Tuesday, December 31, 2013

A good psychiatric hospital experience: part two

Click here to read part one of this two-part series.

The care and company of others

In 2012 I wrote a feature about Fred Lee, an American hospital executive whose insights into the importance of empathy and compassion in hospitals led him to write the bestselling book If Disney Ran Your Hospital: 9 and a half things your hospital would do differently.

Fred told me “Psychoneuroimmunology is the study of the effect of people’s thoughts on their nervous and immune systems, and there is plenty of this research to demonstrate people who perceive genuine concern from those caring from them get better faster, and thus have shorter stays in hospital.”

This insight matches up entirely with my experience. As an inpatient I really appreciated the patience and empathy of the many staff, both clinical and administrative, during my stay. The company of other people admitted for treatment was also a real highlight of my hospital stay. I can vividly recall moments of camaraderie that still give me a warm glow when I think about them.

One such moment was a discussion over coffee I had in one of the cafes nearby the hospital with a new friend sometime midway through my stay. There was an asymmetry to his face because he had a cancer removed from his jaw line and he had subsequently been battling anxiety issues for a number of years. He had a gentle nature and a lisp because of the jaw operation.

It felt like we could have been any two blokes in any city or town chatting things over. I remember it so well because at the time feeling “normal” was a fleeting sensation. It was the build up of little moments like this that led to me gaining confidence in myself again.

The visits I received from members of my family and friends were incredibly important to my recovery and the memories I have of these are powerful and fill me with a deep joy and gratitude. I remember my mum bringing the most remarkable array of water lilies on my birthday (which happened to be the day after my admission to hospital). They meant so much to me.

I thank God for the supportive family and friends I had (and still have) around me. My brother described the situation as a “circling of the wagons” around me to protect and care for me. I love that image.

You can gather from my accounts the many strands that went into the successful treatment of my acute mental ordeal and how they started me on the path to recovery. I think of it kind of like the launch of a space shuttle. Tremendous amounts of energy go into getting that thing off the ground and so many unseen working parts have to work in concert with each other.

Wednesday, September 11, 2013

Remembering a tough September day in a good way

Two years ago I had the privilege of making a five minute mini-documentary to mark the tenth anniversary of the 9/11 terrorist attacks. I have previously written about the panic attacks I began experiencing upon viewing the footage of what took place in New York City and Washington D.C. that day in 2001 and the longer term impact the events would have on my life.

I share this video in the hope that those who are still recovering from trauma in their lives of whatever kind can see that recovery is indeed possible and that there are always others out there who can relate in some way to what you are going through.  


Sunday, September 1, 2013

A good psychiatric hospital experience: part one

From the point of me grasping my diagnosis it would take another six weeks for me to be mentally stable enough to be ready for discharge from hospital.

Over this time period a lot of work had to be done to get me from a place of that first glimpse of clarity to having a reasonable level of day-to-day mental stability.

I had the privilege of being in an excellent private psychiatric hospital where achieving this end was facilitated in every way and I remain immensely grateful for this rare experience.

In clinical terms I was suffering from a double whammy of obsessive thoughts and severe (indeed psychotic) depression which would take a lot of undoing.

There were three basic aspects to my hospital treatment. The first was finding the right type and level of medication to counter the neurological/chemical problems that predisposed me to being in the state I was. The second was group and individual therapy sessions where I became educated about my mental illness and learnt the skills to bring it under control so I could function healthily and sustainably as an individual. The third aspect was just as important as the first two: the care and company of the hospital staff, visiting friends and family, and other inpatients as I began to find my feet again (I will discuss this third aspect in an upcoming post).

Medication
I was put on lithium carbonate to treat the bipolar and a tricyclic antidepressant known to counteract obsessive thoughts in addition to its mood-assisting qualities. Thankfully this combination was a perfect fit for me as the ensuing weeks would show as my condition improved via the obsessive thoughts reducing and my mood regaining some stability. Over this time my doctor adjusted the dosages with surgical precision and was very good at explaining what she was doing.

I was helped greatly by a short book about lithium from the hospital’s library that explained its intended role for people with bipolar disorder. I highly recommend anyone experiencing mental illness to educate themselves about the medications they have been prescribed. Many of the side effect troubles I experienced in my pre-diagnosis phase (during which time I was prescribed a series of powerful drugs) may have been avoided if I had known how important doing this was.

Group and individual therapy
Group therapy sessions were run by a psychologist or social worker and happened during the daytime. Over the course of the week would cover a range of topics including distress tolerance, art therapy, anger management and pain management.

Nurses would lead group sessions in yoga and relaxation plus a daily morning walk after breakfast and a weekly trip to somewhere off the hospital campus. While none of the sessions were compulsory I was encouraged to attend them and did so to my great benefit. (One of my biggest criticisms of the public hospitals I have visited in my work is the lack of structure to the day of inpatients and minimal opportunities for group therapy).

I saw my doctor twice a week to discuss how I was going, did the same with my assigned psychologist or social worker, and had conversations of varying lengths with the different nurses assigned to me on a daily basis.

Crucially important was the time and space I had on my own to think and work through the things that I was learning from the group and individual therapy.

Part and parcel of this time and space was the atmosphere of the hospital, such as its picturesque and quiet geographic location, the decor and size of my room and ensuite and the quality of the food. These things helped me greatly, and they come to mind when I recall another one of those key breakthrough moments that happened sometime during week two or three of my stay.

Gaining control of the mind
I had been reading some literature about Dialectical Behaviour Therapy and in particular the concept of mindfulness which had been explained to me in several of the group therapy sessions. In short, mindfulness is a practice by which one learns to be fully engaged in the present moment with an agile but relaxed mind.

I sat down to practice a basic mindfulness exercise which involved being seated, still and slowly observing a series of things in my field of vision, then a series of audible noises, then a series of feeling points within my body. I can still remember the remarkable circuit-breaking effect this had on my obsessive thoughts the first time I successfully became fully aware solely of my physical surroundings to the exclusion of the troubling thoughts from which I could only ever seem to escape momentarily.

Another newly discovered exercise I found important to breaking the obsessive thought cycle was assigning a specific half hour in my day to “worry time” where I would deliberately focus my attention on those thoughts that were harassing me throughout each day.

The biggest challenge with deploying this exercise was the fear that I was trivialising the seriousness of the thoughts which had had me preoccupied for so long. Essentially obsessive thoughts work by filling the affected individual with an unshakeable sense that those thoughts must take priority ahead of anything and everything else.

It felt like I was going against my conscience when I decided to try the “worry time” exercise for the first time, but I had been gaining confidence in knowing where my mental illness had been interfering with my good sense. The exercise turned out to be another excellent circuit breaker for my mind.

This clip is a scene from the sci-fi classic film The Matrix where Neo (played by Keanu Reeves) achieves a new level awareness that helps him in his quest. I liken it to how it felt to begin to master my obsessive thoughts in hospital.


Friday, August 23, 2013

My story of coming to terms with a diagnosis

As I mentioned in one of my earliest posts, the film A Beautiful Mind spoke powerfully to me about my own experience of having a mental illness featuring psychosis. Part of the reason for this was the power of seeing John Nash (played by Russell Crowe) come to terms with his diagnosis.

The clip at the foot of this post takes place soon after Nash is admitted to psychiatric hospital and I share it because it has much that parallels with my own experience of comprehending my situation.

Coming to grips with a psychotic condition doesn’t quite work like flicking a switch. For me it was more like an oscillation between a fully delusional state and one where I could see my illness for what it was.

Much of that first week was spent up the fully delusional end of the spectrum, which manifested itself as a strong conviction that I was a fraud. I wrote a note to one of the nurses to this effect, too ashamed to tell him in person. I basically said in the note that I had orchestrated my admission so I could prey on other weak inpatients, fully expecting to be taken away and locked up, never to see my family or friends again.

After playing a friendly game of pool with another inpatient I withdrew to my room deeply remorseful that I had acted in such a friendly manner that in some inverted way was intended to cause him spiritual harm.

I recall my eldest brother Matthew giving me a call to see how I was doing and that I was able to speak coherently with him. Shortly after the call I asked my dad to ask him not to call again because I believed I could harm him and his wife and newborn baby simply by speaking to him over the phone.

In a scene much like the one below I shared with my dad that I was a fraud and not really ill. I recall him gently acknowledging my point of view several times during that conversation (I was very insistent) and saying that for now hospital was the best place for me to be.

Within a week of my admission to hospital my doctor put the pieces together and discerned I had been suffering from psychosis, and she made a provisional diagnosis of bipolar disorder type 1. I don’t remember what my initial reaction to the news was, but a day or two later I was reading a pamphlet in the hospital’s lounge area titled “what is bipolar disorder?” It was like looking in a mirror. I began to understand the past three years of my life in an entirely new light.

That evening my brother Henry came to visit and we chewed over the diagnosis of bipolar and I shared with him about reading the pamphlet. He said he also had been doing some reading and had wondered whether there had been something going awry with how my brain had been interacting with my conscience.

As is often the case in life, it took a relational moment like this one to cement in my own mind that I had indeed been suffering quite severely from a mental illness. After Henry left I had a strong feeling of gratitude and knelt and prayed with a clear mind for the first time in months, knowing that my recovery was now underway.


Tuesday, June 18, 2013

Depression, anxiety and psychosis in a nutshell

Depression is a mood disorder. That is, it puts your feelings into disorder by taking what a person normally feels briefly when they are particularly sad over something, and locks that mood in place and stretches it out over weeks or even longer.

Anxiety is similar in that it causes the sufferer discomfort by taking what a person naturally feels when they are physically in real and present danger and locks that state of mind and body in place when the person is not in any danger. This can be over an extended period of time in a like manner to how depression works, or come upon the sufferer briefly and suddenly in the case of conditions such as panic disorder.

Psychosis is a state of mind where the sufferer cannot separate the real from the imagined. This can take the form of hallucinations or delusions. Hallucinations are real-to-the-sufferer sensory experiences involving seeing, hearing, smelling, tasting or touching something that is not actually there. Delusions are real-to-the-sufferer beliefs about themselves, others and the world around them that run contrary to good sense and reason. Psychosis is common in people with schizophrenia and bipolar disorder type 1.

It is important to remember that mental illness is a very personal thing: that is, it differs from person to person and expresses itself uniquely in each person.


Wednesday, May 15, 2013

The guinea pig’s guide to managing time shortage and anxiety

This is the second in a two part series. To read part one click here

Part of the inspiration for my blog came from a British journalist’s book length on-the-ground account of the Spanish Civil War in the mid 1930s which he titled A Field Study of Modern War.

In the same spirit, I attempt to write as something of a guinea pig myself. Here are the findings from my personal field study into dealing with anxiety problems associated with time shortage.

1. Slow down 

Don’t put it off any longer. Anxiety problems mess with us by inducing anxious feelings without due cause. If you suffer from “hurry sickness” like I have then you need to reduce the speed at which you operate. The tortoise always beats the hare in the long run anyway.

2. Allow things to take the time they are supposed to 

Don’t let something you would ordinarily enjoy doing become arduous by being rushed. As an example, I have found myself feeling generally far less anxious since I began stopping properly for meals.

3. Learn to say “no”, and know when to take things off your plate

Enough said.

4. Put the cart back behind the horse 

Don’t allow pseudo necessities get in the way of what matters more. I was interviewing a well known sports commentator recently who had a mental breakdown a couple of years ago. He realised he had neglected to spend time with his son because he was a workaholic (to the point of accruing 105 days of annual leave). He has found it such a relief since then to rearrange his priorities.

5. Be organised 

Anxiety thrives on a lack of confidence and clarity about how we are spending our time. Simple things such as a well kept diary/calendar and a daily or weekly to do list can be extremely helpful here.

6. Be subversive 

There are two levels to this. The first regards going against the grain of the culture many of us live in which promotes the idea that having a crazy busy, run-off-my-feet lifestyle is to be admired and even striven for. Withdraw from competing with workmates and friends for the title of who has the most exhausting life.

The other level to being subversive is about undermining one’s own inclination to be in a state of constant hurry. For instance, when I find myself with a lot on my plate I find it helpful to ask the question: “If I had all the time in the world, what would I do now?” Pondering the answer has on many occasions helped me cut a clear path through decision-making fog.

7. Be realistic 

It is natural for best case scenarios to dominate expectations for the routine aspects of life. Average case scenarios are a much better guide.

8. Take rest seriously 

Quality rest can be hard to come by, but we all need it. I find it helpful to think of rest in the categories of daily (e.g. sleep and meal breaks), weekly and periodic. To neglect any of these - much less all of them - is not sustainable for brain or body.

9. Consider the reassurance the Gospel offers

I know how debilitating it is when anxiety provokes me to be in a constant hurry. Time and again I have found the words of Jesus to be the balm for my troubled mind and body.

This is because he teaches that the key to living confidently with anxiety problems lies not in my own ability but rather in God's provision. I find it deeply affirming to be told that there is actually more to life than meets the eye, and that I am valued highly by my maker. He puts it this way in the Gospel of Matthew:

"Therefore I tell you, do not be anxious about your life, what you will eat or what you will drink, nor about your body, what you will put on. Is not life more than food, and the body more than clothing? Look at the birds of the air: they neither sow nor reap nor gather into barns, and yet your heavenly Father feeds them. Are you not of more value than they? … Therefore do not be anxious, saying, ‘What shall we eat?’ or ‘What shall we drink?’ or ‘What shall we wear?’ For the Gentiles seek after all these things, and your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness, and all these things will be added to you. Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble."


"Get off the treadmill!"

Wednesday, April 24, 2013

Time shortage and anxiety

This is part one of a two part series. To read part two click here.

I interviewed the CEO of beyondblue last year who told me there are two million Australians currently suffering from an anxiety disorder. That’s twice as many as are going through depression. This confirmed for me that my experience is not an isolated one. In my case it was Obsessive Compulsive Disorder, which manifested itself in large part through a problem I had that went unattended for too long.

Around about the time my mental woes began at the age of 18 I was working a full time job and attending university at nights and studying on weekends. I remember operating at a frantic pace and feeling frustrated at the lack of time I had for many things I wanted to do such as meeting up with friends and exercising.

I didn’t realise at the time how vulnerable I was leaving myself to mental deterioration and before long I began experiencing panic attacks and episodes of depression.

Three years later I was convalescing at home after spending two months in psychiatric hospital where I received treatment for significant anxiety and mood problems. By that time I had no employment or study requirements to fulfill, and no obligations to be volunteering my time anywhere. Yet inexplicably my sense of anxiety over not having enough time was just as acute as three years prior.

This experience taught me a valuable lesson I try these days not to forget: Feeling as if you don’t have the time to do what you need to do promotes anxiety. Additionally, it goes against good mental health to be constantly kept from at least some of the things you would like to do.

Awareness 

The first important step in addressing a time shortage problem is to acknowledge it exists.

It is entirely possible to be overworked and unavailable for fun without consciously realising it is a danger to your mental health. You may have even been complaining about how run off your feet you are to your friends, family and work colleagues for months or even years without realising inwardly what you have been telling them.

If your situation is further downstream (e.g. my state of mind post-hospital), it might be a vital step to realise the problem lies not in a lack of available time, but rather problematic thought processes and the accompanying discomforting feelings that have become a vicious cycle.

Getting on top of things 

The solution to the problem will look different depending on your work/life situation and mental state, but the first thing I would recommend is sitting down with a trusted friend or family member and talking about it. It doesn’t need to be a super serious conversation - it’s just a starting point.

If your problems are at an early or intermediate stage the good news is there are plenty of online resources readily available to help you work through things. The best website I know is mindhealthconnect which is a one-stop information hub and directory for online mental health services (including self help resources).

Working through anxiety that is more pervasive has in my experience needed face to face clinical help. If you have not sought this before I recommend seeing your general practitioner as a starting point to talk things through.

Sometimes it takes a major incident to cause us to stop and think about how sustainably we are living. I advocate not waiting for one of these.

Thursday, February 7, 2013

Silver Linings Playbook and bipolar disorder

This is a film which honestly depicts the lived experience of someone with bipolar disorder (Pat, played by Bradley Cooper), someone with depression (Tiffany, played by Jennifer Lawrence), and those closest to them. On this front it breaks new ground cinematically by making the story accessible to a wide audience through the rom-com genre and cast of well known and talented actors.

Bipolar disorder remains a much misunderstood condition amongst the public at large. The US National Institute of Mental Health records 2.6 percent of the adult population has the condition, 82.9 percent of cases are considered severe, and that only 38.8 percent of these individuals are receiving minimally adequate treatment.

A key reason why so few sufferers receive proper treatment is because many have not been diagnosed. It is common for a sufferer to go many years, even decades (as is the case with Pat) without being diagnosed. One very tangible benefit of a movie like Silver Linings Playbook is its power to raise awareness about the condition, helping efforts to reduce the painful and often tragic years of pre-diagnosis experienced by so many.

Additionally, the movie has plenty of insight and comfort to offer those who have been diagnosed. There are few things more helpful to a sufferer of mental illness than others showing they care about, and perhaps “get” to some degree, the challenges the person is going through. When you see this level of empathy and understanding displayed by filmmakers on the big screen it is a heartwarming experience, and Silver Linings Playbook delivers this in spades.

Set in modern day Philadephia, the movie follows the journey of Pat in the months ensuing his discharge from a psychiatric facility following a major breakdown. We learn Pat was diagnosed with bipolar disorder during his stay in hospital which was brought about by a crisis moment of finding his wife having an affair and an ensuing act of serious violence (it should be noted that violence is rare among the vast majority of people with bipolar disorder and other severe mental illnesses).

We also learn that prior to this incident, Pat had demonstrated symptoms of the condition since his teenage years and in the weeks prior to admission had been experiencing psychosis in the form of paranoid delusions about the behaviour of those around him.

The development of Pat’s relationship with his parents (brilliantly played by Robert De Niro and Jacki Weaver) and his friendship with the recently widowed Tiffany steadily lightens the movie up. This follows on from what is in my view a necessarily honest opening half hour where Pat goes through the worst of his struggles in terms of dealing with the traumatic memory of his breakdown and first difficult steps in attempting to recover from it all outside of hospital.

Silver Linings Playbook is a brave step into a genre usually reserved for characters who are fit and well. Most importantly, it insists that hope and healing are possible for a person regardless of how unwell they are or how hopeless their circumstances may appear.