OCD Status

It’s been a while since I wrote about mental health, or more specifically, my mental health. I left group therapy at the end of November this year. It felt like time since early summer and after putting in a lot of thought and reflecting on where I stood in my biannual review with the group I set my mind to leaving.

The last week or so I have been undergoing, what I now realise, is a process of leaving that is pretty much part and parcel of the therapy I have had. I have been down, volatile, self-doubting but I have also felt lighter, self-aware and stronger. I appreciate my personal journey with OCD has not concluded and I may require more therapy in future but I am no longer taking any antidepressant or anti-anxiety medications and I feel in tune with my mental health needs.

It seems 2018 will be a very different kind of year for me in a lot of ways but I don’t regret the journey I took with psychodynamic group therapy and I am so thankful for sharing that journey with everyone who was part of it. My relatively active social life is part of me I reclaimed through therapy and will no doubt be a portal of continuing to be a happier me.

What Do  You Do When You Are Tugged Down The Rabbit Hole (again)? #mentalhealth #depression #weekendblogshare

Most of the time I manage to maintain a sort of equilibrium, but occasionally I slip into a darkness akin to what it would feel like if the dementors in Harry Potter were real. In fact, the depression I am currently suffering from is real. It takes a lot of insight and self-awareness to realise a low mood, flat effect and compulsive pessimistic thoughts are not quite a facile lifestyle choice.

I am lucky to have an excellent sounding board in a therapy group I deeply care for, but when in session I focus on others and pragmatic problem-solving rather than expressing what I feel. Circling emotions is easier than expressing them. It’s a fear of being ashamed of showing my true emotions that hold me back. I know I would tell anyone else that they have nothing to be ashamed of when expressing how they feel in a depressive episode, but convincing myself is harder.

It’s been a long time since I found myself feeling this low and I frightened myself this morning when I woke to utter the words, “I want to die.” I have no reason to feel this way. I am well supported, feel pleasure from doing many things as hobbies, I have the freedom to choose to do anything I wish, but alas that voice in my head tells me I’m not a doo-er. My reading has slowed since my mental health began to deteriorate early this year. For the first time I find myself behind three books in my Goodreads Reading Challenge. It’s taken me weeks to write a suitable blog post about the truth of my mood.

When in therapy there’s a special type of shame that comes with failing to remain optimistic. It’s seriously like I’m failing a course, but I cannot deny how I feel and I no longer have the energy to push it to one side. I’m circulating a crisis, but I’m not being furtive about it. If I was having an acute asthma attack it wouldn’t carry the shame I’m burdened with for having an acute depressive episode, and why not? Administering drugs to ease someone’s airways is heroic as opposed to acknowledging the darkness in their thoughts, which at best is indulging narcissism at worst aiding laziness, if you ignorantly believe anyone would want to feel this way.

I’ve been open and communicated my concerns about myself, now I have to rely on that old adage of time and the new mindfulness based cognitive behavioural techniques I have read and championed. Not so easy when I feel I’m being smothered in a lead curtain of impending doom.I’m tired of being me and no amount of reminding myself how lucky I am, the miracle that is life is so rare and precious, can convince me I have a purpose. 

This too shall pass, they tell me. Eventually. 

Emotional Bait and Switch #weekendblogshare

Whilst undertaking a couple of days of mindfulness, I battled away a few thoughts that persistently came to mind. The ones that stick out the most and stayed with me though were the fleeting memories I have of emotional bait and switch. 

Let me explain; as most of us know bait and switch is a term used to describe the situation where a merchant/seller gets your interest with a product but then when you purchase you get something of inferior quality or one which is more expensive. 

What I consider emotional bait and switch is when a group of trusted loved ones say, “if you want to smoke go ahead, we’re really relaxed about it.” However, after you take your first puff they tell you off for being disrespectful and smoking in front of your elders. So you were lured in with the promise of understanding and acceptance and then humiliated for faith and trust in what those you’ve known all your life were saying, rather than deciphering what they were thinking. Believe me it ruins the memory of your first ever puff irreparably.

Bait and switch is ultimate emotional betrayal. You think you’re getting acceptance, unconditional understanding/love/support, but the cold reality hits when you realise the ropes attached and perceived underlying love, understanding or whatever it is, was an illusion. 

Of course I didn’t see these situations at the time for what they were, I thought and was allowed to believe the fault lay with me for being unacceptably imperfect in the way I trust people, understand the world around me, was curious about smoking and my shocking inability to have children. 

Yes, even my endometriosis/infertility wasn’t spared the bait and switch but I don’t want to lower my mood further by going into the specifics of that exchange. 

There’s a huge gulf between what those I have trusted in my formative years have led me to believe and what I actually got, but I think most of us have complaints of this nature. I’m just glad I understand it for the cold emotional betrayal it was and maybe in a decade or so I will understand why anyone would bait and switch those they allegedly love. 

(Not Successfully) Avoiding Joyless January

After the warm festivities of Christmas and New Year, I often find myself experiencing a bleak void in January. The weather is grey and dismal. It’s cold and wet and extremely easy to follow thoughts that make you feel ultimately bereft.

Procrastinating over stuff that happened more twenty years ago is pointless, but something I actively need to guard against. Unfortunately, due to bad timing I’m also reading a hard hitting novel, which is giving me nightmares. 

Every problem seems momentous and I feel easily tired and have a banging headache. The tiredness in my case could be attributed to a dozen things affecting my health., but this would just be pedantic. I have had to spend a lot of time alone and I’m sure this has had an adverse effect on my mood. 

My sleep is erratic and sporadic and I have uncharacteristically stopped using my CPAP. I just don’t have the energy to do the maintenance etc.

Imminent is my appointment with the heart/lung transplant assessment clinic. In fact when this post is published I will be a few hours away from sitting in the outpatient area for transplant assessment. 

I’m not sure how I feel about needing a referral to such a department. No one expects to need another organ and is it such a big deal in this day and age? 

My questions could be rendered null and void tomorrow after numerous tests I really don’t want and an answer I have no idea how to anticipate. I feel the appointment will be a weighing up of my worth, in general, as a human being. 

It’s odd to feel depressed and dejected knowing exactly why and seeing a pattern in your moods but being detached and watching yourself endure it as an indifferent observer. 

Taking Responsibility

As my mental health deteriorated so did my ability to care for myself. If you think about all the things we need to maintain to live that’s a significant game changer to find yourself unable to work, leave the house or routinely shop for food/cook and pay bills.In hindsight I would say that I fell and I was fortunate to have someone there to catch me and cushion that monumental fall.

Now, ten years on I can take responsibility and do so with pride when I look back and see how far I have come in the last troubled decade. I got back behind the wheel and now not only drive myself locally but volunteer to drive places further afield. The basics may be staple for most others but for me overcoming the red tape in my head is matched with dealing with worsening shortness of breath from my deteriorating pulmonary hypertension. 

I had a good run for a couple of years where my mental health improved and my physical health remained stable, but now my physical health seems to be flagging and my mental health in comparison is the best it has been for years. This is just as well considering the choices and hurdles I face as my limited physical abilities become more restricted.

I am in, what I call, a no man’s zone; I can walk a maximum of 230 yards without having to stop due to chest pain and breathlessness, but I do not qualify for a blue badge until I can no longer walk 200 yards. In the meantime I have to find ways to get from my car to whichever destination I need to go with minimum physical exertion so that I am practically functional when I get there.

The temptation to stay home is overwhelming, but I have worked too hard to get to this feeling of independence and security to let it all just go. From ordering and collecting my monthly medications to going to the dentist, library, hairdresser and multiple medical appointments, taking care of myself is a full-time job and one I cannot afford to lose for my mental well-being. 

It is a limited and fruitless existence to not learn new skills, which is why I’m learning about business management and economics, things I have very little idea of so I may have a challenge and important roll in my household. It took a while but realising that I have to opportunity to choose an occupation again and indulge other interests to an extent to change my life and outlook has been daunting and exciting. 

Maintaining a decent lifestyle has been fundamental in my psychotherapy and is the foundation of how I make choices relating to my physical health. After all, I need a reason to keep physically well and without that motivation I would find myself in a deep dark tunnel of despair I left behind a while ago. This is not to say I don’t suffer from bouts of anxiety and depression, but I no longer live there in a bleak and pessimistic climate.

The number of yards I can walk, books I can read a week or stress I can endure may change but the biggest change is finding a reason to want to do anything at all, when life takes on a grey shroud of unhappiness, that I did not think I would ever shift. Finding joy in anything was my struggle and on reflection I now find joy in many things. 

Me vs OCD

On a daily basis I struggle with defining myself, my personality, likes and dislikes and what would be considered OCD. After all I undergo intense self scrutiny everyday, that I suspect ninety percent of the world’s population don’t, and that’s not even taking into account the self reflection and awareness that accompanies complying with my weekly psychodynamic group therapy.

I’m not sure, even now, six years post mental health assessment and diagnosis exactly whom I’m supposed to measure up to in order to decide if it’s OK to do, think or believe x, y and z. It’s very hard to trust others anyway, again I’m not sure if being so distrustful of people is part of me or the pathological aspect of my mental illness, but the added edge of failing by trusting the wrong people is terrifying.

It could just be me, the annual seasonal affective disorder or the OCD, but sometimes I think the only peace I will ever attain will not be in this realm. The narrative of what I think life should be about, faith should be about, kindness and kinship should be about is not compatible with the reality in which I live and I grow weary of trying to sheild myself from it.

I’m no different to millions of confused people out there who feel we are the individuals that have not been cut quite right and have never been, nor will ever be, fit for purpose. Any useful purpose. However, there’s no way out of this nightmare or these constant questions and self-analysis and denial only gets me so far.

I go through periods of finding purpose in trying to be content and then questioning if content is good enough, finding no answer except abstract negativity and feeling severely worthless for making the effort. If there was an option in the big picture of being broken down to my fundamental elements and ceasing to exist in any way in any form without consequence, I would take it.

Questioning My Avoidance Issues

I have really been affected by the hot weather this year. Most of the time if the temperature reaches above twenty-four degrees Celsius I am just mildly uncomfortable. But this year I have found myself feeling quite unwell. On further investigation with our home blood pressure monitor, we found my blood pressure fell to 99/60, with no postural drop, and at worst it was 70/54. I admit my fluid intake is compromised when I am unwell but I have made an effort to drink more with no effect in these instances.

When I am cooler my blood pressure reverts to 120/70, so I haven’t sought any medical input into these bouts of hypotension, as they are reversible and I feel well afterwards. When I am hot I am unable to concentrate and this has severely affected my reading this summer as I have fallen uncharacteristically behind on my review reading list.

I suppose this mild inconvenience reinforces I am not a robot and although I feel like pulmonary hypertension only slightly affects me day to day, it is lurking in the wings making me physiologically more vulnerable to adverse conditions.

I find myself feeling militant about these bouts of unwellness and this week despite feeling awful, I went to all my appointments and obligations, because I couldn’t let pulmonary hypertension win again and limit my life. I already feel I have lost so much from my avoidance issues.

I may not have been on top form but I was at least present for events and not curtailed at home. This for me is a huge psychological battle with not just pulmonary hypertension but also my OCD, which heavily influences me to avoid anything adversarial. In my opinion this aspect of my OCD has been the most damaging as I have limited experience in trying to overcome adverse situations because of my huge avoidance issues.

This limitation has affected my self-confidence hugely, not just in the past but now in my present too. Knowing this I am trying hard to push myself more, within reason physically, and more frequently mentally to take on situations I would habitually avoid. I’m reserving judgment on how this is going until after summer ends, but I will post about the activities I have undertaken against the shackles of my OCD soon.

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I Feel Fine, I Think

Contrary to popular belief Obsessive Compulsive Disorder is not just about hand washing and house cleaning. It’s much, much more. Imagine every decision, no matter how small, being second guessed. For years I thought of this trait as a lack of confidence or indecision, but it’s not. It’s about attaining a perfection that morbidly does not exist.

It wears me out mentally to keep going over what I said and what I did, superimposing thoughts of what I should have said or done, yet my mind won’t leave it alone, except to show me other situations of where I was yet again imperfect. It never goes away, it doesn’t stop and it rarely lets me sleep. Even in my dreams the imperfections and negativity haunts me.

Every action or reaction I have is skewed in a negative way and where possible my perception is manipulated, by me ironically, to reinforce my negative self-image and thoughts about myself. Basically, it’s like living with person who hates you the most, the one who wishes you were never born and you didn’t exist. Nothing hurts more consistently everyday. What would you do escape?

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My OCD Story

I was invited to write my OCD story by Stuart, who administers the blog, The OCD Stories. This is a great blog to read about how it is to deal with OCD everyday by those who endure it. It is also a positive blog as it focuses on recovery and improvement as well as giving you a small glance into the world of chronic sufferers. Every OCD sufferer is different.

I personally found the blog encouraging and it helped me realise I’m not alone. I wish I had discovered it sooner and I recommend becoming a subscriber to anyone with OCD and those who support them.

I would like to share the unedited version of My OCD story:

I have wondered many times when my OCD story started and I have to conclude I always had a propensity to over-analyse and fixate on things from a young age, but instead of growing out of it and becoming more confident and learning the crucial art of letting issues go, I let my feelings hang around and fester. I learned to live in fear with the expectation of the worst outcomes.

I don’t ever remember not being afraid. I was always terrified, I felt I never fitted in and I was socially isolated. I stuck to routines in order to preserve a feeling of security; when I was at school it involved arriving at the same time every day, using the same routes to get to lessons etc. As an adolescent my symptoms were the worst, I felt extreme anxiety in doing things my peers did, like going to the cinema, shopping, going on holiday and doing anything without my parents. My feelings of depression and worthlessness started at an early age and continued to grow with me.

I had a brief period between the ages of sixteen to eighteen, when I felt more optimistic, confident and I felt accepted by new friends at a new school where I took my A-levels. This was not to last and ended abruptly in the summer of 1992.

What most people in hindsight would consider a minor set back in my career path at 18 has derailed me ever since and I spent a year living in shame, more isolated and in total embarrassment. I went to medical school when I was nineteen but took my shame, self-loathing and my sense of never quite being enough with me. Subsequently, I was ruled by compulsions to avoid getting hurt and to keep my shameful imperfection away from others. I was basically implementing avoidance strategies to such an extreme I was missing out on everything.

My time at university was not one of happiness and discovery, but fear, isolation and despair, which I kept to myself and battled alone. However despite this I somehow passed finals first time, contrary to what I’d convinced myself and took on my first post with excitement. As an adult my compulsions involved using the same route to get anywhere, isolating myself to avoid being out in public and not coping well with any level of deviation from the norm. I kept up appearances for 3 years before unravelling.

My coping mechanisms were limited and I felt dangerously alone and vulnerable. Instead of seeking help I spent years  telling myself to get a grip and simultaneously nurturing the  avoidance which lead to me going into a crisis where I avoided everything. I was diagnosed with OCD in 2009, when I was suicidal and beyond coping anymore, approximately 20 years after I first had symptoms. I was discouraged and too afraid to seek help until my symptoms reached an extreme crisis point, by which time I had put my career aside permanently and life on hold indefinitely.

Three years after I was diagnosed I underwent CBT group therapy for 10 weeks followed by 6 weeks of individual psychotherapy. However, acceptance of having an illness is hard, you are led to believe you have a choice when it comes to having mental health symptoms, like you choose not to walk out the front door and to have fear shadow your actions and thoughts. There is no pleasure in my symptoms or compulsions. Why would anyone want to live this way? I was unable to control my anxiety to leave my home without my husband for 9 years and its only now after a year and a half of psychodynamic group therapy that I have regained some limited independence.

The fear of bad things happening to me or my husband never leaves, but I have begun to feel a level of optimism that has been absent since I was 18. I spent a week by myself, while my husband was away on a course. I tended the cats and myself as well as driving myself to my medical appointments, which is quite a victory for me. I am still a long way from regaining total independence and fully understanding why I feel such fear and lack of personal security, but I am beginning to see the damage that years of hiding, compressing my feelings and living with anxiety and depression have done to my confidence and my life as a whole.

My therapeutic journey has barely begun but now I can talk about it and I feel more positive than I have in years.

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My Depression

I remember as far back as when I was seven years old, I felt such desolation and sadness around  bedtime as I didn’t want the day to end and strongly wished it could be early afternoon again. I didn’t want the days to advance as I had no idea what tomorrow would bring. In hindsight that was a lot of fear for a seven year old to live with. I never told anyone that I felt this and hid my tears from my family because I didn’t want to be ridiculed for feeling this way.

As I got older a dark smudge appeared in my world, always there but never significant enough to take over the landscape of my life. It would grow periodically when I was sad or upset but it remained a blip in the background, mostly, through my teens, but I always felt there was something wrong with me. The few times I tried to express this I was shut down and told everything would be alright.

Things changed dramatically when I was eighteen, a major life event led to the smudge growing to dominate my thoughts. I felt desolation and sadness, but also fear, unworthiness and betrayal. I don’t think I ever recovered from those feelings. My life changed and nothing would ever be the same again, I tried to bury the damage I caught. I think that was my first fork in the road.

Since that time the smudge grew and grew, I pretended everything was fine. How could I not? I had everything I wanted, didn’t I? I was in medical school, my Mum was happy, I was doing what was expected but I never really fitted in and I couldn’t possibly tell anyone about the smudge or my doubts, compulsions or persistent fears.

I qualified from medical school with a smudge that dominated the landscape of my life, it was no longer in the background but took up most of the canvas. I didn’t have time to dwell on it as I went into my first job as a junior doctor, I had a one year contract that involved rotating around three jobs, and immersed myself in the job, working long hours, sleeping little and trying to ignore the smudge. I pretended to be someone else to deny the smudge’s existence, but it didn’t work.

I finished my first post with the smudge resembling a moderate sized hole. The sadness, desolation, isolation and not belonging caught up with me in my second job as a junior doctor and I drew on the hope I had to make it through. If I kept believing I would feel better I could get through this.

My third post felt like a relief as it was such a light job compared to my first and unlike my second, I was around a lot of other people again. I actually felt pride in my work but the black hole remained. I found it dominated at a drop of a hat. The smallest things led me to feel despair, but I had a supportive team and somehow they buoyed me through the choppy seas. I am grateful to them. However, I felt a disconnect I couldn’t describe.

I moved back to London for my senior house officer jobs and the black hole grew and grew as did my uncertainty, fear and despair. By the time I finished my three year contract in London I had two main elements on my canvas: a large black hole and my then fiancee and now husband. I felt the depths of despair but was caught by another human being, who, although didn’t know about my dark hole, was accepting of who I was in a way that no one else in my life could be.

I didn’t know why at the time but I had to go wherever this man would take me, he was my only resistance against being consumed by the black hole that seemed to be taking over everything.

The black hole receded during the first couple of years of our marriage but as soon as I started working again the black hole dominated, it grew and threatened to push my husband out of the canvas. It was at that point I stopped working to curtail the dominance of the darkness, I gained my cats, but ultimately felt I was losing the battle and sought formal help for the first time.

After twenty-eight years of nurturing and growing this malevolence that is depression singlehandedly, I sought help. I acquired various diagnostic labels and learned that the black hole did exist, I wasn’t the only one who could see it and I wasn’t the only one who had it. I am lucky as the few times the black hole has eclipsed everything I have been able to tell my husband and I have had good medical support.

My relationship with my husband is unconditional, all he ever wants is for me to be healthy in body and mind and is willing to give me all the time I need to achieve this. He’s the only one in my life who doesn’t make me feel defective, but accepts me whole with the depression and other illnesses. That doesn’t mean he doesn’t push me to get better and challenge my perspective. He doesn’t tell me what to do or how to do it and above all has gained more respect for me as a person for putting myself through whatever I need to get better.

Now I attend regular session to help repair the canvas, to push back the damage of the black hole and reclaim and reapply the colours underneath. I may never be free of the black hole, it may fluctuate for the rest of my life but the hope is not to let it dominate and to add different new colours to my canvas.

This is the simplest way I can describe living with my depression. It’s not a choice, I can’t just buck up and it’s more than just providing fodder for the gossip mills and is definitely not an excuse for anything. I don’t need excuses because I have nothing to prove to anyone anymore. Depression is a fact in my life and yet another invisible disability I live with.

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