Wednesday, 26 August 2020

Waiting for Fran: A Few Thoughts on Expectation and Boundaries

Originally written December 2012.

Last night I was waiting for Fran to get home and come online for our call. She messaged to say she was home and was just going to send her friend a birthday message. I was happy to hear that and figured she wouldn’t be long. Then she messaged to say she was going to check my Facebook wall.

I started getting impatient. Couldn’t she come on webcam with me while she did that? I put some gentle music on and did some meditative breathing while I waited.

Fran finally called at 11:30. She was thirty minutes “late”. The first thing she said was that she had found the “Two minutes of calm” video I’d posted on Facebook and had meditated to that. I was cross, because I’d thought we could have done that together (which we did, later, once I’d regained my composure).

Part of me recognised that, of course, Fran is free to do whatever she wants. She’d been out all day and must have wanted a little space to herself before meeting with me. But another part of me was sorely aggrieved. Surely she knew I was waiting and was eager to see her. It was a classic pouty moment!

It didn’t last very long. Fran was great with me. She allowed me to acknowledge what I was feeling until I was ready to let go of it. THAT is why we work so well together. We understand how these things work.

The day before, she was uptight about not having heard back from her friend about accommodation for their Barcelona trip. On that occasion I gave her space to express what she was feeling, to let it out so she was ready later to sort things out with her friend. It’s what we do.

Thinking about all that leads to something really important: the changes the well one goes through as the ill one moves towards wellness. The shifts in role. The sense of being abandoned or left behind; that all this care has been given and what is the caregiver going to get back in return? I remember Fran telling me of cases where the person with illness (cancer, I think) had really strong/bad reactions from their carers or partners as they moved towards wellness and the balance shifted.

It fits with what happened last night. I was frustrated because Fran didn’t seem as keen to be online with me as I was. In fact, she was taking care of herself and paying attention to what she needed, in a very healthy way.

I’m proud of her for doing that. I’m proud of us both.

 

Photo by Nordwood Themes on Unsplash.

Wednesday, 19 August 2020

Three Things I've Learned About Mental Health Medication

Following on from my article Three Things I Wish People Knew about Loving Someone with Mental Illness I want to share a few things I’ve learned about mental health medication. First, a disclaimer. I have no first-hand experience of taking mental health medication. What I’ve learned comes from my nine-year friendship with Fran and from other close friends.

My loved ones live with a variety of mental health conditions and symptoms including anxiety, bipolar disorder, borderline personality disorder (BPD), depression, visual and auditory hallucinations, suicidal thinking, and self-harm. Some live with more than one of these. Several also have physical health conditions to deal with, including chronic fatigue syndrome (CFS/ME), type 1 diabetes, fibromyalgia, hearing loss, visual impairment, and chronic obstructive pulmonary disease (COPD).

Despite their different conditions and histories, my friends have many experiences and approaches in common when it comes to medication. I’ve chosen three — compliance, weight gain, and vigilance — which seem particularly important from my perspective as a caring friend.

A Commitment to Compliance

Compliance (sometimes called adherence or capacitance) is the degree to which someone follows medical advice. It usually refers to medication (“taking your meds”) but it can apply to other things such as using medical devices, self-care, or attending and engaging with therapy. My friends all follow their prescribing clinicians’ instructions closely and rarely if ever miss a dose. If they do, it’s through a lapse of attention or because of a change in routine. Fran sometimes asks me to remind her about her meds when she is away from home, for example, and we double check she has all her medication before she travels.

My friends rightly consider themselves experts in their lives and how illness and medications affect them. They also respect the professionals involved in their care, although they may disagree with them at times. Fran has sought second opinions in the past, for example. As one friend said to me recently, “They’re the ones who have studied for years!” That respect comes easiest when the professionals — be they clinicians, psychiatrists, therapists, doctors, nurses, case managers, or other mental health workers — are open to the opinions, experiences, needs, and fears of those they are charged with supporting.

It took Fran many years to arrive at a set of meds which, by and large, allows her to maintain her stability without too many side effects. Some struggle to find that balance or are still on the road towards it. I can only imagine — and commend — the determination it takes to persevere, day after day, month after month with regimes of medication, often coupled with other treatments and therapies, with little success to show for it, whilst often enduring the most horrendous side effects.

I would never judge someone who is unable or unwilling to pursue a particular treatment regime if it proves unworkable or unendurable. Indeed, it should be part of their dialogue with their prescribing clinician. But the consistent message from those I know best is that a commitment to compliance is the straightest path to stability and wellness.

Weight Gain

Amongst the varied side effects of psychoactive medication, weight gain is one of the most common, least understood, and hardest to manage. In our book High Tide, Low Tide Fran and I discuss her struggles with weight, body image, and her relationship with food. Before we met I little understood how hard it can be to unpick the complex knot of interdependencies and make meaningful and lasting changes.

It’s a simple fact that many meds prescribed for mental health conditions lead to increased weight. The mechanisms are not fully understood but I don’t need to understand how it happens to know that it does. Fran and I have seen it with her weight over the years we have been friends. Almost every change in medication has led to a weight increase which has been incredibly hard to counter. I hear similar tales from other friends.

Weight gain is not a trivial or benign side effect. It can have serious physical repercussions and its effects on mood, self-esteem, confidence, and relationships cannot — and must not — be ignored. They can too readily lead to depression, despair, and suicidality. As one friend said to me recently:

My choice shouldn’t be sane and fat or skinny and fucking nuts. How many regular people would consider it and how many psychiatrists would put up with it? Being fat is a whole different stress emotionally and socially. It’s social suicide in many ways. Weight gain makes me very depressed. My mind is heavily weighed down by my thoughts as it is. When you add physical weight into the mix, everything feels heavier.

Ongoing Vigilance

Managing mental health conditions is a dynamic act akin to juggling, or keeping a set of dinner plates spinning. What balls or plates am I talking about? It depends on the person, their life experience, and underlying health conditions, but here are a few things Fran is juggling on a more or less constant basis:

  • Mental health (depression, mania, agitation, anxiety, suicidality).
  • Physical health (fatigue, pain, insomnia).
  • Activity, energy, and rest.
  • Weight, eating, and drinking.
  • Relationships (family and friends).

Each of these requires her attention and ongoing adjustments to keep everything from crashing to the ground. To hijack the familiar saying, the price of wellbeing is eternal vigilance.

Meds are meant to be stabilising but they often introduce new instabilities which themselves need to be managed. Even when things seem stable there is a need for vigilance. It’s the clinician’s responsibility to diagnose and prescribe but no one knows better than the person with illness what they need and are experiencing. For example, Fran can make temporary preapproved adjustments to her medication if she detects the onset of mania. If symptoms persist or worsen she will make an appointment to see her psychiatrist. Another friend recently experienced symptoms of anxiety for which she has been treated in the past. Recognising the dangers she consulted her prescribing clinician to ask if a meds adjustment might be appropriate.

A different friend’s pharmacy stopped dispensing one medication altogether. This wasn’t spotted for some weeks, during which my friend’s stability and safety were severely compromised. It was an error with potentially serious repercussions. Even after the mistake was corrected it took time to restore the full protective benefits of the medication. It’s fair to say my friend will pay very close attention from now on to what is dispensed. It’s also important to keep an eye on — and seek appropriate treatment for — physical symptoms such as insomnia, fatigue, and chronic or extreme pain because these can significantly affect a person’s mental health.

 

We’ve taken a look at some of the things I’ve learned about mental health medication. Do you have experiences you’d like to share? What would you want others to know? What is the most important thing you have learned? We’d love to hear from you.

Photo by Halacious on Unsplash

 

Wednesday, 12 August 2020

Painting, Photography and Positive Mental Health

By Peter McDonnell

As on most weekends, today I was out and about visiting nearby open gardens run by The National Garden Scheme. My mum and I park the car after the usual drive through villages of thatched cottages, village halls, churches and well-kept lawns. During lockdown the large properties that host the gardens are not busy and we are often treated to a personal tour by the owners. You can see how happy they are sharing stories old and new about how their gardens came to be. You can pick out the differences of the owners’ individual spots of fondness, occasionally accompanied by a comment of slight aversion to their spouse’s decision to place some quirky item amongst the otherwise perfect design!

We walk around for about an hour, my mum teaching me the names and attributes of flowers. This is where I get my photography done. Most of the roses are past their best now that it is August, but I’ve taken many photographs of my favourite flower over the last two months.

I think they look especially good climbing up or falling over the top of a stone wall, so much so that I did an oil painting of a photo I took of roses on the wall of a thatched cottage that we saw on one of our recent summer afternoons out.

Rosy Cottage on Abbey Road

Painting and photography has made a real difference to my mental health

I started painting in March, inspired by the coronavirus lockdown. I bought some acrylic paints when I was eighteen in 2000, and they sat in the loft unused for twenty years. Occasionally I’d think about them but it always seemed like a chore to fetch them down and use them.

Recently, though, I watched a few TV programmes about how to paint, including ‘The Joy of Painting’ by the wonderful Bob Ross, the American guy with the afro hairstyle who in the 80’s presented clips painting quick but skilled scenes where he talked us through how it was done.

Inspired, I got the paints out and set myself up in my garden. By the end of the day I had completed something that wasn’t half bad! Of course, it wasn’t skilled but it was imaginative and colourful. I remember thinking about David Hockney and how his works are rarely based on accuracy and he gets on okay… he sells his paintings for millions, £94 million is his record.

Not having the burden of accuracy increased the enjoyment I felt. I remembered a few of Bob Ross’ tips (paint the background first, distant objects need less detail etc.) and away I went. A few days later I bought some canvasses, oil paints etc., and started my second painting. For that one I had a few really interesting ideas about provoking some thought, and the big tree that was the centre of focus looked fantastic. After a couple of days I couldn’t have been happier with the result. Then on to the next one … I have now painted about twenty canvasses. I can’t stop! My boss at one of my part-time jobs liked my online gallery and asked me to paint a series of murals in his large shop. I’m halfway through and it’s a pleasure.

If you are wondering about the connection with mental health, I’m so happy while I’m painting my murals. Mixing up the colours, being adventurous and bold and feeling it actually work into something alluring is a feeling that stays with me for the rest of the day. I step back and feel a sense of achievement. People come and go in the shop and often ask about it. They compliment me too if I’m lucky. I feel a little boost every time someone says they are impressed. When I go to my evening part-time job, colleagues ask how I am and I always say ‘I’m fantastic’ because I am, because I’ve been painting. Some people have spoken about being a little slowed down in activity during the pandemic, but I’ve surprised myself. I’ve never been so productive.

My favourite artists and inspirations are Van Gogh, Monet, Manet and Hockney. I knew who these artists were before lockdown but that was all. Since getting into painting I’ve also started looking at art. I’ve ‘caught the bug’ and I found a wonderful app, the Google Arts and Culture app, which has told me all about these guys. This new passion will be by my side until I’m old. I know much of their work intimately now. A real joy.

Mental Health

I was diagnosed with ‘cannabis-induced psychosis with delusions of a grandiose nature’ and serious anxiety in 2002 and 2005. It has mostly fallen away now. I consider myself ninety percent recovered due to good luck, support and hard work. I have had a long, serious and interesting journey. I am still on anti-psychotic and anti-anxiety medication. The antipsychotic worked wonders for me. I think of it with actual fondness. But it dulls the brain slightly, for some more than others, as do many medications. It slows me down in my cognitive abilities etc, and I feel the difference most profoundly in my memory. Before medication it worked smoothly and quite effortlessly, but these days if I don’t write things down or use mnemonic tips, information and everything else is subject to something of a disappearing act.

Since I started painting though, the creative side of my brain has returned in an enjoyable and controlled way. It’s also affected my memory in a very positive way. A few days after my new hobby began I found that I was remembering things – the best-before dates on refrigerated items coolly awaiting dinnertime consumption, numbers on paperwork at work, my mum’s varying weekly schedule. I must say it’s a welcome change after so many years of being on the forgetful side. It’s connected to the painting and the creativity in the same way that it’s easier to remember a colourful scene than a black and white one. So as well as all the joy of painting it’s improving my memory and cognitive skills too in a real way.

So having that working away, it helps me to build on it, which is where the photography comes in amongst other things. When I’m taking pics of flowers and nature and sharing them, it’s another piece of my mind that is awakened and happy indulging in a hobby. During my recovery my supportive team encouraged distraction techniques, activities that got me out and about, and spending time on an activity that I could enjoy.

One thing I have found for myself is that maintaining good mental health requires small but consistent efforts and doing things every day to keep me happy. This is part of why painting and photography have been so helpful. It seems like a cliché sometimes that art is good for mental health but knowing how it has helped me I’d really recommend it. I hope the positivity continues!

Thanks for reading. I have more to see on my mental health blog petesmentalhealth.com including my online art gallery and posts about how my medication turned my life around, a post about visiting Monet’s garden in France last year, and more about art and mental health.

About the Author

Pete is thirty-eight and lives in Hampshire, England. He is very open about mental health and discussing his journey. He has lived through serious psychosis, suicide attempts, hospitalisations, and panic attacks, then had a slow but steady recovery helped by writing and blogging, and more recently art and photography. He is now enjoying life and working on his memoirs. He is always keen for new visitors to his mental health website and blog petesmentalhealth.com.

 

Wednesday, 5 August 2020

Julie A. Fast on Kanye West, Bipolar Disorder, and Relationships

Kanye West’s recent public struggles with bipolar disorder have brought considerable attention to a condition which affects millions around the world.

One of our regular contributors Julie A. Fast wrote an article for Psychology Today called Is Kanye West Just a Grandiose, Attention-Seeking Rapper? in which she discussed the difference between bragging and grandiose mania/psychosis.

She was subsequently interviewed for US television on the topic of Kanye West and bipolar disorder. It’s worth reading the article before watching the video (below) as Julie mentions it regularly in her interview.

In the interview, Julie talks about herself, bipolar disorder and why it’s so hard for people like Kanye to get help, even with his wealth and resources. She also talks about the message that his wife Kim Kardashian posted on Instagram, from which the following is excerpted:

“Living with bi-polar disorder does not diminish or invalidate his dreams and his creative ideas, no matter how big or unobtainable they may feel to some. That is part of his genius and as we have all witnessed, many of his dreams have come true. We as a society talk about giving grace to the issue of mental health as a whole, however we should also give it to the individuals who are living with it in times when they need it the most. I kindly ask that the media and public give us the compassion and empathy that is needed so that we can get through this. Thank you for those who have expressed concern for Kanye's well-being and for your understanding.” (Kim Kardashian)

Author of Loving Someone with Bipolar Disorder, Take Charge of Bipolar Disorder, and Get it Done When You’re Depressed, Julie is well-placed to offer her perspective on the subject of romantic relationships and bipolar disorder:

  • She has bipolar disorder and a psychotic disorder. She was originally diagnosed with bipolar disorder; later changed to schizoaffective disorder. When a person has bipolar disorder and a separate psychotic disorder, the diagnosis is more complex.
  • Julie was in a relationship for ten years with a man who has bipolar I (bipolar 1 disorder).
  • She wrote the first book ever for the partner of a person with a mental health disorder. Her book Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner has sold over 400,000 copies and remains the #1 book for partners in the world.
  • As you can tell from her Psychology Today article, she has been a fan of rap music since the 1980s!

Julie has guested on our blog several times and is a huge champion of our work. She was an original reviewer for our book High Tide, Low Tide: The Caring Friend’s Guide to Bipolar Disorder which opens with her words:

Friendship soothes the soul and provides hope for people with bipolar disorder and yet the illness creates unique challenges to the friendships we so desperately want and need. Marty and Fran specifically address these challenges in this bright, uplifting and brutally honest book. Filled with stories and practical tips, there is more laughter than sorrow as the reader learns to cultivate a loving, kind and caring friendship that transcends the illness and creates a lasting bond.

Julie often tells people that High Tide, Low Tide is one of the best books for siblings of people with bipolar disorder, as they don’t get the attention they need due to their sibling’s illness. We love working with her and are proud to know her as a friend as well as a valued contributor to Gum on My Shoe.