Running Away

Thankfully the title is not referring to any type of literal or metaphorical escape, but is in fact a reference to my new found addiction to running. Addiction is described as “the state of being enslaved to a habit or practice”, and I believe it’s use in this situation is apt, although thankfully it is not a dependence of the negative variety usually associated with the term. Perhaps ‘addiction’ is too strong a word, as that implies it is an ‘unhealthy pursuit’ precipitated by a belief that you cannot live without something, and that you will go to any length for your next ‘hit’. However, there are clearly some endeavours (such as exercise) where a craving is completely advantageous, and the negative repercussions are noticeable by their absence.

It started off as a functional avocation, primarily as an attempt to lose a bit of weight and increase non-existent levels of fitness. I’ve applied for the London Marathon next year through a few mental health charities and whilst this is not directly related (as a place is not guaranteed…and besides next April is so far away), in the back of mind I thought that it would be a good idea to start some basic training to see how I would cope. The second motivation, and one which has formed a basis for many failed attempts at joining and maintaining a presence at the gym, was the widely held belief that exercise can be invaluable in managing poor mental health. Whilst it can so often be a frustrating cliché (“why don’t you go for a walk”… if only it were that simple), it is certainly a theory based on scientific fact.  Regular exercise can “release feel-good brain chemicals that may ease depression (neurotransmitters, endorphins and endocannabinoids) and it can reduce immune system chemicals that can worsen depression.”

This scientific jargon is all well and good, but putting it in practice is another thing entirely. Often when you find yourself a deep depressive episode you cannot drag yourself out to the gym or the park. Even if you can manage that, finding the motivation to maintain a regular commitment to exercise can be inexorably challenging. However, once I had got through the first couple of days (nearly being sick and struggling to breathe), the effects of the running were quite intoxicating. I haven’t found the confidence yet to run outside the confines on the gym, but I find the static and contained nature of the treadmill quite reassuring. During the actual running I push myself hard, and for that period of exertion my mind can become relatively blank; the need to propel my muscles to their limits, and fight the effects of the lactic acid build up, ensuring that there is little space for any ruminations or worrying. If I’m lucky the only noise in my brain is from the music that is being pumped in from my iphone’s Spotify app.

The effects of a tough run (I’m focused only on running rather than other cardio options) can remain with you for some time afterwards. Whilst the actual exercise can be painful at times, the after effects are mildly euphoric, both in terms of a sense of achievement, but also as a physical act of reducing anxiety and increasing energy levels. Admittedly these sensations wear off within a few hours, and thus only provide a temporary relief, but that is certainly better than nothing. I have occasionally pushed myself too hard, especially considering I’ve only been immersed in the exercise for a couple of weeks, and this can lead to some physical difficulties afterwards. But that is something I hope I will learn to curb over time.

Whether this is a pursuit I will be able to maintain, and whether the concept of achieving a regular attendance (let alone running a marathon) is all but a pipe dream, only time will tell. I’m sure there will be times that I cannot motivate myself to leave the flat, or when my mind is too frazzled to even comprehend a trip the gym. But like depression in general, this is a hurdle to overcome, and the difficult first step has been taken. The Black Dog revels in keeping you weighed down in lethargy and inactivity, so if this can present an opportunity to get one over on the old adversary, then I hope my running shoes will be called into action for a long while yet.

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.

Group Therapy

About 10 months ago I ended a 9 month course of 1-1 psychotherapy. Whilst it was useful to have a weekly meeting with my therapist where I could talk through any issues or struggles that I was going through, the course ended whilst I was still in a bad place, and therefore I didn’t have the chance to determine whether psychotherapy would ultimately prove a helpful tool for me. I fully appreciate that the NHS is oversubscribed, and that there are people on long waiting lists anticipating help, and so it’s only fair that they should have a similar opportunity as me to receive therapeutic support. However, I don’t believe it was conducive to improving my state of mind to cease the therapy when I did, as I lost the only outlet where I felt able to open up about almost anything (other than this blog of course). Continuing the therapy for another year may not have made any significant difference to my wellbeing, but it would have been desirable to persevere until I felt mentally ready to end the treatment. Within a few weeks of finishing the course I asked my doctor to re-refer me as I was still failing to cope with my mental health. It took about 10 months to get a review appointment, and whilst I have become accustomed to long periods of waiting, it doesn’t ever get any easier or less frustrating.

The psychotherapist I met with for a review recommended that I try group therapy as my next step, as this is something I have not attempted before, and he hypothesised that engaging with other people with mental health issues could prove rewarding, as well as potentially addressing some of the social difficulties that I find myself with. Group therapy has always been something I have steered clear of, and I have repeatedly pushed for 1-1 treatments. I have always reasoned that opening up about the most personal of inner thoughts and feelings to one person is hard enough, but to do so to 7 or 8 strangers is a prospect that causes my pulse to race at the mere thought. Of course my rational mind realises the advantages of striving towards this group undertaking, and how it is absolutely the right course of action to pursue. Nevertheless, even though the first session is still 4 days away, I’m already getting the familiar sickening feelings of unease creeping through by body, and find myself questioning whether it is worth putting myself through this extra anxiety. But of course it is, and that is the knowledge that will ultimately drive me to turn up to the first session on Thursday.

The first few weeks will inevitably be the most challenging, and I expect that after a month or so has gone by I will have fallen into a routine and feel slightly more comfortable. It’s potentially a 2 year course, and so I’m in it for the long haul. What has helped greatly is the support I’ve had from work once again, and being given permission to work from home on the days I’m at therapy ensures that I can fully focus on the sessions, and go into them with a clear mind. It’s surprising how tiring talking for 90 minutes can be, and how the mind can be in overdrive for hours afterwards, ruminating on what was said and how I feel the session went.

Despite my unavoidable negative mindset leading me to view therapy as a defeat and failure of myself and my life up to now, I must also keep in mind the fact that I have waited almost a year to be in this position and to have this opportunity, and consequently I need to try to discourage that unfavourable thought process. A trademark attribute of depression is a need to focus upon the defeats, and ignore the victories. Winning a race would not elicit the response ‘yes I won!’, but instead ‘thank God I didn’t lose’. I’m sure this therapy course will have lots of defeats, and days where I feel that I cannot face it, but I’ve got to believe that along the way there will be some victories as well. I have so much admiration for everyone who competed in the London Marathon today, and this includes all of the runners taking part on behalf of mental health charities. The achievements of human beings are remarkable, and I will try to take inspiration from their triumphs and endeavours going forward. It may be a cliché, and an overused soundbite, but there is so much truth in the old adage that “a journey of a thousand miles starts with a single step”.

 

 

Anxiety: the thoughts, the feelings and the physical sensations

The particular void that I presently find myself in is persisting much longer than usual, and I’m not exactly sure of the reason for this. I’ve become accustomed to an acceptance that depression works to its own timetable, and I can never second guess or question its process. The ‘black dog’ does what it wants to, and no leash can ever contain its inevitable wanderings. “Take one day at a time” is the old mantra, but by following that logic I get stuck in a persistent cycle where each day blends into the next, and it’s as though I’ve taken on the role of a robot, where autopilot is a constant state of affairs. I am trying to drag myself free, but do not know how to.

I thought it may be helpful to myself, and to others, to list the thoughts, feelings and physical sensations that I experience. As difficult as it is to confine them to print, it’s the only way of facing them as opposed to ignoring or trying to forget them:

Thoughts

  • “I shouldn’t be feeling like this”
  • “I’m weak and not what a man should be”
  • I don’t want to be me any more”
  • “I’ve done something to upset someone. Should I say sorry even though I don’t know what I’ve done. If they don’t like me anymore then I am even more alone”
  • “I will always be alone. No one will love me.”
  • “I must be highly unattractive both inside and out. Why would anyone ever want to be with me?”
  • “I could have done things so differently, but now it’s too late”
  • “I will die before I experience happiness”
  • “I want people to ask me if I’m ok”
  • “I don’t want people to ask if I’m ok. I will only have to lie.”
  • “It’s too late for me to change”
  • “I want to stop feeling like this.”

Feelings

  • Frustration
  • Resentfulness
  • Deep sadness
  • Embarrassment
  • Heartache
  • Nervousness
  • Tension
  • Loneliness
  • Isolation
  • Abandonment
  • Hopelessness
  • Constant uncontrollable negative worries running through the mind
  • Combination of wanting others to reach out to me, but also to be invisible and go unnoticed

Physical

  • Heart pounding extremely fast, as though having a heart attack
  • Constant perspiration – leading to more self consciousness
  • Extreme fatigue
  • Feeling jumpy and constantly on edge
  • Stomach aches/cramps
  • Inability to relax/concentrate
  • OCD elements – constantly checking things…need constant reassurance
  • Habits, nervous subconscious ticks
  • Crying

These are merely the sensations that are in my mind at the moment, and are by no means an exhaustive list. I believe this demonstrates the 3 pillars that are at work (thoughts/feelings/physical sensations), and that all of them feed into each other, again highlighting the cyclical nature of anxiety and depression. Negative thoughts may trigger a unhelpful emotion, which in turn precipitates an unfavourable physical reaction. That physical reaction can then lead to more negative thoughts, which starts the cycle again.

I must emphasise that many of these thoughts and feelings are irrational, in the sense that I realise I shouldn’t be having them, or that they have no foundation in truth. But the part of the brain that can rationalise my thought processes is sadly overpowered by the part that is consumed with these uncontrollable irrational thoughts. Which is why it’s so difficult to have people say “you’re worrying about things that don’t matter”. Unfortunately that is not my choice, whether I like it or not. An oft unmentioned part of the illness is an OCD like tendency to constantly check things over and over again, whether it be a message, or the state of my appearance, or whether the heating has been turned off. I have to keep rechecking them in order to quiet the roaring animal inside of me that is forcing these negative thoughts into my brain.

The one time of the day I am temporarily in a semi-peaceful state is on the train to work in the morning, when I plug in my music, close my eyes and imagine I’m somewhere else, and someone else. My nervous energy prevents me from concentrating on reading, and so I try to relax my mind by switching my visual senses off, and focusing on the aural. The music and the gentle movement of the train almost sends me to sleep, but the arrival at the station soon brings me back to stark reality. This is not going to help me climb out of the pit, but at least provides a temporary respite where I can imagine that all is well, and that I am a different person in a different place. As Lewis Caroll said in Alice in Wonderland, “Imagination is the only weapon in the war against reality”.

Note

In light on the awful attacks of yesterday, my struggles are incomparable to the friends and families who lost loved ones, and those that are severely injured. In my writings I can only talk about my own feelings, and it is never intended to be compared to other people who are suffering much worse than I am. I just wanted to make that clear.

The Cycle of Thoughts and Feelings

Thoughts and feelings are at the very heart of Depression. The simple fact is that the thoughts we have can influence the feelings we experience, and vice versa. It’s a viscous cycle, and the cyclical nature of the illness ensures that once you are in the cycle, it is very difficult to break free. Thoughts can often pop into your head from seemingly out of nowhere, and of their own volition. Frequently however, these introspections are provoked by associations arising from what we see or hear around us. Photos, friends, people in the street, a piece of music, or a particular building can all conjure up thoughts, and consequently feelings, which are both unwanted and damaging. This can happen to all of us, although I would suggest that those with a depressive disorder will experience them in a far greater frequency.

Memories can be very significant stimuli in depression, and can be triggered by a wide variety of occurrences. For example, the other day I walked past a previous flat I had lived in, for the first time in about 3 years. This induced painful memories of the difficulties I was going through when I resided there, and the dark place that I found myself in. For the brief time the building was in my eye line it reignited the anxiety I had all those years ago, and the effect this had upon me took some time to wear off. Just as they say a smell of cooking can take you back to your family kitchen when you were a kid, this visual reminder conjured up all kinds on unwanted sensations and anxieties. On another occasion, I walked past someone in the street who looked remarkably like a person from a few years ago who I had a bad experience with, and this generated the same feelings of anger, sadness and frustration that I had felt at the time. It acted as a kind of portal, which transported me back to 3 years ago and bestowed upon me the exact emotions I had experienced during that period.

It can work the other way too. A certain image or stimulus may conjure up memories of a happy event, and illicit a smile and feeling of warmth, as though you are living through that event once again. The problem stems from the fact that the effects of positive memories wear off extremely quickly, whereas the effects of negative ones can linger for many hours or even days.

When a particular issue or source of anxiety is at it’s height, I often focus upon those things that will justify and confirm my beliefs about it, rather than seeking out those truths that may offer a counter argument. For example, if I get self conscious or low about my appearance I will ‘notice’ people who in my mind are ‘more attractive’, ‘normal looking’, and consequently to my prejudiced perception ‘happy’. This will then feed my exiting beliefs and anxieties, and prolong the cycle of mental unrest. It becomes impossible to see the things that would offer a counter to these beliefs, as you cannot help becoming blind to them. Depression could be described as like a special pair of glasses that allow you to see the negative things, but blinds you to all of the positives.

It seems to me that a need for support from other people is inevitable, and paramount as a facilitation to help you try and overcome this. Not so much for reassurance, as that can have detrimental consequences and potentially lead to a heavy reliance on reassurance before you can even function at all (another cyclical process). But just having other people who are not wearing the ‘depression glasses’ can encourage you to open your eyes and see things for what they really are. My illness (among other factors) has prevented me from ever having a girlfriend, and that has always been a huge roadblock to getting to where I want to be, and consequently has promoted deep levels sadness and frustration, as well as an inevitable elevation of that part of my ‘desired life’ to a near mythic unobtainable feat. This is not merely because ‘you want what you don’t have’, but because of the knowledge that whilst it wouldn’t necessarily solve everything, it would mean that I would no longer have to do things alone, and would enable me to express my emotions in a positive way towards another person (love, happiness) rather than a negative one (anxiety, fear, stress, resentment). Plus it’s its just too damn appealing to be with someone who loves you for who you are, and for which you can reciprocate.

Obviously thoughts and feelings aren’t going to go away, and nor should they, as they are what makes us who we are. The goal however, is to be in a position where you are in control of your thoughts and feelings, rather than them being in control of you. It feels as though mine do not only control me, but in fact own me, and dictate every step of my life. If there is a way to take back this ownership, then that must be what I, and indeed everyone, should aspire to.

An Unwinnable Tug Of War

Continuing on from my last post, I’m really struggling to climb back out of the pit I currently find myself in. My mind is full of unending doubts and negative assertions, and my body is in a constant state of anxiety. Time seems to drag, and my goal each day is to reach nighttime where I can sleep and find temporary respite. I’ve been dreaming a lot more than usual recently, and have found that these nightly imaginings are formed of idealised life events or pursuits: developing a relationship and ultimately having a family, being with friends and feeling like I belong, and being a child again with all the potential ahead and none of the burdens. Whilst these are pleasurable to engage with, the disappointment upon waking and realising they are not real brings with it a great sense of sadness.

The thing I’m finding most challenging is the persistent tug of war of that is occurring… on the one hand I want to be on my own and shut myself away from the world, whilst on the other hand I feel desperately alone with a unwavering worry that I am alienating my friends. It’s the biggest challenge of the illness, as there are so many contradictions, and conflicting emotions. Balancing a desperate need to reach out to people, with a heartfelt desire not to alienate those same people by being too full on, is a constant source of mental disharmony. When I’m at my most down I sometimes message people with perhaps a little too much honesty about how I’m feeling, and if I subsequently read into this that I may have upset someone or made them feel uncomfortable, then it only leads to more worry and anxiety. Unfortunately I can’t prevent this need to reach out.

It doesn’t help that the NHS ended my therapy last June before I felt I was ready to finish, and after consequently being re-referred by my GP, I haven’t heard anything from them for over 8 months. To say that I’m frustrated by this is the understatement of the year. I went back to the doctor today, to chase the re-referral for a fourth time, and his response was ‘oh, you should have heard something by now’. Thanks, that’s really helpful. With hope already funneling it’s way out of my body like sand through a sieve, this lack of purposeful help from the doctor does nothing to help curb the flow, and in fact just makes the holes in the sieve bigger, and the rush of sand quicker. If the very people who are supposed to help you cannot or will not, then how are you expected to carry on?

I’m going away for a few days now, which may present a chance to reflect. My worry is that it will only act as a temporary respite, and that the knowledge that I will be returning to the darkness very soon will be a burden. That’s assuming it doesn’t follow me away, which it has a devilish tendency to do. Whether it follows, or merely waits, I find myself running out of ways to deal with it, and lacking the  energy to go on fighting the good fight.

Swamped

All around me are familiar faces
Worn out places, worn out faces
Bright and early for their daily races
Going nowhere, going nowhere
Their tears are filling up their glasses
No expression, no expression
Hide my head I want to drown my sorrow
No tomorrow, no tomorrow

Mad World – Michael Andrews & Gary Jules

—————-

How do you feel?

Lie: A little down to be honest, but I’ll be ok. Probably just the time of year.

Truth: I feel like my insides are tearing themselves to pieces. I feel like I’m standing on a stage facing a thousand people and my heart is going to burst right out of my chest. I feel like things aren’t, have never been, or never will be OK. I feel like I want to bawl my eyes out until there are no more tears left to shed. I feel like no one understands, none more so than myself. I feel like I am destined to die alone. I feel like I want to get into bed under the covers and never have to get out again. I feel like I want to throw the towel in. I feel like the light from the centre of the sun could not vanquish the darkness I feel inside.

It goes without saying that I’m not in a great place right now. I’ve been down this road enough times to know that eventually it will subside. But I’ve also been down this road enough times to know that it will happen again…and again. The resolve breaks with this knowledge. How can you expect to drag yourself out of a swamp, when you know that you will be back down in it’s muddy depths within a matter of weeks or months. It becomes too easy to give in and stop trying to pull yourself free.

Time has become a large focus. It’s a thought process of contradictions, on the one hand wanting the day to rush by and be over with, whilst on the other hand being scared witless at how fast the years are rolling by. Being 30 terrifies me, not because of the age itself, but because the milestone reminds me of how much of my life I have wasted, or rather my illness has wasted. I want to go back, and have another shot at things. I find myself not having experienced, or having dealt with certain things that I should have in my teens. I can’t help feeling out of place, and not belonging, and terrified of the past, present and future. On the one hand I want to run away and hide from the world, and on the other hand I want to shout from the rooftops ‘please like me’. I simply don’t know what to do. All I can do is get back up again in the morning and carry on. The Garden of Eden must be out there somewhere. I’m just too tangled up in the undergrowth to see it.