In The Waiting Line

The National Health Service is one of Britains’ greatest achievements, and an establishment that we undeniably take for granted on a daily basis. We are incredibly lucky to have it, and would miss it severely if it were to disappear. It’s an institution, a pioneering organisation, and doesn’t prejudice between people from different backgrounds, creeds, wealth groups or ages. But despite this, it is deeply flawed when it comes to treating mental health, and that needs to change urgently.

This inadequacy comes in two areas; speed and quality of service, both of which I have first hand experience of. The time taken to receive therapy or counselling is ludicrous. Last year I waited about 9 months from referral to my first appointment, which is utterly unacceptable. In that time the mental health of an individual can deteriorate severely, and therefore this wait is deeply troubling as it doesn’t seem to have the best interests of the patient at the forefront. I realise that its impossible for everyone who is referred for therapy to be seen immediately, but 9 months is too long for an illness that at its worst can make you feel unable to function or see any hope of getting better. You wouldn’t say to someone with cancer or a broken leg, ‘unfortunately you are going to have to wait 9 months for treatment’. It again highlights the lack of education around mental health, as well as a significant shortfall in funding for an illness which at the end of the day, can be a life threatening.

This article from the BBC News website shows the stark reality of waiting for mental health treatment, in this case in Wales. “In north Wales, Betsi Cadwaladr University Health Board patients can wait up to 26 months’ and ‘ At Hywel Dda University Health Board, current waits are between 54 weeks for cognitive behavioural psychotherapy and 119 weeks for psychodynamic therapy” Admittedly those are the worst case scenarios, but as my own experiences can attest to, 9 months is a perfectly typical waiting time, and in my opinion, this is disgraceful. As touched upon, these long waits can cause a deterioration in the patient’s mental health, due to the frustration and anger at the perceived lack of support available. Personally I have felt during these lengthy periods of waiting that there is no one to turn to, or nobody that can help me, and this contributed to a further downward spiral of feelings and emotions.

The other major issue is that most GP’s are relatively ignorant of mental health, perfectly willing to just put you on any old antidepressant and suggest that you “see how you feel in 3 months time”. Then if there has been no change they just increase the dose for another 3 months, and so on, until before you know it a year has passed, and you are no closer to feeling any better, or getting to the route of the problem. All this waiting is remarkably demoralising, and time is something a sufferer of mental health doesn’t necessarily have. It’s one of the few illnesses where time isn’t necessarily a healer. I actually visited a doctor once who had to get out a catalogue of medications and browse it to find one that he could suggest. When I asked him about its benefits, side effects etc, he just read them out from the book. This didn’t fill me with any confidence whatsoever, and he may have well just opened his laptop and typed ‘how to treat depression?’ into Google. Similarly another doctor responded to my plea for help with the suggestion  ‘why don’t you do an activity that you enjoy doing’. Really? Is that the advice that you have garnered after 7 years medical training? Besides that being one of the worst and most patronising comments to say to a person suffering with depression, it surely also shows a complete lack of understanding of the illness, as well as an inability to offer any meaningful medical advice. If it was as easy as getting a hobby, or doing an activity you enjoy, then depression wouldn’t exist. I came out of that appointment feeling utterly helpless and lost, thinking that if a GP couldn’t help me, then what hope did I have?

I’m not proposing the notion that the NHS doesn’t offer any support, but simply that it takes far too long and is not nearly thorough enough. A lucky few are able to engage in private healthcare, but the majority of people only have the NHS as a viable option. I realise I’m biased in this as its such a personal and emotive issue, but I suggest that a significant amount of money needs to be thrown at mental health, as well as training many more specialised metal health practitioners. We are at a pivotal point, with admissions for mental illness treatment increasing, and consequently the next 10 years are crucial to tackling the problem before the damage becomes irreparable. Around 90% of people who take their own lives have a mental illness, and if we have any hope of bringing this rate down, we must tackle the methods of treating the illness, and ensure that it is given a priority status. One of the core principles of the NHS was to ‘meet the needs of everyone’, and quite frankly this isn’t being done. The only way we can achieve this is by raising awareness, shouting from the rooftops if necessary. Elizabeth Wurtzel said: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” Lets find that key, and lift the fog, before its too late.

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If You Want The Rainbow, You’ve Got To Put Up With The Rain

This week has been bad…excruciatingly bad. I’ve not felt as low as this in a long while, and by Friday it got to a point where I was in danger of spiraling down so far that it would prove extremely difficult to get back up again. Sometimes these phases have a recognisable trigger, whereas on other occasions they seemingly arrive from nowhere, like rain springing up on a bright and sunny day. In this instance it was a bit of both. There certainly was a trigger of sorts (which I’m not going to go into here), although I was already struggling and teetering on the edge, and consequently it only required a gentle push for me to fall in. It’s incredibly easy to be pulled down, but desperately difficult to get back up again, and requires a superhuman amount of effort.

When in these difficult periods it feels like I’m a different person, and that the real James has been kidnapped. Normally I thrive on having fun at work, making people laugh, and generally trying to make people happy. However, when the mist descends, and the darkness creeps in, it feels like I am looking at everything from far far away, and all I want to do is be alone, invisible, and slip under the radar. Depression is cruel as it takes away a persons true identity, and instead creates a defeated, tired, hopeless impression of a person, one without any fire in the belly, and very little fight left to carry on. It’s not the real me that I despise, its this false, hijacked manifestation.

The things that normally make me happy instead become a cause of sadness, anxiety, frustration and the sensation of feeling bereft of any hope. For example, going out with friends at work for lunch, or drinks in the evening, is usually a cause for happiness and enthusiasm, and something to look forward to. However when the depression hits, these events actually cause pain and anguish, and thus have the reverse effect from what they are intended to have. Seeing people laughing, socialising or having fun causes a sense of unfounded jealousy and bitterness. Why can’t I be like that, why can’t I be included and why is everyone else having able to be happy? These thoughts are entirely unjustified, because of course its not me that is being excluded, but in fact I am the one excluding everyone else, pushing away the very people that can make me better. Another one of depressions’ evil characteristics…it forces away the people that you need at the times when you need them the most.

It’s impossible in the these dark moments to prevent thoughts entering the mind, infesting every corner of the brain, even if they have no credence, or are utterly unjustified:

Why can’t I be happy?
Will anyone every love me for who I am?
Why can’t I go back and start my life again, with all its hope and potential?
What can I do to get myself out of this hole?
Do people actually like me or care about me?
Does my depression put people off me?

These thoughts pollute the mind, clouding your judgement, and ensuring that it becomes even more difficult to pull yourself out of the hole you find yourself in. I find on a personal level that they cause me to reach out to people, purely for the fact that I know that I can’t get out of the pit without someone throwing me a rope.

It may take 3 days, 3 weeks or 3 months, but I always eventually pull myself free and am able to get back to my normal self. I’m not sure how I manage this really, it just seems to happen. Much of the time I simply need to get away from everything for a few days to clear my mind, and cleanse the soul. It’s a process where you have to remain patient, and know that however deeply you become trapped, there is always a way out. The one thing I would say, is that if you know anyone with depression, or similar, never be afraid to talk to them about it, or ask how they are, especially if you can sense they are in a bad place. Loneliness is one of the biggest issues during these difficult periods, as you feel like no one cares about you, and therefore the realisation that people do actually care about you and your wellbeing, can some times be all it takes to set you back on the road again.

I’m not quite out of the pit yet, but I can at least see the rope being lowered down, and that is certainly a start. This week I’m being filmed at ITV about my experiences of mental health, and so that is giving me some positivity as it could be quite a cathartic process, whilst also hopefully helping and inspiring others. I am pretty nervous…i’m much more comfortable on the other side of the camera! But it will give me something to focus my energy on. I’m not naive enough to think this may be the last painful slump, and I’m sure I will have worse ones, but the hope each time is that it will get longer and longer between each episode. You have to dig deep and try and find a glimmer of belief that things will get better. After all, whilst the rain and clouds may fill the sky, and be the only thing that you can see, you have to try and remember that once they clear, then the sun will shine through. And very often a rainbow will follow the rain.

The Heart Wasn’t Made For Aching

The heart wasn’t made for aching
The mind is meant to be free
The spirit wasn’t designed for breaking
The eyes are open but cannot see.

The day without hope
The night without cheer
The dawn full of worry
The dusk full of fear

Always feel like your falling
Not flying as you need to be
The mind is like a caged animal
And all it wants is be free

The laughter of others
Rings out like a bell
You want to be part of it
Not in this living hell

The heart wasn’t made for aching
The mind is meant to be free
You look to the heavens for a glimmer
But hope flickers like leaves on a tree

The crowds bring sadness
The people bring tears
The loneliness breeds madness
The pain that no one hears

Time rushes by
Like sand in the wind
There’s no end to the sorrow
The lights have all dimmed

A candle that burned brightly
Is flickering in the night
It not gone out yet
But its given up the fight

The heart wasn’t made for aching
The mind is meant to be free
If there’s still chance of redemption
Then I must be blind for I cannot see.

James Wiffen 22/04/16

Sad Clowns

There is a stereotype representation of comedians as ‘sad clowns’, with the notion that the jokes, pratfalls and funny faces are just a mask to hide their true feelings of melancholia, self loathing and crippling anxiety. As with most stereotypes, there is a foundation of truth, and you only have to look at the list of people who have admitted as much; Stephen Fry, David Walliams, Paul Merton, Ruby Wax and Robin Williams to name a handful. The later being the most poignant example, as Williams couldn’t bear living out the ‘sad clown’ role anymore, and it’s heartbreaking how his story ended.

Comedians aren’t the only examples of ‘sad clowns’, and in fact I believe its an accurate way of describing many sufferers of depression and anxitey, and certainly one that I can relate to within my own life. It’s the illusion of putting on a front to the outside world that you are happy, content and that everything is ok. But the big smiles and glowing eyes are painted on, in order to mask the truth of whats happening beneath the surface. The motivations for hiding mental health issues with this false outward appearance are varied; embarrassment, frustration, stubbornness, fear of losing a job or friends, or simply a desperation for people to view you as the positive happy person that you desperately want to be. This article from the Daily Mail refers to this as ‘smiling depression’, and I feel this is a pertinent description. In the article Dr Cosmo Hallstrom comments that “Sometimes they tell you, ‘No, I’m not depressed’ — and they smile. But it’s a sad smile. To the outside world, they give no hint of their problem — often holding down a full-time job, running a family home and enjoying an active social life. But underneath they are suffering secret panic attacks, insomnia, crushing low self-esteem and even suicidal thoughts.”

People deal with depression in an assortment of ways, and its manifestations are numerous and complicated. For some people this ability to project a positive veneer and hide ones true feelings is unattainable, and no amount of practice can allow them to bottle up all of their emotions or feelings inside. However there is a significant number of people (myself included) who become so expert at generating this mask, that it becomes second nature, and in fact becomes far easier than presenting an accurate picture of whats really going on inside. For me the clearest indication of being proficient in this technique, is the number of people that are surprised when I’ve told them off my illness, or remark “I would have never thought that of you”. Is this hoodwinking of peoples perceptions a good things or a bad thing? I’m not sure.

Here is an excellent article about ‘hidden depression’ which I find particularly difficult to read due to how applicable and accurate it is. There are so many relevant quotes I could list where the author hits the nail on the head, but for me the most appropriate and perceptive one is:

“Some people can totally fake it. They can smile and laugh; they can act like everyone else, even while they are in excruciating emotional pain…. People who are depressed but act like they are fine may not confide in anyone. Usually they find a way to spend time alone crying or letting down the facade and then go back to acting when they have to be with people. I’ve had clients who lived with their families and only found time to cry after everyone went to sleep, and only in the bathroom. The rest of the time they were acting like someone who wasn’t in pain. On top of the pain they already feel, acting happy is emotionally exhausting, and having this secret is isolating. So, faking it can even increase the depression.”

I also appreciate the description of the ‘cement jacket’ when referring to depressions ability to pull people down. It epitomises the act of being dragged down, kicking and screaming, desperately trying to keep your head above the surface, but finding that the weight pulling you down is too strong. It also presents a solid argument about how exhausting ‘acting happy’ can be. From the outside you’d think that it would be a way of lessening the effects of low mood and depression, whereas in fact the physical and emotional exertion required drains what little energy is in the tank, consequently  expediting the inner torment and sinking feeling.

I guess the main conclusion from this blog is that you can never accurately judge how people are feeling from their outward appearance. There may be people out there that you are convinced are the happiest people to walk the earth, but in fact that may just be exceptional actors, able to put on a show for the public, only to reveal their true selves once they are alone. So what can be done to help solve this smoke and mirrors approach to depression? The answer is to talk about it. If people can be encouraged to open up about their feelings, without fear of criticism, judgement or even ridicule, then it will no longer be necessary to wear the mask. They can be themselves with the knowledge that people will understand what they are going through, and be there to help and provide support. Admitting your true self is the best thing that you will ever do. It can’t solve everything, and it wont cure the illness, but you will no longer need to hide behind the facade of a painted on smile, and suffer the emotional toll that this takes.

Underneath the article there is a plethora of comments from people who see their own experiences encapsulated in the words written by the author, and identify with the pain of hiding ones true feelings away. Channing says “I think that I have been at that place in my life when I was depressed but never really let on to others what I was feeling on the inside. They always just saw me for the funny guy that they were used to seeing, and had no idea the pain that I had chosen to hide within. I think that it took a few really close friends top finally get me to own up that something wasn’t quite right, and quietly i sought and received help for it.”
So take a look around you on the bus, in work, at school or in the supermarket and look into peoples eyes. Are you seeing the real them? Does that laugh or smiling face reflect the true person, or is it how they want society to see them? Everything is not as it seems and things are never black and white, and if we can dismantle that perception of single mindedness, then its first step on the road to getting a grip on this terrible illness.

Living To Die Or Dying To Live

I have never considered suicide. I want to put that out there straight away. Yes I have often thought ‘is this really worth it?’, or ‘why can’t I have a different life?’ when feeling particularly low, but I’ve never thought about ending things all together. There are probably a number of reasons for this outlook, such as the fact that my illness is not as severe or debilitating as other sufferers of depression, and its probably accurate to suggest that those who feel that suicide is the only option are severely ill, and suffering deep emotional turmoil. Another possible reason is that my idealised desire to get better, have a happier mind set and sense of fulfillment, is my overwhelming priority, and consequently I have no thoughts of ending my life, but rather changing the one I have for the better. Whilst this may seem like a pipe dream for the majority of the time, it is enough of a glimmer to keep on going. It may seem obvious, but taking ones life means giving in to the idea that there is no hope of getting better, and I can never envisage getting to that point where all other options have expired.

This 2015 article from the Guardian offers a stark reality of suicide rates in the UK, and in particular those amongst men. The shocking statistics show that suicide is the UK’s biggest cause of death in men under 45, and that in 2014 there were on average 12 suicides per day. 75% of people who take their own life are men, which I was rather surprised to read, but perhaps less shocked that 90% of suicide victims suffer from a mental illness or psychological difficulties. The article suggests that men’s reservations about discussing thoughts and feelings, combined with a sense of embarrassment and inadequacy, plays a significant role in the high rate of suicide. Jane Powell from CALM (Campaign Against Living Miserably ) gives credence to this, stating that “we see from the research that men feel they shouldn’t need such support, that they are failing as a man when feeling suicidal.” I recognise the credibility in this argument based upon my own experience, as it was extremely difficult to open up initially about my thoughts and feelings,  and the illness in general, and I find that the written form is the only method that allows me to be 100% honest and open. I find it significantly more challenging to talk about the issue in person, and I often clam up, and claim everything is ok in order to avoid the embarrassment or awkward questioning.

Another pertinent consideration, that I can relate to personally, is that its verging on the impossible for men to open up to other male friends. I find it inordinately more attainable and reassuring to open up to female friends/colleagues, rather than  to males. As the father of a suicide victim states in the article “as a bloke, if you go out with your mates, you drink a few pints, you talk sport, you might moan about the missus, but you won’t talk about your feelings, about how you can’t cope. Your mates would run a mile. They don’t know how to talk themselves. Men don’t, it is not seemly”. Whist I believe he is being slightly flippant, and overgeneralising and stereotyping the issue, I do support the perception that the predicted reaction of other people is a significant cause in the bottling up of thoughts, and precipitates an inability to open up about the internal struggles that may be being suffered. Despite the fact that perceptions have significantly improved, even the last 15 years or so, and stigmas are slowly starting to be challenged, the brutal truth is that men don’t talk to other men about these types of issues. I certainly never have, with the exception of close family, and would feel deeply uncomfortable and disconcerted, which is why its fortunate that most of my friends and colleagues are girls!

The 64 million dollar question is what more can done? I truly believe that the most beneficial and potentially life changing way forward is to raise awareness, break down the stigma attached to mental health, and encourage role models to inspire those who may feel they they are alone, and encourage them to start talking about their illness. Organisations like CALM are crucial, and we need to give them as much support and funding as we can. Similarly, if more celebrities, or people in the public eye, come forward and describe their experiences with mental health, then I am convinced it would lead to sufferers gaining the confidence and incentive to talk about their experiences, without fear of embarrassment, isolation, or ridicule. These figures of inspiration can also be on a more local level, such as ambassadors within schools, workplaces, clubs etc. They can act as a beacon of hope for those who are unable, or unwilling, to open up about their experiences.  A significant reason for starting this blog was to try and create awareness, and also as a way of talking through and examining my thoughts and feelings, which I wouldn’t have the confidence to do in a verbal or one on one setting . It’s undeniable that the rates of suicide won’t fall if nobody is talking about the difficult issues, and meaningful honest conversations are crucial and severely lacking  in schools, workplaces and society in general. The ultimate goal is to get people to a place where rather than living to die, they are dying to live.

 

Missed Opportunities

As is my nature, and the essence of my illness, I often find myself contemplating the past, and analysing certain events . This can take the form of nostalgic trips back to childhood, or recollecting the stress and pressure that exam season created. The most significant subject of my reminiscences is that of the many opportunities and possibilities that my illness has taken away from me. As repeatably touched upon in my blogs, depression and anxiety purposefully garner negative thinking patterns, and as a consequence, these missed opportunities become the focus of the mind, rather than any achievements or positive events that may have occurred. Even a nostalgic ramble down memory lane is not immune to these negative thoughts, as a happy memory induces hypothetical questions such as “why can’t I be happy now?”, or “why can’t I go back to those days when I had everything ahead of me?”. Its these questions that force their way to the forefront of my mind, rather than allowing a joyful recollection of a happier time.

The aforementioned missed opportunities take  a variety of forms, and conjure up a multitude of emotions; regret, dejection, frustration and a deep sense of sadness. I have arranged many activities or events in the past, such as going to music gigs, school reunions, nights out with friends, and trips away. When arranging them I was full of enthusiasm, and a significant sense of optimism. However, I’ve lost count of the number of occasions that as the event has got closer, I have canceled or said I’m ill, just because the anxiety was too much to bear. I even returned after less than 24 hours from a music festival as it got too much for me, and I needed to escape from the situation that was causing me so much discomfort. This leads to a deep sense of guilt for letting people down, as well as shame that I am unable to achieve even these most basic of feats.

Jobs and career opportunities have also been affected. When I was in my mid to late teens I quit a couple of jobs after only a few days as a result of being so riddled with anxiety, and needing to shut myself away from people, which of course had the detrimental consequence of it becoming even more  difficult to push myself out and try and conquer my fears. The fact that this has improved significantly since my late teens/early twenties is certainly encouraging, and I’ve achieved things that I would never have dreamed of being able to; moving on my own to London, holding down long term jobs, making friends and interacting with people on a daily basis. Whilst these are the most basic of human endeavors, for me they are significant achievements, and certainly seemed a million miles away when I left school.

Perhaps the most heartbreaking missed opportunities involve people, such as friendships that dwindled away because I wasn’t able to battle through the anxiety pain barrier, and took the easier way out of hiding myself away. Also there has been the inability to make the deeper connections of a relationship which may have been that spark that could have changed the course of my life, and set me on that road to happiness and fulfillment.

Whilst I have admitted to myself that things are undeniably better than they were 10 or 15 years ago, and the James from 2016 is unrecognisable from the one in 2000, the illness still means I can only present myself with regrets, and ponder the ‘what if’s’. If I hadn’t had this illness, could I have achieved more, fulfilled my potential, made longer lasting connections with people, and been able to enjoy the moments in life that make it worth living? Of course any rational person would say that you can’t do anything about the past, and should instead focus on all of the opportunities that the future holds, and they of course would be correct. However my brain is not set up to find that an easy way of thinking, and I am constantly dragged against my will into the past, and to the conclusion that I have missed out on the best years of my life.

“Life is short. Love someone, spread happiness, laugh as much as possible. Forgive and forget, live the life without regret.”

The above quote is from Anurag Prakash Ray. I see it as a description of the ideal, the holy grail that everyone aspires to find, and I postulate that if I fulfilled all of those suggested life goals, then I would be a step closer to finding happiness…in fact we all would. Alas that the ‘Black Dog’ refuses to make it easy for me. But that won’t stop me trying.

Riding the Rollercoaster

It’s been a while since my last blog, due to illness initially, and then as a result of being on holiday for 2 weeks. All in all the last couple of weeks have been steady, and i have enjoyed the time away. The week I spent in Dubai really felt like an escape, and then having a week at home with the family was a perfect follow up to that. However, on my return from holiday it feels like a reintegration into the reality of my pre-Dubai anxieties and low mood. I feel as though I had a two week vacation from my mind, but now I have returned, its determined to make up for lost time.

At the moment the most frustrating facet is the constant ups and downs. While the persistent long term lows are undeniably exhausting, debilitating and desperately frustrating, the day to day rise and fall of emotions I’m feeling at the moment is equally infuriating. The stark reality involves receiving a glimmer of positivity and a hint of happiness, only for it to disappear as swiftly as it arrived, like water draining down a plughole.

I came across this article which is really effective at describing the rollercoaster of emotions that characterise depression on a day by day, or even hour by hour basis. As the author Erin states, “even in the span of one day, I can go from feeling pretty okay about things to feeling like I want to throw in the towel. It’s so confusing and frustrating.” It certainly leaves you feeling indescribably helpless knowing that you have no control over these fluctuations, and any positive moments always bring with them the knowledge that they wont last forever. They have a finite lifespan.

Erin makes another pertinent point regarding shutting oneself off from people, suggesting that “this leads to isolation –one of my biggest pitfalls in depression. The more I avoid the world, the more I get focused on my negative self-talk, putting myself down and using words like never and always.” Generally my depression is worst during evenings and weekends, and it can’t be a coincidence that these times are often when I’m alone, and therefore prone to ruminating on my thoughts, with an absence of distractions to attempt to combat this. There are other possible reasons why the evening especially brings the lowest of moods. For example tiredness from lack of sleep or a particularly hectic day at work can precipitate a strained mental state, but I believe its impossible ignore the significance of isolation, and the impact that being around people can have.

So as each morning dawns its just a question of which point of the rollercoaster I start the  day on, and which point I end it on. It’s difficult to conjure up positivity about the the path ahead, or generate the concept of ‘looking forward to the future’. Not so much in terms of  the short term events (holidays, meeting friends, days out etc), but more in terms of the bigger life achievements and aspirations: the attainment of happiness, contentment, fulfillment and a meaningful relationship. Depression feeds on destructive thinking patterns (negativity, sadness, loneliness, resentment), rather than nurturing the positive ones (hope, contentment, happiness, passion). The ups and downs are something I’ve learned to live with, but that doesn’t make it any easier. I’ve always been a big fan of theme parks and rides, but in all honesty, this is one rollercoaster I’d be happy to not set foot on again. Give me the slow and steady road any day of the week.