On Mental Health Awareness Week and my Mental Health

Because it's Mental Health Awareness Week I thought I should talk about mental health.  I've talked about this before - but it's always good to revisit as I learn new things over time.

My official diagnosis is PTSD resulting in anxiety, depression and dissociative disorder.  PTSD stands for Post Traumatic Stress Disorder, and in my case it's childhood trauma - so I can never  remember a time where I wasn't mentally ill.

I wasn't officially diagnosed until I was 20, but I have been symptomatic my entire life.  When I was  11 I was diagnosed with exercise induced asthma.  Retrospectively, what I was actually suffering from would have been panic attacks.  Kids didn't get diagnosed with mental health stuff back in the 80's and NZ has the second highest rate of asthma in the world, so it was a reasonable assumption.  Even though my peak flows were always off the charts.

How does having this illness affect me in daily life?

Like Masha and the Bear only not so cute...      

Well, sometimes it doesn't affect me much.  Living with mental health issues is like living with a friendly bear.  You live together side by side, most of the time it's just a little uncomfortable because it's a bit weird living with a bear.  But some days the bear just shits in your bed.  And you have to clean it up before you can go to sleep.  And some days the bear totally maims you with its claws and you feel like you will bleed to death and die.  But you don't want to tell anyone because your flatmate is an unpredictable bear.

And you don't always know when those messy days will occur.

Sometimes I know when things are starting to get bad and you I help.  But sometimes I've convinced myself that I'm ok, so I don't.  I have been in and out of therapy for 22 years now and I still don't get it right all the time.  I am sure this is not uncommon.

If only I had a protocol droid

The everyday things I struggle with are social.  I need to know what is socially expected of me to feel comfortable - I wish I had a protocol droid like C3PO at my side 24/7 to help me negotiate my way through social situations.  If I don't know what is expected of me I tend to panic and then shut down - like an overheated engine.  Consequently, I am scared of phoning people I don't know, walking into a situation I have little information about, or trying new (social) things.

This may seem odd to people who know me because I am a social, friendly person.  It's because I like people.  And I am fine in social situations if I know what's expected of me.  That's why I like working in retail - there are obvious parameters for most interactions.  The kinds of things I'm not good at are small talk with parents I don't know, or interacting with tradespeople or going to job interviews.

The other thing I suck at is conflict resolution.  I may seem bold on social media, and in person, but when it comes to actual conflict I freeze.  I have watched myself do it.  When someone touched me inappropriately recently (even after I had told him 'no' insistently) I just froze*.  It's like I'm a deer caught in the headlights.  I don't want to respond this way, but my body physically refuses to do anything else.  It's part of my dissociative disorder.

The other part of this is that I often zone out so much I truly do not see or hear anything outside of my 'zone'.  If I am out of the house, I am usually on a mission - so I'm in my 'zone'.  People have often accused me of 'snobbing' them because I have completely ignored them despite their bids to get my attention.  I'm telling you now, 98% of the time I would have just not seen or heard them at all.  This isn't the greatest for my kids - I have to work really hard on trying to be present for them, but it is really handy for getting work done in a noisy environment, or staying on task to complete a project.  So it's not all bad.

If I am unwell, I will try and manage my survival by procrastination or total avoidance.  I will avoid areas of known potential conflict.  I will not make the phone calls or open my mail.  I won't engage in unpredictable social activities.  When I was extremely unwell at 20 I just stopped leaving my house entirely**.

Sertraline - truly a lifesaver for me      

    

These days I manage my illness primarily with medication.  I take a low dose of Sertraline (the safest anti-depressant for when breastfeeding or pregnant), which is an SSRI that helps balance out my brain chemistry a little.  For me, being on medication means I can actually just live a normal life.  When I came off my meds recently, cashing up at work would often cause me to have a panic attack** even though I'm very experienced and good at this.  Because I was panicking, I would make mistakes.  Taking my medication means I can actually do my job competently without freaking out.

I've heard many misconceptions around antidepression and antianxiety medications - the main one being that it makes people into zombies.  Sure, if someone is on lithium or loads of sleeping meds or a combination of meds then maybe yes.  But in my case it just helps me feel, I guess, like a well person.  This will likely be the same for most people with long mental health histories - over time we have found the right chemical balance for us.  There are many, many different medications out there, and you often have to try several before finding the right one.  Dissociation makes it difficult to feel connected with reality.  It often feels like I am watching everything through plastic, like I'm a voyeur in my own life.  For me, medication helps me feel more connected with the world and consequently, makes it easier to make better decisions***.

I've also heard that it kills your creativity.  Maybe it does for some people, but not for me.  I try and write about something I care about at least once a week.  I photograph birds daily.  I try and have an annual creative project to work toward and look forward to.  Medication actually reigns in my manic tendencies which allows me to have better focus.  And my creative tendencies help me manage my mental health in a productive way.

Consciously engaging with nature daily in a creative way helps me to feel grounded

I do other things to manage my mental health as well.  Medication is the stabiliser, but in order to stay well I need to live consciously.  I try to make sure I have regular time to myself.  I focus on gratitude - daily when I'm not coping well.  I connect with the bigger world outside.  I walk.  I read.  I utilise routines.  I (try to) practice mindfulness.

1 in 6 New Zealanders will experience mental illness at some point in their lives.  And women are 1.6 times more likely to be diagnosed than men.  I don't believe is necessarily because we experience it more.  I think that Kiwi men still struggle to talk about their wellbeing so are less likely to get a diagnosis - I'd say our suicide statistics reflect this.  I am so grateful that we have men like John Kirwin and Mike King working to change this.

If I could impress one thing on those struggling to understand mental illness, it would be that it is a real illness.  We are not just really sad.  We are not just high strung.  We cannot just 'get over it'.  Like managing any illness, we need to visit our Drs regularly.  We need to utilise tools (medication, therapy, changes to lifestyle) to manage our illness.  And living like this is tough.  For some of us we have to live this way for the rest of our lives.  And it's not to feel special, or because we are too lazy to be 'normal'.   Mental illness is not a choice.
No-one would choose this.

But with understanding, patience and compassion you can choose to support those of us who experience it.

*            *            *            *            *            *             *            *            *            *

If you think that you, or someone you know may be suffering from mental illness read this.
If you want more ideas on how to help someone suffering from mental illness, read this.

* It was (again) due to social disconnect.  If he were some rando I would probably have kicked him in the balls.  But he wasn't.  He's someone I know who is older and doesn't speak much English, and I didn't know the social convention of how to handle bad touching from an old person I know.

**At that point I didn't think I could cope with any social interactions in an appropriate manner (besides with my Mother) and was terrified of running into people I knew on the street - there was also a high chance of doing that as I was living in the suburb I grew up in where everyone knows pretty much everyone else.

***Because of perceived time pressure leading to awkward social interactions with managers.
 
**** When you don't feel like you actually exist it's very easy to make poor choices.  It's like you're playing a video game and you're curious to see what will happen if you walk into that pit with the spikes.  You know that you can just start over.  Because you're not really dead.  If you don't feel connected with existence to begin with it is difficult to feel afraid of death or of the outcomes of poor choices.

On Being Glad

Oprah and Dr Phil generally piss me off.  But one thing Oprah harps on about that I agree with, is the importance of being grateful.  Reading Pollyanna as a small child, however tacky it may sound, had a profound impact on my world view.  I related to Pollyanna as my childhood was what would be considered dysfunctional.  But my trials and tribulations had nothing on hers.  Being able to be 'glad' for crutches when you really wanted a doll, purely because you didn't need them, was an important lesson for me.

Being grateful helps you to step back from the intensity of existing within what might be a painful experience.  It helps you to look at it from another angle, and to have compassion for those who may be in a worse position to you.  Often when things get bad, it's easy to overlook the things in life that are really great, or the people around you who are amazing.  It gives you perspective.

Perspective is an important thing to have when things are tough.  Getting wrapped up in your head is one of the least useful things you can do.  Obsessing about bad things makes everything seem worse than it is.  Being grateful is not about belittling the feelings you have - it's ok to be sad/upset/pissed off about things/people/situations.  But after venting that stuff, it's really important to refocus that negativity into something positive - gratefulness is an excellent tool to aid in doing that.  There is no situation that this is not applicable to.  Things we take for granted, like having clean water to drink, are still things to be grateful for.  I know I probably sound like a Nana saying this, but it's true.

When I was younger, a serial monogamist with relationship drama after drama, when things were really bad I would watch this movie called Atanarjuat: The Fast Runner.  This film is set in the Arctic and is about a community that is cursed by an evil spirit.  It is three hours long, and highlights the difficult life of those who live in the Arctic, made more difficult by this evil spirit.  For almost an hour of the film, the protagonist is running buck naked across the ice being chased by three guys who are trying to kill him.   Watching this long, subtitled film pulled me out of my life for a bit.  I always came away from it thinking 'Well at least I'm not an Eskimo' (yeah, yeah - Inuit, I know).

I can't even begin to conceive of living in an igloo in close contact with other people where a big part of my day will consist of chewing on seal skin.  I hate the cold.  I don't really eat much meat, and I needs my personal space.  How could I exist with only lichen for greens?  And only over Spring/ Summer?   How would I cope with everything smelling of blubber, smoke and fish?  How would I live in a highly structured community with strict male/female roles?  Let alone coping with some curse which means my whole family gets killed and I have to run naked across the ice with no shoes for ages?  Watching this film has always put my life into perspective for me.

I've watched it enough by now to have this message ingrained, so I don't watch it any more.  Instead, I take some time to think about the things I am glad about.  It's such a habit now that it's seldom a challenge.  On really bad days where everything feels horrible, I focus on the simple things - like eating cheese, or having a bath, or getting up off the toilet without my hip displacing.  On better days I can focus on bigger picture stuff.  Being glad for things gets me through hard times like now.  So today I thought I'd write a short list of what I'm grateful for today:

1) I am grateful to be pregnant with a healthy baby.  At all.  We are so lucky that this even happened for us given my previous health issues.  Many people can't get pregnant or carry babies to term.  Even normal pregnancy is statistically unlikely - so many things have to happen at just the right time for it to occur.  I am glad I didn't go into labour last Thursday because it may have compromised the baby's health.  I am glad for every day we get closer to 37 weeks (only 8 sleeps to go).

2) I am grateful to live in a country/be of a belief system where I can choose how many children I want to have.  I am glad that if I choose not to, I never have to do this again, and I'm glad to be in a relationship where I do have a choice.  I am grateful to have access to safe contraceptive methods, and the knowledge with which to apply them.

3) I am grateful for my partner.  He has fetched me food from far away just because I'm sick/sad and want to eat a specific food from a specific place.  He gives me massages at least every couple of days.  He has come to all the classes I've asked him to, and is as invested in everything as I am.  He is definitely the best person I could ask for to be my birthing partner.  I have no doubts that he'll make an amazing Dad.

4) I am grateful for my friends and whanau.  I have an amazing support network which can never be taken for granted.  So many people who struggle do so because they do not have what I have.  These people amaze me on a daily basis with their willingness to support us in a multitude of ways.  Today my Grandma and Aunt dropped books off for me to read while stuck at home because it's hard for me to go to the library - I am so lucky.  I am grateful that both mine and Murray's parents are alive to be grandparents to our child.

5) I am grateful for the support and free services we have in New Zealand for mothers to be.  I am grateful for the range of birthing options we have, and free access to education about them.  I am grateful for my Midwife, for my Physio and our local hospital.  I am grateful to have access to the internet and pregnancy/baby related forums.  I am grateful that my cousin is training to be a Midwife, and has answered so many weird questions for me.  I am grateful that my brain is no longer overwhelmed by the information on offer.

6) I am grateful that we are fairly financially stable and that I am not working and not worried.  This is a luxury that could easily be taken for granted.  I don't know how I could possibly work in my current state although I'm sure there are many women out there who do because they have very little choice.

7) I am grateful that I'm not on bed-rest.  I don't know how I would cope with that.  Being housebound is bad enough.  Being bed-bound, particularly with what I've learnt through yoga, would be devastating. 

8) I am grateful for our pets.  Even though they can be annoying, they are a reason to get out of bed in the morning and a reason to laugh.  I am grateful we can afford to have pets, the small things they bring to life have more impact than we give them credit for.  I am also glad Murray let me put the rabbit in the house today (raining).  He looks like a cute wookie thing.

9) I am grateful for cheese.  Especially the nice cheese left after the family baby shower yesterday.  Especially because we have mustard and hummus and yummy other things to have with cheese in our fridge.  Especially because ODing on cheese totally combats my constipation.  Because I'm not supposed to eat that much of it. 

10) I am grateful for crappy TV, especially comedies.  Laughing at other people doing silly things helps get me through the day.  I am especially grateful for It's Always Sunny In Philadelphia.  I am grateful to have friends who understand this.

On Living With Anxiety and Depression

After writing the diatribe that was the 2012 Summary, I realised a few issues needed expanding on.  I'd just assumed that at some point in time I'd have written a post about anxiety and depression.  Turns out I haven't.  So thought I'd attempt to do that today.

So what causes people to have these things?  For some people it'll be purely chemical, possibly hereditary or even contributed to by hormones.  And for others it's as a result of some sort of trauma.  I was diagnosed with PTSD when I was twenty, and this diagnosis made complete sense to me.

I didn't grow up in what would be called a 'stable' living environment.  My parents continually broke up and got back together.  I moved homes often, and attended four different primary schools.  I witnessed violence within my family.  I was poor.  The thing that made this hardest was that I knew  this wasn't right.  From around the age of nine I felt like the only sane person in our household.   And I couldn't do anything about it.

When I finally escaped this situation I was fourteen.  Things had reached a point, partly to do with my father's mental health, and partly to do with me being a teenager, where I just couldn't do it any more.  Mum helped me to get to a friend's place on Christmas Eve and my Aunt picked me up from there.  Mum managed to get out a month or so later (I can't remember how long it took) and we got a little flat together with custody of my brother every other week.

Although it took years after leaving for Mum to realise that the situation we were in was one of 'domestic violence', she knew that I was messed up, and sent me off to counselling.  I've been in and out of counselling now for more than sixteen years.

I'm not going to give a history lesson on all the times things got really bad, or all the crazy things I consequently did.  I will summarise by saying that there was a half-arsed suicide attempt in my teens, there was a point where I was so unwell I couldn't leave my house, and I did a multitude of harmful things to myself and others over the years.  Now, through experience, I feel that things are more manageable, but this is something I can never be complacent about.

For people who haven't experienced anxiety I'll do my best to explain what happens to me.  First of all, it's actually a physical thing.  Usually something will 'trigger' a physical response (adrenaline).  My heart starts beating super fast.  I get flushed.  My hands get clammy.  My legs get shaky.  I feel like I need to pee.  I often have difficulty breathing.  And this starts what I call 'the head/body anxiety cycle'.  Whatever has triggered the panic attack is usually something I'll be aware of.  Once my body starts going crazy, my brain starts to catastrophise all the things I was initially a little worried about.  My brain catastrophising keeps my body 'triggered' and none of this goes away until the thing I was initially worried about leaves my immediate vicinity.

This is why anxiety/depression is a cycle.  It's chemical.  Once your body has run out of adrenaline and endorphins, there's not a lot of happy stuff left.   So then you get depressed.  Again, depression is a physical thing.  I feel exhausted.  Everything feels heavy.  I feel as though I am viewing every day life from afar, like watching TV - I feel physically distanced from my life.  It is this sensation in depression which is the most dangerous.  Because I just want to feel something, and will do harmful things to do so. 

While I've been in and out of counselling for a long time, I've been on and off drugs slightly less.  I OD'ed on prescription sleeping pills as a teenager, which made me really anti drugs (why give someone who's depressed something they can use to kill themselves?).  It wasn't until I got very ill in my early 20's that a doctor convinced me to try  SSRI's.  I tried three or four different ones over the space of a year and a half, and none of them helped.  I was regularly seeing a therapist at the same time which helped me through that particular time.  It wasn't until about four years later that I tried Fluoxetine (Prozac) and found it actually worked for me.

Fluoxetine is something I think of as a stand-by for when I can't stop my body getting to that dangerous state.  I want to be well, and I know that at certain points no amount of talking it out will keep me from going there.  I have had so many people say 'do you feel like a zombie' re: being medicated.  I feel like a zombie when I'm unwell and not medicated.  When I'm medicated, I feel like a normal, well adjusted person (with a dry mouth, side effects do suck).  I am not on Fluoxetine all the time.  I just use it when I feel it is necessary.  I've been off it for over a year currently.

The other thing I've found very useful is not believing in 'regret'.  For many people trapped in the depressive cycle, regret's an easy habit because there is so much you'd rather have not had happen.  But it puts you in stasis.  You can't move forward, and it's not possible to move back.  I acknowledge the things that have happened to me, and the things I have done, but I don't regret them.  Regret makes people bitter and miserable.  Being bitter and miserable doesn't seem very fun.  I do believe in mistakes.  I think of them as 'mis-takes', as in 'we're retaking this scene because it wasn't quite right', where you do it over, again, and again, learning each time how we can improve on the last 'take', and appreciating what we've learned from it.

Understanding why this cycle happens also makes it more manageable.  I do not think I can ever 'fix' this.  Basically, my body is programmed for 'fight or flight', which is why it reacts with the adrenaline so quickly.  This is because in the past, 'fight or flight' has been a necessary survival skill, and has often arisen out of seemingly banal things.  So when I'm feeling just slightly off kilter, anything which causes 'confrontation' will result in me having a panic attack.

This is what happened in November.  I was terrified about having to tell my new employer that I was pregnant.  This fear was impacted by the very rough year prior, which already had me frazzled.  I catastrophised that I would lose my job as a result.  Even though the reality is that this wouldn't be the end of the world, much of my esteem is wrapped up not only in my job, but it how it contributes to our household earnings.  So these feelings snowballed into daily panic attacks and the panic attacks led to a cycle of depression.  I genuinely thought my husband was going to leave me ('dangerous' point in depression aided by feeling worthless), and started to try and work out how I could live as a single mum...

It is ridiculous that things got to this point, but it is often difficult to see what point you're at when you're living in it.  And I still find it hard to ask for help, even from those closest to me.  Because you have to admit you aren't coping, and are being irrational, and you aren't a proper functioning 'grown up'.  And sometimes when things are really bad, it can mean compromising things important in your life.  Like your job, or your relationships.  That's bloody hard to do.  Once I did finally ask for help, things started to become more manageable pretty promptly.

I am certainly not a magically 'sane' person now.  But my life is 'manageable' and I've banished this particular fear by being proactive with my boss (which was terrifying, then a huge relief).  Chemically, things have reached a balance because I'm not having panic attacks any more.  And I got through this patch with my husband, home, job and everything, intact.  This is successful anxiety management.

And I hope that writing about it will help other people understand what it's like to live with this.  And for those struggling with depression or anxiety, to know that you can live with it.  Things will be ok.