Thoughts / supporting someone with a mental illness

Avoiding avoidance

There’s been a lot of things that I’ve been getting a bit worked up about lately. Sometimes a bit frustrated with. Sometimes even maybe angry about. Things like natural disasters. And inconsiderate human beings. And climate change. And that Neil Young is no longer coming to this year’s Blues Fest. And the sustainability of my projects at work. And international politics.

And I’m observing how others react to things that piss them off too. What I’m noticing is that a lot of us seem to react to discomfort and unpleasant situations with statements like “I can’t stand it” or “That’s intolerable” or “I just can’t be around it”.

Sometimes when I’m getting a bit uncomfortable or worked up about these things, some people like to offer me advice. Bless them. And what’s interesting is that their advice, or what they claim to do that helps, is all based around the same thing. Avoidance.

I love avoidance. Particularly if it involves a pillow and a nap. Avoidance was one of my main survival techniques for quite some time. But in all of these situations it is not the trigger – whether it be a politician slurring racist comments or a person at work chewing their food way too loudly – that is the cause of our discomfort. It’s the feelings associated with it.

And when it comes to avoiding feelings of discomfort, that’s something I’m trying to avoid now.

We are really not meant to feel happy 24 hours a day, 7 days a week, any more than we can feel any one emotion for every minute of your entire life. And if we do feel too much of just one emotion for too long it generally impacts on our ability to function, becoming a mental illness. To be a functional human is to feel a broad spectrum of emotions. This broad spectrum of feelings is in fact what has kept us safe and helped to perpetuate the human race for all this time.

Pain and unpleasantness are an important part of this human experience, yet it seems that we’re becoming conditioned to lean towards more positive emotions and away from these feelings, accepting them as somewhat unnatural. But is there anything really all that unnatural about sadness? Frustration? Anger? Restlessness? Boredom? Irritability? Anxiety? Shyness?

We all have a natural survival instinct embedded within us that creates our aversive reaction to unpleasant or uncomfortable events. This hard-wired instinct tells us to avoid things that are unpleasant, because they are likely to be dangerous or harmful (e.g., a man running at you with a weapon or an oncoming car). However, this same instinct can affect our internal processes as well, disconnecting the self from thoughts, emotions, and physical sensations

According to recent psychological research one of the main causes of many psychological problems is the habit of emotional avoidance.

On numerous occasions of late when discussing international politics, several of my friends and acquaintances have responded with “I’ve stopped watching or reading anything to do with international politics because I can’t handle it.” But I wonder whether this really helps them to reduce their feelings of discomfort.

In a 2009 study, at the Queensland University of Technology, Kavanagh and colleagues asked people in treatment for alcohol abuse and dependence to complete a questionnaire that assessed their drinking-related urges and cravings, as well as any attempts to suppress thoughts and triggers related to booze over the previous 24 hours. They found that those who often fought against intrusive alcohol-related thoughts and triggers actually harboured more cravings. Similar findings from a 2010 study suggested that pushing back uncomfortable emotions could spawn more emotional overeating than simply recognising that we were feeling something unpleasant, whether it be upset, agitated or angry.

Attempts at avoiding uncomfortable emotions are usually futile. Telling ourselves that a certain emotion is intolerable or dangerous can trap us into a state of constant vigilance regarding the very thing we are trying to avoid. We might become hyper-vigilant about any possibility of this feeling arising. And this fear of the impending negative experience becomes a negative experience in itself.

What often happens here though is while we feel we are minimising the pain with these techniques and avoidance behaviours, we are often amplifying them. The other concern is that avoidance and distraction techniques can escalate. We might distract ourselves with a seemingly innocuous glass of wine following a tough day at work, to overeating to mask feelings of loneliness, or even to severe cases of self-harm. In the short term, avoiding the news or drinking half a bottle of wine may feel soothing. But in the long run, it may only spike stress. We might experience guilt if we then try and stop the avoidance behaviour, or our inability to remain calm whilst discussing politics at a friendly dinner party might cause some relationship strain.

In other words, when we fight against emotional pain - when we judge it, try and push it away, avoid it, or ignore it - it can trigger off other painful emotions, resulting in more emotional pain. However the biggest loss is that if we keep distancing ourselves from our negative emotions we can limit our effectiveness and potential to cope with life. And that includes both the opportunities and challenges.

What might happen though if we choose to accept our emotions? To sit with our discomfort and experience the pain for what it is? I can answer this!

Firstly, we can use our emotions as the wonderful sources of information that they are. Our feelings are there to tell us things about what is going on with us and around us. They’re not the only source of information available though. We also have our rational thoughts, our knowledge and experience, our values and goals. We can evaluate our emotions in light of all these other sources to help us decide how to act in certain situations.

As humans we are going to have all kinds of feelings. Like we’re going to have to have to endure all types of weather. These emotions are, more than anything else, just a part of being a real life human. By accepting our emotional life, we are affirming our full humanity. Emotional acceptance, whilst probably a bit more difficult, is usually a far better strategy than avoidance.

Second, when we accept the emotion, we give ourselves the opportunity to learn about it, become familiar with it, become skilled at managing it, and integrate it into our lives. We don’t ever learn this with avoidance.

Most importantly we can find out that when we accept an emotion, it tends to lose its destructive power. It can hurt. And be unpleasant. And uncomfortable. But naturally all emotions will pass if you accept them.

Some will just pass faster than others.

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One of the most glorious of things happened this morning. When I woke up, the sun was shining on my face!  Oh miraculous life!

It has been a very long time since we have had the pleasure of a visit from the sun here. We have been seeing more than our fair share of rain. It’s been so long since I felt natural warmth on my skin. In fact, it’s been exactly 11 sleeps ago that we had a day where we saw the sun. And prior to that it had rained for what felt like decades as well.

Weird stuff was starting to happen after ten consecutive days of cloud cover. My psychological health was not in a sunny place. Throw in a very wet natural disaster and I had completely forgotten what happens when you wake up to the sun.  

Natural disasters and cyclonic circumstances aside, the weather can affect our mood and have some significant impacts on our lives.

Rain pretty much makes all of life more difficult. It's super frustrating when you run out of clean undies and have to face the never ever conundrum of where you've left your umbrella. But over the past few weeks, my mood has also deteriorated somewhat. I’m sleeping a lot. But poorly. And I’m irritable and dysphoric (more so than usual anyway). There’s also a well-worn carpet trail between the couch and the fridge. And it’s marked with carbohydrate crumbs.

I have been socialising a lot less, staying in at home thus missing out on one of the most powerful natural antidepressants of all. And then by staying in, I’m probably feeling more tired and low. And then this lack of socialisation is probably contributing to a lack of stimulation causing more frustration and restlessness.

There’s a lot of variable, sometimes-conflicting research about the weather and our mood, so broad, general take-aways from this are not always best to be had. Nevertheless, here they are.

In general, the daily influence of the weather will have more of an impact on a person’s negative mood, rather than helping one’s positive mood. So for people on the ‘depressive spectrum’ (aka yours truly), higher temperatures can raise our mood, whilst things like wind or not enough sun can make us feel even lower.

But it’s the effects of light, or lack of, that will probably have the most significant impact.

As it turns out, there’s even a weather-related mental illness. Seasonal Affective Disorder (SAD) is a very real kind of depressive disorder. Listed in the psychiatrist’s bible (the DSM) with this condition the person’s major depressive episode is connected to a specific season. Whilst we most commonly observe SAD affecting people in the autumn or winter months, a minority of people will experience SAD during the spring and summer months too. In America this condition is estimated to affect 10 million people.

Either type of SAD usually includes some of the symptoms that are present in major depression, such as feelings of guilt, a loss of interest or pleasure in activities previously enjoyed, ongoing feelings of hopelessness or helplessness, or physical problems such as headaches and stomach aches. In addition, symptoms of SAD tend to reoccur at about the same time every year.

This is by no means a new condition. In 1974 Faust and colleagues studied 16,000 students in Basel City, Switzerland. Although not the most robust study designed, the researchers nonetheless found that nearly one-third of the girls and one fifth of the boys responded negatively to certain weather conditions. Symptoms reported included poor sleep, irritability, and dysphoric (depressed) mood.

For a couple of years, I had the privilege of living in Australia’s capital city. There were many things about this big town that I adored/tolerated – open spaces, large roads, limited traffic, driving in circles, bicycle paths to everywhere, public servants. But the weather was not one of these. The first winter was a novel experience. I marvelled at a tree’s ability to change colour and then drop its leaves. I bought copious amounts of scarves and coats. I felt grateful that someone told me not to pour hot water on my car windscreen to rid it of frost.  

Unfortunately the second autumn announced itself when I was already in the throes of an episode of a mental illness. And whilst I can’t blame Canberra’s whether in its entirety for my mental state, I think the frost on the ground and the thick blanket of fog may have been a bit of a contributing factor. Even though I had a shitload of pretty coats.

There are various explanations as to why someone might experience SAD, but in general the theories centre on the amount of light (or lack thereof) getting into the brain. When we stand in the sun we tend to absorb bits of light through the thin parts of our skulls and this helps to dictate our circadian rhythms (our body clocks). 

Light triggers many chemical reactions in our brains that can make us feel more alert and more content. The presence of light causes the pineal gland to stop producing melatonin - the sleep hormone that makes us tireder and less alert. Because light prevents melatonin production this in turns means that it makes us feel more awake, switched on and alert and with more energy. As the winter days get shorter and darker, or we experience 10 consecutive days of flood rain, we might suffer from melatonin mayhem deprivation making us feel sleepy, cranky and craving hot chips. 

In general, sunlight also helps us to produce serotonin (one of our pleasure chemicals in the brain) and improve neurotransmitter activity and function. Research has also suggested that people who experience SAD may also produce less Vitamin D, which is believed to play a role in serotonin activity.

The clouds are coming in over my head again now. But it’s okay. I’ve had a day where I bounced out of bed and felt alert and joyful. I ate hardly any carbs. And even though I drove home in the rain, I've got some hopefulness back. The sun might just shine again.

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Rebuilding. And thriving.

Mother Nature really came out swinging this week. For so many communities up and down the east coast of Australia there was not really much that could be done. Mother Nature decided to show us she was the boss, and she did so with all her power.

The Northern NSW town that we grew up in – Lismore – copped some of her power with the river breaking its banks, the water topping the flood levee and the CBD and the surrounding regions becoming inundated with water. It all happened incredibly quickly.

The community of Lismore is fascinatingly wonderful. And I have written about this place before. Being the town I grew up in, at age 18 I was very ready to leave. And leave I did. But after 16 years, I returned and I feel so very blessed to be able to work in, and for, the community now. When I drive in to the Lismore CBD each day I feel comforted. It feels that I am in the right place.

To highlight the community’s character, when I stated to a colleague recently my love for Lismore, he remarked “I like that it is the only Australian town where you can see a drag queen in glitter heels and a farmer in RM Williams boots walking down the Main Street".

It does have a reputation for flooding though. Geographically it is shaped like a basin. Or less affectionately, a hole. Stuff gets trapped in there. Heat. Fog. Copious amounts of muddy water.

I wasn't yet around for the great flood of 1974, but shortly after our arrival to the town we saw the flood of 1987. It coincided with the birth of my sister Trudy. She literally arrived in a flood. Neither the flood, nor Trudy brought me much joy at the time.

And there were other floods growing up, where my recollections are limited to family friends having "holidays" at our house high on the hill or coming over to use our washing machine and dryer whilst we sat and watched the pools of water in the valley from the verandah.

I am incredibly ashamed to admit that during my late teens and early 20s (the floods of the early 2000's) I would visit the flood as a ‘tourist’, driving down town to have a good sticky beak and check out how much damage Mother Nature caused. I hate to think the additional pain this self-absorbed behaviour caused and how it would have hampered recovery efforts. I’m pretty disgusted about that now.

I’m also disgusted at how cranky I got one time when I tried to travel home from Brisbane and fifteen minutes from home, I encountered flood waters. I had to turn around and add an hour or so to my journey. A pretty minor inconvenience for some pretty major anger.

Luckily, I've wised up to responding to natural disasters a little bit with age. It may have been the Brisbane flood of 2011 when I lived in an apartment on the Brisbane river. There’s no underestimating what it feels like to have no control at all over what’s about to happen to your home and everything you own and very little warning or preparation to do something about it.

But these feelings of insecurity and lack of control were totally diminished by the tremendous community support we were shown at that time. Little could have prepared me for the way strangers, community groups, the Army, other organisations and who knows who else turned up in the street to assist in the immediate aftermath of the flood.

But my flood stories are incomparable though to the ones I have been hearing this week, from our elders in the community. The people calling in to the local radio. My friend’s Dad interviewed for a newspaper article. The conversations you have with people about town. This is where some real community beauty lies. Stories of experience. People who have responded well in the past and will do so again this time round. Who can set an example for the rest of us. Stories that will continue to encourage our community resilience.

Because this weekend’s flood was a big one. And this time round I'm feeling pretty amazed and pretty damn devastated. Things were different this time round. We were already sitting on pretty damp ground in the lead up to this, but on Thursday morning I drove to work on a a clear, dry road. By Friday morning that road was under 1.5 metres of water for kilometres. Even more seasoned flood-affected community members felt unprepared. And we can see the effects of this now. Homes and businesses gone.

And again I'm hardly personally affected. My home is out of the Lismore area and which despite warnings was unaffected. My Lismore CBD office is on the second floor. It'll probably be a bit wet and smell for some time, but we'll still be able to do our jobs.

But it still hurts to see the places where I buy my coffee and my bread roll suffer. And this community in pain. My heart breaks. 

The other thing that has happened is that the areas most affected by Mother Nature’s force, are those that are also most likely to be affected by other aspects of disadvantage.

Socio-Economic Indexes for Areas (SEIFA) is a product developed by the ABS that ranks areas in Australia according to relative socio-economic advantage and disadvantage, Lismore City's SEIFA score for 2011 is 953 (a ranking of 66 in NSW). Within the local government area, the five areas with the lowest IRSED index scores (i.e. the areas of highest disadvantage in the Lismore City), were: Nimbin and District (860.0); Lismore - Girards Hill (871.2); South Lismore (872.5); Lismore (907.4); North Lismore (921.5). The areas which have experienced significant flooding.

In addition this community experiences high levels of unemployment. In 2011, 8.2% of the Lismore labour force was classed as unemployed compared to 6.1% in regional Australia, 5.9% in NSW and 5.6% across Australia (ABS, 2012). The five areas with the highest unemployment rates were: South Lismore (15.7%), Nimbin and district (15.6%), Lismore-Girards Hill (15.4%), North Lismore (14.0%) and Lismore (13.0%). Again, all areas that were inundated with water. 

And to add to the levels of disadvantage, no insurance company will insure a home or business that resides in a flood-prone area. 

So for people who were less likely than others to be having an easy time of things, Mother Nature just made things even tougher. 

Like most parts of life, in a crisis some of us behave worse than others. There’s people running into the danger that others need to be rescued from. And there’s been reports of looting occurring in flooded businesses and properties. For some people, it seems that they can’t help but voice their own sentiments about what should or should not have been done in the lead up to the event. And we really have to wonder whether right this minute any of these things are helpful?

But one of the beautiful characteristics of human beings is that because our sense of community is so deep and powerful within us, we have the capacity to respond almost unthinkingly to the needs of others when they are suddenly in our face. And the more acute the need, the more reflexive our response. Most of us can really rise to the occasion in a crisis. Responding not just satisfactorily, but brilliantly.

We’re not being heroic. We’re just being social creatures. We know – viscerally rather than cognitively – that we are all connected to each other; part of each other; bound by our common humanity. I don’t need to know the person in the next suburb over, or the lady with the awesome haircut who makes my morning coffee, to share his or her pain.

And over the weekend, we have started to see people band together in time of a disaster. We can see that the vein of generosity is rich within us, needing only to be tapped. People are putting on free barbeques in the park. Others are turning up to the CBD with mops and brooms and buckets in tow. Mothers are organising collections of children’s clothes and toys to be delivered wherever they can.

When we feel that we belong to a community that shows us hospitality and generosity it can assist in these post-flood weeks to reduce the feelings of uncertainty and despair. With a sense of collective hope and resilience we can continue to learn from past disasters and better prepare for future ones. And we can adapt to the challenges and rebuild. Like we have done before.

Communities survive by us continuing to engage with and attend to them. And here’s a wonderful opportunity. No one is a position to do nothing. We can all contribute in some way. Already people are offering free services and goods to assist with the clean up. We can all make the choice to support a local flood-affected business get back on its feet by giving them our business. We can donate to charities that support local people. For those of you who have been affected by the water, please don’t be too shy to ask for help. And all of us can check in on our loved ones regularly. To see that they’re traveling okay.

This is the stuff of not just rebuilding. But thriving.

For information on providing psychological first aid for flood-affected people the APS has this excellent information sheet. 

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Battling defensiveness

There’s been a minor car parking issue in our street of late, where some of our neighbours have had some alternate views to that of me and my housemates. Whilst the current Ballina Shire Council regulations regarding 45 degree angle parking in residential streets is somewhat fascinating when it concerns your own Mazda 2, what is more interesting is how the people have been reacting. Myself included.

Almost automatically, I became pretty defensive about the whole thing.

We all get defensive in different ways to different things. Some of us may be triggered by particular things and emotionally over-respond when it comes to specific areas such as our religion or appearance. For some of us, it might have to do with aspects of our sense of self, like when we feel challenged or threatened by perceived criticism.

Most of us have probably experienced some form of defensiveness in our close relationships. If we’re not defensive, then we interact with people who are. It can be like the relational disease that has the power to imprison and destroy intimacy. It can prevent love and connection between partners and friends. And neighbours.

Defensiveness refers to a situation where we are feeling personally attacked. It is usually some aspect of our sense of self that is being attacked. When we are feeling attacked by another person, the alleged attacker may deny the attack; and an observer may or may not see the attack. In other words, often we may feel attacked when there is no attack intended.  The sense of being attacked may originate within oneself.  When we defend ourselves against a felt or perceived attack rather than a “real” attack we become defensive. We are protecting our sense of self.

One of my favourite definitions comes from the  author Sharon Ellison: to be defensive is to react with "a war mentality to a non-war issue." In other words, defensiveness is often an impulsive and reactive mode of responding to a situation or conversation. Rather than listening with an open heart, we respond with our metaphorical shields up and weapons drawn.

And these signals of ‘war’ come about when we witness defensiveness in action.

When our neighbour bought the parking issue to my attention, there were a number of things I did pretty automatically:

  • The voice in my head runs through a list of reasons why negative feedback isn’t true.
  • I began talking quickly and run through a series of points without taking a breath.
  • I pretty much stopped listening to what my neighbour had to say.
  • I found a lot of justifications for the situation that may have had something or nothing to do with the actual situation.
  • I used the word ‘but’.
  • I crossed my arms and closed my body off to my neighbour.
  • And eventually, I submitted to smiling and nodding in the hopes that he would stop.

Being defensive is a sign that we’re in fight or flight mode, and it’s not often a place where we can accomplish anything constructive. Defensiveness battle mode also sends terrible signals. When we indulge in it, we’re likely to be seen as insecure, closed-minded and overly emotional. None of these labels is usually going to help us be successful or build stronger relationships.

We’ve made some minor adjustments to our parking out on the street. But not many. We still sort of reckon we’re right. The big learning for me was about being more aware of my own defensiveness signals so I can nip these combative reactions in the bud. It’s suggested that defensiveness can be suppressed with deep breaths, with listening and curiosity, and with demonstrations of accountability and willingness to learn.

And maybe with less meddlesome neighbours.

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The argument against hope

So, I came across a concept this week which has blown my mind a little bit.

I read a book over the weekend which was hilarious and smart and for 203 pages I wholeheartedly agreed with every single point that was made. Every single point.

And then this happened.

The author mentioned that she unequivocally hates hope. That no good comes from it.

“Hope is a lie. Hope doesn’t work. Hope to be clear, doesn’t fix shit.”

Reflecting on time spent with an unwell ex-partner on a neurological ward in hospital she writes:

Even if few truly believe that pain can be treated with bone broth or a Tesla pendant, many believe in the medical power of hope. They believe that if a patient is not sufficiently ‘positive’ to believe in the possibility of a cure, however unlikely it is, then they are not prepared to live…

This is absolute bollocks, of course. Often nothing works at all. ..

These moments of hope serve only those of us in good health who do not care to see hope disappear.

It goes on. Like me, this author enjoys a rant.

Some of the ranting really resonated. There are probably a number of times we do need to be cautious with hope. Possibly during a break-up (as the author was experiencing), and maybe unrealistic hope in the face of terminal illness is unnecessary, but to be cautious all the time?

Turns out there’s some evidence that backs up her point a bit too.

Research, published in the Economic Journal, suggests that hope makes people feel worse. The researchers' starting point was what happens to the long-term unemployed when they reach retirement age. According to 25 years of German data, ‘retiring from unemployment’ delivers a significant increase in life satisfaction. It isn't explained by other factors, like a change in benefits, and the employed don't get the same boost when they retire. Nor, the authors argue, is it simply that other people judge the jobless more harshly. It's that when we're unemployed, there's always the hope of finding a job, and people "thus feel the permanent pressure to fulfil the norms of their social category… Ironically, it is hope that keeps them unhappy while unemployed, and it is only when hope fades that they will recover." Retirement means the end of hoping for a job, which feels like a release.

It’s possible that this odd notion sheds light on another mysterious but well-supported finding about trauma. As we'd expect, we take it harder when we become widowed than when we lose our jobs – but all else being equal, we actually recover more fully. It’s hypothesised that this might be because widowhood is irreversible. We’ve always got the hope of being happy again, certainly, bit no hope of changing our widow(er) status. Bereavement is a hope-free zone.

There’s a few out there who share the belief that if we give up hope we will be set free. John Ptacek, a US author, wrote of finding meaning through hopelessness after his wife's terminal cancer diagnosis: "Time spent hoping for happier days is time spent turning away from life." Derrick Jensen, an environmental campaigner, believes hope makes activism less effective since it involves placing faith in someone or something else to make things better, instead of doing what's needed yourself: "A wonderful thing happens when you give up on hope, which is that you realise you never needed it in the first place… you become very dangerous indeed to those in power."

However, I don’t know if this is abandoning hope all together. But finding the difference between false and realistic hope. And also attempting to find the degree of agency we have.

When confronted by the reality of the concentrations camps, Victor Frankl did not hope to dig his way out of his prison. That was not possible, and such hopes would soon have been thwarted. Instead, he controlled his own mind, and (probably) vaguely hoped for something realistic—that the war would end and he might be freed. That made the difference.

Abandoning hope all together is definitely not for me. Like all the good stuff, probably another of those things best enjoyed in moderation.

I have no hopes to become the world’s most famous Beatle impersonator. Or the next Dr Phil. Much better to hope that over time people with mental illness get access to the treatment they deserve. I hope that these little cards of ours might make someone feel just a little bit better. Or that someone experiencing an episode of mental illness can have enough hope to hang on through the dark times. Like I did.

Here’s hoping.

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How does it all start?

I have been getting my life in order of late. In extremely exciting and very adult news, I have paid off my HECS debt! I now actually own my two degrees. I have consolidated my fifteen superannuation accounts. This week I got my car serviced and after a very assertive talking to from the mechanic, I have two brand new tyres. And I am going through the process of having a ‘proper’ General Practitioner. Like, a GP who actually knows me. Not just the one who is available when I've got myself an ear infection from washing my hair too frequently in the bath.

I haven’t had a regular GP since I was a very young person. So new GP – let’s call him Dr Nick, because that is his name – had a bit to catch up on. And we’ve spent time together looking over and listening to different parts of my body. And I’ve attempted to succinctly summarise my mental health history for him. This has not been as easy as I’d hoped. Turns out I’m not the eloquent historian I envisioned. And also, answering personal psychological questions short and sharp, is tough. It’s not like sitting on the couch with psychiatrist Dr Matt and being able to babble on for a forever until you think you might just nearly maybe have it sort of figured out.

Take this, question for example. Dr Nick asks – ‘Have your episodes been triggered by anything?’ (Except he didn’t ask it like this. Because he is a doctor. And sometimes doctors prefer to use really complicated language to remind us that they’re really smart. Technically he asked – ‘Have your episodes of mental illness had an etiological cause or event?’)

It’s a warranted question to ask. There is immense scientific literature on this topic. People who have a severe depressive episode are most likely to have experienced a stressful life event within the past year (like divorce, moving, job loss, death of a loved one, medical illness etc.) compared to people without mental illnesses.

But I found it a tricky question to answer. In a short GP consult.

Probably, my episodes were brought about by a complex interaction of biological, cognitive, social and psychological factors all conspiring together in wonderful ways.

What I reckon probably happens to me is that there may be a build-up of life events (yes, we could call these social factors, or environmental causes or triggers), and when these events are of a particular kind that holds an inherent threat to my sense of who I am (the psychological part) then my mood is more likely to shift. Probably downwards.

So, there’s been times in my life where there has been a lot of life events or stressors and because of the nature of these events, they’ve affected me in a particular way. There’s been periods where I have been working full time, feeling a bit anxious, but keeping my head above water, to quite a different state of mind. When I am there I feel quite different. I don’t only feel sad, I feel physically ‘changed’; heavy of limb, tired, unable to sleep yet also very agitated and restless. I ruminate about things that at other times I would be able to cope with easily and I can be full of fear and panic. When I look in the mirror I am quite sure I can see it in my eyes. There are times when my fear can shift into obsessive and paranoid thoughts and feelings of wanting to end my life. It’s terrifying and yet oddly familiar at the same time.

And there’s other times where there’s been life events or stressors that have occurred, but an episode of mental illness hasn’t followed. Why? Probably because these stressors didn’t play into my vulnerability so much. They didn’t attack my sense of self or my psychological state in the same way. Or my psychological state was stronger or more resilient at the time.

I reckon the most toxic kind of life event that can trigger depression is one that resonates with a particular aspect of the person’s underlying vulnerability. Life almost seems to conspire to match the event to the person. Eventually anyway.  

And as I’ve mentioned before that vulnerability for me is the big Ps. Please. Perform. Perfect. The belief that if I do things perfectly I can minimise or avoid the pain of blame, judgment and shame. This comes with the nasty and debilitating belief ‘I am what I accomplish and how well I accomplish it’. So when events or stressors come along that target this belief system (which happen reasonably regularly), I become more susceptible to depression and anxiety.

So why do I experience depression when others experience far worse life events then me, yet don’t become diagnosed with mental illnesses? The only way I can explain why only some of us seem to become depressed in response to life events is by drawing on the concept of vulnerability. A combination of genetic factors, early life experiences and life stresses can cumulatively add to our vulnerability. Such that, when a torrent of life events come along, those of us who have the greatest vulnerability and lowest threshold for becoming depressed, can get washed away by the waves while those who are fortunately more resilient seem to remain standing.

So, how did I respond to Dr Nick. Unfortunately not with a neat and succinct hypothesis regarding predisposing factors, psychological vulnerabilities and precicipating events. Instead I said something along the lines of “Yeah, sort of.”

Because that’s maybe nearly about right.

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Kristen's story

This is our first post from Hope Street Cards guest blogger - Kristen Malake. Welcome Kristen and we can't wait for more contributions from you!

I have a long history with mental illness. It began in middle school in the form of an eating disorder. One day a ‘friend’ taught me how to make myself throw up.  I purged, tried to hide food, threw food away and exercised in the middle of the night. One night I was going to head out with a friend. We had spaghetti for dinner and even though I ran the shower my mother could hear me throwing up. I remember a loved one saying, “if you can’t control what goes in and out of your body then you can’t go out”. But really, at that point in my life, those felt like the only 2 things I could control. That’s what eating disorders are all about anyway, right? Well, my weight loss landed me in in my first impatient hospitalization. I was there for almost 3 weeks, which is almost unheard of these days.

Following this we went to family counseling, which I did not find to be helpful at the time. The therapist asked me where I would like to start and when I spoke my thoughts, she belittled me. The silence and tears began. I said to my mom: “you talk too much”, and to my dad: “you don’t talk enough”.  Looking back, I would like to think the therapist was inexperienced because her response to me totally made me shut down. At this time, I was 16 and began my never-ending journey with medication. I am now 43 and am still taking medication. In the times that I have tried to go without, I have ended up in crisis, having suicidal situations. I have come to understand that my brain is wired in such a way that it needs certain chemicals that only medication can provide.

During this time, I was diagnosed with Major Depressive Disorder and Social Anxiety Disorder. Those diagnoses never changed until only a few short years ago. The therapist I had been seeing for about 5 years was certain that I had Bipolar Disorder. Over time, it has become apparent to me that this is a true diagnosis for me, as well as the Social Anxiety Disorder.

I think society has been taught to believe that Bipolar means the same thing for everyone. The “ups” meaning feelings of exuberant joy; 2 am cleanings of the house, top to bottom; extravagant shopping sprees; losing thousands of dollars gambling, and; having multiple sexual partners in short periods of time. The “downs” meaning not being able to get out of bed; going for days without showering; missing multiple days of work; crying constantly; self-harm, and; avoidance of people. However, this is not the case for me and probably not for a lot of people. My symptoms are more subtle, to the point when I don’t always know when I am becoming manic or depressed. I usually have to check in with my husband and he is typically right. When I feel manic, I talk frequently and rapidly. Often people find me difficult to follow. I may shop more than usual, but I always keep in mind that we do live on a budget. I become more anxious and have difficulty sitting still or just relaxing. I have to be doing something to feel okay. I generally feel like the world is full of mostly good people and that I am one of those people. It is easier for me to tell when I am becoming depressed. My need or want for sleep increases and I eat more without really tasting the food. I become agitated and irritable with my loved ones. I feel hopeless and helpless and yes, sometimes still suicidal. I feel like I should have a better job at this point in my life, that I’m not a good mother and that I don’t deserve the patience my husband has provided. I cry out of the blue. Sometimes I just want to be done, to be gone. By that I mean that I don’t necessarily want to die, but to just disappear.

When my diagnosis changed from Major Depressive Disorder to Bipolar, I was prescribed mood stabilizers. I don’t know that I have noticed much difference. I have had a few psychiatrists, one for many years and have been on multiple medications. I have heard several times, “well, it looks like you have tried about everything” and “have you looked at Electroconvulsive Therapy (ECT) as an option”. This is not what a person who is already feeling  hopeless  needs to hear.

To fully understand me, you must also know that I am an alcoholic. I have been in recovery since April 16th of 2009. My drinking and smoking cigarettes began around the age of 18 and the use of many illegal drugs soon followed. It started with wine coolers and throwing up in bed and not being able to move to clean myself up. My parents eventually nailed my bedroom screen window on to prevent me from sneaking out to drink. In college I would wake up on door steps and in apartments where I didn’t know the people and didn’t remember how I got there. In my early adult years, I somehow managed to earn an Undergraduate and Graduate degree in Social Work. However, I continued drinking. Vodka and lots of it. In the beginning I had it every night after work. Never mixed, just shots. I kept one bottle outside and one inside, as well as airplane size bottles in my purse. I would put water in the bottle to make it look like I hadn’t drank as much. When I hit bottom I was drinking ¾ bottle a day. I began between 7:00 and 7:30 in the morning, drinking straight from the bottle that I kept in the freezer. I drank until noon and then stopped to “sober up” by 4:30 when I had to work. During the day I stayed home with our young children, ages 1 and 3. When my husband came home, I would go to work, assisting adults with mental illness interestingly enough. I hit rock bottom as many do and it was very, very low. In short, I was given the choice to sober up or lose my husband and children. I chose to sober up. Thanks be to God and supportive family and friends, I am still sober to this day.

What I want those who love a person with mental illness to know, above all…..this is NOT about you. It isn’t your fault and it isn’t your job to “make things ok”. If you had the power to do that, I’m sure you would. But you can’t. This is not your doing and this is not your battle.

That doesn’t mean that you are helpless to watch your loved one suffer. I love hearing “what can I do for you” and “how can I help”. These phrases allow me to say what I think you could try that might help me feel more loved. It’s about support and helping me to feel that even though I’m ill, I’m still me. At the heart of me, I am still the person you fell in love with or have come to enjoy the company of. I don’t mean to be hurtful with my words. I don’t want you to feel responsible to make me happy. Only I have that power.

Intermittently as my illness has allowed, I have been an advocate for persons with mental illness in both a personal and a professional capacity. It remains clear that society still does not have a clear understanding of mental illness. If they did, mental illness would be equivalent to a physical illness in terms of stigma or lack thereof. People fling around words like crazy, say I think she missed her meds, or take a chill pill. At Halloween there are haunted houses where the goal is to escape the “psych ward”. I used to be ashamed of my condition. I used to try to hide it, but it was hard to hold a job without an eventual breakdown. I feel ashamed no longer. This is a part of who I am, only a piece of my whole puzzle. I didn’t create this problem. I was born into it through a combination of family history and brain chemistry. Those who know me and love me will continue to.

My biggest supporter is no longer. She committed suicide four years ago. We were friends for 34 years. She took the easy way out. Often times I wish that I could do the same. I will never place blame on her, but I will never get over her loss, how it occurred and the reason why.

My sister has been a constant my entire life. She has dropped everything to come to me when I have needed her. She is and forever will be my best friend. My parents were always quick to get me professional help when I needed it and have supported me consistently. A friend literally let me lay in her room until I could keep myself safe. A coworker held me when I felt like I was falling apart. My husband has stuck with me through it all. We met as social workers assisting adults with mental illness. He has continued the same work for over 20 years. Perhaps out of not knowing any other way, it is difficult for him to provide me support that differs from the kind that he provides his clients.  I can’t imagine how difficult my illness has been for him to cope with. There are times when I wonder how he can even stand me because often, I can’t even stand myself. I know that my emotional instability is difficult to live with.  He could have left a million times, for a million different reasons, but he didn’t. He’s still here.

When I am unwell, I may reach out and I may not. It depends upon the severity of the symptoms. Often at work, I pretend to be even better than I usually am. I say that I’m fantastic, wonderful, peachy. Fake it until you make it as they say. But that can be what turns out to be helpful. I pretend to be someone that I’m not. Because people like happy people. Let’s face it. They enjoy being with those who laugh and smile.

One of the most unhelpful things I hear is “smile”. Really? Why? So that you can feel better. So that you can go about your merry way without having to worry about me. The other thing I don’t like to hear is “everything happens for a reason”. I don’t believe that to be true. Sometimes things just happen. People die. Children are abducted. Families lose their home. What reason justifies these things? And would having or understanding the reason make the situation any better? I don’t think so. People say what they feel like will placate the situation, so that they can walk away feeling like they have done something.  That’s not to say that there are not people who genuinely care because there are. There are very kind people who have heard me and held me through some of my darkest hours.

I don’t need or want expensive gifts to make me feel better. The things I love the best are notes that I find on my car after work that simply say, “I’m thinking of you”. Or a bag of my favourite chocolate hanging on my doorknob when I get home. It says that I am important enough for you to take the time out of your day to think of me. Cards in the mail are always appreciated. They are a surprise and who doesn’t like a card right?!?  

Please do not try to fix my situation. Do not give me options of what to do when I just want you to hear me. Just listen to me. Sit with me. Don’t tell me what you think will or will not work. When I am in the middle of my pain, I’m not thinking about solutions. I’m thinking about breathing, calming my shaking body….that’s all I can think about. I’m certainly not in the mindset to problem solve.

So really, what it really comes down to is the support of those that we love and trust. It’s knowing that there are a select few who will never leave, not even in my darkest hour. When my mascara runs black down my face, dripping snot on their shoulder, barely able to breathe through the wretching sobs. If I am lucky enough to have even one of those people, I am lucky enough.

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Cake and depression

Our brand new card for depression is all about cake. Well, sort of.

I am a big believer in the power of cake. It celebrates things. It connects people. It makes otherwise dull functions way more exciting. It can do wonders for an individual at 3pm on a Monday afternoon.

Cake could probably fix a mild dose of unhappiness I reckon. The magical combination of sugar and butter. The care and love that has gone into smooth icing. Knowing how frustrating it is to use a piping bag.

But depression is not the same as unhappiness.

When I am in remission from a depressive episode (as I am now), it can be difficult to remember the full weight that depression had on me. Sometimes I wonder whether that weight was really as heavy as I had thought. Maybe it has not so much as melted away as never been there in the first place? Maybe I was just bunging it on? Exaggerating, pretending, and trying to escape my responsibilities at work, in life? It is hard to remember how heavy the burden of depression can feel when all you want to do is forget about it.

But then I might hear the unique story of someone’s own personal experience with the black dog. Or hear of a friend’s loved one cutting them self off from the world. Or hear of a suicide following a drawn out battle with depression

And then I manage to remember bits.

Depression is a much more cavernous feeling than the unhappiness that haphazardly visits me these days. It is a much deeper and more powerful sense of despair which colours how we see the world and interferes with our ability to go on with our life.

For every person who experiences depression, there are different dimensions of biology, psychology and life events and difficulties at play in both precipitating the depressive episode and maintaining it.

From a biological perspective there’s all sort of imaging around that can show us some of the stuff that’s happening in our heads. For people who experience chronic and severe depression, there are changes which can be seen in the structure of the brain. When a person has experienced one episode of severe depression triggered by stressful life events, there appears to be some kind of ‘kindling’ effect in the brain which makes further episodes more likely to occur.

Also there are certain symptoms of depression – low mood, inability to enjoy life, loss of energy, inability to think clearly and feelings of hopelessness – which can, at least to some degree, be reversed with medication. And I’ve found that medication helps me. It takes some of the weight off.

Having said all of that, personally and as a psychologist, it’s impossible for me to believe that the complexities of human thought can be explained by a simple chemical imbalance. The nature and essence of mental illness – the most subjective and personal of human afflictions – couldn’t possibly be distilled to something quite as straightforward as just the replacement of a substance depleted from the brain.

We are all wonderful, complex beasts and often depression is intertwined with other realities of the human condition: our vulnerability, fears, losses and wounds. Our need to be loved, the pain of loneliness, the problems in our past, grief and unresolved guilt.

For me, depression was a profoundly personal experience. It burrowed into me and damaged my sense of self and my reason for self. It caused quite a bit of damage. Probably the reason I try and forget most of it, is that depression is a singularly awful experience. It can sap the life out of you and make each day seem like a lifetime.

Unfortunately cake probably wouldn’t have provided me much of a solution. But I know that there are lots of other more effective options out there. And with time, patience, love, support, hope, commitment and bloody hard work the full weight of depression can be lifted.

You can find our 'Cake for Depression' card right here.

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Please don't tell me your dreams

The other night I caused a small raucous at a very civilised dinner party when I refused to participate further in a conversation that for some of the others around the table they appeared to have fully engaged in. They were discussing green m & m’s and then bodies being decapitated and just before it started to really deteriorate I interrupted and stated I would not be a part of a conversation of this matter any further.

Because a few years ago I decided that I had had enough. I was not going to listen to (healthy) people bang on about what they dreamt about anymore.

Seriously, I find that there really is nothing more boring than listening to people talk about how interesting they find the content of their dreams. I would rather sit and listen to paint dry.

I totally agree that dreams can be absurd and weird. They can go from being terrifying to erotic to bizarre to banal. And sure, it is an interesting question – How on earth do our minds conjure up such ridiculous imagery, such inane thoughts, such spectacularly vivid and surreal landscapes, intense emotions—such narrative trash? But, I can guarantee that we will not answer this question around the dinner table.

Firstly, we all dream. And we probably dream a hell of a lot. But we don’t remember them all (thank the heavens, because then we’d be talking about it even more).

Dreaming occurs during the rapid eye movement (REM) stage of sleep, which accounts for about 20% of our sleep time. During sleep, we dream about every hour and a half (as the brain cycles in and out of REM sleep), and each dream period gets progressively longer. If you happen to remember your dream, chances are it’s simply because you woke up during it. Waking up during a dream is by far the best predictor of you remembering a dream. It’s fresh in your mind. Or it could be that you’re only remembering the last dream that you had. We tend to have most of our REM sleep in the second half of the night.

We will probably also remember our dreams when we’re experiencing other significant emotions as well. We’re more likely to remember our dreams if we are feeling anxious or down, perhaps because we’re waking up more when we’re worried. Maybe in the middle of dream.

And physical health gets in the way as well. Certain medications can supress REM sleep, including some anti-depressant medications, which makes it more difficult to remember dreams. As can sleep apnoea. Whilst there’s other medications, like the smoking cessation medication, Zyban which can cause vivid dreams which are reportedly easily recalled.

Over the last half-century, researchers have identified a few factors that may influence dream recall, from age and gender to specific personality traits. Studies on the biological basis of dreaming have found people with high dream recall show different patterns of neurological activity than their forgetful friends. Other researchers have looked at differences between men and women, younger and older people. In general, we remember our dreams more when we are younger. Probably because we are sleeping much more deeply. And women usually have higher dream recall then men.

And whilst we might claim that our dreams are sooooo surreal and bizarre, chances are they probably aren’t. There are patterns.

Older people report more death themes in their dreams. Male dreams have more sexual and aggressive content than female dreams, which have more themes dealing with home and family. Women report that they dream of their mothers and babies more when they are pregnant. Introverts report more dreams and with greater detail than extroverts. People who experience psychosis, depression and people who have occupations in the creative arts (musicians, painters, and novelists) report more nightmares. People with schizophrenia and severe depression provide shorter dream reports than those of better mental health. It is also reported that people experiencing depression dream of the past more than those who are not experiencing depression.

Environmental factors occurring before and during sleep can shape the content of dreams. What people experience prior to falling asleep can show up in dreams in blatant, subtle, or symbolic forms. People watching movies that evoke strong emotions tend to have highly emotional dreams. In fact, the greater the emotionality of a daily event, the greater the probability that the event will occur in a dream during the subsequent sleep period. Those who are wrestling mentally with a problem often dream about that problem. Some have even reported that the solutions to their problems occurred during the course of dreaming. The German physiologist Otto Loewi's Nobel Prize-winning research with a frog's nerve was inspired by a dream he had. Sometimes events during the day show up in a compensatory form in dreams. Those deprived of food, shelter, friends, or other desirables report an increased likelihood of dreaming about those deprivations at night.

Events occurring during sleep can be integrated into the dream plot as well. External stimuli such as temperature changes, light flashes, and various sounds can be detected by the sleeping person's senses and then become part of the dream. However, research indicates that sensory information is only infrequently assimilated into dreams. Internal stimulation from physiological activities occurring during sleep may have a greater chance of influencing the nature of dreams. Dreams about needing to find a bathroom may be caused in part by a full bladder. Similarly, nighttime activation of the vestibular system (which controls the sense of balance), the premotor cortex (which initiates movements), and the locus coeruleus (which plays a role in inhibiting muscles during sleep so that dreams are not acted out) perhaps can stimulate the production of dreams about falling, chasing, or being unable to move, respectively.

But more interestingly, our dreams are actually not all that unique. From the 1940s to 1985, Calvin S. Hall collected more than 50,000 dream reports at Western Reserve University. In 1966 Hall and Van De Castle published The Content Analysis of Dreams in which they outlined a coding system to study 1,000 dream reports from college students. It was found that people all over the world dream of mostly the same things.

Personal experiences from the last day or week are frequently incorporated into dreams. The most common emotion experienced in dreams is anxiety. Other emotions include pain, abandonment, fear, joy, etc. Negative emotions are much more common than positive ones.

Content-analysis studies have identified common reported themes in dreams. These include: situations relating to school, being chased, running slowly in place, falling, arriving too late, a person now alive being dead, a person who is dead being alive, teeth falling out (this is not uncommon Trudy Booker!), flying, future events such as birthdays, anniversaries, etc. (with different scenarios), embarrassing moments, falling in love with random people, failing an examination, not being able to move, not being able to focus vision, car accidents, being accused of a crime you didn't commit, suddenly finding yourself naked, going to the toilet, and many more.

The thing we really don’t know is why we actually dream. Why does the restorative function of human sleep require dreaming? There are plenty of theories around from Freud’s wish-fulfillment theory to evolutionary theories of external vigilance. But none yet confirmed.

What we do know though, is that what you’re dreaming about is probably not all that unique and unusual. So please, don't tell me about it.

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