Happy Pills

I ws recently told of a lady who was a long term housebound agoraphobic and of how she made it down to Manchester from the North of Scotland for a christening- one my family went to last week but I of course didn't. Now that my wife is back I can report that all went well for the lady. Not only did she also go out for a meal both nights while she stayed down there but even went ten pin bowling with the kids the yesterday before coming home. My sister-in-law reports, via my wife, that although she still has her moments her prescription of Prozac has "given her her life back". As I said previously it is good to hear these stories of return to wellness by whatever means. It is another illustration of how the path for everyone is different as I am sure Prozac is not the answer for all .

It got me thinking. I am very lucky to have a good understanding GP. Were this woman to be his patient though she would still be housebound for the simple reason that he refuses to medicate unless under special circumstances. The thing is though I agree with him even though I can see in this case this woman would still be stuck in the misery of confinement. His reasoning is that most medications are addictive and medication is only a short term solution which doesn't actually aide the recovery process ong term unless it is supplemented by some other form of help. That additional help would be CBT, group therapy, counselling or whatever is specific to the patients needs. For this he is not specialised as he is a general practitioner so he refers people with mental health issues to their specialist services- in the UK that being community mental health. Furthermore he sees it as their duty as the overseers to medicate as required. That seems reasonable to me. My next question will be who is medicating this lady and if it is her GP I would wonder what additional long term help she is getting. I will ask. In this type of reasoning I am think of long term agoraphobia rather than other anxiety related issues.

So what about my situation? Well a long time ago I came to the conclusion that I had to go it alone. That is something I have accepted is the best way forward for me. I've heard in the past how mental problems are costing the NHS a fortune but I would wonder why when so many people I have talked to have been picked up and dropped by mental health services never to be contacted again. My first referral led to a couple of months of CBT-lite by a CPN relating back and forth with a collegue via post-it notes attached to things I had written. It was mainly concerned with depression, working out money problems and the like which was of no use to me and I was glad when she said she had done as much as she could before leaving for good. My second referral brought two psychologists who listened to me for around 15 minutes, asked what I wanted them to do for me and then said just keep doing what I was doing before disappearing for good. Between those visits I was in the wake of the crisis which saw my wife rushed into hospital indefinitely and had me left at home with the kids. I phoned the CPN to ask for help and she basically told me it wasn't her problem and to contact my GP instead. That is what I did and despite being against medicating he gave me a few boxes of Diazapam. He saw my plight and at least had the compassion to ease my worry at the time.

Those boxes of pills are virtually untouched 2 years after I was prescribed them. I guess I just needed too know they were there in the event of a mental breakdown. A year ago I took one pill and had a bad reaction but that could have been my own fear of pill taking that caused it. Since hearing about this lady though it has put doubt in my head. As I have been resigned to going it alone that means no medication but then I see someone achieve a better standard of living via medication so it casts doubt. Every time I am in the bathroom I see those boxes and ponder. Should I take one?, I think to myself. Remember what happened last time?, I also follow up with. But still I wonder whether a better life in the short term is contained in those boxes. This is where I get annoyed with myself. I think I have something fixed in my mind and then I start to doubt it but I guess that is understandable given how suggestive the anxious mind is. I won't be taking any in the near future but it is a question that will fly about my head for the next week at least until I make a decision- though I should check the best before date first I suppose.

The thing with general anxiety disorder is that some days it weighs heavier than others. There are days you can get by just fine and days where you just cannot find peace anywhere- those are the ones I clock watch hoping for the night to come quickly. Today was one of the latter. The anxiety was in truth overshadowed by the sheer frustration of being. After a few good days I just awoke as a bundle of nerves and in agitation suggested to my wife we go out for a drive. She in turn suggested the beautiful Chatelherault Country Park. Since I have not been there since my problems started it was a reluctant agreement and as soon as I had the seat belt on the apprehension was growing. We were just 2 minutes drive from it when I asked my wife to turn back and I put away my camera losing out on the promise of beautiful views. My wife then got sneaky after I said we didn't have to go straight back home. We then found ourselves on a little country road surrounded by expanses of barren fields and I was quite relaxed. As we turned a corner though I recognised we were at the gates of Calderglen Country Park. Just that knowledge of where we were and the fact that I had not been there for over 4 years was enough to send us back the way again. The lure of owls, Meerkats and a conservatory full of tropical animals wasn't enough to stop the urge to flee. So we headed back home and ended up in a traffic jam and me being me I panicked for a third time until we finally got moving again. It turned out to be a broken down bus causing the hold up but we were lucky as behind us the tail backs disappeared into the distance.

Like I said there are days like that. I've had times in the past year when I have went out further over the course of weeks and got out tof he car too for short walks without so much as a threat of panic. So much again relates to our general state. That is why I think when I got back home I started to mull over those boxes of pills. My mind kept asking whether by taking one of those tiny things I could have enjoyed the day instead of running from it. In turn it would have given my wife and son a better day too. One of those little pills has the potential to do that but at the same time its not the road I want to go down if I can help it. For one what would I do when I ran out because nobody would give me more.

But coming back to community mental health I have started to feel an anger. I made up my mind I will go it alone and that is what I will do. To be honest though I had little choice in the matter and I know that is the case with a fair few people. They don't seem to want to know unless they can provide a short term fix. In matters like deciding whether to medicate and what to medicate with I feel they should be there. As they should also for help in terms of information, strategies and regular check ups- even just an email correspondence every few months. People with anxiety issues need questions answered and direction. Were it not for the internet I think I would be a wreck by now and that should not be the case when there is supposed to be a funded service provided. But they are not there for a lot of people and so a lot of people have to go it alone not even sure if what they are doing is the right thing- that uncertainty alone is enough to keep them stuck. Ideally I think most people would like to do it on their own but some days it seems impossible, other days we are glad for doing so when we don't have to speak to someone taking part in a different conversation. I know that as frustrated with the so called "community" help as I am at the time of writing they will be far from my thoughts tomorrow or the day after. That's just the way it goes. Frustration builds in waves and then crash into the shore. Those little pills will still be there though. Maybe I should just bin them and be done with it.

Not Alone

Today I made the decision to go back down to the river again but it was a half hearted gesture as I knew in my mind I would never get there. Sometimes you just know. So instead I thought I would go down as far as I could comfortably venture. My plans to put myself in panic are on hold because I forgot the kids are off school until Wednesday which is enough to be getting on with. Off I went down the road.

Sometimes you just know, as I said. Instinctively something did not feel right and I was beginning to get nervy. This was not generated from thoughts of distance though but paranoia. That is nothing new. It can happen when I go somewhere where there are not a lot, or no, people about. As I wandered down the path to the railway bridge there was a dog running about and then a lady owner appeared from under the bridge. This is something I worry about. Me and a woman alone and what she may think or fear. My aim is to blend in with the shadows and definitely not to strike fear into a woman on her own.

She headed off down the woodland path so I stopped where I was and took photos of puddles and reflections. Basically I lingered long enough for her to make her get away without the spectre on the lone figure stalking her. Then slowly I walked down and to the path she had gone along knowing she would be out of sight. That was where I had planned to go if I could not make it down to the river and I now felt so nervy that it was my direction of choice. And why shouldn't I?

So as I turned down the path I found it empty as I expected. I then started taking some photos of the surrounds and path itself. All the while I was listening intently for the sound of a train so I could photograph it on the bridge. Then this dog came running down the path. It stopped a little way from me and started to bark. I tried to ignore it and while I flicked through the images I had taken it edged forward growling which was unsettling. I could feel panic rising and the last thing I wanted was to fend off a rabid dog. Then the lady owner appeared calling it back and after about a minute the two were gone again. I'd had enough, time to go home. These kind of things make me pig sick.

As I walked out the woodland path I saw the nose of a car appear then reverse back at an angle as if doing a three point turn. Its a dead end down at this part so that is what is required. I instinctively knew what it was though. Again I stopped and flicked through my images waiting for it to leave but it didn't. So slowly I walked out to see the window come down and a policeman stick his head out of window. They asked if I was OK, if anyone was down here with me, what I was doing here and then via long silent pauses they encouraged me to explain myself more. Apparently it was OK as long as I wasn't photographing anything I shouldn't be and had I not been on the verge of panic I might have asked exactly what that was.

As they left I walked back home I felt a bit hacked off and despondent. Panic had been replaced by anger. From leaving the house all this had happened in the space of between 10-15 minutes. It was no coincidence. There is no reason for the police to drive down to a dead end which is otherwise usually people free. Someone called them. I don't know whether it was that lady dog walker but doubt it. More likely it was a curtain twitcher. It really does annoy me. My wife said it better not stop me going down there and I can't let it as I have so few routes open to me as it is. But people won't just leave you alone to do your own thing, they always have to interfere. And from following some innocent pursuit you are made to feel like you have committed some criminal act. The agoraphobic life suddenly feels more appealing.

So I've made a decision. For the most part while I go out walking I will keep my camera in my pocket. The more I think about it the more I feel I am becoming more noticeable and that is not something I want. I'll just mainly use the camera if we go a drive somewhere. Were I to see someone regularly up my street I guess I would get suspicious too. Drawing attention to myself defeats the purpose so I'll keep my walks for walking alone and only take the camera out if it is really required rather than for the sake of it. Still though I am pissed off and what limited liberty I have open to me is encroached by faceless interfering idiots.

Clearing away the mists

In the past few days I've had a bit of a reading frenzy. Nothing specific. A little bit of this and a little bit of that. I have become a bit of a binge reader. I go months without picking up a book and then I am entrenched in words for long spells. Given how things have gone recently I have mostly been looking at things to lift my spirit, give me direction, provide distraction and seeking comfort. One place I always seem to return to Dr Claire Weekes. I guess we all find something that speaks to us more than others and that book I have read cover to cover so many times I have lost count. Today I was reading a bit more and it is very in keeping with my last post but in a much more positive way- I feel. Between 1976 and 1982 Dr Weekes sent out a yearly letter to a group of people to provide encouragement and answer some questions while on their road to recovery using her method. One of the letters I read today seemed very apt to my last post so I thought I would post part of it here and hope it gives anyone who reads it something to think about. It was written 32 years ago yet to me does not seem dated apart from some of the terminology.

October 1978: Clearing away the mists

In a letter recently, a woman wrote, 'Nobody can convince me that I won't go berserk, collapse, if I find myself in a situation I cannot handle and when I am a long way from home. How could I cope if I felt I could not stand another minute of it and there was no way to escape? Perhaps you could elaborate on this in some future article?'

In other words she longs for some cure outside herself which will rid her of her fear. She hasn't accepted yet that riddance must come from her. It would help her if she could see clearly just what would happen if she found herself in such a situation; now she sees it as if through a haze. Two factors are to be considered here. First, how can she stop the intensity of her panic building up and second, if she can't, what will happen then? She must understand that only she encourages her glands to keep secreting the chemicals that increase panic. I'm not talking about that flash, that lightning flash, of first fear that seems to come automatically to a sensitized person in a frightening, or even only slightly frightening, situation; for example, a mere cold blast of wind! No-one, let alone a sensitized person, can immediately control that flash and I would never ask them to. But this first, apparent, automatic flash, comes as one single flash. And always passes. The panic that continues flashing must be added by the sufferer himself to that first flash. And it is so very easy to add panic, when sensitization triggers panic so easily.

Naturally panic that comes so easily bewilders the sufferer and she (here it is a woman) makes the mistake of thinking that it can, of its own accord, grow beyond her control. She does not understand clearly that panic can build up only if she builds it up. By doing as I have taught her so often by taking a deep breath, letting it out slowly, and letting her body slump- whether sitting or standing- and then being willing to let the panic flash, the panic will gradually decrease and there will never be a 'build up'.

So if that woman takes a journey in any vehicle she cannot stop at will, she should start the journey knowing that she will probably panic- fear of it will bring it- but also knowing that if she is prepared to sit and let the panic sweep through her as willingly as she can manage, THE PANIC WILL NOT MOUNT. But she must stay willingly. So many manage to be willing at first, but if panic strikes again too soon after the first flash, they too easily forget willingness and start withdrawing in desperation and fear. Stopping panic mounting is in everyone's hands by not adding FEAR OF PANIC.

I know this sounds simple. It's not simple and I don't underestimate the strength of her panic, but she can do it and so can you.


This I think reflects my last post very well. So much so that if I had read it yesterday I'd have probably just posted this one instead. This part of her letter I think describes perfectly what I was trying to say. I now fully understand this process as she describes it. That though does not mean I am going to cope any better by understanding alone but finally it is clear to me. For the moment anyway because I do have a problem retaining these things, in fact anything, for long.

The most important part here is the first and second fear theory. At first, a couple of years ago, I did not understand it but when the penny finally dropped I couldn't believe how obvious it was. But as much as I understand it I also forget it which is what happens with a tired anxious mind. For example when I panicked last week it was one big panic attack in my eyes which when set in motion I could not have stopped and it was never going to subside unless I got myself out of that situation- so getting out was the only course of action open to me. Not true. Let me explain how I now see that event based on what Dr Weekes preached. I would hazard a guess that anyone who has had a panic attack they can recall could by the same token see this process in play.

1. I walked to the river out of my comfort zone. (I put myself in perceived danger)
2. I realised that danger- how far I was from home. (First fear)
3. That thought scared me. (Second fear)
4. I panicked. (The fear of fear cycle)
5. I fled. (Avoidance)

It would actually look better in a flow chart where the fear of fear cycle is a loop of fear of symptoms creating the symptoms and creating more fear. My avoidance was not the only way to break the cycle but the one I chose thinking it was the only option.

By moving out of my comfort zone, step 1, the realisation, step 2, was inevitable. My hope has always been to stop step 2 but it cannot be stopped while it is expected- again that comes back to trying not to think of something which inevitably brings it. My reaction to the thought was the problem, step 3. This is the most important point and what defines the difference between someone with a disorder and someone who has not. The reason being is that everyone goes through steps 1 & 2 whether they have a disorder or not. Its part of life. People without a disorder will be able I am sure to recount at least one incident of steps 1 & 2 recently in their life. Where we differ is in the reaction. Some might add second fear but they do not continue the loop for long and with the person who has a disorder the adrenalin release is more trigger happy given its constant use. In my case the thought scared me so I released adrenalin as the mechanisms of fear kicked in. This created the sensations that I feared and so the cycle continued until I got out of the situation . And the thing to remember here, the thing that has always confused me since it is contrary to what most people say, is that had I stayed there I would have continued to panic. It would not have subsided. Why is that? Because I would have continued to fear the original thought while still there and the sensations that fear was giving me.

If Dr Weekes' theory is true then it does bring comfort- to me at least. And I am inclined to believe her. Everyone will have a different opinion on that but we can only base those judgements on our own experiences which are varied. When I have read of people sticking with panic and seeing it through then I have wondered why I can't do it. I have wondered why most people say it will subside yet my experience says different. But here I can see why. By whatever means these people have managed to break fear cycle when sticking with it by losing the fear of fear. At some point in the cycle the second fear has been lost because they no longer fear the sensations and the original thought. That is important to know. If you stick with it and you continue to fear the sensations then they won't subside. That has been lost on me. In my mind I thought you just had to stick with it whether you feared the symptoms or not and they would eventually go but that is impossible while you still have fear.

In this part of the letter Dr Weekes explains that by stopping second fear you can break the cycle before it has a chance to occur. The letter was too long to post in full but she also goes on to say that it can be broken at any time after by changing that reaction of second fear in the loop. Again second fear is the key. So this is the part I have to look at when I go out. It requires two changes in attitude. The first is easy and that is to expect the inevitable thoughts to come rather than hoping they won't or that I can suppress them. The second change is how I deal with the thoughts when they come. That is the hard part. I will have to firstly try to stop fearing that initial thought but if I do get scared then I will still have to try to lose that fear while contending with the sensations of panic at the same time. Ah not easy at all but I have to look at ways to do that. Maybe the labelling in mindfulness holds a possible answer though that is not really dealing with the thoughts. I'm not sure but I will think of something. Dr Weekes suggested willingness but I am not sure how to do that. More reading perhaps on that subject. I can't see me being very willing and were I to be so it would be an empty gesture. How do you willingly welcome something you have always feared?

Attacking Panic

Back in August last year I got close to the Clyde and here I stood again looking down frustrated. There looked to be no way down and I was already well out of puff just getting this far again. I've been here many times looking down for a path that does not exist. This time I thought it would be different but it wasn't. My mantra for the week had been "Attack! Attack". By that I mean not allowing panic to turn me back but instead pushing forward attacking back through gritted teeth and worrying about the consequences later. This week in my head I have been visualising where I want to go and while there in that head space pushing through the panic to re-enact it later for real. Its not the solution but has given me some small victories this week. I won't bore you with them all at this time but the best one was probably going into the nursery again and this time standing talking to my daughter's teacher for a good 5 minutes. Little things that mean so much but are tainted by the torment that must be endured each time to do them.

On this occasion I imagined being here again. The density of nature stood between me and the river but this time, like the panic, I was going to force my way through it. That was the thought anyway but when I got there I was frustrated once again to realise that any attempt to do so was futile. It was just too dense to push down through. See how tightly packed the trees are but it does it show the steep decline down to the river.

Attack! Attack! There was nothing to attack or at least nothing that would yield. I couldn't just go back so thought I might as well test myself while I was here and go a little further than I had been before. I decided I would walk down a path and see how far I could get before I had to flee.

There are some wooden stairs leading down so no problem with footing but after that its all mud track and on this particular day there had been heavy rain. It was messy and slippery underfoot. At least it was level though so I would walk along trying to loosen up my body and take deep regular breaths. As importantly though I had fend off the thoughts of how far from home I was. And as has been discussed many times before: how do you not think about something without first thinking about it?

I didn't get very far but that was not because I was ready to flee. In fact quite the opposite. I stopped near a couple of trees to my left and peered down at what looked to be a faint foot trail leading down. A possible route down to the water? Internally I was swinging between excitement and trepidation. This could be what I was looking for but I was already outside my comfort zone. Still though I couldn't head back just yet. I had to at least try seeing how far down I could get and also to see if I could see the water through the trunks and branches in my way.

 The further down I went the more tightly packed the woodland became until it got to the point where I was having to bend branched and step over things. I then reached a point where I had to pause to take stock. That was a bad idea. As soon as I done it images flooded into my head of where I was in relation to home. It was at this point I realised I could go no further. Panic was setting in. I had opened the door and now the opposing force was too strong to allow me to close it. It is very much like a flood. Even if I could close the door again I would still be left with what had already got in. It was time to flee but before I did that I wanted to take a photo to analyse later and see if I could see the water when I zoomed in or even get an indication of how close I was to it. If you enlarge this photo you will see how blurry it is. That is how much I was shaking. But it would have to do. Panic was going to get worse before it got better so my time was up and now it was the long road home for me.

Oh yes I nearly forgot about the dream as I nearly did also at this point. As I turned to leave something really nagged at me. I had stood so long looking down and now I knew I was close. Would I get this opportunity again? Would I get so near again? I was so close yet compelled to give up just like in the dream. I wish I could say it was as easy as a simple choice but it wasn't. Anyone who has experienced panic will know it is difficult to follow your desire over self preservation. When you are feeling the onslaught most things that were precious to you become of little value and the only important thing is to stop the attack. Attack! Attack!, part of me was saying but the greater part was trying to drag me back up incline by the hand. I knew that as bad as I felt and as much as I wanted desperately to be home I could not pass up this chance having come so far. The consequences I knew would be bad but I'd already incurred them by getting here already. In my dream I'd walked away after getting so near because of the realisation I was agoraphobic. This time I was not going to let it beat me come what may. It was time to throw myself into the fire. So against my better judgement I tensed up, gritted my teeth and basically launched myself downwards crashing through everything that was in my way like a mad man. And finally I could see the river.

Wringing out the last drops of effort I got right down to the bank. In truth I was now much calmer. I'd made it. Finally after all this time of frustration I was down there at the river and if it wasn't so dirty looking I may have put my hand in it too ensure I was not dreaming again. Where I had failed asleep I wanted to ensure I had conquered awake. I could actually have stayed longer. I took a few snaps and even on zoom there was no blur as I was not shaking. My breathing had regulated again. What kept me from staying longer though was the prospect of the return journey. If I had the ability to click my fingers and be in the house again when I wanted then I would have spent a great deal of time down there. The panic had been washed away by the sight of this great body of water that I always see from afar but now all alone with no one to bother me I was relaxed, apart from getting home.

It should have been a cause for celebrating. To the left you can see the journey which looks less impressive from above but is there nonetheless and is enlargeable. To long to do something and finally do it should be applauded, or at least you should give yourself some credit. But as every agoraphobic will know who has endured a trial and come through it the reward is not pure. Its scarred by the torture that is not only in that present moment but lasts for a long time after. My temporary serenity was about to be crushed. Even though I was relaxed the mind was too preoccupied fighting off the negative thoughts hammering on the gate to remember what I had been planning to do when I got down there. I had actually envisaged trying out different camera settings and also to use my mini tripod to capture 3 different exposures of the same scene to blend later in an HDR image. It was more a snapping frenzy than a controlled photography session. And what I also realised was that this Attack! Attack! mantra was nonesense. Pushing through panic is not difficult. Dealing with the consequences of doing so is the hard part.

There was only so long I could keep my back to the inevitable. At some point I would have to turn around. What resources I had within me I had spent in full getting this far and had nothing to repeat the journey in reverse. To add to it the return was all uphill and would begin with a fairly steep incline. All it took was turning around to face what I could not see for full blown panic to hit me. It was my worst nightmare come true and one of the things I had been dreading most would happen some day- a panic attack alone in seclusion. This panic though was very different. Panic for me always starts with a shaking at the back of my neck. This started with heavy hyperventilation. That in itself was not new. The night I tried to get to Bothwell Bridge it happened there, also one the return, but I did also have the shakes first then. I couldn't see the top of the incline and in fact I could see very little as the image illustrates. In my mind just getting back to the path seemed like a 3 day trek. I had no idea how far I had come and feared it was a long way. With panic raging I started the climb to get out of the woodland and it was one of the most horrible and frightening experiences I've had in recent months.

Somehow, probably because fear was propelling me, I got back on to the path and could see the stairs leading up to the clearing but things had gotten a whole lot worse. My whole chest was heaving. I tried to take a deep breath but it was impossible as my body commanded short sharp intakes. One of the things I have been thankful for over the years is that as bad as my panic attacks are I don't get one usually common symptom- something concerning the heart. Now I knew what that was like. It was thumping against my chest and racing at high speed. More worrying was the thumping speeding pulse in my right ear which I have to admit was scaring me no end. People usually wake up with these sensation in their bed and that is bad enough but I was in the middle of nowhere and hadn't even told my wife where I was going. As much as I needed to sit down my urge to get home pushed me up the stairs, under the bridge and up the road back home but now without incident. Its not an experience I want to put myself through again any time soon but I can at least tick another checkbox on my to-do list.

Was it worth it? Maybe in a week or longer I will think so but not at the moment. The consequences of pushing beyond the norm don't just stop when you get home. The rest of the day was virtual write off, though I did go out in the car again almost straight after, and the day after has been difficult. Mainly the chest is very tight which was probably down to the exertions, tensions and overall panic. It makes breathing more shallow and can be quite uncomfortable. I also feel shattered- like I've run a marathon. So was it worth all this grief for a moment that I am unlikely to repeat? Time will tell. As bad as I felt today I still went for a long walk. Not to the point of panic but I was surprised when I mapped it later to find I'd actually walked further than yesterday. All roads lead to the mind being the main protagonist- maybe even the only protagonist. I want to just walk one day until I can walk no more and see where it takes me. I just wonder how far I can push my body against my own mind. I just wonder how far I can walk if I don't need to look back. For now though I will try to take things a little easier. A 6 month obsession has been realised but there are many more that won't rest until I have lived them.

One last thing I am not comfortable about typing here but will anyway. When I finally got out of perceived danger and on the way home I saw something coming out of the woods. Something I have to suspect was a hallucination. It was someone I am sure. They seemed to be coming right for me out of the woods to my left, as seen in the photo below I took on the way down. They were coming beyond on the wall and at the time I was sure it was a Native American and yet wearing a bright yellow jacket. Bizarre I know but it freaked me. And I kept thinking someone was coming when I got through the tunnel and waiting to hear footsteps quicken behind me as I struggled for breath but they never came. As I said it feels stupid typing this but I feel I need to. That is was happened at the time as irrational as it sounds.