Brave New Flower

Doodle

Yesterday, my daily anti-depression walk took me through a meadow where I saw a small dandelion. So what’s the deal?

    Well, this field had just been visited by the Grim Reaper Mower and its friends. First the grumbling monster that razed the waving knee-high grass and left it out to dry. Then the sucking, whining monster that dropped a row of neat big bales. And finally the truck that lifted the bales and took them away.

They had left a barren field. Grass had just begun to make a new start:

The Meadow

Traversing this field, I came across one single tiny dot of bright yellow.

One Spot of Yellow

It really was the only one in the entire field. A closeup:

A Brave New Flower

Tiny Splashes of Color

So you are depressed? Then here is the inevitable metaphor, the one you saw coming.

    The barren field is your mind, your life. Your once lushly-waving flowery colorful existence, that now sadly has been razed flat by the Grim Monster of Depression. Ugh.

    But somewhere in that dull monotonous plain of your depression you may find a tiny hesitant spot of color.

    My little flower symbolizes any little moment, however briefly, when you manage to forget how ravaged you are by your depression. Those few seconds when you’re not fretting about yourself: when your feelings of utter hopelessness are pushed to the side, if only for one fleeting instance.

    The little lone flower stands for any of those rare moments when, through the gray self-centered haze of your depression, something from the outside comes through strong enough to be noticed.

    This can be anything. Some really stupid joke on TV that makes you smile for one brief moment, even when you didn’t feel like smiling all day. Or it could be a bite of hot chili pepper from the pizza that you sat munching so thoughtlessly that you didn’t taste anything before.

Pizza Peppers

The dot of color might even come from a sudden little flash of actual feeling – even if it’s deep sadness – that comes piercing through the numb blanket of depression, bringing some unexpected tears to your eyes. Or else it could be simply when for one moment the task of scrubbing a blackened saucepan claims your full attention, leaving no room for other thoughts. Or

    However depressed you are, I’m sure you can fill in something here for yourself.

Concentration

The secret here is concentration. You don’t need to wait for that single rare moment when you encounter such a tiny lost flower in the barren field of your depressed day. You can go looking for such experiences. And this you do by trying to concentrate, by consciously focusing not on yourself but on where you are and what you are doing.

    If necessary, set an hourly alarm on your phone as a reminder to keep trying this: to fully concentrate for a moment on whatever you see, hear, smell and touch right now. Right where you happen to be.

    And when you do this, chances are you will encounter a few more little “flower moments”. For concentration will bring rewards.

    When I spotted that single small yellow dandelion in the razed meadow, it made me a little more aware of my direct surroundings. Was there more to be seen? While walking on I kept looking around more carefully, more concentrated. And sure enough I came across another cluster of modest flowering right at my feet:

More Brave Little Ones

Concentration is like a pocket knife that can pierce small peepholes through the all-covering blanket of depression. It can bring you back brief moments of color and taste and feeling. The surprise of such moments can be like a reward. And the more you concentrate, the more often you encounter such flowers of mindfulness, the more they will spread.

    And anyway, such moments should also be seen as glimmers of hope. Like this one little dandelion proved stronger than the big grumbling monster that had razed everything.

Sorry (Just In Case)

I think my optimism is well-founded. Concentration efforts can really do a lot for us all.

    But if my optimism here offends you in the depths of your own depression, if it comes across like I’m not taking your plight seriously enough, then I am sorry for that. I do understand that when we are very depressed, any kind of optimistic advice can look just futile and stupid. So if all this only makes you more depressed, I’m truly sorry for that.

    Just remember I’ve been locked in the very same pit where you may be now. It was concentration on little things that gave me back a foothold, that helped me climb out. Even though I keep falling back from time to time, all the way into depression again.

    Sometimes, if you try, the mere effort of trying is enough to be helpful – regardless where it will get you.


 tip: I cannot say this often enough. Please try to concentrate. Concentrate. Concentrate. Concentrate: concentrate on anything that’s not yourself.


New WHO Suicide Report

Doodle

The World Health Organization (WHO) just published an extensive report about suicide and suicide prevention, worldwide. With many statistics and graphs, this 2014 publication is based on what we know about the year 2012. It also gives recommendations, and tries to correct some common misconceptions about suicide.

Core Data

In 2012 about 804,000 people killed themselves, meaning one suicide death every 40 seconds. This exceeded the number of deaths due to homicide and war combined.

    Globally, in the 15-29 years age group suicide was the 2nd second leading cause of death; in the 30-49 years age group it was the 5th leading cause of death. Among men, the number of effective suicides was almost twice as high as among women.

    It is estimated that in 2012 for every effective suicide, there were over 20 suicide attempts. This would mean that in 2012, there may have been over 15 million suicide attempts.

Probably Even More…

It is important to take into account that the real number of suicides for 2012 may have been even higher than reported, because the numbers above are based on aggregating just official data. To quote the WHO:

    Since suicide is a sensitive issue, and even illegal in some countries, it is very likely that it is under-reported.
    In countries with good vital registration data, suicide may often be misclassified as an accident or another cause of death. Registering a suicide is a complicated procedure involving several different authorities, often including law enforcement.
    And in countries without reliable registration of deaths, suicides simply die uncounted.”

Why?

2014 WHO Suicide ReportPeople can kill themselves for many different reasons, and the WHO report also indicates some cultural differences. In Europe and North America we see relatively more “depression” suicides, while Asia has relatively a little more “impulse” suicides.

    But obviously, in general, depression remains one of the main suicide risk factors everywhere.

    I would certainly like to know how many of those 804,000 suicides were directly caused by depression – but understandably there is no place in the world where with every suicide, authorities will also systematically register the motive or background.

    Let’s just leave it at this: these 804,000 suicides stand for 804,000 individual tragedies. Just think about this for a moment. Try to imagine just one or two of them. And we can be sure that with better mental health care (both on individual and on national levels) many of these tragedies might have been prevented.

Download

Since yesterday many news sources have superficially covered the release of this new WHO report. I found it a little strange to see none mentioning that we all can simply download the entire report.

    I would certainly recommend reading it. The full 92-page version is available in Arabic, English, French, Japanese and Russian. For Chinese and Spanish, there is a summarized version could an organization like the WHO really not afford a few more translators? Anyway, here is a link to the WHO downloads page for all editions.

    And here is a direct link that will download the full report in English: Preventing suicide: A global imperative (PDF file).

Suicide Prevention Day

In cooperation with WHO, the International Association for Suicide Prevention (IASP) every year organizes a World Suicide Prevention Day. Next week it’s for the 11th time: September 10, 2014.

    This World Suicide Prevention Day comprises a very wide array of activities, both online events and varied real-life events. It’s meant for everyone who feels involved with the theme of suicide prevention in whatever way. This includes, for example, those of us who lost a family member through suicide.

    Link: IASP – World Suicide Prevention Day – 10 September, 2014. After September 10 the site will still remain worth a visit because of its many resources.

World Suicide Prevention Day 2014

Just one gripe here: this also happens to be one of the ugliest sites I’ve seen lately. Somehow, they managed to make it look exactly like a 1998 Geocities amateur website. Was that really necessary? The world is full of mysteries.

Music

To conclude this post, for my own fuzzy reasons I’d like you to listen to the indie group Bright Eyes (from Omaha): the song We Are Nowhere and It’s Now, from their 2005 album I’m Wide Awake, It’s Morning.

    They sing here about someone who is feeling really lost, but who in the end gets a good luck charm.

    It’s not clear to me which Bright Eyes website is the main one. So here are three links: their page at Saddle Creek; their page at UMusic; and the official site of Conor Oberst, the singer-guitarist (left in the photo) who is the driving force behind Bright Eyes.

Bright Eyes

 
Bright Eyes – We Are Nowhere and It’s Now


In Memoriam: Robin Williams

Yesterday we heard about the suicide of actor Robin Williams. One more wonderful person who lost a long battle with depression.

Robin Williams

I was a fan of him, ever since I saw him for the first time way back in 1982 in The World According to Garp. And even in his most comical, manic roles you always could feel there was more behind the surface. A human being. One of us. That’s why even his funniest jokes sometimes had a touching undertone, too.

    Maybe it’s weird, but for myself I also feel somewhat unsettled by the fact that Williams and I were the very same age (63). Couple this to the fact that I think I can understand his decision, and perhaps you see why it makes me feel a little shaky.

    For the rest – the past day there has already been written so much about his life, his work, and his death that I have little to add here.

Depression Publicity

    There is something else, though. A celebrity suicide like this one brings depression back into the focus of public attention. Briefly – before the focus shifts to other news again.

    In reaction to the news coverage of Williams’ death, fellow depression patient Molly Pohlig wrote a few sensible words about this kind of publicity. It’s a very short post in Slate that you may want to read:

When the Illness You Live With Becomes Breaking News

A Ballad

As I have little left to say here myself, I’d like to say goodbye to Robin Williams with some speechless music.

    Here is Ballad of a Lonesome Maestro, an almost kaddish-like piece of melancholy played by Joscho Stephan and Helmut Eisel on their 2012 one-off-together album Gypsy Meets The Klezmer:

 
Joscho Stephan & Helmut Eisel Quartett – Ballad of a Lonesome Maestro


Are You a Genius?

Doodle

First, a brief update because I’ve been silent here for the last six weeks. I’ve been, and still am, so thoroughly depressed that I’m not capable of writing any of my usual brilliant stuff. Sorry.

    My psychiatrist is going to put me on heavier antidepressants and if all goes well, the new pills should begin to have effect a few weeks from now. I intend to be back here as soon as I’m a little better again. Thanks for your patience, once again.

Reading Tip

Instead of trying to write something myself now, I’d like to give you a link to an interesting article that was published a few days ago in The Atlantic. It’s a long but pleasant read, written by a true professional, University of Iowa neuroscientist and psychiatrist Nancy Coover Andreasen: Secrets of the Creative Brain.

    Her article is based (among other things) on personal analysis of well-known creative personalities from the realm of arts and science. She asks herself where true creativity comes from, whether it is true that there is a relation between creative genius and mental illness (brief answer: yes, statistics do indeed suggest this is the case) and why such a relation exists.

    This really is intriguing reading stuff, not just because it is refreshingly factual but also because every once in a while, you may be tempted to draw some personal parallels. For example, when Andreasen referred to the relatively very high frequency of mood disorders among poets, I suddenly had to think of my own sister who killed herself in her thirties: she also wrote poetry.

    This immediately calls for an obvious warning: sadly, the simple fact that you are suffering from depression does not automatically imply that you’re a creative genius yourself. If only that were true…

    Well, I hope you’ll take the time to enjoy Andreasen’s thoughts on the links between creativity and mental illness.

Music

For reasons I’d rather not explain, I am not going to offer you a depression-related song as background music today.

    Is it possible to be conventional and creative at the same time? And can we stick to ancient almost-rigid formulas, while at the same time kindling a few emotions?

    As an answer, here is the famous Portuguese fado singer Amália Rodrigues (1920-1999) with her classic beach love song Barco Negro (“Black Boat”). With my best wishes to you all: take care.

Amalia Rodrigues 
Amália Rodrigues – Barco Negro


Teens and Depression, Worldwide

Doodle

Two days ago (May 14, 2014) the WHO, World Health Organization, released a report “Health for the world’s adolescents”. The report is based on comprehensive research on the health situation of adolescents all over the world, in over 100 countries.

Adolescents are defined as the 10-19 age group, in other words, teens. There are 1.2 billion adolescents on planet Earth (1 in every 6 persons).

I just want to show you some parts of the WHO report that I think will speak for themselves.

First, these two lists:
 

    Top Causes of Illness and Disability in Adolescents:

  1. Depression
  2. Road traffic injuries
  3. Anaemia
  4. HIV/AIDS
  5. Self-harm
  6. Back and neck pain
  7. Diarrhoea
  8. Anxiety disorders
  9. Asthma
  10. Lower respiratory infections
     

    

    Top Causes of Deaths in Adolescents:

  1. Road traffic injuries
  2. HIV/AIDS
  3. Suicide
  4. Lower respiratory infections
  5. Violence
  6. Diarrhoea
  7. Drowning
  8. Meningitis
  9. Epilepsy
  10. Endocrine, blood, immune disorders
     

    

And a few quotes:

“An estimated 1.3 million adolescents died in 2012, mostly from preventable or treatable causes.”

“Half of all mental health disorders in adulthood appear to start by age 14, but most cases are undetected and untreated.”

“Depression is the top cause of illness and disability among adolescents and suicide is the third cause of death. Violence, poverty, humiliation and feeling devalued can increase the risk of developing mental health problems.
Building life skills in children and adolescents and providing them with psychosocial support in schools and other community settings can help promote good mental health. Programmes to help strengthen ties between adolescents and their families are also important. If problems arise, they should be detected and managed by competent and caring health workers.”
 

    

Not very surprisingly, the WHO notes that many later problems in adulthood (addictions, for example) may be prevented by tackling the same problems earlier in adolescence.

Therefore, they urge all countries to pay more attention to this particular age group in their governmental health policy.

To be honest, I’m left with the question: will this help, a well-meaning report like this? Will it really awaken politicians and other influential people? Will it have any effect?

Well, I guess these cynical questions indicate that right now I am feeling rather depressed myself. Yes, I am.

Some links for further reading, should you want to:


Rebuilding Your Life

doodle124

How long does it take people to recover from months or years of serious depression, if they do recover at all? And what extra problems should you be aware of when recovering from depression?

Recovery Chance

There is no general answer to the first question because individuals can differ widely when it comes to recovery. Jan Spijker, chronic depression expert at Nijmegen University in the Netherlands, paints the following global image of depression recovery today:

    Many depression patients can indeed (often helped by medication) recover successfully, but not always in a way that can be said to be definitive. About 50% of all depression patients will recover in a non-definitive way: at some point in the future, they will suffer from a second depression episode. And about 10% to 20% of all depression patients will develop truly chronic depression, lasting longer than two years. According to Spijker, some patients “should accept that depression has become a part of their life”, in one way or another.

    Based on my own experience (I belong to those 10-20% myself, and have also have seen depression recurring in others) I think this is a fairly realistic assessment. In a way, serious depression will always remain a part of your life simply because it remains a part of your life history.

    Regardless of what group you belong to, for most of us comes a day when for the first time we are strong and lucid enough again to take a proper analytical look at our lives – at the smoldering ruin that remains of the life we had before depression struck us down.

    This is the moment when we notice not just that we are recovering, but also that we will have some rebuilding to do.

Additional Damage

Basically, speaking in general, recovering from serious depression also entails (1) acknowledging some losses, evaluating whether what you lost can be restored or not; and then (2) either fighting to rebuild whatever you lost, or accepting some losses and compensating for them in a different way.

    Your losses can range from physical ones to social ones, in all terrains of life. For example, you may have less energy because you sleep less well than you used to; you may have lost your former self-assurance or even self-respect; medication side effects may keep slowing down your reaction times; after a lengthy period of depression you may have lost many of your friends; as a consequence of depression you may have lost your job or even your partner in love.

Recovering...

For some parts of the smoldering ruin of our former life there may be no other option than to write them off, to replace them with something different. Other parts may and should be rebuilt. Let me give you a brief (and of course too-schematic) overview.

Routines Recovery

One basic loss that in most cases can and should be recovered, is the self-discipline and energy to pick up normal daily chores again. Shopping, cooking, eating (yes that can feel like a chore), cleaning, walking or exercising, showering, taking care of your cat, all things like that. Even if your depression didn’t involve hospitalization, chances are that for an extended period your illness did make you lose your proper routine.

    My tip for reclaiming it: in the early phase of your recovery process, write down a daily list of tasks on a piece of paper. All of them, including those that seem self-evident or those that still a little too daunting. Tick off each one you’re done with. Don’t feel guilty for what you didn’t do yet; feel relieved for what you already managed to do.

Condition Recovery

Both your depression and the depression therapy can have resulted in collateral damage, physically and mentally. Your physical condition may have deteriorated by lack of exercise, or by some depression-related addiction: drinking? smoking? As for therapy effects, your medication may have left you sexually near-impotent. Or (this happens to many) hospitalization may have eroded your subconscious mental image of yourself as an independent, goal-oriented person, making you too passive. Or (this is what happened to me) electroshock treatments may have permanently wiped out parts of your long-term memory.

    It’s hard to give some kind of general tip here because it can greatly differ, from to one person to another, exactly what damage is repairable and what is not. Try to discuss things with your doctor and your psychiatrist. For example, if your recovery process allows for experimenting with less strong antidepressant medication, this may (though not for everyone) help solve sexual problems.

    My basic tip here would be: above all, be realistic. Don’t try to achieve what you’re not up to yet, don’t force yourself. If trying to jog again somehow makes you feel like a sad failure, begin with simple walks instead. Try to accept irreparable losses and temporary setbacks. In such cases, it’s safer to go for compensation by some other activity than to end up with an inevitable defeat: because ongoing “failures” might result in a return of your depression.

Recovering...

Work Recovery

As a consequence of years of serious depression and the inability to work when ill, many of us have lost their jobs. This happened to me, too: I lost the university job I’d had for over twenty years. And along with your job you may have lost other things. A large chunk of your income. Your home. And quite possibly, some of your identity and self-respect. I know about all of that.

    Again, there is no easy one-size-fits-all solution here. Some of us may be capable of restoring the situation that existed before illness set in. But for many of us, that won’t be possible, or only in part. Meaning that you’ll have to look honestly at yourself and your options, and then to some extent redefine yourself. You may have to give up your former ambitions.

    The main thing here, I think, is to find a new and realistic balance between (a) what you need to do to survive, (b) what you can do best with your knowledge and skills from the past, and (c) what you would really like to do again. And then, accept the new balance. Ending up with a less stressful job might be much more important than being able to afford a seaside vacation every year, don’t you think?

Social Recovery

In many cases, when you emerge from years of deep depression, you’ll discover that you have lost many of your former friends. There are several reasons for this, one of them being that for a long time you as a depression patient had not much to offer to others. Another reason can be that during your depression, they changed – or that the depression period did change you. Personally I also think one huge problem is that some people, even good friends, can deep down be very afraid of depression – as if it’s some contagious kind of leprosy. Many other things can also play a role (like in my own case, my lack of memory caused by ECT proved a complicating factor: I didn’t even recognize some of my old friends).

    I think that often one or two meetings will be enough to judge if an old friendship is restorable or not. Sorry, but here you’ll have to be realistic again. Mourning what was in the past will not help you any further. If you end up with nearly no friends at all, then you’ll have to find some new ones, maybe in the context of your new job or new activities.

    My basic tip here: above all, be honest to others. Whether you like it or not, your having a psychiatric past is now one part of your identity. It really is best to be open about this to all potential new friends. This honesty will help you to easily separate the understanding ones from the ones with prejudices, right away. Say good riddance to the latter category.

Recovering...

Love Recovery

In some cases, the love relation with your partner may not have survived your years of depression. If this is the case, it’s the most sad and difficult complication that can happen to both of you. But you should not blame the other one for it, nor feel guilty about it yourself. Often, it is a very understandable consequence of years of unbalance, of relational disequilibrium: the other one had to care for you and carry an extra burden while your illness prevented you to give something back.

    It’s not unusual for the healthy partner to break down right at the point when finally, after years of illness, the depressed partner arrives at the brink of recovery. This is a sign that for the other one, the burden had in fact already become unbearable since quite some time. Let me say again that guilt and blame are completely irrelevant terms here. This can be a quite natural and understandable situation.

    In some cases like this, when you both are still motivated, it obviously is worth the trouble and energy and time (this can cost years) to restore the relationship and find some sound mutual balance again. In other cases (let me be blunt) it can be simply too late for that. Your partner can have become too worn out, or he/she can already have fallen in love with someone else: compensating for what amounted to his/her own loss over the past years.

    I have no easy solution here. Evidently, the intense sadness over a lost, ruined, not-restorable relationship can seriously hamper one’s recovery from depression itself. It can easily throw you back. Maybe you should seek extra psychotherapeutic support in a situation like this.

    At the same time, please remember that one of the essential elements of your own recovery is becoming an independent, self-supporting person again instead of a patient who is mostly dependent from the care of others. The better you manage your over-all recovery in this sense, the more chance there is that you and your former partner will at least repair part of the relationship, to remain warm and close friends.

Getting Better...

Closing Words

I wrote all the above for those among us who are taking their first steps on the long and difficult road towards full recovery from depression. I’m sorry if to you this reads like a daunting list of dangers and difficulties, or like a heap of too moralistic advice. I can understand if it does. Sorry.

But still I hope (that’s why I wrote it all down) that this overview may help you a little to view and tackle the problems of your recovery in a systematic and successful manner. I hope you will restore some parts of your smoldering ruin, and perhaps replace some other parts of the same ruin.

Things will never become exactly like they were before mental illness struck us down. For many of us, depression will never completely go away.

But may I say something here that (if you are still depressed) may sound stupid? In the end, years of battling depression and of recovering may leave you not just a as different person, with a different life, a different job. Unexpectedly, this whole long depression struggle can also have made you into a better, wiser, more human person – even if it didn’t make you more happy, rich or successful.


 footnote: This post was inspired by an article Recovery and Accepting in the Dutch newspaper Trouw (printed version, April 18, 2014) that centered on the example of Nathalie Kelderman.
    She once worked in the Dutch Foreign Office aspiring a diplomatic career. After seven years of depression and recovery (for the second time in her life) she now works as manager for the Dutch Depressievereniging, a national association of depression patients (website Dutch language only).
    Kelderman, by the way, succeeded with much effort in salvaging her marriage that after her years of depression was on the brink of falling apart: she herself calls it “a miracle” that she and her husband are still together.



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