A Pill Popper's Progress

Please note: the following is my experience only and is not advice about whether or not to take antidepressants. If you are experiencing any serious side effects from pharmaceutical drugs, including suicidal thoughts, contact your doctor or a close family member immediately.

Now that Christmas is over and I have time to breathe I can finally catch up on this neglected blog. It's more than three months since I started taking an antidepressant for the first time in ten years – and probably the first time that I was capable of handling the side effects and waiting for the worst ones to stop. It's high time for a progress report!

I'm taking only 25 mg of Luvox a day, a miserly dose compared with the allowed daily maximum of 300 mg. Being incredibly sensitive to anything I put into my system, I can't imagine what I'd be like on the full dose, apart from comatose – I'd probably make a zombie look like an ADHD sufferer. So even on my tiny 25 mg I'm declaring the experiment a success. This amount is enough to take the edge off my fears and obsessions, to the extent that I can perform certain social feats, and I've totted up a few triumphs that are improving my quality of life. Then there's the relative freedom from obsessional thinking that was becoming more and more debilitating.

On the minus side, there are continuing side effects that won't go away. I consider the trade-off worthwhile but they are significant enough to warn me off a higher dose. As well, despite my progress, the basic structure of my social anxiety is still intact.

The graces

When I started taking Luvox, I was amazed at how quickly I noticed positive change (I know what you're thinking – the placebo effect!) and how quickly life itself seemed to respond to my improved resilience.

Reduction in OCD

The most quick-acting and lasting effect of the Luvox has been a reduction in obsessional thinking – a low-level form of OCD, I'm now convinced. My obsessional fears about people and groups have been par for the course for decades, and in recent years I'd developed a mild body dysmorphia that had me examining various body parts in the mirror in an attempt at reassurance that instead led to horror whenever I discovered some shocking new flaw. But I hadn't realised just how debilitating my OCD had become until my latest periodic fixation reared its head yet again – stains on clothes.

Every now and then, an incident in which a piece of clothing was ruined by an irremovable stain – oil is a common culprit – would spark an obsessional fear that all my clothes, as well as sheets, doona covers and so on, were or would become irrevocably stained. Everything else shrank in the face of that possibility and I would wonder how civilisation was at all possible with this ever-present threat, and how people with children managed to afford to clothe them, when surely the little blighters would be routinely ruining everything they wore (I'm still amazed at the temerity of anyone who wears white, including brides!). I'd had a couple of these attacks when I started to realise they might actually signal the OCD that I'd been wondering if I had.

The strength of this fear in me is a good measure of my obsessional thinking in general, and Luvox has quietened these fears. When a loved piece of clothing stains, I still get upset but it no longer signals the arrival of the four horsemen of the apocalypse. I still obsess about people and social situations, too, but less so.

Reduction in social anxiety

Work has been an area of giant strides. Two days in a row – try to imagine the angst – I had to drive out to different locations to meet clients I'd never met before (well, I didn't have to – but with the drug in my system I was willing to give it a burl). Both of these involved long drives to locations of varying familiarity with all sorts of fears of doom and dark forebodings going on beforehand.

Having the two meetings in the same week created an accidental curve of therapeutic exposure. Upping the ante even further, both happened to be male clients, which I find far more anxiety-provoking than female. The second one was far harder than the first, connected as it was to my main copywriting client.

To top it off, I actually went into the workplace of a long-standing publisher client and worked in-house for three days – three whole days! While this was a triumph, there's no way I could have sustained it – or would even have wanted to. But to be able to actually achieve some work while in the company of others, and to say hello and interact with people I hadn't seen for a couple of years and had communicated with mostly by email was a huge boost to my confidence.

In all these scenarios the drug didn't take away the fear but it took away the worst of the physical symptoms. Having fear is strange on an SSRI like Luvox. To an extent your body and mind still perform their usual, rusted-on routine (mind conjuring up social catastrophes while stomach churns and somersaults) but there's a numbness there too, a sense of detachment, as if you know you're bluffing and there's a fair chance you might actually be alright. The first time around on Luvox in 2001, I remember telling a friend it was like having a platform underneath me for the first time, whereas before in social situations I was always falling into the cellar of my unconscious terrors. This time around it sometimes feels as if the drug is holding me, keeping me steady. It's like a good fairy or a guardian angel.

The other triumph is that I'm now attending a mental health group that meets on a weekly basis. We sit in a circle in the front room of a forties Tudor-style house converted to the group's office in a middlebrow suburb about fifteen minutes' drive from my place. I can't say I go every week – sometimes work forbids it – but the exposure has been incredible. The meetings go for two hours, way too long for someone like me, and my usual habit of homing in on 'scary' people is still there, but the Luvox allows me to stay put and work through this (touch wood – as I become more familiar with the group members, it actually becomes harder for me).

Better sleep

I'm also sleeping better. Nothing seems that pressing any more that I can't eventually get to sleep. My dreams are clearer too, vivid and fun to interpret in the morning, although they fade quickly after I wake.

The curses

Here are the side effects of Luvox that have continued into my third month on the drug. I can't speak for others – I suspect some of my symptoms are to do with have a dodgy immune system and a sensitivity to common food chemicals rather than being typical side effects of the drug, but I could be wrong.

Memory

My memory isn't as good on Luvox. For example, I struggle to remember what is on telly that evening after checking the guide online (the litmus test for me of good working memory). The other thing is reading. Depending on the level of detail, I struggle to recall much of what I've read even after a few paragraphs. Non-fiction, with its endless new names of players and organisations, is much worse than fiction. Part of this, I tell myself, is low blood sugar. There's no doubt the drug makes me even more susceptible to blood sugar fluctuations than I was previously.

Being more careful with my diet would definitely help. My weekend treats, mild as they are (rice cakes, tomato and hummus; cashews) result in greater tiredness, even exhaustion. So I need to indulge less, and this is difficult.

However, it not's all bad where memory's concerned. Having a quieter mind in some ways increases my ability to focus (although I can be a bit slow on the uptake), so I suspect in some ways I might be retaining some information better, especially the kind that occurs in conversation.

Digestion

There is evidence that SSRIs can disrupt the workings of the digestive system. I don't know whether this is related, but I have a permanently bloated stomach. (I've heard people complain of putting on weight while on anti-depressants, although I haven't put on a pound, probably because I'm on such a strict anti-allergy diet.) On the other hand my body image issues are reduced on Luvox, so the slightly distended tummy isn't such a terrible thing now I've got used to it.

Numbness

Unlike many on SSRIs, I mostly enjoy the relative emotional numbness I feel on Luvox. It's preferable to the combination of disassociation and depression I used to feel. I still feel just as concerned about the fate of the world, and the suffering of humans and animals, but the concern doesn't make me feel as unhappy and unsettled as it did in the past.

However, the reduced sexual response that is a common effect of SSRIs is also my experience, and this is where numbness (not just sexual but emotional) can become a burden.

Future possibilities

While Luvox alone is helping me, combining it with therapy would enable me to get the maximum benefits.

As I've said, Luvox blunts rather than removes my social anxiety. For me there are two aspects: the performance itself and then the replay at home afterwards. Common to this is an 'oh no!' reaction as I relive one or two incidents where I feel I've made a terrible fool of myself. I torment myself by going over the incidents again and again, and cursing myself for whatever I said or did. (I'm aware that the 'oh no!' is something my brain has built into it, and then finds a memory to attach itself to, but awareness doesn't seem to make much difference to the angst.)

The Luvox doesn't actually stop this process, but it blunts the pain and shortens the length of the remorseful period. Therapy could be a useful adjunct: someone to hold my hand as I expose myself to the horrific social possibilities my mind conjures. In theory I could do much of this exposure work alone, but in practice I need a skilled and knowledgeable psychologist who can parent me through the worst. 'So what if you acted strangely in front of aunty X and cousin Y the other night. What if you're right, and they do think you're weird – so what?' the skilled psychologist might say.

Or as I face my mental health group and try not to blush and look self-conscious, I could be doing something more useful: not simply allowing myself to think disallowed thoughts but actually making myself think them. My imaginary psychologist might encourage me to picture myself in bed with half the meeting as they sit opposite me – so that I'd gradually become more accustomed to, and less fearful of, such 'scary' thoughts.

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Coming your way - the empowered patient

I was reading a forum recently on the topic of 'staring OCD', a very distressing condition. The discussion was headed by a doctor who was either a psychiatrist or psychologist. Some of the sufferers suggested that their condition seemed to be caused by a combination of social anxiety and OCD. The doctor responded that this wasn't the case; instead the staring OCD was causing the social anxiety.

How could he know that this was true for each individual sufferer? To my mind it's arrogant to make a sweeping dismissal of patients' lived experience of comorbidity in this way. Staring OCD has been all but ignored; many therapists seem not to have heard of it. For some patients it could well start off as an obsession with staring and progress to social phobia, but it's not exactly farfetched to suggest that the two are often connected from the beginning; the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) acknowledges that social phobia and OCD in general often occur together.

This is an example of doctors being in love with particular categories that patients then have to squeeze themselves into, even if it's an uncomfortable fit.

It also suggests how important it is for patients to empower themselves and learn to trust their instincts (as opposed to 'listening' to their illness).

An empowered patient might refuse to take this doctor's opinion as gospel truth if it doesn't chime with her lived experience. At the same time she might recognise the doctor's overall expertise and use his knowledge in other areas as a resource.

What does empowerment mean if you have a mental illness?

About two months ago, for the first time in a decade, I started taking Luvox, an SSRI that is often used to treat OCD. Around this time I became fully aware of one of my 'conditions' for the first time, and the many ways it has affected me over the years and continues to do so – pure obsessional OCD, or 'pure O' as it's sometimes called (sounding more like a soap powder than a mental illness).

Being on the drug has made me think a lot about what it means to be mentally ill, to have a condition that affects the way you relate to others, and to be 'medicated'. It's renewed some of my regrets about my earlier failures to make the most of drugs to improve my mental health, and to take responsibility for my life rather than handing over too much power to therapists. Here, then, are some of my thoughts about these issues. Please be aware that the recommendations I make are reflections of my own experiences.

Psychiatric drugs that have an acceptable degree of clinically proven efficacy and safety are neither good nor bad – assuming, of course, that the patient needs the drug and can benefit from it. Along with therapy they are tools, with two people wielding them and responsible for their safe use – the therapist and the patient.

Both need to understand that a drug is not a cure but a starting point. Assuming the drug is compatible with the patient's biochemistry, along with therapy it may enable her to reach a level of functioning that makes further change possible. Positive changes in the brain made by the combination of drugs and therapy may lead the way to further brain changes as the patient gets used to ever riskier and more challenging activities.

Whether positive change takes place depends on the commitment and hard work of the patient, and the effectiveness of the therapy, but there are also a host of other factors: the severity of the illness, the patient's support structure, whether she has security in housing and finance, and whether she has other addictions or health issues.

All this suggests an approach that considers the dynamic between patient, drug, doctor and the patient's larger social context. Within this dynamic there is one factor beyond all others that to my mind determines success.

The patient's degree of maturity is a key element in the treatment. She must be ready for the effects of the therapy, including the initial side effects of drugs, and the ups and downs to expect. She must be able to 'hold herself' and to withstand the whirlwind of change without dropping the therapy in a panic if her beliefs are challenged or as soon as something goes wrong.

Maturity enables the patient to be as fully aware as possible of the nature of her illness, and the way it operates in her life, and to separate the illness from her own self-image.

Maturity implies empowerment and self-advocacy. In some instances it may mean a patient who talks back, who appears to be non-compliant, who doesn't always take the therapist's word as gospel.

In some respects the patient may be more knowledgeable than the doctor about the day-to-day, lived aspects of her illness. This should not be surprising; given that less than half a century ago some doctors were still sticking ice picks into people's eye sockets and detaching the prefrontal cortex from the thalamus, it's fair to say we're at an early stage when it comes to understanding the nature and causes of mental illnesses. For example, we now know that the diagnosis of schizophrenia actually refers to a cluster of illnesses rather than just one.

However, the doctor will be more objective and have insights that the patient needs; the patient must find a balance between trusting her own instincts and taking full advantage of the doctor's expertise and objectivity. And doctors need to retain a degree of open-mindedness about the lived experience of patients and to look at qualitative as well as quantitative evidence, while not indulging or kowtowing to their patients.

Benefits of empowerment

It took me years to become empowered because I had to struggle with lack of information from therapists and my own dysfunctional thought processes to get a clearer view of the world. You need to know yourself and the operations of your illness very well before you can be an empowered, assertive patient and not simply non-compliant.

Ironically, the very psychiatrists who disempowered me by refusing to give me a clear diagnosis – something I didn't think to ask for myself – helped me in other ways by encouraging me to shed many of the deluded ideas I had about life, to grow up and to take some responsibility for myself.

It's my belief that if therapists want ultimate success they should try to foster empowerment in their patients. I'd go so far as to say that encouraging the necessary maturity for patients to actually grapple fully with their illness should be one of the major goals of therapy. While a certain degree of empowerment and self-knowledge can only come from experience, therapists can do a great deal to hasten the process.

No therapist should feel threatened by the idea of an empowered patient. Without life skills, self-knowledge and maturity, the patient can't get the full benefit of the therapy. An empowered patient is one who is motivated to change and recover to the extent possible. An empowered patient and their therapist can become a team with a common goal while still having separate roles and responsibilities.

Below are my ideas for the way therapists might do this. Of course some therapists already do some of the things I call for, such as encouraging their patients to join a self-help group.

A better way

These are the steps I believe therapists should take when they're establishing a relationship with a new patient.

• After gaining an overview of the problem, explain herself, her qualifications and methods of treatment, and let the patient 'interview' her.
  
  The patient needs to find out whether she wants to work with the therapist, while the therapist needs to ascertain whether she feels she can help the patient or whether the patient should be referred to someone else. Many therapists simply assume that they are the person for the job.

• Once enough information has been gained, tell the patient exactly what she believes is wrong with her and the implications of this. The therapist should be open-ended about these implications.
• Point the patient towards resources rather than suggesting that she is the only resource.
• Encourage the patient to arm herself with knowledge and join self-help groups.
• Encourage questioning and feedback, while being willing to call the patient out when she exhibits thoughts and fears that may be related to the disorder.
• Set up a treatment plan with goals (to be agreed by the patient) and ways to achieve those goals.

• Encourage the patient to pursue a healthy lifestyle and to get the basics of life right – housing, work or financial support, strong relationships. If there are barriers to any of these, they should be treated as goals and included in the treatment plan.

• Work out if the illness has created distorted thinking and ideas about life, society, and important life goals, and personality factors such as dependency and narcissism. If these kinds of things aren't identified they could stymie the treatment. Personality problems don't need to be fully blown personality disorders to sabotage progress.
• Share these findings with the patient and incorporate them into the treatment plan. 

• If the patient has concerns about medication (common for OCD sufferers, for example) rather than taking offence or trying to fob the patient off she should talk about risks versus benefits, ways to minimise side effects, and assume the patient has a 'What's in it for me?' approach.

Empowering young people

I was pleased to hear that some aspects of this approach are being used in the treatment of schizophrenia in young people. In a recent discussion on Radio National about the latest treatments, the practitioner spoke about the importance of early intervention, and the need to tell young patients that it was important to focus on two things that are basic to happiness: work and love.

I couldn't agree more. Young people with mental illness need to be encouraged to grow up faster than their peers. Work and love are, after all, the goals of most people's lives (which is not to say that a recovery plan should always aim for, say, a full-time nine-to-five job and a long-term relationship – recovery for some people could mean volunteering and establishing new friendships).

Following a thorough diagnosis (including personality factors) and treatment plan, this is what I wish I'd been told when I first presented to a psychiatrist at the age of 21 with an unspecified nervous problem. I would like to see all young people receive a similar introduction when they first enter therapy.

•  How you manage this condition will affect the quality of your life.  The most important thing you can do now is grow up and learn to look after yourself, and work on your treatment plan. While a certain degree of rebellion and acting out is normal for your age group, it may just hold you back and threaten your recovery.
• Get the basics right.  A secure roof over your head, good diet and exercise, strong and healthy relationships are essential to your recovery.
•  Alcohol and caffeine are not your friends.  If you have any serious addictions, go into treatment for them.
•  Use your time wisely to develop as a person.  Focus on strong friendships, and work towards being partner-ready without being obsessed about finding a partner. A strong relationship can greatly assist your success, so work on yourself.
• Don't try to do all this perfectly.  There will be plenty of times when life gets temporarily busy, and there will be setbacks as well as strides forward.
• Be sensible about sex. Sexual experimentation can be good and healthy but only if it is fully consensual and you feel happy and comfortable about it. But sex as an escape, or sex that is exploitative and not enjoyable for you, is simply a waste of your time.
• Learn to separate your thoughts and intuitions from your feelings.  Trust yourself, but don't necessarily trust all your feelings all the time – they will chop and change. Learn about your intuition and separate it from your emotions. Learn to follow your gut but remember your emotions aren't always telling you the truth.
• Don't give away responsibility for yourself.  Respect professionals and their advice but view them as resources.You are not there for their benefit; if they're not helping you, you are under no obligation to keep seeing them. On the other hand, try to tolerate a state of openness and unknowing; it may take time to form an opinion on whether a treatment is working. Leaving simply because a therapist challenges your boundaries, prejudices or distortions would be self-defeating.
• Understand that there is nothing wrong with the essential you.  Your disorder is stopping your true self and personality from expressing itself. Your goal should be to come home to, and learn to love, the body and mind you have, and to live your own life, not someone else's.
• Work towards a sustainable career.  Where work's concerned, it's a fine balance between taking your illness into account and stretching the boundaries. Accepting and managing the illness is vital to your success. Choose your vocation carefully – whether you have to give up on a particular dream or pursue it will depend on individual circumstances but management of your illness must come first if you want long-term success and health. At the same time, sometimes only experience can tell you if a career path is right or not; cultivate flexibility and be willing to change to a related career or different way of working if a job or vocation is too stressful.

I was a very rigid thinker, and had strange ideas about the world, when I was 21 and first spoke to a psychiatrist about my nervous condition. Would I have been able to take advice like this on board at the time? Probably not if it was verbal, but if something similar had been given to me as a leaflet, and presented as advice from other sufferers, it might have helped.

Most of all, if I'd been told that I had a serious condition, a chronic illness if you like, that I would have it all my life, that no magic Freudian catharsis was going to get rid of it and that it was up to me to accept this and learn to manage it, I might have cultivated more sticking power, patience and resilience. I hope people going into therapy for the first time can get the full benefit of the many resources now available to them, and understand that they are their own greatest resource!

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Writing a Memoir: Tips for Bypassing the Inner Censor

When you’re figuring out how to write a memoir, it’s sometimes easy to get caught up in the mechanics. Of course these are important. But unless your memoir is primarily factual in nature, getting to the emotional core of the story – the most profound version of what really happened – is vital if you want your writing to be compelling.

But how do you do this? I’ve written in the past about the challenge of finding your memoir voice. Your unconscious mind may be prey to all sorts of strictures about telling the truth that you’re not aware of. You may have an inner censor that metaphorically blacks out your most intense memories.

Yet this censor is often asleep on the job, and it may not be difficult to get past them. Below are some tips for doing just that.

Mind’s eye

Sometimes your inner censor is only working on the level of the writing itself, and not your actual recollections. It may be that you’re easily able to picture and remember whatever you were feeling at the time of the event you’re writing about, but somehow the link between this internal state and the writing process is missing.

You need to be conscious of the gap before you can bridge it.

As an exercise, start writing about a memory. As you write, focus on what is present in your mind’s eye. Does your subject matter accord with the picture in your mind’s eye? If so, chances are you’re in touch with what was really going on emotionally at the time.

If there is a discrepancy between the two, start to explore this inner picture. Ask yourself the following:

Which room or environment are you picturing? Why is this room significant?

What are the feelings or thoughts that circulate around this mental image? Can you put them into words?

Sometimes there’s a delay between completing a piece of writing and being aware of the underlying emotions that accompanied the original experience. You may complete the writing and only later become aware of a deeper layer of feeling and experience. Try to capture this deeper layer in words as soon as it comes up, and use this later writing to enhance what you’ve already completed.

Studying photos

Photos are a great way of jogging memory and unearthing perceptions about the past.

One option is to find a photo that appeals to you, study it, and start to write freely about anything that comes to mind. Think about what was happening around the time the photo was taken, and what the underlying dynamics were. If you're writing about relatives, a photo that appeals to your imagination can spark a search for more information.

Another option is to keep a photo nearby, or in your mind’s eye, as you write, as a general reminder of the subject matter. In this case you're not so concerned about whatever is going on in the photo, but of the individual character of the people that feature in it. Whether the photo is of you alone, family members or other significant people, use it to help you retain a strong sense of the character, emotional burdens, or general circumstances of those you're writing about.

Perceptions on waking

One of the times we’re most vulnerable to unconscious thoughts and memories is when we first wake up in the morning.

Sometimes a deeper layer of perception or emotion may reveal itself in a dream, or simply as a general impression when you wake. Keep a pen and paper or writing device next to the bed to capture these impressions, or alternatively write about them as soon as you get to the computer in the morning.

If you enjoyed this blog entry, you might also like Haunted by the Ghosts of Memory: Is Memoir Writing Good Therapy?

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The Lure of Hoarding: Keeping Our Appointments with Memory

I'm a mad thrifter and lover of op shops, but I also like the idea of decluttering. Indeed, thrifting and decluttering are both megatrends that have swept the consumer world in recent years, yet they have totally opposing aims. Does a love of thrifting inevitably lead to hoarding? Can a scourer of op shops like me actually lead a minimalist lifestyle?

My preoccupation with hoarding comes from the fact that my parents display totally opposing tendencies in this area.

My father is a hoarder of sorts. This trait took years to fully reveal itself, and remains limited to a few rooms in the house because my mother is a tidiness freak. 

While I was growing up my dad’s hoarding hardly impacted on me – except as an exemplar of untidiness – apart from the garage and garden shed, both almost unusable because stuffed with useless junk, including a canoe that to this day hangs upside down from the roof of the shed like some bizarre art installation, and is purported to have a hole in it. Oh, and my dad's huge glass-topped mahogany desk, whose surface was even then obscured by papers, that my mum had to suffer in their bedroom for many years. As she's gotten older, it's become harder for her to control my dad's messiness.

When we kids grew up and moved out of the house, Dad inherited a bedroom that became his 'office'. He used to complete his watercolour paintings in there, but it's so full of junk now, apart from a small space cleared for a computer and chair, that he’s abandoned it for this purpose. With its boxes of obsolete papers, discarded canvases, painting materials and plastic bags of electrical cables taking up most of the floor space, and the desk obscured by nests of manila folders stuffed with papers, it's a safety hazard.

Ominously my father has been 'given' another room for his painting, a tiny room at the back of the house that was formerly a spare-cum-sewing room. So far it's sufficiently free of junk that my dad can paint again but I predict that in a few months this room too will be unusable. He will occasionally create messy outposts in the rest of the house – for example, spreading his tax return documents around the dining room table, completing a painting project in the sunroom – but these are always temporary and are soon shooed back into the general chaos by my mother.

Dad is in some ways not a typical hoarder. Hoarding is often associated with compulsive shopping; Dad hardly ever shops for non-necessities unless he has to. Nor does he actively accumulate material objects in other ways (although he used to buy the odd broken-down car that he would tinker with on weekends). It's the past he hoards: religious pamphlets, old copies of journals, financial and administrative documents, and anything to do with his political battles with his teachers union, the local council and government bodies. He still has papers from at least fifty years ago.

While hoarding didn’t impact much on my childhood, its roots were present in subtle ways. For example, I knew one thing that would always garner my mother's approval (the usual things didn't really cut it with her): 'cleaning the kitchen' at night. What this meant was not just doing the dishes, but sorting, filing and taming the accumulations of junk that regularly spread themselves around the kitchen benches (this wasn’t just Dad of course – we are a family of seven). Organising this assortment of mail, torn pieces of envelope with phone numbers written on them, tiny miscellaneous toys, coins, sets of keys and so on, and creating sweet if temporary order, was something that my mother and I could both rejoice in.

Has Dad passed down his hoarding tendencies to me? Not at first glance. I'm a tidiness freak and I like to think I’m a great declutterer, but in that regard I’m fooling myself. I'm good at getting rid of some things but not others.

I hold onto clothes for longer than many, but I can get rid of the most treasured garment once I’ve made the decision; I actually enjoy the process of weeding out my wardrobe and dropping off a bag of goodies at my favourite op shop. Once it's time for a piece to go, I don't give it another thought.

But the fact is I do have my own hoarding weakness – books. I have five bookshelves if you don't count the one in my office that is stuffed with folders of edited educational materials.

I find it very hard to let books go. I have thrown the odd few out, but my decisions are extremely conservative. And I still have many books that I won't read again and that bear little relationship to how I live my life these days. Do I really need my secondhand copies of Emotional Intelligence and Steven Covey's Seven Habits of Highly Effective People? (These books were both written before the financial crisis – if they were so influential, why didn't their sage advice for corporate types stop the Goldman Sachs executives plundering the USA and destroying the world economy?) To me the knowledge these books hold represents security, and a link with past versions of me, and I can’t let them go, not yet anyway.

Another thing I hold onto is appointment diaries. Mine go as far back as 1994. I keep them in my bookshelves so it doesn’t feel as if I’m hoarding them. I tell myself they’re useful as primary sources for memoir writing and so on, but they’re really just another link with earlier versions of my life and myself. In the rare times I go through one, trying to discover when some long-ago incident occurred, I’m strangely comforted by the mundanity of the various lists I was so fond of making. Whatever my emotional and material struggles, I continued to go to the supermarket, have my hair cut, drop my books back to the library and pay my rent.

Flyers relating to arts and cultural events – exhibitions, readings, films, plays – are another weakness. It’s so easy to forget the details of these experiences, and while there’s enough room in my filing cabinet, I can’t bring myself to throw away anything that jogs my memory.

In fact, the things I hold onto suggest that I’m more like my father than is comfortable to contemplate. Like him, it’s reminders of the past that I cling to. In the absence of a photographic memory, these refugees from my past testify to my changing life and the things that continue to sustain it.

If you enjoyed this blog entry, you might like Furni-phobia: the fear of buying big-ticket consumer goods.

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New and Improved Version? Or Slightly Nutty Does Drugs

Please note: the following is my experience only and is not advice about whether or not to take antidepressants. If you are experiencing any serious side effects from pharmaceutical drugs, including suicidal thoughts, contact your doctor or a close family member immediately.

I am 49 years old, and it sometimes feels as if my evolution as a human has consisted of removing one inadequate story to explain my life – one veil over my eyes – and replacing it with another. The replacement story is never completely accurate but gets closer to the truth each time.

My latest revelation is this: not that it would be beneficial for me to be on medication, or that I would do better on it, but that I should not be let out of the house without being drugged to the eyeballs; and that this has probably been the case for my entire adult life (except they didn’t have SSRI antidepressants when I was 19, so I and the entire universe are excused from responsibility for my mental health until the creation and dissemination of Luvox).

Having been on ‘drugs’ for a grand total of six days I realise that this is just another story to explain where I’m at right now; whether relatively accurate or not, it’s too early to judge.

Crunch time

I had a crisis on a recent weekend. I’d come to a total halt. Just about everything had become hard, apart from buying groceries at the supermarket using the self-serve checkouts, and browsing in clothes stores. Hairdressers too hard, didn’t like the close contact, podiatrists too hard, what if you have a panic attack while they’re literally holding onto your feet? Dates too difficult, how not to hyperventilate when the date is sitting opposite you and you don’t even trust yourself to pick up the glass of mineral water, carry it to your lips and sip from it? Family gatherings increasingly too hard: this has been all too easy to be in denial about and to dismiss as a symptom because I don’t get on with my family – it’s their fault I feel so uncomfortable, not the fact that I suffer from a virulent combination of social anxiety, OCD and panic disorder undergirded by affect phobia and hypervigilance.

And even – get this – too hard to sit in the audience – not in the podium, but in the audience – at an author talk or discussion forum. What if I catch the eye of one of the speakers and there are not enough tall, big-headed people to hide behind? It feels as if the person on the platform can see right through me. Yes, folks, this is how bad my whatever-it-is actually is these days, how controlling it’s become. Extreme, but in a quiet, polite, implosive kind of way. I can’t even have a conversation with an uncle or male cousin at a family do without a panic attack hovering in the background.

How did I take so long to reach this conclusion? There have been so many warning signs. It’s amazing how many books you can read about people coming to terms with being on medication and not think it applies to you in the slightest.

I did make some progress when I saw a psychologist for a period in 2010-11, but when I stopped seeing her I started to slip backwards again.

My physical difficulties are the reason why I’ve been (mostly) undrugged for most of my adult life (along with my attitude towards them). If you already suffer from brain fog from food intolerance and low blood sugar, and an eating disorder that makes it difficult to stick to a restricted diet, and you live in a cold, mouldy old house with a gas heater that sends you to sleep whenever you lounge in front of it, why would you further compromise your precious grey matter?

Because you have almost nothing to lose.

Because there’s no other option.

Because you are almost two-thirds of the way through your expected lifespan, and suddenly it makes no sense to preserve future cognitive ability for some mythical perfect self, rather than make life better in the present moment.

Because you are curious.

What I’m hoping is that there’s a pay-off: the drugs will get me out of the house, especially at night, so that the mould and the cold won’t matter so much.

My not-so-hidden agenda is to be able to sit in meetings. Social meetings, support meetings at this point. Later, political meetings (a very big ask). I want to start off with a mental health meeting and take it from there.

My hidden agenda is that I’ll actually make some new friends. This has been a huge sticking point with me all my adult life, but especially in recent years. I made my last new friend way back in 2004, and no-one I’ve met since then in the world of internet dating has stuck, yet I’m haemorrhaging old friends. It’s time to go out in the world to find people with common interests.

Never have the words ‘easier said than done’ been more applicable. Some days I am confident that I am on the way to becoming the most socially phobic person in Australia. I have no confidence in my ability to sit in a circle with a group of people with the slightest degree of equanimity for, oh I don’t know, two minutes. This hurts to write, because I can chart how I’ve gone downhill in the last 12 years: it was never easy, but some one-off workshops and ongoing classes and meetings were once manageable, depending on where I was sitting and the combination of people.

So last Thursday I finally came to the end of my tether and made an appointment with my GP, whom I hadn’t seen in 13 months.

‘I want to go back on Luvox.’

‘What’s going on?’

‘I’m the kind of person ...’ I said, repeating my dramatic ‘drugged to the eyeballs’ line.

She was great. Scrutinised me in her no-nonsense, non-judgemental way, curious as to why, after briefly flirting with Luvox in 2010, I’d suddenly come to this decision. I mentioned the crisis but didn’t go into much detail.

Loving and leaving Luvox

I have a history with this drug that made the flirtation in 2010 possible. I first started on Luvox in around 2001, when I began a writing and editing diploma. It was a low dose, but it helped me sit in my classes more comfortably in the first year, and perhaps, towards the beginning, took the edge off my social anxiety.

Luvox is one of the SSRIs used to treat OCD as well as social anxiety. My psyche at the time, an elderly Freudian with compassion and wisdom, had chosen Luvox for me instead of a host of other SSRIs, so he perceived I was obsessive. But I regret that he chose not to suggest to me that I might have some low-level form of OCD, and that this might be affecting my ability to handle my social anxiety. To his credit he wanted me to increase the dose to 50 mg (which is still low: the maximum is 300 mg) but I was too paranoid about brain fog to comply.

But – and this is an indication of how all-over-the-shop I was in those days – I have no idea how long I stayed on it beyond the months in which classes were held in 2001. Whatever the length of time, and whether it stretched into the second year of my course, I must have at some point stopped monitoring its effects on my social life or believing it made much difference to my social anxiety, because when I did decide to stop it in early 2003, I was very blase (surely I must have noticed, though, its ability to reduce my obsessiveness?). Whatever the time period I was on the Luvox, I took only 25 mg a day. I feared a higher dose would turn me into a zombie.

I'm now curious as to whether I stayed on the drug continuously the following year, 2002, the second year of my editing course, but I marvel at my stupidity either way. If I did stay on it, I should have upped the dose: it was a year of accumulating social and emotional disasters. I remember being very phobic in a couple of classes; sabotaging some emerging acquaintanceships; starting a doomed fling with a randy right-wing barrister; and moving out of my Carlton cottage, which was in the centre of everything, to a lonely and undersized one-bedroom flat further north of the city that I eventually flooded. Towards the end of 2002 I embarked on a course of useless homeopathics, which just made my blood sugar problems worse because the only active ingredient in a homeopathy solution is the alcohol. If I was still on the Luvox then, I evidently put no thought into what the combination of Luvox and the alcohol solution would have been but I soon realised how spaced out I was becoming.

I finally went off the drug completely some time early in 2003 because I remember writing that it was making everything ‘white and exhausting like a snow storm’ and I wanted my brain to be as clear as possible for the editing business I was in the process of establishing. As I’ve said, I have no idea if my use had been continuous throughout 2002.

What I wanted then, and would still choose now in the best possible world, would be some kind of perfect non-drug therapy that involved a return to an infantilised state and reparenting. I have read about this kind of therapy and often thought it sounded perfect for me; I’ve also had the sense that given a strong, resilient enough therapeutic community that could deal with the acting out of my symptoms I would over time heal.

But in a perfect world.

First days on the drug

So now I’m back on Luvox again, starting with a low dose of 25 mg. Once I’ve adjusted to this dose, I am hoping to increase the amount to 50 mg.

The adjustment period is impossible to describe. I have felt very odd things that are difficult to put into words. None has been unbearable, but some are turning out to be pretty hellish. If these feelings persist beyond a month I’ll stop the drug but I want to give my system time to get used to it before I make a decision.

Last Saturday afternoon at the local mall: a horrible jumping sensation when I lift my self-conscious feet as I prepare for the escalator. I feel that I must focus on my feet in order to walk normally, but I notice that already I am less self-conscious about the rest of me. People aren’t staring at me all of a sudden; they’re not that interested in me. We are in our separate worlds.

Tiny beads of sweat like powder on my skin.

I am in an awful mental brace. Back at home, I go online and find other people complaining of things like ‘feeling medicated’ and a sensation, apparently common, of having two brains.

Hmmm. I can sort of understand what they mean. One brain feeling all the feelings, the other brain containing the feelings and stopping them from spilling out? Are two brains better than one?

Or two heads? Back in 2002, someone in my 12-step program said, of her battle with depression and her firm belief that drugs, however difficult to get right, were essential to her wellbeing: I don’t care if they give me three heads, at least I can function.

Once you can’t function any more, side effects and future risks become moot.

Saturday night: awful. I ring up one of the few friends I have left who is as usual too tired to go out, as she had promised. (If any of my friends are reading this: it is not a complaint. I’ve somehow set it up that way.) As we talk an unutterable, mildly suicidal depression kicks in along with that medicated feeling. A sort of terminal gloominess, like an extreme version of boredom. But I am bored, terribly bored, and I’ve been bored for ages.

(This feeling returns in the evenings of the following week from around 8.30 pm, seemingly when the drug starts to wear off and when the hormonal changes caused by nightfall have well and truly kicked in.)

Sunday is drastic. I wake with unutterable relief that the drug has started to leave my system and my intuition screams at me not to take it. I listen to it and don’t take the Luvox, wondering if this will be the end of my drug experiment; but I end up taking it every day of the following week – Sunday’s refusal turns out to be just my body telling me to ease into the new regime.

It’s a sunny afternoon and after going back to bed and nursing a need for an extra hour’s sleep I have plenty of energy to get out of the house and even brave Melbourne public transport’s new and fairly disastrous ticketing system (worth a blog entry on its own). And go to the National Gallery of Victoria (oddly named as it’s actually a state gallery with ideas above its station).

While the punters pay twenty bucks to see a blockbuster on Napoleon, I swan through the almost deserted eighteenth century art rooms, and my memory being shit, am pleasantly surprised at how good and interesting the collection is even though I’ve seen it before (the drug still lingers in my system, a positive offshoot of my sensitivity to drugs).

On that entire visit, not so much a sense of having two brains as two contradictory feelings: unutterable, yet low-level depression and a sense of meaningless and lack of being rooted in the world (I often get this in public spaces, as if I don’t belong in my society any more, but this is more intense) and an awareness of a new social ease.

Galleries are hard for me these days, yet today actually isn’t too bad, apart from the extreme aloneness that the drug seems to highlight rather than mask.

Things pan out a bit as the week progresses. I feel a bit hyped up and spacey in the mornings. At the same time, because of the increased energy, I have a sense of urgency about getting things done. There’s also a sense of my energy feeling scattered. These last two are both unwelcome, in the case of the former because I already experience obsession about getting things done, but it has seemed to dissipate as the week has progressed. I am still feeling shy, but on the other hand my brain is far quieter in ways that are impossible to explain.

Something else is happening that I did predict, because it occurred the previous time. Because I am less depressed and frightened on Luvox, some of the more objectionable parts of my personality, normally repressed by the depression, are coming out to play. The desperately competitive, ambitious girl who gave it up because she was too ambitious and didn’t want to be cut down. The narcissist who dreams of fame.

It’s not such a terrible thing, these personality factors coming up for air. They may make me painful but at least if they’re showing themselves they can be dealt with.

The drugs aren’t doing my blood sugar much good. I want to collapse at around 3 in the afternoon but this effect reduces as the week goes on.

Thursday: I brave a mental health group. The drug holds me like a mother, although I make a couple of inappropriate comments. I see my GP afterwards and she asks me about my OCD and remarks on how cheerful I am. I tell her it’s the drugs – they are making me a bit hyper. But at night, as the drug wears off, that guttering sense of angst that borders on despair.

On Friday night I have a terrible sleeplessness combined with a vivid sense of my brain being so alive it is playing, constructing nonsense sentences just because it can (as a wordy person, I’m used to this happening as I drop off to sleep, but this is occurring at an earlier stage and is quite disturbing). I wait it out and eventually get to sleep.

One other thing I’m noticing: in a minor way, my brain is more acute, especially in conversation; it’s as if the anti-depressant effects of the drug make it easier to make connections, be less self-conscious and think laterally. On the other hand the drug is definitely affecting my memory adversely and even more so my concentration: when I read, I have to sometimes focus on slowing down so that I retain the information my mind wants to skim over. Sometimes I find that I’ve stopped reading and started ruminating, and I have to jog myself into starting again. Still, early days.

Warnings

Information about Luvox available on the internet suggests that it is not suitable for children, adolescents and young adults as it can create suicidal feelings when first taken. It also seems to create that feeling in smaller percentages of people in the older age groups. The information expresses uncertainty about whether these feelings are caused by the drug or are simply a symptom of the depression for which the drug has been prescribed. My experience: it’s the drug!

I have no recommendation about whether or not anyone should take a particular anti-depressant – each person must use their own judgement. But I would suggest arranging to be ‘babysat’ by someone when you first start to take a drug such as a Luvox, at least for the first week. If that’s not possible, have someone you can check in with regularly. These drugs can have very strange effects on our brains, even if some of these effects are short term. I’d also suggest making an effort to eat sensibly and keep your blood sugar levels steady while on such drugs.

Onward and upward, with Luvox in my system and a song(?) in my heart(?)

If you enjoyed this blog entry, you might like The Dilemmas of Therapy.

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Dog Despair

Neurotic and self-obsessed as I am, minor physical problems can throw me into a tizz. I metaphorically shake my fist at the sky and am haunted by dark imaginings of future health nightmares: rosacea will scar my face horribly; tinnitus will sound like a crazed pizza deliverer who keeps knocking at the front door, never realising he's come to the wrong place; I'll get permanent brain damage from the black mould on the kitchen ceiling. And then I pick myself up and gradually learn to manage and adjust to the latest issue that life and ageing have imposed.

When other people in my life show signs of ill-health it’s even more dire. These people are not supposed to get sick. They are there to support me, aren’t they? (Well actually no, but that’s what I believe deep down.) When family members acquire conditions much more serious than whatever I’ve had to put up with physically speaking, it feels as if the universe is making a direct attack on my fragile support systems. Forget the people themselves.

The people may not necessarily be human.

So far I’ve taken three paragraphs to get around to the point of this blog entry: Jordan, the 99-per-cent-cocker-spaniel-one-per-cent-cute dog that belongs to the family of one my sisters and that I used to walk in the park twice a week, has a slipped disc.

As soon as I write this, it starts to sound trivial. Anything to do with dogs ultimately does. Their status is infinitely limited compared with humans. The ones who are truly cosseted are derided by society with the label ‘pooch’.

As with all non-human animals, part of the reason we trivialise their suffering is because they can’t tell us how they’re feeling. So we take the easy way out and assume they put up with suffering more easily than we do. We tell ourselves that animals are hardy creatures who live and die in the wild without doctors, artificial heating, or guarantees of a regular food source, and that with us as their carers they have it made. I wish that as a society we could start to give them the benefit of the doubt.

Jordan has his own chair in the lounge room because the family don’t like him sitting on their large modular couch. His old chair – a black swivel leather chair – was fine. But they didn’t like the look of it so they got him a new one and that’s when the trouble started. The new chair was too high for him and he slipped a disc when trying to jump up onto it.

I went around to my sister’s place last Friday to say hello to Jordan and sit with him for a while. I kind of invited myself, something I normally don't do, but I was anxious to see that he was okay and give him some time. My sister agreed to me dropping over at 4.30 that day, and I promised her she wouldn't have to stop and entertain me. The self-invitation turned out to be a perfectly predictable mistake. 

I found him worse than I’d wanted to believe. He greeted me at the front door so excited he was shivering compulsively, but when placed back in his previous position he lay there listlessly. He can walk around slowly but should be resting. Watching his attempt to simply sit on his haunches was pitiful: tentatively moving his bum towards the floor, then giving up; obviously too painful. He is, to put it bluntly, temporarily disabled. Someone who didn’t know what was wrong might assume he was an elderly dog with a terrible case of arthritis.

My sister has taken him to the vet and he is now on painkillers and will go back for a further check-up next week, with x-rays a possibility if he makes no progress. He is obviously in some pain even when still, but it is not so extreme that he is yelping, as he was before the painkillers. ‘It could be months ...’ I said to my sister, who is a nurse and understands the travails of recovery. She nodded. ‘I know,’ she said in her irritable way. When she lets herself stop and focus on Jordan, she has a reservoir of affection for him, calling him puppy even though he's now five years old, and insisting that he uses his long ginger-coloured eyelashes to communicate: 'Look, see how he blinks to tell you how he's feeling!'

But the spigot of her empathy is easily turned off. Since the onset of the condition Jordan is allowed to sit on the couch with a towel underneath, but apparently only during the day when my sister is not at work. ‘We need the couch to ourselves,’ she explained as she relegated him to a corner next to the television at around 5.30 pm. In this alternative position he lies on a doubled-over rug where he can’t see the television screen; not that he seems much interested in it, but it means he’s cut off from what the rest of the family is doing when they’re all sitting down together to watch it. Jordan’s haunted, unhappy eyes shone darkly from this lowly (and probably colder) position; I imagine this alternative spot is because my sister’s husband doesn’t like him being on the couch, and was due home any minute.

There's no one to blame for this mishap, and it wasn't foreseeable. But I can't help seeing a kind of metaphoric correlation between the family's lack of care and Jordan's current state. They seem obscurely to blame for not watching over him more closely. And assuming Jordan’s new chair was higher than the couch, the family’s subtle distancing of him (not allowing him on the couch in the first place) has inadvertently contributed. My sister is cosseting him somewhat, but not enough.

My tenuous relationship with him has become even more fragile, because I can only see him within the confines of the house, where I am soon made to feel unwelcome – ‘of course you can stay, sorry, could you get off the couch? I have to tidy up, I’m always like this on a Friday afternoon’ – and I am shooed out along with the dirt my sister is sweeping up from the living room floor in preparation for her husband’s return from work.

If you enjoyed this post, you might also like Dog Days.

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Memoir Writing: How to Find Your Voice as a Writer

Writing a memoir sets you on an inner voyage of discovery. At the end of it you’re almost bound to know yourself much better than you do at the start.

A vital key to writing a successful memoir is finding your voice as a writer. The irony is that you may have to listen to many other voices before your own comes through.

Your authorial voice is an organic thing that makes your writing unique. But how to unearth it successfully differs from person to person.

Some lucky people simply start to write, and the voice of their earlier self suddenly bubbles up and they simply channel it. For others it’s not so easy. When you start to write, there are likely to be psychological restrictions you’re unaware of: parental dictums to be polite; fear of hurting or embarrassing family members; the restrictions imposed by well-meaning teachers; even the sense of what is syntactically correct can all interfere with voice.

One way to get the flow going is to read lots of different memoirs. I’ve read hundreds of memoirs by now and they’ve all helped to put me in writing mode.

Reading other memoirs can provide permission. ‘She dared say that!’ you think, and a hidden part of you that has been crouching in the attic of your psyche for years, ignored or reviled, starts to stretch and parade herself. And there are things she’s desperate to tell you.

Like how you really felt when you moved house at the age of nine. And why you stopped dancing classes at the age of twelve. And who you really had a crush on, even though they weren’t at all cool. This disowned self is far more interesting and subversive than you realise and if you let her speak she may give your writing a force and immediacy that might otherwise be lacking.

When I first started writing it became apparent after a while that I was repressing the most interesting and subversive parts of the narrative. I would describe the event and then find myself mentally rehearsing something I hadn’t thought interesting enough to include. Hmmm. Over a period of time it became clear that the most interesting things were the things that I didn’t want to look at.

Good writing is about bravery. It’s about daring to look. Experiencing the feelings again is likely to be painful. But the pain won’t last. The record will.

When I consider voice, I find myself also looking at style, tone and language. Perhaps voice is the combination of these, powered by the essence of the narrative self who is the subject of the memoir.

When you read other memoirs, take note of the tone, as that is a key aspect of voice. Tone can range widely from highly emotional to melodramatic, from blackly humorous to cheerful or self-contained (and can also be a combination of any of these).

Also important is language, which also varies depending on the aims of the writer. For example, you can use language to bring the reader closer to the emotion or distance them from it. Language combines with tone to tell the reader who the narrator is, what life stage they’re at, and how much distance they have from the subject matter.

Two stand-out memoirists

Out of all the many possible examples of memoirists I want to choose two that illuminate voice. Both are excellent writers yet their styles are in  sharp contrast, at either end of two extremes.

In Borrowed Finery, Paula Fox (above) writes about a horrific childhood in small, jewel-like vignettes that have a haiku quality about them. They are highly visual recollections that together make up what one admiring reviewer called  ‘a montage of scenes and epiphanies’.

Fox was abandoned by her feckless parents at birth, and passed around from person to person, sometimes finding temporary sanctuaries, often not. In writing her memoir she seems to have stuck to the rule: ‘thou shalt not wallow’. There is little sentiment here and no self-pity. There is a sense of someone surviving sufficiently to retain the observer self, who notices the unique detail and stores it for later. 

Whether a restrained style is right for you will depend on your strengths as a writer and your subject matter. If you want to write with drama and urgency, you’ve got to read Marya Horbacher (pictured at top). She’s written two outstanding memoirs, Wasted: A Memoir of Bulimia and Anorexia and Madness: A Bipolar Life. The first details a near-fatal eating disorder that Hornbacher developed at the age of nine; the second her experience of, and coming to terms with, a severe form of bipolar disorder. Hornbacher’s work is fast-paced, highly dramatic and a miracle of immediacy. She is a lyrical writer from whom the words seem to pour. 

Hornbacher’s work is also noteworthy because, especially in Wasted, she combines an intellectual and at times scholarly approach with a highly vernacular, heightened and poetic style. A chaotic, free-for-all quality accompanies the powerful imagery and strong narrative drive.

There are occasional drawbacks to both styles. Fox has deliberately stripped emotion from her writing; Borrowed Finery  is almost an essay protesting the misery memoir genre. At the same time it occasionally becomes a little frustrating to read because you don’t get much of a back story (or a sense of Fox’s adult life – perhaps a sequel is required).

And while Hornbacher is brilliant, quixotic, un-put-downable, at times the reader feels trapped in the narrator’s hellish world and, especially in the earlier work, her self-destructive tendencies (of course, involuntarily identifying with the writer’s experience is a sign of good writing and probably what Hornbacher intended).

Neither of these memoirists is ‘wrong’. Far from it. Both have sought and found the voice that’s right for them.

Are you struggling to find your memoir voice? Which writers have helped you?

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Birthday Depression - Cured or Simply in Remission?

Three years ago I sat down to write a blog entry for Slightly Nutty. My recent birthday had been a day of dark thoughts, with a sense of underlying menace. Not because of anything that happened on the day but due to an undercurrent of feelings concerning what was then my forty-sixth birthday. I called the entry ‘Hit by pre-birthday depression’.

The response was strong. The entry became the most widely read of my entire blog, with 1,810 page views. It seems there’s a bit of a syndrome out there. A lot of people fall into a heap at this time, and then kick themselves in the guts because they feel guilty about not appreciating the efforts of friends and family to help them celebrate. Others simply feel sad because their loved ones don’t show their appreciation on the one day of the year that it matters most. Many of those who commented thanked me for sharing a common experience that doesn’t very often get an airing.

A year later I suffered a much milder bout of birthday depression and decided to record what I’d learned about the phenomenon to date. This second entry was also popular, with over 1,100 page views.

In that second entry I reluctantly gave some suggestions for dealing with birthday depression. I didn’t want to tell people what to do, or imply that they shouldn’t be feeling bad, when I knew many would already be feeling guilty. Much of the awfulness of birthday depression stems from the belief you have no right to be feeling so bad.

Well, I’ve just had another birthday. And like an eccentric doctor who operates on herself, I was curious to see how I’d go this year. It wasn’t what I expected at all.

A low-key celebration

First, I need to set the scene a bit. I have a rather fractious family. Given that we’re Irish Catholics, a group that tends to operate in closeknit clans, it’s taken me more than half my life to realise that this is an intractable situation and I don’t have to try and change it. So for the second year in a row, I chose not to spend the day with any of my four sisters. There was no acrimony. Three of them phoned me to deliver birthday greetings – I’m planning to catch up with one of them next weekend – and the other sister delivered greetings via Facebook.

So what did I do instead? I went out to lunch with a friend, to a cheap cafe in a vibrant, eclectic part of town that served the Middle Eastern food I crave (Balaclava Road East St Kilda for the Melburnites). Afterwards I had afternoon tea with my parents, who spoiled me with flowers and a very welcome monetary gift. Then I went home, answered my phone messages (which led to some cosy chats), and lounged in front of the television, alternating between watching it and reading a good book.

And guess what? I felt fine.

Why the change?

In reporting my experiences I want to make it clear that I’m not making any generalisations. The many comments I received suggested to me that the experience of birthday depression is different for each person who suffers it. ‘Depression’ is a catch-all term anyway that is often used to mean sadness or grief.

So while I would love what I say to be useful, I’m certainly not saying ‘I beat birthday depression – you can too.’ Quite the opposite: birthday depression is very common, and the only recommendations I would make is that people let themselves experience it, be nice to themselves, and take their needs into account when planning the birthday. But the mystery of why there was no birthday depression for me this year is still worth solving. Here are my theories:

Grieving in advance. Over the past few years as I’ve hit my late forties I’ve been grieving quite a bit for past mistakes and the direction my life has taken romance-wise. In the last year or so I’ve reached a much greater level of acceptance of where I’m at. Perhaps I am finally accepting ‘life on life’s terms’. (Not that I don’t get angry sometimes – I do – but for some reason the anger didn’t surface on my birthday.)

Planning the birthday to take into account my family’s shortcomings. From my years of celebrating birthdays with my siblings, I knew I’d end up feeling bitter and angry if I included them on the day. So for the second year in a row I spent the birthday without them. It was easier this year for everybody because it wasn’t a new thing. I felt not a shred of guilt. I freely admit that I’ve been lucky that my family have simply accepted this and yet were still able to wish me well on the day – not all families would be this forgiving.

Writing and sharing the experience. The experience of blogging about birthday depression and receiving so many positive responses to the entries has empowered me and given me the courage to explore the process more deeply in myself. I’m very grateful to all the people who have commented, and I sincerely hope you’ve been able to adjust your celebrations to minimise the pain.

Preparing for the feelings. I told myself it would be okay to feel sad on the day, and allowed any feelings to come up in advance.

Lowering my expectations. Just as I’ve let some of my most cherished dreams go (not completely of course – they are still there, but I accept my present) so over the past three years I’ve learned to adjust my expectations of the birthday. I plan ahead, choosing activities that are in line with where I’m at, and don’t expect the birthday to be super-fantastic. (I’ve had to learn to do this gradually – don’t feel guilty if you find this hard to do, or don’t want to.)

In fact I felt so light, cheerful and special on the day itself that the following day I found myself with a whole new phenomenon on my hands – post-birthday depression! No flowers,  birthday greetings, gifts or trips out for lunch. It was back to normality, and I didn’t like it one little bit.

Having said all that, my fiftieth is coming up next year, and if I don’t experience a new round of wailing and gnashing of teeth on the day and in the lead-up to it, I’ll be quite surprised. But at least I have a whole year in which to farewell my forties.

Please note: if you're suffering ongoing depression then you may need to speak to a professional. These words are no substitute for medical advice - please seek help if you need to.

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The Tyranny of the List: How to Break Free of Your ‘To Do’ List

Lists are great things. They help give us focus and remind us of things we need to do. They’re essential in most work situations. They’re useful for remembering to buy a present or ring someone, keeping appointments, getting what you need at the supermarket, and completing an urgent admin task to avoid getting fined or penalised. And they’re absolutely indispensible in goal setting. They can also be important for people suffering depression or struggling to fill unstructured time.

But.

Every now and then they need to be ditched. I’ve discovered that letting myself off the ‘list-leash’ on a regular basis can be a good thing, even if it’s just temporary. If you’re fond of lists, or you want to become more spontaneous, it could be a worthwhile exercise to have a list ‘holiday’, no matter how short. (If you’re a bit chaotic and just starting to use lists to get more focused, it’s probably not a good idea – yet.)

Not that it’s easy. Truth to tell I’m addicted to lists, especially the daily ‘to do’ list. Writing the list and then ticking the items off once I’ve completed them gives me a sense of comfort, security and achievement. Perhaps you’re the same. Sometimes not doing something that we strongly believe we need to do right away, even if intuition is telling us to leave it for now, can be excruciating.

And that’s part of the problem.

Over the last two decades or so I’ve worked very hard to develop and trust my intuition. One of the reasons for this is my tendency to behave in quite compulsive, driven ways. Many of my actions over the years resulted in putting much energy into particular aims, goals or activities that weren’t right for me.  All too often the form – getting something done and ticking it off – was more important than the worth (and sometimes timing) of the behaviour. I would complete a task or work towards a goal in a bloody-minded way, while completely failing to listen to the faint intimations within that were gently telling me what I really needed to be doing at that particular time.

I’m now much more intuitive, but this ability has been hard won (wish I’d learned it when I was a young ’un!).

In the past six months or so I’ve noticed that, especially where the weekend is concerned, I  write my ‘to do’ list and then often partially, and sometimes completely, ignore it. That’s because my intuition is telling me to do something completely different. I might end up sprawled on the carpet watching DVDs on a Saturday afternoon instead of mopping the floor, or staying home and writing instead of meeting up with a friend (or the opposite).

The results have been fascinating. When I ignore the list, I follow my energy, and yet things still get done, although not always in the timeframe I’d envisaged. When the right time to mop the floor comes, the energy is magically there to do it. Or suddenly I might get the urge to do some yoga in the lounge room instead of having to force myself. And after my slothful afternoon watching DVDs, hey presto! I’m recharged and ready to face the world again.

 What if you procrastinate?

There’s  a really important caveat here. Following your energy isn’t the same as procrastinating. I may still not want to mop the floor (in fact I never do; it’s the domestic task I hate the most, with cleaning the bath coming a close second). But the energy is there once I start, and the task is done in an optimum way.  If you’re trying to overcome procrastination it may be a challenge to ditch a  ‘to do’ list, but it could still be a worthwhile experiment.

On the other hand, list-ditching can sometimes help with procrastination. Imagine you’ve been planning to get a Twitter account. You’ve been putting it off because you assume it’s going to be difficult and complicated, and the more you think about it the more trouble it seems. Then one day when you’re being spontaneous your energy leads you to Twitter and before you know it, you’ve signed up. Spontaneity can help ditch the overthinking that can lead us to put things off.

None of us has unlimited energy or time. We’re all trying to juggle various roles, interests and activities. When I trust my energy and  throw the list away, even for a short while, I find I get a surprising amount done with less effort.

I don’t want to make out that I’m some sort of spontaneity saint. Quite the opposite. In fact at the moment I’m itching to update my long-range goal list; I’ve let this go for a while and I’m really feeling the need to have that structure again.

But even when I give myself the safety and structure of a list, whether it’s a daily or long-range one  – and as I’ve said, I need daily lists during the week – there’s flexibility in it. If something doesn’t feel right to do at a particular time, I won’t do it. Sometimes it may feel right to do at a later time, and sometimes not at all. I still keep my A4-sized  diary open on my desk, reminding me of any appointments or particularly urgent tasks.

Ditching the list can be especially valuable for creativity. We all know that the muse doesn’t turn up at scheduled times (although self-discipline encourages it to do so – that’s a separate topic). Being willing to drop everything and write a book chapter, complete a sketch or strum the guitar for half an hour means you make the most of your creative energy.

An exercise for the list-addicted

If you’d like to be more spontaneous, you could experiment with ditching your ‘to do’ list, but you don’t have to go all the way.

One option is to write your daily list and then simply give yourself permission to ignore it if necessary. Try doing one or two things on the list, and see how that feels. (Better still, write your list slowly and intuitively - you may be surprised at some of the items you end up with!)

Another option is to give up the list for, say, a few hours. Write it, but give yourself a few hours off, or don’t write it at all until halfway through the day.

The more daring option is to have an entire list-free day – scary but fun! Enjoy the ride!

I’d love to hear about where you are with  ‘to do’ lists – whether you’d like to become more disciplined with using them, or are trying to be a bit more spontaneous.

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