A Challenging First Day

Last Thursday I attended my first group therapy session, something I have been waiting almost 10 months for. The week preceding the first session brought with it a mounting anxiety, which continually increased in intensity, culminating in a feeling of nausea and panic when the day finally arrived. Throughout that morning I had an almost continuous internal argument, convincing myself that I should abandon the therapy before it had even begun, with the knowledge that whilst in the long-term this course of action would be detrimental to my state of mind, in would at least in the short-term go some way to curbing the wretched anxiety I was experiencing. Despite a pounding heart and an inability to think straight, I forced myself out of the house, onto the bus, and into the waiting room of the West London Psychotherapy Department. Before entering I lingered outside on a bench, not wanting to go in too early and spend any extra time than was necessary in what was sure to be an uncomfortable situation. After eventually entering the building, and composing myself in the toilets, I proceeded into a waiting room which contained the 4 people that I would be sharing my most personal and painful thoughts and feelings with over the coming months.

I realised that the worst thing I could do would be to sit in silence in the waiting room, as the anxiety would only escalate, and the awkwardness of the situation would be heightened. I therefore introduced myself and engaged in the usual pleasantries and introductions, which would in turn make the start of the actual session slightly less terrifying. As it happened there was a lady who was also attending for the first time, which ensured that I didn’t feel completely alone, as we were both in the same boat. Over the next 90 minutes (which at times both dragged and raced by) I mainly listened and took everything in, contributing only the occasional comment or reaction in response to what someone else had said. As a result of my difficulty in opening up, and my discomfort at engaging with new people, it will inevitably take a few weeks before I am confident enough to begin talking about myself and my illness. The other members of the group were incredibly welcoming and made me feel very at ease. On the one hand they encouraged me to open up about anything I felt comfortable talking about, whilst on the other hand they also reiterated that if I merely wanted to take a backseat and simply listen to them speaking, then that would be perfectly ok as well.

Not knowing what to expect, I quickly realised that the sessions would be very fluid, and the therapist would be taking a hands off approach, essentially acting as an arbiter, and an occasional provoker of debate. I was hoping that there may be some attendees who were of a similar age to myself, but the rest of the group were quite a bit older. However, I soon dismissed this from my mind, as at the end of the day we are all in similar positions, regardless of age, gender or background, and that this shared unifying knowledge is the most important factor. Some members the group had been attending for 18 months, whilst others had been coming for only 6 months. Not everyone starts their 2 year course at the same time, and it is inevitable that I will meet a variety of different people over the next couple of years, as new members join the group to replace those that have moved on. For now though I welcome the fact that for the first few months I will have consistency and stability in those that I engage with, which is crucial in facilitating an environment where it feels comfortable to open up.

I continue to find great difficulty in thinking positively, and the usual doubtful thoughts creep into my mind, such as “this isn’t going to help me”, or “there must be a better alternative”. However, a couple of the long-term members of the group  were unequivocal in their explanations of how the therapy has helped them, and this acted as a source of comfort and slightly reinforced the knowledge that I was doing the right thing. It was also very apparent that some of the group had not sought help with their mental health until late in their life, and therefore I feel some relief having started the process as early as I did (back in my early twenties). I have no idea what the coming months will bring, and how the therapy will play its part in my life, but the most significant thing is that I forced myself into that waiting room last Thursday lunchtime, despite every fibre of my being screaming at me to run straight out of the door. I’d like to tell myself that the hardest part is over, but I know that I haven’t even touched the surface yet, and when I begin to open up to the group about myself and my experiences, that is when the real hard work starts. I will need all my strength and resilience to ensure that I don’t give in to the desire to hide away and bury myself within the protective bubble of ‘avoidance’, rather than facing the challenge head on.

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Art Imitating Life

Cinema is a big passion of mine, as it is one of the few pursuits that allows a total escape from reality, and a departure from everyday worries and emotional pain. Books and TV also provide this path to escapism, but cinema is the master of this craft as it is a full sensory experience, where you can forget within moments of the opening credits that you are sat in an air conditioned building in Tottenham Court Road. You can leave your worries and baggage at the door, and inhabit a new world for the next precious few hours.

There are two types of movies for me, the ones that engage me, and the ones that affect me. A good proportion of films that are released act as a way to pass the time, and can excite, shock, scare and allow the eyes to widen with wonder. However, there are also those releases that deeply affect the way I feel, whether because they reflect an aspect of my life, or mimic the way I am feeling at that particular moment in time. In the last few weeks I have seen three films that have had this effect on me; La La Land, Manchester By The Sea and T2 Trainspotting, all to varying degrees. The three films couldn’t be further apart in their stories, settings and characters; however they very perceptibly share some common human themes: regret, nostalgia, loss of hope, ageing and relationships. At various points throughout these three movies I felt deep wells of sadness, poignancy and sorrow, not just at the predicaments the characters faced, but also because I could relate to the thoughts and feelings that the characters were experiencing. Particularly the ideas of nostalgia and regret, as looking back and imagining how things could have turned out differently is a constant source of discomfort for myself. In La La Land there is actually a montage where a character pictures how a particular moment in time, if tackled in a different way, could have led to a completely different life, and it felt like the director had plucked  these series of thoughts straight out of my head.

Movies can act as powerful emotional triggers, and have a unique ability to affect you to the very core. Why do people watch sad films, especially people like myself who suffer from depression and emotional struggles? To the outside it may seem a tad perverse intentionally putting yourself through the emotional ringer, and surely it would be preferable to watch a happy and uplifting movie? It’s very difficult to answer this, but I can posit a few theories. Firstly, there is a fascination with seeing how characters navigate through dark episodes and experiences, which can in turn make you feel like your own story is being represented upon the big screen. They can help us analyse our own foibles and emotional frustrations, without having the pain of actually going through them ourselves. Perhaps it makes us feel like we are not alone in our struggles, and can engender a sense of reflection that we all need to engage with at one time or another.

It’s also true that any strong emotion makes us feel more alive. It’s not just exercise that produces endorphins, but also strong surges in emotion, whether positive or negative. It’s perhaps inevitable that we are drawn to stories that reflect our own emotions; and a feeling of fiction induced sadness, whilst uncomfortable at the time, can lead to assurances that we have an ability to feel, and an ability accept our emotions. For instance, I am not going to be able to adequately relate to an action film, or a sci-fi adventure, as I have no experience of these topics, but a film involving a character struggling with their emotions, that’s something I can get on board with.

Maybe there is credence to the notion that by seeing characters experience, deal with, and possibly overcome certain life events and mental strife can give us hope that we are potentially able to do the same. It might make us feel less alone knowing that other people are thinking the same thoughts, and experiencing the same lows, albeit in a fictional setting. This may not lead directly to an improvement in mental health, but at least it could foster a sense of satisfaction that our story is shared by others. It is perhaps inescapable that when you are in a period of depression, you are drawn to media that reflects your own personal mental state, rather than ‘uplifting’ music or films which counter-intuitively would not help improve your mood, but rather emphasise how far away you are from the faux happiness exuded by these pieces of work.

These are just theories though, and I can’t categorically state why emotionally challenging art causes such a draw. All I know is that these 3 films in particular deeply affected me, and left me with a sense of melancholia that persisted for some time after leaving the cinema. Not necessarily in an unpleasant way, but rather as a way of inducing a strong sense of reflective contemplation. My only hope is that one day I will have no desire to watch these type of films, because they will no longer be able to act as a mirror to my own life, and will instead merely act as a reminder of a previous dark time. That is the hope anyway.

 

 

Trigger (Un)Happy

When finding myself in the midst of particular difficult period I often get asked ‘what triggered it this time?’ This is a perfectly legitimate question, and one that a non-sufferer would be completely justified in asking. Of course there are some obvious triggers, such as big life events like bereavements or breakups, that are bound to cause a whirlwind of emotions and a downward spiral into depression. However, for the majority of the time there are no rational or tangible triggers that precipitate the relapse; instead it appears out of the blue, like a bullet train rocketing out of a tunnel. In some instances it builds up gradually before it reaching its painful crescendo, but on other occasions it hits you full pelt in the stomach, with no warning or let up.

According to this the article Top Relapse Triggers for Depression & How to Prevent Them “the risk of recurrence — ‘relapse after full remission’ — for a person who’s had one episode of depression is 50 percent. For a person with two episodes, the risk is about 70 percent. For someone with three episodes or more, the risk rises to around 90 percent”. That statistic doesn’t provide much comfort, as clearly the chances of relapse increase with each depressive episode that occurs. Putting it bluntly, things will only get worse.

The article proceeds to suggest 3 potential trigger categories, and how they can manifest into a period of depression:

Not Following Treatment

The article proposes that “The biggest issue regarding relapse has to do with children and adults not following through on their treatment plan… this includes anything from skipping therapy sessions to missing doses of your medication to ending therapy too soon”. I can certainly relate to the negative effects of ending therapy too soon, although through no fault of my own, but rather the underfunded and oversubscribed NHS. If these support structures are not strong enough, or are fragmented and disturbed, then it undeniably ensures that a relapse is increasingly likely. The article also suggests that “while your life may involve psychotherapy, medication and the need for a protective structure that keeps your illness at bay, also realize that you have passions, desires, gifts and talents that require just as much attention.” It is all to easy for these facets of life to fall by the wayside, which consequently prolongs the negative cycle.

Ruminations

“Negative self-referential ruminations play a key role in recurrence… for example, individuals with depression tend to dwell on their (supposed) flaws and failures. They also may view neutral events with a negative lens.” Ruminations are a big deal for me, allowing my mind to dwell on my insecurities, and conjure up thoughts of sadness, hopelessness and a misguided longing for a perceived better life. This trigger is particularly problematic to tackle, as the thoughts come out of the blue, and linger sometimes for days or weeks. Unfortunately the mind cannot be switched off, and the more time you spend alone, the more the thoughts penetrate deep into the brain, eating away at you, with little or no regards to the consequences. Despite being a cliché, it’s like being trapped inside a prison, with only your thoughts as the ruthless prison guards for company.

Knowing Your Personal Vulnerabilities

“Triggers may be very specific to each individual’s situation, since all of our emotional responses are unique to some extent…learn how to recognize the who, what, whys and whens of your emotional and physical life.” For example particular dates or times of the year can prove to be difficult and act as triggers for a depressive state of mind. For me personally my birthday and Christmas are particularly troublesome as they can provoke the ruminations mentioned previously, and cause them to take hold, whilst also proliferating ideas of another year having passed by and another year when I still feel trapped in a deep well of unhappiness. Regret, frustration and sadness are emotions that become second nature. The article also notes that “If you find yourself excessively fatigued, irritable, having trouble eating or sleeping, you might be in the midst of a trigger event.”

Identifying certain triggers doesn’t really provide much assistance or solace. I sometimes have anticipated an event 8 months in advance as a potential cause of anxiety or depression, and despite this warning, it plays out exactly as I had envisioned. Plus the fact that there are so many invisible and intangible triggers at play ensures that any attempt to fight the process becomes virtually impossible. The article concludes that you “don’t measure your success living with depression on whether relapse happens or not. Instead, realize that if relapse occurs, true success comes from rising after the fall…Fall down seven times, get up eight.” The difficulty comes in the fact that falling down is so easy, but getting back up again requires reserves of energy and determination that are in very short supply.

Reflections

To get to my office from the main reception you must traipse down a corridor that is flanked by mirrors on all sides. Most people surreptitiously glance in the mirror as they walk by to check whether their hair is in pristine condition, or whether that annoying spot that emerged in the morning has been successfully hidden away. For myself, I try not to glance sideways as I’m afraid what I will see. It’s not so much my physical appearance (although admittedly I have always had nothing but disgust for that), but more the fact that it causes me to visualise who I have become, and to analyse my life, including where I have come from and where I’m going. In the fleeting moment I gaze upon my reflection I don’t merely see myself as I am now, but instead I’m forced to rocket through the years from childhood to the present, the snapshots berating me for for how much of my life I have wasted,  and taunting me for how much of it the demon inside has taken. I don’t see a young face looking back full of promise, but rather a tired face looking back full of regret.

I’m in one of my dips at the moment, which frustratingly has come so soon on the back of my last one. Usually I get a few months respite at the very least. It’s kind of like quicksand, the more you struggle to get out, the deeper you sink. For example, socialising or going out somewhere only leads to further feelings of low mood as you inevitably see what you perceive that others have (relationships, friends, hope, happiness) and the unavoidable comparison with your life proves too much. So what am I supposed to do, just shut myself away for ever in order to avoid these things? No that won’t work either as that will merely create a blanket of isolation that would smother me, and simply serve to ratify to myself the idea that people don’t care about me. What are you supposed to do when you reach a fork in the road with the option to go left or right, when you know that which ever path you take it will lead you to the same outcome?

I saw a quote that said “If you are searching for that one person who will change your life… take a look in the mirror”. I think that epitomises the difficulties of depression. A mirror doesn’t just reflect back an image or reality, it offers up a perception based upon your own insecurities and fears. You chose what you see, and how you interpret it, depending upon your own internal thoughts and feelings. For me now I can only see the negatives, the missed chances, the defeated moments, and the lack of optimism. The face morphs into my younger self and leads to a yearning to go back to a time where pain was less intense, and a positive future still seemed within reach. Looking back is much easier than looking forward. The key is not to change the image that the mirror reflects, but rather to change your way of looking at it.

So perhaps that’s why it is so difficult for me to pull myself from the quicksand; there are just too many reminders out there which trigger feelings of regret, envy, sadness and a inconsolable anger at the existence of the beast inside.  Afterall, people themselves also represent mirrors, as you see reflected in them the person you want to be, and it merely reiterates your own weaknesses and failings. The ultimate goal for me, and a far greater aspiration that wealth or success, is to be able to face myself in the mirror without turning away in disgust. However, if that day should ever come, then I fear an old man will be peering back at me, as it seems that such an achievement would take a lifetime. Or more.

‘He Saw The Troubled Man’

He saw the troubled man
As he walked down the street
His eyes were full of sorrow
His head bowed to his feet.

He followed closely behind
As the man made his way
No one glanced in his direction
As he gave a nervous sway.

He couldn’t stand it any more
So he sped up to the lonely man
Glancing deeply into his eyes
He tried to formulate a plan.

“What troubles you my friend?” he asked
“Why so sad on this lovely day?”
And the man raised up his head
His complexion dark and grey.

The man opened up his mouth
But no words escaped from within
There was no way of knowing
Where his pain did first begin.

He was just about move along
When the man began to speak
“If you can’t answer that question then
its obvious why things are so bleak”

And with that the man was gone
Leaving in his wake
The realisation of one simple thing
One huge foolish mistake.

There was no man, only a reflection
That bounced off the window pane
It was him with the eyes of sadness
And his heart that was racked with pain.

He was the troubled man
Who walked on down the street
He kept his face looking downward
So his reflection he’d never need to greet

By James Wiffen

“Flying High and Falling Low”

Written at 19:00 on 30th April 2016

Saturday morning, 3 day weekend, sun shining outside…this should be a cause of positivity, enthusiasm, and a generally relaxed and happy vibe. So why was it that I sat for at least an hour at the table just staring at the walls, thoughts bumping around in my mind, my heart racing, my body racked with exhaustion, and my nerves shattered? Of course, the first question you may (quite rightly) ask is, ‘why on earth didn’t you just get out of the flat and do something to take your mind off things’. Unfortunately it doesn’t work like that. The biggest need becomes the biggest fear and an insurmountable mountain. The ‘bubble’ (in this case the flat) becomes a safety net, one in which you don’t willingly want to exit from. In the afternoon I went out to try and do the exact thing that the aforementioned advice recommends, but even a short trip to the shops left me yearning for the protective environment of my living room. I tried…and failed. The mountain loomed too high, and I was stuck at base camp.

A significant effect of depression and anxiety is a feeling of lethargy and complete lack of enthusiasm. The idea of going out to the cinema, the park or the shops doesn’t offer any sense of pleasure, and sadly reiterates how this illness removes any measure of enjoyment or satisfaction from the things in life that should make it all worthwhile. Upcoming events, trips or activities that I have arranged and paid for are causing that initial prickly feeling of anxiety and fearful worry, to the extent that I’m already starting to talk myself out of doing them, assuring myself that I can afford to lose the money, and convincing myself that ‘its for the best’ as I can remain in my bubble, my safety net. This has been the story of the last 15 years or so.

Fast forward to Saturday evening and I’m sat back at the table (this time accompanied by music to try and break the silence), having cancelled plans for the evening yet again, and possibly burnt more bridges, and the feelings of guilt, frustration, anger, sadness and a massive perception of weakness aimed at myself come crashing down. All I want to do is sleep…and have a break from the thoughts, a respite, and much needed rest, but I know that the ‘black dog’ isn’t kind, and will instead serve me up another restless and sleepless night. Sometimes I tell myself that being in my own ‘bubble’ is necessary because without surrounding myself with others, I can block out the existence of people engaging in all the things I yearn for: loving, being loved, exploring, hoping, laughing, crying, living out their dreams on a daily basis. The pain I feel when perceiving people carrying out these basic of human actions and behaviours leads to such heartache, as I want so desperately to be part of it. I’m not naïve or insensitive enough to suggest that everyone is happy, as of course there is much suffering out there, and everyone has their demons, and can fall into a routine of monotony. But I crave to be able to break free, to throw of the shackles holding me back, and not look back in 50 years and realise that I allowed my depression to define my life.

I’m not trying to be overly melodramatic, or fishing for any sympathy (as I don’t deserve any), I’m simply expressing the facts of what is going on inside my head, and what I’m thinking and feeling, as honesty is one thing that I am completely at ease with. Unlike in previous blogs, I can’t find it in myself to offer any words of advice or analysis of what needs to be done to get out of these dips. This time I haven’t got the energy. The constant cycle of believing things are on track, only to be enveloped by the inevitable slide downwards have broken down my resolve, and left me with a great sense of emptiness, that I can’t see any chance of being filled. As I sat writing this a my ipod shuffled onto a song that struck at my heart, as the lyrics epitomised how I was feeling:

Please
I’ve had enough
Please
I’ve had enough
In circles I’m turning
From this world I’m burning
Tell me what happens after this

Somedays I’m flying high, I’m falling low
Somedays I made of gold, I made of stone
Somedays I’m flying high, I’m falling low
Somedays I made of gold, I made of stone

Link to track

 

 

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.