Book review: The Book of Joy

BookofJoy

The Book of Joy: Finding Happiness in a Changing World is the product of a week-long series of discussions between His Holiness the Dalai Lama and Archbishop Desmond Tutu, facilitated by author Douglas Abrams, who has frequently collaborated with Archbishop Tutu.  The meetings were held at the Dalai Lama’s residence-in-exile in Dharamsala, India.  Much of the book is presented as dialogue between the Dalai Lama and Archbishop Tutu.  Translation services for the Dalai Lama were provided by Thupten Jinpa, whose book A Fearless Heart I recently reviewed.  The dialogues were easy to follow, with a beautiful simplicity underpinned by profound wisdom.  The short chapters break the book into small tidbits that are manageable even if concentration is a challenge for the reader.

The photos included speak volumes.  On the front cover is a close-up of the two grinning at each other.  On the back cover is a shot of them busting a move.  In the small photo on the book’s spine, the two are hand in hand.  Abrams observed that “one of the most stunning aspects of the week was how much of it was spent laughing”

The Dalai Lama and Archbishop Tutu dancing

Despite practicing two different religions, there was much commonality between the two, which is a positive example in a world where too often religion is used as an excuse to divide people.  What really stands out is their capacity for compassion, forgiveness, and joy despite the hardships that both they and their people have endured.  In a modern world that seems plagued by intolerance and fanaticism, the Dalai Lama identifies education and wider contact as the key solutions, along with love, which “is really the practice at the core of all the world’s religions.”

Joy as described not as happiness but as something much deeper, a distinction that resonated with me (I recently blogged about my concerns regarding the idea of happiness).  Archbishop Tutu said “Joy is much bigger than happiness.  While happiness is often seen as being dependent on external circumstances, joy is not.”  He described joy as arising from natural human weakness rather than despite it.  The Dalai Lama finds joy in kindness and compassion, and remembering the interrelatedness and interdependence of all things.

The Dalai Lama likened mental health to immunity, an analogy that resonated with me: “If your mental health is sound, then when disturbances come, you will have some distress but quickly recover.  If your mental health is not good, then small problems will cause you much suffering.”  He suggested that stress and anxiety can arise from expectations of how life should be rather than acceptance that things are the way they are.

I was moved by Archbishop Tutu’s observation that “Resignation and cynicism are easier, more self-soothing postures that do not require the raw vulnerability and tragic risk of hope.  To choose hope is to step firmly forward into the howling wind, baring one’s chest to the elements, knowing that, in time, the storm will pass.”  Mental illness can make hope seem impossible sometimes, and it’s encouraging to see someone who demonstrates as much hope as Archbishop Tutu acknowledge how challenging it can be.

I’ve recently blogged (here and here) about trying to find forgiveness, and it was interesting to read the words of two leaders who believe so strongly in the power of forgiveness.  The Dalai Lama emphasized the importance of differentiating between the actor and action, so it is the human being who committed the action that is being forgiven rather than the action itself.  Archbishop Tutu stated that,“Without forgiveness we remain tethered to the person that harmed us.  Until we can forgive [them], that person will hold the keys to our happiness, that person will be our own jailor.  When we forgive, we take back control of our own fate and our feelings.  We become our own liberator.”  Archbishop Tutu has laid out a fourfold path of forgiveness, and has developed a Global Forgiveness Challenge at forgivenesschallenge.com.

Drawing together the elements of their discussions over the week, the Dalai Lama and Archbishop Tutu identified eight pillars of joy.  Four involved the mind: perspective, humility, humour, and acceptance.  The other four involved the heart: forgiveness, gratitude, compassion, and generosity.  These pillars are all described as active rather than passive practices, and areas where people can grow and develop.  While Christian and Buddhist examples are drawn on, the concepts are those that bring all us together as human beings rather than divide us.  At the end of the book, there is a section devoted to meditative and other practices focused both inward and expanding outward in order to build joy.

This book is uplifting, with much attention given to our shared humanity.  Joy is immediately apparent in the relationship between the Dalai Lama and the Archbishop and as a reader one can learn not only from what they have to say but how they relate to one another.  The Book of Joy is well worth a read.

 

You can find a list of my other book reviews in my blog index.

Image credits: Amazon.combookofjoy.org

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TMI Tag

TMI_tag

I’ve been tagged by the fabulous Therapy Bits for TMI Tag.  So, off to the races!

WHAT ARE YOU CURRENTLY WEARING? Yoga pants and a tank top.

HAVE YOU EVER BEEN IN LOVE? Yes.

DID YOU EVER HAD A TERRIBLE BREAKUP? Yes.  I broke up with him, he got high and showed up at my work and created a scene.  Cops were involved.  Despite that,  we reconnected as friends later on.

HOW OLD ARE YOU? 38.

HOW TALL ARE YOU? 5 foot 8 inches

HOW MUCH DO YOU WEIGH? I haven’t weighed myself lately, but around 185 lb.

DO YOU HAVE ANY PIERCINGS? Ears

DO YOU HAVE ANY TATTOOS? Three.  Small ones on each hip, and a large one on my left side.

WHATS YOUR FAVORITE DRINK? It’s not the most interesting, but I’ll say water because I drink so much of it.

WHATS YOUR FAVORITE SONG?  Don’t really have one.

WHATS YOUR ZODIAC SIGN? Pisces.

HOW LONG DOES IT TAKE YOU TO SHOWER? From 5-15 minutes, depending on if I’m shaving or exfoliating or anything like that.

WHATS FAVORITE SHOW? The Daily Show with Trevor Noah.

WHATS YOUR FAVORITE BAND? Don’t really have one.

SOMETHING YOU REALLY MISS? My close friend Ron who passed away a couple years ago.

WHERE DO YOU GO WHEN YOURE SAD? In my bedroom with my guinea pigs.

HOW LONG DOES IT TAKE YOU TO GET READY IN THE MORNING? 10 minutes.

HAVE YOU EVER BEEN IN A PHYSICAL FIGHT? No.  Just wrestling with the guinea pigs – they like vigorous play.

WHAT TURNS YOU ON? Kindness.

WHAT TURNS YOU OFF? Meanness.

QUALITY YOU LOOK FOR IN A PARTNER? Accepting, non-judgmental, kind.

WHATS YOUR FAVORITE COLOR? Blue.

LOUD MUSIC OR SOFT? Usually loud, especially in my car.

FAVORITE QUOTE? There’s a few, but a favourite from Confucius is:

“Our greatest glory is not in never falling, but in rising every time we fall.”

FAVORITE ACTOR? Matt Damon comes to mind first.

DO YOU HAVE ANY FEARS? WHAT THEY ARE? Spiders.  Gives me the heebie-jeebies even thinking about it.

WHATS THE LAST THING THAT MADE YOU CRY? Yesterday I cried feeling scared being vulnerable.

MEANING BEHIND YOUR BLOG NAME? It’s something I’d thought of as a name if I were to start a private mental health nursing practice.

LAST TIME YOU SAID YOU LOVED SOMEONE? Not sure actually.

LAST BOOK YOU READ? The Introvert Advantage.

THE BOOK YOURE CURRENTLY READING? My Age of Anxiety.

LAST SHOW YOU WATCHED? The Good Doctor.

LAST PLACE YOU WERE? I’m in my bedroom right now.

LAST SPORT YOU PLAYED? I guess that would be softball a couple years ago, although “played” is perhaps an overstatement of my contribution.

WHOS THE LAST PERSON YOU TALKED TO? My doctor this morning.

LAST SONG YOU SANG? Nothing today, but I sang several songs in my car yesterday.

FAVORITE CHAT UP LINE? I don’t even know what this is…

DO YOU HAVE A CRUSH? When I think crush I think crazy, obsessive, and unreasonable, so by that definition, not right now.

THE RELATIONSHIP BETWEEN YOU AND THE PERSON YOU LAST TEXTED? My brother.

FAVORITE FOOD? Cheeseburgers.

PLACE YOU WANT TO VISIT? Lots of places, but for my next trip I’m thinking Slovenia and Croatia.

WHATS THE LAST TIME YOU KISSED SOMEONE? at weekend I kissed my mom.

LAST TIME YOU WERE INSULTED? The last thing that stuck in my mind was being insulted by my boss last year.

FAVORITE FLAVOR OF SWEET? Chocolate.

WHAT INSTRUMENTS DO YOU PLAY? I have played piano, clarinet, and flute in the past, but it’s been quite a while since I played anything.

FAVORITE PIECE OF JEWELRY? I don’t wear much jewelry.

LAST TIME YOU HUNG OUT WITH ANYONE? Had dinner with my brother last week.

 

So, there you have it!  Rather than tagging specific people, I’m going to say if you want to join in the fun, consider yourself tagged!

Profiles in Tremendousness

screen shot - the Daily Show with Trevor Noah

Profiles in Tremendousness is a segment on the Daily Show with Trevor Noah that pokes fun at the competency (and lack thereof) of various characters in the Trump White House.  I’m going to borrow that idea to take a look at the less than stellar characters I’ve come across in my mental health journey.

My first hospitalization was a sh*tstorm of incompetence all around as far as I was concerned, and years later I found out a little tidbit that gave at least some objective confirmation of that.  One of my discharge diagnoses was borderline personality traits.  There’s nothing wrong with that diagnosis if it’s accurate, but unfortunately sometimes it says more about a practitioner’s stigmatized views than anything else, and is applied as a euphemism for “difficult patient”.  Any competent psychiatrist would know that a diagnosis of personality traits/disorder can’t be made cross-sectionally (i.e. just looking at a specific point in time), particularly when someone is acutely ill; it needs to be made based on patterns that are relatively consistent throughout the person’s life.  The hospital psychiatrist seemed to  have skipped this lecture in med school, and instead decided to ignore taking any sort of social history or gathering any collateral information and instead just slap a label on because I fought the treatment team tooth and nail while I was in hospital.  Not only does this leave me with a diagnosis that doesn’t accurately reflect my experience, but it minimizes the significance of the challenges that people with BPD often face every single day.

I used to go to a medical clinic associated with the local university’s medical school, and I would get seen by whatever medical resident happened to be on for that day.  The discharge summary and who knows what else from my first hospitalization were in my chart at the clinic, and I think a lot of the residents were scared because I was the crazy girl who had tried to kill herself and they didn’t know how to deal with that.  When I went in for pap tests, they would always insist on doing a PHQ-9 (a depression screening test).  One day I went in asking for a lab requisition to get routine blood sugar and cholesterol  checks.  I was stuck there for an hour because, even though my illness was in full remission at the time and I had a psychiatrist who I was seeing regularly, the resident had a very hard time believing I wasn’t going to jump in front of a bus the moment I left the clinic.

The first time I tried therapy was okay but not particularly productive.  I decided to try again when I became depressed a few years later, and made an appointment through my Employee Assistance Program.  I wasn’t thrilled with the therapist’s interviewing style, but the real treat came as we were wrapping up the session.  Her advice was that I would feel better if I started dating.  Seriously?  That was the end of that.  And to top it off, when I emailed her to say that I wouldn’t be seeing her again and explained the reason, she thought it was peculiar that I would have chosen to fixate on that particular statement.  Um, perhaps because it represents incompetence?

That theme came up again more than once.  I clearly remember a nurse in hospital who observed that I must be depressed because I was single, and that must have been why I attempted suicide.  Between her and the nurse who was convinced that I must have attempted suicide because I was angry about something, it was a sad state of affairs.  But the stellar lack of competence didn’t end there.

freudThe hospital psychiatrist who initially treated me on the inpatient unit knew I didn’t like him (I guess the screaming and swearing was a pretty strong hint), so he decided to transfer my care to a different doctor.  This character was very much of the psychoanalytic/psychodynamic therapy persuasion, and as far as I could tell he was even more of a nutbar than I was.  My first meeting with him was all very Freudian, with a focus on sex and early childhood.  How old was I when I lost my virginity?  Did I like sex?  Did I remember how I felt when my brother was born when I was 3 years old?  He told me that the ONLY way for me to get better was to get psychoanalytic therapy, and I should only be on meds for a couple of months and then come off them.  Wowza.  But I wanted to get discharged, so I said the things he wanted to hear.  Later, my community psychiatrist commented that he wasn’t sure who that discharge summary was written about, but it definitely didn’t sound like me.

A couple of years ago, things started falling apart.  A very close friend died unexpectedly. I was bullied at work and ended up quitting because of it.  I was worried about getting sick, but I held it together.  And then I found out that my ex-manager was doing his best to destroy my career (in very much a reality-based sense, not a cognitive distortion sense), and the sh*t really hit the fan.  When I went in to see my psychiatrist, I was so slowed down that I moved from the waiting room to his office at a snail’s pace, and had a hard time even stringing a sentence together.  He knew about all the other stuff I’d made it through, but the best he could come up with was that I needed therapy to learn better coping skills so I wouldn’t get depressed when things like this happened.  I’m not sure why he thought that was the appropriate response and the appropriate time, but that was the last time I ever saw him.  Once trust is broken, I’m done.  So I decided to go see my new GP, who didn’t know me from a hole in the ground.  And what did she have to say after I told her the reason I’d decided to stop seeing my psychiatrist?  “Don’t you think you do need better coping  skills?”  Are we passing around stupid pills?

Don’t get me wrong, there are some great mental health professionals out there; I know because I’ve worked with some of them.  Unfortunately there are also some real duds, and in the next edition of Profiles in Tremendousness I’ll cover some of the specimens that I’ve worked with.  It would be nice if this wasn’t an issue we faced when trying to access mental health care, but sadly it’s far too often the reality.

What have been some of your worst experiences?

 

Image credits:

The Daily Show with Trevor Noah

Skeeze on Pixabay

Allowing vulnerability

woman in bath surrounded by flowers

I had a tough weekend.  It started off badly with a friend contacting my brother to check up on me, which rocked the walls of the little cave I’ve built for myself.  And then something happened with my safe person that made me feel very unsafe.  The dark voice inside my head kept repeating “He’s using me.  He’s using me, and now he’s trying to pay me.  I’m not a f***ing prostitute”.  Some of the same thoughts I’ve had to rein in before, but taken to a new  level.  I chose to withdraw rather than unleash a tantrum, and spent much of yesterday crying and just generally feeling awful.  I felt angry at myself for trusting someone and allowing myself to feel safe, because I should have realized that everyone really is out to hurt me.  Why did I let down my barriers, why this, why that.

I woke up this morning feeling somewhat more human.  In a brief moment of wanting to be mature I emailed him to apologize for going MIA, saying that I was feeling upset but needed to figure it out in my own head.  He responded and said I could should go ahead and tell him whenever I felt ready, so I let er rip.  My ugly, messy, depressive thoughts coalesced in email form, and I hit send.  The response I got surprised me, although it probably shouldn’t have.  Totally supportive.  Glad that I’d opened up.  Wanted me to tell him right away if those kinds of thought distortions come up in the future so we can work through them together.  As I was reading this I was crying and my head was spinning.  Was this what it feels like for vulnerability to be okay?

I recently watched an amazing TED Talk by Brene Brown about vulnerability.  She said a willingness to be vulnerable underpins our ability to feel worthy and experience love and belonging.  She encouraged us to allow ourselves to be vulnerably seen.  And maybe I did that, at least a little bit.  It was scary as hell, but maybe that doesn’t have to be a bad thing.

Cave-dwelling

cave

I live in a figurative cave that is of my own making (although I suppose of my depression’s making would be more accurate).  I have pushed nearly everyone out of my life, and while that is occasionally lonely, it feels much easier.

My oldest friend keeps trying to remain in my life, even though I don’t allow her in.  It’s been over a year since I last saw her, and almost as long since I last responded to any of her messages.  Yet she stubbornly continues texting me every few months.

She texted again a few days ago to ask how I’m doing.  I thought about whether I should respond or not, but then realized I wasn’t there yet.  Even if I wanted to respond, what on earth would I say?  This is someone who has a normal life and does normal things, and I just feel so far removed from that.  I feel like we live in totally different worlds.  It’s not that I don’t think she cares; I know she does.  Maybe what scares me is that I would be reminded of what I’ve lost, and what I can’t do any more.  There’s probably more to it than that, but I feel a strong sense of revulsion at the thought of interacting with her.  And it’s not anything about her; she knows about my illness and has always been supportive and nonjudgmental.  It’s 100% about me.

I got an email from my brother yesterday.  He said this friend had contacted him to ask if he’d talked to me recently.  The idea of them talking about me was disturbing.  It’s not that they would say anything “bad” about me, but it just doesn’t sit well with me.  Part of me feels annoyed with my brother, although logically I know there’s nothing to be legitimately annoyed about.

I thought writing this post might help me figure out in my own head why I’m feeling a messy jumble of emotions about this, but I’m still feeling just as jumbled.  I hate what I’ve become, and I know that’s not fair and I don’t hate the self that’s at the core, but this has caused a bit of a stumble.  I’ve stumbled before, though, and like before I will pick myself back up and carry on.

 

Image credit: Glavo on Pixabay

Do antidepressants work? What a new meta-analysis says.

meds

A recent paper published in the Lancet looked at how effective antidepressants are, and this has been reported on in the media.  Since media outlets don’t necessarily have strong research literacy, let’s take a look at what the paper itself has to say.  My earlier post on research literacy explains some of the terms I’ll be using here.

Full reference details for the paper:

  • Cipriani, A., et. al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet. doi:10.1016/S0140-6736(17)32802-7

A systematic review involves collecting a body of relevant literature on a topic using academic databases and search terms that are clearly specified, and then narrowing that down by applying certain criteria to find studies that are academically rigorous and fit with the research parameters being considered.  Typically, different investigators go through this process independently and then come to a consensus on which studies to include in the review.  The results are then evaluated to get a picture of the current state of the evidence.  A meta-analysis goes a step further by pooling the data from the various studies and then performing statistical analysis.

Inclusion criteria for this paper were:

  • randomized, double-blinded, controlled trials (either placebo-controlled or head-to-head trials of different antidepressants)
  • study participants were adults 18+
  • diagnosis of major depressive disorder
  • no more than 20% of participants in a study had bipolar disorder, treatment resistant depression, psychotic depression, or serious concurrent medical condition (while this might sound like a bad thing, when pooling numbers for a meta-analysis you want to make sure you’re comparing apples to apples)
  • evaluation of quality of evidence and risk of bias met specified academic standards

The outcome measures were response rate and acceptability (as measured by number of discontinuations due to side effects).  While ideally patients should be treated to full remission of symptoms, response rate is often used in research studies.  Response rate is defined as a 50% reduction in score on a standardized depression rating scale such as the Hamilton Depression Rating Scale (HAM-D).  For this meta-analysis they chose to evaluate outcomes at the 8-week point, and for the included studies that didn’t take ratings at 8 weeks this was imputed using statistical methods.

Findings:

  • All 21 antidepressants considered were more effective than placebo in adults with major depressive disorder.
  • In head-to-head studies, agomelatine, amitriptyline, escitalopram, mirtazapine, paroxetine, venlafaxine, and vortioxetine were more effective than other antidepressants.
  • Fluoxetine, fluuvoxamine, reboxetine, and trazodone were the least efficacious drugs.
  • For acceptability, agomelatine, citalopram, escitalopram, fluoxetine, sertraline, and vortioxetine were the most tolerable.
  • The most discontinuations occurred with amitriptyline, clomipramine, duloxetine, fluvoxamine, reboxetine, trazodone, and venlafaxine.
  • Agomelatine was the only antidepressant with a lower dropout rate than placebo.

So, what does this paper not give information about, i.e. what conclusions are we not able to draw from it?

  • How effective these antidepressants are in terms of achieving full remission
  • Efficacy measures are only based on a 50% reduction in rating scale scores; there is no information about which particular clusters of symptoms are more or less likely to respond
  • What outcomes are beyond the 8-week point
  • Whether a specific antidepressant is or is not likely to be a) effective in a specific individual or b) more or less effective than any other antidepressant in that same individual
  • Whether a specific antidepressant is or is not likely to be tolerable for a specific individual
  • How often people experience side effects due to any of the antidepressants (it only looks at discontinuations due to side effects)
  • Whether any specific individual would or would not benefit from antidepressants at all
  • How well antidepressants work outside of the population considered in the review (i.e. under 18 years old or with treatment resistant depression, psychotic depression, or bipolar depression)

And what does all of this mean?  It’s important to keep in mind that a systematic review/meta-analysis such as this is only aiming to tell us very specific things.  The authors are deliberately comparing apples to apples so they can pool large groups of numbers and draw conclusions from that.  There’s a lot of real-world information that it doesn’t give us, but it’s worth keeping in mind that it makes no claims that it is.  The authors do not suggest that their findings can be extrapolated to answer any of the questions I’ve mentioned that the paper doesn’t give us information about.  What it does tell us is that antidepressants belong in our arsenal of available treatment strategies.  Anything more specific than that always needs to be a collaborative decision between the individual and their treatment team.

 

Image credit: matvevna on Pixabay

Savoring the small victories

shopping-list

I have always been a big fan of lists, especially when it comes to grocery shopping.  When I’m depressed, lists tend to move from a preference to a necessity in order to compensate for the decline in my memory and concentration.  When things are really bad I even try to organize my shopping list into produce section, dairy aisle, etc., because otherwise I end up wandering back and forth all over the store, my pattern of disorganized movement mirroring the disorganization of my mind.

Yesterday I was walking to the grocery store, and about halfway there I realized that I’d forgotten my phone at home.  I use Google Keep for my grocery list, so no phone meant I was list-less.  I was then faced with two options: go home and get my phone, or just go ahead and do my grocery shopping trip without it.  I’ve noticed that my thinking has been clearer this week, plus there weren’t a lot of things I needed, so I decided ok, I can do this.  It also helped that the sun was shining, and I had actually bothered to put on real non-yoga clothes and a bit of makeup.  This was my day, dammit.

I didn’t spend a lot of time in the store, and when I got to the checkout I was feeling pretty confident.  On the way home I thought of 2 things I had forgotten, but I felt ok about it.  When I got home and checked my list, I had gotten 7 of the 10 things I’d intended to get.  70% ranks an A+ compared to how I’ve been functioning most of the time lately.

What I’m particularly proud of is my willingness to go for it, to just dive in without my list as a safety net.  I focus less on the fact that I forgot 3 things as the fact that I remembered 7 things.  I believe it’s the little things like this that are often really important indicators of progress.  So yay for me!

 

Image credit: 422737 / 2074 images on Pixabay

Aromatherapy and mental health

field of lavender

There are various sources that can be found online that talk about the mental health benefits of aromatherapy with certain essential oils.  I started using aromatherapy daily almost a year ago.  Mostly I use a diffuser but I also have a few topical roll-ons.  It’s hard to say if there’s a benefit aside from the very real benefit of a regular practice of engaging in self-care, but if nothing else it smells really nice.

An article by Dr. Axe lists a top 4 of essential oils for depression:

  • Bergamot: calming, works well in combination with lavender
  • Lavender: useful for stress, anxiety, depression, and PTSD
  • Chamomile: soothing, calming
  • Ylang ylang: boosts mood, mild sedative

Other essential oils that may be helpful are rose, geranium, clary sage, jasmine, sandalwood, sweet marjoram, frankincense, wild orange, lemon, patchouli, grapefruit, and neroli.

I get most of my essential oil blends from Saje Natural Wellness.  I specifically pick blends that contain mental health-boosting oils.  My favourites are Embrace (which includes ylang ylang, patchouli, and geranium, among others), Stress Release (with lavender, clary sage, geranium, and roman chamomile), Tranquility (with lavender, ylang ylang, and roman chamomile), and Unwind (with lavender, bergamot, and geranium).

I subscribe to a sort of the more the merrier holistic approach to mental health.  My treatment-resistant depression doesn’t seem to be inclined to budge, so I throw at it whatever I can come up with in the hope that any little bit helps.  And if what I’m throwing at it happens to smell nice, so much the better, meaning I will keep taking care of myself with aromatherapy.

Why did I get sick?

strands of DNA

There is so much that we don’t know about what causes mental illness, and very little that we do know.  This means that asking why is rather futile at this point, but it’s hard not to.  It feels like maybe if I had some idea where my depression was coming from I’d have a better idea how to manage it.

We know that there is often a genetic element to mental illness, but we know very little about how that actually works.  One way of examining this is twin studies.  Monozygotic twins come from a single egg and sperm, and so have identical DNA.  Dizygotic twins come from 2 separate egg/sperm pairs, so they do not share the same DNA.  The concordance rate (probability of sharing a specific trait) for major depressive disorder in monozygotic twins is almost double that for dizygotic twins.  For schizophrenia, the concordance rate is even higher, suggesting an even stronger genetic link.  In my own family, there was one great-uncle (possibly two) on my dad’s side with schizophrenia.  That’s it  There is no other known mental illness in the family.

Childhood trauma may be a contributing factor, and there’s some really interesting data from the Adverse Childhood Experiences research on this.  Stress and trauma, particularly in childhood, can cause “epigenetic” changes.  We have the genes we’re born with, but it’s more complicated that that.  Sections of genes code for various proteins, but when and how our bodies decide to actually make protein based on that code is studied in the field of epigenetics.  Interactions with our environment are a major factor, but there is still so much more to learn in this field.  There is even some research suggesting that epigenetic changes can even be passed down to offspring.  It’s a really interesting area that I suspect is going to be the source of some major discoveries as the science moves forward.

Yet I didn’t have any childhood trauma.  Yes, I had the “normal” challenging experiences that people are likely to have, but I was not abused, neglected, or bullied.  I was lucky enough to have parents that were caring, affectionate, and supportive.  We were financially secure enough that I had opportunities that might not have been available to others.  I did well in school, and although I was kind of geeky and unpopular, I was generally quite comfortable in my small circle of close friends.  The really challenging stuff that’s happened in my life, including bullying, came after I got sick, not before.

Substance use was never an issue.  Yes, I drank a lot of alcohol in my late teens and early 20’s, but there were no apparent negative consequences other than the odd hangover, and I had no problems stopping drinking when I moved on to the next stage of my life.

I was not someone who was prone to low moods.  I’ve always been emotionally sensitive, but overall I was a happy, optimistic person with good self-esteem.  I didn’t have my first episode of depression until age 27, although looking back there may have been an earlier hint of things to come.  When I was around 15 I had a period of 2-3 months with unexplained physical symptoms, including weakness and fatigue severe enough that I could barely get in and out of bed.  Various tests were done, but no physical cause was identified.  From what I can recall, I was terrified by what I was experiencing, but my mood at the time was numb more than anything.  Still, physically there is a definitely a resemblance to what I experience when my depression causes psychomotor retardation (significant slowing of movement and thoughts).

When I had my first episode at 27, it came on over the space of maybe 4 months, triggered by situational stress.  My ex-boyfriend and I had remained very close friends after I’d broken up with him, but then he started dating someone and all of a sudden my best friend didn’t want to be in my life anymore.  It was difficult, but something that I had sufficient coping skills that I would’ve expected to be able to handle it.  I had two suicide attempts in the space of a couple months, then ended up in hospital for 2 months, psychotic and continuing to try to take my own life.  Later that year I went off meds because I felt they weren’t working, but I ended up achieving full remission despite that.  I stayed well for 4 years, and then got very sick again very quickly, with no apparent trigger.  I noticed symptoms coming on and got started back on meds quickly, but within four weeks I ended up in hospital.  It took a year and a half, 3 hospitalizations, and many different treatment trials to get into remission.  It wasn’t a stable remission, though; there were a lot of bumps that were mostly manageable with increases in my medication dosages.  That is, until I had another relapse almost 2 years ago.  My illness is now more treatment-resistant than ever.

So where the heck did this come from?  I doubt I’ll ever know the answer.  In the end I suppose it doesn’t really matter all that much, but I wish I knew more about this beast that has intruded into my life.  How did it sneak up out of nowhere, and why did it pick me?  Is it the ghost of that distant great-uncle’s genes swooping in to haunt me but sparing everyone else in the family?  There can be no answers, only more questions.  I hope that some day science is able to start to answer these questions for others, even if it comes too late for me.

 

Image credit: Qimono on Pixabay

Anti-inflammatory brain food

 

It was spring of 2017, and my depression had gotten worse despite being on plenty of meds.  I decided that I needed to add in other elements to my treatment plan.  I’d had some labwork done that showed I had elevated levels of inflammation as measured by something called C-reactive protein.  I decided the perfect person to talk to was the naturopath who I’d first started seeing the year before to help get my gut back on track after a parasitic infection.  She recommended that I adopt an anti-inflammatory diet and supplement with omega-3 fatty acids and a combined vitamin/mineral/antioxidant supplement called Ultra-Preventive.

I’ve never been interested in doing any sort of diet, but I started doing some reading and was interested by what I found.  Inflammation is involved in a variety of physical health problems, and recent research has also suggested a link to mental illness.  Depressed people with elevated levels of inflammation (as indicated by C-reactive protein and a few other markers) actually have differences in how well they respond to different types of treatment, and some studies have shown that anti-inflammatory medications can have a beneficial effect in depression.  Some types of food are thought to promote inflammation while others reduce it, and the goal of an anti-inflammatory nutritional approach is to improve health by reducing inflammation.  It’s quite similar to a Mediterranean way of eating.  Weight loss is not the goal, so I prefer not to call it a diet.

Pro-inflammatory foods to limit:

  • Sugar and refined carbs: Simple sugars (including high fructose corn syrup) and highly refined carbs (e.g. flour, white rice) cause spikes in blood sugar, leading to a cascade of reaction in the body that can increase inflammation.  My naturopath wanted me to cut out bread entirely and as well as sugar-containing drinks.  I managed to stop sweetening my tea and coffee by first switching from sugar to stevia (a plant-based zero-calorie sweetener) and then steadily decreasing the stevia.
  • Grain-fed red meat:  What the cow eats actually makes a difference in how your body reacts to the resulting food product.  Grass would naturally be a staple food for cows, but in modern farming cows are sent to feedlots where they’re given corn or soy-based feed.  There are a number of adverse health effects that appear to be linked to high consumption of grain-fed red meat (i.e. the beef typically found in grocery stores), and it’s something that’s recommended to avoid in an anti-inflammatory diet.  Grass-fed beef is considered a better choice, and butter from grass-fed cows contains significantly higher levels of healthy fats.
  • Highly processed foods:  As a general rule of thumb, the less a food product resembles simple, natural ingredients, the less likely it is to do good things in your body.
  • Trans fats

vegetables

Foods to look for:  

Fibre, plant-based nutrients, and healthy fats are your best friends with this nutritional approach.  Dr. Andrew Weil’s anti-inflammatory food pyramid is a useful place to start from.

  • Veggies (especially dark leafy greens and crucifers like broccoli and cauliflower): These are full of fibre, phytochemicals (i.e. nutrients found in plants), and antioxidants, which scavenge harmful free radicals.  I tried to make myself like broccoli to no avail, but I did find a yummy way to cook cauliflower.
  • Fruit: Berries in particular are packed with antioxidants.  The fibre in fruit helps slow down absorption of naturally occurring sugar to minimize spikes in blood sugar.
  • Whole grains (eg brown rice, quinoa, steel cut oats):  The whole grain contains the nutritious parts that get stripped away during refining, and these nutritious bits, including fibre, also slow carbohydrate absorption, reducing spikes in blood sugar.
  • Beans and legumes:  These are protein- and fibre-packed nutritional powerhouses.  Chick peas are a favourite of mine.
  • Pasta: Dr. Weil suggests 2-3 servings per week.  When I first started my plan I cut out pasta altogether, but I’ve since added whole wheat pasta back into the mix.
  • Healthy fats: Yes, fat can be good for you!  Fats found in extra virgin olive oil, nuts (especially walnuts, cashews, and almonds), seeds (including hemp seeds and flaxseeds), and avocados help to decrease inflammation.
  • Wild-caught fish and shellfish:  Fish like salmon and sardines have lots of healthy omega-3 fatty acids.  Wild-caught is preferable to farmed.  Shellfish contains choline, which is a precursor in the production of neurotransmitters.
  • Whole-soy foods: Tofu is a very versatile food with great nutritional value, but personally I’ve just never been a fan.  It’s worth noting that processed soy-based products do not have the same benefits as whole soy.
  • Cooked Asian mushrooms (eg shiitake and oyster)
  • Other protein sources: The food pyramid includes occasional consumption of foods like dairy, eggs, poultry, and lean meat.  I’ve never had any problems with lactose intolerance and had no interest in cutting out milk, but I did cut back somewhat on cheese.  I’ve gone from being an ardent carnivore to eating very little meat.  Eggs I like to include because they’re rich in choline.
  • Herbs and spices: Turmeric is an anti-inflammatory superpower.  Cinnamon, ginger, garlic, basil, rosemary, and thyme are also good choices.
  • Tea (preferably white, green, or oolong)
  • Treats: Red wine and dark chocolate with at least 70% cacao are yummy goodies with the benefit of antioxidants.  70% cacao chocolate isn’t very sweet, but gradually I’ve built all the way up to a preference for 85% cacao so I can get yumminess factor as well as antioxidants with minimal sugar.

 

After a few months of sticking pretty closely to my anti-inflammatory plan, my bloodwork showed that my level of C-reactive protein had come back down to normal range.  Despite not trying to lose weight, I did lose some of my medication-induced weight gain.  Since then, I’ve eased up and don’t follow my nutrition plan as closely, but I’m still far more conscious than I used to be about what I’m choosing to put into my body, and I’ve cut way down on my intake of processed food.  I use the app My Fitness Pal to keep track of what I’m eating, and that was particularly useful when I was starting out as it helped me to understand what exactly I was putting into my body, including a breakdown of fat, protein, and sugar.

So, has this actually helped with my mental health?  It’s hard to say, because there are so many different factors that influence my depression.  Still, this approach to eating can’t hurt, and at least in theory bringing down inflammation is a good thing, so any little bit helps.

What’s your favorite?

WYF

wyf_fairy_tales

It’s what’s your favorite day over at Revenge of Eve, and this weeks #wyf is fairy tales.  Like Eve, I had to rely on Google to come up with something, and Wikipedia came to the rescue with a seriously long list of fairy tales, most of which I’d never heard of.

For my actual favorite, I’m going to say Cinderella.  For my favorite random, never-heard-of-it fairy tale, I’m torn between “The Hen-Wife’s Son and the Princess Bright-Brow” (in which I would play the hen-wife) and “The Wise Woman, or The Obstinate Princess: A Double Story” (which may or may not be about DID…).

Who woulda thought I’d get Botox

Botox_before

Botox

I’m not a cosmetic procedures kind of gal.  Power to others if that’s what works for them, but given that I can’t even be bothered putting on makeup most of the time, all things physical appearance-related don’t rank very high on my priority list.

But that’s not why I’ve just gotten Botox.  To keep my knowledge base up to date in the field of psychiatry I try to watch webinars on a somewhat regular basis.  The other day I was watching a webinar on novel treatments for depression, and one of the things mentioned was Botox.  There have been a few small research studies (one from 2014, one from 2012, and another from 2006) that found that injecting Botox into the frown line areas on the forehead actually led to an improvement in depressive symptoms, even in people with treatment resistant illness.  The thinking behind it is that not only does facial musculature express mood states, but it gives feedback that in turn regulates mood states.  By preventing frowning, Botox may disrupt that harmful feedback loop.

Will it work?  Who knows.  At this point, I’m willing to try just about anything.  I’m doing this with my naturopath, who does cosmetic procedures as part of her practice.  I trust her, and she thinks it’s a good idea, so what the heck, might as well give it a go.  Fingers crossed!

 

Images from Botox Cosmetic

In times of life or death

shadow_face

As some of you are likely already aware. one of our fellow members of the mental health blogging community attempted suicide earlier today, and posted a suicide note on her blog.  I choose not to link to her blog here because for those of you who aren’t already familiar with her amazing work, I don’t want to introduce you to her at her most desperate moment.

I saw it about an hour after it was posted, and my heart started pounding as I wondered what the hell I was going to do.  I flailed around feeling powerless for a bit before realizing that her Twitter page stated where she lived.  I called the police there, and they said they’d already made contact with her.  I then saw that I’d gotten a message from one of her Twitter followers, who had made the initial contact with police that resulted to them getting to her in time (thankfully; who knows, this may not have been the case if mine had been the first contact).  The police were able to get to her and get her much needed help because there was sufficient identifying information in her online accounts for them to figure out who and where she was.

That got me thinking.  Many of us value our anonymity, and very deliberately choose not to put identifying details about ourselves online  And at the same time, many of us do experience thoughts of suicide at times due to our illnesses.  If we, in moments of desperation and hopelessness, were to publish our intentions or actions with respect to suicide, would fellow bloggers who wanted to help us be able to figure out how?

WordPress doesn’t have a lot to say about the matter.  In their page on “Self-harm and online safety“, they suggest calling the authorities if you know the person, and posting suicide resource information for them if you don’t.  You can “report content“, but it doesn’t sound like this is likely to accomplish much, if anything.

Thinking about myself, the city where I live is displayed on my Twitter account.  I don’t use my full name, but I’ve done some guest posts under my full name, and that probably wouldn’t be too hard to find.  They would mean my first, middle, and last names woild be available, , plus I’m already in the local police system as an “emotionally disturbed person” (police jargon for contacts they have with someone with mental health problems), so they’d probably track me down fairly quickly.  I’m not sure how comfortable I feel with that, to be honest.

Being on the other end, as a fellow blogger wanting to help, the feeling of powerlessness is terrifying.  The desperate desire to help crashes headfirst into having no idea where to even start.  In this particular instance, enough pieces were there, but what if that wasn’t the case?

I’m not sure what the answer is, or if there even is an answer.  We can hope this is an issue that won’t come up very often, but I think the reality is that it’s inevitable that sometimes it will arise.  It’s probably better that we start to think about it when we’re not trapped in the darkest depths, and consider how many crumbs of information we’/re prepared to dole out, and much power we are willing to offer to our fellow bloggers to help us if things get really bad.

 

Image credit: Ian Espinosa on Unsplash

Book review: A Fearless Heart

Book cover: A Fearless Heart

In A Fearless Heart: How the Courage to Be Compassionate Can Transform Our Lives, Dr. Thupten Jinpa offers a practical guide to creating change through Buddhist-inspired compassion practices.  Dr. Jinpa is a former Buddhist monk, who left the monastic life to pursue higher education, completing a Ph.D. in religious studies at Cambridge University.  He has been the principal English language translator for His Holiness the Dalai Lama for a many years.  While he weaves in his own experiences to reinforce various concepts relevant to compassion, this is not a book about his own story.  Rather, the major focus is the elements Compassion Cultivation Training, a standardized secular compassion training program that he was involved in developing at Stanford University.

While the author’s approach is steeped in Tibetan Buddhist tradition, he makes it very accessible for non-spiritual audiences.  He provides clear explanations of relevant terminology, and incorporates a variety of concepts and research findings from the field of psychology, often pointing out the parallels to classical Buddhist thought.  Some ideas will be familiar to those who have done cognitive behavioural therapy work, such as distinguishing between observations and evaluations, and recognizing that thoughts are not who we are.

Dr. Jinpa describes three elements of compassion: perceiving another’s suffering or need, emotionally connecting with the suffering/need, and wishing to see that situation may relieved.  Empathy involves the first two of these elements, and is a complex phenomenon in the brain that appears to involve the limbic system, attachment system, and pain matrix.  Dr. Jinpa explains that “compassion acknowledges the fundamental truth of our human condition that not all pain can be fixed…  In many situations, it’s not fixing that is needed; rather, it’s our empathic response, our acceptance, understanding, and solidarity.”

The importance of self-compassion is emphasized throughout the book. A free online self-compassion test is mentioned, which can be found at https://centerformsc.org/learn-msc/take-the-self-compassion-test/.  The test breaks down scores on scales of self-kindness, self-judgment, common humanity, isolation, mindfulness, and over-identification.  I completed the test, and scored particularly low in the areas of common humanity, isolation, and over-identification.  This helps point me in the direction of the type of work that I need to focus on.

Dr. Jinpa explains that while the practice of self-compassion and the capacity to self-soothe and regulate emotions is heavily influenced by experiences and attachment early in life, the capacity for compassion is innate and therefore growth and change are possible.  Self-compassion work includes cultivating both compassion (a wish to be free from suffering) and loving-kindness (a wish for happiness) towards ourselves, with a goal to cultivate the capacity to genuinely accept and care for ourselves and a profound appreciation of our natural and legitimate aspiration to kindness.  The book offers specific, uncomplicated exercises to build skills in these areas.

Self-hatred is something that many of us living with mental illness have experienced at some point or another, and Dr. Jinpa offers an interesting view on this.  He states that self-hatred comes from actually caring a great deal, but being unable to accept/forgive imperfect selves.  As a result, people hide behind the “layers of armor we put on when we feel like we’re under attack”.  When approaching self-forgiveness, Dr. Jinpa suggests that it is important to acknowledge the legitimacy of unmet needs that prompted the behaviour in question, which I found very powerful.

The Tibetan practice of “tonglen” (literally “giving and receiving”) is offered as an active compassion meditation.  It involves breathing in another’s suffering (while visualizing dark clouds or smoke) and breathing out happiness and good fortune (visualizing white clouds and light).  Rather than drawing us into another’s pain, this voluntary taking on of another’s suffering is presented as an empowered state of mind that allows us to get out of ourselves and our own pain.  Thus it differs from the empathetic taking on of another’s suffering, which is liable to cause what’s often referred to as “compassion fatigue”.  Working in a helping profession myself, I found this to be an interesting differentiation.

Compassion training has been shown to improve psychological well-being in a number of different ways.  It is correlated with decreased suppression of emotions and increased resilience.  It teaches us to become less self-preoccupied and see ourselves in the context of our relationship with others rather than in isolation.  It also increases self-acceptance, social connectedness, and a sense of purpose in life.  The exercises in the book provide a useful roadmap, and I’m looking forward to adding a compassion practice into my holistic wellness plan.

 

You can find my other book reviews here.

Happiness is a choice, my @ss

happiness.jpg

On a fairly regular basis I come across people online talking about how happiness is a choice.  It bugs me whenever I see it, even when I can tell the poster is trying to be motivational and positive, so I thought I’d dive into that a little deeper.

A quick search on Amazon reveals a multitude of books entitled “Happiness is a Choice”.  A Huffington Post headline claims “This is Scientific Proof That Happiness is a Choice“.  There’s a whole field of positive psychology that focuses heavily on happiness.  Then there’s the law of attraction business that essentially says if you put positive (or negative) stuff out there into the world then you’ll attract positive (or negative) stuff in return.

I call bullsh*it.  Saying that happiness is a choice is just a short hop, skip, and a jump from saying that mental illness is a choice.  It’s one thing to say it’s good to look for the positive, and try to reframe things in a more positive light, but to say that happiness can be had as long as you want it badly enough and try hard enough is a slap in the face to those of us dealing with mental illness.  A common symptom of multiple mental illnesses is anhedonia, or an inability to feel pleasure or enjoyment.  Our symptoms involve our thoughts, emotions, and bodies, making it seem like there’s little that’s under our control.  How does all of that fit in with “happiness is a choice”, pray tell?  I can feel my blood pressure rising even as I write this.

I don’t think these positive psychology cheerleaders are necessarily trying to make us feel badly, but there really does seem to be a fundamental lack of understanding.  The way I look at it, mental illness tends to (at least temporarily) limit our capacity to experience certain things, including positive emotions.  This is not a choice we make, it’s an illness.  We can’t choose our illness out of existence, but with effective treatment we can at least start to gain back the capacity that we lost.  To suggest that it all comes down to a choice, whether that choice be about happiness or mental illness, is cruel and insulting.

Is happiness even a good thing to focus on?  Dr. Russ Harris, an expert in acceptance and commitment therapy, challenges that idea in his book The Happiness Trap.  He argues that being perpetually happy is neither realistic nor desirable, and it is the human experience to feel a range of different emotions.  Instead he suggests that we should work on mindfully accepting we are experiencing, and make choices that keep us more in line with our identified values.  Sticking to values can offer a much more meaningful existence than chasing happiness because it’s what we society thinks we “should” feel.

Probably the reason this idea of happiness as a choice bothers me so much is that it feeds into stigma.  This most likely has more to do with well-meaning ignorance than intentionality, but the end result is the same nevertheless.  If people are being told that happiness is a choice, they may be more likely to think that other emotional states are also a choice, and that can set us back in the fight against stigma.  Mental illness offers us a certain menu of emotional options, and often we can’t control what does or does not end up on that menu.  If happiness was a choice, I would have made that choice already.

 

Image credit: Pixteller

Happy Valentine’s Day to us all

 

heart-shaped I love you pillow and 14 February blocks

Valentine’s Day sometimes seems like it has two primary purposes: gross commercialism, and making single people feel like crap.  Flower and chocolate-sellers win, single people lose.

Well, I’m a single person and I’m here to say f*** that sh*t.  I would much rather snuggle into the warm, cozy, loving blogging community.  So happy Valentine’s Day to us all, and sending out lots of love, especially to those who need it the most.

 

Image credit: Alexas_Fotos on Pixabay

Forgiveness – a follow-up

A while back I wrote a post about unsuccessfully trying to find forgiveness for those who have harmed me and done so much damage to my mental health.  Shortly thereafter, I first heard of the song Praying by Kesha in a post on Deanna’s Dark Diary.  I’ve had that song playing on heavy rotation since then, often singing along at the top of my lungs.  My attention was then caught by a subsequent post of Deanna’s in which she referenced the song again, specifically mentioning the line “some things only can God can forgive”.

All of a sudden, something profoundly clicked for me.  This forgiveness that I haven’t even known how to even begin to find… well, maybe it’s not mine to find at all.  “Some say in life you’re gonna get what you give, but some things only God can forgive.”  That shift in perspective resonated incredibly strongly with me.  Being a non-religious person, I think of “God” rather loosely, in a more general sense of a higher power, but the fundamental idea is still the same.

Forgiveness is burden for me to carry.  Forgiveness is not supposed to be a burden, but it was feeling like just one more way that I was not good enough, not compassionate enough, not mature enough, and on and on.  And that sounds a lot like victim-blaming.  The responsibility for the bullying I endured lies squarely on the shoulders of the bullies.  “I hope somewhere you’re praying, praying.  I hope your soul is changing, changing,  I hope you find your peace, falling on your knees, praying.”  It’s not up to me to forgive or find peace with what they’ve done, the damage they wrought in my life; that’s between them and their higher power, whether that’s God or simply the genuine humanity that lies deep within their own hearts and  souls.  That is their task, their journey, their burden to bear.  It is not on me.  The onus is 110% on them.  That reframing has been incredibly freeing for me.

“When I’m finished, they won’t even know your name.”  My task now is to find a way to thrive, to outshine the darkness they brought.  It’s up to me to be “proud of who I am.  No more monsters I can breathe again.  And you said that I was done, but you were wrong and now the best is yet to come.”  It is possible to “find a strength I’ve never known”; somewhere, deep within, I will eventually be able to find that.  That needs to be my focus.  Whether they eventually find forgiveness has nothing to with me.  “I’ll just say this is I wish you farewell.”  And given that letting go was why I was trying to find forgiveness in the first place, maybe I have actually found what I was looking for all along, just in a different way.  There is now the glimmer of possibility that I can let the past go and move onwards and upwards.  It’s really remarkable how much we can gain from the growth others find through suffering.  So thank you Kesha.

What’s Your Favorite?

WYF

#wyf_room

It’s What’s Your Favorite day over at Revenge of Eve, and today’s topic is room in the house.  For me, like Eve, it’s definitely my bedroom.  It’s south-facing, so it’s nice and bright on sunny days like today.  My girl guinea pigs live in the bedroom, and the boys are next door in the bathroom.  The guinea pigs kick up lots of hay and bedding so the floor is always dirty.  I like to sit on my bed to write and have a big soft cushion for that purpose.

 

So much for healthy coping strategies

head_hanging

I think I used to be fairly resilient, although it’s hard to remember because it’s been so long.  I am most definitely not resilient any more.

My weekend was not great, even though I tried to be mindful of self-care and include good stuff like journalling and meditating.  My mood was low, and I felt alone, unproductive, and worthless.

My exercise of choice has always been dance classes, and even when I’m depressed and have no interest, I try to keep it up.  There was one teacher I really liked and had taken classes with for several years.  Although I never talked to her about it, she seemed to understand that I wasn’t well and sometimes couldn’t keep up with choreography unless I could see her doing it.  It worked out well, and I felt reasonably comfortable.  But then someone that I used to work with started going to the class.  I pretended that I didn’t recognize him, but then eventually he commented that he recognized me.  At that point, I decided I was done with that class; I knew the inevitable question would be where are you working now, and I was in no way prepared to talk about the shitstorm that has happened to my career since we worked together.  Avoidance has become an old favourite coping strategy for me.

So I had to find a different class.  It was okay, but a lot less comfortable.  The teacher liked to announce a few times during the hour-long class that we should all move to a different spot in the room to shake things up.  This is fine if you’re 10 years old or in a big studio where people in the back can’t see very well, but I think it’s rather silly otherwise.   Anyway, I had staked out my territory in a back corner because it involved the fewest number of people around me, and the consistency of staying in the same spot made it just a little bit easier to keep up with the choreography.  It was frustrating, though, because I tended to get odd looks from others in the class when I was the only one not switching places.

That brings me to this past weekend.  I went to  class, and there were more people in the class than there usually are.  The teacher was quite pleased with this, and was very keen on having the students switch up spots frequently.  I stayed in my back corner, and I got a lot of strange looks, and on a couple of occasions people asked me if I was going to move.  My frustration grew and grew until the point that I decided f*ck it, I’m done.  Hmm, that sounds familiar.   So I grabbed my purse and walked the f*ck out of there.  The girl at the front desk noticed that I was leaving early and asked “Is everything okay?”  I ignored her and walked out, managing to hold back my tears until I got to my car.

When life hands me lemons, I don’t make lemonade; instead, I turn to wine and potato chip therapy.  No, it’s not the best combination, and hell no, it’s not productive, but that is what I feel like when life makes me feel shitty.  I would like to think that I am sufficiently functional in life to handle things like this, but I’m not.  I cried the whole drive home, and decided that healthy coping strategies just weren’t going to cut it for instant relief.  I knew that a bottle of wine (yup, the whole bottle) and a bag of potato chips (yup, the whole bag) were  not going to fix anything, but they seemed like the only thing that would let me escape.

This disappoints and frustrates me on a few levels.  One, that I couldn’t just deal with something in class that in the grand scheme of things was really not a big deal.  Two, that running away was my go-to coping strategy.  And three, that rather than using some of the self-care strategies I’ve been working on, I turned to booze.

I went to bed at 5:30pm, still in my clothes, and without even thinking of taking my meds.  But today is a new day, and it would seem that I’ve still got quite a bit to work on.

 

Image credit:

Carolina Heza on Unsplash

Blog award extravaganza

VersatileBlogger

Liebster5Blogger Recognition Award badgeSunshine blogger award badgeMystery blogger award logo

 

Wowza.  I have been nominated for 5 different blog awards recently, and I feel so incredibly honoured to be recognized by my fellow bloggers.  This is an amazing little love-fest we’ve got going on in the WordPress community.  Since I get overwhelmed easily, I’m going to combine them all into one big adventure.  I’m using the spreadsheet I have for all things blogging to try to make up for my brain being not very on the ball, but if any of what follows gets jumbled and makes no sense, it’s the brain’s fault, not the spreadsheet’s 😉  And the take-home message in all of this is please check out the blogs I’ve linked to in this post, because they are all fabulous.

It’s always hard to figure out who to nominate for awards, and a lot of it comes down to who happens to be at the top of my WordPress feed when I happen to be working on the post.  I try to mostly nominate people who aren’t already in my spreadsheet as blogs I’ve nominated, but I’m generally pretty discombobulated.  If I haven’t mentioned you, it’s not because I love you any less!  And for those I have nominated, please feel free to ignore the nomination, accept it and leave it at that, or join in and do your own award post…  whatever feels right for you.  I know these award posts can take a lot of work, so no pressure to take that on.  And on a side note, if anyone’s not familiar with pingbacks yet, if you link to a blog’s website (not the blog’s page in WordPress reader), the blogger will get a pingback notification that you’ve linked to their their blog.  It definitely took me a while to figure that whole situation out.

Alright, time to dive right in!

 

VERSATILE BLOGGER AWARD

The lovely Sweet Summer Online has nominated me for the Versatile Blogger Award.

The rules:

  • Write 7 interesting facts about yourself
  • Nominate 15 amazing bloggers for the award.

7 Facts about me:

  1. I have 5 pet guinea pigs, 3 girls and 2 boys.
  2. My middle name, Leia, comes from my great grandmother rather than Star Wars.
  3. My ancestors are a hodgepodge of English, Scottish, Danish, and Lebanese.
  4. I am a plant killer extraordinaire, but I have a prayer plant beside my bed that’s doing well and does a lot of moving around, which is cool.
  5. Dance has always been my favourite form of exercise, and I’ve done everything from ballet to ballroom to hip hop.
  6. The only famous person I’ve seen up close was Penelope Cruz in Cannes.
  7. My favourite book is a tie between Pride and Prejudice (Jane Austen) and Tale of Two Cities (Charles Dickens).

My nominees:

 

MYSTERY BLOGGER AWARD

I was nominated for the Mystery Blogger Award by the fabulous Hyper Child Chill Mom.

What is the “Mystery Blogger Award” ?

It’s an award for amazing bloggers with ingenious posts. Their blog not only captivates; it inspires and motivates. They are one of the best out there, and they deserve every recognition they get. This award is also for bloggers who find fun and inspiration in blogging, and they do it with so much love and passion.  It appears to have been started by Okoto Enigma

Rules

  • Put the award logo/image on your blog.
  • List the rules.
  • Thank whoever nominated you and provide a link to their blog.
  • Mention the creator of the award and provide a link as well.
  • Tell your readers 3 things about yourself.
  • You have to nominate 10 – 20 people.
  • Notify your nominees by commenting on their blog.
  • Ask your nominees any 5 questions of your choice; with one weird or funny question (specify).
  • Share a link to your best post(s).

Questions:

  1. What is the weirdest scar you have and how did you get it?  I have a round indented scar between my eyebrows from chicken pox.
  2. Shark diving, bungee jumping, or sky diving? I’ve already tried bungee jumping and sky diving, so next up would be shark diving.
  3. What is one of the weirdest things you used to do as a teenager? I was a geek and had a pretty tame life in high school.
  4. In your opinion, what is the best Disney movie to come out since Disney’s Golden Age?  I’m not so up on my Disney and don’t actually know what the golden age was, but I’m going to say Lion King.
  5. What is your favorite Wikipedia article? I don’t think I have a favourite, but I do use Wikipedia a lot.  A few years back I went through a phase of doing a lot of Wikipedia article editing (which, by the way, anyone can do).

My nominees: I pass on to all of you the same questions I was asked by Hyper Child Chill Mom.

 

LIEBSTER AWARD

I was nominated for the Liebster Award by the very cool former Rude Girl in an Aspie World, who’s now blogging at Discovering My Authentic Self.

The Rules:

  • Write about your blog and thank the person who nominated you. Share a link to their blog and write a little something about their blog too.
  • Display the award on your blog
  • Nominate 5 – 11 blogs that you feel would enjoy blogging about this award.
  • Answer the questions provided.
  • Make a new set of 10 questions for your nominees to answer.
  • List these rules in your post
  • Inform the people/blogs that you nominated.

The Questions:

  1. What inspired you or why did you start blogging? (This could also be related to writing. You choose)  I was looking for something to give me a bit more sense of purpose, and I think it’s really important to talk about mental health.
  2. What is the reason behind your blog name and/or url?  It was something I’d had in mind as a potential name if I start a private nursing practice at some point down the road.
  3. In your personal opinion, what is your favorite blog or best blog you have posted so far and why?  I honestly don’t have a favourite, because they’re all about topics that matter to me.
  4. What are some of your favorite tips for new bloggers? Write about what moves you.
  5. How has blogging changed your life? It has absolutely changed my life, making me feel much more connected to the world.  Plus it means I’ve always got something productive to do with my time.
  6. Do you like music? If so, what are some of your favorite artists or songs etc?  I like to crank up the tunes while I’m driving, but I’m not really that attached to any particular artist.  Favourite song tends to rotate based on where my head is at.
  7. Do you read? If so, what are some of your favorite books or authors?  I do like to read.  I used to read more fiction, but for the last while my concentration hasn’t been that great, so non-fiction is easier.
  8. What are some of your hobbies? Blogging and being a guinea pig mom.
  9. What places do you really want to see, experience or visit? I really want to visit Lhasa in Tibet.
  10. If there was one thing (anything) in humanity or the world you could change without question ifs or buts, what would it be?  I would make people more compassionate.

My nominees:  I pass on to you the same questions as I was asked by Discovering My Authentic Self.

 

SUNSHINE BLOGGER AWARD

Functioning in my dysfunction and Little Lost One Blog nominated me for the Sunshine Blogger Award.  Interestingly enough, I discovered both of these lovelies through the award post nominating them on Scarlett’s BPD Corner.

RULES FOR THE AWARD

  1. Shout out to the blogger who nominated you with a link to her/his blog.
  2. Answer questions given by the blogger.
  3. Nominate 11 bloggers for the sunshine award, with links to their blogs.
  4. Don’t forget to notify your nominees.
  5. Come up with your own questions and tag 11 other bloggers nominating them to do the same.

Questions:

  1. What is your favorite animal?  Guinea pigs – I have 5.
  2. You’re streaming Netflix, what are you watching? Lately I’ve been watching true crime stuff.
  3. What’s the biggest goal you want to accomplish this year? I’ve got a paper about bullying that’s almost finished that I’ve been to nervous to submit to an academic journal because I worry about negative feedback from peer review, but I’d like to move forward with that later this year.
  4. If you had the chance to travel the world, what’s the first place you’d visit? I think my next trip will be to the former Yugoslavia area.
  5. What’s your dream profession and what made you choose it?  My dream profession is being a nurse.  I love my work, I just don’t like the politics and the crappy management that tend to go along with it.
  6. Who is your biggest role model? I don’t have one in particular, but there are a lot of amazing people out there.
  7. What are the top 5 songs on your playlist? Right now I’ve got a couple of John Legend songs in heavy rotation.
  8. What do you do for fun?  Fun?  What’s that?  …. Unfortunately, I don’t really remember.
  9. Why did you start blogging? To add to the conversation about mental health.
  10. What keeps you focused?  My meds.
  11. What do you hope people take away from your blog posts?  That it’s ok to talk about difficult things.

My nominees: I pass on to you the same questions that I was asked.

 

BLOGGER RECOGNITION AWARD

I was nominated for this award by my dear name-sister Ashley at Practicing Imperfection.

Here’s how the award works:

  1. Post the Blogger Recognition Award Rules.
  2. Use Blogger Recognition Award badge on your website.
  3. Share the reasons why you blog.
  4. Share two tips for new bloggers.
  5. Nominate other bloggers for this award and notify each of them about this nomination.

Why I blog

The more we talk about mental health, the better things will be for all those of us living with mental illness.

Tips for new bloggers:

  1. Decide on an intention or purpose for your blog, and bring yourself back to that regularly, because it can be easy to get swept away.
  2. Write about what matters to you, and don’t limit yourself with what you think you can’t or shouldn’t say.

My nominees:

 

If you’ve made it to the end of this epic post, good for you!  This post is all about spreading the love, so I hope you’ll check out the blogs I’ve mentioned.  Thanks again to the wonderful bloggers that nominated me – hugs to all of you.

Book review: Strong at the Broken Places

StrongAtTheBrokenPlaces

Strong at the Broken Places: Voices of Illness, a Chorus of Hope is an intimate look at living with chronic illness.  Author Richard M. Cohen, who himself has multiple sclerosis, works with five participants who have various chronic illnesses to capture their stories and help others understand the overwhelming toll that chronic illness can take.  The participants are Denise, who has has ALS (often known as Lou Gherig’s disease), Buzz, who has has non-Hodgkins lymphoma, Ben, who has muscular dystrophy, Sarah, who has has Crohn’s disease, and Larry, who has bipolar disorder.  The author engages with those featured in the book over a span of not just months but years, getting to know them on a far deeper level than simply the words they chose to use.

This is not a sanitized, at-face-value look at chronic illness.  Rather, it probes the depths of it, encompassing the myriad ways in which chronic illness affects the lives of those it touches both directly and indirectly.  The author skillfully ties the stories to one another, illustrating the many commonalities among the experiences of disparate chronic illnesses.  The book gives voice to those who society tends to silence: “Too often the sick are seen and not heard.  Listen.  Their songs are soft but steady.  Hear the sound of steel, the quiet toughness at the core.”

There were a few things that surprised me and at times somewhat disturbed me about Cohen’s approach.  He openly brings in his own opinions and expectations of how the participants should behave, including questioning Buzz’s decision to accept his oncologist’s recommendations rather than seeking additional information or other opinions.  Initially this struck me as inappropriate, but as the book progresses, as a reader I become more comfortable with it, as the purpose seemed to be a deeper exploration of the participant’s ideas and behaviours.

The author’s interviews with people who knew the ill participant initially felt awkward to me as a reader, seeming almost a betrayal.  In particular, his attempt to interview Buzz’s 9-year-old son accomplished little besides making the child uncomfortable.  However, in checking my own reaction I recognize that at least to some degree I’m projecting because of of my own illness.

A  mildly irritating quirk was that the dialogue didn’t contain the contractions that would typically be used in casual speech.  This made the dialogue feel a bit stilted at times, which is unfortunate, as it seems unlikely that this accurately reflected the quality of speech.

Cohen describes the “daily brushes with public ignorance and indifference and the stigma of being sick in a society that worships health, brand and define us.”  The weight and pain of the burden this imposed were difficult for the participants to carry.  Larry likened chronic illness to a battle with two fronts: the disease itself and public ignorance.  Denise’s slurred speech led people to ignorantly jump to conclusions, such as assuming she’d had a stroke or was drunk.  Sarah was quickly identified as abnormal because of the side effects of long term steroids, which significantly reshaped her face and body, and this took a heavy toll on her self-image.

I had to smile when Cohen identified “How are you?” as the most insincere question that people ask.  I share the experience that “people really do not want to know and inquire under the assumption that no one will be rude enough to actually answer the question honestly.”  Another point that strongly resonated with me was Larry’s experience that others tended to place him into a diagnostic box, attributing much of his behaviour to his illness.  “When does the diagnosis stop and the human being regain a sense of control of a life?” he asks.

Social support varied amongst the participants, and maintaining relationships could be challenging.  Denise was divorced and had limited family support.  She pointed out that she was alone before she was diagnosed, and there was no reason for that to change after her diagnosis.  She observed that a benefit of this was not having to experience guilt over being a burden on a spouse.  The author repeatedly challenged Denise on her choice to be alone, which initially struck me as imposing his own preconceptions.  His attempts to intercede in Denise’s family situations seemed like inappropriate interference, even meddling, or a misguided attempt to apply his own agenda.  Yet again, I must check myself, since like Denise I have chosen to isolate myself because of my illness.

Roles and identities are a recurring theme across the participants’ stories.   Buzz, unable to work, fell deeply into debt and feared ending up homeless, which compromised important role identities he held as a husband and father.  Ben’s parents, especially his father, struggled with the idea that their son would die before they did.  Sarah’s illness “constantly makes me second-guess myself and question who I am”.

Buzz drew heavily on his faith in God to maintain a positive outlook.  The stoicism that resulted was challenging for those around him to face.  Larry identified himself as a very spiritual person, and found it frustrating when doctors dismissed his spiritual experiences as psychotic, attempting to “force patients into non-psychotic behaviour with such zealotry that they dismiss too many possibly positive and healthy dimensions of the patient’s mind, body, and soul.”

Hope was a theme that arose often.  Larry struggled with doctors who would try to take away hope, saying he would never get his life back.  He felt they had no right to do this, and he saw hope as being as necessary for the soul as oxygen for the body.  The book concludes on a very hopeful note, with all of the participants presenting their stories to Harvard Medical School faculty and students.  Meeting one another and speaking together was a way to come together as a community and connect in finding hope, voice, and inspiration.  Through the advocacy work they engaged in, they were able to take ownership, find a sense of purpose, and establish identity.  As Larry observed, “We are connected, and were strong at the broken places.”

This book is a fascinating journey into the depths of chronic illness, and while there are some elements I wish were done differently, the message of being strong together at the broken places is certainly a powerful one.

 

You can find a list of my previous book reviews in my blog index.

Travelling with depression as a carry-on

world map

Travelling has always been a passion of mine.  In the 10 years since I developed depression, my illness has certainly gotten its hands dirty interfering in my travel plans and hopping along for the ride.

In 2007, I had planned to do an organized tour across China, Mongolia, and Russia with a  couple of friends.  Around two months before our planned departure, I ended up in hospital with psychotic depression following a suicide attempt.  So much for that trip.  It was the one time I had ever purchased trip cancellation insurance, so I went ahead and made a claim, but the insurance company came up with an excuse to deny it.  I’ve never bothered purchasing cancellation insurance again.

In 2012, I was feeling quite a bit better after a 2-month hospitalization in late 2011, so I booked a 2-week trip to Russia for that summer.  As the trip neared, it was taking more and more effort to hold myself together.  Then the day before I left, things just fell apart.  I went ahead with the trip, thinking it would at least be a distraction, but my mood remained low, and I found myself just going through the motions and not enjoying anything.

In 2014, I had planned a trip to central Asia (Uzbekistan, Kazakstan, and Kyrgyzstan).  A few weeks before I left, a stressful event brought on a relapse of my depression.  I was very slowed down, both in movement and in thinking.  An increase in lithium helped, but I still wasn’t feeling great when I left for my trip.  I found myself having to schedule at least one or two nap breaks into each day, and sometimes I would just run out of gas and have to sit myself down wherever I could, even if that meant the floor or the sidewalk.

I think teleportation is the invention that I would most like to see happen in the near future.  I’ve never been all that keen on the actual in transit part of travelling; it’s uncomfortable and often a real pain in the ass.  But when I’m not feeling well, uncomfortable is definitely not a strong enough word to capture how yucky it is.  As I was at the airport waiting to leave on my recent vacation, I felt totally overwhelmed by external stimuli, which made me feel so dizzy I thought I was going to pass out.  I was desperate to drown out the onslaught of noises, so I blasted my music on my headphones as loud as my ears could tolerate.

seats in an airplane cabin

Being on the plane was also difficult.  I’m a fairly hippy girl and the girl next to me was even more endowed in that department, which meant that it was very hard to prevent our legs from touching.  Normally this would be no big deal, but as sensitive as I was feeling, this was just not working for me.  This translated into me trying as hard as I could to pour myself out of the seat and into the aisle.  Luckily on the flight home I had an empty seat between me and the next person over, but she was very antsy, and that in turn triggered me.

I am quite prone to motion sickness, and having barfed mare than once before on planes, I always take drugs for this.  Normally I take Gravol (dimenhydrinate), and it has the side benefit of sedating me at least a little bit.  But on this particular occasion I had run out of Gravol, so instead I took some promethazine that I’d picked up in India a couple years ago.  That’s not actually as dodgy as it sounds; it does prevent me from barfing, but doesn’t sedate me at all.  Damn it, should’ve brought Ativan!

I have to recognize that my early 20’s, a time when my body and mind were functioning optimally mental illness hadn’t yet reared its ugly head, and I could sleep almost anytime, anywhere…  well, those days are far, far behind me.  I need to drill it into my brain that I can’t function that way anymore, and it’s important to prepare myself better for experiences that used to come much more easily.  If nothing else, I’ve learned that Ativan needs to be a basic part of my sizeable travelling pharmacy (which I’ve written about before in How do you say antidepressant in Uzbek?).

Lithium is definitely the hardest medication for me to travel with.  I have to be very mindful of my hydration, and sun, heat, and alcohol all can have a major impact.  Particularly in countries where tap water isn’t necessarily the best idea, water intake requires effort and planning.  When it’s hot, I can’t be sure if I’m losing much lithium or mostly just water through sweating.  When I was in India, I had diarrhea most of the trip, and again, I knew I was losing fluids  but wasn’t sure how much salt I was losing as well.  When my lithium level gets too high I get a bad tremor, headaches, and nausea.  With no handy way of doing a quick lithium level check (besides a teleporter machine, I need a blood sugar-type monitor for lithium to be invented), I just have to guess.  When I was in India and again when I was in Mexico, I made the assumption based on my symptoms that my level was high and lowered my dose accordingly, which did seem to help.  I was able to find a few research studies that suggest there can be climate-based variations in lithium levels, but it doesn’t appear to be something that’s been studied very much.  It bugs me having to think about this.  It’s not that I have a problem with lithium per se; I just hate having to blindly approach the situation without the benefit of a lab or a doctor to problem-solve with.  At least my recent 1-week trip was short enough to be fairly manageable, but still, the frustration persists that I have to think about it at all.

Adding to my fluid balancing woes is that my body seems to have learned to automatically kick into travel mode, with my kidneys presumably trying to make life easier for me.  This has served me well when I’ve been on long train or bus rides with icky toilet options, as I can sometimes go up to 24 hours without urinating.  On the day I returned from my recent vacation, I went 12 hours without urinating despite drinking around 2L of water during  that time.  I don’t know if this is something that happens to other travellers, or perhaps I’m just a random oddity.

Speaking of oddities, it would be nice if solo travellers weren’t seen as going against social norms/expectations.  I’ll leave most of this rant for another post, but for now I’ll just say that when I’m not feeling very well and I’m treated like a weirdo because I’m on my own, it just plain sucks.  I wish I could bring my pet guinea pigs along to display as my companions, but they are non-stop poop factories, so it just wouldn’t be practical.

I’ve accumulated enough credit card points for a free flight to Europe, and I think I’m going to aim to do a trip this fall.  It would be the first time I’ve booked an international trip (other than a short beach getaway) knowing that I’m not feeling so great.  Given that I’m just working casual I don’t have to worry about booking off vacation time advance, so I can leave it until relatively last minute to make a decision.  I’ve seen from past experience that I can get by travelling when unwell, so it may be a good idea to push myself to do something that I might actually end up enjoying  Stay tuned.

 

Image credits:

Christine Roy on Unsplash

ty_yang on Pixabay

Bringing the sexy back

IMG_0638

The dress in this photo has been dubbed my “sexy dress” by a fabulous female staffer at a resort I recently stayed at, and apparently I am “sexy girl”.  It has been a long time since I thought of myself as sexy in any way, so that made me feel pretty darn good.

At the same time, I was working on turning the book 101 Ways to Live Well into my own personal self-care manual as part of my journalling project, and 2 of those 101 ways involved livening up your libido and feeling sexy.  And that got me thinking, why shouldn’t I feel sexy?  Because sexy isn’t necessarily about sex (which hasn’t happened for a long while).  It’s about feeling fierce, and it really can fall under the umbrella of self-care.

Shortly before all of this came up, I’d read a post by the lovely Girl with the Paw Print Tattoo about planning a boudoir photo shoot.  Curious to learn more, I stumbled across some boudoir pics of a dance teacher I’ve done classes with, the amazing Portia Favro, and I thought WOW.  At this point the cost of a boudoir shoot just isn’t in the budget, but it’s an interesting little goody to put on the back burner.  And just as I was finishing up writing this post, the oh-so-sexy Girl with the Paw Print Tattoo published her post-shoot follow-up.  Yay!

Back to my self-care manual.  So, what did I come up with for ways to bring the sexy back?  Well. here goes:

  • Go commando: I went for a walk on the beach commando one morning; to be honest, it was because I had a bit of a sunburn on my butt so it was just more comfortable.  But then I realized hey, this is kind of hot.  Perhaps I should do this a little more often
  • Wear sexy lingerie just for me: I don’t have a huge stash of sexy lingerie, but I do have some that I never wear because there’s been no sexy business going on.  Sexy business or no sexy business, it’s still worth it just for me every once in a while.
  • Sticking with that same idea, buy some more sexy lingerie just for me.
  • Show a little cleavage once in a while.
  • Do a little at-home selfie boudoir shoot.  (note to self: don’t save the photos to iCloud)
  • Do a little at-home version of the Victoria’s Secret Fashion Show, with some fierce tunes and a fierce strut to match.
  • Fantasize.  Not someone from real-life.  Maybe rockin it old school like Brad Pitt in Legends of the Fall.  Not fantasizing sex, but all the fun stuff that comes before getting down and dirty.
  • Do a professional boudoir shoot at some point down the road.
  • I have an aromatherapy blend called Embrace that’s supposed to be sensual.  I use it in my diffuser because several of the oils in it are supposed to be good for mood, but maybe it would make a good pairing with the Brad Pitt Legends of the Fall fantasy.

That’s what I’ve managed to come up with so far.  What do you do to make yourself feel sexy?