Diagnosis ~ what seems to be the matter?

Naming health problems is important for lots of reasons: in identifying treatments, establishing eligibility for welfare support and funding through government health schemes, providing an overview of likely recovery phases and times, and in giving us a point of reference when it's necessary to explain long term disability or indisposition.  We can then undertake our own research and become more fully informed.  

But getting a diagnosis isn't always straightforward and indeed may prove immensely frustrating.

Problems can arise when a range of symptoms is common to a group of health disorders.  Symptoms associated with trauma such as sleep and memory problems, difficulty concentrating, irritability and outbursts, depression, susceptibility to over-stimulation, fatigue (which may worsen with exercise) and headaches are also indicators for depression, burnout (which isn't recognised as a medical condition by authorities here in New Zealand) chronic fatigue syndrome/M.E., the long term effects of head injuries and post-concussion syndrome, as well as post-traumatic stress disorder. If you are female you may even find menopause suggested.

That cures are elusive and treatments often limited to 'managing' these conditions can compound the situation.

Furthermore, one's state may fluctuate inexplicably but not seem to change much overall.   Some of the time we are likely to be fine, at others not at all.  And since it's natural to make an effort when relating to others they are likely to get the impression that we are absolutely fine - another handicap in terms of being understood. 

I am sure that any chronic health disorder is likely to be caused by a cluster of factors.  This certainly seems to have been true for me. (Refer earlier article.)  Had these health challenges occurred singly they might well have been overcome. Although I am long past the acute stage various symptoms persist often in a seemingly random fashion.

Contributing factors may have accrued from much earlier in our lives: when reading up about post-traumatic stress disorder I was interested to discover that those who have experienced trauma earlier in their lives, particularly in childhood, are much more likely to develop this disorder than those who have not.  Motor vehicle accidents, assaults and the sudden, unexpected death of a loved one are all statistically very high stress factors.

In the area of trauma there are no easy answers, but I do encourage others to persevere in finding a doctor who recognises disability and loss of normal function and puts pen to paper accordingly.  Hopefully robust good health will reassert itself over time.  

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Diagnosis ~ medical terminology  

Diagnosis ~ medical terminology

Medical terminology can be baffling to those seeking help.  Once more I urge those in this position to describe their symptoms, and to keep an open mind about the terms that doctors use in response.  I encourage you to focus on the access your doctors diagnosis gives to help, be it medication, counselling, subsidies, or whatever else is available.  

Here are the medical terms I've come to better understand after extended periods of bafflement:

Depression equals, well, just about anything: 
This diagnosis seems to be used as a general term for emotional and mental dysfunction over a wide range.  It's a diagnosis which is readily accepted by bureaucrats as well as the medical profession.
     For years I resisted this diagnosis of my condition; while I do see this as one element of it I don't see it as the primary one, but regardless of my point of view, accepting this diagnosis has given me access to a lot of help I wouldn't otherwise have had. 

Shock equals trauma: 
The medical term for shock seems to be trauma.  Shock that results from being subjected to physical violence or sudden and unexpected bereavement is widely understood to be deeply distressing.  Shock that results from uncovering deceit and the consequent loss of trust or faith is more complex, and often baffling to bystanders, possibly even to those to whom it happens.  It was for me.
     I knew I was suffering from shock, trauma, or whatever else you choose to call it, but health professionals routinely responded with the familiar hold-all, depression.  So be it. 

Burnout equals Chronic Fatigue Syndrome - or depression!
Burnout is not accepted as a medical condition here in New Zealand, and the legal ramifications are far-reaching: without this recognition sickness benefits cannot be obtained and health insurers won't come to the party at all, never mind the medical profession, which leaves the sufferer high and dry.  Until this is established doctors must call it by another name.  Alternatives I've across are Chronic Fatigue Syndrome/M.E. or yes, here we go again, depression, or both. 
     My doctor cheerfully declares that I have both, which in his view isn't surprising because "fifty percent of those with M.E. also suffer from depression".  M.E. is a baffling illness identifiable only by it's symptoms, and definitions vary.  However, I have read one profile that does fit my condition and its inception very closely indeed, so maybe my doctor is correct. 
     There seems to be no literature at all which identifies the physiological components of burnout, which is immensely frustrating.  This is in contrast to studies done on the brain function of trauma victims.  I'm quite clear that my condition is neurological whereas at present burnout is regarded as psychological.  I defy anyone who has experienced severe burnout to agree with that fully; partially certainly, but fully, no! 

Depression-and-anxiety:
Doctors now consider that depression and anxiety often occur together or are closely related.  Treatments offered may be the same or specific to one or the other.  Chronic anxiety may be hard to identify in our own personalities if it is ingrained and habitual. 
     This was certainly the case for me!  I could see it in other members of my family but not in myself, until its sudden absence (temporarily) when trialling a new medication.  While the medication proved unsuitable in other ways it did make me realise how chronic my tensions were, which I could have read in my habitual defensiveness.  I wish doctors had raised this as a possibility when my illness was acute, when it could have been really helpful.
     If you think this may be an issue for you and your doctor hasn't already raised it, you may wish to do so yourself.

Panic attacks:
Believe it or not I experienced these for some time without having the least idea what was going on!  I knew other people had them and that treatment was available but doctors never suggested this to me.  I worried that I might have developed a heart condition, and no wonder.
     A panic attack can seem like a heart attack: the heart may race or thump, and breathing becomes, or seems to become, difficult.  The hyperventilation that can result may cause tingling and faintness.  It's perfectly natural to panic as a result!  Oh dear! 
     I must say I was gratified to see that Jack Nicholson's character in the movie "Something's gotta give", mistakes these symptoms in his convalescence following a genuine heart attack, and the doctor has to explain to him what the difference is.

All this emphasises the importance of describing symptoms adequately to your doctor, and doing what you can to get proper medical advice and information; also the importance of conducting your own study so that you can be your own best expert. 
     If your condition is chronic or long term, you are likely to be seeing a number of specialists.  You are the connecting link and likely to have the best overview.

I'm creating separate entries for some of these conditions so that informational books, articles and links can be usefully placed together.  Refer to the subject index at the right hand side of the page for easy access.

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Treatment ~ it's about looking after you

Treatment ~ it's about looking after you!

Sleep and rest issues:
The combination of deep distress and chronic fatigue can have very serious long-term consequences and I urgently counsel those of you affected in this way to get as much rest and respite from your troubles as early in the piece as possible.  

Proper, restful sleep is so important, as is having a buffer-zone from your own pain.  Talk to your doctor and to trusted advisers and friends about how this could be achieved for you.  

Taking adequate time out early on when a crisis occurs may make a significant difference to your chance of a full recovery.  Allowing yourself to be subjected to more wear and tear when you are already vulnerable until you are unable to continue may cause parts of your system to fail, making this hard or impossible.  I made this mistake with very painful results.

Getting help and treatment in whatever form it takes, isn't giving in to or avoiding the problem, it's looking after yourself, so that you can get through it and have the chance of a normal, healthy life in the future, and hopefully sooner rather than later.

Orthodox medicine offers:
Medication in the form of antidepressants, anti-anxiety pills, pain killers, anti-inflammatory pills and sleeping pills. It may take time to work out what's suitable for you.  If you are fearful of these treatments say so to your doctor and those you're close to.  It may take time and a lot of reassurance to find what's suitable for you - don't give up.
     I've found pharmacists very helpful in discussing medications, and more forthcoming about them than doctors.
     You may like to gather your own information from reputable websites such as the New Zealand Medsafe site.

Medical doctors are also able to facilitate referrals for counselling which may then be able to be subsidized.

Other therapeutic treatments which may be available are:
Acupuncture, nutritional advice, and Ayervedic medicine and practices, and many more.
     I'm cautious about speaking of these forms of treatment as in my opinion they may promise more than they deliver, and there are fewer safety mechanisms with them than with orthodox medicine.  Medical doctors and other personnel can be called to account if need be, whereas alternative health practitioners do not operate within similar structures. I know it can be difficult to find the right doctor, but while that role can be supplemented by alternative health practitioners and treatments, it's important not to substitute alternatives for a regular doctor altogether.  If you've become seriously distressed and/or unwell, you need proper medical supervision.  This is one of the few instances in which I am making a bald statement rather than a suggestion!  I am speaking from considerable experience of success and failure in both quarters.

Adverse reactions:
Hopefully the medicines and treatments you choose are successful or at least satisfactory.  However, even the best of doctors and most routine of treatments won't be suitable for everyone - there are always exceptions and there may be no way of knowing that in advance.  I've had good and bad reactions to the most humdrum of orthodox as well as alternative treatments.
     Quite a lot of people think that if a remedy or therapeutic practice is natural it can't do any harm, or even that more is better.  Both concepts are faulty as I have found to my cost.  
     In my case four out of five serious adverse reactions resulted in  intense depression.  They resulted from transcendental meditation, a homoeopathic remedy I was not told the name of, Ayervedic self-massage, and the mildest possible dose of a widely used antidepressant.  These would seem harmless enough for most people but were clearly unsuitable for me.  (The homeopath was in fact delighted: "A classical response!" was her cheerful pronouncement, which was all very well for her, but  potentially dangerous for me!)  These episodes were widely spaced over three decades and were not preceded by anything that might have suggested this response.  In each instance depression receded after I stopped the practice, remedy or medication.
     I've said it before and I'll say it again, I do caution readers to exercise self-care before any other consideration in pursuing therapeutic options.  If they make you feel worse it may be wise to discontinue them, at least for a time.  An adverse reaction is our body's way of giving us important information.  Everything in the right time and place - don't push yourself.  Go gently.

Those interested in reading more about the possible adverse reactions that can arise from meditation may wish to read:
"Meditation, delusion and deception", by David J. Bardin and is about general problems which can occur.
"Warning: meditating may be hazardous to your health" by Sandy Brundage and is about transcendental meditation in particular.

My rule is this, and yes, it is a rule, which I urge you to follow: if a treatment makes you feel more stable and steady, fine; if it doesn't, stop!  Practitioners who are otherwise intelligent may encourage you to persevere, to push through a difficult patch in order to clear out old blocked energy or resistance.  My advice is the complete opposite!  You have enough difficulty in your life already.  What you need is respite from it. It's vitally important to go slow and allow your system the time it needs to clear itself at its own pace and in its own style.  Struggling may be what landed you in your present predicament and you don't need more of it!  Do you walk on a broken leg?  No!   Do you go out into the cold and snow if you have pneumonia?  No!  Do you recover from violent upheavals by forcing yourself to take on more hardship?  No!  If you think you can sense the steam pouring out of my ears you're right - and it still is!
     I think a lot of health professionals don't comprehend the hyper-sensitivity which can result from distress and an overwrought nervous system.  What is needed are calming influences and quiet, and some serious rest.  The instinct for self-preservation is to block out further disturbance and this should be respected.

The healing power of contact with the natural world and its peace and quiet is considerable: when most unwell, I spent a lot of time in an easy chair at an open door, wrapped in blankets and resting my eyes on the big trees and watching the birds come and go.  Unable to find rest and respite in sleep which was routinely a kaleidoscope of nightmares, and plagued by headaches and other troubles by day, I found that sitting gazing out into the natural world and breathing the fresh air was a life saver - literally.  Gradually things calmed down.  

More about medications I've tried:  (This passage added 29th August 2011)
Please note that what I say here is not medical advice, but the sharing of my own experiences.  I wish someone had talked to me about this sort of thing when I was making these choices myself.  As with so much of what I was coping with when my difficulties were most severe, no one talked to me about it in the way that I could take in or identify with - so here you are: this is the path that I took:
     Lacking knowledge of better choices, there were a number of years when I took Ibuprofen (also known as Nurofen) regularly, which I found helpful for settling what I call 'a bad head', when my head ached or I couldn't think straight or see clearly.  And when my nerves felt completely out on stalks or I simply couldn't sleep I found that Panadeine helped.  Both can be bought over the counter here in New Zealand, but I had mine prescribed by my doctor.  For a long time he was happy for me to take them as long as I stuck to the recommended dose.  (Exceeding that can have dire results so care is important.)
     More recently my doctor expressed concern that my regular usage of painkillers could be contributing to my lowered state. He said that research now shows that use of painkillers on more than ten days a month can actually cause headaches and suggested I try a different strategy.  As a result I drastically reduced the amount I was taking, and did feel considerably clearer as a result, and surprise - experienced fewer headaches.
     Having established what was something approximating normal for me I then started on the mildest possible dose of Citalopram, an SSRI medication used for treating depression and anxiety. This has turned out to be much more effective.  Although there were some side effects initially, they did fade in about a week, and an almost immediate benefit was that I am now able to get to sleep relatively easily most nights.
     I have never accepted that my main problem was depression, but could identify that I suffered from chronic anxiety and nervous tension.  The major benefit from the new medication has been that I now feel more relaxed generally and have a bit more ease in my nervous system.  I wish I'd tried this out years ago.  It hasn't magically set everything to rights or blotted out my 'issues' but it has helped, and I've needed that.
     It's important to be clear that medications work very differently on different people, so what has worked for me may not work for others the same way, and having a bad experience can be very off-putting.  For example, my system can't tolerate Amitriptyline at all, an older style of medication, and the appalling reaction I had to that totally put me off trying anything else, which in hindsight is a pity.
     So one more time, I'll say firmly: Do get adequate medical support when making these choices and do not hesitate to phone up your doctor, and / or consult your pharmacist if you have any concerns at all once you've started trialling any new medicine.  Let them help you.  Keep that support close at hand and improvement will hopefully become evident with time. 

In conclusion:
During that most difficult time I did try to find a suitable doctor, but when it was most crucial I lacked the medical support I needed.  If I had had proper medical attention things could have been so much easier.  For this I was partly responsible as I did largely resist orthodox medication.  This is why I'm putting these points so strenuously - I'd like it to be easier, less harmful, for others.  
All strength to you.

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Chronic Fatigue Syndrome / M.E. ~ comments and links

Chronic Fatigue Syndrome / M.E. ~ comments and links

There is a mass of information and material on the web about this condition.  My purpose here is to present a useful cross-section from what look like reputable sources.

Chronic fatigue can have many causes and long term fatigue is not necessarily the same thing as Chronic Fatigue Syndrome, otherwise known as Myalgic Encephalomyelitis or M.E.

The Whittemore Peterson Institute provides a good crisp definition.
Definitions vary somewhat so I have also included two others:
New York Times health guide - definition

Those suffering from chronic fatigue conditions could expect their doctor to investigate other possible causes before arriving at a diagnosis of CFS.

Difficulties in diagnosing CFS arise from lack of identifiable causes and no conclusive tests.  However, the Pacific Fatigue Lab in California has recently conducted heartening research on post-exertional fatigue.  It shows not only that many CFS sufferers are uncharacteristically exhausted by exercise and take a long time to recover, but also that if exercise is repeated after a reasonably short interval, there is a further, much more severe drop-off of exercise capability.  This unexpected response is distinctive in many CFS sufferers.  The original article published by the lab itself has been removed from their site recently.  Fortunately I found this article which provides a full discussion of it. 

Other research has extended to the study of genes which is referred to in this BBC news item.

CFS sufferers include some very articulate people whose views and experiences can be read on the following sites:
  • The link here is to the review of a book on CFS which includes interesting comments from sufferers.  Please note that this book has proved unpopular with most reviewers.
The book "Surviving M.E." by Joyce Fox (Vermillion, 1996) is highly recommended by a friend.  Here is a brief review.  Note that it's the top review only.  Despite its old publication date it can still be obtained new from both Amazon UK and Amazon.com.


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Burnout ~ comments and links

Burnout ~ comments and links

At a basic level burnout could be described as a combination of severe exhaustion, distress, dis-empowerment and depression.  When we keep going and our inner self has been saying "Stop!" unheeded for too long burnout may result.  In severe cases continuing in the old way is then impossible.  Recovery requires time, lifestyle changes and clarification of personal issues and values.

This article in Wikipedia provides a good overview which is just as well as I found no mention of it on either the BBC or the New York Times health guide sites.  I know that burnout doesn't have medical status in New Zealand or in the U.S. and from its omission from the BBC site I presume it isn't recognised as such in the U.K. either.

The medical profession's refusal to recognise the condition is puzzling as any web search immediately throws up masses of articles about the degree to which those in the medical profession suffer from it.  Here is an example in the New Zealand Medical Journal.
 
Some years ago I read a book which discussed the legalities involved with this in America, but unfortunately have no record of the title.  Those researchers were well aware that this lack of recognition meant that doctors and patients had to find another way of placing it. Chronic Fatigue Syndrome, otherwise referred to as M.E., is one of them, and as this condition is often accompanied by depression it would appear to fit it quite well.  My personal view is that it is a distinct condition and I hope that one day it will be recognised as such.

Burnout certainly does have strong psychological components.  With CFS, on the other hand, depression is considered to be a separate issue.  Those who claim that burnout and CFS are related are unlikely to have formal research or health authorities supporting their views.  Such claims can at the best be considered as conjecture.

So how then do doctors end up making this compromise?  I don't know, but I suppose that if burnout isn't acknowledged as a medical condition it isn't seen as a compromise at all, and if CFS-like symptoms continue for an unexpectedly long time it's not a surprising conclusion.  Alternatively, maybe the physical and emotional trauma of burnout makes one vulnerable to developing the more serious and long term condition of CFS.  Clearly more research is needed.

I do highly recommend Dina Glouberman's book  "The Joy of Burnout" which I found very helpful indeed.  The author describes the condition with the conviction that arises from her own experience.  Dina is a psychotherapist so this is her angle on profiling  it, relating different cases, and offering suggestions about managing recovery.  It's very easy to read and her crisp identification of what's distinctive and important kept me turning the pages.
Here are:
And also:

Dina makes the important point that burnout isn't caused by overwork, but by overwork in situations in which we repeatedly over-ride our own judgement, ethics and natural limitations - often in order to please others.  Those with an over-active sense of duty and obligation please step forward! 

If this is you, I suggest you urgently reassess your situation and scale your efforts back to what fits you better.  It's not worth repeatedly going that extra mile for others, believe me.  You might consider bringing that fine quality of duty to bear on your own well-being. 

It may be helpful to remember the instructions of what to do if you are on an aeroplane and the oxygen masks drop down: you put on your own mask first before attempting to help others.  If you pass out before doing so, you are of no use to anybody - rather the reverse.  Our own well-being really is our first responsibility!  This may seem obvious or selfish depending on your point of view, but it's true nonetheless and very easy to lose track of when we are closely involved with those who are dependent and / or demanding.

My only disappointment with Dina's book is that there is no discussion at all of the physiological effects of burnout.  It certainly is frustrating that so little research seems to have been done, and what I have been able to find focuses on the adrenal function rather than neurological factors.  Severe burnout isn't marked only by what feels like near-death fatigue and emotional malaise, but also by what feels like a neurological disaster: blinding headaches, cognitive incompetence, super-hyper-sensitivity to absolutely everything and chaotic nightmares - all, in my opinion, obvious signs of a brain in melt-down.

While it's important to address the mindset and behaviours that landed us in this degree of physical crisis, recovery isn't going to be achieved purely by changing our priorities and improving our outlook.  Much more is needed, but what?

I have come across one doctor who responded affirmatively when I asked him about burnout.  I needed medical attention for quite a different matter, but asked this question in addition.  Yes, he said quite matter-of-fact, it was a condition in its own right and distinct from Chronic Fatigue Syndrome.  He went on to say that once one loses the degree of function that I had it wasn't possible to fully regain it.  His acknowledgement of burnout as a condition was heartening but his prognosis sobering.  I wanted to talk more, to find out more, but greatly to my disappointment he was 'only a duty doctor' at a twenty four hour health practice so I was unable to consult him again.

I do hope you have better luck.  I'm sure that most people would understand that doctors need properly researched and accepted studies before making their own pronouncements.  We expect that.  If doctors are taking their present stance due to these and legal constraints it would be helpful if they could at least say so.

Footnote, 29th August 2011: 
I've added a passage about medications I've tried in relation to this, to my article Treatment ~ it's about looking after you.

Book shop link for interested NZ readers:

Fishpond.co.nz - sorry, no image of cover available.

Depression ~ my experience

I've found this a difficult subject to write about and decided that the only valid way to do so is to relate my own experience.

But first, for those looking for general points of reference, here are the links to:
And on the other side of the equation, here is the link to:
  • Anne Sheffield's website.  This woman has written a number of books about  surviving the depression of loved ones.  One of her books comes to my attention with a particularly high recommendation: 
  • "How You Can Survive When They're Depressed: Living and Coping with Depression Fallout"
There are no easy answers to the difficulties of managing depression.  It requires patience, staying power and insight.  Medication and understanding all have the potential to help, but still leave us with our own choices to make and lives to live.  What works for some may not work for others.  It's a very individual thing and good solutions are likely to take some time to work out.  All the best with it. 

Regarding my own situation I had always thought that the main symptoms of depression were an absence of feeling, a sort of paralytic numbness and lethargy, and a general loss of interest in life.  Although I've experienced this at times it certainly didn't fit what was going on for me when I was sick: my interests and motivation remained high and my level of feeling was at the other end of the scale - too much and a lot of it destructive, although not towards myself, I must add.  I contained all this only with considerable effort.  I knew I was suffering from shock, grief and anger, but depression, no.  Or so I thought.  No one talked to me properly about this.

One of the difficulties about defining depression is that it is a very general term which is used to cover a wide range of emotional difficulties and states of mind.  A measure I've since found much more useful is loss of pleasure.  Medical people these days have charts and weighted questionnaires from which they are able to deduce this sort of thing by totting up the resulting scores.  That approach has its place: the difficulty with measuring an emotional state is that there is no laboratory test for it - it cannot be seen under a microscope.

As I've said elsewhere I realise now that anxiety has been a really big issue for me, and as with any chronic condition we can become so inured to it that it feels normal.  However, when I was most ill I did know I was anxious and would have been much more responsive to the idea of treatment for that than for depression, even if the treatment for both had been the same.

But to put it most simply, I needed some kind of buffer zone between myself and the pain I was in to save my frayed nervous system and teetering sanity from further wear and tear.  As it was I refused antidepressants.  Looking back I can see it could have helped if a suitable sort could have been found; possibly I would have emerged from that acute phase sooner.  It's very difficult to recover if one is constantly stretched out like a high tension wire.  Relaxing was practically impossible - so I stayed stuck for a very long time.  To some extent I still am, although in a different sort of way.  It's frustrating.

Finally, a year or so ago, I did try a very mild antidepressant on the lowest possible dose.  It was not successful: in the week after I started taking it I found it harder and harder to get out of bed, to climb the stairs, to do anything.  After about a week I really did have raging depression: I was disoriented, had no idea why I had moved house a year previously, or why I had chosen the house where we now live.  I had no idea why I had ever decided to live with my partner and considered separating.  (He wasn't that keen on me just then either, although he was too kind to say so!)  I felt absolutely awful.

Fortunately, I had enough brain to get to the chemist and have a proper talk about the medication, which helped me decide to stop taking it.  The pharmacist expressed puzzlement as to why I had been prescribed that medication when I already had a serious fatigue problem...  Also fortunately, on the way home I came across a second-hand collection of some of Georgette Heyer's novels.  These two things saved the day: I got myself home, climbed into bed and enveloped myself in those stories, blocking everything else out.  I did not take my pill that evening.

The next morning I woke up feeling fine.  It was as if a switch had been flipped - I felt better than I had for a very long time, cheerful without trying in the least.  It was such an abrupt change that if I hadn't experienced it I wouldn't have believed it possible.  Probably the direct physical effect was accentuated by my relief but I did realise I had relaxed - fantastic!  I also knew that that particular medication was not right for me at all.  I realised more fully that anxiety and tension were areas I needed to become much more vigilant about addressing and / or discarding.  A psychotherapist I was seeing at the time added weight to my decision not to pursue trying other antidepressants saying "they are completely ineffective for those with M.E."  I accepted that pronouncement then because it chimed with my own decision.  Now I wouldn't do that so readily.

It wasn't until I was writing the earlier passage about adverse reactions that I thought more seriously again about depression for this reason: when I counted up the adverse reactions I'd had to therapeutic treatments four out of five resulted in raging depression - which lifted after I stopped the treatments.  I thought to myself that this must be more than a coincidence.

So I think that yes, I probably do suffer from depression, but it must be trapped underneath what I'm usually aware of.  If this is so it would explain why it surfaces when I'm receiving various treatments and I start relaxing.  Oh dear.  But why the depression?  I'm still looking for answers.  At present what I've experienced seems too large and shapeless to even begin.  I have no idea what it's about even, although I can think of reasons.  One can always think of reasons...  Fortunately I am currently seeing a psychotherapist with whom I'm comfortable and we are starting to look into this.  I definitely do need to have someone skilled to walk through this with me.

A few days ago when I sat down to begin work on this article I couldn't get started at all.  Sometimes if I'm stuck I find it helps to write just whatever comes to mind, so I did that and wrote the following passage - and abandoned the project for the day!  I'm pleased to be able to report that the next morning I felt much more normal, cheerful even, but it was a stark reminder of what it can be like.  I was interested to see that it centred around problems with fatigue, noise, tension and lack of sleep.  All of these factors seem to be triggers.  Here it is:
It's an odd coincidence, maybe, that in the few hours leading up to beginning work on this article I find I am feeling quite distinctly depressed.  I'm not often like this.  But now I am.  Feeling heavy and awkward, neglected and listless.  Not about anything in particular although I can always find a reason.
Good things have happened today, I remind myself: we did the shopping, paid a bill, collected this and that.  That's our weekly shop done now and out of the way.  Good.  Tired now.  Tired when we got home.  Bone tired.  Lay down but couldn't sleep.  Lay there, rested anyway for an hour or so, then decided nothing further gained by continuing horizontal and something further to be gained by getting up and doing a bit more to tidy the garage.  Energy will come with action, hopefully.  All the sound, sound louder, clatter ricochets in my head and out through my nerve endings, rattling me, again and again.  I'm shaking inside my feelings too, crashing about.  I just want to be still and sink down, sink down, sink down, silent, silently, silence.  But no, more rattling about.  No use complaining or shushing.  Just go on, first move, second move, third move.  Small gains.  Dishes washed up and put away; one more corner, one more side of the garage clean and tidy.  Colder now.  Lonely though not alone.  Lonely.  Inside television on.  Stupid people making stupid noise.  Stupid.  Tired again, tired.  Feel flat and empty.  Sit starring.  At nothing. 
My attempt to get some kind of line into starting this isn't working tonight.  Bed.
So it's an on-going story...  And a lot more of it still to be worked out.

More about those adverse reactions:
The other treatments that triggered me into serious depression those other times were: transcendental meditation, a homoeopathic remedy I was not told the name of, and Ayervedic self-massage.  These would seem harmless enough for most people but were clearly unsuitable for me.  (The homeopath was in fact delighted: "A classical response!" was her cheerful pronouncement, which was all very well for her, but potentially dangerous for me!)  These episodes were widely spaced over three decades and were not preceded by anything that might have suggested this response.  I've said it before and I'll say it again, I do caution readers to exercise self-care before any other consideration in pursuing therapeutic options.  If they make you feel worse it may be wise to discontinue them, at least for a time.  An adverse reaction is our body's way of giving us important information.  Everything in the right time and place - don't push yourself.  Go gently.

Those interested in reading more about the possible adverse reactions that can arise from meditation may wish to read:
"Meditation, delusion and deception", by David J. Bardin and is about general problems which can occur.
"Warning: meditating may be hazardous to your health" by Sandy Brundage and is about transcendental meditation in particular.

More about medications I've tried:  (This passage added 29th August 2011)
Please note that what I say here is not medical advice, but the sharing of my own experiences.  I wish someone had talked to me about this sort of thing when I was making these choices myself.  As with so much of what I was coping with when my difficulties were most severe, no one talked to me about it in the way that I could take in or identify with - so here you are: this is the path that I took:
     Lacking knowledge of better choices, there were a number of years when I took Ibuprofen (also known as Nurofen) regularly, which I found helpful for settling what I call 'a bad head', when my head ached or I couldn't think straight or see clearly.  And when my nerves felt completely out on stalks or I simply couldn't sleep I found that Panadeine helped.  Both can be bought over the counter here in New Zealand, but I had mine prescribed by my doctor.  For a long time he was happy for me to take them as long as I stuck to the recommended dose.  (Exceeding that can have dire results so care is important.)
     More recently my doctor expressed concern that my regular usage of painkillers could be contributing to my lowered state. He said that research now shows that use of painkillers on more than ten days a month can actually cause headaches and suggested I try a different strategy.  As a result I drastically reduced the amount I was taking, and did feel considerably clearer as a result, and surprise - experienced fewer headaches.
     Having established what was something approximating normal for me I then started on the mildest possible dose of Citalopram, an SSRI medication used for treating depression and anxiety. This has turned out to be much more effective.  Although there were some side effects initially, they did fade in about a week, and an almost immediate benefit was that I am now able to get to sleep relatively easily most nights.
     I have never accepted that my main problem was depression, but could identify that I suffered from chronic anxiety and nervous tension.  The major benefit from the new medication has been that I now feel more relaxed generally and have a bit more ease in my nervous system.  I wish I'd tried this out years ago.  It hasn't magically set everything to rights or blotted out my 'issues' but it has helped, and I've needed that.
     It's important to be clear that medications work very differently on different people, so what has worked for me may not work for others the same way, and having a bad experience can be very off-putting.  For example, my system can't tolerate Amitriptyline at all, an older style of medication, and the appalling reaction I had to that totally put me off trying anything else, which in hindsight is a pity.
     So one more time, I'll say firmly: Do get adequate medical support when making these choices and do not hesitate to phone up your doctor, and / or consult your pharmacist if you have any concerns at all once you've started trialling any new medicine.  Let them help you.  Keep that support close at hand and improvement will hopefully become evident with time. 


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Trauma ~ comments and links

Trauma ~ comments and links

In any discussion of this subject it is important to distinguish between physical and emotional trauma. Physical trauma relates to serious injuries resulting in a medical emergency. Emotional trauma relates to emotional injury and is psychological in nature.

Physical trauma may result in emotional trauma, but not necessarily. For those who want an overview of both fields here is the link to the Wikipedia article about trauma.

My focus is on psychological trauma. Again, Wikipedia provides a good overview. When intense emotional shock has been experienced trauma may result. Many people may use the term 'shock' whereas a doctor may use the term 'trauma'.

Abuse in any form may result in trauma although not always.

Initially, this may manifest as an Acute Stress Reaction, also referred to as an Acute Stress Disorder. Here is the Wikipedia definition.

If disabling symptoms persist for months doctors may consider a diagnosis of Post-traumatic stress disorder, or P.T.S.D. Here is the Wikipedia definition. This disorder can have a much delayed on-set.

Broadly speaking PTSD is characterised by the following symptoms:
  • Re-living the trauma in the form of repetitious unwanted memories, flashbacks, as well as the physical symptoms experienced at the time, such as palpitations, and other indications of panic.
  • Avoidance and numbing - anything associated with the event is avoided as the individual attempts to block out memories. 
  • Hyper-arousal - the individual is constantly on-guard and irritable, easily upset, and has difficulty sleeping.
Not surprisingly, the wars in the Middle East have caused untold chaos in the lives of many returned soldiers. Figures in one of the articles below indicates that one in eight subsequently suffers from PTSD. This has spurred research.

It must be presumed that local populations in these war-torn countries have also had their lives severely disrupted, leaving whole communities not only physically shattered but also traumatised.

Related articles:
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Calming panic / agitation with a simple physical pose

Calming panic / agitation with a simple physical pose ~

29th December 2013
We all have times of feeling vulnerable, panicky or just plain all over the place, and at such times it can be hard to calm down.  This pose, which was passed on to me by a psychotherapist, is one I have found helpful and may provide others with some relief.  It can be done almost anywhere and without attracting attention, a big plus if you happen to be sitting on an aeroplane or other crowded space. 

It's done seated. 
Feet:
  • Start with both feet flat on the floor side by side.
  • Lift your left foot over the right and rest the soles of both feet in comfortable contact with the ground / floor.
Arms:
  • Stretch your arms straight out in front of you and turn the palms together.
  • Holding the position of the hands just as they are, lift the right arm over the left.  The backs of your hands will now be in contact with each other.
  • Roll your hands apart keeping the little figures of each hand in contact so that the palms are together again.  Your thumbs will now be pointing down.
  • Lightly clasp your hands by interlacing the fingers.
  • Still holding your hands linked drop your arms and turn your fingertips towards your tummy and then inwards and upwards towards your chin.
  • Rest the small fingers against your sternum / breast bone, or thereabouts.
Breathing ~ gently!
  • Breathe in through the nose.  Keep your mouth closed and rest the tongue against the roof of the mouth.  Gently expand the belly as you do so.
  • Breathe Out through the mouth.  Rest the tongue on the floor of the mouth.  Gently contract the belly as you do so.  
Continue while it helps.  You may start to yawn, which is expected, even helpful.  Keep going if you want to.  

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Rage as a response to pain ~

Rage is a natural response to acute and enduring pain.  It is anger pole-vaulted to its extreme, a reflexive reaction in which we may be fighting for our lives, physically, or for our identity, our conscious sense of who we are.  Rage can provide us with the capability of getting out of traps with the energy and strategy which would otherwise be beyond us.  It's about survival.  But if escape is not possible and rage turns inwards chaos can result.

To express rage can be dangerous, a pathway of violence and hatred that can lead to greater harm.  To contain it may be even more toxic, a possible road to self-mutilation and madness.  But we can't always let it out, or may not know how.

Rage contained and denied expression for years is likely to result in all manner of disturbances, among them a weird sense both of disembodiment and rigidity, a sense of split realities, in which one's awareness of a situation may seem both normal and emotionally indifferent and on another level intensely abnormal.  The contradiction between inner and outer levels of functioning can be overwhelming and confusing.  Emotional responses, and even thoughts about emotions, may be unpredictable and extreme, a welling up of pain and desperation leading to panic and outbursts.

I am still coming to terms with trauma in my own life.  I often seem fine when I'm not.  Hearing myself sounding normal, and observing myself behaving normally when I'm feeling quite dreadfully unwell can make me feel even more unwell and distinctly weird.  There are times when even sleeping hurts.

Before exploring the depths of my own trauma and rage I had an intense aversion to Michael Jackson's more recent recordings.  Over the years he seemed to become increasingly rigid, brittle and unhappy-looking.  His movements lost fluidity and became robotic.  His handsome features disintegrated.  I still see him this way.  The difference now is that I've confronted parallel distortions in myself and having done so see his work with fresh eyes.  It now makes complete sense.  These things are not random or meaningless.  They comes from deep places within us which demand recognition - and expression.  Michael sang and danced it out with astonishing creativity and artistry.

His song and video of "Scream" perfectly exemplifies the weird head space and out-of-control feelings of a deeply traumatised person struggling to be normal, in the company of another, in this case his sister, Janet.  Like Michael I've found the sense of static in the brain almost unendurable at times.  No wonder that latterly Michael could not sleep.  Very likely by that time he was hot-wired to out-run or out-dance his own inner catastrophe.  Even dancers have their limits. 

Here is a version I found on YouTube:


When I first watched this recording the link was slow, which gave me the opportunity to watch the video in slow motion.  It's masterful - art work in action, frame by frame.  I'm grateful to have seen it - and to have been able to find meaning in it, a reflection of aspects of my own troubled inner world, thank you Michael.

Looking elsewhere:
In the preceding article about Trauma I provide a link to an interview with Jessica Stern, described as America's top expert in the motivation of terrorists.  Prompted by her publisher she has recently written a book about herself entitled "Denial: a memoir of terror" in which she relates her experience of being raped when a teenager.  The interview closes with these words:
"People have asked me, 'Is this what you recommend as a way to recover from rape?' And the answer is absolutely not," Stern said. "This is not a model for how to recover from rape, to write a book like this. What I did was expose myself to madness."
My experiences have been different, for which I give thanks, but I recognise the signature of this depth of suffering.  One's sanity can seem dangerously tenuous at times.  Kia kaha, sister, I wish you strength.

There are no easy answers.  Acknowledging these difficulties is a start.  In my article "Speechless" I make the point that "Suffering of a deeply personal nature often seems to be accompanied by strange and incomprehensible taboos about speaking of it".  Starting to express it in some way can be an important beginning.  Expert help is likely to be required.

I have written further about dealing with the effects of trauma in my article "Trauma in the world around us and striving for peace" as well as in other articles in Part Five of this Chronicle.

This article was originally published in the companion chronicle, Rushleigh ~ Beyond Belief

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Abuse and related mental health issues ~ comments and links  

Abuse and related mental health issues ~ comments and links

Abuse could be defined as the misuse of power over others which results in harm.  Those so abused may not be able to defend themselves or believe that they can, or may not even realise that they are being abused - until later.  This last form, being insidious, can be particularly difficult to address, or at least I found it so.  

Abuse can take many forms.  This Wikipedia definition shows a broad sweep of them and provides many links which may be of interest.

The resulting trauma may be so severe that the sufferer becomes mentally ill.

Whatever form it takes the harm caused by abuse can be traumatising and require many years of assisted recovery.  Some recover rapidly, while others never do.  Hopefully with the right support and encouragement these wounds gradually heal.

I have written a number of other articles which include references to this subject.  These can be found through the label index on the right hand side of the page.

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Hearing voices ~ mental health and other issues

Hearing voices ~ mental health and other issues

Hearing voices is a much more common experience that many would imagine and may occur in up to ten percent of the population.  

Research carried out at Auckland University indicates that there is a direct link between trauma and the onset of hearing voices in seventy to ninety percent of cases.

Attitudes to the hearing of such voices are gradually shifting, with more people insisting that such voices be accepted as aspects of those who hear them, an involuntary coping mechanism for surviving insurmountable odds.  Seen in this light it makes perfect sense that they be listened to with respect.

Wikipedia provides a good overview of the Hearing Voices Movement

New Zealand has its own Hearing Voices Network

Jacqui Dillon of the U.K. Hearing Voices Network, and Rufus May, clinical psychologist, have both recently been interviewed about their work in this field. 

In the following Radio NZ interview, Jacqui gives an insightful view into a child's response to abuse by offering her own experience.  She relates how this has continued to affect her throughout her life.  She also talks about the deeply held prejudice she encountered within the medical profession regarding her own hearing of voices, the view that such voices should be medicated away with the use of tranquillisers. 

This document provides further information which may be of interest:

Here is the newspaper article Chris Barton wrote about Rufus May: "Speaking for the voices".

This BBC web page about mental health includes lots of interesting articles, including a clip of Rufus working with a client.  The audio clip on the same page featuring Peter Bullimore talking about his hearing voices experiences is also well worth a listen.

Those interested in further reading may find the following reference useful:
Angels at our tables - New Zealanders experiences of hearing voices

There are a lot of strong emotions and conflicting beliefs about this field from health professionals, voice hearers and the general public alike. Surely the bottom line should be a focus on finding the approach that is most helpful - which is likely to vary from one person to another.  Whatever one's point of view about treatment, individuals still have to be helped to live their lives as fully as possible.  I would think that the best long term results are likely to be those in which the person in crisis is helped to get back in charge of their own life, helped to make their own decisions about what works best for them.  We all deserve that.

It should be noted that the voices we may hear in our heads do not necessarily indicate mental health problems.
     Dennis Gersten, psychiatrist, looks at this subject within a broader perspective in his book entitled "Are You Getting Enlightened or Losing Your Mind? How to Master Everyday and Extraordinary Spiritual Experiences". This perspective is re-iterated from a slightly different angle by Ingo Lambrecht in his 2009 article Shamans as expert voice hearers.
    I am not a voice hearer.  My chief interest in this subject lies in exploring the distinction between voices which are considered to be parts of ourselves, and those which are experienced as part of shamanic or related work.  According to Ingo Lambrecht, voices heard in the course of shamanic activity are considered to come from separate entities, usually those of ancestral spirits.

Both ends of the spectrum are important and need to be recognised for what they are and given their proper place.  In the middle of the spectrum there is a great deal of room for confused 'channelling' which, if taken seriously, can be both misleading and harmful.  I will talk further about this in a separate article.

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Positive thinking pitfalls and medical prognosis

Positive thinking pitfalls and medical prognosis

I used to think that positive thinking, or the lack of it, had a direct effect on my own health and life circumstances.  Now I see things differently:

When we are relaxed and feel good about life our blood vessels relax and energy flows around our bodies in a natural fashion: blood, hormones and nutrients flow where they should and as a result we can think, move and exert ourselves comfortably and well.

When we are anxious, jittery or tired we tense up, and don't function as well.  Our muscles and nervous system become tense and jerky.  We simply can't function as fully.

If this state of tension and fatigue continues for long periods of time, without proper sleep and recovery intervals it's much more likely that we will develop health problems because of it.  In my own case I'm sure this was so, and once that circuitry is messed up it can be difficult or impossible to get it back.  So for me getting proper sleep and relaxation makes a big difference.  Not the whole difference, but it certainly helps a lot.

This much I'm clear about, at least for myself.  It makes sense.

In the field of classical Chinese and Japanese acupuncture there is a sophisticated set of concepts about how energy flows around the body and how problems in different areas are likely to indicate dysfunction of a less physical nature.  It all works together.  This is all well and good, and indeed can be helpful to understand.

Some years ago, a medical doctor skilled in Chinese acupuncture, made a very definite statement about an energy problem he found relating to my kidneys, which I had been unaware of.  According to him, it was this that was causing trouble further down the line, and he said indicated I had suffered a severe shock of some sort which had stayed registered in my system.  I had nearly been killed in a car accident when young, I responded.  That would be it, he affirmed.  Having this angle on things was helpful.  I stopped blaming myself for the other trouble.  My doctor wasn't giving me a psychological diagnosis, but explaining how the physical problem I'd come to him for help with had probably arisen many years after a traumatic event.  He then set to work in doing what he could for that - with needles - with a very effective and measurable result.  

So my reservations about the mind-body approach lie not with acupuncture, but in the borrowing of these principles by others, mostly Westerners, who use them to create their own mix of mind-body philosophy, usually accompanied by large doses of "Thou shalt think positively" maxims, and without any medical foundation.  Thus, heart problems are a result of issues to do with love, and digestive problems to do with not being about to 'stomach' things, and so on.  These will all be 'healed' if we can only learn to abandon old negative thoughts and replace them with positive ones.  If we can change our minds we can change our bodies - and our lives...

Taken at the level of superficial aches and pains this is a fairly harmless approach, but should never be applied to those who have serious or chronic conditions - unless you want a blood nose, that is.  If we take this approach to ourselves it is likely to lead to a lot of fairly useless self-castigation, and equally useless self-talk.  If we apply it to others we are likely to get a hostile response.  It may also mean that we don't pursue proper medical attention when we need it which can have fatal consequences. 

A surprising number of these positive-thinking 'practitioners' take their message one step further declaring that we create our own reality entirely, both the good and the bad, some going so far as to say that we even choose our own parents.  The implication of this is that if bad things happen to us it's our own fault.  These people would counter that it also means that we can then do something about them to make everything come right again.

My view is that taken by itself this attitude of total control shows a vastly inflated assumption of our own self-importance and abilities.  I now see this as a rather infantile attitude, one we are likely to have had when very young before the reality of further life experience set in.  While there are things in our lives that we can influence and control there is much that is dependent on a myriad of other factors which are well outside of that, like chronic illness and disability, for instance. 

Life is unpredictable: good things happen, but so do disasters, accidents and illness.  Those who don't have these experiences are likely to be fortunate both in having strong constitutions and exceptionally good luck.

Anyone who disagrees can open any history book at any place and see the wreck of suffering and disaster which occur all over the world all the time, impacting as much if not more so on very ordinary people, going quietly about their own business, while the tyrants of the world often rampage around unimpeded by what should be the immediate consequence of their bad behaviour.  

I used to read a lot of mind-body literature which I took very seriously.  I still own quite a few of these books.  Don't mistake me: there's some good and uplifting literature out there, but I hope you don't make my mistake and take it too literally.  If your efforts are not met with success these can too easily become the tools of self-judgement and failure.  

For me it has been vastly more helpful to accept my own very difficult situation for what it is, and to do what I can in small practical ways to improve things, to keep myself motivated and in good heart, to try to find answers of a more prosaic nature, without apportioning self-blame.

If I were to apportion self-blame it would be for my best qualities: loyalty, generosity, altruism, a strong work ethic, etc, and ... a rather large dose of naivety.  It's not my fault that people who were less than fair, honest and scrupulous took advantage of me.  What I needed to learn from it was to be a little more street-wise, that's all.  And to say NO a great deal more often than my inner mechanism suggests.

A study I read some years ago about women who had breast cancer examined their attitudes to their condition and whether positive thinking was helpful.  What the researchers found was that those women who had positive attitudes who did get better had a prognosis which indicated it was likely they would recover, whereas those who were depressed and unhappy about their condition had good reason to be concerned as their conditions were much more life-threatening.

In the article "The tyranny of positive thinking", by Dr Jimmie C. Holland, M. D., you will find a compassionate doctor's view of the harmful effect that the 'think positive' approach can have on cancer sufferers, as well as some sound comment and advice.

This article is in fact Chapter Two of her book "The Human Side of Cancer: Living with Hope, Coping with Uncertainty". She has generously made chapters one and two available on-line.

She quotes from Susan Sontag's book "Illness as Metaphor and AIDS and Its Metaphors"
Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick.  Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place. ... Illness is the night side of life, a more onerous citizenship.   
I include the link here to a particularly strongly worded review of Susan's book.  Look at the one which is entitled "This book changed my life".  Thank you Susan and Jimmie. 

Like Jimmie, I encourage you to follow your own natural bent for coping with whatever difficulties you have in whatever way suits you best.  Be yourself. 

Footnote: Regarding acupuncture I'm not recommending this treatment per se - practitioners and methods vary and the suitability of this method of treatment will be dependent on many things.  What I am saying is that that course of treatment with that particular practitioner was very successful for me. 


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Part 3 ~ The Spiritual Wasteland ~ my personal reassessment