Weight and depression - time for a healthy diet

I am munching my way through my last packet of crisps before the Healthy Eating weight loss diet starts in 2 days on 1^st August.  Getting breathless walking Gabi this summer has got me worried.  I have been on blood pressure meds for 2 years already, and I’m only 41.   My BMI is no longer in the overweight category but I have crossed the line into obese.   I need to lose 20% of my current weight to reach the top end of the healthy range for my height.  

This is partly linked to my mental health.  A lot of mental health medication can encourage weight gain, mostly I think from giving us the major munchies, though some may affect metabolism too.  I also spent time on one that has a side effect on blood pressure.   But it is not all the medication.

Depression can be exhausting, acting ‘normal’ in the big wide world means coming home and flopping out. For me that puts meal prep way way down the ‘to do’ list, whilst duvet time is right at the top.  Of course at some stage my body demands input, and Now!  

That means quick calories and no effort.  So surface from duvet and reach the kitchen, problem is that making a decision is as much of an effort as anything else and I am left standing in the middle of a supply of food but paralysed by the decision process.  Default kicks in and I reach for the instant calories of a packet of oaty biscuits, or crisps, or anything instant, and retreat with the packet back to the duvet and munch, and munch, through the whole packet.

That isn’t every meal, or every day – but far too frequently, and in between are the ready meals or that sole meal of the day turns into eating both portions of the meal for two.  Basically my eating is rubbish and all over the place, and that’s before alcohol calories.

So 1^st Aug is the new beginning, I have been researching, I have produced a 4 week menu plan so that the effort of choice is taken away, and I have been shopping – with a strict list!   I had a trolley full of veg and fresh fish, some chicken and not much else – no biscuits, no doughnuts, no multipacks of crisps.

The discipline will be to eat at 3 specific points each day, the diet is low in carb and limited calories but full of healthy nutrients.  Yes it is a low calorie – quick impact diet but not in a faddish cabbage soup diet way.   I know my stickability to a new project is not great once the novelty wears off, so something that feels like it is getting somewhere is better for me.   And to start with a mild obsessio

n about the healthy eating project is good for getting off the blocks well.

So enjoying the last pack of crisps and last glass of wine for a while, and the church faith lunch tomorrow – then Monday morning I will rediscover proper breakfast.  I will let you know how I do.

Living with pain

I have friends who live with great pain in their bodies, not a mere paracetamol or ibuprofen pain, but the kind that gets offered the strongest pills possible which still only dulls the worst moments.   They don’t talk about the daily pains that often – it is enough to feel it without talking about it too, and they don’t want to bore you or themselves with saying that it hurts every time someone asks ‘how are you?’

I admit to being a wimp over physical pain, and don’t even mention nausea!  What my friends live with as normal would lay me out.  But life has to be lived, and my friends like so many others find a way to keep functioning with these pains.

If only it were that easy - physically or emotionally

When they do mention how bad a day is – then it is a day when it is not just the permanent ‘normal’ pain (which the rest of us would consider a ‘bad day’) but an extra extra bad day when the meds are not helping much – or at least it feels they aren’t, though how much worse could it be without them? We all experience pain, but they live with it.

To understand depression is a similar distinction – yes we all have low days but to live with depression is to have as a normal what those without the illness know as a really bad day.  We may not tell you how tough living with that emotional pain as daily life is, like my friends finding a way to function with great physical pain, so those of us living with depression find ways to function in the big wide world.   Physical or emotional, you may not glimpse the limp or grimace with a wave of pain, we have got used to not letting it show.  But it costs us – this functioning and blending in.

And some days the cost is beyond our budget, beyond our energy overdraft limit – then we may say ‘I’m not too good today’. But remember we are likely to be using a completely different scale, so saying ‘I’m having a bad day too’ – unless you are using the same currency as us – is not really understanding.   In the same way as if I were to respond to one of my friends whose body is regularly wracked with extreme pain with the comment ‘yeah? I have a bit of a headache today too’.

I am sure that on a normal day they would be very willing to commiserate with my headache, but I should not be under any illusions that I understand their experience.

So when someone living with depression doesn’t talk about how it feels, don’t assume our normal is your normal.  And when we do say it is a bad day then believe that it is and give us space when functioning is a challenge.

They say that ‘grass is greener on the other side’ – strangely that is not the case here, at least for me, having learned to live with depression it is a housemate (lifemate?) whose habits I have got to know and learned to cope with at some level.  As said I am a wimp about physical pain and so the challenges of friends living with that seem much worse than my own journey. I wonder if they feel the same about depressive pain?

I write this on a functioning day, but where depression is as always lurking in the background, in the hope of helping anyone travelling with someone with depression to understand a bit of the difference in what we say and what that describes.

To cope or not to cope?

I have started to be involved in a mental health facility – in many ways it is like a care home for those not needing full scale inpatient care but not considered able to cope at home.  The residents are a mix – some I can see as significantly unwell, but others I wonder why they are not under home support.  I have only had a few visits so far and know my observations are based on brief and shallow encounters, I don’t have - and it wouldn’t be appropriate for me to have – details of individual situations except what they choose to share as time goes on.  However it makes me wonder about what it is to have mental ill health and to be judged able to cope at home, or not.

Is there a difference about whether you would be home alone or have live-in support? It must be a key issue if you have a spouse or parent to support you then you are not managing the fullness of domestic life alone – bills, shopping, cooking, someone to encourage you out from under the duvet.

I consider this as someone who lives alone, and struggles with mental health.  As someone who in low times struggles to get proper meals and needs Gabi the dog to nag me into getting out. I have the huge privilege to be in a role as a church minister that gives me the freedom to adjust around my moods. And I have come to accept that effectiveness and busyness are not be the same thing, so give myself permission to do the admin on a laptop from under the duvet, and not expect much in the mornings – unless I really need to be somewhere. (I am much more comfortable with evening meetings).

I have days when I can cope with the complications of domestic life, and enough of the role of ministry.  I have days when I am buzzing with ideas and possibilities – a gift but also potentially a symptom, not always being grounded in reality. I have days when my mood is so low that maybe I could be one of those considered not able to cope alone.  If I had not been in a communal college situation when I had my deepest collapse would I have coped in any way – it was enough of a struggle to make it to the dining room to eat food prepared for me.

What does it mean to be one of those who copes? On one level it is positive, it suggests that I am not as unwell as some others. On the other hand it can be an excuse to deny the needs I do have – by services and by myself – pretending I am not unwell when I am.

Coping is about looking like things are okay when in reality every step is both a struggle and an achievement. When getting a shower and putting the mask on for the outside world costs almost all we have – but others see as merely normal. The skilled observer may see the eyes are dead or the responses pre-programmed – but we are skilled at hiding it and the chance encounter at the local shop is brief enough for us to disguise our pain.  Why? Because to get caught in a conversation about how we really feel, and your theories on what will help, that I have to be polite about – that would demand so much more from us.

So back to those deemed to need the care of the unit – whilst glad to be considered not ill enough for that, I do have a certain degree of envy for those who have permission to not cope, who don’t have to pretend or struggle to cope but have aspects of life happen for them.  An odd position it may seem to some, but maybe others will understand my feeling.

Marking Easter in the company of depression

Unlike Christmas when the mood of anticipation is ever upward, the Easter journey encompasses a wide spectrum of emotions. The growing tensions as Jesus enters Jerusalem, challenges the authorities in the temple and talks of death. The betrayal by Judas, one of Jesus' inner circle on the Thursday, other friends flee, there is a mock trial and a baying crowd. Humiliation, pain and death for Jesus. Grief, loss and confusion for his friends and followers - and his mother.   

Most of the range of human emotions are here, places to connect with the journey for people facing all sorts of situations. And the traditional Holy Week services encourage us to face all the different stages, to embrace those emotions.

Then after the waiting of Saturday we arrive at the 'first day of the week' - Sunday - and it is all Alleluias, and the proclamation that 'He is Risen' - the tomb is empty and Christ is alive. Wonder, awe and celebration are the themes, but should we forget the pain before? Is it like the claim about childbirth all forgotten in the face of a new life?

For some it seems so - as the churches together gathered midday Friday for an outdoor service a colleague from a different church tradition spoke on the victory of the cross, and how Jesus' death brings freedom from guilt, fear, sin and general misery and a saving from hell. Traditional enough Christian doctrine but to gloss over the suffering of Maundy Thursday and Good Friday felt like a glossing over of the pain of this world. A world that sees bombs in Brussels and Lahore, sees people facing death, sees people feeling despair. The message of the incarnation is that God came to be in this world with us, even to the point of knowing death.   Mere victory speeches take away from this message of God with us, and are like rushing from the entry to Jerusalem with cheers, to Easter morning.

As someone living with depression I find links with the Thursday in the garden, a long night of mental distress for Jesus whilst friends didn't understand and though trying to be with him fall asleep. Others may feel other connections, my point is that the full journey is important.

Yet in the Methodist Worship book the Easter morning prayer of confession says -

The empty tomb is in the shadow of the cross,
and the new life doesn't obscure the cross still present.

If we have fallen into despair
Lord, forgive us

If we have failed to hope in you
Lord,forgive us

If we have been fearful of death
Lord, forgive us

If we have forgotten the victory of Christ 
Lord forgive us

I know from discussing this online that some have found comfort in these words, but for me they feel like a stark rejection of the emotions that we have been invited to share on the journey through Holy Week, and for those who live with those emotions is it a rejection of our experiences too?   In my depression I can feel despair, can lack hope - these are symptoms of an illness not sin to be forgiven.

There are some corners of the Christian church where mental ill health is seen as spiritual not as an illness, one group locally even producing a booklet about the dangers of psychology and psychiatry, and that self pity is a sin of selfishness.  But they are not the majority and I am sure the compilers of the Methodist Worship Book (1999) did and do not hold such extreme views.  Maybe in the midst of depression I am over reacting to words that do not trouble others - but I could not offer those prayers with my congregation on Easter Day, and I wonder what message others like me might hear on what maybe their biannual church visit.

The empty tomb and sighting of the risen Christ on the first Easter are to be celebrated, but those who lived then needed time to understand, and gently Jesus gives them that time over 40 days of encounters to guide and reassure them.  And he showed the marks, even in resurrection glory the pain was not forgotten or dismissed, but part of the new hope

The pastoral visit

As a minister part of my role is to visit, especially those not able to join us at church.  Living with depression, as an introvert and probably with roots in my disconnect from others when bullied throughout school - I find this the hardest thing I face in the job. This is a poem that expresses how it feels when I am unwell and trying to visit -

It’s not you it’s me – the pastoral visit

I come into your home, your space

You welcome me, grateful that I have come

The church has come with bread and wine.

You deserve my attention

Care to the tales you tell

The memories you recall

I turn my face to you

Nod and smile in hopefully the right places

I mustn’t show the scream inside

Don’t let the mask slip

It’s not you it’s me

And this is supposed to be your time

Your time - that I have put off again and again

Denied you my time

Because, because, because…. I am broken

Because my head is full of fuzz

Because though I can do the act from the front

One to one I don’t know the script

People may see me visiting you in your vulnerability

But I am the vulnerable one

And you can unmask me

I feel a fraud – pretending to be normal

When inside is a mass of chaos and the suppressed scream

I want to be home, safe in a duvet cocoon

But finally I have made it here

I sit still, I nod, I break bread

And countdown to when I can flee

It’s not you it’s me

Helen Roberts Feb 2016

Being in two minds - the voice of insecurity

Feeling vulnerable - my successor visited the churches yesterday. Like me it will be his first appointment as a minister following training, and I suppose a bit of me had been thinking about I had felt at the start.

The 5 years experienced me considering what the nervous new me would have liked to have known, not quite reached the idea of the old hand pegging out the safety net for the new kid on the block - but some confidence in myself.

Then we hear who has been allocated to come, and he visits, experienced business life, good rural knowledge, had lots of experience of different roles in church life, been a school governor..... and all the feedback is that he is likely to be good at the very things I have struggled with.  This is good for the churches and the strength of a regular change of minister - that we have different mixtures of gifts and weaknesses so the next one can balance things out.

It is great news for the churches, but another opportunity for the depressive insecurity to surface - not only does he sound better equipped than when I started out, the niggle starts to suggest he will be better even than the 5 years of learning and growing version of me.

I do know that I have a whole range of gifts, that people have appreciated my ministry here, and we have achieved some things together - it is just at the same time, in the same mind I have these thoughts of insecurity and falling short, that I have been just been muddling along and don't really know what I am doing.

How can it be possible to hold two opposing views in your head at the same time? I don't know, but it is something I have experienced for years.  It seems to be healthier than just believing the voice of negativity, but the positive knowledge is just not enough to drown them out.  This is my experience over many things, and I have been very low all autumn and into the winter.  Knowing that it is the illness not reality doesn't stop the emotions of uselessness and pointlessness, it reduces the risk of acting on those feelings but doesn't stop them settling in, stretching out on the sofa and picking what TV channel is playing - like an uninvited guest you can't get rid of.

Living with two minds seems to be my normal, and it can be hard work.  Days like this are a reminder that although I have left the uninvited guest in one room and got on with living elsewhere, they are still in my house and can make a big noise.

To work or not to work - a complicated question

A fellow minister elsewhere in the country has written about her experience of returning to work after depression and the challenge of 'Are you better now?' greetings

Sally's Journey

That is part of the package of having time 'on the sick' when you are in a community role, it is noticed when you are not upfront as expected on Sunday - and so lots of sincere but unhelpful greetings as Sally explains.

Edit to add link - other thoughts on those tricky how are you conversations from Suddenly Bipolar

This is a funny type of role being a church minister, lots of things we do is out of sight then the rest is the opposite - right up where they can all see.  It makes work or not when unwell a complicated question.  A day under the duvet with the snuffles can be made up if things just need to be done, and some times of the year are more hectic than others which have more breathing spaces.

I have been crashed low since the start of November, to the very bottom - I have had weeks of officially being in work but doing the minimum for what has to be now and has to be me;  now I have a few weeks officially on a sick note - but the psychiatrist thinks good for me to be doing bits of work.

So from in work but barely; to off work but dabbling - it may look similar but the difference is that now I have no pressure of deadlines or fixed times to pull it out of the hat and fronting up to the world on a day I'm a mess.  On the other hand it is 'out there', public knowledge, so cue reactions as my colleague Sally discussed in her blog.

It is a tricky choice at times - to be officially in work or officially not - but I am grateful to be in a role that allows me the flexibility within either.   For many people mental illness and work is much more complicated - push on till collapse under the weight, then returning afterwards can be hard to gently edge back in.  Not to mention the stigma about the cause of the absence.

All reasons to challenge the stigma, educate that it isn't a sudden fix if back in action, but that will have to wait for one of those getting up days, and gently does it.

Too good at being bad* ??

I live with major depression. I suffer with competence, or at least being able to do a good impression of it. On the outside I look competent, so yes I make meetings, may even be in fresh clothes, but can take hours to psych up for sending basic email, and if you need a phone call...

I feel needy, or wrong, or just demanding. And if I didn't get your reply to my query I feel even worse about nagging.

But I can't do ill well enough either. I sound too together to the psych team, and if in work then...  But that doesn't quite mean as they may think. Not neat office hours of coping, more spurts along the way.

So a new person to see, the plan from last one shelved, new plan, see you in 3 or 4 months. If it is still you not the next rotation, what will the next one say?

Meanwhile I muddle on, will have a month of staged withdrawal from one of my current meds - that is known to be tough so if cranky a month from now you know why (let alone the nausea etc). Then start on the 2nd drug that increases weight - from the munchies I think, for a month on starter and then up to full - so guard your cakes in Harvest Festival season and beyond

* Bad is Wenglish (South Wales speak) for being 'poorly', as in the clichéd "she's been bad in bed under d'doctor"

Back home. Now where were we?

I had planned lots of deep and insightful blogs from a whole range of my experiences in North Carolina, but day to day plodding and still having ups and down to manage meant I didn't get around to that.

Now I am home, have been for a couple of weeks, and just about getting used to that - suddenly it is September and the season of frantic activity begins again.  End of year accounts for churches are being compiled, new plans being made, team meetings etc.  And this year the planning for ministers moving, including me.

What do we say about the churches and communities I serve as the profiles are put together, where we are, where we would like to be, what skills and gifts will help us on that journey? I put my profile together before I left for America, slept on for 6 weeks and then submitted.

It all concentrates the mind on what ministry is about - what I will be leaving and how someone with different gifts could take things onwards. And what is it that I will take with me to the next appointment next September.

My time in North Carolina was very affirming, I got to know the church folk fairly well with seeing them several times a week, and I left with compliments in my ears and in cards to read again.  Yet I still feel overwhelmed and doubt that I have the abilities and gifts to meet the needs, or even to cope.

This week I have been involved in confirming arrangements for the district synod with workshops around mental health issues - I have been in denial that I am down to lead one of them.  I also had a reminder/update email for a 10 min slot telling the story of one of my churches in a conference on rural churches.  It sounds like I have something to say, to offer - but all it has been has been me muddling through. I have grand ideas but wouldn't know how to cope if they came to be.

I know partly it is normal and partly it is the depression, but I feel so inadequate, and as I face the process of deciding where next, and with a frustrating appointment with (another) new junior psychiatrist leaving me wondering if there will be improvement over the next hill after all, it all feels so hard.   I can do what I did in America, but that was free from all the other expectations, and practicalities.

For now time to walk Gabi - having not had enough time out with her over last couple of days. Feel that I am not even good enough for that. Then get guilty for moaning when others face so much more. Ho hum, well settle for a walk on the common - hoping that Gabi can run free without embarrassing me in front of the other dog walkers with very obedient pets.

In the psychiatrist's chair

So what would it be like, at the mental health centre, for an appointment with a psychiatrist?  Well standard NHS waiting room and then into a room with a desk for her to use writing notes and a few chairs.

It shows the stigma that mental health has in that in every physical medical speciality being referred to the specialist, a consultant and their team, is seen as a positive step forward in getting advanced focussed treatment. A referral to Ear Nose & Throat, or to the Oncologist or....   but try saying in general conversation that you are off to the Psychiatry Dept.   I have tried to be open about mental health in my life and did tell friends I was due to see a psychiatrist - but then found myself referring just to a hospital appt, or that GP had sent me to a specialist.

I was counting down and hopeful - since the autumn and before my referral I came across information on Bipolar 2 where the highs are not as high but the rest is much the same as Bipolar 1. The definition was a close fit and explained various points in my life, including at college before my grand crash down.  I have been on a peer support web forum and listening to others to see if it still felt a fit, it would explain why the anti-depressants have not had the level of effect hoped for over these years.

Ready for the day, with notes of my history of depressed times over the years, a mood diary from Jan 1st with the chart numbers put on a pretty graph, and hopeful.  It has been a long hard winter of depression, I would have gone to the GP to plead for something else, or a change in dose or... but no point when the psych appt on the doorstep - they will be able to offer something, a new approach, new hope.....

And?

A sensible, take it slowly, possibly bipolar stuff going on, too soon for labels, you are coping with life so no meds yet, carry on as before - come back in 6 weeks with more mood diary.  Disappointed.  Although, whether placebo effect of hope anticipated or the pendulum due to swing, I had headed up in mood a day or so before and that is still with me - so will cope for six weeks. Now where did I put that diary and mood chart?

Surviving someone's emotional collapse - hints from inside

I see your confusion, the pain of looking on as your loved one crumbles from within and the cloud of chaos engulfs you all.  And then what,  where do you go from here?

Somewhere in your community, usually tucked discretely behind closed doors of course, sometime this week, someone, or lots of someones are going through this.

As one who has lived in the centre of that swirling mist, and visit it still I offer these tips -

1. Don't try to fix us - it is more than solving a jigsaw puzzle, there is no single piece you can find to make the difference.  I know that is hard to understand, and that if there was something you could do you would.  This doesn't have any quick fixes, and we are so caught up with the chaos and the chaos with us that when you try to get rid of the problem it feels like you want rid of us.  I know that is the last thing on your mind, but our thinking gets screwed up.

2. Don't keep asking how we feel, or if we are alright - we all know that things are not ok, we don't need to always talk about it.  And when you ask how we are feeling it can be like the hardest question in an exam, we are often not sure ourselves, at least not in ways we can put words to. And even if we could then we are anxious about saying it out loud - will the raw mess of it scare you, or hurt you?  We see you on the eggshells, and want to reassure you, to find some way of protecting you - so every time you ask how we feel there is so much to work out and it is exhausting.

3. Don't be afraid of being normal with us - we are more than our illness, pretending the elephants aren't in the room is not an option but that doesn't mean they have to be the only thing in the room. We won't be up to mad parties, but we need to be reminded of the variety of who we are.  Without trying to fix us  just talk to us the way you normally would, of football, computers, telly, whatever. We need to hold onto to the normal things whilst the rest spin us dizzy.  And it's good for you too.

4. Pack for a long journey, remembering all you will need too - this is a marathon not a sprint, and one none of us trained or planned for. So take the pace carefully, get all the support you can - we need you, so need you to love and care for yourselves.  We are not well enough to help you, so you will need others, friends, family, professionals - don't be afraid to ask for the help you need.

And there are lights out there, some along the way, and even those at the end of the tunnel. And others are on the path too.  Sometimes we may stop and sit for a bit, sometimes we may seem to double back, that's all ok, all normal - as long as we are together we can cope and hope.

And thank you for being there, and for trying, and most of all for loving us at our messiest.

Labels...

'My name's Helen and I'm.....'

Fill in the gap according to context - single, minister, Gabi's owner, late, lost, depressive ....

Labels are useful, it is a shortcut to what you need to know, or have others know about you. Yes  I am /am not the person you need to speak to. This and not that is why I am here talking to you.

They can be affirming - 'My name's Helen and I'm ordained'
After years of delays, and illness, and times when I thought it would never happen it was a good feeling to reach that point.

They can be releasing - 'My name's Helen and I'm a depressive'
I remember when months after my breakdown 5 yrs ago and finally at the doctors for help someone officially wrote the D word.  I came home strangely happy to have the label, 'I'm not loosing it I'm depressed'  - I wanted to to tell everyone about it.  Oddly looking back over journals of the time, even months before 'crash day' I was referring to being in a depression, and to previous years when similar had happened.  So why it was so significant the day the doctor used I don't know, but it was like a release, permission to declare I was ill person, rather than a failed human.

For others though a diagnostic label is something to be feared within mental health. Conditions are not as neatly measurable as many aspects of physical health are, people are moved between diagnoses as the experts try to work out which label fits best.  And people don't fit in neat boxes - mental health diagnoses have a habit of ending up as x with a hint of y and aspects of a and b - we are all on a spectrum. Well lots of them really - multi dimensional axes covering the many aspects of life.  But labels put us into categories, and categories can divide.  Labels can feed stigma and discrimination.  How many sick notes sent to workplaces have referred vaguely to 'stress' rather than depression to avoid the official label going on file?

Yet, I recall from biology days how important classification is in trying to understand - seeing what is similar between some things and different from others.  And as I am exploring aspects of my depression that might give me an added 'hint of' label that is how I see it.  I won't have changed, treatment probably won't, but the label would help me understand myself better and maybe cope with the ebb and flow of depressive life.