Finding the light

Hello friends,

I’m back. Sorry about missing the blog last week! I tried. I came up with one draft, then discovered it was totally over-dramatic and not what I wanted to say. I did another one, but when I read it back over it just didn’t really seem like much of anything! So, here I am with two discarded drafts, no post for last week, overdue for this week and next week is coming around fast! A bit frustrated!

Why am I so stuck? Why am I spinning my wheels? I want to write about suicide, but this time it’s real, somebody that I used to know. And despite however much distance you’d think “used to know” would put between me and this event, it has gotten under my skin.

For people who suffer with mental illness, hearing about another person’s experiences can be a trigger for a worsening of your own condition. We’re so susceptible to worsening when we’re unwell. It’s different when we’re doing well; we’re resilient and strong. This is especially true abut suicide. Talking about suicide, hearing about suicide, reading about suicide can be a trigger for someone who is unwell to start thinking in circles, over and over about suicide. That’s not to say that someone can cause another person’s suicide. But to a person on the edge metaphorically, it only takes a tiny bump to over-balance.

I’m not suicidal. I’ll clear that up now, and relieve any worried minds. I’m actually doing quite well, but this event has given me pause to think about not being well. It’s quite a long time since I have been suicidal. I have been very fortunate that suicidal thoughts have only been a small part of what I’ve experienced over the last 3 years. I tend towards grey days, nothing dramatic. But still, hearing about someone I’ve known, someone who was one of my first childhood friends, someone who I grew up with ending their life creates a moment of questioning of the situation and myself.

Of course there’re so many questions that come with any death by suicide. Thankfully in this case some of those were answered before the last day. The family were well aware of the mental illness and very supportive of their son, including providing a flexible workplace. Relationships were good, things had seemed to be going well. But there was no questioning why he died because the answer was clear: mental illness. Of course there was the question of could we have done more? But the answer is no: medications, counselling, support all given in full. Just an overwhelming sense of wishing it hadn’t ended this way this soon, but feeling that maybe it couldn’t have gone any other way.

Could something have stopped it happening that day? Yes. Would that have stopped it ever happening? No. Could we the long lost friends have done more, kept in touch? Yes. Would it have changed anything? No. Because it’s not about us, the friends and family. It’s about the mental illness battle ground in a person’s head. However much we love someone and want to help them, we can’t climb inside their head and fight the fight for them. We can only do what we can do from the outside.

Someone with mental illness has different questions that are all for themselves. This person had depression, I have depression; he ended his life, so where does that leave me? If it took xyz for my friend to take his life, what would it take for me to get to that point? They took their life this way, could I do that; if not, what would I do? It’s like being inactively suicidal and contemplating ideas and theoretical points of view, but you have no plan to carry them out; no active suicidality (the medical term for being suicidal). It’s like ruminating on whether I’ll get to go on holidays this year, and if I do where will I go, and what luggage will I need to pack? When patients are actively suicidal they will often have their will written, letters completed to their family, plans for handing over the business and literally will have signed themselves out of their life having hoarded enough poison, collected enough rope, built up the nerve to jump in front of the train etc. Then again sometimes it’s pure impulse on a background of ongoing suicidal thoughts that are just eating away at your will to live. A tipping point is reached, and that’s that.

So I’ve had a period of questioning myself: how am I? Am I doing okay? Are things still under control like they were before I heard the news? I run through my “on the edge” symptom check but there are no tell tales signs; maybe I’m a bit more shaky in my left hand, maybe I’m a touch more anxious, a bit more fixated on anything changing. But after giving myself a few days to take the impact of the news, attend the funeral and debrief, things are okay. I’ve gotten through a potential trigger okay.

Which is bully for me! For the family, the friends grieving now and for a good while to come, where is the light? Where are they to look to find something good out of this? One place that I’ve found comfort is to see the men and boys in my old friends life passing the okay sign around on Facebook in a campaign to vow to listen to each other, to talk about mental illness and suicide, and to try to prevent this from happening again. This has to be one of the best ways to commemorate a death by suicide; a pledge to fight it’s influence and talk about it openly.

I know that its difficult for people to talk about this awful thing that’s happening in their heads. And it’s hard for others to hear what they have to say about it! But we have to be brave; be strong and talk about it. Bringing it out into the daylight is the only way to make it less scary, and to take away its power over us. Talk, talk, talk, talk, talk. And remember the souls who couldn’t fight it’s power anymore. It wasn’t their fault, they didn’t mean it or even want it, but they were overpowered. Remember that. They were fighting the battle and lost, through no fault of their own. Remember them. Talk about them. Share their story. There is someone out there that you can help if you talk about suicide.

Check out Conversations Matter for videos, fact sheets and resources for talking about suicide.

Use one of the umpteen helpline services that are available in this country. You don’t have to have a mental illness to call. You can call to talk about a friend, someone you knew who died, or just to learn more about mental health. So many people are reluctant to call, so go ahead and buck the trend! Call! Ask questions, learn things, talk to someone on the end of the line anonymously before you talk to a friend. Whatever you do, do something to improve awareness of suicide and prevent it occurring again.

beyondblue 1300 22 4636

SANE 1800 18 7263

Lifeline 13 11 14 (crisis support and suicide prevention service)

Suicide Call Back Service 1300 659 467 (free service for people who are suicidal, caring for someone who is suicidal, bereaved by suicide)

Kids Help Line 1800 55 1800 (5 to 25 years old)

Victorian State Suicide Help Line 1300 651 251

Mensline 1300 78 9978

Veterans and veterans families counselling service 1800 011 046

Qlife 1800 184 527 (lesbian, gay, bisexual, transgender and intersex communities)

Carers Australia 1800 242 636

Many more helpful phone numbers and web sites can be found at Mental Health Commission’s Get help page

Shared from WordPress

What Is It Like To Be Adopted? – http://wp.me/p6S0sI-rM

This is a brilliant piece of writing from a friend about adoption. Every question that you’ve ever had is answered, and as a bonus it’s pointed out how wrong is was to ask! Share it far and wide, so many people need to read and understand this point of view! A brave, brutally honest piece of writing that just makes you want to give her a big hug!!!

No reason why

This conversation happened more than a year ago now and I’ve just remembered it this week. Something prompted me I guess; I’m not sure. I was just sitting eating my tangelo outside in the weather on my tea break and it popped into my head.

This person was very well meaning. I’ve stripped back the conversation to those parts that are relevant to the point I want to make, which is that there is a difference between being sad, and having a disease called depression. This person offered several lovely and kind offers of sympathy and best wishes, and in the end we understood each other perfectly well, which is a satisfying and lovely point to come to between two people.

I don’t bear them any ill will, either now or at the time. I just understood then and now that when they said these things, they were meaning well and just didn’t understand what depression was and how it worked. So I explained my point of view, they understood that and asked several questions to help them get the facts straight, and we parted better friends. I’ve given the pertinent parts of the conversation below. At no time do I intend to reveal the identity of my friend. Honestly, the reason this conversation stands out to me is less because of who it was that said it, than that it wasn’t the first or last time I’ve been asked about sadness, or the cause of my depression, or had interesting versions of depression presented to me.

This post is to add clarity to what is depression, what is sadness or grieving or emotion, and why the difference is of any interest to you and me.

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Person, via text: “Danika, why are you so sad? Are you ok?”

Me: Yes I’m okay. I’m not sad, I have anxiety disorder and manic depression, or bipolar disorder.

Person: “You have everything a girl could wish for! A job. A loving husband. A place of work. A faith and I’m sure you have friendships and family. You have more than most. You have more than me. I don’t quite understand the reason for your depression”.

Me: There is no reason!

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This post is about you. And me. And everyone we know. It’s about how we think about mental illness. I’m not going to even go into the issues of stigma, discrimination, fear etc. There are many places where you can read about that. I just want to talk about how you, and I, and the next person think about, and talk about mental illness. I’ll narrow it down even further to my area of “expertise” which is depression, and manic depression or bipolar.

No one has more right or claim than anyone else to suffer from the medical condition that is depression. Depression just occurs. Like coeliac disease, or asthma, or cancer. There are people that are predisposed by genes or environment but at the end of the day, stuff just happens! We all know this about medical disorders but we tend to think differently about mental illness.

The opposite is true also. No one has less claim than anyone else when it comes to what diseases they get lumped with; their environment may be better but maybe their genes are worse or there may be life events that induce so much stress that the disease pathway is triggered. We don’t have to and don’t want to be competing for who should and shouldn’t have depression. Let’s just take it at face value and focus our efforts on supporting and caring for our friends who have depression.

Depression is not choosing to be sad. Depression is not a choice, just like grief and sorrow are not choices. Depression is feeling sad, mostly without a cause, and being bewildered by how extremely awful you feel in a situation where 5 minutes ago you were fine.

Bad things, very bad things happen in people’s lives. And the badness that they bring causes great sadness, grief, stress, sorrow, pain, hurt. When the badness can’t be removed or goes on for a long time or is so very hurtful that a person is under constant stress, mental illness can follow including post traumatic stress syndrome, depression and anxiety. I don’t dismiss or belittle any of the emotions caused by bad events. Like I don’t belittle mental illness. People suffering from either need our kindness and sympathy.

But I do believe they are two different things. And I do believe that knowing they are separate things, and talking about them in different ways will help the people suffering to know that you are trying to understand, and help them. And this is an extremely valuable thing when you are suffering; knowing you have people on your side who are trying to help as much as they can.

As far as I can see, there’s a) direct pain and suffering from specific situations, then there’s b) random pain and suffering from mental illness. I seem to suffer from random pain, for whatever the “reason”; but of course randomness doesn’t have a reason, it’s random!

At all times I have been very well aware of how blessed I am in life. That makes suffering depression worse in my view. Not easier.

I used to run this checklist over and over to find a source of why I felt so awful and like life was unbearable: a fabulous supportive amazing husband, a really nice house that we used to live in and now rent out, a satisfying career that pays well, a rented apartment in a great part of the city much closer to our families. Our lives looked picture perfect from the outside.

But looks can deceiving. Many people didn’t know then that I was depressed, my husband included to an extent. I don’t know what your life is like right now. I can look and see, but what does that really tell me? You’re smiling, wearing nice clothes, visiting your folks for the weekend and playing happy families.

I know that I don’t know you, or what’s going on with you unless I ask. Unless we have a chat, a bit of a delve into the goings on in each others lives.

So I try not to judge from the outside; easier said than done! It’s just impossible to know what’s under the skin of a person. You can try to figure it out, but there’s only one tried and tested method. Just ask.

So why am I sad? Or why was I seen to be sad at that time?

No reason. Absolutely no reason.

No fight, no situation, no happening.

I was happy, contented in my married life, satisfied with my new job, safely housed, no stress, no worry, no issues.

Believe me I have scoured my life for something to show me why.

I had the lovely-turned-awful awful ex job, the horrid horrid ex-commute of my husband’s and his very unsatisfying ex job, and the commute of mine turned solo for the part year plus not seeing each other apart from after 8pm at night. Those had brought a lot of strain over a year couple of years, but we’d fixed it, it was better now!

We both changed jobs, we both moved closer to work and to family support, we were getting on famously and then this! Just out of the semi-blue and into my head.

Crying, anxious, panic attacks, tired, exhausted, famished. .. Just spent! Barely surviving, hardly keeping on going, struggling!

And why?

There is no why.

This is my favorite saying about depression. There is no why!

I was and am well aware that apart from my mental health, I lead a charmed life. I consider myself very lucky, very blessed.

But that don’t stop those tears a falling!!! Doesn’t stop the hurt, the pain, the anguish, the struggle with to-live-or-not-to-live. Although of course it’s not really living to live with full blown depression.

It’s like this: you’ve gone to the seaside for a weekend getaway. You look at the sea. You know logically from experience, from knowledge, by other ways that the sea is beautiful. You love the sea. It’s your favorite place to be.

But. You. Can’t. Feel. It!

You can’t feel it. You stare and look and look again. You touch it, you taste it, you smell it. Everything you do increases your certainty that you should love it, you should be happy here, you should enjoy this moment.

But you can’t.

You try to put yourself through the motions. You walk barefoot on the sand like you used to love to. You let the waves wash over your feet. You breathe deeply and take in the salty, seaweedy smell. Something inside of you should be rejoicing at this moment; thrilling, embracing it, loving it, loving life.

But it isn’t.

Why?

Because. There is no why. That’s depression, that mental illness.

Just like you can’t change your thyroid function, your heart beat or the pain in your toe by wishing it, you can’t will your mind to work differently. It will happen eventually. Medications, counselling, mindfulness, GP consultations, psychiatrist consultations in my case, and simply time.

But it can’t be rushed, it won’t be hastened, and then one day you will feel something more, a bit of excitement, some happiness, some joy and it will be amazing, and you will know you’re starting up the path to regular emotions and a regular life. What a moment!!

I should explain one more thing. Depression is a lack of feeling, feeling awful, pain and hurt. But not every minute of the day. Sometimes in a bad day there are still moments that remind you of your previous life, that just work, and feel good. These can help to disguise and abate some of the depression. But going back to depression feels a little worse after that.

I think this is what throws people off, including me at the start. Did you know that the night before I went to the emergency department because I thought I might die, I went with my husband to our good friends house for dinner and we laughed for 3 hours straight until my belly ached, my face muscles went into spasms and I was completely exhausted? In hindsight it is possible that I was on a high that night, but it’s still a point worth making, that depression doesn’t take up every minute of every day, but when you’re in it, it certainly feels that way because you can’t remember happiness or the good times. So if you can, remember the good times. Write them down on your wall, set up reminders in your phone; anything to remind you that it’s not all bad, and maybe that will help you get through to the day when some of your feeling comes back, and you can see the light!

So tell me…?

Something that I’ve found out along this journey with me, my head and I is that questions are really important.

It was that question that has become an advocate for helping others with mental health concerns that first triggered my understanding of the need for questions; R U OK?

I’ve always been interested in mental health and I saw this group pushing people to understand and use the question R U Ok? to start talking to others about what’s going on, what’s wrong, what’s troubling you, what’re your concerns? I thought it was a great idea and I bookmarked it in my head to use someday if I saw someone having a hard time.

I wasn’t sure that it would be effective but I planned to give it a go anyway; nothing ventured, nothing gained, right?

But then, before I had a chance to use it to help another person, someone asked me, and I burst into tears!! Just like that! That is how powerful the question is and how right on target it is to really hit the spot when someone is down, anxious, fearful, despairing etc.

I didn’t think it would work. But I walked into a doctor’s room to get some routine results, she asked ‘are you okay?’ and it turns out I wasn’t, to a severe degree which I had not even realised up until that moment.

When she said, ‘how are you?’, as I walked in the door I said fine. That question is just too automatic and we are too programmed into a standard response that doesn’t really give an answer. We know when we ask it that it’s more for form than for really enquiring into someone’s health. It has become a greeting more than a query. Not to say that it can’t be used as a question; some people can inject that something extra that shows that they genuinely are enquiring about your health, but usually that’s not the case.

But there is something unique, direct and unusual about the question ‘are you okay?’ that hits a nerve, that registers with a person as an actual question and that demonstrates some extra kind of care and interest on behalf of the asker.

Questions are so important in mental health.

We can’t lay open a wound, or show an obvious dislocation, or contusion, or register a positive blood culture, or low blood level as evidence of our condition.

We may not look ill, or sick, or injured to other people.

All the evidence of our ailment is locked inside our heads.

It is literally all in our minds, but not in the way that that saying is usually used, to suggest that it’s a figment of our imagination!

There is nothing imagined or exaggerated or fictitious about any mental illness.

However there is a level of difficulty for anyone treating a mental illness, be it doctors, nurses, psychiatrists, psycholgists, counsellors or any other health professionals.

To diagnose a mental illness, as with any other condition, a set of diagnostic criteria must be met. But none of those criteria are obvious when a patient walks in the door.

The diagnoser (doctor or psychiatrist) must be able to draw out the information that they need to make a diagnosis by asking questions. They need to ask a lot of questions. Questions designed to gather information, to confirm suspicions, to determine signs and symptoms of the condition.

They have to be very skilled in asking questions AND in listening to the answers for clues about what is going on with the patient.

It takes time! Sometimes a lot of time. Sometimes questions are asked over and over. There is a purpose to that; it is to gather the right information so that the right diagnosis is made and the right treatment given. It might seem repetitive but every question fills a useful part of the overall picture. It’s not a sign of incompetence on the part of the person asking the questions; its a part of their professional skill.

Patients most often don’t know what is going on with them. I’m a health professional with a clinical understanding of mental illness but I still didn’t recognise mental illness in myself. I just thought I was stressed at work. The fact that I was constantly obsessing over work all day and night, that I couldn’t sleep, that I was being clingy and petty and being a huge strain on my husband with my concerns and fears and anxiety didn’t occur to me to be an excessive reaction. So I can’t even imagine how patients with no prior knowledge of mental illness feel when they start to suffer from symptoms.

They might be scared, afraid, stressed, anxious, overwhelmed, confused, in denial or fearful of what the diagnosis will mean and what treatment will be prescribed. So the doctor also has to tread carefully around the person’s soft or sore spots but still trod and poke enough to get what they need to do their job.

In any emotional state a person has more difficulty remembering and recalling, trouble giving an accurate history, limited ability in listening and responding, and struggles with taking in information. This is one of the reasons why questions need to be repeated; to be sure that the right answer has been given. It’s also why seeing multiple doctors on different occasions can be useful in building a clearer picture of what is going on.

Often a patient may not be diagnosed immediately, because of these factors. It may be considered in the patient’s best interests to allow them time to go away and calm down, to give more thought to the history of symptoms that they have experienced, and then to bring them back and ask further questions. Of course it isn’t safe for all patients to be sent away; some need to be kept for their own safety, some need to have treatment started immediately. For those who are sent home to return late, maybe the same questions will be asked all over again, and although it seems tedious to the patient, it is all for the purpose of gathering as much information as possible so that the best outcome can be achieved for every patient.

So, questions.

Tell me what’s been going on?

How have you been feeling?

When did this start?

Who have you already seen about this?

What treatments have you tried?

Has anyone in your family experienced any mental illness?

How long have these symptoms been going on for?

How severe are your symptoms?

What symptom is the most difficult for you?

What has brought you here today?

How are you today?

Compared to then, how are you now?

What do you think has triggered these symptoms?

What has happened that might have caused this?

What do you know about your condition?

What do you know about the treatment for this condition?

What’s the worst symptom that you are experiencing?

How are you coping?

Are you experiencing any side effects?

Give me a run down on how the last week has been for you?

How often do you shower?

How often have you been getting out of the house?

Are you finding enjoyment in life?

How has your motivation been?

What have you been getting up to?

Have you been hearing or seeing things that don’t exist?

Has anyone been speaking to you through other objects?

Are you suicidal?

Have you had thoughts of harming yourself or others?

Do you have a plan to harm yourself?

Have you had suicidal thoughts?

Have you had thoughts that are frightening to you?

How has your sleep been?

Tell me what you are afraid of?

Do you ever have periods of great energy when you can achieve a lot? Or when you don’t need sleep?

When are you not anxious? Are there any places where you feel comfortable?

What things make you anxious? What things trigger a panic attack?

There sure are a lot of questions that can be asked!! And this is probably the tip of the iceberg really, these are just the questions that I can remember from the health professionals that I saw. I’m sure there are many others for other mental health disorders.

And yet, the most important question is whichever one you ask to the person that you see struggling. It really doesn’t matter what it is. It can be r u ok?, how ya doing?, what’s up with you?, how are things?, how have you been going lately?.

As long as you take the courageous step of asking and listening, you will be doing the right thing. Go you!!