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.

Tweet

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.

Tweet

Killing Your Darlings: How to Delete Material from a Manuscript without Tears

When you’re working on an extended piece of writing, whether it’s a novel, memoir or other form of non-fiction, editing is one of the most important and painful tasks. Hard as it is to face, much of what we write has to be ultimately turfed, chucked out, trashed. Whatever word you use, it’s all the same – it won’t belong in the piece. It will interrupt the flow, confound the narrative, or have the wrong tone.

Information on the practical aspects of editing your work is widely available, but it doesn’t make the emotional part any easier. Knowing a piece of copy isn’t right doesn’t make it any easier to cut out.

But it’s not all bad news. You don’t actually have to trash what doesn’t belong. In fact, there are many options for putting it to a completely new use. Below are some suggestions.

Store deleted text in a separate file. Don’t simply delete the text you need to discard. Create a file with a name that makes it easily identifiable, eg ‘Copy deleted from memoir’. Cut and paste any deleted copy into that, separating each piece of text with a line break. Even if you never use the copy, you’ll have a record of it. In the case of a memoir, you’ll retain scenes that have emotional resonance for you. View these scenes as the textual equivalent of the deleted movie scenes sometimes included on DVDs as extras – worthwhile revisiting for their own sake.

Make different versions of your manuscript. If you complete a draft of your manuscript before making major structural changes, you’ll probably have a strong level of emotional involvement with the earlier draft. In the case of a memoir this may be particularly strong because the earlier draft may include more information about your life, and what made you the person you became, than the later one. Retain two versions of the manuscript: the long version and the edited version. Publish the shorter version to rave reviews(!) and keep the long version as a record for your personal archive.

Repurpose text to create a new piece of writing. Deleted copy could become the basis for a new story, article, poem, play or blog entry, or perhaps a whole book!

A description of an eccentric relative or a significant trip could become the basis for an article that is published in a newspaper, magazine or journal, whether in hard copy or online. (This could be used as valuable publicity for your published book, as the bio that would accompany your piece would mention your book).

A descriptive line from a novel could become the inspiration for a poem.

A real-life incident that had to be cut from a memoir could become the basis for a short story, play or novel.

Alternatively, it might be the starting-point for a second memoir dealing with aspects of your life the first one didn’t. Augusten Burroughs, the acclaimed author of Running with Scissors, has now written a total of six memoirs, including three collections of stories from his life. Kathryn Harrison, author of acclaimed memoir The Kiss, has completed three memoirs and a book that is a combination of memoir and travelogue. (She has also published six novels, some of which deal with the lives of her maternal grandparents.)

Condense the copy and use it somewhere else. You don’t always have to explain everything in detail. Sometimes a paragraph or scene contains information that has value for readers but could be expressed more succinctly. My memoir originally included a scene in which my sister and I were taunted by a group of non-Catholic schoolchildren on the way to school. I deleted the scene because it wasn’t pivotal and made the memoir too lengthy, but its emotional import remains in the line ‘Would they laugh in my face when I cried, like the state school kids laughed?’

Describe your experiences of editing when you publicise your book. Readers are fascinated with the process of constructing an extended piece of writing. As well as the technical aspects, they’re curious about the emotional ups and downs that come with the territory, and the ways in which the writing impacts on real life. If you’re giving author talks to publicise your book, discussing what you took out (or left out) of your book and why, and the process of editing in general, can be rewarding for readers. It can also be the basis of an article itself – as this blog entry testifies!

Tweet

Is Personality Destiny? The Evolution of Personality Disorder in Mental Health

The term ‘personality disorder’ has an ominous ring. It calls up images of white-coated psychiatrists scribbling on clipboards as they probe young men in straitjackets, or a crazed commuter jumping out of his vehicle to smash an offending driver’s windscreen with a steering lock.

Perhaps that’s why despite all the public debate about anxiety disorders, depression and the need for better mental health services, the term rarely gets an airing in the media – except when describing a nasty crime, or the rise of the corporate psychopath.

But it seems to me that if you’ve got any sort of mental illness, an accompanying personality disorder, even a minor one, can play a huge role in how successfully you manage it – and your life in general. Personality disorders strike at the very heart of who we are, and can profoundly affect our career and romantic destinies.

Yet personality disorders remain underdiagnosed and untreated.

More than 1 in 10 of us may have one, according to Professor Eddie Kane from the UK’s Institute of Mental Health. He estimates the rate of personality disorder in the community to be somewhere between 4 and 13 per cent.

And mental disorders don’t conveniently travel alone. According to the 2007 Australian National Survey of Mental Health and Wellbeing, about 25 per cent of people with mental disorders were found to have two or more classes of disorder.

To make matters more complicated, the difference between an anxiety disorder and a personality disorder is not as clear cut as you might think. Proneness to anxiety is actually a character trait in some personality disorders.

What about the poor sods who suffer both anxiety disorders and some degree of personality disorder? (I’m one of them.) Do they cancel each other out? Hardly. I’m too socially phobic to open my mouth in some situations but when I do, I have to watch those nasty personality quirks that are lurking, waiting to come out.

Thankfully, the categorisation of personality disorders is currently undergoing revision to reflect the complexity of human behaviour.

What is personality disorder?

The UK National Health Service defines a personality disorder in the following way:

Personality disorders are mental health conditions that affect how people manage their feelings and how they relate to other people.

 Disturbances of feeling and distorted beliefs about other people can lead to odd behaviour, which can be distressing and which other people may find upsetting.

People with a personality disorder are said to respond in a habitual way to life’s problems, regardless of how dysfunctional the response is. They do this to a degree that damages their relationships with family members, friends, and coworkers. Both genetics and upbringing are involved.

Personality disorders are said to differ from anxiety disorders, or more traditionally neuroses, because the sufferer is supposed to identify with the behaviour and have no interest in changing it – that is, the behaviour becomes ‘ego syntonic’.

The assumption is that the sufferer doesn’t think there is anything wrong with their behaviour, but believes the world is to blame; they won’t seek help without outside pressure, or perhaps will seek it only when their life is inexplicably not working out for them. This is the truism offered by the MerkOnline Medical Manual:

People with a personality disorder are unaware that their thought or behavior patterns are inappropriate; thus, they tend not to seek help on their own.

This suggests that those with personality disorders project the disordered parts of themselves onto the world, rather than internalising them. This may often be the case, particularly for, say, a narcissistic personality disorder. But it also implies that as soon as someone with a personality disorder gains insight into their problem it is, by definition, no longer a personality disorder!

Perhaps it would be more accurate to say that the behaviour is so familiar and comfortable that it seems like second nature. Someone who has avoidant personality disorder will feel more comfortable avoiding people but may feel unhappy enough with the consequences to seek help.

I’d always thought that those with personality disorders but not anxiety disorders were more able to operate in the world compared with anxiety and phobia sufferers because they made life more difficult for everyone else rather than turning against themselves, but this doesn’t seem to be true at all. The Merck Manual states that:

Regardless of their usual style … mentally healthy people are likely to try an alternative approach if their first response is ineffective. In contrast, people with a personality disorder are rigid and tend to respond inappropriately to problems.

Perhaps the degree of functionality depends on the severity of the disorder. One of my relatives is unbearably narcissistic, with an overbearing manner and a strong sense of her own superiority. She’s been causing angst for her family for decades now, and had a detrimental effect on my own childhood. Yet she functions capably at work, maintains friendships, and would not dream of seeking professional help in a million years. A major part of the problem is the collusion of her friends and siblings – no one has dared to challenge her over the years, preferring to bitch behind her back instead.

Yet her disorder has caused her some unhappiness. She’s never had a partner, and is constantly feeling let down by people whose behaviour doesn’t conform to her expectations.

Similarly, certain kinds of social organisations and social positions actually encourage and prop up certain disorders, rewarding social dysfunction but enabling the retention of power and position. Thus, patriarchy may encourage narcissism in some men; certainly any degree of celebrity does, in both sexes.

Latest personality disorder definitions

The standard text for identification of mental disorders is the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. The current edition is DSM-IV; DSM-V is due for publication in May 2013.

DSM-IV identifies 10 main categories of personality disorder and places them in three clusters.

Cluster A (odd or eccentric)
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

Cluster B (dramatic, emotional, or erratic)
Antisocial personality disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder

Cluster C (anxious or fearful)
Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder

It also identifies an additional four disorders, placing them in a ‘personality disorder not otherwise specified’ category. These are:

Sadistic personality disorder
Self-defeating personality disorder
Depressive personality disorder
Passive aggressive personality disorder.

In DSM-IV, all these disorders have ‘subtypes’. This suggests that the overarching labels may be too simplistic. It would probably be more useful to talk about a finite number of tendencies, behaviours and traits that cause problems if taken to an extreme, and to acknowledge that any combination of these traits, in different strengths, is possible.

DSM-V seems more aware of these nuances and has a more sophisticated approach to personality disorders.

Now there are only seven categorised disorders. Allied to these are five personality trait ‘domains’, with each one broken down into its own set of ‘trait facets’, 25 in all. The wording acknowledges the grey areas: ‘domains’ and ‘facets’ suggests far less rigidity than ‘type’. The seven disorders are:

Borderline
Obsessive-Compulsive
Avoidant
Schizotypal
Antisocial
Narcissistic
Personality Disorder Trait Specified

Five broad personality trait domains are defined, and within these, various trait facets. The trait domains are:

negative affectivity
detachment
 antagonism
disinhibition vs compulsivity
psychoticism

This presents much more flexibility when treating someone who may not be sufficiently pathological to be diagnosed as having a full-blown personality disorder – it’s now possible to have a bit of this and a bit of that. The new schema also allows clinicians to ‘describe the personality characteristics of all patients’. In other words, it’s not exclusively about pathology any more.

This blog entry describes some of the implications of the changes.

This kind of mapping could be very useful. Potentially it could enable treatment protocols and options for tendencies rather than illnesses.

Wouldn’t it be great if every patient was given a personality map showing particular traits that were too pronounced for good mental health, and was then given individualised treatment for dealing with those various traits. If I have a touch of narcissism, there should be behavioural and mental exercises I can do to reduce its effects.

Psychiatric labels – good or bad?

These days there’s a tendency to label an increasing number of human emotions and characteristics as disorders, and it’s just as popular to attack this practice. Grief is an obvious example; a proposal to make it a disorder in DSM-V is causing much controversy.

Abhorrence of such labelling isn’t surprising. Whenever a new malady is created, whether physical or psychiatric, there’s a strong chance of finding the grubby paw prints of the pharmaceutical industry somewhere in its conception, eager to flog a drug to treat it. The industry is often accused of inventing diseases to sell drugs.

As well, once you whack a label on someone, the label then affects how they see themselves and how others see them. I’ve written on this blog about an unfortunate experience I had with a psychiatrist who was determined to diagnose me as an ADD sufferer, and wanted to drug me with dexamphetamine.

Can psychiatric labels be empowering?

 Despite these risks, I still believe that identifying and coming to terms with conditions and tendencies is a necessary first step to effectively managing them. If a doctor is scared to pin labels onto her patients she may be reluctant to look out for all the pathologies that dog them. Once you have a label that you’re ‘happy’ with, it’s up to you to find the treatment that most suits you. And whether that includes pharmaceutical drugs is up to you.

Sandy Jeffs is an advocate for sufferers of schizophrenia who has written a memoir about her condition. She refuses to call herself a schizophrenic, instead describing herself as someone who suffers from schizophrenia. She’s not defined by the label; she uses it simply to identify the nature of her suffering.

Effective criminology also relies on labels. The importance of psychological profiling for crime solving is highlighted in Erased: Missing Women, Murdered Wives by Marilee Strong. This confronting book investigates a particular type of murderer, the eraser killer. The author, not a criminologist but an experienced crime and social issues reporter, suggests a new kind of profile for a certain form of intimate partner killing, very different from the traditional domestic violence perpetrator, who kills in anger and feel remorse afterwards. According to Strong, these men are not the wildly impulsive serial killers of popular imagination; instead, it’s their unique combination of disorders – excessive narcissism and Machiavellianism with a degree of sociopathy – that enables them to kill wives and girlfriends when they become inconvenient.

The reason this knowledge is so important is the same reason it’s so unpalatable. The thought that murderers are not monsters but human beings with extreme version of normal human traits, existing in particularly destructive combinations, makes it difficult to ‘other’ them – there but for the grace of God go we. These killers are not inhuman – on the contrary, they’re all too human.

Yet this degree of knowledge also raises the possibility of prevention through early intervention, social supports, and parenting training. It begs the questions: what style of parenting might produce such a combination of traits, and what styles of parenting would prevent them?

The perfect therapy

Imagine if every consulting psychiatrist and clinical psychologist provided a comprehensive diagnosis for their patients, possibly assisted by brain imaging. This could include a list of all anxiety disorders, including low-level conditions, and personality traits, with traits at a pathological level listed separately.

The therapist would then provide an outline of an individualised treatment plan. This could include acceptance and commitment therapy, exposure therapy and traditional CBT, as well as development of life skills and social skills. The various treatment options would require the patient to undertake various exercises. In some cases drugs might be involved, but not necessarily.

The perfect therapy would include a long-term relationship with a trusted therapist. In a recent Radio National program on self-harm, one sufferer spoke of the slowness of her recovery, hampered by the fact that her therapists were always moving on. Now she's seeing someone she trusts and her need to self-harm is reducing.

A lot of work and public money perhaps. But in the long run it would save money by producing happier and more functional people. And needless to say it would improve the quality of life of not just the sufferers of mental illness but their families.

Tweet

Looking for Alternative Sources of Sustainable Energy? Try a Menopausal Woman

Picture: Retro Adverto

I’m going through it. It’s got me. It seemed as if I’d only just completed my second adolescence when it struck.

It was perimenopause for a while, a long while. Sleeping badly. Thinning skin and other signs of ageing. The onset of tinnitus, rosacea and a worsening of allergy symptoms. Losing more hair than usual with each wash, and constantly finding stray hairs on every household surface. Terrible PMT but longer and longer gaps between periods. Then my cycle seemed to have packed up and called it a day, and instead all the blood went to my head.

I didn’t mind the first set of hot flushes. I just found them weird and disorientating. The flush seemed like some strange form of energy, some odd kind of bodily weather, that started in my chest and literally moved up my body, expelling itself in a facial heat wave. As if I was suffering a kind of automatically induced induced embarrassment. Set and forget.

But then my periods started again, and the PMT was truly awful, starting about nine days before the onset, manifesting in heightened anxiety and reduced sleep, with extreme fatigue just beforehand.

Then the periods stopped and the flushes started again, as if my body couldn’t decide whether or not it wanted to end my child-bearing capacities. This is where I’m at right now. And this time, I don’t like the species of hot flush at all. It engulfs me quickly, fills the upper part of my body with heat, then drops me like a hot potato, going away somewhere to plot its imminent return. I’m left not only wildly throwing my outer garments off in an attempt to cool down (I can deal with that) but uncomfortably sweaty. I wish I could store some of this heat and use it to warm my house in the mornings.

Through all these changes, and starting from perimenopause, an increased level of body- and self-consciousness has manifested. No one warned me that my anxiety, already unmanageable, was going to get worse. That every bodily perception would be heightened and every fear increased. Menopause is like adolescence without the good looks and sexual opportunities.

Sorry to bore you with these details, but I can see why menopause has a bad name. The symptoms become tedious not only to those suffering them but to their partners and families. The awful thing is, you have no idea how long it’s all going to go on for. At least the progress of adolescence is entirely predictable – pimply and pained followed by lissome and love-hungry followed by substance-abusing and driving homicidally followed by reluctantly growing up. But how long will this transition take? And what will the new me look and feel like at the end of it?

Pharmaceutical help?

I have considered HRT, but I foresee many problems with it. 

I’m not worried about the increased risk of breast cancer, heart disease and stroke that was reported in a large and controversial 2002 study on the effects of HRT use. The study has since been discredited because the women who took part in in were older when first put on HRT than the optimum age of commencing, and because of dosage issues. Anyway, I’m on a strict allergy diet, don’t drink or smoke, have low blood pressure and no family history of breast cancer so am probably in a low-risk group.

It’s more the cosmetic side effects of HRT that concern me. As someone with body image issues, I’m not sure I want to risk the facial breakouts that are one possibility (confusingly, HRT can sometimes clear the acne that perimenopause produces). I shouldn't let this put me off, however, as I can always try an alternative medication if the first one isn't right for me. The possible weight gain wouldn’t bother me – I could do with some extra weight.

On the other hand, the protection from osteoporosis that synethetic oestrogen offers could end up being crucial to my future health. A few years ago my mother developed  osteoporosis  in a way that was both sudden and disabling, as well as incredibly unfair – she'd been eating yoghurt regularly for years, and her GP worked in an expensive practice that prided itself on its preventative care. As someone who rarely eats dairy, I need all the protection from brittle bones that I can get.

An upside of menopause?

I know there are women who want to reclaim menopause as a time of personal power, creativity and freedom. Certainly as a feminist I want those going through it to be supported rather than denigrated, and given a range of effective treatment options. And I don’t want to exaggerate its ill effects. I’m no vaguer than usual and while I’m sleeping less, I rarely lie awake trying to get to sleep – it’s waking too early that’s the problem. Also, oddly enough for such a low-energy person, I’m surprised at how much energy I have, during the day at least. I get up as early as 5.30 in the morning and work away at the PC for hours (although I do tend to collapse into a stupor of exhaustion early in the evening). And apparently women who experience hot flashes early on in menopause are actually at lower risk of heart disease and stroke.

But the bodily changes lead to difficult emotional reckonings. Women, it's said, are more grounded than men because our reproductive cycle never lets us forget that we are embodied beings whose lives are at least partly determined by biology. While we can make lifestyle decisions that influence our health, we are to some extent the playthings of an impersonal force that has far larger ends in mind than our individual health and wellbeing. Menopause is a bodily reminder of a specific kind: that reproductive life is at an end, and old age looms. I’m fine with not having had  kids, but in the years to come sex and relationships will be complicated by further bodily changes. And that part of my life is difficult enough for me already. In a way, menopausal women are reaching the pointy end of the life cycle.

But this forced change is part of an even larger story than the end of the possibility of motherhood and challenges to sexual fulfillment. In menopause, whether we like it or not, the force that is ageing our bodies has as its ultimate aim for us that great taboo of Western culture: death. It's an eventuality that  our consumer culture, obsessed with youth and endless novelty, fails to prepare us for.

To make things even more difficult, the timing of menopause means that it frequently coincides with a number of other life crises and losses. I’m currently coming to terms with the facts of parental illness, which I’ll write about in a future post.

Someone once said old age wasn’t for the faint hearted. I think the reckoning comes much earlier. As we face our fifties, we’re forced to jettison the illusions we had about life in our earlier years. We’re also challenged to take control of our health and make decisions about how we can minimise problems in years to come (something I’m signally failing to do at the moment).

It’s not an easy time by any stretch, but it can produce a great deal of strength and resilience. Without illusions, it’s possible to appreciate the present and enjoy life for what it is, rather than what we’d like it to be. It's possible, too, to make lifestyle choices that at least swing the odds into our favour where future mental and physical health is concerned. Accommodation to reality, while not succumbing to negativity – that’s my major challenge now, and it will remain so in the years to come.

If you enjoyed this entry, you might also like Vein Hopes.

Tweet

Haunted by the Ghosts of Memory: Is Memoir Writing Good Therapy?

Photo by Harmony and Home

Can writing a memoir actually help heal a painful past? Is it therapeutic, or does it simply provoke bitter memories and angry ghosts that are better left alone? Like an explorer returning exhausted but triumphant from a gruelling journey, full of information about the terrain she’s traversed, I can assure you that the psychic knowledge that results from memoir writing is well worth the effort.

But there is a catch. If you want your writing to come alive, you'll need to revisit the raw trauma of the original pain, and risk being seared and burned by it once more.

To write a memoir that I considered worthwhile, I had to relive painful experiences and periods. I was aiming for a sensual, immediate tone that strongly evoked each episode (I’m not saying I achieved that – just that I tried). So I plunged myself back into each stinging memory, and consciously tried to recall exactly how it felt to be in that situation at the time.

Not an exercise for the fainthearted.

That goes for particular episodes. But what happens when you’re writing about a significant period of your life for a matter of weeks and even months? When I was 20 I moved into a share house in the inner-city suburb of Fitzroy that was opposite an estate of high-rise public housing flats. This was way before Fitzroy’s gentrification and the culture shock was immense, not only in regard to the geography but to the lifestyles of my lefty housemates. I soon developed a crush on one of them, and the intensity of those feelings is inseparable from the bohemian romanticism of the shabby iron-laced terrace we inhabited.

While I was writing the scenes set in my Fitzroy abode, I felt haunted. I was living in two eras at once, the present and the early 1980s, and two places at once, the terrace house and my current flat. The contrast between my past and present lifestyle, combined with strong feelings of connectedness with people I hadn’t seen for more than 25 years, was profoundly disorientating. I was surrounded by ghosts who would not let me go. Perhaps – and here’s the kicker – I was releasing feelings for them that I hadn’t felt secure enough to fully experience (let alone express)  at the time.

When you’re going through something like that it can feel as if it will never end. You wonder if you’ll be permanently trapped in an emotional time warp. But it does pass. Not that the feelings don’t come up again every now and again – I believe now that if a traumatic experience is sufficiently intense it creates its own momentum in the psyche, and complete freedom from it may never be possible. But for me at least the intensity is now far less, and I’m a freer human being through having released those pent-up emotions.

Not only that, but in a strange way you may gain a stronger relationship with yourself. I know myself better now. I’m Adrienne McGill who experienced certain very human emotions at a particular time, not simply Adrienne McGill who went into meltdown when she moved out of home for the first time. I’ve become better acquainted with the non-pathological aspects of my younger self; it’s like meeting a scary stranger who is much less frightening once you get to know them.

Memoir writing and forgiveness

Sometimes writing the memoir involved not just reliving old emotions, but experiencing difficult new ones. A memoir forces you to examine your personal journey with a keen and bloodless eye. While you're working out what really happened, no one can be allowed to get off the hook.

So, not the most forgiving daughter at the best of times, I was faced with powerful anger as I put together the jigsaw puzzle picture of my life. The mistakes my parents made were routine rather than extreme, but they sometimes had profound effects. For much of the time of writing I was furious with both of them in a way I hadn’t been before, but particularly so with my mother.

But understanding something cognitively ultimately allows you to move beyond it. Discovering something new about the reasons for a pathology makes you realise that your brain is much more adaptable and creative than you'd given it credit for. You begin to perceive the perverse rationality of your dysfunction, to view it as a logical reaction to circumstances. Aha you say, this is why I closed up, or this is why I acted out. You gain more compassion for yourself.

You may also end up with compassion for the authority figures that once oppressed you. It took me a long time to escape from the deep well of anger for my mother that I was thrown into. I was angry with her even before I started writing the memoir and, in the way described above, my anger intensified while writing it. I’ll never completely lose the anger, but it has now substantially subsided.

This is partly because however egregious my mum’s perceived failures, writing about her has forced me to see her as a separate human being with a life independent of me, and her own story of parental failure. (Making me less narcissistic in the process.)

But it’s also because I now own my own story. I’ve set it out, and my mother’s an important part of it, and I’ve told what I believe to be the truth about our relationship. I’m somehow freed by the fact that the story of me and her is now on the public record. And this is not dependent on some kind of public naming and shaming – it’s all been done very discreetly.

This greater ability to distinguish my identity from hers makes it possible for me to go forward with the understanding and knowledge that I don’t have to live my life as an endless response to our story and relationship. Instead, I can live my life with courage, stretching myself and fulfilling the potential of the creativity that was buried so long under neurosis.

Publishing a book can give you a stronger sense of self regardless of whether it's about your own life. Completing my first book, which was about shopping, and having it out in the public realm helped me start to separate from my family. The memoir has boosted this process simply by being another book, but its subject matter has also helped to free me from the psychoanalytic aspects of my background. I’m now an author with my name on the cover of three books (even if it’s a pseudonym for two of them). I can begin to stop hoping that my family will one day be what I want them to be, and instead get on with being the person that I am.

If you enjoyed this blog entry, you might also like You Must Remember This.

Tweet

Body Dysmorphic Disorder and the Sins of the Camera

I have a mild verson of body dysmorphic disorder. I impose impossibly high standards on my attractiveness and then feel dismayed and inadequate when I can’t meet those standards. It’s a mean way to live, to judge myself so harshly.

I’ve never been diagnosed with BDD, and its arrival in my life was subtle – it never really felt like a new disorder, more like another outlet for my existing obsessiveness.

Most of the time I’m okay with my appearance these days, but every now and then something happens that throws me completely off kilter.

Given that BDD is related to OCD, I imagine one treatment would be exposure therapy based on getting used to the sufferer's own appearance. In the case of ageing, this exposure would need to be constant: our faces regularly show small alterations as we age, alterations that would be imperceptible to the average person but can spell doom to the BDD afflicted.

This is disconcerting, but I’ve learned to cope. I can now adjust my expectations each time there’s some slight change in my actual appearance. I’ve learned to accept and live with many changes  in recent years and I’m confident I can keep doing this.

Photos of me present an additional problem: I have the sort of bone structure that doesn’t flatten well into the two-dimensional image. This means that the face that I’m familiar with simply doesn’t translate to a photo. I look different in the mirror from how I look in a pic.

Just as I’ve gotten used to my changing appearance in real life, I’ve resigned myself to the fact that photos of me will not look like the image I see when I look in the mirror. I don’t like this state of affairs, but I can live with it.

This shouldn’t matter. Photos are an important means of recording our lives for ourselves, friends and family as well as posterity. Even if we personally let down by them (as I do), avoiding the camera isn’t the answer.

But flash photography represents another degree of foreignness altogether.

The other night I was planning to spend the evening at a friend’s place, and I asked him if he’d mind taking some photos of me for my business website. The photo that’s currently on the site is two and a half years old. I’ve kept it on the site that long not just because it shows a younger version of me but because it’s a good photo – and I’m not the most photogenic person in the world.

Because it was evening, my friend took the photos using flash. The result? Pictures that were so at odds with my actual appearance that they gave me a distinct downer. I looked like a ghost, incredibly gaunt and with dark shadows under my eyes.

I don’t think I’m being overly critical here. I think the camera is! Now I've reached my late forties the camera's two-dimensional images are harsher than they've ever been, and flash photography increases the disparity between the real me and the photographic one.

So the question is: now that I know flash photos show a ghostly avatar that bears little resemblance to the real me, what should my response be? Should I gradually expose myself to these images for longer and longer periods of time so that they eventually lose their ability to discombobulate? Or should I avoid flash photography like a vampire avoids the light?

Tweet