I only just got used to being chronically depressed when I discovered there was actually a name for all my other funny habits.
Find out all about depression, diabetes, low self-esteem and Tourette Syndrome, and how cognitive behaviour therapy, mid-life crisis and drugs (therapeutic, of course) changed my life!
THIS PAGE COULD CHANGE YOUR LIFE!!!
- Crazy mixed-up kid
- When things got messy
- Stabilised in a state of functional disrepair
- Depression
- Diabetes
- Tourette Syndrome
1. A crazy mixed-up kid
As I've mentioned elsewhere, by the time I reached adolescence I had a firmly-rooted emotional conviction that I was never going to live up to what others believed me capable of. All the significant people in my life -- parents, grandparents, teachers I respected -- insisted (sometimes kindly, some quite brutally) that I could achieve so much if only I'd put in the effort. But somehow I just couldn't "put in the effort". I didn't understand why, and it wasn't as if I set out to thwart the expectations of my elders and betters: I just couldn't get it together. That's not to say I didn't achieve: academically and creatively, I collected enough gongs to establish a reputation as talented and very bright. But of course, it was never enough, or good enough. Eventually, I came to feel that the plaudits I did receive were unearned and therefore undeserved. And I came to equate achievement with affection.
Of course, this wasn't a black and white, single-factor, cause and effect process. There were a lot of factors impacting on each other. My parents were very young, with baggage of their own, and constantly struggling against the restrictions imposed and ambitions thwarted by an unplanned family. Dad's temper was uncertain, exacerbated by a catastrophic illness (viral encephalitis) which he contracted when I was 9 or 10. Punishments for behavioural infractions were unpredictable and harsh. Mum just wanted peace and quiet and a little time to herself. Dad was big on physical fitness, and constantly exhorted me to be more active, using a combination of inducements and threats. I wasn't at all motivated by exertion for its own sake, so that was one more point of friction. Constitutionally, I was a big, robust, chubby girl -- fat, according to my parents.
So...fat, idle and indolent. I heard it so often, told in so many ways and with such conviction, that I accepted the verdict. Not good enough, not good enough.
Adolescence was hellish. I spent a lot of time feeling anxious, weepy, guilty and in pain. I had a persistent sniff that seemed to have nothing to do with catarrh, and a variety of minor nervous habits: I started to smoke. I was dutiful (fairly) and well-behaved (mostly). I passed exams and matriculated, underachieving all the way, and scraped over the line to earn a Commonwealth Scholarship to the University of Queensland. My rebellion was subtler but ultimately more damaging. In my honours year, and used to feeling ugly and incompetent, I got married to my first serious boyfriend. I graduated with an undistinguished honours degree in psychology, and took up a bonded position with the Queensland Health Department as a clinical psychologist at a large psychiatric institution, on the day after my 21st birthday. Offfially I was an adult.
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2. When things got messy
I floundered in the job, not having a clue what was expected of me and feeling totally inadequate. So I had a baby. I was enchanted with her, enthralled by an idealised vision of myself as a model modern parent, who would never ever repeat the mistakes her parents made with her. A sideways move at work seemed to provide a solution to the increasing problems I was having there: I took up a position as manager of a residential unit in the newly-formed Intellectual Handicap Services.
Again, my lack of confidence, involition and general confused inadequacy equipped me badly for leadership. I floundered once again, so of course I had another baby. Unfortunately, by the time I was 3 months pregnant with my second child my husband had decided he was bored with this game and didn't want to play anymore. He left as soon as I had returned to work, when I was 25 and my younger daughter was 6 months old. I was depressed, anguished and panicky throughout the pregnancy and separation. I struggled and flailed against the wrongness of it all.
I embarked on a desperate manhunt, unable to face the prospect of life not so much a single mother, but as a woman without a man. Within a year of the separation I was living with Tony. He had been married twice previously (a fact that emerged only gradually), was 12 years older than me, and seemed to offer, if not a soulmate, then at least a refuge from isolation and alienation. We married in January 1982 and he became father to my girls.
As the girls grew up, and my career progressed almost in spite of myself, I continued to struggle with a lowering sense of being unequal to life's tasks. I drank far too much, berated myself for my failings as a parent and as a professional, grieved for a relationship that went nowhere but was hard to let go, and fretted for a more satisfying emotional and intellectual partnership. I had dreadful black periods when I longed not to be. At work and at home, essential tasks were neglected and projects foundered: I didn't seem to be able to start anything, or, once started, was unable to progess. A conflicted relationship between my husband and younger daughter, and my failure to see in time what her difficult behaviour was developing into, became a nightmare of school truancy, suspension and expulsion; absences from home; self-harm, substance abuse and criminal dealings. We screamed for help from every possible welfare agency. Life became an upredictable to and fro of court appearances, state care homes, long periods when we had no idea where Cecily was, and innumerable attempts to try again.
Eventually, of course, I reached a point where I could not go on. I was drinking myself into a stupor every night, and acquired a horrid dry racking cough that doubled me up until I vomited. I developed hypertension that was resistant to treatment. Too many days I couldn't face work, and the prospect of getting there provoked panic. My section at work had been restructured, and I applied for a newly-created senior position because I thought I ought, not because I wanted it or believed I was worthy. I approached the interview with mounting panic. When I entered the interview room to face the panel I started to explain that wished to withdraw. I began to weep uncontrollably, and gasped, "I can't do this". My warmly supportive boss stroked my arm and hugged me. Later, both she and the director came to assure me that they would reschedule the interview whenever I felt ready. But I had hit the wall.
I simply could not bear to think about work. I had panic attacks. My cough got worse and my blood pressure was still too high. The doctor juggled medication, started me on antidepressants, sent me for tests, diagnosed asthma and eventually pneumonia. A wisdom tooth abscessed and I had surgery to remove it. I became antisocial and immobilised by sadness. I couldn't see the way forward, but I knew I couldn't go on the way I was.
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3. Stabilised in a state of functional disrepair
I stayed reclusive for nearly a year, on a superannuation disability benefit. The doctors tried a number of antidepressants: some helped but not enough, others had upsetting side-effects. Much of my memory of this period is blurs and blanks. The anchors of my sense of self were cast loose.
I started seeing a psychologist who practiced cognitive behaviour therapy and who accepted my cynicism about both psychology and psychiatry, particularly anything resembling gestalt or psychodynamic therapies. Over the course of treatment we established a high degree of mutual respect. Michael's approach was intellectual, conceptual, evidence-based, interactive and transparently sincere. I liked him very much.
(I won't go into the details of my therapy -- I always think there's something very unattractive in expecting a reader to be fascinated by the minutiae of one's psychic self-exploration. It smacks too much of narcissism. And of course, having said that, I am cringingly aware that this slight and self-deluding omission of detail on my part cannot disguise the awful truth that I have in all probability reduced the Constant Reader to tears of tedium with my navel-lint-gathering).
During this time, my younger daughter's problems got deeper and deeper. With the stressor of work removed for the time being, I was able finally to confront the fact that the daughter I hoped to have was gone, and to accept that I could not change the daughter I had. She kept in touch sporadically, neither of us willing to abandon the bond, but otherwise I no longer considered her my responsibility. Whatever I did for her, I did because I chose to, not because I felt obliged. What a profound release this was.
I began to feel myself released in other ways, too. The terror of losing a huge part of my identity began to subside, and I accepted that I no longer wanted to do the work I had been doing and perhaps would not work again. With a growing sense of freedom, I started tentatively to explore talents that I'd never taken seriously before. I designed and made costumes for a dance teacher I knew -- and got paid for it! I was offered several small commissions to do drawings and illustrations, including some for my psychologist, who had almost finished writing a book on cognitive behaviour therapy. (I'm very proud to say that a number of my illustrations and graphics are included in the published work). I enrolled in an on-line TAFE course on short story writing, and got very encouraging feedback from the tutor.
Eventually, in April 1998, I was offered voluntary redundancy from my job, which I accepted enthusiastically. I had thought long and deeply about why I felt a failure, and was now able to take a more objective view of my strengths and weaknesses. I could believe that there were some things I did very well: what was even better, I could accept that, for whatever reason, there were other things I did not do well at all. But I could simply choose not to do them, and that was fine. Receiving the redundancy package and superannuation payout of course meant freedom in other ways, too. I paid out the mortgage on our house, bought a new car, made some modest home improvements, and took my very first overseas holiday. A little later, I was offered some short-term casual jobs with my former department, and found that I could indeed cope when I controlled the limits on what I took on. My cough had disappeared.
A word here about funny habits (about which I have said little so far). About four years or so ago, my much-loved and talented nephew Marcus developed some alarming behaviours. He was anxious, troubled by obsessive thoughts and compulsions: later he began to make strange noises and bizarre repetitive movements. One psychiatrist he consulted casually mentioned that the symptoms sounded a bit like Tourette Syndrome. The tics worsened and threatened to become severely restricting on his career and personal life. A neurologist specialising in this area confirmed that he did indeed have TS. Subsequently, my elder daughter Frances and Marcus' younger brother were also diagnosed.
Naturally, we all found out as much as we could about the condition, dispelling a few of our misconceptions in the process. For instance, we discovered that there is considerable evidence for a genetic basis for TS. We found out that coprolalia (compulsive uttering of obscene words) is not invariably present, and in fact is one of the less frequent manifestations. Other evidence suggests a strong association between TS, obsessive-compulsive disorder (OCD) and attention deficit/hyperactivity disorder (ADHD).
A lot of the more outre aspects of our familial character started to make sense: my Dad's jiggles and nervous mannerisms, brother Chris's more flamboyant eccentricities and intense hyperactivity, sister Steph's twitches, grimaces and compulsions, my own collection of "bad habits". (I sat down one evening to reflect on my various tics and twitches, and listed 32 different ones before I gave up). Further delving into online resources on TS revealed some intriguing lines of inquiry into the cognitive aspects and subjective experience of the disorder. My obsessive need for things to be "right"; my lifelong difficulty moving to a new focus before the first is, if not complete, then "right"; the necessity for me to have mentally planned out a new project and understood it thoroughly before I can start work -- in short, my "laziness" and characteristic procrastination -- began to have some explanation. I felt like jumping up and down and yelling, "See! I told you I was sick!"
Life became something to be enjoyed and, perhaps more important, not to be feared. I began to believe that I was strong, was competent, that I finally was an adult. The rosy picture was far from complete though -- I was still drinking heavily, and increasingly tired with the guilt and self-disgust this entailed. I longed to stop but feared the loss of this final perverse anchor. But, as is the way with self-destructive habits, I was finally forced to decide. My weight had gone up, up and over into morbid obesity, and after a couple of fainting spells I was diagnosed, unsurprisingly, with Type II diabetes. In a strange way, the diagnosis was a relief. With astoundingly little effort of will or even regret, I stopped drinking. Just like that. With the guidance of a very good dietician, I began a healthy eating program and lost 36 kilos in around 8 months: my clothing size went from 26 down to 16-18. My blood pressure and blood glucose levels normalised and I stopped taking antidepressants. I hadn't felt or looked as good in a long, long time: I changed my habitual style in clothing to trim and sedate "smart casuals", and, wonder of wonders! went totally, determinedly, in-your-face blonde.
In December 2000, my grandson arrived (as described elsewhere). The worst-case scenario materialised, and I ended up with virtual full-time care of the baby by the time he was 6 months old. My daughter recognised her inadequacy to rise to the demands of his care, and asked the baby's dad to take responsibility for him. I continued to have him with me most of the time, and made sure that our home would be his place of security and love whatever else happened. Not long afterward, we suggested to Corbin's dad Brent that he and the boy should come and live at our house "officially", for as long as he chose. He did, and is still here. Corbin has a stable, happy home and an extended family who love and care for him. In the meantime, I have begun working on an extended casual basis in the current equivalent of my old job. I don't have job security, but I do have a degree of control over what tasks and projects I take on. I can refuse work that I know I'll have trouble with, and can work from home when it suits. And that suits me very well.
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4. Depression
If you've managed to stay with me this far, you might have gleaned one or two insights into the subjective experience of depression. However, if you suffer from depression youself, well, you most certainly don't need me to add to the burden. (At least we can cry on each other's shoulders, but).
Let me see if I can compose a few pithy observations about the Black Dog:
- Depression is more than feeling sad. Painful life events and external stressors can precipitate or exacerbate it; but equally, an acute depression can hit you out of the blue (as it were).
- Depression presents in different ways, and some signs and symptoms may be more prominent than others. One person might feel anxious, agitated and tense, while another is predominantly sad, weepy and lethargic. Some find they feel very little of anything, or become virtually immobilised.
- Like me, one can be depressed for a long time and not recognise it. Loss of pleasure in life is a Big Clue.
- There is evidence that many people with depression have an hereditary vulnerability to the condition.
- Some people experience only one or two acute episodes: others are "dogged" throughout their lives.
- Effective treatment is essential, since depression can be life-threatening. If pain persists, see your doctor. A combination of antidepressant drug treatment and psychotherapy seems to work better than either treatment alone.
There are some very good organisations and online resources on depression. Two I can recommend:
Beyond Blue
National Depression Initiative
www.beyondblue.org.au
BluePages
Information about depression provided by the Centre for Mental Health Research (CMHR)at the Australian National University (ANU) &
CSIRO Mathematical & Information Sciences (CMIS)bluepages.anu.edu.au
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5. Diabetes (Type II)
I am fortunate in that my diabetes is mild and well controlled. Weight loss and a minimal daily oral dose of glucophage (metformin) have virtually put it into the background. At first I checked my BGLs four times a day, as the doctor recommended: for the last 18 months it's only once in a blue moon. However, I do have my recommended regular tests and check-ups:
* HbAIC (glycohaemoglobin, a measure of blood glucose level control) and urine microalbumin (to check healthy kidney function) two or three times a year
* biannual assessment of eye health by an opthalmologist
* regular GP checks of blood pressure and weight
I have impaired circulation and peripheral neuropathy in my feet and lower legs, which is a damned nuisance: my feet are always cold and superficially numb, except when I experience paraesthesia (wierd, unpleasant skin sensations) and pain. Finding comfortable shoes is consequently a problem, and I can't get by without my Damart bedsocks!
Diet is less of a problem than you might think. Many of the old ideas about eschewing sugar in all forms no longer apply, especially in relation to the non-insulin dependent type of diabetes. The Glycaemic Index of foods (G.I.) is the key. The G.I. is a measure of how rapidly carbohydrates are converted to glucose by the body. High-G.I. carbs cause the BGLs to peak and decline rapidly: low-G.I. foods or food combinations produce a slower and less dramatic rise and fall. Diabetics need to aim for a diet built around the latter. More information, recipes, a listing of the G.I. of common foods and much more can be found in the publications of Dr Jennie Brand Miller and associates, particularly: The G.I. Factor: the glucose revolution (1998 revised edition), and The New Glucose Revolution.
More than 7% of Australians over 25 have Type II diabetes. It is a leading national health concern. The best forms of prevention and management are healthy diet, regular exercise and maintaining one's body mass within the healthy range. (Wouldn't you know it...bloody diet and exercise. Bah!) Anyway, my recipe pages include a few diabetes-friendly favourites.
Internet and community resources on diabetes:
International Diabetes Institute
Information, research & fact sheets www.idi.org.au
Diabetes Australia
The Australian non-profit peak body promoting research, awareness, prevention, services and supply of essential health products. www.diabetesaustralia.com.au
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6. Tourette Syndrome
I've written a bit up above about TS in my family. Here's some information from the Tourette Syndrome Association of Australia web site:
Tourette Syndrome (TS) is a neurological disorder which most often begins between the ages of 2 and 21, and lasts throughout life. TS is NOT degenerative and people with TS can expect to live a normal life span.
TS is characterised by rapid, repetitive and involuntary muscle movements and vocalisations called "tics", and often involves behavioural difficulties. The term "involuntary", used to describe tics, is a source of confusion since it is known that most people with TS do have some control over their symptoms. What is often not recognised is that the control which can be exerted, from seconds to hours at a time, only delays more severe outbursts of symptoms. Tics are experienced as irresistible and eventually must be performed. Typically tics increase as a result of tension or stress and decrease with relaxation or concentration on an absorbing task. TS symptoms have long been misconstrued as a sign of behavioural abnormality or "nervous habits", which they are not.
The two categories of the tics of TS and some common examples are:
SIMPLE
Motor - Eye blinking, head jerking, shoulder shrugging, facial grimacing and sniffing
Vocal - Throat clearing, barking noises, grunting and tongue clicking
COMPLEX
Motor - Jumping, touching other people and things, twirling about, repetitive movements of the torso or limbs, and self-injurious actions including hitting or biting oneself
Vocal - Uttering words or phrases, coprolalia (the involuntary utterance of inappropriate or obscene words), echoalia (repeating a sound, word or phrase just heard)
The variety and complexity of tics or tic-like symptoms that can be seen in TS is enormous.
Studies suggest that TS is inherited as a dominant gene that may produce different symptoms in different family members. A person with TS has about a 50% chance of passing it on to his/her children. That gene may however express itself as TS, as a milder tic disorder or as obsessive compulsive symptoms with no tics at all. It is now known that a higher than normal incidence of milder tic disorders and obsessive compulsive behaviours occur in the families of TS patients. In some cases TS may not be inherited, and is identified as sporadic TS because the cause is unknown. TS used to be thought of as a rare disorder. It is now thought that it could affect up to 0.5% of the population.
Internet and community resources on TS:
Tourette Syndrome Association of Australia
Australian non-profit body providing information, awareness, support and counselling www.tourette.org.au
Tourette-syndrome.com
An interactive meeting place for anyone interested in Tourette Syndrome or people wanting to help others who have TS. Online community services include free e-mail, message boards, chat rooms, pen-pal listings, and life story publications. www.tourette-syndrome.com
Tourette Syndrome Association (US)
American national non-profit organisation providing and promoting information, education, research, advocacy, support and services. Website offers extensive resources.
www.tsa-usa.org
alt.support.tourette
Well-frequented Usenet newsgroup for people with TS, parents and family
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