Mental Illness

Understanding BipolarDisorder, depression and other illnesses

Times six.

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Two summers ago, on a dry Saturday morning in London, Si and I set out for a walk. We headed to our local park, Streatham Common. As we took a turn into the Rookery, we noticed a young man sitting on the third step of the wide, well-trodden staircase descending towards the South-East. He held his bent head in both his hands.

An invitation.

I took a deep breath, softly stepped up to him with a ‘Hi. Good morning.’ He slowly raised his head and mirrored back my faint smile. None of our smiles reached our eyes. They were not real yet, only polite.

We got talking and forgot about the walking. Miles was in his late thirties, a father of two. He had been unable to work for a few months because of disabling symptoms that suggested something like Chronic Fatigue/ ME/ Long Covid. Of late his stress levels had rocketed as his employer had started suggesting ‘malingering’ in his letters. Even though his GP understood and validated his medical condition, his employer showed no understanding.

We gathered for coffee in the park on two more occasions that year. We enjoyed our chats, kept in touch and met up regularly even though not frequently. This year, he tells us he has been dismissed from his job after a “fair process” for “gross misconduct” for being physically and mentally unable to work. Gross misconduct includes physical violence, theft and fraud, intoxicated while at work and similar serious offences.

A study at King’s College London looked at the causes of death in 2000 patients with CFS/ME conducted over the years, 2007-2013. A total of 17 patients died in that period – eight died from cancer, five from suicide, and four from other causes. When compared to the general population, less than one suicide would be expected in a study population of this size. Yet five deaths by suicide were recorded. This means that, after controlling for age and other factors, the rate of deaths by suicide in this study was approximately six times higher in people with CFS than in the general population.

The reasons for this vulnerability are – poor quality of life with no hope for relief, loss of employment, finances, and/or relationships, chronic pain, secondary depression, and other associated mental and/or physical illnesses.

Miles felt he was losing his sense of self as a capable human being with integrity. People didn’t always believe or understand him. Maybe he is what they called him, a malingerer. This is hard on his family, but they support him all they can. The kids are delightful. He still has good days and bad, still has serious brain fog he cannot work through sometimes, still can’t do much but he tries his best. He carries a lot of shame for this thing that happened to him. He feels trapped.

No tests can prove his diagnosis. No definitive treatment is available yet.

Resource: Action for ME: https://www.actionforme.org.uk/

If not now, when?

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‘This is difficult.’

‘What I need is absolution.’

‘I don’t deserve it. I failed to be a good parent to my son.’

The subject of our meeting last evening was self-compassion, one of the recurring themes in the Circle of Remembrance. It was an opportunity to revisit the ways in which we can be our own best friend. As we have been encouraging the practice of self-compassion in the group for as long as we’ve existed, I assumed it would be an everyday practice for most of our members.

I was surprised to hear the above responses coming forth. The jaws of the beast of guilt must’ve loosened their grip on me.

Three years after Saagar’s death, I heard of ’Self-compassion’ for the very first time. My innate belief was that the only way to progress was to work hard, like the coachman whipping his horses to move forward. Finally, after having lost my marriage, my child and all pride in my professional achievements, I was learning.

Dissecting events from the past and looking at them under a microscope seemed pointless and silly. Still, I was doing it all the time. I had spent most of my life doing the things that I thought I had to do as opposed to the things that I wanted to. And it was never enough. There was always more that could be done. I was always inadequate.

When Saagar was six, I was working full time and studying for exams. When I returned from my Part 1 Fellowship exam, Saagar looked up from his toy helicopter and asked me, “Mamma, did you win?” I was unable to see this was a game, and I needed to enjoy it a little bit. In the middle of all the working and doing, I completely forgot to relax and look after me. I was unable to stop and reevaluate my priorities. This was normal. Everyone around me seemed to be in the same situation.

Through years of therapy, I learnt that I had been the unconscious creator of the jinn that kept me spinning, leaving little time to sit down, relax and have a heart-to-heart. I was invincible and so should everyone else be. Until now, the art of conversation was oblivious to me. I had never witnessed good listening, except in films. I listened to fix as that is what I was trained to do. Sitting around talking was not as credible as being busy, doing important things. That’s what I had seen and here I was, on repeat. But all these hours of sitting with the gift of my therapist’s listening had helped me turn to myself with empathy. Working through various threads of my life had loosened a tight knot. I was able to tease each thread apart and see it for what it was.

I learnt that I was my tyrant and my slave, pushed by the whip of time and pulled by the notion of success. Despite being determined to not become my ancestors, they were more present in me than I was.

Underneath that jumble, sat my grief, patiently waiting. As the thick oil-slick of self-ignorance thinned and washed away, I was able to grieve properly for the suffering and death of my child. A hundred tonnes fell off my shoulders and I bawled with relief – I was perhaps not entirely responsible. I was simply living by what I knew then.

I was worthy of my own kindness.

I deserved to be held gently by me.

In time, I might even forgive myself.

Possibly, even have compassion for me.

For all these years I had been trying my best to serve my patients and family from a punch bowl that had been empty. I couldn’t see this emptiness as I didn’t know what a full one looked like. In my home and work settings, self-sacrificing mothers and doctors were nobility. These ideals had seeped into me while I wasn’t looking. 

But now, thankfully, I could see that my bowl was empty.

I was going to polish it and replenish it gently.

If not now, when?

What’s been good?

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(Canna indica – grows wild by the roadside everywhere in Sakleshpur)

What’s been good?

It’s healthy to ask this of oneself – what’s been good? Not with the aim to overlook or deny what’s not been good or run away from it. Simply to acknowledge the things that have felt and still feel positive, no matter how tiny. The good and the not-so-good coexist but the mind tends to focus and fixate on what we resist which often falls in the latter category. This is a great way to redirect the mind and train it to pick up on the good, one little thing at a time.

Here’s my list from the last few days:

  • An unexpected packet of 100% Cacao powder showed up in the kitchen cupboard. The previous packet had finished. So, yay!!! This kind of a thing is a special blessing when you live at the back of the back-of-the-beyond and the nearest proper confectionery is a five-hour drive away.
  • Our neighbour sent across the freshest, sweetest pineapple from their garden.
  • For the last 24 hours we’ve had no electrical supply (normal) but our inverter worked beautifully, which meant we didn’t spend last evening in darkness.
  • Mangoes are in season!!! Need I say more?
  • The long-awaited monsoon is here. The farmers are happy and the temperature has dropped to a very comfy range.
  • Our landlord was clearing up his Heliconia bed and offered us 35 root balls!
  • There was a break in the rain this morning and I could squeeze a nice little walk in the coffee plantation where I saw the tiniest yellowest butterfly flitting past.
  • The breeze was cool and refreshing.
  • Most of the shoots of the Jade-plant that I was trying to propagate have taken root.
  • Playing rummy with friends yesterday, I surprised myself by closing two hands that were utterly hopeless to start with.
  • When I returned from my walk and opened the fridge, it lit up. The electricity was back.

How does this list help?

It shows us our resourcefulness in the middle of chaos. Helpful and friendly neighbours, ability to enjoy food and be creative, prioritise physical health, ability to feel relaxed and connected with nature, be joyful and have a sense of achievement – all the things that we can easily take for granted.

So, what’s been good in the last week for you?

A prayer

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She’s a friend who’s been sober for more than 20 years. A devout member of the AA, she is religious about it. Even today, her ex-alcoholicness is an important part of her identity and her sense of achievement. It is her story, her life.

At a recent dinner …

“Oh no! This is your glass. I’ve already had half of it thinking it was mine. I didn’t even taste the gin in it. Oh no!” She said to Si.

‘Yes. We made our drinks together before I went to the loo. Your lime-soda was in the pink glass and my G&T was in the blue. I thought you knew. This is an easy mistake to make amidst all the music and the noise. Don’t worry. Forget about it. You obviously didn’t do it on purpose. It just happened.’

“Yes. But …”

The AA says: “No one who has become an alcoholic has ever ceased to be an alcoholic. The mere fact of abstaining from alcohol for months or even years has never qualified an alcoholic to drink “normally” or socially. Once the individual has crossed the borderline from heavy drinking to irresponsible alcoholic drinking, there seems to be no retreat.”

I dread to think of the turmoil within her in the aftermath of that innocent mistake. I can’t claim to understand how she must feel. It came as a shock when she texted us to say she didn’t want to see us anymore.

It made me sad. It made me see the power of our beliefs and narratives, how they can hold us hostage if we let them. I can’t do much except pray for us all.

May we all grow in the ability to love ourselves, and one another.

May we grow in the ability to catch ourselves when we start spinning out.

May we all be able to stay with our experience as it is.

May we all remember, when we’re getting all caught up, to go look at the sky.

May we remember when we’re hurting, that other people are in the same boat. Rather than letting our hurt make us more afraid, allow that same suffering help us realize our shared humanity.

Connection of Care

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What did I miss most when I retired from being a doctor?

Patients.

The dignity with which they put up with so much angst and uncertainty constantly inspired me. They smiled. They tried to be gentle, often through pain. I felt a deep connection of care with them. When I stopped working, I missed my patients most.

Over the last 15 months, I have been studying the principles of Hypnotherapy and learning the skills of Solution Focused Brief Hypnotherapy. Anaesthesia is to Medicine what Hypnosis is to therapy. The parallels are clear to me. The course was enjoyable and insightful, and the practice is deeply satisfying. I can now work online with my clients from this remote little village where we live. Once again, I have that caring connection with people.

The fundamental physiological principle on which Hypnotherapy is based is that of Neuroplasticity – the ability of the brain at any age to grow and morph in response to repeated use of certain neural tracks. Cells that fire together, wire together, states Hebb’s law. This essentially means that the repeated use of certain pathways strengthens them and disuse of others, weakens them.

The belief at the root of this practice is that all the resources we need are already present within us. The art is to have access to them, to be self-aware and make decisions from a place of strength, not fear.

Insomnia, weight loss, depression and anxiety, stopping smoking, grief, getting over a phobia, relationship issues and stress are the most common presenting complaints. I am fascinated with the process as I see people identify small steps for themselves that add up over time to produce the big changes they want in their lives. One or two bonus ones as well.

One of my clients was mainly concerned about her weight. She didn’t like her photos and hated shopping for clothes. Otherwise, her life was good. She shared it with her husband of 28 years. After 6 weeks in therapy, she started to comment on her relationship with her husband, which seemed to be improving. She was responding differently to the things he said and did. That really helped. By Week 8, she was enthralled by how famously the two of them were getting on. At our 10th and last meeting, the weight wasn’t even mentioned. She had taken charge of her life.

“I think I have been more positive since we started. More considered, certainly.  My responses have become calmer. This has helped many of my interactions, especially with Mike. There are people who trigger me, however, that I still find it difficult to respond in a calm way (my mother). My activity levels have been steady. I rate my confidence as being a bit improved. I am trying to value myself more and my body. I am still a very organised person, but I suppose I am ‘letting things happen’ a bit more. I find that the small improvement in my levels of confidence and interactions have made a difference.  My reactions and responses help me.

As far as happiness is concerned, I often rate how I feel and think about what little thing I could do to improve how I feel. In general, the sessions have helped me view how I act and interact with others. I can ‘hear’ your voice calmly in the background when I take time to consider how I feel. I am also good at scoring myself. 

There have been some difficult moments recently (regarding my mother), and I have managed to step back for a few days and recharge.”

I feel fortunate to have found this new line of work that is essentially a series of creative conversations.

Resource: An international School for training to be a Hypnotherapist: https://inspiraology.com/