Were you always depressed/anxious?

I ask this question in this post’s title because I know for some people their illness struck at a relatively young age, or there were always hints of what was to come even if the full-blown illness didn’t hit until later.

It wasn’t like that for me. My first episode of depression didn’t start until I was almost 27. Before that, I was a happy, optimistic person who enjoyed life. I was an introvert, but I still really enjoyed socializing with my small circle of really close friends. I was passionate about travelling, and did a big international trip every year.

After my first depressive episode came to and after a long hospitalization and multiple suicide attempts, my illness went into full remission.  After I was depression-free for almost 4 years, although I tended to have small dips in mood and sleep each year in the late summer.  Otherwise, though, I was back to my happy, optimistic self, and able to handle some reasonably significant situational stressors without too much difficulty.

I got depressed again in 2011, seemingly out of the blue.  I was sick for over a year and hospitalized multiple times,  but in 2013 I got back into full remission.  Except my remission wasn’t as stable as before, and there were some bursts of depressive symptoms that medication increases would take care of.  I got really sick again in 2016, and now it’s looking like remission just isn’t going to be in the cards.

The point of this little ramble is that I wasn’t someone who was always a little bit depressed.  I was emotionally sensitive, but I was pretty happy much of the time.  I liked myself, and I liked my life.  When depression first made an appearance in my life, I conceptualized it as an illness that happened to me rather than something that was inherently part of me.  Part of that was a sense of “sick me” and “well me”, who were the same person deep down, but their thoughts, feelings, and ways of looking at the world were very different.

I know it’s not like that for a lot of people.  It seems like anxiety in particular tends to show up fairly young and persist throughout a person’s life.  I would imagine that when mental health problems, even if it’s not full-blown illness, start at a young age that becomes inextricably intertwined with identity.  It can’t be easy to have an identity separate from depression or anxiety if those things have always been present.

It’s now been almost 3 years since my illness was in remission, and the likelihood of achieving remission at this point is pretty slim unless some remarkable new treatment is developed.  It’s been a bit strange to wrap my head around identity-wise.  I still remember “well me”, although she feels further and further away.  The things that she used to think and feel have become increasingly foreign.  While I still think of my illness as a sort of outside entity that isn’t inherently me, I’ve had to shift my perspective from one of episodic illness to one of chronic illness.

There’s a sense of mourning almost that goes along with that.  Yes, I’m still the same person deep down, but the joy, optimism, and passion that were once so prominent in  my life are now gone.  I’m now indifferent to the things that used to interest me.  More and more, depression has become part of who I am, and it has influenced every area of my life.  Well me is not someone I have much access to anymore.

It makes me wonder what the identity journey is like for those people whose illness has been a part of them for much of their lives.  Does illness play a different role in establishing identity in that context?  Can identity ever be truly separated from illness?

What are your thoughts?

How do I compare thee…

“Don’t compare yourself to others. You have no idea what their journey is all about.” –  Regina Brett

The internet makes it very difficult to avoid comparing ourselves to other people.  There they are, in their Instagram-perfect photos and their seemingly amazing lives.  Perhaps the “nice” thing to do would be to feel good for them, and maybe the reasonable thing to do would be to recognize that things probably aren’t as perfect as they seem.  But how many of us in our worst moments are nice or reasonable?

In some ways I’m a bit of a dinosaur, cruising along on the tail end of generation X.  I didn’t grow up in an ultra-connected world.  I had a Facebook account at one point, but I ended up  deleting it, partly because I was playing way too much Farmville (does that even still exist?) but mostly because seeing other people’s supposedly happy lives was making me feel utterly alone and bitter in my depressed state.

Quitting Facebook wasn’t that hard, but what I continue to struggle with to this day is Google stalking.  Not of the hardcore creepy variety, but finding out what former classmates and colleagues were up to, and using that information to conclude that my life was even more pathetic than I thought it was.  A lot of it was career-oriented, and it was particularly bad in situations where I felt like I was at least as capable as the other person.  Jealousy is never particularly pretty.

It’s interesting, when I’m well I’m not prone to fall into that trap of comparing myself to others.  I always had pretty good self-esteem, and I was very independent, preferring to do my own thing than to follow the crowds.  I was pretty content with where I was in life.  I had goals and ambitions, but they were more focused on what I wanted rather than being relative to what other people were doing.

Depression totally changes things.  The biggest trap I fall into is comparing myself when ill to myself when well, because it’s been a big drop.  The friendships, close family ties, full-time work in a career I loved… that’s all gone.  Sometimes I will then turn to Google stalking to reinforce these views.  I’ll see how much career success a former classmate or coworker is having, and compare that to myself being hardly able to work.

Sometimes I’ll start should-ing on myself.  I should have done this, and then I’d have that.  If I hadn’t done this, I should have been able to have that.  There is a reasonable part of me that knows hindsight is 20/20.  That reasonable part, though, also recognizes that there is a germ of truth underlying all of this; I have had substantial losses.  I just need to re-orient where I’m focusing my comparisons.

I’ve tried really hard over the past year to stop with the Google stalking, and I’ve gotten a lot better with it.  It’s been a long time since I’ve logged into Linked In, and when I get an email with a Linked In connection request I just delete it.  My Twitter and Pinterest accounts are only for blogging-related things.

The online mental health community has been really helpful in shifting my focus to the reality that we’re all facing a lot of challenges and trying to fumble along as best we can.  The respect and admiration I feel for others in the community reminds me that I deserve to get those same things from myself.

It would be so easy to let myself get sucked up in the social media whirlwind and go back to my Google stalking habits.  It would be easy, but I choose not to go down that road; or, when I head in that direction, I will reorientate myself to where I need to be.

 

Is comparison something that you struggle with?

Book review: My Bipolar Mind

Book cover: My bipolar mind

My Bipolar Mind by Samantha Steiner is written as a series of blog posts that capture her recovery from addiction while living with the effects of bipolar disorder.  The story begins in April 2017 she hit her personal rock bottom, and from there began her slow journey towards recovery.  Of course, the full story began long before that.

Along the way, she describes her experience of rapid cycling mood episodes and multiple mixed mood episodes.  After she stopped drinking, she was also diagnosed with PTSD.  She explains that she began self-harming at age 12 to try to cope with the domestic violence that was going on at home.

Samantha openly shares the excuses she made for her drinking, and her thoughts that she could quit on her own without help, despite the fact that she’d experienced alcohol  poisoning multiple times and needed to be resuscitated after an opioid overdose.  She also shares her struggles against the desire to drink again, and the important role her partner’s limit-setting played.

She provides an excellent example of how the “good” parts of mania are actually not good at all.  She wrote regularly both on her blog and in her job as a writer for a website, but during manic episodes she would often become hyper-fixated on writing, to the point of neglecting her most basic needs.  She explains that there were times she decided not to reach out for help because she didn’t want to be hospitalized, something I can certainly relate to.

She described feeling emotionally overloaded: “I hate feeling like this; like I am drowning again, like I am getting pulled under the water and I can’t get out, and I can’t breathe. I feel like I can’t fight this or these feelings.”

Unsurprisingly, stigma makes an experience, as it so often does in stories of mental illness.  Someone she had known for years accused her of just making excuses, saying everyone is bipolar.  We all know that people say these kinds of things, but it still makes me heart hurt each time I hear about a specific instance.

Relationship challenges are hard to avoid with mental illness, and these make an appearance in Samantha’s story.  She shares her difficult breakup with her boyfriend and the subsequent reconciliation that prompted some of her family members to break off contact with her.

The book ends with two blog posts that convey a more hopeful tone.  In the final post, she observes “I really do feel like I am learning to love life for the first time.”  There’s no happy ending, but instead an acknowledgement that the work of recovery is ongoing.

This book offers a raw, uncensored look into the daily realities of living with concurrent mental illness and addictions.  Some bits aren’t pretty, and others are downright ugly, but that’s what makes it so real.

 

You can find Samantha on her blog My Bipolar Mind.

 

On a bit of a side note, transforming blog posts into book form isn’t something I’ve ever thought about; I don’t generally blog diary-style, so it wouldn’t really be a good fit for me.  It’s an interesting form, though, and I’m curious if it’s something that other people have contemplated.

 

You can find my other book review here.

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Adapting ambition to circumstances

What were your ambitions for yourself when you were a kid?  Ballerina?  Astronaut?  President of the whole world?  When we get a little older, reality intrudes on some of the fantasies, and we make some adjustments.  Then maybe we get on track and things are chugging along just fine, and suddenly reality comes knocking again.

I’ve never been a particularly competitive person, but I’ve always wanted to find things I enjoy and that I’m reasonably decent  at and make the most of that.  I knew by the time I was in high school that I wanted to work in healthcare.  When I got to university I did a degree in pharmacy, but was fairly certain all along that was just a stepping stone.  I had medicine in the back of my mind, but then in my final year of pharmacy school a close friend had started nursing school and really enjoyed it, and that sounded quite appealing.  So I applied to both medicine and nursing, leaning more towards nursing because it would involve a lot fewer years in school.  I bombed my med school interviews and didn’t get it in, so nursing it was.

A few years into my nursing career I decided I wanted to do a masters degree, but initially I wasn’t sure if I should stick with nursing or switching things up and do something like a masters in social work.  A Canadian university had recently started up a Master of Psychiatric Nursing program by distance education, so I decided to go with that.  It’s not all that common for nurses to do graduate work, and those that do often end up going into management roles, which I had no interest in.  The psychiatric nurse practitioner role hasn’t caught on in Canada yet, so that wasn’t option.  Even though I didn’t have any particular career goal in mind, I still wanted to do grad school.  My illness and some hospitalizations posed some challenges along the way, but I defended my thesis at the end of 2014 and received my degree in 2015.

There I was, with a fancy new degree, and things should have been looking up.  Except life got in the way.  The workplace bullying began, which resulted in me quitting my job.  Then my depression struck with a vengeance.  The aftereffects of the bullying significantly limited the potential job options open to me, and the effects of my illness have had a major impact on my capacity to work.  Now I have 2 casual nursing jobs, neither of which is really the kind of work I want to do (and am skilled at).  I’m over-educated and under-functioning.

Whatever ambitions I may have had before really aren’t relevant now.  To try to hold on to some of those ideas seems more likely to be counterproductive than helpful.  So expectations need to change.  The ebb and flow of my various symptoms means that it makes more sense to come up with process-oriented things to work on rather than target specific endpoints that may or may not turn out to be reachable.

Right now my ambitions revolve around writing.  Part of adapting to these changes in my life is recognizing that outside factors are a lot more unpredictable and unreliable than I once thought they were.  As a result, the things that I’m choose to reach towards are mostly within my own sphere of control.

That sense of sphere of control has become very important to me.  Being non-competitive, I never really worried about surpassing others, but things like career ambitions were dependent at least to some extent on others allowing certain things to happen.  Depending on others in any way for my own internal sense of success doesn’t feel safe anymore.  I suppose that limits to some extent what I am willing to reach for, but as long as I’m setting my process goals for myself I’m moving forward rather than stagnating.

Have your goals and ambitions changed over time?  Has illness played a role?

 

psych meds made simple

 

Speaking of writing ambitions, my first book, Psych Meds Made Simple: How & Why They Do What They Do, will be available soon on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!  Find out more on my Psych Meds Made Simple book page.

 

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

Here’s what happened in my life over the past week:

  • I announced the upcoming release of my first book, Psych Meds Made Simple.  I was thrilled by all the supportive comments I got.
  • I saw a couple of clients for my job that involves both administering injections and doing self-injection training.  They went ok, although for one of them I had forgotten to take propranolol beforehand and my tremor was pretty bad.  I’m reminded, though, that I used to be able to work full-time no problem, and now even working a few hours in a week feels like a lot.
  • I got my final draft in for a book project I’ve been lucky enough to get involved with.  It’s called The Silent Scream, which is being put together by the fabulous Maria Alfieri.  I heard about it recently from Karen at Blue Sky Days 365, who’s also involved, in time to be a fairly last-minute inclusion.
  • Physically I haven’t been feeling that great.  My doctor isn’t sure what’s going on, but wonders if it’s a persistent infection that’s flaring up.  I went to the lab yesterday to get some bloodwork done, and aside from a couple of non-specific markers indicative of inflammation, there was nothing remarkable in the results (I love that I’m able to access my results online as soon as they’re available).  My doctor also gave me some samples of Ritalin to see if that works any better than Dexedrine to get me thinking more clearly.  It’s only been a couple days, but so far I feel like Ritalin is less effective.  These last 2 days I forgot to do gratitude entries in my journal, which is very unusual for me.
  • I continue to struggle with my relationship with the one in-person friend that I have.  It’s getting tiring; it just feels like so much work.

 

How has your week been?

What is… Psychopathy

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Psychopathy

We’ve all heard the term psychopath, but in popular culture it’s not always used accurately.  So what does it actually mean?  Well, psychopathy is not a diagnosis in the DSM.  The diagnosis that comes closest is antisocial personality disorder, but many people with antisocial personality disorder are not psychopaths.

Arguably the most prominent psychopathy researcher is Canadian psychologist Dr. Robert Hare.  The Hare Psychopathy Checklist is generally considered the authoritative measuring tool to assess for psychopathy.  It involves an extensive review of an individual’s history, and evaluation for some of the following elements:

  • glibness: they’re very smooth talkers
  • an inflated sense of self-worth
  • easily bored and looking for new stimulation
  • pathological lying
  • manipulative behaviour
  • no remorse or guilt
  • shallow emotions
  • lack of empathy
  • poor impulse control

The triarchic model of psychopathy revolves around three central features: boldness, disability, and meanness.  Typically psychopaths are well aware of the nature of the behaviour that they’re engaging in, which would make it not particularly useful as a defense for a crime, for example.

Psychoanalyst Dr. Otto Kernberg suggested that psychopathy is an extreme version of narcissism.  While there is some overlap, there are also a number of other distinctive elements os psychopathy.   The combination of psychopathy, narcissism, Machiavellianism, and sadism is sometimes referred to as the dark tetrad.

It’s not clear what the causes are.  There appears to be some genetic influence in the development of psychopathy.  Brain injury may play a role.  Environmental influences are also a factor. There have been patterns observed of certain deficits in brain structure and function in  psychopaths, including in the amygdala and prefrontal cortex.

Some psychopaths engage in criminal behaviour, while others may appear to be outwardly successful in the world, performing well in areas like business.  It’s been observed that criminal behaviours tend to drop off after around age 40, although this doesn’t correspond to any changes in psychopathic traits.  Psychopaths who do commit crimes have higher recidivism rates than other criminals, particularly if their crimes are violent in nature.

This topic came to mind recently while I was watching Serial Killer with Piers Morgan on Netflix.  While it seems like there are some people who think that to commit horrendous acts someone must be out of touch with reality (i.e. psychotic), to me psychopathy seems like a far better explanation in most cases.  Still, it’s bizarre to think that such monsters can live among us.  As far as I know, I’ve only had contact with one psychopath, and while he wasn’t a killer, he was frequently violent.  His skillful attempts at manipulation were frightening to watch.

Do you think you’ve ever encountered a psychopath?

 

Sources:

Wikipedia: Psychopathy

How can we fight stigma most effectively?

I was inspired to write this post after reading the book The Stigma Effect: Unintended Consequences of Mental Health Campaigns.  It’s written by psychologist Patrick Corrigan, whose research on stigma I first encountered when I was working on my Master’s thesis, and in it he challenges a lot of commonly held ideas about how we should fight stigma.

The stigma effect that the book is based on refers to unintended negative consequences of anti-stigma efforts.  While public campaigns to reduce stigma are well-intentioned, in turns out that in some cases they may actually end up having the opposite effect.  That’s why I think it’s really important that we pay attention to what Corrigan has to say in order to make sure that we’re being as effective as possible in the fight against stigma.

What is stigma?

Corrigan starts the book with a primer on what stigma is.  Stigma is not actually inherent in mental illness itself.  Instead, things like psychiatric symptoms, social skills deficits, poor hygiene, and illness labels act as cues for people to apply stereotyped beliefs and discriminatory behaviours.  Stereotyped beliefs are framed as facts, but in reality are based in inaccurate assumptions.

We’ve all been exposed to the stigmatized belief that people with mental illness are dangerous and unpredictable.  Corrigan explains that in a 2006 study, around 40% of Americans thought people with mental illness were dangerous.  This was about the same as the figure in 1996, and double that from 1956.  Yet it would seem that there is much more education now about the reality of mental illness and public exposure to anti-stigma campaigns, so something isn’t adding up here.

How do we fight it?

The book outlines three broad types of anti-stigma approaches: protest, education, and contact.  These may be informed by different agendas depending on who’s leading the campaign.  Professional groups tend to promote the idea that decreasing stigma will lead to more people accessing mental health services.  Families and other supporters may have a similar agenda, whereas people with mental illness may be more focused on promoting dignity and self-worth.

Slacktivism

Corrigan uses the term “slacktivism” in which people are able to easily endorse or support something, e.g. on social media.  This takes little effort and generally doesn’t translate into any sort of meaningful action.  There are multiple large campaigns that allow for slacktivist engagement, like Time To Change’s Time To Talk Day or Bell Let’s Talk Day.  There is a ton of promotion and these efforts capitalize on the easy buy-ins across a broad swath of the population, but from what Corrigan has to say these may not be very effective.

Language usage

Chances are many of us have seen (or been) people arguing about language change, such as using “completed suicide” rather than “committed suicide”, or “person with schizophrenia” rather than “schizophrenia”.  Except you know what?  It can actually have a negative effect, according to Corrigan.  There are a couple of elements to this.  If you tell someone not to think about a white bear, what are they guaranteed to think about?  A white bear.  Also, we haven’t necessarily come that far from our inner 6-year-old; telling people what not to do naturally triggers psychological resistance resistance to change.  Corrigan also points out that language is the result of stigma, not the cause of it, so targeting language ends up trying to address the issue backwards.

I found it interesting that Corrigan uses the term patient to refer to a role that people play.  I choose the same term in the same context, although I recognize some may see it as archaic.  Apparently surveys of people with lived experience show no particularly label that’s preferred; however, consumer has been found to be the least preferred.  That rather surprised me.  Personally I can’t stand the term consumer, but thought I was somewhat alone in this; apparently not.  The term consumer is fairly popular, though, which makes me wonder if its use is because organizations are trying to be politically correct.

Education as an anti-stigma strategy

When it comes to attempts to educate the public about mental illness, Corrigan doesn’t mince words: “Education, at least for adults, is an overrated, mostly feckless approach to erasing stigma.”  He gives the example of myths versus facts as a common type of educational approach.  This seems rather unfortunate; I certainly love me a good myths vs facts!  The messages are likely to go right over the head of the average person who is already prejudiced; plus, they can trigger a psychological resistance effect that can actually increase stigma.  Corrigan gave the example that something similar been observed with campaigns to educate parents about vaccines, which have actually increased resistance to vaccination.

Another surprise?  Apparently public service messages that mental illness is biologically based are actually unhelpful, because people seeing these messages tend to conclude that recovery is unlikely.  Even cheerful antidepressants about suddenly un-depressed people singing and dancing and enjoying life can also lean people towards conclusions that recovery is unlikely.  One of the messages that I tend to be quite attached to is that mental illness is just like any other else, but guess what?  Such messages can actually increase perceptions of dangerousness and unpredictability.

Contact as an anti-stigma strategy

Ok, so what does work?  For “normal” people to have contact with people living with mental illness.  It’s most effective when the contact is with average people rather than seeing celebrities open up about their experiences with mental illness.  Contact works best with people who are believable as having a mental illness, but don’t conform closely with stereotypes.  Contact with someone who is acutely unwell and acting like a “crazy person” is more likely to reinforce stereotypes.  Contact also works better when it’s with people from similar sociocultural groups.

Corrigan explains that contact is effective because not only does it decrease negative beliefs, it helps to replace them with positive ones.  It’s 2-3x more effective than education at changing stigmatized attitudes.

What advice does he have for us to share our stories effectively?  We should share stories of our illness experiences, but also about our recovery journeys.  We should talk about how we have been affected by stigma in spite of what we’ve managed to overcome, and conclude with a call to action to address this injustice.

The thing with contact, though, is that it requires us within the mental illness community to speak up.  To have the greatest effect, we need to not openly speak up anonymously online, but also “come out” as mentally ill in our regular environments.  We need to make it personal.  We need to demonstrate that there are many faces of mental illness, not just the stereotyped homeless person on the street.  That’s not to say that coming out is easy, but to really make a dent in stigma a critical mass of us needs to do so. We truly can be the change we wish to see in the world.

Were you surprised by anything this book had to say about what does and doesn’t work? Do you have any ideas about the best way for us to tackle stigma?

 

I received a reviewer copy of The Stigma Effect from the publisher via www.netgalley.com.

This post contains affiliate links.  By using these links to make a purchase on Amazon you are helping to support my blog at no extra cost to you.

Book review: My Brother’s Journey

Book cover: My brother's journey

My Brother’s Journey: From Genius To Simpleton by Marie Abanga is a moving tribute to her younger brother Gabriel, whose life was taken away far too soon by mental illness.  It includes not only Marie’s words, but also the words of others who knew and loved her brother.

In the book she shares what a kind person he was with great personal and academic promise until illness entered his life and irreversibly changed him.  The “simpleton” reference in the title reflects the challenges he had with performing basic tasks towards the end of his life.  The book includes letters he had written, which showed a clear decline given that he had previously done very well in school.

He was diagnosed with epilepsy while he was still in school, and had multiple hospitalizations.  He was later diagnosed with schizoaffective disorder.  He moved to Germany to further his studies, but ended up being deported because his illness was uncontrolled.  Marie shares how difficult it was when he returned home to Cameroon; it was difficult to tell which parts of what he was saying were real and which were not, and she described him as resembling a ghost.

He later was able to get a visa to move to the United States.  At the time, it was thought that it would be the best thing for his health, and perhaps the “black magic” that affected him might not be able to cross the ocean.  However, his health further deteriorated there.    Marie describes the numerous challenges in trying to get adequate care for him, made even more difficult by the fact that his immediate family was back in Cameroon, and Marie was unable to get a visa to go to the U.S.

When the family were informed that Gabriel had died, the cause was unknown.  Marie is openly critical of the health care system that let him down.  In particular she condemns the institution where he was held after an altercation with police.  She shares a letter her mother had written to the institution asking that his medical needs be addressed, but this seems to have fallen on deaf ears.

Marie writes about the stigma around mental illness in Africa, where the subject is considered taboo.  Those who are ill may be shunned by their families and rejected by their communities, and may be talked of as being wicked, bewitched, or possessed.

What really stood out for me was the prevailing attitudes in Cameroon regarding mental illness.  I’ve heard that ideas such as black magic exist, but this book really brought it to life.  It’s also interesting that he seemed to do the best when he was in Cameroon, and worse when he was in countries with supposedly more advanced health care systems.  This is a sad story of a very promising young man who fell through the cracks – the very wide cracks – in the health care system.

 

You can find Marie on Marie Abanga’s Blog.

 

You can find my other book review here.

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The body is a strange creature

Yesterday afternoon I was trying out one of the single-use thermometer strips I have for work, just to remind myself how to use them.  It told me that I had a mild fever. I confirmed it on my regular thermometer.  That got me thinking about how strange my body has been acting over the last few years.

In 2015, after weeks of having an intermittent mild fever, I developed a severe bacterial pneumonia that required several days of IV antibiotics.  It seemed to be out of the blue; there was no cold or other mild respiratory infection that preceded it.  That is very odd for a physically healthy person my age.  Since then, I’ve had a couple of bouts of what seemed to be viral pneumonia (less severe symptoms, no significant fever).  Any time I have a cold now (like I did a few weeks ago), I get a lot of chest congestion that makes breathing difficult.

Around the same time I started getting migraines that involved a lot of nausea and sometimes vomiting.  I don’t get them often, and they don’t seem to be triggered by anything that I can identify, but they’re not something I’d ever had before that.  I ended up getting a migraine yesterday evening, just before I was supposed to see a client for work.  Luckily she ended up needing to reschedule, because I felt like I was in the process of dying.

In the last year or so, I’ve had vertigo, including rocking vertigo (a sense of the ground rocking); again, this is something I’d never had before.  Often vertigo is linked to inner ear issues, but with the pattern it’s taken for me it seems more likely to be psychiatric in origin. I’ve also had some odd perceptual disturbances, and even more so than the vertigo there seems to be a pattern consistent with psychiatric causation.

Sometimes I wonder if there’s something wrong in a physical sense.  It’s not health anxiety; if anything, my health professional training makes me more inclined to brush these things off as vague and non-specific.  The thought sometimes wanders into my head that maybe I have a brain tumour.  That thought doesn’t make me worry; if anything, it gives me a sense of relief to think that there could be something that would naturally cut short my life.  It’s not that I’m suicidal, I just don’t have a desire to live a long life.  I also don’t care sufficiently to push my doctor to order imaging tests that really don’t seem warranted.

Does your body do strange things sometimes?  Does it seem linked to your mental illness?

 

psych meds made simple

My first book, Psych Meds Made Simple: How & Why They Do What They Do, will be available soon on Amazon as an ebook or paperback.  It’s everything you didn’t realize you wanted to know about medications!  Find out more on my Psych Meds Made Simple book page.

An announcement!

I’ve decided to jump on the book-writing bandwagon!  I’ve been really inspired by my blogging friends who’ve written books, and thought it would make a good challenge to set for myself.  I actually started writing a couple months ago, but hadn’t really decided whether I was going to move forward with it or not.

Well, now I’ve decided.  Not that I had any sort of earth-shaking epiphany; I just realized it was time to make up my mind.  I had two different books that were both mostly finished from a writing perspective, so the timing seemed right.

Before doing an announcement about it I wanted to figure out what was actually involved in self-publishing a book.  Wow, there’s a lot to learn!  I’ve decided to publish through Amazon exclusively, mostly because it seems easiest, and even that feels like a lot to try and get sorted out in my head.

psych meds made simpleSo, what exactly am I writing about?

My first book is Psych Meds Made Simple: How & Why They Do What They Do.  I’m launching it on Amazon on February 4.  You can find out more on my blog page Psych Meds Made Simple.

My second book will be available sometime in the fall, and its title is Making Sense of Psychiatric Diagnosis.

So far the memoir bug hasn’t bit me, but that might be a project for down the road.

 

Have you self-published before?  Are there any tips/tricks you’ve learned?

 

Oh, and previous self-publishers may appreciate this.  Canada actually lets you get your own ISBNs for free under your own publishing imprint.  Mental Health @ Home Books is born!

 

New year, new bullet journal

journal cover with tree of life

This is my bullet journal to start off 2019.  It’s made from 100% recycled paper, so it’s nice and environmentally friendly.  It’s a soft-cover journal, although it’s fairly stiff.

Here’s what I’ve got laid out in it so far:

  • Each month gets two one-page monthly calendar overviews; one is for tracking mood/emotions, and the other to capture external events and some other factors.
  • Each month also has 2 pages devoted to tracking self-care activities and what’s happening in my body.  I’ll probably come up with some kind of colour-coding system for this, but I haven’t figured that part out yet.  Still, it’s already a lot more organized than what I was doing in 2018 with a lot of different things in a lot of different places
  • I also have weekly overview pages that include my goals for the week.  Doing the weekly goals was working well for me last year.  So far all of these things I’ve mentioned I was already doing in 2018 at least to some extent, but because I started doing them at different times they were scattered in multiple places throughout my journal.  Now they’re all clustered at the beginning.
  • I’ve written out the whole year worth of dates for my daily gratitude log.  I did this in 2018, and apart from missing a few days I was really consistent with it.
  • There’s a page to keep track of all my medical and any other health-related appointments.
  • I’ve got pages devoted to goals, accomplishments, things that make me smile, and inspirational quotes.  I found it useful in 2018 to set aside pages for positive things.

Pretty coloured pens and some cool stickers are the extent of my visual artistry, and I’m okay with that.  I’ve given up any pretence of being able to draw even simple geometric shapes.

I still have some room in my 2018 journal, and I plan to use that for free-form thought dumps and keep the 2019 journal quite structured.

Have you started a new journal for 2019?  How have you laid it out so far?

 

I was going to keep my lack of artistic talent to myself, but there have been some requests, so here goes…

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The top half is my overview.  In case you doubted my evaluation of my artistic abilities, the purple alien claw in the lower left corner for the last few days is my version of a hand, which is my symbol for when my eczema is acting up.

The lower half is my mood and emotion tracker.  The number is a mood ranking and the colour-coded letters are emotions.  The code for that is on the colourful page shown below.

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This is where I track some of the things I’m doing, both healthy and unhealthy, and what’s going on in my body.  I’m not thrilled with how I’ve organized it, so I think I’ll change it up for next month.

 

 

 

 

 

 

 

 

 

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This is exactly how I did my weekly summaries and goals last year, and it worked well.

 

 

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Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

Here’s what happened in my life over the past week:

  • I don’t like Facebook.  Since I started blogging I’ve opened and then deleted a Facebook account a couple of times.  I decided to give it another go this past week, until I saw that Facebook was creepily accurate in suggesting people I might know.  This was despite the fact that I used my blog-related email address rather than my normal personal email. My guess is that it’s because Facebook now forces you to give a phone number when opening an account, and they must know that number is associated with the account I had years ago.  I don’t want these people I knew in the past seeing me any more than I want to be seeing them, so that’s it, Facebook and I are permanently broken up.
  • I worked 3 night shifts this week.  I felt rather dazed and confused, but at least working at night that’s not too much of a problem.  I saw an email sent by a colleague criticizing how I handled a situation with a client a few months back.  I was aware she had sent this email, because she’d sent it to the whole team in response to an email I’d sent to the whole team, but it was the first time I actually read it.  It was extremely condescending and just as extremely full of shit.  I was tempted to respond and stand up for myself, but sadly I have learned that in this particular workplace speaking up accomplishes nothing but create problems and keeping my mouth shut is the best way to go.
  • I’ve been having weird vibrating sensations this week.  It was happening a lot a couple of months ago, and then it had stopped.  I’m sometimes noticing sounds that seem out of place.  This was happening mostly on days I was working, and it seems to be triggered by feeling overstimulated.  I had meant to go see my doctor this week, but work kind of got in the way, so I’ll see him next week.
  • I had a massage, one of my favourite self-care activities.  My massage therapist has booked me in for every Thursday morning for the rest of the year.  Sweet!

 

My writing off the blog this week:

 

How has your week been?

What is… melancholia

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Melancholia

Melancholia comes from the Greek for black bile, part of the ancient four humours medical belief system.  In the 5th century B.C.E., Hippocrates first identified melancholia as a disease with various mental and physical symptoms.  In the 16th and 17th, the idea of a melancholy temperament became fashionable in English art and literature.

In the present day, melancholia is used to to specify a type of major depressive episode.  Some researchers have argued that it warrants its own diagnosis, but the committee formulating the DSM-5 was not convinced that it was a distinct disorder.

In the DSM-5, melancholic features specifies a subtype of major depressive episode.  Melancholic symptoms include anhedonia (inability to feel pleasure), lack of positive reaction to normally pleasurable things, a quality of mood that is distinct from grief/loss, early morning awakening, psychomotor retardation (slowed movement and thinking), significant loss of appetite, and symptoms that are worse in the morning.

People with melancholic depression tend to have normal levels of developmental stressors, and no significant problems with relationships or work when they are not depressed.  Melancholic depressive episodes are more likely to happen with no identifiable triggers, and people are more likely to identify their depression as an imposed disease rather than a logical reaction to life stressors.

Melancholic depression is thought to caused mostly by biological factors.  It is associated with an increased likelihood of family history of mood disorder.  It is also associated with higher severity depressive episodes, including psychotic depression and suicidality.

Individuals with melancholic depression tend to respond less well to SSRIs, and respond better to antidepressants that target the neurotransmitter norepinephrine.  MAOIs (monoamine oxidase inhibitors) tend to be the most effective antidepressant in this population.  The addition of a psychostimulant like an amphetamine may be helpful.

My most recent psychiatrist thought I had melancholic depression.  I don’t have all the symptoms now, but the prominent anhedonia definitely matches.  The types of meds I’ve responded best to also matches.  I suppose it really doesn’t make that much of a difference; everyone’s illness is unique, regardless of subtype.

Does melancholic depression sound like something you may have experienced?

 

Sources:

https://en.wikipedia.org/wiki/Melancholia

https://en.wikipedia.org/wiki/Melancholic_depression

 

Brokenness

I’ve been thinking lately about my inability to maintain relationships with people.  Depression has caused me to shut a lot of people out of my life.  Mostly I haven’t given it much thought, but it dawned on me that it has to do with a sense of brokenness.

My illness makes it hard to be around people, and it seems like things ending up getting to the point that the relationship itself is broken, and no more fixable than trying to glue broken glass back together.  And the brokenness is always my fault.  Not my fault in terms of blame, guilt, or shame, but my fault in that the sense of brokenness wholly (or at least mostly) exists in my head, and may or may not have a strong basis in reality.

Probably what gets me into the most trouble is that once I feel that brokenness, it seems irreparable.  It feels final.  And I don’t know how to overcome that barrier. It’s not that I feel that I am broken myself; the brokenness applies only to the link between me and the other person.  There’s a very detached quality to it; there really isn’t much of anything in terms of thoughts or feelings attached.

One of my oldest friends tried to stick by me the longest with this current episode of depression (although is it even an episode any more at this point?).  While her efforts to reach out on a fairly regular basis struck me as kind, it didn’t change the brokenness.  Did she do anything wrong?  Not really; I felt invalidated by some things she said at one point, but I knew full well that was not her intention.  And that wasn’t what triggered the brokenness.  What really cemented it was when I went over to visit her and her kids while they were putting up their Christmas tree.  I’m sure my friend thought the visit went not too bad, aside from me not saying much.  In my head, though, that afternoon was inexplicably the death knell of the friendship.

It’s also a problem with my parents.  I had my reasons for initially pulling away from them when depression came into my life again a couple of years ago, but that’s not really an issue now.  What persists, though, is the sense that the close connection I used to have with them is permanently broken.  I’m not sure how I would even go about trying to change that thought pattern.  It’s almost like key pieces are missing that makes it impossible to reassemble the relationship as it was.

This has all come to mind as a result of an altercation I had with a friend recently.  It was over something that’s not really that important, but I’m getting that done and broken feeling.  It’s not a conscious choice that I’ve made; it’s just there.  Yet another casualty in depression’s destructive march through my life.

 

 

 

Book review: The Inflamed Mind

book cover: The Inflamed Mind

The Inflamed Mind: A Radical New Approach to Depression is written by psychiatrist Edward Bullmore, and presents inflammation as a new frontier in tackling depression.  The author’s bio at the beginning of the book reveals that he works at pharmaceutical giant GlaxoSmithKline.  He doesn’t try to be subtle about disclosing this, and I didn’t pick up any sense of bias.  He explains that in 2010 GSK shut down its mental health research and development (R&D) programs, and this was what prompted him to start thinking seriously about neuro-immunology and the role of inflammation.

The author refers multiple times to an anecdote of his experience of social withdrawal and morbid rumination immediately following root canal surgery.  It was gone by the next day, but he wrote “you could say I had been a bit depressed”, and attributed this to inflammation related to the surgery.  While I understand the point he was trying to make, as a person living with depression myself I couldn’t help but roll my eyes.

Cartoon drawings are used effectively to capture neuro-immunology concepts.  Explanations are given in simple terms, without making the mistake of sacrificing accuracy for metaphor.  Scientific terms are used, such as the immune cells known as macrophages, and the signalling molecules they release, called cytokines.  While it’s somewhat difficult for me to judge, as I was familiar with many of these concepts before reading the book, I think it was pitched to a level that a reasonably intelligent person could understand without having a science background.

A patient referred to as Mrs. P. makes frequent appearances throughout the book.  The author encountered Mrs. P. during his medical training.  She had rheumatoid arthritis as well as depressive symptoms, but her treating physician insisted that the depression was a normal psychological reaction to her physical disease.  It was a relevant example, but it struck me as a bit over-used.

There was what initially felt like a bit of a detour to philosopher René Descartes to explain the persistent idea of separation between mind and body.  However, Descartes ended up appearing even more often than Mrs. P. did, to the point that it got to be a bit much.  The author writes “I can fondly imagine that Descartes himself might have agreed with me, but I can’t be sure.”  Oh my.  He did make the interesting point, though, that the mind/body divide is a sort of “medical apartheid”, and I very much agree that a more holistic approach will better serve patients.

Bullmore argues that placing depression solely within the mental domain actually serves to increase shame and the likelihood that people will think the illness is their fault, which is in many ways what the idea of a “chemical imbalance” tries to counteract.  He goes on to explain the shortcomings of the serotonin hypothesis, which was used as the  basis for the development of selective serotonin reuptake inhibitor (SSRI) antidepressants.  He also explained that approaching depression with a focus on serotonin and related neurotransmitters has stalled out, and there have been no major advances in the treatment of depression since around 1990.  He writes: “To this day, in 2018, I could still safely and acceptably treat most patients with mental health disorders based solely on what was written in those those textbooks” that he used when he started his specialty training in 1989.  While I understand the underlying point that there haven’t been any revolutionary advances in psychiatry, the notion of seeing a psychiatrist whose knowledge base is rooted in 1989 is unpalatable, to say the least.

The book explains that according to the DSM: “According to the official diagnostic criteria of the American Psychiatric Association, depressed patients can only have a diagnosis of [major depressive disorder] if they do not also have a bodily disease.”  Based on this, he concluded that Mrs. P. who had rheumatoid arthritis couldn’t have a depression diagnosis.  To me this interpretation seemed a bit odd.  The exact wording in the DSM-5 is: “The episode is not attributable to the physiological effects of a substance or another medical condition.”

The possible relationship between depression and evolution is discussed.  The author explained that back in the caveman days social withdrawal could have been a form of quarantine to prevent infectious disease, adding that: “One might even wonder if the stigmatization of depression in 2018 is somehow related to the isolation of ancestral tribe members who were behaving as if they were inflamed.”  That seems like a bit of a leap, and is followed by yet another leap: “Could the common feeling that ‘we don’t know what to say’ to our depressed friend conceal an ancient inherited instinct to recoil from close contact with people who are behaving as if they are inflamed and infectious?”  By that argument, though, why is there not such a social recoil from people with type I diabetes or Crohn’s disease?  Or the oft-referred-to Mrs. P. with rheumatoid arthritis?

While there is a strong argument that inflammation is a factor in depression and an important target for research, there isn’t much yet in practical terms.  The book describes the “Remicade high” that some clinicians have seen in patients who rapidly cheered up while getting an infusion of that anti-inflammatory medication.  There have been some small studies with anti-inflammatories that have had positive results, but there isn’t a clear indicator of something particularly effective that’s available right now.

Vagal nerve stimulation is also mentioned as a possible intervention  to target inflammation.  Cytokine receptors on the vagus nerve respond to high levels of inflammation by signalling to the spleen to deactivate macrophages in order to maintain homeostasis.

I started this book quite prepared to buy what the author was selling, given my prior knowledge of some of the research in this area.  I was a bit surprised by the book’s presentation of the idea as though it’s something that everyone is denying, because it’s sufficiently accepted to have made its way into the mainstream continuing medical education activities that I’ve viewed.  Bullmore writes that “we could be on the cusp of a revolution”, and I know personally I’m hoping that advances in anti-inflammatory treatment approaches will end up being able to help with my own depression.

The book makes a strong argument that further research into inflammation is going to open new doors in depression treatment.  However, the fact that we don’t have keys to those doors yet limits its practical usefulness.  Still, this book is worth reading if you’re interested in finding out more about a new way of looking at the biology of depression.

 

I received a reviewer copy of this book from the publisher via www.netgalley.com.

 

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2018 year in review: Guinea pigs

My guinea pigs are among the best parts of my life.  Here is their year in pictures.

This little octopus hideaway is made for ferrets, but it’s also great for guinea pigs.

 

I adopted these boys almost two years ago.  They were geriatric and in need of a retirement home.  Zippy (the darker coloured one) passed away earlier this year, but his best friend Squeaky is still going strong.  Squeaky is kind of a grumpy old man, so I haven’t gotten him a new friend, but he can hear the girls in the next room, so he knows he’s not the only guinea pig in the world.

 

Casper, the off-white one, was the most recent addition to the family.  I adopted her a little over a year ago.  She’s got thick luscious hair that will stand up nice and tall if I brush it that way.  The girls know their food comes through the door of the cage, and they know that if they stick their heads out and look cute it can increase their chance of getting treats.

 

guinea pig cuddled up against hay manger

The girls like to knock over their green wire hay manger.  Not only that, they like to snuggle up against it.  To each their own.

 

guinea pigs visiting grandma's house

I took the guinea pigs with me on a couple of trips to Grandma’s house this year.  The cages are kind of large and unwieldy, so I improvised with their little travel boxes.

The guinea pigs would like to wish all of you a very happy new year!

Happy New Year!

2019

TheDigitalArtist on Pixabay

Happy 2019!  Wishing each and every one of you amazing people a joyous and healthy new year.  I appreciate all of you so very, very much.

For me, the biggest accomplishment in 2018 was really committing to blogging.  My main goal for 2019 is to expand where, how, and what I write.  I’ve never made new years resolutions  because it seems like such an arbitrary way to try to make behavioural changes.  Instead, I’m committed to doing the things that I know have positive effects, however small, on my life.

Where would you like to focus your energy for 2019?

 

 

 

 

2018 year in review: Blogging

laptop screen with 2018 calendar

geralt on Pixabay

This has been my first full year of blogging (I started in October 2017) and it’s been quite the adventure.  It’s become a huge part of my life, and it’s been my primary source of connection to other people.  It makes me wonder why on earth it took so long for me to clue in that blogging was something I should try.  It’s interesting to watch the ebb and flow of people coming and going in the blogging world.  Some bloggers who were very active early in the year have faded away, while others have continued to grow and amazing new bloggers are joining our community all the time.

It seems like a good time to reflect on some of my stats for the year.  Not the likes and follower numbers and that kind of thing that can get stressful, but the quirky insights that WordPress can give you.

International reach

My blog has been viewed in some interesting areas, including Iraq, Mongolia, Sierra Leone, and Angola.  There was also one view from Kyrgyzstan, which was likely by my future husband and/or his yak.  I guess they get internet signal in the yurt, which means that even when I decide to run away from the world I’ll be able to keep blogging.

Number of posts

This year I’ve done 412 posts, for a total of over 200,000 words.  That brings my total number of posts to 455.  I decided in the spring that I wanted to post daily, and with the odd exception I’ve been able to stick to that.  Not that I actually write every day; the scheduling feature on WordPress is my best friend.  I always have multiple drafts on the go.  I mark some of them with notes in all caps at the beginning of the title to help keep me organized, but a few times I’ve forgotten to remove them and came very close to accidentally publishing “TEMPLATE: Weekend wrap-up”.

How people got to my blog

Most came from WordPress.  Pinterest was #2 and search engines were #3.  And that’s where things got interesting.  #4 was the website havingtime.com.  I’ve never heard of this site before, and when I take a look at the specific pages WordPress lists I don’t actually see links to my site on any of them.  I’m puzzled, but not sure how to solve the mystery.

Some interesting search terms that led people onto my blog:

  • “documentary about fsu student on psychotroic meds that goes on a killing spree”
  • “when ight or flight is suicide for the victim”
  • “you always remember where you begins”
  • mountain climbing
  • “”i met” “sex””

Gotta enjoy the typos, but it’s also a bit creepy that what we enter into search engines is so public.

What people look at on my blog

My home page has had the most views overall.  The post with the most views is Identifying emotions.  It’s had 100 more views than the next most popular post, and 300 more then the third most popular post.  I have no idea how it got to be so popular.

Branching out

I feel very comfortable on my blog, but I’ve tried to extend myself beyond that comfort zone.  I’ve done guest posts on some other bloggers’ sites, and I’ve had stories on mental health sites like Time to Change.  I’ve discovered that the sites Medium and Psyche pay (albeit a very small amount) based on number of views of your post.  Even if I get a few cents that’s pretty cool.

How has your blogging year been?  And what’s the most obscure country that’s viewed your blog?

Why I hate the 1-10 mood rating scale

happy face rating

mohamed_hassan on Pixabay

I became a nurse 14 years ago, before I became mentally ill.  Even then, I wasn’t a fan of asking people to rate their [mood, etc.] on a scale of 1-10.  It struck me as such a cop-out, a poor substitute for actually exploring with the person how they were feeling.

And then depression hit, and I ended up in hospital myself.  Almost every day someone was asking me to rate my mood, and I hated it.  That feeling I’d had before about it being a cop-out?  Quadruple that – at least.  It felt like none of them actually cared how I was doing; they just wanted to get in and get out.

There is a huge array of different emotions that we can experience.  While we may label some as good and others as bad, they all have their time and place.  No one wants to be excited when something bad is happening just like we don’t want to feel angry when we’re getting a relaxing massage.

Reducing mood to a scale ranging from sad to happy seems totally arbitrary.  What if I feel anxious?  That’s neither sad nor happy, but somehow it has to be slotted in on the scale.  What if I’m angry because the professional asking me the question is being a prick?  That’s not happy, but telling them to go f*** themselves might be rather satisfying.

The idea of imposing a 0-10 rating is also arbitrary, because the frame of reference is subject to so many different influences.  What’s “normal”?  If I was bipolar, maybe 5 would be expected to be my normal.  But since I have depression, people may expect me to cruise along at an 8 most of the time.  What’s a zero?  If I’d experienced childhood sexual assault would that be my zero and anything else is pretty much automatically an 8 or above?  My zero before I got depressed was a whole lot different from the zero when I was trying to kill myself, so how’s that supposed to work?  And does my zero if I’m suicidal today necessarily correspond to the zero I was at if I felt suicidal six months ago?

I get that it’s helpful to track mood.  I track my mood in my bullet journal with a numerical ranking from -3 to +3, with zero being neutral.  I also use coloured coded letters to record specific emotions.  Different days may have the same ranking but a very different mix of emotions, but a numerical rating alone wouldn’t capture that.

What’s really important here is that mental health professionals should take the time and effort to dig a little deeper.  A number that I pull out of my ass has very little meaning on its own if someone doesn’t try to understand the complexity of what’s actually behind that number.  If the person asking is just looking for something to write in my chart so that it looks like they’re doing their job… well, chances are, I’m going to sense that, and whatever I tell them is going to be a load of BS.

The reason this has come to mind recently is something a friend of mine said.  He’s in psychiatric nursing school right now.  He tries to be understanding of my illness,  but in many ways he’s clueless.  I’ve tried to explain to him what it’s like, and he just doesn’t get it, although not for lack of trying.  I was talking on the phone with him on Boxing Day, and he hadn’t asked how I felt about Christmas.  He can’t seem to wrap his head around the concept of anhedonia, and I think he just figured I chose not to do anything for Christmas.  He was babbling on about some stupid work-related anecdote, and then finally he asked how I was doing.

I told him I wasn’t doing very good.  There was a pause, and then he asked me how I was feeling on a scale of 1 to 10.  Oh for crying out loud.  I told him he could f*** off with his stupid 1-10, and I hung up on him.

He wasn’t trying to be a jerk, but the last thing I need is a friend making a lame-ass attempt to assess me using a crappy assessment tool that pisses me off to begin with.  I’m not sure what to do about this whole thing.  I’ve tried explaining, and he just seems to be a bit thick when it comes to this issue.  So maybe I need to either just put up with it, or back off on the friendship (except he’s my only in-person friend).

I don’t know, but what I do know is that people can take that 1-10 and stick it where the sun don’t shine.

Weekend wrap-up

wrapping paper, ribbon, and twine

Rawpixel on Pixabay

Here’s what happened in my life over the past week:

  • Christmas sucked.  I was alone, and reminded just how much my illness has hijacked my life.
  • I haven’t had the motivation or inspiration to write much, and have been sort of flopping around like a figurative stranded fish doing not much of anything.  I have various drafts on the go, and I’ll write a sentence or two and then lose interest.
  • I think I’ve watched all the good documentaries on Amazon Prime, and what’s left is total crap.
  • I’ve decreased my stimulant dose because I’ve been feeling weird.  I’m not even sure how to explain it; it’s sort of like focusing but dissociating at the same time.  Maybe I should cut down on the amount of tea I drink, but I’m not particularly interested in doing that.
  • I got some work shifts assigned for the next few months, which is a bit of a relief.  It’s been three months since I last worked, and while I’ve got savings it was concerning that there was no money coming in.
  • I’ve decided to mentally commit to moving forward with a project I’ve been considering for a while now.  More info to come on that soon.

 

How has your week been?

What is… seasonal affective disorder

Seasonal affective disorder (SAD) is a subtype of depression with symptoms that occur based on a seasonal pattern.  Typically depressive symptoms occur during the winter, but other patterns are possible.  For example, depressive symptoms may appear in the spring, or anxiety symptoms may show up in the summer.  The potential symptoms of SAD are the same set of symptoms that can occur with other types of depression, although winter depression tends to be more likely to be associated with oversleeping and increased appetite.

People with bipolar disorder who have a seasonal element to their illness may be diagnosed as bipolar I or II with seasonal pattern.  Seasonal fluctuations are more common with bipolar II than bipolar I.  Spring and summer may trigger the onset of mania or hypomania.

Approximately 6% of Americans experience SAD, while around 14% experience seasonal dips in mood that don’t meet the full diagnostic criteria for a depressive episode.  One survey found that 20% or Irish people experience SAD.  The exact cause of SAD isn’t clear. Rates of SAD are elevated at higher latitudes that have less light in the winter, which may effect melatonin production by the pineal gland in the brain.  This can affect serotonin production, as melatonin is a precursor to serotonin.

Light therapy one option that can be effective for treating SAD.  It involves sitting in front of a 10,000 lux light box for 30 minutes or a 5000 lux box for an hour.  Times may need to be lower for those with bipolar disorder.  It’s recommended to sit 30-60 cm (about 1-2 feet) away from the box, at an angle that allows the light to shine in your eyes without staring directly at it.  Light therapy and treatment with SSRIs have been shown to have approximately equal effectiveness.

Getting regular exposure to outdoor light (even on cloudy days) and physical activity may also be helpful.

I live on the wet west coast of Canada, just north of the 49th parallel.  The biggest issue in the winter here is that it rains a ton, so the sun doesn’t make an appearance very often.  While I find cloudy vs sunny days make a transient difference in my mood, winter doesn’t seem to affect my symptom patterns overall.  However, since early on in the course of my illness I’ve had a consistent seasonal pattern of a major drop in mood starting in late August and lasting through September.

I have a light box that I sometimes use in the winter, but I don’t notice much of an effect from it.  I actually prefer the warm glow of my Himalayan salt lamp, even though it’s not the right kind of light to be effective for SAD.

Do you have a seasonal component to your illness?

 

Sources: 

https://en.wikipedia.org/wiki/Seasonal_affective_disorder

https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

 

Book reviews: Poetry from Maranda Russell

Book cover: Not Afraid to be real          book cover: From Both Sides

This week I’m doing a 2-in-1 book review of two poetry collections from Maranda Russell.

From Both Sides: A Look Into the World of Foster Care from Those Who Know It Best is a short book of prose poems that’s written both from the perspective a foster child and that of a foster parent.  Maranda herself has been a foster parent.  She explains that her aim is to clarify the challenges faced by foster kids and parents, and bring encouragement and inspiration.

Themes in the poems about being a foster kid include feeling like damaged goods,  being shuffled around and lacking permanence, and self-hatred.  One poem that I found particularly moving is False Hope, which is about being led to believe that a return home will be happening soon.  One of my favourite lines in the book: “I’m like fruitcake, the gift that no one really wants.”

The parents section talks about things being stolen, the ongoing effects from the child’s previous abuse, powerlessness, and a flurry of other challenging emotions.  The poems provide insight into both the rewards and the difficulties that go along with foster parenting.


In Not Afraid To Be Real: A Poetry Collection, Maranda writes that she prefers “gritty, down-to-earth poems that speak to the heart and make us see life in a way that we might not have before.”  The themes in the book move from love to struggle and darkness and then on to hope, concluding with some quirky fun.

I really liked the ending of the poem Accept Me As I Am:

“Hurt me –
then heal me.

And most importantly,
keep loving me
even when I
refuse to love myself.”

The Living Dead looks at expectations that we let go of  dreams that are no longer considered acceptable.  Other themes running through the darker sections of the book include feeling dismissed, unwanted, and unaccepted.  Everybody Loves You ponders the rose-coloured glasses through which we tend to see those who have passed on, and whether its worth being remembered in such a way.

And, fitting for this time of year, does flatulence belong in Christmas?  Absolutely, and it makes an appearance in Bad Christmas Poem!

I very much enjoyed both of these collections, and they’re written in a way that’s very accessible and real even for people who don’t typically read poetry.  Maranda definitely delivers on her preference for a gritty, down-to-earth style of poetry.

 

You can find my other book review here.

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2018 year in review: Health

2018 in gold numerals

BiljaST on Pixabay

Depression does a number on my recall ability, so I turn to my bullet journal to help me look back on 2018 from a health perspective.  The chances of my illness ever going back into full remission seem very slim at this point, so I think it’s probably better if I set aside hopes of that and consider it more in terms of managing a chronic illness.

Mood

September was my hardest month of the year, and it was the time when I had the most sustained suicidal thinking.  There have been a few days scattered through the year when I rated my mood as neutral, but nothing above that.

Cognitive symptoms

I get overwhelmed very easily, and have a hard time with concentration.  My memory isn’t too bad, but my recall tends to be slow.  These symptoms have fluctuated in intensity, but over the last year they’ve always been there to some extent.  I’ve worked hard at having a system to be organized to compensate for that, and I give myself credit for that.

Anhedonia

This has been steadily present throughout the year.  It doesn’t necessarily affect my level of functioning, but I feel like my quality of life takes a considerable hit because of it.  Going on a couple of vacations reminded me that this aspect of my illness doesn’t take a holiday break.

Physical symptoms of anxiety

I haven’t had a lot of emotional/cognitive anxiety, but I do sometimes get the heart pounding and chest tightness kind of physical anxiety.  Sometimes it seems to be attributable to situational factors, but sometimes it feels totally random.  I also struggle sometimes with feeling like I’ve been overloaded by environmental stimulation and I’ll start to have mild panic symptoms.  That hasn’t been as much of an issue this year as it was the year before.

I’ve had vertigo on and off throughout the year.  Some of the time it coincided with tension headaches, and my massage therapist thought this might be related to me carrying a lot of tension in the sternocleidomastoid muscles in my neck.  Other times, the vertigo seemed related to anxiety or feeling overstimulated.  When I was travelling in Italy I had what is apparently called “rocking vertigo”, and I felt like all of the time I was on a boat bobbing up and down on the waves.

My tremor  is primarily related to taking lithium, but it gets worse if I’m anxious or overstimulated.  That’s fluctuated a lot during the year and there doesn’t seem to be a clear pattern.  Sometimes it gets bad enough that it’s quite noticeable to other people, and I hate that.

Gastrointestinal

My GI system tends to act up related to what’s going on in my head, and I can see that it tends to be most problematic in the days following stressful events.  Overall, though, it hasn’t been too bad this year.

Alcohol

I used alcohol for numbing more than I should have, although it was a sporadic thing rather than something I did regularly.  I seldom drank large amounts, but it’s still not the greatest choice of coping (or non-coping) mechanism.

 

Well, that’s me for the year.  Having a bullet journal that I’ve made regular entries in definitely makes it easier to see what’s been going on with my mind and body throughout the year.  As for patterns, I see some, but there also seems to be a lot of randomness.

Do you keep track of things related to your health?  What have you noticed from 2018?

A few silly pet peeves

It’s all well and good to try to be more positive in life, but I can be a grumpy old llama sometimes.  I figure if I direct that at inconsequential everyday things it will allow me to blow off steam without it having to spill over too much into other things.  So here are a few of my pet peeves, and I forewarn you, I have a potty mouth.

  • Wearing an underwire bra when it’s hot – either during the summer or in the winter with the heat cranked way too high; this is just inhumane
  • Speaking of undergarments, getting a wedgie while out in public – trying oh-so-subtly to extract your underwear out of your butt-crack, but of course not being subtle in the least.
  • Weight fluctuations (especially with psych meds!!!) and trying to figure out what to do with your old-weight clothes.  Hang on to them in the hopes that they’ll fit again someday, knowing that if you do get rid of them then you will lose weight and get annoyed because you have to spend money for clothes in a size you already had but got rid of?!
  • Insects and related critters in my home.  It’s mine, not theirs, so fuck off!
  • Landscapers making noise when I’m trying to sleep.  I’ve come very close to bellowing out my window at them to shut the fuck up.
  • People in the grocery store who are totally in the way and happily oblivious to that fact.  In my neighbourhood there’s a large immigrant population, and for whatever reasons they seem to most often shop en masse as a family.  That means there are 4+ people obliviously in the way rather than 1.
  • Drivers who make left turns very slowly so that only one other car (and of course it’s not mine) can manage to get through on the advance left turn signal
  • People who are habitually late.  I detest lateness so much that I’m always at least 10 minutes early (and usually more like 30 minutes).
  • Speedos on anyone other than an elite swimmer are a crime against humanity and should be banned from public beaches
  • People setting up shop on the sidewalk trying to solicit donations for charity.  It’s one big guilt trip – they know it, I know it, everybody knows it.  And then there’s the entrapment involved in phone calls to solicit charitable donations, where the only way to extricate yourself is to hang up on the poor volunteer calling from the children’s hospital who hints that you’re a bad person if you don’t donate to the poor kids with cancer.
  • GIFs: I know they’re popular and a lot of people love them, but to me they’re just creepy and weird.

 

What are some of your pet peeves?