappointment. Sadness is often in perspective and is related to or reacting to an actual happening. Low mood, on the other hand, can arise unexpectedly and can be out of proportion to any events in your life.



      Obviously low mood can vary in intensity from a mild inconvenience to a major change in the weather. If you are suffering from a low mood it can be useful to keep a mood diary to monitor how it changes and why. In this way you may be able to identify potential causes and cures.

      Check my post of 13th May to see whether you have any of the other classic symptoms of depression.

      ECT

      Electroconvulsive Therapy (ECT) is a medical procedure - conducted under general anesthesia whereby a small electric current is passed through the brain. This causes a seizure which can potentially help alleviate symptoms of mental illness - especially severe depression. It all sounds very scary, I know, and when one thinks of ECT one tends to have visions of Jack Nicholson's character in One Flew Over The Cuckoo's Nest. However, ECT is much safer these days and more controlled and doesn't have as many side effects as previously.


      ECT

      ECT is normally only administered to patients who have treatment resistant depression. It is normally the last port of call after medication and other therapies have failed to work. If you have mild to moderate depression then ECT would not normally be an option.


      Severe depression can completely incapacitate some people. In some cases sufferers literally can't move, eat, talk or get out of bed because of it. ECT is normally administered for between 6-12 sessions - two or three times a week. It's also used for dementia sufferers - particularly those who become aggressive and also for treating mania in Bipolar sufferers.

      Success rates can be as high as 80%. It's benefits can be short lived though and therefore patients may have to have more than one set of treatments. One of the common side effects of ECT is memory loss.

      I have never experienced ECT so can't vouch for it's effectiveness. However, I was very worried that I might have to have it - especially when I was in hospital.  My mother had it and I think it's far to say that it didn't improve her depression. It seems like a pretty invasive procedure - but has a good track record for severe depression.

      Wednesday, 10 June 2020

      The Paradox of Work

      With regards to depression - work can be a paradox.  In some cases it can be the cause of the depression; in others the relief from it. In her 2012 book Out of the Blue, the journalist Jan Wong outlined how working as a journalist at The Globe and Mail in Toronto Canada caused her descent into clinical depression. For others like TV gardener Monty Don or the journalist/PR guru Alastair Campbell work is their life-line.



      For me, I was in the first category. Work literally killed me. Years of upheaval at the FE college where I worked led to ever increasing anxiety. New principals, ever-changing line managers, redundancy, reorganisations, appraisals and relentless staff development eventually tipped me over the edge. By the summer of 2015 my anxiety had flipped over into clinical depression.

      But, the weird thing was that as soon as I resigned in 2017 (after 25 years) I realised that without work I would spiral even quicker into total oblivion. Work  may seem like drudgery or stress but without it life can open up like a enormous void. Days can become extraordinarily long. And if you are already in the void that is depression - then the double void can literally be bottomless. Here is a list of the things that work provides:

      • money
      • social contact
      • distraction from negative thoughts 
      • learning new skills
      • makes you tired so you sleep at nigh
      • gives you something that you have to get up for in the morning
      • interaction with the public
      • boosts self-esteem 
      • fills time
      • gives you something to talk about (other than depression)
      In those early days after I resigned, I was in a terrible state. I was still suicidal;   I was horrendously dizzy, leaden and confused and demotivated. Every day was a life and death battle against the negative voices in my head. Sitting at home was exactly what I didn't need. But then going back to the college wasn't an option either; it was completely toxic to my mental health. But what was I to do? How could a person in my state hold down a job? Well, very kindly a friend of the family had offered me some gardening work at £10 per hour. I wasn't sure that I would be able to do it (physically or mentally) but I said yes anyway. The next week I drove out to their old rectory and started working in their wonderful rambling, unkempt garden. I kept going for several weeks - weeding and digging, grubbing out bamboo and ground elder or harvesting comfrey.

      Then one day, when I was off, I decided that I needed some bark for the front garden and I popped up to my local garden centre. How I got my head round something as practical as this at that time is an amazement. But I drove the mile up the road and while I was there a lady customer came up to me and asked if  I could put some compost into her car for her. I said that I didn't work there and she apologised. But, when I got home, the incident made me think. If a customer at the garden centre could mistake me for an employee maybe the manager might do the same. After all, by this time I was a time-served, jobbing gardener.

      So, a few days later I popped into the garden centre and had a chat with the owner - enquiring if he had any vacancies. I felt certain that I was wasting my time but then to my surprise he said yes and offered me a trial starting the next day. So there I was the next day - sequestered in this tiny oasis off the Norwich ring road - watering perennials at the end of a long yellow hose.

      Since then I have worked in two other garden centres and a tree nursery. Three years and I am a reasonably experienced plantsman, hold a forklift truck license and am one of the senior members of the horticultural team. I also scan in plant deliveries on the computer, print out and laminate posters, print out price labels and operate the till. Vestiges of my previous working life have meant that I always turn up on time, listen well and have good customer service skills. Not bad for a virtual zombie.

      For me - throwing myself into work has been the only way to go. It has filled my days, given me money and allowed me to meet lots of new people. It has allowed me to feel more normal and to make a contribution. It is also proof, once again, that depression lies. At the start of all this depression was shouting in my ear than I had no future - other than as some kind of nameless, moribund character out of a Samuel Beckett novel.

      .....you must go on, I can't go on, I'll go on.

      These are the final words of Samuel Beckett's 1953 novel The Unnamable. I first read it when I was in my 20s. It is part of a trilogy of novels: Malloy, Mallone and The Unnamable in which Beckett gradually takes the novel to places where it has never been before. With The Unnamable, which is the final book of the trilogy, we have a nameless character who goes nowhere, meets no-one and ruminates endlessly in his chair. (Sound familiar?) Thirty years on and I feel even more affinity with this strange, trapped individual who has nothing left but words.


      Samuel Beckett

      To me, Beckett's work reeks of depression. In fact, one could do a PhD on the link between clinical depression and Beckett's work. He was writing in the post war period - which was certainly an era characterised by economic depression - but the texts of his novels and plays are rife with actual depression: anhedonia, low mood, forgetfulness, brain-fog, hopelessness, thoughts of death, suicidal ideation etal. His characters personify what it is like to be depressed - to be living in an absurdly bleak world - with no hope of redemption. In fact, to me his works are depression - albeit relived by a wicked black humour. Strangely, the bleakest of them is probably Endgame - which IMHO is one of his less successful pieces. In the 1980s, I went to London to watch Max Wall play Krapp's Last Tape and it was hilarious.

      We know that Beckett suffered from depression  - even as a child - despite having a reasonably happy, affluent childhood in Foxrock Dublin. And it continued to trouble him throughout his life - leading to a lot of psychosomatic illnesses. Having suffered from clinical depression, I can now appreciate Beckett's work in a new light. In fact, for me clinical depression is just like being stuck in Beckett's universe - except without the dark humour.Clinical depression turns you into The Unnamable.

      The other fascinating thing about Beckett is that, as an artist, it was his avowed intent to reach a point of complete silence. In his work he seems to be moving towards an acknowledgement of the futility of words and thoughts. Almost in a Buddhist kind of way - he seems to be struggling back towards his original mind which is free of thoughts. Ironically, freeing oneself of thoughts is one of the best ways to conquer depression.

      I will leave you with a few classic lines from Beckett:

      The sun shone, having no alternative, on the nothing new.

      Murphy


      ESTRAGON
      I can't go on like this.

      VLADIMIR
      That's what you think.

      Waiting for Godot

      Ever tried. Ever failed. No matter. Try again. Fail again. Fail better.

      Westward Ho


      ESTRAGON
      Let's go!

      VLADIMIR
      We can't.

      ESTRAGON
      Why not?

      VLADIMIR
      We're waiting for Godot.

      ESTRAGON
      (despairingly) Ah!

      Waiting For Godot

      Sunday, 7 June 2020

      Pitched past pitch of grief

      The poet Gerard Manley Hopkins (1844-89), who was a depression sufferer, famously wrote six sonnets about his struggles with the illness. 

      GMH

      These are known as the 'Sonnets of Desolation' or 'Terrible Sonnets'. They were probaby written between 1885-6  when he lived in Ireland. Surprisingly Hopkins didn't send them to his friend Robert Bridges; they were discovered after his death. I have included the two which I feel best capture the horrors of depression:

      I wake and feel the fell of dark, not day.
      What hours, O what black hours we have spent
      This night! what sights you, heart, saw; ways you went!
      And more must, in yet longer light's delay.
         With witness I speak this. But where I say
      Hours I mean years, mean life. And my lament
      Is cries countless, cries like dead letters sent
      To dearest him that lives alas! away.

         I am gall, I am heartburn. God's most deep decree
      Bitter would have me taste: my taste was me;
      Bones built in me, flesh filled, blood brimmed the curse.
         Selfyeast of spirit a dull dough sours. I see
      The lost are like this, and their scourge to be
      As I am mine, their sweating selves; but worse.


      No worst, there is none. Pitched past pitch of grief,
      More pangs will, schooled at forepangs, wilder wring.
      Comforter, where, where is your comforting?
      Mary, mother of us, where is your relief?
      My cries heave, herds-long; huddle in a main, a chief
      Woe, wórld-sorrow; on an áge-old anvil wince and sing —
      Then lull, then leave off. Fury had shrieked 'No ling-
      ering! Let me be fell: force I must be brief."'

          O the mind, mind has mountains; cliffs of fall
      Frightful, sheer, no-man-fathomed. Hold them cheap
      May who ne'er hung there. Nor does long our small
      Durance deal with that steep or deep. Here! creep,
      Wretch, under a comfort serves in a whirlwind: all
      Life death does end and each day dies with sleep.

      Considering that depression is almost an occupational hazard for poets - there have been surprisingly few good poems about the illness. Anyone know of any?

      Nature Cure

      Research has now shown that by being in nature our brains can create serotonin and dopamine and/or reduce cortisol. Hence nature is good for our mental health. There is a lady I follow on Twitter called Emma Mitchell - who is a fellow depressive - but who has done a lot of work on the efficacy of nature cures. She has written a bestselling book on the subject called The Wild Remedy.


      River Bure


      She also advocates being by water (rivers/sea etc) as another way of boosting our mental health. I've always been instinctively drawn towards rivers. This is a picture of the River Bure at Little Hautbois in Norfolk. I used to go canoeing here and its a place I regularly visit today.

      Here is a poem I wrote about another Norfolk river - the Tas - which hopefully shows how mindful moving water can be.

      River

      You flow endlessly.
      Over you your lights are beautiful—luminous and dark, moving and still, broken and whole.

      In summer, columns of light—mottled by leaves.

      In winter, the bleak light over farmland, the frosted-grey depth.
      Today, in spring, lights dancing in and out of shadow—concealing and revealing.

      In your course you are infinitely changing—neither crooked nor straight.
      You fit your banks.
      Running you are beautiful—slow in the deep pools—vociferous and fast in the shallows.

      In private land you are hidden.
      In public land you are open.
      Beneath bridges you reflect back the faces of watchers
      .
      In winter, you fill with water and become clouded.
      You race between alders, pound through sluices, tumble over fords.
      You wear a sullen expression.

      In summer, you slow up and become limpid.
      You display your weed in long floating trails.
      You glitter past grazing cattle.

      Then after long concealment your fish  appear—sparkling-sided, melting and merging, vanishing and visible.

      There have been many books advocating nature as a cure for mental health. One of the earliest was Nature Cure by Richard Mabey which, despite its title is not really about his cure for clinical depression but about his subsequent move to Norfolk from the Chilterns. Another one with a Norfolk connection is Bird Therapy by Joe Harkness about his use of ornithology to help after he experienced a nervous breakdown in 2013. The book was crowd funded and has since become a best seller. Joe used to be on Twitter too but closed his account after as he found it was not helping his mental health.

      I used to be indecisive but now I'm not so sure

      Indecisiveness is another sympton of anxiety and depression. In fact, deciding on the smallest of things can throw a depressed person into a complete meltdown.




      Every day we have to make many decisions. Most of then are small. Shall I have tea or coffee? Shall I wear blue socks or black socks? Shall I put the radio on now? Shall I have lunch now or later? Under normal circumstances these sort of decisions are made almost automatically - but if you are depressed they can literally be agony. Why is this? Well - it's not known exactly why depression/anxiety causes indecision but it could be due to the fact that:

      •  depression strips you of a sense of hopefulness so you fear that any decision you make will be wrong. Subsequently, part of you may be trying to put off all decision making.
      • a general lowering of cognitive function (or brain fog) caused by depression may also impact upon decision making.
      •  depression can often cause a general feeling of pointlessness. Hence the internal dialogue: 'What's the point of making any decisions if I'm doomed anyway?'
      •  people with depression often lack motivation and a sense of reward for their actions - which tends to nullify any decision making process.
      Curing  indecisiveness - like other depression-related symptoms is not esay. The hope is that if you can shift the depression then your decision making may return.


      Friday, 5 June 2020

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

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

      Alcohol is a depressant - so if you're already depressed then it's not a good idea 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.
      :-)