Diane was an intelligent petite neatly dressed woman in her early thirties with an air of no nonsense efficiency about her. Apart from some redness around her eyes there was little to indicate any emotional distress. She announced that she had been suffering from depression that had developed four months previously and she required a repeat of her antidepressant medication.
A quick scribble would have sent her on her way. I asked her if she was sure she had depression.
Yes she said she had looked it up and had been to see her GP. She had all the signs and symptoms. I thought I might just sound her out a bit more just to get some more information for myself.
This was the first time in her life she had experienced depression but she had finally she realized she was ill and needed treatment.
I asked her to tell me how it began and the following extraordinary tale unfolded.
Diane was from the UK of a middle class family. Her mother taught at University and her father was a respected businessman of renown. She had gotten good marks at School and had gone on to get a degree in Business with 1st Class Honors. She had been sought after to help in the reorganization of the British Health System in London and had acquitted herself well.
So well in fact, that she had attracted the attention of the NZ Ministry of Health. She had been head hunted by the Ministry to advise in the transformation of a Hospital Board to a Crown Health Enterprise. This was a big step but she thought overseas experience could only assist her career, especially if she acquitted herself well.
She was recruited to advise a team of managers, all male, in the setting up of the CHE (Crown Health Enterprise), a job that was to take two years and her salary was commensurate with theirs.
Right from the start she had some misgivings about the rather simplistic ideas she thought her male colleagues had. But she gave them the benefit of the doubt.
Her unease grew as the months passed as she began to realize they were serious about their ideas.
She voiced her doubts in one of their meetings. She was respectfully and politely listened to and then ignored. They went on as if she had said nothing. As she listened to the terms of reference, and the magnitude of the job ahead, she realized would take a lot longer than two years, way beyond the expected end of her's (and their) contracts.
She took the floor and outlined her case. Again they listened but pointed out that her version would take a lot longer than the two years they had at their disposal. Once again she was ignored and they went on with their own solutions.
Again she sat back listening. This time she began to realize that their management plans were not only simplistic but had no possibility of working. She commanded the floor in one of their meetings, and spoke her mind. There was some embarrassed smiling around the table. She flushed, aware all eyes were upon her.
Her statements that their solutions were completely unworkable, fell on deaf ears. She had at least expected that they might argue with her her and enter into some dialogue but they did not. She felt embarrassed, not used to being ignored in such a flagrant manner. They simply heard her out with faint condescending smiles on their faces.
Afterward they asked if she was OK. They thought she was upset.
She thought to herself that maybe she had got it wrong so she took some work home re re work her own solutions. But no. She could find nothing the matter with her plan. Even putting the best frame around their plans they were still unworkable.
She went back into the meetings determined once again to have her say. Again they ignored her and this time she lost her temper. Through angry tears she told them their plans would not work in two years if then, that she had been hired as a consultant and was determined to have her say.
There had been an uncomfortable silence, she recalled. They had all stared at her. One apologized for his indifference to her plight muttering that he hadn’t realized how upset she was. They asked that perhaps it might be a good idea for her to have some time off and again apologized for not noticing how upset she was earlier. Someone wondered about her fitness for the job.
With a sinking feeling she rose and left the meeting. Nothing in her past had trained her to deal with such condescending patronizing circumstances. She began to doubt herself. Perhaps she had got it all wrong. She again went over her work waking in the night thinking about the problems. No, there were no mistakes. Surely they must know they were wrong she thought. No one could be that stupid. But she was completely outnumbered and outvoted by her all male counterparts. She decided to just listen in subsequent meetings.
As she did so she began to realize that the were fully aware of what they were doing. The occasional sly smile, the odd conspiratorial look between them. And slowly the penny dropped.
They were all on contract and the payment bonus for finishing the job on time in two years was substantial. They were not interested in their plans being actually workable. They were interested in finishing in 2 years, by which time they would have all fulfilled the contract, collected their bonuses and someone else would have to clean up the mess they left behind! Anything that even hinted that what they were doing would not work would be disastrous.
Nothing had prepared Diane for this assault on her integrity. If she confronted them she would be ignored and her mental health and emotional capability questioned. It had already been alluded to in the meeting. If she went along with them she would have to live with herself afterward and her reputation as a consultant would be in tatters.
Being new to NZ she had few friends here and she had thought of returning to the UK but that would have meant leaving the job half done admitting failure on her previous unblemished career, returning with her tail between her legs. She felt she was in a blind alley with nowhere to go. She began to wake up at night worrying, and she began to lose some weight. Maybe they were all right about her after al she thought. She was not emotionally up to the job. She was becoming depressed. She looked up depression and found she had many of the symptoms. She saw a GP who started her off on antidepressants.
Being an executive manager she had managed to hold herself together. She had convinced herself that she would just have to resign herself to the fact that she was a depressive and would probably not be able to cope with the future she had planned in business.
It was in these resigned circumstances that I saw her.
To say I was appalled was an understatement. I had heard about the managers she was working with. Several were brash young executives with their new MBA’s under their belt newcomers to health, out to make big money. I had seen others who had been intimidated by their power hungry disenfranchising maneuvers and arbitrary methods. They thought that ‘adequate consultation with all staff’ meant giving orders.
What to do?
Because I had dealt with similar cases in the past said, “I don’t think you actually do suffer from depression. I think you have been deliberately shafted. You have been taken down, and deliberately ignored.”
She let out an explosive breath of relief. “You mean I don’t really have depression?” she asked.
“Well all I can say is that I have seen other folk exactly like you who have been treated in the same contemptuous way by similar managers and they couldn’t sleep, lost weight and thought that they were depressed. I think this has got to stop.”
“Really!” She said. And then she talked of all the slights she had received, their patronizing offhand comments about women in business, what she had done, and how her indignation seemingly had been translated into her having an ‘emotional problem’.
Her story happened to coincide with the histories of others who had come to see me with similar stories about the same individuals.
I asked her if she had some documentation of what had happened in the meetings. She said yes she had. She had written notes of times dates and meeting agenda’s to re scrutinize where she had possibly gone wrong and what she might learn. However no matter what she did she had realized she was outnumbered, and out voted and no matter what she said or did they would continue with their unworkable agenda.
She explained that her immediate Bosses were the Ministry of Health. Complaining to them would almost surely result in their canvassing the rest of the team and the outcome would almost certainly be a vote from the others that she was mentally unstable.
I suggested she write out a full summary of times, dates, and plans, what she had said, what they had said, the outcome of votes cast up until the present leaving out emotional reactions any interpretations as far as possible. Could she do that?
Then I said we would meet again to go over the details and see what might be done.
Yes of course she said. (She was after all an accomplished manager.)
A couple of meetings later we discussed the issues.
She seemed to be transformed.
She had been very busy. She said that after our meetings she thought of what she might do. She had decided to return to the UK. She had then written a comprehensive report of everything that had happened to her with the times, dates and the minutes including who had said what, of all the meetings she had attended. To this report she attached her resignation stating exactly what had happened and her reasons for her abrupt departure. She had sent it by registered mail to the Ministry that had employed her.
She booked a flight back to the UK and thought that her experience in NZ would form the basis for a thesis for a doctorate.
I asked her what about the antidepressants?
“Oh those,” she said. “I don’t need them. I don’t think I really needed them in the first place.”
Some months later I heard via the grapevine that the management project had been disbanded by the Ministry and its members made redundant.
Saturday, August 28, 2010
Wednesday, August 18, 2010
Saved from Burnout
An all too familiar story.
Joe came to see me. He looked tired. He told me he had been off work for 18 months because of mental illness.
“ It was a good thing my doctor spotted it.” He said. “He got it right first time.”
“He told me I was suffering from work stress and depression, and I was getting burnout. He said I needed time off. I got time off but every time I tried to go back to work I got worse. He said I was getting a clinical depression and had to give me medication. That helped a bit but then I got panic attacks whenever I tried to go back to work and he had to give me something to sleep and he had to up the medication. Now I can’t go out without getting panic attacks. My doctor also thinks I have got phobic anxiety. They’re not going to keep my job open anymore, I’ve run out of sick pay and had to make do on the benefit. “
I asked him what went wrong with his job.
“It was my boss.” He said. “He just had it in for me.”
The story gradually unfolded in our talking together.
I found that two years ago Joe had been a middle manager in a fairly large firm. He had done pretty well. He was married with two children on a good salary. No history of mental illness.
“What had happened” I wondered so that he was now jobless, on a sickness benefit, because of multiple mental illnesses. Ie Stress, depression, phobic anxiety.
Two years ago nothing had seemed to alter this tranquil existence. He liked his work seemed to get on well with his staff, and met all his deadlines. Then his line manager was replaced.
This man had a completely different agenda from his previous manager. He was very officious in his manner and had a completely different way of doing things. He wanted a lean mean machine. Joe went out of his way to please him and show him he was up to the job.
None of his efforts seemed to satisfy this man who seemed to continually find fault with his work. The new manager kept laying blame with Joe’s attitude but Joe could never find out what he meant. He made repeated efforts to find what this meant but this only reinforced his manager’s opinion that his attitude was at fault.
He began to get worried that his job might be at stake and wondered it the new manager had an agenda to restructure and get rid of him. He knew that if he shared these misgivings with his boss it would only reinforce the adverse opinion he had about his ‘attitude’.
He discussed it with Rosie his wife. She was sympathetic and very supportive.
However as the situation at work continued Joe began to worry more about his predicament. He was not used to being continually the subject of criticism especially when he was doing his best to take them on board.
He began to worry at night and wake early in the morning dreading the day before him.
He took a vacation for a couple of weeks. He and the family had a great time but as the time approached to return to work the worry began once again.
Rosie was concerned about his health and suggested that he see his GP.
Joe was couldn’t see what the GP might do but decided it wouldn’t do any harm.
His GP checked him out physically and then began to ask Joe a lot of questions.
‘How long had he been worrying? On a scale of 0 to 10 how bad was the anxiety. Did he wake early in the morning? Had he lost any weight?
What were his energy levels? How was his concentration?
Did he think life was worth living? Had he ever thought of taking his own life?
His GP seemed to concentrate on Joe and said little about the situation at work with his manager even when he explained it.
Finally his GP announced
“ I think you have an early clinical depression triggered by work stress. It is just as well you came to see me otherwise you could have gotten burnout’.
“Hang on said Joe. You mean I am mentally ill?”
“ Yes you might say that” said his doctor.
“How do you know?”
Well because you have many of the symptoms of depression.”
This came as a revelation to Joe. He had never thought he had a mental illness.
“What do you think I should do? He asked.
“Well I think you should start medication and take at least a month off work to allow the medication to take effect. If you don’t you run the risk of burnout.”
This was a revelation to him. He was getting depression all along. Maybe it was that his new manager had seen in him, right at the start. Of course!
He went home buoyed up by the fact that the medication would soon get him back on board.
He had enough sick leave and took the time off. He began to feel better anticipating the effect of the medication. The weeks went by. Yes he did feel better but as the deadline approached for returning to work he started to become more anxious. His Boss said he was not to return until he was completely well. Yet Joe knew he would be coming back into the same environment. He began to worry and pace anxiously about the house in anticipation of returning to work. Maybe this meant he was not quite better. Because he knew he had a mental illness he began to doubt his own thinking and his own feelings. He would frequently have to check things out with Rosie to make sure he had got it right. She became exasperated with his ruminations and he in turn began to get panic stricken.
Finally she took him back to their GP.
He listened to all their concerns and to the tales of anxiety and finally said that Joe was suffering from phobic anxiety, and that he would have to change the medication.
Joe was aghast. I have phobic anxiety as well as depression? He asked now completely demoralized.
Yes unfortunately they can go together but they are well recognized.
“When can I go back to work?
“Well I wouldn’t recommend it. It would only exacerbate the illness and you could end up with burnout he said.
Once again the medication was changed and Joe returned home. He wrote a letter to work saying he would return as soon as he was able. He decided he could stay home until he had used off all his sick leave. This extra time off helped but once again whenever the deadline approached he became anxious. By now he was also angry about had had happened to him but was persuaded by the GP that this anger was just a symptom of stress.
By now he had used all his sick leave and was on a benefit. He got a letter from his boss saying that they could only hold his job open for six months on leave without pay after which they would have to replace him.
So there he was sitting across from me asking for advice.
I thought to myself
“How to turn someone from a well off productive business man to a hard up sickness beneficiary in only eighteen months.”
As I was thinking he remarked “Just as well my Doctor caught me just in time. I could've got burnout!”
I felt sick and sighed. Maybe I should have been a lawyer.
Joe came to see me. He looked tired. He told me he had been off work for 18 months because of mental illness.
“ It was a good thing my doctor spotted it.” He said. “He got it right first time.”
“He told me I was suffering from work stress and depression, and I was getting burnout. He said I needed time off. I got time off but every time I tried to go back to work I got worse. He said I was getting a clinical depression and had to give me medication. That helped a bit but then I got panic attacks whenever I tried to go back to work and he had to give me something to sleep and he had to up the medication. Now I can’t go out without getting panic attacks. My doctor also thinks I have got phobic anxiety. They’re not going to keep my job open anymore, I’ve run out of sick pay and had to make do on the benefit. “
I asked him what went wrong with his job.
“It was my boss.” He said. “He just had it in for me.”
The story gradually unfolded in our talking together.
I found that two years ago Joe had been a middle manager in a fairly large firm. He had done pretty well. He was married with two children on a good salary. No history of mental illness.
“What had happened” I wondered so that he was now jobless, on a sickness benefit, because of multiple mental illnesses. Ie Stress, depression, phobic anxiety.
Two years ago nothing had seemed to alter this tranquil existence. He liked his work seemed to get on well with his staff, and met all his deadlines. Then his line manager was replaced.
This man had a completely different agenda from his previous manager. He was very officious in his manner and had a completely different way of doing things. He wanted a lean mean machine. Joe went out of his way to please him and show him he was up to the job.
None of his efforts seemed to satisfy this man who seemed to continually find fault with his work. The new manager kept laying blame with Joe’s attitude but Joe could never find out what he meant. He made repeated efforts to find what this meant but this only reinforced his manager’s opinion that his attitude was at fault.
He began to get worried that his job might be at stake and wondered it the new manager had an agenda to restructure and get rid of him. He knew that if he shared these misgivings with his boss it would only reinforce the adverse opinion he had about his ‘attitude’.
He discussed it with Rosie his wife. She was sympathetic and very supportive.
However as the situation at work continued Joe began to worry more about his predicament. He was not used to being continually the subject of criticism especially when he was doing his best to take them on board.
He began to worry at night and wake early in the morning dreading the day before him.
He took a vacation for a couple of weeks. He and the family had a great time but as the time approached to return to work the worry began once again.
Rosie was concerned about his health and suggested that he see his GP.
Joe was couldn’t see what the GP might do but decided it wouldn’t do any harm.
His GP checked him out physically and then began to ask Joe a lot of questions.
‘How long had he been worrying? On a scale of 0 to 10 how bad was the anxiety. Did he wake early in the morning? Had he lost any weight?
What were his energy levels? How was his concentration?
Did he think life was worth living? Had he ever thought of taking his own life?
His GP seemed to concentrate on Joe and said little about the situation at work with his manager even when he explained it.
Finally his GP announced
“ I think you have an early clinical depression triggered by work stress. It is just as well you came to see me otherwise you could have gotten burnout’.
“Hang on said Joe. You mean I am mentally ill?”
“ Yes you might say that” said his doctor.
“How do you know?”
Well because you have many of the symptoms of depression.”
This came as a revelation to Joe. He had never thought he had a mental illness.
“What do you think I should do? He asked.
“Well I think you should start medication and take at least a month off work to allow the medication to take effect. If you don’t you run the risk of burnout.”
This was a revelation to him. He was getting depression all along. Maybe it was that his new manager had seen in him, right at the start. Of course!
He went home buoyed up by the fact that the medication would soon get him back on board.
He had enough sick leave and took the time off. He began to feel better anticipating the effect of the medication. The weeks went by. Yes he did feel better but as the deadline approached for returning to work he started to become more anxious. His Boss said he was not to return until he was completely well. Yet Joe knew he would be coming back into the same environment. He began to worry and pace anxiously about the house in anticipation of returning to work. Maybe this meant he was not quite better. Because he knew he had a mental illness he began to doubt his own thinking and his own feelings. He would frequently have to check things out with Rosie to make sure he had got it right. She became exasperated with his ruminations and he in turn began to get panic stricken.
Finally she took him back to their GP.
He listened to all their concerns and to the tales of anxiety and finally said that Joe was suffering from phobic anxiety, and that he would have to change the medication.
Joe was aghast. I have phobic anxiety as well as depression? He asked now completely demoralized.
Yes unfortunately they can go together but they are well recognized.
“When can I go back to work?
“Well I wouldn’t recommend it. It would only exacerbate the illness and you could end up with burnout he said.
Once again the medication was changed and Joe returned home. He wrote a letter to work saying he would return as soon as he was able. He decided he could stay home until he had used off all his sick leave. This extra time off helped but once again whenever the deadline approached he became anxious. By now he was also angry about had had happened to him but was persuaded by the GP that this anger was just a symptom of stress.
By now he had used all his sick leave and was on a benefit. He got a letter from his boss saying that they could only hold his job open for six months on leave without pay after which they would have to replace him.
So there he was sitting across from me asking for advice.
I thought to myself
“How to turn someone from a well off productive business man to a hard up sickness beneficiary in only eighteen months.”
As I was thinking he remarked “Just as well my Doctor caught me just in time. I could've got burnout!”
I felt sick and sighed. Maybe I should have been a lawyer.
Friday, August 6, 2010
The Writer
James was depressed. He had been depressed for over four years.
He had been around the world, lived in the UK as a fitter and turner, earning enough money to finance periodic tours of Europe, and Asia. He seemed pretty accomplished and articulate, and had, on one job, even taken over as resident engineer, on account of his troubleshooting skills.
After some years he returned to New Zealand as he said, to settle down. He continued to work as a fitter and turner, but life began to lose its glamour and lose its gloss. He would wake in the morning before going to work and contemplate the day. As he did so he would be filled with a nameless dread. He would ask himself “Is this all there is to life?” And, “ Am I going to spend the rest of my life like this?”.
He did not want to go to work and had to force himself to get up.
It was OK once he got there but sometimes in those mornings he would wake early, anxious and begin pacing the floor. He became increasingly apprehensive at work and would worry over minor matters. He felt he was stuck, his life had somehow stuck . He was stuck in a dead end job with no where to go. He felt his life stretching out into the future, every day the same.
At first he thought is was just a reaction to settling down, that he would get over it. People told him that all jobs were boring at times and he was expecting too much. They said he had a very successful job and would eventually get over it, but he did not. The situation became worse. He tried drinking but that made him feel even worse in the mornings. He had a hangover in the mornings as well as the dread. He would snap angrily at his workmates and friends over minor matters. They told him he “had a problem” and should see someone about it. By this time the penny dropped. He really did have a problem. He asked his GP about it and he arranged a visit to a psychiatrist.
The psychiatrist was very sympathetic and understanding. He was very professional and seemed to know what he was doing. He asked a lot of questions about his habits his sleeping his concentration his energy level and his early history and childhood.
James parents were ‘lower class’. His mother did house cleaning to make ends meet and his father worked on the wharf. His father was a somber unhappy man who worked hard every day of his life. James could not recall a time he had seen his father happy.
His father repeatedly said to his son “Just you be thankful you’ve got a job you’re good at. You don’t have to like it.” The psychiatrist seemed to think this was quite important and suggested that his father had suffered from depression. He said that there was frequently an “hereditary component” to depression intimating that this somehow explained James current complaints.
He asked a lot more questions about his moods. Had there been times when he had felt really happy that ‘he could do almost anything’? Had he at these times gone without sleep? James racked his brains. Yes there had been one or two times. Were these times interspersed with not so happy or even depressed times. James had to admit they were interspersed.
The psychiatrist’s interest was aroused and James noticed that the conversation had shifted somehow. He would describe the details of his happy and unhappy life situations, whilst the psychiatrists would respond by referring to them as “episodes” and “mood swings”. Describing them in this way seemed to give them some special significance.
He was asked if there were there recent times when he was happy. Yes there were responded James. It didn’t have anything to do with being depressed or his job. He felt better when he wrote.
He had over the past year or so written three novels one of which was on the verge of being published. When was writing he forgot about his horrible life at work but whenever he returned to work he felt worse. The psychiatrist suggested to him him that this was in fact an escape mechanism to keep him from dealing with his real problems. It was a way James had developed to compensate for, or escape from, his depression. He was escaping into fantasy as it were. James had to agree.
At the end of the interview the psychiatrist said that the indications were that James had a Major Depressive Illness. He was informed that there was a hereditary ‘component’ but it was an illness like any other. In addition he said that it was highly likely that overall, he had a Bipolar Disorder of which his current depression was a manifestation. He thought that this was partly genetic and probably reflected a chemical imbalance in the brain that was triggered by the environment. The appropriate treatment was medication which he would probably have to take for an extended length of time. At last James thought, someone knows what is wrong.
The psychiatrist carefully explained that he would be taking lithium which was a mood stabilizer to minimize the ‘mood swings’, and an antidepressant to treat the depression.
The medication worked for a while. Each day James awoke hopeful that he would feel differently. This hope made him feel better just in and of itself.
However as the months rolled by, nothing much changed. His life kept bumping along and he became resigned to the fact that this was all life had to offer. He kept returning for repeat prescriptions but there was little respite from the unremitting gloom except when he was doing his writing or watching a screenplay or reading existential philosophy in which he had recently developed an interest. Because of his lack of response to treatment he was referred for Cognitive Behavioral Therapy.
He was quite interested in this but like the medication before it didn’t last. He got sick of writing down his thoughts and although he got to know about his core beliefs and his self image improved it made no difference to his feeling of dread in the mornings as he contemplated his future, and he eventually abandoned the practices altogether.
Finally someone thought that he might benefit from talking to someone else.
I have learned from long experience over the years to take nothing for granted so I asked him in this first session what he wanted and how I might be of some help.
He told me he had been suffering from depression for around 4 years and had been told that it might help to talk to someone about it.
I asked him what he would like to talk about, and he told me he had written a novel ready for publication and had two others on the go.
So for the next three quarters of an hour we talked about writing. We talked about fiction and non-fiction. We talked about science fiction, poetry and prose. We talked about thrillers and romances, and novels. How he wrote, on a computer with a pen or in pencil where he got his ideas from; did he write in the morning or in the evening. Writers he liked writers he disliked and why. We talked about the difficulties in publishing, artists and the artistic temperament. We even talked about mental illness and writing, including and Ernest Hemmingway and why he might have killed himself. We had odd sorties into film video and screenplays and ended up in his interest in existential philosophy. At the end of the session it was apparent that we had barely started on his interest so eager was he to talk. During all this time in the conversations we had, it was clearly apparent that he was not depressed at all.
I commented that that there was a lot more to talk about and wondered where the depression fitted in all this. He replied that that was just the problem. He was a fitter and turner, a good one at that. He earned a good living. This was just the problem. He couldn’t see a way out.
As a throwaway line as he left I commented that I was not surprised he was depressed trying to be a fitter and turner when all the time he wanted to be a writer. I said I’d be pretty depressed too trying to do something my heart and soul wasn’t really in to.
Next time we again talked about writing. We talked about books and writers, he might touch base with. Movies, screenplays, and education. Life and the artistic temperament, and what life might actually be about. The world of the artist and how hard it was to get ideas across. University courses, writing groups, the world of ideas.
In the third session he said he had applied to Otago University to do a course in creative writing with film video and screenplay thrown in. he had also applied to do a course in existential philosophy, to fulfill the requirements of a Masters degree. He had been visited by an old friend from California, a woman who had just finished a PhD he said proudly, who was wholly supportive of his endeavors.
I asked him about the depression. Funny thing you should ask me he said. After 4 years of anxiety and dread it had suddenly vanished. It had left him. I just feel quite different in the mornings. That’s interesting I said. When did it leave?
After the first session he said.
What was it I asked?
Something you said at the end stuck with me, he responded. What was that?
You said something like “I’m not surprised you are depressed trying to be a fitter and turner when all along you are a writer.”
“No one had ever said that to me before.”
He had been around the world, lived in the UK as a fitter and turner, earning enough money to finance periodic tours of Europe, and Asia. He seemed pretty accomplished and articulate, and had, on one job, even taken over as resident engineer, on account of his troubleshooting skills.
After some years he returned to New Zealand as he said, to settle down. He continued to work as a fitter and turner, but life began to lose its glamour and lose its gloss. He would wake in the morning before going to work and contemplate the day. As he did so he would be filled with a nameless dread. He would ask himself “Is this all there is to life?” And, “ Am I going to spend the rest of my life like this?”.
He did not want to go to work and had to force himself to get up.
It was OK once he got there but sometimes in those mornings he would wake early, anxious and begin pacing the floor. He became increasingly apprehensive at work and would worry over minor matters. He felt he was stuck, his life had somehow stuck . He was stuck in a dead end job with no where to go. He felt his life stretching out into the future, every day the same.
At first he thought is was just a reaction to settling down, that he would get over it. People told him that all jobs were boring at times and he was expecting too much. They said he had a very successful job and would eventually get over it, but he did not. The situation became worse. He tried drinking but that made him feel even worse in the mornings. He had a hangover in the mornings as well as the dread. He would snap angrily at his workmates and friends over minor matters. They told him he “had a problem” and should see someone about it. By this time the penny dropped. He really did have a problem. He asked his GP about it and he arranged a visit to a psychiatrist.
The psychiatrist was very sympathetic and understanding. He was very professional and seemed to know what he was doing. He asked a lot of questions about his habits his sleeping his concentration his energy level and his early history and childhood.
James parents were ‘lower class’. His mother did house cleaning to make ends meet and his father worked on the wharf. His father was a somber unhappy man who worked hard every day of his life. James could not recall a time he had seen his father happy.
His father repeatedly said to his son “Just you be thankful you’ve got a job you’re good at. You don’t have to like it.” The psychiatrist seemed to think this was quite important and suggested that his father had suffered from depression. He said that there was frequently an “hereditary component” to depression intimating that this somehow explained James current complaints.
He asked a lot more questions about his moods. Had there been times when he had felt really happy that ‘he could do almost anything’? Had he at these times gone without sleep? James racked his brains. Yes there had been one or two times. Were these times interspersed with not so happy or even depressed times. James had to admit they were interspersed.
The psychiatrist’s interest was aroused and James noticed that the conversation had shifted somehow. He would describe the details of his happy and unhappy life situations, whilst the psychiatrists would respond by referring to them as “episodes” and “mood swings”. Describing them in this way seemed to give them some special significance.
He was asked if there were there recent times when he was happy. Yes there were responded James. It didn’t have anything to do with being depressed or his job. He felt better when he wrote.
He had over the past year or so written three novels one of which was on the verge of being published. When was writing he forgot about his horrible life at work but whenever he returned to work he felt worse. The psychiatrist suggested to him him that this was in fact an escape mechanism to keep him from dealing with his real problems. It was a way James had developed to compensate for, or escape from, his depression. He was escaping into fantasy as it were. James had to agree.
At the end of the interview the psychiatrist said that the indications were that James had a Major Depressive Illness. He was informed that there was a hereditary ‘component’ but it was an illness like any other. In addition he said that it was highly likely that overall, he had a Bipolar Disorder of which his current depression was a manifestation. He thought that this was partly genetic and probably reflected a chemical imbalance in the brain that was triggered by the environment. The appropriate treatment was medication which he would probably have to take for an extended length of time. At last James thought, someone knows what is wrong.
The psychiatrist carefully explained that he would be taking lithium which was a mood stabilizer to minimize the ‘mood swings’, and an antidepressant to treat the depression.
The medication worked for a while. Each day James awoke hopeful that he would feel differently. This hope made him feel better just in and of itself.
However as the months rolled by, nothing much changed. His life kept bumping along and he became resigned to the fact that this was all life had to offer. He kept returning for repeat prescriptions but there was little respite from the unremitting gloom except when he was doing his writing or watching a screenplay or reading existential philosophy in which he had recently developed an interest. Because of his lack of response to treatment he was referred for Cognitive Behavioral Therapy.
He was quite interested in this but like the medication before it didn’t last. He got sick of writing down his thoughts and although he got to know about his core beliefs and his self image improved it made no difference to his feeling of dread in the mornings as he contemplated his future, and he eventually abandoned the practices altogether.
Finally someone thought that he might benefit from talking to someone else.
I have learned from long experience over the years to take nothing for granted so I asked him in this first session what he wanted and how I might be of some help.
He told me he had been suffering from depression for around 4 years and had been told that it might help to talk to someone about it.
I asked him what he would like to talk about, and he told me he had written a novel ready for publication and had two others on the go.
So for the next three quarters of an hour we talked about writing. We talked about fiction and non-fiction. We talked about science fiction, poetry and prose. We talked about thrillers and romances, and novels. How he wrote, on a computer with a pen or in pencil where he got his ideas from; did he write in the morning or in the evening. Writers he liked writers he disliked and why. We talked about the difficulties in publishing, artists and the artistic temperament. We even talked about mental illness and writing, including and Ernest Hemmingway and why he might have killed himself. We had odd sorties into film video and screenplays and ended up in his interest in existential philosophy. At the end of the session it was apparent that we had barely started on his interest so eager was he to talk. During all this time in the conversations we had, it was clearly apparent that he was not depressed at all.
I commented that that there was a lot more to talk about and wondered where the depression fitted in all this. He replied that that was just the problem. He was a fitter and turner, a good one at that. He earned a good living. This was just the problem. He couldn’t see a way out.
As a throwaway line as he left I commented that I was not surprised he was depressed trying to be a fitter and turner when all the time he wanted to be a writer. I said I’d be pretty depressed too trying to do something my heart and soul wasn’t really in to.
Next time we again talked about writing. We talked about books and writers, he might touch base with. Movies, screenplays, and education. Life and the artistic temperament, and what life might actually be about. The world of the artist and how hard it was to get ideas across. University courses, writing groups, the world of ideas.
In the third session he said he had applied to Otago University to do a course in creative writing with film video and screenplay thrown in. he had also applied to do a course in existential philosophy, to fulfill the requirements of a Masters degree. He had been visited by an old friend from California, a woman who had just finished a PhD he said proudly, who was wholly supportive of his endeavors.
I asked him about the depression. Funny thing you should ask me he said. After 4 years of anxiety and dread it had suddenly vanished. It had left him. I just feel quite different in the mornings. That’s interesting I said. When did it leave?
After the first session he said.
What was it I asked?
Something you said at the end stuck with me, he responded. What was that?
You said something like “I’m not surprised you are depressed trying to be a fitter and turner when all along you are a writer.”
“No one had ever said that to me before.”
Tuesday, August 3, 2010
Sofia
The Schizophrenic.
Sofia was 18 years of age. She was a Pacific Islander from Samoa.
She was referred to the Group because she had been depressed because of family conflict and wanted to talk about it. She was the youngest there.
She had returned to school in the sixth form to repeat a lost year looking after relatives and she was doing well.
But there was trouble in the family because her parents were splitting up and her relatives were angry.
Sofia was the youngest client in the group. She was bright and attractive. She had returned to high school to do her 7th form year. Being successful this year was important to qualify for entrance to University. She hoped to train to become a primary school teacher. She felt things were just starting to go well for her.
Her parents splitting up at this time made things quite difficult for her and for the family. They expected her to be involved and she fully agreed as a matter of course.
She told us all about the difficulties in the family. She spoke clearly and listened carefully to what others in the group said. Sofia announced that a social worker had arranged a family meeting to sort things out. She wouldn't be able to attend the group for the next few weeks because she had to attend these family meetings.
More than a few weeks passed. It was three months before we heard from her . All of us in the group wondered what had happened to Sofia.
Finally, I phoned her to see what had happened. She was still living in the family home and I invited her back to the group. She said she would come. When Sofia turned up, she looked dreadful.
She had put on a great deal of weight. Her once beautiful black hair was unkempt. She shuffled into the room, chain smoking home rolled cigarettes.
Everyone was appalled by the change in her. Everyone began talking at once. "What has happened to you?" "What is the matter?" "What's going on?" everyone wanted to know. She told us that they had discovered she was very ill. In fact, she said they found that she had been unwell for a long time. But before now, it seemed that neither she nor anyone else had known it.
Sofia was besieged by questions from the group. "What illness?" "Why were you unwell?”
Thomas, always an outspoken member of the group asked "Were you lying to us?" Everyone in the entire group was on the edge of their seats. Sofia hesitated. I gently prompted her and she spoke using broken phrases.
Yes, she went along to the family meeting. There were harsh words spoken. She had become upset in the meeting. Somehow, she had found herself talking about the help she got from her "friend.” She had had this friend since childhood. And it had talked regularly with her. She had never spoken about it before because it was so ordinary. She thought everybody had one.
Her friend would advise her; and sometimes chide her quite harshly When things were difficult or she was upset, her friend would advise her and sometimes chide her quite harshly when things were difficult in her life or sometimes when she was upset over little things. Sometimes Sofia thought her friend spoke to her through a character on the TV or radio.
She was never sure whether it was real or imaginary but somehow it didn’t seem to matter very much.
A Social worker running the meeting told her parents that Sofia should see a psychiatrist. The entire family was alarmed. They respected her opinion. She was a professional. If she was worried about Sofia, then they would be too.
This social worker was very good at her job and arranged for Sofia to have a psychiatric assessment within a week.
Sofia said the psychiatrist was very nice. She was scared of him at first. She felt shy about talking to him about school or her school friends. Sofia said she was very relieved to find that for the most part all the psychiatrist wanted to know about was the voice of her imaginary friend.
She didn't have to talk about things that upset her. She didn't have to talk about school at all. Instead, for the first time in her life, someone really was very interested in her friend’s voice and what she said to her. She had never told anyone about it before.
Sofia said the psychiatrist was a little strange. He asked a lot of questions that didn’t seem to make any sense. He asked her a lot of questions about things she had never thought of. Were the voices she heard male or female? He asked her if she felt everyone was against her?
Did she think something or someone put thoughts into her head against her will? Did she think she could put her thoughts into other people’s heads. Did she hear voices arguing? Did her friend ever ask her to do things she didn’t want to do? Had she ever thought of killing herself?
Would she count backwards from a hundred in sevens? And who was the prime minister? "But he didn't say whether he meant Samoa, Tonga, New Zealand, or Australia." She sighed.
At the end of the interview he became very serious. He told her that hearing the voice meant that she, Sofia, was unwell. She would probably have to take medication for a long time, possibly for the rest of her life. Sofia then suddenly realized that she must have been ill for years without knowing it, and without any treatment.
Her parents were informed and were very understanding. She was started on medication but it made her feel very drowsy in the mornings. She had difficulty getting up and going to school. When she got to school she couldn't concentrate. All morning, she felt like dropping off to sleep.
They had to tell the teacher who was very understanding. The teacher suggested Sofia ought to take time off until she got well because she wasn't coping with the lessons.
So Sofia stopped going to school.
Then the psychiatrist reduced the medication. That helped a bit. But when Sofia told him that that she felt very depressed thinking she might be like this for the rest of her life, the psychiatrist added antidepressants to her medication. She became even drowsier and she started to smoke heavily and put on weight. Finally she stopped going to school because she couldn't concentrate on her study.
Everyone said she couldn't concentrate on her study because she was so unwell, and she agreed.
Sofia finished telling her story to the Group saying the psychiatrist said she had something beginning with "S". "Schizophrenia?" someone said with disbelief. "That's it," Sofia said.
Thomas, always indignant and outspoken in the Group, snorted loudly. He jumped up, about to make another of his pronouncements. As the person running the group I was about to head him off. I was afraid he would hurt Sofia's feelings. So I was shocked when he unexpectedly turned to me and waggled his finger. "See Doc?"
Now he pointed at Sofia. "I know you're new to this so I will tell you what's happened here. Sofia's "been psychiatrized" and I hope you're proud of it. It's a great profession you're part of.”
Sofia was 18 years of age. She was a Pacific Islander from Samoa.
She was referred to the Group because she had been depressed because of family conflict and wanted to talk about it. She was the youngest there.
She had returned to school in the sixth form to repeat a lost year looking after relatives and she was doing well.
But there was trouble in the family because her parents were splitting up and her relatives were angry.
Sofia was the youngest client in the group. She was bright and attractive. She had returned to high school to do her 7th form year. Being successful this year was important to qualify for entrance to University. She hoped to train to become a primary school teacher. She felt things were just starting to go well for her.
Her parents splitting up at this time made things quite difficult for her and for the family. They expected her to be involved and she fully agreed as a matter of course.
She told us all about the difficulties in the family. She spoke clearly and listened carefully to what others in the group said. Sofia announced that a social worker had arranged a family meeting to sort things out. She wouldn't be able to attend the group for the next few weeks because she had to attend these family meetings.
More than a few weeks passed. It was three months before we heard from her . All of us in the group wondered what had happened to Sofia.
Finally, I phoned her to see what had happened. She was still living in the family home and I invited her back to the group. She said she would come. When Sofia turned up, she looked dreadful.
She had put on a great deal of weight. Her once beautiful black hair was unkempt. She shuffled into the room, chain smoking home rolled cigarettes.
Everyone was appalled by the change in her. Everyone began talking at once. "What has happened to you?" "What is the matter?" "What's going on?" everyone wanted to know. She told us that they had discovered she was very ill. In fact, she said they found that she had been unwell for a long time. But before now, it seemed that neither she nor anyone else had known it.
Sofia was besieged by questions from the group. "What illness?" "Why were you unwell?”
Thomas, always an outspoken member of the group asked "Were you lying to us?" Everyone in the entire group was on the edge of their seats. Sofia hesitated. I gently prompted her and she spoke using broken phrases.
Yes, she went along to the family meeting. There were harsh words spoken. She had become upset in the meeting. Somehow, she had found herself talking about the help she got from her "friend.” She had had this friend since childhood. And it had talked regularly with her. She had never spoken about it before because it was so ordinary. She thought everybody had one.
Her friend would advise her; and sometimes chide her quite harshly When things were difficult or she was upset, her friend would advise her and sometimes chide her quite harshly when things were difficult in her life or sometimes when she was upset over little things. Sometimes Sofia thought her friend spoke to her through a character on the TV or radio.
She was never sure whether it was real or imaginary but somehow it didn’t seem to matter very much.
A Social worker running the meeting told her parents that Sofia should see a psychiatrist. The entire family was alarmed. They respected her opinion. She was a professional. If she was worried about Sofia, then they would be too.
This social worker was very good at her job and arranged for Sofia to have a psychiatric assessment within a week.
Sofia said the psychiatrist was very nice. She was scared of him at first. She felt shy about talking to him about school or her school friends. Sofia said she was very relieved to find that for the most part all the psychiatrist wanted to know about was the voice of her imaginary friend.
She didn't have to talk about things that upset her. She didn't have to talk about school at all. Instead, for the first time in her life, someone really was very interested in her friend’s voice and what she said to her. She had never told anyone about it before.
Sofia said the psychiatrist was a little strange. He asked a lot of questions that didn’t seem to make any sense. He asked her a lot of questions about things she had never thought of. Were the voices she heard male or female? He asked her if she felt everyone was against her?
Did she think something or someone put thoughts into her head against her will? Did she think she could put her thoughts into other people’s heads. Did she hear voices arguing? Did her friend ever ask her to do things she didn’t want to do? Had she ever thought of killing herself?
Would she count backwards from a hundred in sevens? And who was the prime minister? "But he didn't say whether he meant Samoa, Tonga, New Zealand, or Australia." She sighed.
At the end of the interview he became very serious. He told her that hearing the voice meant that she, Sofia, was unwell. She would probably have to take medication for a long time, possibly for the rest of her life. Sofia then suddenly realized that she must have been ill for years without knowing it, and without any treatment.
Her parents were informed and were very understanding. She was started on medication but it made her feel very drowsy in the mornings. She had difficulty getting up and going to school. When she got to school she couldn't concentrate. All morning, she felt like dropping off to sleep.
They had to tell the teacher who was very understanding. The teacher suggested Sofia ought to take time off until she got well because she wasn't coping with the lessons.
So Sofia stopped going to school.
Then the psychiatrist reduced the medication. That helped a bit. But when Sofia told him that that she felt very depressed thinking she might be like this for the rest of her life, the psychiatrist added antidepressants to her medication. She became even drowsier and she started to smoke heavily and put on weight. Finally she stopped going to school because she couldn't concentrate on her study.
Everyone said she couldn't concentrate on her study because she was so unwell, and she agreed.
Sofia finished telling her story to the Group saying the psychiatrist said she had something beginning with "S". "Schizophrenia?" someone said with disbelief. "That's it," Sofia said.
Thomas, always indignant and outspoken in the Group, snorted loudly. He jumped up, about to make another of his pronouncements. As the person running the group I was about to head him off. I was afraid he would hurt Sofia's feelings. So I was shocked when he unexpectedly turned to me and waggled his finger. "See Doc?"
Now he pointed at Sofia. "I know you're new to this so I will tell you what's happened here. Sofia's "been psychiatrized" and I hope you're proud of it. It's a great profession you're part of.”
Monday, August 2, 2010
Medicine; Science or Religion
You visit your Endocrinologist.
You are diagnosed with insulin dependant diabetes.
Diabetes, he/she informs you is due to a deficiency of insulin.
The treatment is designed to correct this imbalance.
You visit your Psychiatrist.
You are diagnosed with Major Depressive Disorder.
Depression, he/she informs you is almost certainly due to a defficiency of serotonin.
The treatment is designed to correct this imbalance.
Treatment is commenced.
After about three weeks you revisit your Medical Professionals for a progress report.
Your Psychiatrist asks you "On a scale of zero to ten, ten being extremely depressed, zero being not at all depressed, how bad would you say your depression is today?"
You think for a bit. "Oh I would say about two!"
You Psychiatrist looks up and says authoritatively "You are responding to treatment"!
Your Endocrinologist asks you "On a scale of zero to ten, ten being extremely bad, zero being not at all bad, how bad would you say your diabetes is today?"
You think for a bit (amazed). "Oh I would say about two!"
Your Endocrinologist looks up and says authoritatively "You are responding to treatment!"
Question,
Which of these two professionals would you trust and why?
There are no right answers here only things to think about.
My friend Wilton will appreciate this.
Look him up at http://crookedpencil.crookedpencil.blogstream.com
You are diagnosed with insulin dependant diabetes.
Diabetes, he/she informs you is due to a deficiency of insulin.
The treatment is designed to correct this imbalance.
You visit your Psychiatrist.
You are diagnosed with Major Depressive Disorder.
Depression, he/she informs you is almost certainly due to a defficiency of serotonin.
The treatment is designed to correct this imbalance.
Treatment is commenced.
After about three weeks you revisit your Medical Professionals for a progress report.
Your Psychiatrist asks you "On a scale of zero to ten, ten being extremely depressed, zero being not at all depressed, how bad would you say your depression is today?"
You think for a bit. "Oh I would say about two!"
You Psychiatrist looks up and says authoritatively "You are responding to treatment"!
Your Endocrinologist asks you "On a scale of zero to ten, ten being extremely bad, zero being not at all bad, how bad would you say your diabetes is today?"
You think for a bit (amazed). "Oh I would say about two!"
Your Endocrinologist looks up and says authoritatively "You are responding to treatment!"
Question,
Which of these two professionals would you trust and why?
There are no right answers here only things to think about.
My friend Wilton will appreciate this.
Look him up at http://crookedpencil.crookedpencil.blogstream.com
Alive
I thought I might write down a few things.
Not so much that anyone might like to read what I write but to get it out of my head where it is cluttering up my hard drive.
Well, that is what it seems like ever since an ayahuasca experience left me with the notion of exactly how much stuff was cluttering up an otherwise a perfectly good collection of neurones, the slowest of which have been weeded out by timely cullings of red wine.
Be that as it may it gives me something to do.
At a certain age it begins to cross ones mind that all the irritating things one has been keeping to one’s self for fear of recrimination, fear of being seen as a troublemaker, non PC, bounced out of one’s profession, held to account for some conduct unbefitting, actionable, or libellous, simply become so overwhelming as to throttle the integrity of one’s own self expression.
Then the only question left is:-
To go or Not Go Gentle into that Good Night
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.
Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.
Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.
Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light. (D. Thomas)
My Father is dead.
My Son is dead
But I AM alive!
Not so much that anyone might like to read what I write but to get it out of my head where it is cluttering up my hard drive.
Well, that is what it seems like ever since an ayahuasca experience left me with the notion of exactly how much stuff was cluttering up an otherwise a perfectly good collection of neurones, the slowest of which have been weeded out by timely cullings of red wine.
Be that as it may it gives me something to do.
At a certain age it begins to cross ones mind that all the irritating things one has been keeping to one’s self for fear of recrimination, fear of being seen as a troublemaker, non PC, bounced out of one’s profession, held to account for some conduct unbefitting, actionable, or libellous, simply become so overwhelming as to throttle the integrity of one’s own self expression.
Then the only question left is:-
To go or Not Go Gentle into that Good Night
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.
Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.
Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.
Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.
And you, my father, there on the sad height,
Curse, bless, me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light. (D. Thomas)
My Father is dead.
My Son is dead
But I AM alive!
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