Meds?

A girlfriend was saying she thinks she may have been depressed all of her life.

“It’s hard to reach out” she said.

“It’s hard to get what you need” she said.

She did reach out, and consulted her doctor who gave her a prescription for an SSRI. Selective Serotonin Re-uptake Inhibitors or SSRIs are commonly prescribed for the treatment of depression. She went to a pharmacy and the prescription filled, and she now has an unopened bottle of Zoloft. She’s not sure what to do next.

Having the medication has already improved how she feels. She’s tried waving the little jar of meds around her head to imbibe the benefits. She’s also thinking about placing them under her pillow and then trying to sleep. She’s not only joking, she is hesitant and wants to think carefully before starting on meds – the implications, the risks, and the benefits. She’s taking her time…

Movember 2011

That’s funny I wrote about Movember in 2009 but not in 2010. What happened there? Last November is a bit of blur to recall, maybe I had nothing new to say in support of the Movember awareness and fund raising effort. I hope wasn’t just in a dismissive mood and thinking pooh-pooh, I can be a bit that way. I am relenting this year, my innate sense of scorn has softened, and I am enthusiastic and supportive particularly thanks to a friend who is participating.

Men involved Movember’s fundraising don’t shave for a month. They are visibily changing the face of men’s health. My friend is the founder of FilmDude; the grey dude (I’m the red film reviewer). He’s fabulous, even before Movember he was quietly fabulous. Not shaving this month means he is also hairier than he was at the start of last week. I wonder if not shaving might prove more difficult than it looks? I am guessing that it will, starting with the itch he has described.

There is gallery documenting the awesome not shaving effort. See here to view progress and to donate in support to a couple of worthwhile men’s health causes.

Pooh-poohing not allowed.

Abnormal? grief!

I spoke with a friend, Shelley, recently. Actually Shelley is the sister-in-law of one of my friends, we’ve known each other for a long time as friends of friends. We enjoyed the catch to see each other and chatted, sharing and catching up. Shelle mentioned she was concerned about her Dad, his meds had been mixed up, not administered correctly and it had put him out kilter.

Shelley explained her Dad has been on anti-depressants since being diagnosed with complicated grief after her Mum, his wife of 50 or more years, died. Apparently he couldn’t stop crying. If I were he, I might have had the same reaction. If happiness is going along where life takes you with a particular special person, then grief on the death of that person might be vast and enduring.

Complicated grief is also known as abnormal grief. Shelle’s Dad’s reaction doesn’t sound all that abnormal to me, but I wasn’t there. I can’t really say how he experienced his loss, I can imagine it. I also can’t understand how 5 or so years later, well after he stopped weeping, he is still on anti-depressants.

Something in me is offended by the term abnormal grief. I know grief is complicated, almost by definition. The loss of someone close changes everything.

I believe we are more resilient than we think we are, I know that was true for me. I didn’t always feel resilient but there was something strong willed in me that helped me to cope and continue. Grief is a persistent state, there is something unyielding about being in the grip of grief. Grief can also be unknown and frightening, many confided to me that they did not know if they could make it through what I went through. That’s where resilience comes in, I kept going. Call it resilience, whatever I drew on it was my choice to navigate through grief and loss as best I could, I did not give myself other options. I did not believe I had a physiological disorder that could be treated with drugs, I didn’t even think to seek medical advice.

Another concern I harbour about Shelle’s Dad is about his ongoing medication, he has been taking medication for more than 5 years now for his complicated grief, or should I say his deep and enduring grief. I know that antidepressants can take time to take effect, it can take a month or more before receiving a therapeutic effect. Antidepressants alleviate symptoms but do not address underlying psychological causes for moods. I don’t know about the continuation of antidepressant medication, and how long you might expect take treatment for. My impression was even after years, this was ongoing medication. Is that how it goes? Can you not resume life without medication at some time?

I am troubled by Shelle’s Dad’s story for many reasons. The thing that occurs to me is that grief is a time when you should ask very little of yourself and when others should not ask too much.

Electroconvulsive therapy

I had lunch with a girlfriend last week, and I mentioned ECT, I can’t remember what we were discussing, I don’t know how the topic came up, but I do recall her response. I said something about electroconvulsive therapy and she stopped chewing mid-mouthful, her eyebrows arched upwards she was surprised and disbelieving, “No” she said, with a drawn out emphasis on the o , “that’s not a treatment” she said, and I assured her it is.

I have heard ECT touted as the best treatment we have for depression. At the same time many people don’t realise it is still used as a treatment. I mentioned ECT once before in a post and I am revisiting it after my friend’s lunchtime reaction. Another friend, a psychiatrist, has told me it would be his treatment of choice. As effective as it is, it’s hard not to have negative reactions when ECT is mentioned.

I can’t think of the complexities of ECT without thinking of this TED talk. Sherwin Nuland describes himself “as a man who almost 30 years ago had his life saved by two long courses of electroshock therapy”. He speaks briefly about the history of ECT as a treatment and tells of his own experience. The talk runs for 22 minutes, I recommend it as informing, and as one perspective…

Who is asking?

I’m troubled by R U OK? Day. Something has been niggling at the edge of my thoughts and I am concerned that R U OK? Day might not be entirely OK for some. Well not the day so much as the question…

I have sat with my consternation for awhile trying to embrace the idea, and not quite able to. I like the suggestion that we are reminded to check in with someone who might be depressed on at least one day of the year. R U OK? describe themselves as “…an independent, not-for-profit organisation whose purpose is to provide national focus and leadership on suicide prevention by empowering Australians to have open and honest conversations and stay connected with people in their lives.”

Even knowing the good intent behind the push something still doesn’t sit well with me and I am unsure of how to explore my feelings. I’m in a quandary about where to start, so start with me and ask myself: R U OK?

Am I OK? Do I know what it is to be OK, well enough to answer the question? I struggle to form an answer to the ubiquitous pleasantry “How are you?” and now “R U OK?” is a question I see as more complex. It’s a question that feels inherently difficult to answer. I’m unsure how to assess if I am OK in relation to you, the person asking. Do I know you well enough to tell you how I really am? How much trust is shared between us?

I am going in circles, that’s how my mind goes…

“R U OK?” has a lot of assumptions about what is OK and what is not built in on both sides – the one who is asking and the one who is being asked. Am I? Are you?

More questions surround the central question; What is sought or hoped for in the reply? Why is the asker posing the question? What are the possible responses? What does the inquiry imply about the one being asked? How much support is wanted, needed, or available? What is it safe to reveal in response? What will the inquiry-maker do with the response? How far can we take the conversation?

What is best for us? We being the one asking and the one who is asked. I imagine the question R U OK? sitting in space between us, along with care and caring, all tangled up and awkward, and surrounded by many more implied and unanswered questions.

R U OK? is not a simple question, and it is not meant to be but I am still not quite OK with it all…

Book Club and tears

Book Club met yesterday, we’re a long standing book club, a group who have become close thanks to our regular bi-monthly Sunday afternoon get together. We are an in-sickness-and-in-health book-club and we’ve celebrated a wedding, births, holidays, job-promotions and we’ve shared difficulties and now the death of a husband.

When we first formed, years ago, we planned to be a book club focused on the books we read together. We find that we do discuss books and often there are other things happening in our lives that draw us into a conversation more rewarding than talking about the book. That was the case yesterday with a significant life change unfolding for one of us whose husband had died, and her daughter – our loved Book Club convener and her Mum – have been plunged into grieving, that’s the experience we shared and talked about yesterday.

As they talked I was reminded of the heightened sense of feeling and emotion that comes with grief and how our ability for joy is not lost when grief floods in. Everything changes, each day presents its own challenges. You learn you can be more sad and more lost than you ever imagined, and there are amazing moments when laughter is the only possible response. The best analogy I know of, for this surprising unknown experience, comes from Joyce Carol Oates Memoir, A Widow’s Story.

I heard her speak about her book recently and when she spoke of the absurd and surprising things that happen during grief, she talked of things familiar and known to me. I was surprised and then reassured that they were part of her experience as well. Joyce Carol Oates described playing in King Lear, she felt she was playing out a tragedy with the script and the lines as they are supposed to be read but with such odd things happening it was sometimes like the Marx Brothers had centre stage. Some things that happened would almost only make sense if framed as a tragic black comedy directed by the Marx Brothers.

When your world is turned inside out by the death of someone close, normal takes leave, there is no normal to fall back on.

It’s an unexpected shared experience of some widows that such odd things happen when we can least put up any resistance, that we have to sometimes laugh through our tears and then wonder what the world will present us with next. One day and then the next. It was good to share our stories at Book Club.

Another shared experience, in my very small sample, is:

“Of the widow’s countless death-duties there is really just one that matters: on the first anniversary of her husband’s death the window should think I kept myself alive.” Oates, J. C. (2011). A Widow’s Story: A Memoir. New York: HarperCollins Publishers.

That’s why we have friends and book clubs, to share with and to be with, to help keep ourselves alive…

I am because you are

Ubuntu

When I first heard Ubuntu described it was in relation an African greeting. When two people met one would say “Sawubona” and the other would reply “Ngikhona”. One person saying “I see you” and the other replying “I am here to be seen”.

Ubuntu, is a philosophy, a way of being in community. I now understand Ubuntu can be loosley translated as something like “I am because you are”

That is me tonight, feeling a deep appreciation for who I am, knowing that whoever I am is shaped by you. Tonight I am sending gratitude and thanks to the people who read Wonderer’s Heart, Ubuntu to those who send me thanks, links and comments. I am changed by those who share their own experiences and stories with me.

Sawubona to my friends who might not read me here but know why I write and the importance of casting a little light onto these dark topics. Thanks to Shortbread for her unquestioning devotion, her constancy as she sleeps at my feet snoring while I write. I write to be read, I am here to be seen, and I am. I’m also heard – that’s a big deal to me – and appreciated. Thank you, I have a forum that give me the space to breathe, to rant and to question and to wonder…

I am changed by each encounter, every conversation, each posting, I am changed by what is shared and by what is held back. I am because you are.

Thank you.

Tell it like it is or don’t tell it at all

A challenge for anyone visiting or talking to a friend who is unwell is what to say to them. Nobody knows what to say in those situations and as a word of warning, few people who are ‘in treatment’ or ‘in recovery’ or worse, perhaps ‘in treatment without hope of recovery’ want to hear upbeat cheery platitudes.

From dictionary.com:

Main Entry: platitude
Part of Speech: noun
Definition: dull, overused saying

I can’t count how many times I was told that in time I would better and grieve less. The advice was couched in different ways, and I believed none of it. Time was offered again and again as a healing salve. I felt like I was being put on hold, I was a little much to deal with right now, but maybe later, in time, when I was healed in some way we could pick up where we had left off.. Sure time passes, things change. I knew that my feelings and ability to cope would change over time, I was grieving and not stupid. What I needed was caring and empathy. For me consolation would have been found in someone saying something as simple as “Oh you must be so lonely…”

I wanted to be heard, I wanted my dear friends to listen to me – and the dear ones did – I didn’t want to see disappointment in their eyes or all over their faces when the best I could be was less than they might have hoped for. The pressure to be better, well, fixed, or back to normal was a burden.

From my friends point of view, it can be hard to be a good friend when you are worried and concerned, when you would wish to make things better. In that situation there is a tendency to say silly things, not helpful things. You might find yourself saying things that you hope no-one says to you one day.

As this article points out, sometimes saying nothing but listening is the best a friend can do. Here in another article are six things to never say, and four suggestions of things to say.

If you didn’t know what to say to someone who is going through something then try listening to them.

A Friend Indeed

What can you do for a friend with severe depression? It is an important question, I am sometimes asked what should be done, what might help? Depression is a serious condition that people can die from, it needs treatment. I would just say that if a problem is shared with you don’t wait, start listening and understanding. There is a lot you can do as a friend:

• Be a friend to your friend.

• Hold your friend’s hand in any way that is comfortable. If a substantive physical clasp isn’t your style (or perhaps their style) hold on metaphorically.

• Talk to them and listen to them. Stay in touch, be around. Answer the phone if your friend calls, and ring them just to check-in and say hello. Here is a great practical list of things to say and not to say to a friend with depression.

• Seek support, encourage them to see a doctor. Support your friend to get to appointments, sit in the waiting room and drive them home, be supportive of their treatment. Help them feel safe.

• Look after yourself, make sure you have a soft place to land and seek support for your own well-being.

Here is another practical list of things, there’s some overlap with the list above (as you would hope), it is useful information. Being a friend to someone with depression can be demanding, and you can make a difference.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.

What does it matter now?

A sad story to start the New Year.

Simone Back died by suicide on Christmas Day. She posted a note on FaceBook, where she was linked to more than 1,000 friends, she wrote “Took all my pills be dead soon so bye bye every one.” Nobody tried to make direct (as opposed to on-line) contact with Simone until the next day. It was too late.

I have been thinking about Simone all day since reading about her death. I am troubled and deeply saddened by her death and her FaceBook posting.

As Albert Camus wrote in The Fall, his last complete fiction work, “People aren’t convinced of your sincerity, your motives, and the depth of your sorrows except by your death. As you long as you are alive, your case is uncertain, and you are entitled only to their scepticism.”

Sadly many of Simone’s friends were sceptics, and apparently not convinced of her sincerity. I can’t know anything beyond the newspaper report and what does it matter now if anyone believed her or not? She will not know their reactions, their sorrow or shame, she is unable to experience her own funeral.

I am sorry there was no-one to hold her hand and be with her through a dark night.

Crisis counselling is available around the world. In Australia Life Line 13 11 14.