Mental Illness

Pharmaceutical wonders are at work
but I believe only in this moment
of well-being. Unholy ghost,
you are certain to come again.

Coarse, mean, you’ll put your feet
on the coffee table, lean back,
and turn me into someone who can’t
take the trouble to speak; someone
who can’t sleep, or who does nothing
but sleep; can’t read, or call
for an appointment for help.

There is nothing I can do
against your coming.
When I awake, I am still with thee.
–Jane Kenyon, “Credo,” from “Having it Out with Melancholy”

I’m not in a good place psychologically at the moment, so I thought it might be a good time to get round to writing a blog about mental illness. I had been intending to do this for a while but its difficult because, although with some people I am very open about what difficulties I have, there are still many friends and groups of people in life, work and family who I still feel uneasy discussing things with or even being around when I’m not feeling right. It’s not that many of these people are bad people who are particularly judgemental or hard-hearted, its simply the case that there is a stigma to having this kind of illness and no amount of caring and sharing will change that reality.

What my actual problem/diagnosis was and still is really isn’t important. Anyone who has any kind of mental health issue goes through similar stigma and has much of the same difficulties when trying to lead a normal, fulfilling, happy life. So it doesn’t matter if I have Bipolar, Depression, Schizophrenia or any other condition, I want this blog to relate to everyone and anyone in this group and not just focus on my own specific problem.

First I want to explain what it’s like living in my head and what I imagine it’s like for many people who have a mental illness. My main symptom (the one that is currently causing me the most disruption) is anxiety. Now when I say anxiety most people imagine a bit of stress, work related, money worries that kind of thing. What I mean when I say anxiety is more than that. The only way I can explain it is to ask you to imagine this:

You’re on a plane and it starts having difficulties in the air. At first you are only mildly bothered, (in-convenient turbulence) but then the seat belt signs come on and the plane gets even more erratic, you notice that the air hostess is looking worried. Perhaps now you are feeling mildly panicked but you have faith in the pilot and you believe that it will all be over soon. Then you realise that there is smoke in the plane and the engine is starting to fail, people are getting thrown around, everyone around you is starting to panic, the pilot instructs everyone to prepare to crash land and you realise that the plane you are on really is about to crash and you are more than likely going to die. Imagine the adrenaline rush that would run through your body at that moment of this realisation. Almost everyone has had some instance in their life when the fight or flight response has kicked in (remember that just now as it will help you get a picture of what I’m trying to explain), the feeling of wanting to vomit, the shortness of breath, the smashing heart beats, the stomach pains, sickness and sweating and imagine that those feelings are coming over you for no reason that is logical. It comes and it rushes over you and then it gradually subsides and you think that it’s over but then a little while later it happens again. It wakes you up in the night, it happens when you are on the bus, at work, in your own home, no place feels safe anymore this intruding feeling interrupts everything you do, when your trying to relax, shower, eat, read, it keeps happening over and over again, and there seems to be nothing you can do to stop it.

This kind of anxiety for me is hell. The fight or flight response is continually being activated for no reason and any small amount of stress sets it off again. I’m only just calming down and it starts all over again. I’m trying to think of a reason why this is happening because if I could find out why I’m afraid maybe I can logically think myself out of it but really there is no reason. When I talk to people who are close to me about it they will try and help by asking me what I’m stressed about and logically talking to me about any stresses in my life; but in reality the stresses in my life are not the cause and there is in-fact something chemical going on in my brain that’s making me feel this way. That means no amount of logic can take the feeling away. If this goes on for more than a few days, maybe even weeks then my mind starts to fill in the blanks. I’m afraid, really afraid and my body is ready to fight or run away and so there must be something to be afraid of. At this point I haven’t slept for more than a couple of hours at a time, for days or longer, it’s becoming increasingly difficult to think clearly. I start to fixate on small issues, maybe I fixate that the people at work don’t like me, or Rick is going to leave because he’s had enough, perhaps the there is a person on the bus with a bomb, or the man behind me in the street is a murderer. So I have to double check things, ask people if they are annoyed to seek reassurance that everything is ok. However because my thought patterns are disturbed any reassurance I get from those around me doesn’t sink in and I start to repeat myself, driving everyone around me as crazy as I am. The longer this feeling lasts the more illogical my thought patterns become until the lines between what’s real and what’s just my own mind are blurred. Reality being blurred is not cool. It’s not blurred in a good trippy LSD kind of way, it becomes like a nightmarish out of control hell. Paranoia kicks in and throw in some auditory or visual hallucinations and before I know it I’m in the middle of a psychotic episode.

Anxiety is a symptom that is part of most mental health issues. I have met a lot of people with a rainbow of issues and I can’t remember one person that didn’t feel anxious.

When you’re suffering from that kind of anxiety the world becomes a scary place and it gets even harder when you have to start explaining to people what’s wrong. It becomes necessary to hide away because the truth is that no matter how open minded a person thinks they are, this country is, their group of friends are, their workplace is, their church is, (fill in blank here) there is always stigma.

I remember telling a family member years ago that I was having therapy. At this time in my life I was having therapy only because I was training in person centred therapy myself and therefore it was necessary for me to undergo therapy as part of the course. This person had no idea I had any kind of problem myself and the therapy was only mentioned in passing in regard to my coursework. However the reaction I got from this person was disgust, I was immediately challenged “why do you need therapy, what a waste there’s nothing wrong with you, you just need to get a grip” needless to say this person isn’t someone I would ever involve myself in a conversation about mental illness with again.

The problem with mental illness as opposed to physical illness is that people who don’t have a mental health problem seem to suppose that you can just snap out of it; that if you were a strong person, or if you had a good upbringing, mental attitude, you wouldn’t have this problem. Let me put the record straight now. I know many strong, creative and wonderful people who have had a fantastic upbringing, who also have a mental illness. Nobody would challenge someone with a condition like asthma, or diabetes and say “snap out of it” “think yourself better” and yet this is a shockingly popular attitude to mental illness. We are in the 21^st century, and it’s been shown time and time again that with almost all mental illness there is a physical/chemical imbalance within the brain and yet still people are coming out with this bullshit. The cause of an imbalance may vary, and yes it can come about from trauma and upbringing. I’m not saying circumstances and life events don’t play a part for some people, but whatever the reasons are there is still something going wrong in the brain of a person who is mentally ill that is NOT going wrong in the brain of someone who is not mentally ill, and therefore what right do they have to tell anyone to snap out of it! I would like very much for those people to have just one day with the same thing going wrong in their brain and then they will know just how impossible snapping out of it is!

http://www.youtube.com/watch?v=Dw_I-G1smoo

Then there is the problem of getting help. It seems simple, something is wrong with you and so you go to the doctors. You presume that the doctor will do whatever he/she can to help you get better and manage your symptoms. If you had a persistent upset stomach, or a sore throat you would go to the doctor and they would help, so it shouldn’t be any different with something mental? Doctors know how to treat mental illness these days so this shouldn’t be a problem right? Wrong. Doctors can have just as shit an attitude as everyone else. I have had some wonderful doctors and I have had some stupendously unhelpful ones. Going to see a doctor about a problem like this is exceptionally difficult task because by the time it gets to the stage when you are prepared to go to a complete stranger and tell them what’s going on in your mind, you’re already feeling isolated and scared about other people’s reactions to what you are experiencing. Chances are the erratic behaviour has already attracted some unwanted attention and a few people have already given some negative remarks about how you just need to, snap out of it, get a grip, open up, get on with it etc... So when you get to the doctor you’re frantic.

I was lucky because the first doctor I spoke too at least took me seriously and wanted to treat me. I was started on the standard med to treat depression (Prozac) I was also put on the waiting list for some therapy and sent on my merry way.

PROZAC otherwise known as flouxatine and probably countless other brand names, if it’s an SSRI then there’s a good chance it’s a Prozac type of med. In-fact I would go as far as to say that if it’s the first time you have been to the doctor with depression like symptoms and you come out with a prescription then if you double check the brand name its going to be from the Prozac family. From what I know Prozac is prescribed because it is cheap, it’s also not as harmful in an overdose as some other pills but I’m not deluded enough to think this is the main consideration here when the NHS recommended it be the first med prescribed. I’m sure it’s done wonders for some people with depression. That doesn’t mean it is the best course of treatment for any kind of mental health problem. Unfortunately it’s the first course of action for most patients presenting with depression and I was depressed as well as anxious. I was just glad to get help, I think at that point if they had prescribed me anthrax and told me it make me well again I’d have swallowed those pills. Unfortunately Prozac made me worse. It made me manic, so instead of being anxious, paranoid and depressed I became anxious, paranoid and feeling like I was permanently on speed! Let’s just say that this was not a good time. Luckily my partner at the time had the sense to urge me to go back and the doctor (something to do with me setting fire to the fridge and deciding that I could see dead people). The doctor quickly took me off those pills, and 9 meds later I finally found a combination that worked for me (most of the time).

The therapy I got also helped and I think that was thanks to the fact that I had an amazing therapist who I still have the greatest respect for today and the fact that it was psychoanalysis/person centred therapy and not the most common “NHS cure all” Cognitive behavioural therapy (CBT). I have had CBT with several different therapists during times when my symptoms flared up and although in the short term in helped manage some acute symptoms it did nothing for me long term. The thing about CBT is that its all about treating the symptoms, calming the patient down, “giving them tools to cope” and this is fantastic in the short term with things are really erratic but in the long term you never have time to get to the root of the problem . 12 weeks is usually the standard NHS CBT course of treatment (in my experience) and for many patients that’s just not enough time. It’s 40 to 50 minutes a time and it’s really impossible to get to know the therapist in that window. I have learned whilst undergoing my own counselling skills course that the reason the NHS mostly focus their therapy on CBT and not other modes of therapy such as PCT (person centred therapy) and psychoanalysis is because CBT is the only one that can show statistical results and its no secret that the NHS just LOVE statistics! “1 in 10 people have this and 1 in 3 people have that...”

With CBT the patient fills in a form at start of treatment, and fills in form at end of treatment. They get asked questions along the lines of ‘on a scale of 1 to 10 with 1 being calm and 10 being most anxious, how do you feel?’ If the CBT has worked in the short term then the person might have been 10 at the start and then 5 after treatment and the NHS thinks ‘BINGO! CBT cure all for mental illness’. From my experience the reality is that after 6 months the anxiety is back because the root of the problem has not been treated. With person centred and psychoanalytical treatment its more about finding the root cause, it takes longer (so costs more) and the patient tends to get worse before they get better (needs more support in the short term thus more money) and so the NHS thinks too expensive ‘off to the CBT bin you go’. The catch is that in the long term PCT and psychoanalysis is more likely to make lasting results but since most figures work on short term scales, the long term doesn’t seem to exist as far as the NHS is concerned. The psychoanalysis and person centred therapy I had has given me far more benefit in the long run than any CBT program I have been a part of.

I am well most of the time, that doesn’t mean that I’m symptom free because I have my off days but if I manage my medication carefully and I don’t go on all night benders and put myself in all sorts of stressful situations then I am more than capable of living a normal, active life, working, socialising and just generally getting on well in the world of sane people. The problem is that like other long term conditions that are managed by medication and lifestyle changes its still part of me. There isn’t a cure (sorry to break this to anyone who works for the CBT department in the NHS) at certain times symptoms that are not manageable re-appear for no good reason other than my brain feels like it reminding me that it has the ability to wreck havoc on my life. Sometimes a small amount of stress starts off bigger feelings of anxiety that lead me to having worse symptoms reappear (domino effect) and other times it can happen for no reason at all – perhaps some small, seemingly insignificant thing happens and the effect is destructive (butterfly effect). I am lucky I’m well most of the time, sometimes I can go for a year or more when I am completely well and happy. At the moment I’m not right, I know it because I’m highly anxious, fixating and feeling generally irrational. Every-time this happens I feel like I’m failing. I might know logically that this is an illness and it’s no more shameful than having a stomach disorder and yet the stigma and judgements do get me down. I feel frustrated, afraid, and isolated. At the moment I know I’m not right and even though I can have a few hours at a time when I’m ok, I’m swinging back and forward from being a logical rational person, to feeling high in a manic sort of way, or feeling extremely afraid, irrational and paranoid. I feel like all the hard work I’ve put in over the years to stay well and lead as normal a life as possible is being eroded away by this one set back. My relationships, my job, everything rests on me being well. The problem is my own fear of the consequences of my illness taking over completely, makes me more anxious which makes it more likely that I’ll get worse and so it’s a vicious cycle.

I’ve had to take a giant step back from my own life to deal with this which means letting certain people down until I get well again. That sucks and I’m annoyed at myself for not being able to work through it and still carry on with my usual day to day, but I can’t, and past experience has taught me that it’s not wise to try pretend like I can manage. I lost a job once through forcing myself into work in a similar mental state and I don’t want to do that again. I also know that I have been here before and come through it and I can get through it again. This time I’m being a little bit more open with people who I would usually hide away from when I’m not right. This time I also have Rick who keeps reiterating that I’m stuck with him for life and it doesn’t matter how crazy I am he still loves me (by far the most patient man on the planet but I know everyone has a breaking point). So hopefully it won’t last long and I’ll be back to normal soon. That means hoping I get an ok doctor next week who doesn’t decide to try something new and actually listens to me about what works for me and what doesn’t work, and hopefully have understanding people around me who don’t make me feel like I’m the biggest waste of space on the planet.

So please bear with me whilst I’m going through this, and I hope also having read this everyone will be more understanding and supportive of others who are facing similar difficulties.

useful links

http://www.mind.org.uk/ English charity but still has some useful Info
http://www.seemescotland.org.uk/about

The Buddha's head

I’ve been looking for inspiration for the blog for a few weeks. Today something transpired /concluded and I thought it would be a nice story to share J

I’ve been reflecting a lot recently about what kind of person I am. Thinking about life in a different way over the past year has given me a sharp, somewhat uneasy discernment of my own faults. For example, I know that I can be a very demanding person. As I’ve got older I have mellowed to some extent, but even now if I look at myself from an external viewpoint I can see that at times I am a nightmarish, drama creating, monster. I can be analytical about this, go over the events of my life and understand exactly what shaped my ego into what it is today (a few years of therapy and my own PCT training taught me that) but this knowledge has not prevented me from reacting in extremes. I am far too emotional and I often resort back to old habits whenever I face stressful conditions.

The main problem is that I frequently react in extremes. I am high or low, happy or sad, calm or angry and there is no middle ground. For Rick and for friends, family, ex-partners and anyone who spends time with me this is not an easy thing to tolerate. When I feel emotional I feel really emotional! That’s an incredible advantage when I’m happy and content, but it’s not so convenient when I’m angry, or upset because with the severe emotions come actions that I later regret. Deep down I know that this is not a good way to live my life. What I need is to find ways to ground myself and not be controlled by my past issues, and consequent potent emotional reactions. Although I enjoy the times when I feel happy to the extreme, this is not real joy because it’s easily interchangeable with fanatical anxiety and restlessness. Therefore because I am conscious that something relatively small could happen that will change my mood back to more negative extreme, even in my moments of “happiness” there is an underlying feeling of unease.

I have a persistent feeling of agitation because the things I believe make me happy are always things that can be taken away and so there is a chronic anxiety about when this will happen and the anticipation of the grief and unhappiness this will bring. I have a crushing need to be loved and yet any love I am given I rarely believe belongs to me. Rick is the most loving, thoughtful man I have ever met. He genuinely has the patience of a saint and yet I am incessantly fearful that his love and kindness will change into something dark. This causes me to act in ways that mean I am not always easy to be around. It also means I can’t appreciate fully the amazing nature of the love that we share because even if sometimes I get a glimpse of a realization of just how very lucky I am those moments are lasting because I can so easily burry any contentment that comes my way with my very own bubble of anxious doubt. Somewhere along the line I have learned that I am neither likeable nor lovable.

So in order to assert some control over my fretfulness I will create in my imagination a certain chain of events that have to happen in order for me to feel secure. I have a plan in my head and when things go according to plan I have temporary feelings of security. However things do not always go according to plan and often my make believe security is challenged. My plan can be simple, we will decorate the kitchen in a certain order, A, B, C and then D and even though it might not matter if B and C come in a different order because I have this set order planned out in my head if that doesn’t happen I’m thrown into a fit of anxiety and irritation.

Some months ago I had an argument with Rick over something like this. I can’t remember exactly what the argument was but it was something that I had imagined happening a certain way that was not happening the way I had planned and so I was feeling insecure, anxious and over emotional. I yelled at him, cried and generally acted in a way that was self grasping and centred on me, me, me, my wants and my needs. In that moment it felt like the small thing that hadn’t gone to plan was the end of the world.

Rick is remarkably accepting when it comes to things like this, he knows me well and understands the reasons why I react the way I do. In the first 2 weeks of our relationship I had listed off every negative quality I possessed and told him all of the things that I struggle with and why. He learned all of my history in regards to mental health and he still accepted and loved me regardless. With him there is no shame around my problem, it’s talked about frankly and explicitly, he knows what meds I take and helps me keep a close eye on that side of my health. If things get bad I can’t always see it but I trust that he will and he will help me get back to normal as quickly and kindly as possible. I think he is the first person I have been so honest with because he has never made me feel like it’s something I should hide. This honesty means that he rarely gets annoyed with me and usually he rides out whatever emotional state I am in without getting involved in an argument. I know when it comes to making plans and getting things done in the house he often does things my way so that I don’t get over anxious or feel out of control. However inevitably stuff will happen that is out of my control and I can’t always blame my ungrounded reactions on the fact that I have a mental health problem.

On one occasion some weeks ago, in my frustration I threw something across the room. This used to be a common way for me to deal with anger but nowadays I am usually mature enough to know that this is no better than a child having a tantrum. On this particular day I was stressed and reacting to something relatively small in a heightened emotional state, therefore throwing something seemed like a good idea.

Myself and Rick are Buddhist and we have a fair few Buddha’s in our front room. What I threw (I think it was an unlit candle) hit against the back of the living room wall and bounced of the piano knocking one of the Buddha statues off the piano and onto the floor. As soon as I had thrown the candle I immediately regretted it, seeing the little Buddha statue fall to the floor instantly reminded me how unacceptable my behaviour and actions were. We believe the statues themselves are to be treated with the same respect as the Buddha himself and so knocking him onto the floor in a fit of irrational irritation was as bad as pushing the Buddha himself onto the floor. Even worse was the top of his head broke off and so I had without meaning too just completely disrespected my faith, and everything I believe in all because I was not in control of my emotions.

We hunted high and low for the top of the Buddha’s head, we moved the piano, the chairs, rugs, we searched everywhere and couldn’t find it and so we had to put the Buddha statue back on the piano minus part of his head. The idea of throwing him away wasn’t an option because I felt bad enough that I had damaged him let alone chuck him out with the rubbish. I apologised to Rick and anything I had been ranting about previously seemed silly and irrelevant.

For several weeks every time I saw that statue sitting in the living room I was ashamed, but deep down I still didn’t get it. I knew that responding to situations in such an extreme way usually meant that I would do something I would later regret yet I was still allowing myself to carry on like this. I felt bad about what I had done but I didn’t change anything, I just kept thinking that I needed to minimise the amount of stress I was dealing with so I could stay calm. Thinking along the lines of, if only the flat was tidier, my job was better, I got to spend more time in meditation or with Rick relaxing then I’d be fine and things like that wouldn’t happen. I wasn’t exactly taking responsibility for my actions.

Yesterday I observed someone else who lives there lives in this kind of extreme way. Someone I know who was clearly swinging from one emotional state to another and basically acting in ways similar to how I act out. I saw clearly this persons overwhelming yearning for love and attention and understood exactly why they had certain behaviours. I was also able to see how those negative habits did the person no good and for me it was like looking in a mirror. I was feeling irritated by this person and yet they where doing exactly the kind of thing that I do myself. I suddenly realised just how other people could view me and how damaging it was for me to carry on this way. As I was walking home from the bus stop I suddenly wanted badly to find a way to ground myself and I realised that this is what I had to do if I ever wanted my emotional state to change for the better. I could see clearly why the “middle way” really was the best way to develop personally and spiritually and I made a determination that I would find a way to change my way of dealing with stressful conditions. We got home and I started to prepare a meal as Rick gave the living room a quick tidy I was telling him how I felt that I wanted to try hard to make a change. To my surprise he immediately found the top of the Buddha’s head just sitting at the side of the couch (a place I swear we have looked before). I felt so relieved to find it and it seemed like the entire thing taught me a lesson in a round about way, or at the very least it made me mindful of what I am doing. I glued it back on and he is now sitting back on top of the piano looking as good as new. It seems like now I understand what I have to change it was the right time to find his head and now when I look at him I don’t have to think about how awful my behaviour was. Instead I can remember the fact that I have made a determination to change and stop making the same mistake over and over again.

I’m certain that I won’t be able to just click my fingers and change all my negative habits at once but I think this is the first time that I actually understand that I must change this way of interacting with the world other wise I won’t ever progress in Dharma or be happy and content. I think I could have gone on with this habit for the rest of my life and so it feels really good that I can see clearly where I need to make changes. So hopefully with some work and Rick pointing out to me when I am acting irrational I can start to keep myself grounded and create as little drama as possible.