For this third post on my experience I’m pulling together a number of thoughts about the process of overcoming depression and of ‘getting better’, as it has been for me. As this is a long article I’ve divided it into sections, to make it easier to digest.
Alongside the treatment for depression my GP started a series of tests to establish if there were any physical conditions for which I needed treatment. I’m overweight, so there were some obvious possibilities. I was given one of those cards to take to the hospital for blood tests – it felt like I’d hit the jackpot, every box had been ticked and a few other tests had been written in the blank space too! I was also referred for an ECG, as my GP had noted some irregularity in my heartbeat, which she thought might have been a contributory factor in the sleep problems. And my blood pressure was apparently very high, well into the range of being treatable, although she didn’t tell me that at the time! Fortunately it was back down to a more normal level within a couple of weeks, so treatment wasn’t required, and amazingly most of the tests were OK. Cholesterol was low to normal, not sky high as might have been expected, and there was no diabetes or anything else to worry about. But the tests showed something odd with my liver, so I was then sent for a liver scan. Again, fortunately, this showed no abnormalities.
Ironically, I think, I work for an NHS Trust which provides mental health services. I’m not a clinician, but I know how much emphasis we place on caring for patients’ physical wellbeing as well as their mental health. I now see why. Just to be reassured that there was nothing to worry about with my body was good for my mental health – at least there were no other problems to worry about. I still have my sleep problems, but this is a big subject so I’m intending to do a separate piece about it.
Despite those ongoing sleep issues I seem to be getting by sufficiently well to function in the real world again, albeit slowly and carefully. The depression is more difficult to pin down. I feel better and since I’ve been back at work many people have told me I’m looking well, and that they can even see an improvement in the time I’ve been back. But I know that I’m not ‘cured.’ I’m not sure if that is even possible. I have to accept that this may be something I’m going to be fighting for the rest of my life.
I have what Winston Churchill called ‘black dog’ days. These manifest themselves as a sudden, severe downward shift in mood, which usually happens for no reason, and out of nowhere. They only last a day or two, and at the time of writing it is six weeks since the most recent one. I am very vulnerable at such times, as I can give the outward impression of functioning well, but inside I know how much of an effort I have to make. I think I’ve had three or four of these since going back to work, but haven’t missed a day’s work from them. But they play havoc with my emotions and with my ability to interact with people, particularly those to whom I feel close. I can behave stupidly, I can behave badly, and on one occasion the damage has not been possible to repair, although I hope that it might at some point. However, I am learning from experience. I can now recognise the signs of the sudden mood changes, and when I am in a dark place again. But it is this level of self-awareness which is in itself a sign of getting better, I think. This view is shared by all of the professionals, and I now have to turn the ability to recognise those signs into the ability to exercise more control over my emotions and actions, until the black dog has gone.
Something else I have experienced for the first time in my life is a panic attack. A couple of weeks after I went back to work I was in a large crowd outside the local station, which was closed for safety reasons while a smoking train was hosed down further up the line. Although of course it wasn’t, I gradually came to feel that the crowd was pressing in on me, like a large, shapeless monster, and as this feeling got worse I felt progressively less able to cope. It got to the point where all I could do was get out of it, and as I live close to the station I went home and emailed work to say I wouldn’t be in. Apparently, this is quite normal for someone coming out of depression, as you adjust to being back in the world again, and I’ve been told that it may well happen again. All part of the experience!
I have been on the second highest level of medication possible for the past ten months. Both my psychiatrist and my GP think it is too early to reduce the dosage, as my ‘recovery’ may be put back. I’m disappointed at this, but recognise that they are professionally qualified to make that assessment, and they are doing it because they believe it to be right for me. I know I’m still fragile and vulnerable – even on days when the black dog hasn’t come to visit, little things can upset me when I know that they shouldn’t, but I feel powerless to stop them. An unkind or insensitive word or action that wouldn’t normally hurt me can now assume huge importance. So I know that they are right: I’m not ‘100%’ yet, if I ever will be. And how is ‘100%’ defined anyway, in relation to mental health?
Going back to work
After initially seeing my GP fortnightly, she began to see me for a monthly review instead. I felt this was a sign I was getting better, and each time I went to see her I thought ‘this is my time; I can go back to work now’. And for three or four months I came out of the surgery disappointed. But I now realise that depression isn’t an easy thing to overcome, and identifying the right time to go back to work isn’t easy, either. Being realistic, I was the last person to be able to judge that for myself! When my GP felt that I might be able to cope with work again, I was referred to the Employee Health Service (EHS) for an assessment. This resulted in a staggered return, working mornings to begin with, leading into some full days, over a four week period until I was full-time again. But the EHS was also able to arrange for me to have counselling, much more quickly than the local service to which I had been referred when I first saw the psychiatrist eight months earlier, and I started counselling a week after my first assessment with the EHS. This then led to a suggestion from my counsellor that I start using the hospital gym service too. At the time of writing I’m just coming to the end of my fourth month back, and generally I’m feeling good. I still feel very tired, partly due to my sleep difficulties and partly, I think, to the mental pressure of functioning regularly in the work setting, but I’ve learned not to expect too much of myself. I am working more regular hours than before I was ill, when I almost always did an hour more than standard every day. People have been lovely to me; I’ve enjoyed getting back into a routine and having regular contact with the world around me. I am even finding it easy to get into work at least an hour earlier than before I became ill, so things are looking up! But I still feel fragile and vulnerable, knowing that something could set me off. I don’t cry as much as I was doing, but it does still happen. I just dread the thought that it could happen in public, either at work or somewhere else.
I’ve never had any counselling before, so I wasn’t sure what to expect. Contrary to popular misconception, there weren’t any questions about what my mother did to me while I was in the womb to make me the way I am! The focus has been on picking out things in my life and my character, which if addressed can help me improve. My counsellor was able to read me well after just a couple of sessions, and was very adept at knowing which buttons to press to make me think about myself in new ways. As I have said, this is being written at his suggestion, both to help me work out what has happened to me and also to share it in the hope that it helps others. And I can see that it does help me. Whilst I’ve always been able to talk a lot about myself it has been about the superficial, everyday things, not my innermost thoughts and feelings, which I have, I think, hidden away and not given enough thought to throughout my life. We agreed at our most recent session, yesterday, that we had taken this as far as we could and I’ve therefore been discharged from this part of my treatment. I know that the door is always open if I feel the need for help in the future, which is comforting. But the one thing I would say about the whole counselling process is that if you are in the same situation I was, do give it a chance. Many people see it as pointless: they think you just talk aimlessly about yourself. It is far from being that! I have been challenged, made to think and write about some quite deep thoughts and emotions, and have surprised myself at my response. I am now thinking and, I hope, feeling, in ways that had lain hidden all those years. If you get the opportunity, go for it too, it can make such a difference.
Losing weight, getting fit
The only times in my adult life that I had been near a gym were when collecting my sporty daughter. Surely this wouldn’t help, would it? But then I thought, why not? I know that physical health is important and was assured that, being hospital based, this was not the mass production, battery hen style of gym that I might have seen before. It was compact, friendly and ideal for those like me who were terminally afraid of exercise. After only a few sessions I began to feel some benefits, and there were little improvements each time. I then did something I never expected to do: I actually bought some gym equipment for home. I now exercise regularly and am enjoying it! Alongside this, I was referred to the dietician at my GP practice. I needed to lose a lot of weight but was wary of ‘going on a diet’ as there are so many, each of which claims to be the best thing since sliced bread (sorry!) until they are discredited. Again, I had a pleasant surprise. The conversation was largely around how to eat a healthy and balanced diet, without the need to start a formal diet programme. So far, this seems to be working: I have lost 17kg in 19 weeks, and I feel so much better for cutting out all the bad stuff and eating well. This then has a circular effect: the happier I feel about losing weight and getting fitter, the better my general mood is. My advice, in the words of the prophet Nike, is ‘Just Do It!’
I don’t have many close friends; I’ve never really been any good at keeping in touch. It sometimes amazes me that I ever got married, as I don’t think I’m good at relationships. But this last year has made me realise that we all need a support network around us, not necessarily there every day, but just to have people you know you can rely on for help and support when you really need it, and who will come to you for help and support when they need it. But you can’t just create that, can you? I guess what I’m trying to say is that we should all value our friends and those who care, and be positive about it. In other words, be proactive – don’t always wait until someone gets in touch with you, call them to see how they are. It can help, believe me. This is also a theme I’ll be developing in a later post.
Have I changed?
Am I the best person to answer this? I certainly feel different from a year ago, but is that just a continuing recovery from being in a very bad place? Am I ‘different’ from the way I was? Am I a changed person? I’m trying to answer all of these questions, but it’s a work in progress. My recent experiences and the support I’ve received have made me think more about myself, what kind of person I am, but not in a self-centred way (I hope!). They have taught me to question myself and challenge myself more, as it was all too easy before to settle into a routine which in effect became a kind of trap, and getting out of it was difficult. I’d like to think that, by developing, understanding and using my greater sense of self awareness I am being a ‘better person’, whatever that is! I hope others in situations like mine feel the same.
Can I help anyone else?
I don’t know, can I? I’d like to think so. I don’t think I’ve been good at supporting other people in the past, and would like to feel that I could be better at it from now on. Maybe this is a start. I don’t think I’m offering any deep insights – I know I’m not qualified to do that. But I hope that anyone who reads this and recognises something of her or himself in it can take it as a stimulus to look at the person they are. If that helps even one person it will have been worth sharing my experiences. I know it sounds trite to say it, but if I can change things around, so can anyone – with the right treatment, support, mindset and determination.
To follow this up, I plan on doing the occasional short post in the future on ‘tips’, small points I’ve learned along the way which may help others. Nothing professional, just things I’ve picked up which have helped me cope, and which may work for others.
I retire when I reach 60, in September 2013. As my daughters are both grown up and have their own lives, I don’t necessarily need to stay where I live now. Of course I want to see them as often as I can, but there’s more than one way of doing that. I won’t be able to afford to live on my pension within London commuting range, so I’m thinking about moving back to my Kentish homeland. I haven’t decided anything yet, but I’d hope that would give me a retirement which would include getting out and about enjoying nature and the landscape, and supporting Kent CCC and my home town football team, the mighty Dover Athletic! Until now, I don’t think I could have done that properly – so I’m aiming to keep up the exercise, a healthy diet and generally thinking more about life, so that everything comes together and I can have the kind of retirement I’d like.
I hate phrases like ‘he’s been on a long journey’ but have to admit that it does feel a bit like that, although I’m not stupid enough to think I’ve arrived anywhere yet. I have had, and still have, some wonderful support and I’d like to close by acknowledging those who have contributed to this. No names though, they will know who they are, both on the professional and personal fronts. Thank you all. I hope I do justice to your support and kindness.
And thank YOU for reading. I hope these three pieces have perhaps informed, helped, maybe even amused you in places. I’d love to hear your views and what else you might think I have to tell that may assist and/or entertain. I’ll be posting fairly regularly now, on a wider range of subjects, and I hope you stay with me – let’s face it, there wouldn’t be much point posting this just to myself!