The Other Curve Being Flattened

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Mental health extremes in our house. Where does everyone at your place sit? By the end of this post you might have a better idea.

The Covid pandemic feels as though it has equalised our collective mental health. Or if not equalised, then it has certainly ‘flattened’ the mental health curve.

Most people who live with a mental illness have at some point experienced unpleasant times with no fixed end point, over which they have little control. And now the rest of the world is being forced to experience this too.

I imagine everyone’s mental experience of this pandemic differs based on their mental health history (among other factors). But it’s fair to say that right now most, if not all, of us are experiencing some form of mental discomfort.

On the surface, those who live with mental illness appear to be most vulnerable to this. But, this demographic may not be as at risk as we think.

As someone who lives with a severe mental illness but is currently relatively asymptomatic, I feel surprisingly resilient…for now.

Having previously lived through the rock-solid horror of psychosis, the inevitable Covid anxiety that flits through my brain now feels relatively easy to manage. I have an arsenal of finely honed tools to combat it. All that Cognitive Behavioural Therapy, the Acceptance and Commitment Therapy, and individual sessions with my psychologist are coming in handy.

I am also familiar with having my freedom restricted at times. When I am on fifteen-minute observations in hospital, I can’t go outside. At my sickest I have been too unwell for visitors. It doesn’t mean I like it, but I have at least previously encountered similar conditions to the ones I am living with now.

But what about everyone else?

Many people had been living with mild to moderate undiagnosed or poorly managed anxiety and/or depression for several months or years before Covid hit. I am particularly concerned for this group.

They don’t have solid medical and social support systems in place yet. The all-encompassing Covid generated stress is the perfect trigger for worsening symptoms. And accessing good mental health care quickly and efficiently may become even harder than it usually is.

Depression and anxiety symptoms can make the sufferer feel isolated even if they are closely surrounded by loved ones. Social distancing – so essential to manage virus transmission – will exacerbate symptoms of mental ill health in this group.

Then there are the people who have never lived with mental ill health.

They may never have experienced racing thoughts, heart palpitations, chest pain, irritability, distractibility, gastrointestinal signs such as nausea, vomiting and diarrhoea due to anxiety, a low mood, insomnia, incessant worry, or any other mental and physical symptoms that can arise due to stress and/or mental ill health.

These people may not know why they are experiencing symptoms or have the psychological skills to put them in perspective. So, they will suffer more than they need to.

But there is good news in the quagmire of black headlines we are sucked into daily.

We can use our own mental health histories to help ourselves and others in this crisis.

Here’s how:

If you live with mental illness and are currently symptomatic, your sole focus must be to do what you can to get well. I know from my experience I am of no help to anyone if I am symptomatic. It’s a cliché but one that applies here:

‘Put your own oxygen mask on before you help anyone else with theirs’.

Firstly, contact the medical professionals you would usually consult when you are symptomatic – whether that’s your psychiatrist, psychologist, GP, community health workers, or psychiatric hospital.

Limit your exposure to the news to once a day – if that. If you have family or friends who can reliably update you on the essential news only, do that. Immersing yourself in the details, is of no practical value, and it can make you feel worse.

Use the same tools you would usually use to distract yourself when you are living through an episode of illness. Eat regularly and well. Don’t consume alcohol or recreational drugs. And move your body in some way, even if it’s small, every single day.

If you live with mental illness and are currently asymptomatic be vigilant but not obsessed. Just because this time is stressful, doesn’t mean developing an episode of illness is inevitable.

Your oxygen mask will consist of continuing to take medication (if you take it), keeping your regular appointments with your psychologist, psychiatrist or GP where possible, eating regularly and well, exercising most days, avoiding or minimising alcohol consumption, and practising whatever psychological skills (for example Cognitive Behavioural Therapy) that you have learnt over the course of your illness.

Be aware of any news developments that have practical ramifications for you, but don’t marinate in the news. Once you have done all this and whatever else you need to stay well – consider this:

You can offer support to those who are struggling mentally, those who have never experienced symptoms of mental ill health. Reassurance that their symptoms are survivable with the right care, could mean a lot to someone who is new to these issues.

That said – only do this if you have the mental energy to spare – otherwise just look after yourself.

To those who sense they may have been living with anxiety or depression for a while and it is worsening: All the suggestions with regards to eating well and exercise apply. Don’t self-medicate with alcohol or other recreational drugs. It will make things worse. Getting the right help is also crucial.

I am acutely aware that accessing good mental health care is a challenge in this country even when we are not mid crisis, but some excellent online resources to start with are: Lifeline, Beyond Blue, and SANE (Links at the bottom of this post)

To all the people who have never lived with mental illness: Distraction, exercise, eating well, and maintaining social connections via technology are a good start. Don’t self medicate with alcohol or recreational drugs. If you are still experiencing symptoms related to anxiety or depression (as listed above) then the online resources at the bottom of this post may be useful, or make an appointment with your GP as a starting point.

And one more thing…

Once you have done what you need to help yourself – take stock of how this situation is making you feel. And then imagine feeling like this for much longer periods of time than this pandemic will last.

Imagine feeling like this but the pandemic didn’t exist and people around you made you feel as though your symptoms weren’t real.

Then translate your feelings into compassion. And when you feel like yourself again (and you will), extend some sympathy and support to those whose mental illness lasts a lifetime.

And to everyone: We can use our individual experiences of mental health and ill health to support each other through this strange new world and into a kinder future.

So look at who you are sharing your living space with at the moment and consider starting a conversation about where on the spectrum of mental health and illness you and your housemates or family sit. Then think about how you could help each other psychologically.

My own household is one of extremes (regarding the adults). I live with severe mental illness, currently asymptomatic. My husband has never experienced mental illness.

So, when he expressed frustration a couple of days ago about his attention span feeling like that of a gold fish, I said:

‘Yes, I know it sucks feeling like that. But it will be ok.’

And I gave him a hug – something which I believe (at the time of writing) is still acceptable and safe to do in a household in which no one is symptomatic or has returned a positive Covid test.

 

Disclaimer:

This post is based only on my own experience and anecdotal evidence.

For professional mental health advice please contact your psychiatrist, GP, or for more mental health and ill health information check out the following links, all three of which are currently set up to deal with questions about Covid related mental health issues:

SANE https://www.sane.org/

Beyond Blue https://www.beyondblue.org.au/

Lifeline https://www.lifeline.org.au/

You may also like to check out these other Thought Food posts:

When Covid-19 And Bipolar Recovery Collide With Unexpected Results

Mental Illness Doesn’t Respect Deadlines

My Mental Health Toolbox

What a mental illness can teach you about your mental health

Psychiatric Medication And Stigma

 

 

When Covid-19 And Bipolar Recovery Collide With Unexpected Results

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I have spent the last five weeks in a psychiatric hospital for management of a Bipolar 1 Disorder episode.

I am no longer sick. But still fragile. Like an egg without its shell. I always reach a point on the return to wellness where I can get no better in the controlled bubble world of the hospital. A point where staying longer is of no benefit and can even become detrimental.

I ventured back out into the world at the end of last week. A world that hasn’t grown any softer in my absence. It is the same hustling harsh, bruising, breaking place it always has been, but perhaps more so. No one was fighting over toilet paper five weeks ago.

That said, after any admission for a Bipolar episode, jumping back into my life can feel like steel wool on newborn skin in the early days.

No one can tell by looking at me when I leave the hospital that I need rehab and resilience building before I am ok again. For me, on average that takes the same amount of time I was hospitalised for. So, in this case – another five weeks.

People tend to be congratulatory about me being well enough to come home. I don’t want to be a downer. I am grateful to be home. But just because I’m out of hospital it doesn’t necessarily mean it’s over. It can look like it is slinking away not to be seen again for a couple of years. But appearances can be deceiving.

Once, this illness spent a whole year of my life bouncing me in and out of hospital so often, I got dizzy. By the end of that year, in which most months had held a hospital admission for me, it had nearly killed me. So, that’s why I don’t think about exhaling as soon as I am home.

Today is my fourth day at home. I am still acclimatising. But I also recognise something unexpectedly positive borne of the last five weeks.

Being in hospital with Bipolar symptoms has prepared me for the Covid-19 headlines very nicely.

I get a sense from these headlines and the empty toilet paper and pasta aisles in the supermarket that many people are panicking, or at least are very worried by the uncertainty they are being force fed right now.

I am still in the mindset it took to get through my last five weeks. I lived that time (and do every time I go into hospital) in two-day increments. Why? because it is pointless to look or plan any further ahead. Neither I nor my psychiatrist could fortune tell what would happen. Five weeks of observing, tweaking medication or not, and then waiting another two days before assessing again.

To be clear, there is a difference between not taking something seriously, and choosing to engage only in what is in front of you. I take my Bipolar Disorder seriously, especially when it flares. But does that mean it would be helpful to spend my entire admission panicking that this is the time I become a permanent inpatient (they exist)?

Or should I break it into chunks the size of a couple of days and hit repeat, until at some unknown time in the future I am out the other side?

I’ve spent early admissions, years ago, engaging in the first option but have learnt that the way through with the least energy wasted is the second one.

In the same way, I take the Covid-19 pandemic seriously. But you won’t find me panic buying or worrying about whether or when it will end. Breaking this issue down into two-day increments feels helpful to me right now. Every two days (or sooner if the headlines change dramatically) I reassess the basics: Do I and my immediate family have enough food, water, medication and accommodation for the next two days? I am fortunate. So, far the answer has been yes.

Is there any point in trying to predict what might happen next month or even next week, and worrying about it?

None!

Because no one knows where we will be then. You can only act on the information you have at the time.  And if right now your basic needs are met and you are well, don’t buy more and more and more food or toilet paper (unless you are doing it for the vulnerable members of our population).

Breaking the overwhelm of a difficult situation with no known endpoint into smaller portions lessens the strain on our mental health and preserves our energy for more productive tasks.

And if we do it often enough that’s what will get us to the other side of this situation too.

 

You may also be interested in:

What a mental illness can teach you about your mental health

Where’s Your Comfort Zone?

Interruption To Regular Programming

Update 27.2.2020

 

Update 27.2.2020

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Photo by Emiliano Arano on Pexels.com

And so, we enter week four in hospital.

I emerged from the manic symptoms about a week ago. Pummelled into exhaustion by the high doses of Lithium and antipsychotic medication, and by the manic episode itself. Even in a hospital setting, taking all the right medication, and having good insight into the symptoms, manic episodes accrue a negative energy balance. It means when you eventually recover you are depleted, bone tired.

And this is where it gets tricky:

That exhaustion can mimic rebound depressive symptoms. One improves with rest and dialling back the antipsychotic medication. The other progresses beyond exhaustion to include other insidious signs that envelop you in a black, poisonous mist. Appetite drops off. The words ‘zero fucks left to give’ cast in a concrete block take up residence in your skull. Motivation evaporates and has to be faked until it decides to return in its own sweet time.

For a week now my psychiatrist and I have been watching and waiting. At first, we were both hopeful. We even (stupidly) dared to imagine I could be well enough to discharge by the end of this week. There is a reason we have a policy of never looking more than two to three days ahead when I’m in hospital. It’s because this illness has taught us – there is no point.

My psychiatrist entered my room mid morning today, looked at me back in bed and said

‘This isn’t good. You’re usually out walking.’

I turned towards him.

I don’t like it when his face arranges itself into concern within ten seconds of seeing me. It confirms what I already know. It also reassures me, because it is evidence of how well he knows me.

I have tilted towards depression, in the opposite direction to where I was headed when I was admitted.

This means we change our treatment plan in the opposite direction. We will cut back the Lithium and we will increase one of the two antidepressants I take. We will give it two or three days.

UNLESS…

My mood begins to shift back up before then, in which case I will inform the nurses and they will page my psychiatrist for further instructions. We don’t want to risk another ascent into mania. I’m not reaching for a YoYo or rollercoaster metaphor here, because they both imply the possibility of fun, which this decidedly is not!

The other switch over is the behavioural management of active Bipolar symptoms. For me it means telling myself to do the opposite to what my body wants me to do. So during a manic episode I should seek out quiet environments, be on my own, try not to overexercise. During a depressive episode it means kicking myself out of bed, engaging with others, and above all else exercise, exercise, and then exercise some more.

What a mind fuck.

While I continue to wait out my life in two to three day increments, I don’t feel inclined toward gratitude. But that’s largely depressive symptoms talking. So, I will do the opposite and stubbornly find something to be grateful for. Here we go:

I am grateful that at their current level my depressive symptoms are much easier to manage and tolerate than my manic symptoms were. The intense manic irritability has disappeared, and my concentration and short-term memory have mostly returned…for now.

 

You may also like to check out:

Interruption To Regular Programming

Misunderstood Mania

Mental Illness Doesn’t Respect Deadlines

Visiting Someone In A Psychiatric Hospital?

What a mental illness can teach you about your mental health

 

 

These Fires

 

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Are racking up an invisible bill.

Most would agree that even just seeing the billowing smoke, the hellish glow, buckled tin roofs, smouldering ash, the ghostly silhouettes of dead animals lining the roads into obliterated small towns, even when viewed from the safe parts of the country and the globe, even when the horror is confined to a steady scroll behind a screen, is overwhelming. The helplessness bruises our emotions. We can be forgiven for making a donation, posting something derogatory about our inept prime minister and then switching off our screens for a bit.

For the fire fighters, the people in masks in boats under those bloodied skies there can be no thought other than surviving one hour or minute to the next. The same goes for the emergency services, the army personnel, those with loved ones in the danger zones, those who have lost loved ones.

But what about the rest of us. Yes, we can donate to the Red Cross or Celeste Barber or any of the other funds set up to try and help deal with this unprecedented crisis. We can go shopping and buy things on a list that are needed by the emergency services.

But then what – what to do we do next?

Continue reading “These Fires”

My Sliding Doors Encounter With Our Public Mental Health System

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Have you ever had a moment when your answer to a question determined whether your life imploded?

I have.

It came five days into parenthood. I was lying on the floor in my maternity hospital room crying because I was trying to outrun a jaguar chasing me towards a cliff. Things were starting to go very wrong in my brain.

In the following months, when my mind warped and writhed in the grip of psychosis and later catatonic depression, and when what started out as postnatal psychosis turned out to be a first episode of bipolar 1 disorder, I could not imagine things being worse.

But they could have been.

Continue reading “My Sliding Doors Encounter With Our Public Mental Health System”

Visiting Someone In A Psychiatric Hospital?

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2010 My daughter visiting her little brother and I in the mother/baby unit of the psychiatric hospital

‘My daughter never visits me in hospital. She doesn’t like this place.’

An elderly woman told me this in a private psychiatric hospital several years ago.  Sadness dripped from her words.

The thought of visiting someone in a psychiatric hospital (especially for the first time) can leave people feeling: Awkward. Uncomfortable. Fearful. Repulsed. Guilty. Ashamed. Misinformed. Unsure. To name a few.

What do you say and do if that’s you?

Continue reading “Visiting Someone In A Psychiatric Hospital?”

My Mental Health Toolbox

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This week I had the pleasure of giving a keynote address for one of the departments at PWC (Price Waterhouse Coopers). As part of this I ran through some of the things I have found helpful to help me monitor and manage my mental health.

I got some really positive feedback after the presentation and requests for the list of things that help me with my mental health. So I thought I’d share that list as a post here:

EARLY WARNING SIGNS AND INSIGHT:

In this context insight is the ability to identify early signs of mental ill health in yourself. This is much more challenging than it sounds, because signs of mental illness can masquerade as normal feelings and emotions.

For example – irritability and sadness are part of the normal spectrum of human emotions, but if they are overwhelming and persistent and interfere with normal functioning, they can also be symptoms of depression.

It can take time to identify their intensity or persistence as abnormal. The other challenge is that when we are well, we can often think our way out of sadness or irritability. But when they become symptoms that is impossible.

Someone affected by symptoms of a mental illness can no more think their way out of them than someone with a nasty case of gastro can think themselves out of their vomiting and diarrhoea.

But whereas vomiting and diarrhoea are obvious signs of illness (both to the person experiencing them and everyone around them) it takes insight to recognise when symptoms of mental illness emerge.

For me early warning signs can be an inability to sleep even with a lot of medication, intense irritability, and poor short-term memory and concentration.

Early warning signs are different for everyone. By learning what ours are we can be proactive about seeking help rather than waiting for symptoms to worsen.

For further reading on an example of insight into a depressive episode you can go to: Razor Blades In Mud: Laziness Or Depression?

Continue reading “My Mental Health Toolbox”

Who Holds You When You’re Broken?

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I’ve been told the first time we met I was shuffling slowly up and down a blue carpeted corridor. Slumped body. Empty eyes. I barely registered being asked how I was with a slowly exhaled

‘Not so good.’ before moving on with my pram.

I say ‘I’ve been told’, because I don’t remember our first meeting or the following weeks. I was sicker than I’d ever been. Not many people would have repeatedly made friendly conversation with someone as unresponsive as I was.

She did. At a time when she wasn’t well herself.

When I finally re-emerged after several months of illness, I was delighted to find I had a new friend. A friend I never would have met in my geographical or professional circles. A friend who, like me, had spent the early months of first-time motherhood in a psychiatric hospital instead of at home.

Continue reading “Who Holds You When You’re Broken?”

2018 – The Year I:

Thought about homelessness, after I witnessed displaced people with cardboard placards to explain their belongings smudging the busy and important streets of Sydney in the first days of the new year. My emotional barometer flicked between pity, sadness, relief, and settled on horror because this could still be me one day. The Right To A Home

Went to work. After twenty years the neural pathways for running a consultation competently and compassionately, for reading who I am in a room with, and being a shock absorber for their anxieties and concerns, are so well-worn they are almost automatic. Contrary to popular belief (and this photo), we spend much less time playing with puppies and kittens, than we do using our communication skills to explain, empathise, and advise our way to the best outcome for our patients via their owners.20170619_130857

Felt it come for me. In February, over two days. My sanity stepped into quicksand. Mania swallowed me. I called into work sick. I said goodbye to my family. I went into hospital. Battened down my hatches and prepared for the usual long stay. Only to be pleasantly surprised. Four weeks in hospital. That’s short for me.

Lost my job. I do every time I get sick.

Opened new neural pathways by setting up a website, which enabled me to write and publish this blog. My technological ineptitude is boundless, so the existence of Thought Food is a minor miracle.

Supported three men. All stepping through the sticky tar of depression at some point this year. All blindsided by the ferocious nature of this beast. All strong, kind, intelligent, undeserving.

Exercised most days. Ate green vegetable omelets for breakfast some days and Nutella on toast with mug loads of coffee on others. #NotFitspo

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Welcomed Clarence, our baby Stimsons python into the family. He is the lowest maintenance pet I have encountered. Gentle, inquisitive, and only needs to be fed every seven to ten days.

Continued to receive rejection after rejection of the manuscript for my memoir from publishers via one of the best literary agents in the country. Each one stings. Each one frustrates. According to publishers’ feedback the quality of the writing is great, but it’s not commercial enough. In other words: No one wants to read about psychosis if you haven’t killed someone in the throes of it or at the very least been picked up wandering the streets nude and ranting.

Began considering self-publishing the manuscript for my memoir.

Climbed back into some weekend work.

Heard my mother’s voice tell me my father had nearly died after a massive heart attack. Seeing him on day two after triple bypass surgery, comatose, tubes and wires snaking in and out of him, and the comforting blips and beeps and numbers flashing on familiar screens was easier than seeing him on day four, awake, in agony with each movement. He survived. My Father’s Heart Broke

Applied for, was accepted into, and completed the SANE Peer Ambassador training program. The glow of being in a room with others who went through hell, survived, and are now well enough to use that experience for good, still warms me. And I finally feel I’m not advocating on my own anymore. The Chosen Ones

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Gathered friends for dinners and lunches to enable my love of cooking, baking, great food and wine, and conversation…so much conversation.

 

 

 

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Became familiar with the inside of an ambulance courtesy of seven night time trips to hospital in ten days. My son developed partial seizures lasting up to ninety minutes each. Relief flooded me when his MRI scan was clear (of brain tumours) and he was diagnosed with benign rolandic epilepsy (infinitely more manageable). Lessons For A Control Freak

Clung to small wins amongst the manuscript rejections. Three posts published on Mamamia, one on SANE, and a submission for Dr Mark Cross’s book on anxiety accepted.

https://www.mamamia.com.au/mental-illness-language/

https://www.mamamia.com.au/symptoms-of-postnatal-psychosis/

https://www.mamamia.com.au/signs-of-depression/

Narrowly avoided a second hospital admission in October. I pounced on the onset of a depressive episode with an emergency psychiatrist appointment, a medication adjustment and slashed away all commitments except exercise for several weeks. Razor Blades In Mud: Laziness Or Depression?

Became a spokes person for the Australian Genetics of Bipolar Disorder Study, and suggested edits to make the language in the main study survey more consistent and less stigmatising. Most of my edits were approved and included less than twenty-four hours before the study launched. A clip of some of my participation and how to participate in the study can be found here:

https://www.geneticsofbipolar.org.au/hear-from-study-participants-alex-anita/

Attended my first ever non-veterinary conference: ‘Empowering online advocates’ and came away feeling much more hopeful than the trip to Sydney in January had left me. #HealtheVoicesAU

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Discovered the joy of camping, absolutely enabled and enhanced by beautiful friends who supplied (and set up) most of the gear.

Resigned from veterinary work. Ostensibly to stop straddling several worlds and free up more time and energy for writing, mental health advocacy, and my children. That is all true. But I am also bone crushingly tired of the cycle. Work, get sick, lose employment because the nature of my illness means I can’t give a date when I’ll be well enough to return, and I can be sick for months. Then I clamber my way back into a demanding profession you can only inhabit when you are functioning at 100% of your capability. I expend time, energy, and money to do enough CPD (continuing professional development) to keep my registration up to date…only to lose it all again the next time I get sick. The plan is two years off. Then see where I’m at.

Received a handwritten Christmas card and instant scratchie from my pharmacist… one of my six medications alone costs $30/week. Treatment

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Reminded you to end the year saying no when your gut tells you to, and being kind to yourself when you feel like doing the opposite.

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Razor Blades In Mud: Laziness Or Depression?

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(Contains Confronting Content)

The amnesia of good mental health is powerful. When I’m well I struggle to conjure up what a depressive episode feels like. I can’t remember not being able to think my way out of it. I can even understand how easy it could be (without the experience of this insidious symptom) to dismiss those who suffer it as weak or lazy. This inaccurate, hurtful labeling occurs when people fail to understand the fundamental differences between a psychological challenge and a psychiatric symptom.

Continue reading “Razor Blades In Mud: Laziness Or Depression?”