Dorset Cream & Quetiapine

It's a little difficult to recall the events of yesterday's meeting with Dr A, a psychiatrist. As I write now I'm distracted by two things: an unabated hunger and the sedative effects of my new medication. Oh, and the lady on the television is cooking in a sweet little domestic Parisian kitchen, breaking eggs onto a blue rimmed enamelware bowl.

Alicia came into the meeting with me and we sat in a glass office high above the coastline on comfy, fat, green chairs. On another day, under different circumstances, I imagine we would all have stood silently at the glass, noses pressed into the windows, hypnotized by the tides muted motion.

It was difficult talking through the story again as though it was the first time. I could feel the pressing need to cover a lot of ground in our allotted hour. I found it frustrating spending any of that time answering detailed questions about my employment history, and the occupation of parents and siblings. Perhaps it is relevant in ways I don't yet appreciate. The time line was important too, and I am hopeless at recalling the years in which various events took place. Alicia, helped me greatly with these questions.

I came away with a supplementary medication to be taken alongside the fluoxetine I already take. Quetiapine, a medication used as a mood stabaliser in lower doses. I am to take it daily at 8pm on an empty stomach, which has left us wondering when we should sit for dinner. One could consider eating a late supper after downing the medication, but for the fact that it makes me drowsy soon after. Slumped over my soup is hardly an attractive look is it.

Sorry, you lost me a couple of times there. I keep falling asleep you see. I started writing this post around six hours ago. The birds are singing in the tree tops outside my window. The family have been transplanted to a farm house in Dorset for the week. We travelled along the coast yesterday afternoon and arrived at dusk. The cottage is peaceful. A good place to be unconscious. These days away are a very generous gift from Alicia's grandmother, who overcame cancer last year. Xavier is a human space hopper in these new surroundings.

So the question of diagnosis is, for the moment, unanaswered. But, for the first time somebody spent time asking me about what life is like between the depressive episodes. Making sense of the last three years, however, seems impossible. The experiences are overlaid with the shifting reactions to different medications, the challenges of enormous life changes and extensive periods of poor mental health. From this muddy memory it is not possible to extract a simple story of manic and depressive episodes. It is as though the ink bottle was upturned onto the page and now the underlying story is obscured. Now with this further change to my medication I find it difficult to understand how this won't complicate the picture further. This seems to be the inherent difficulty of diagnosing mental health conditions mid treatment.

Anyhow, I embark on another phase of acclimatization to a new medication. Each time the experiment is unique, the first time this drug has inhabited this body and affected this brain. The notion is that the dose on this medication will be steadily increased as I find my feet with it. Under its influence my mood should become more even, which is something which sits uneasily with me. I have become rather attatched to my own particular vivid experience of this world's beauty and wonder if that is one of the mental creases to be ironed out by Quetiapine. I shall have to wait and see.

Waiting Room Thoughts

In three hours I'll be sat with a psychiatrist for the first time. I'm filled with anxiety. I will have one hour. Perhaps in that one hour I'll be asked the right questions. Perhaps I'll be fit enough to respond meaningfully. Perhaps he will have the expertise and experience to fill in the gaps that one can't cover in an hour. Perhaps he will understand how important that one hour will be to me. Perhaps.

Depression takes several forms and correct diagnosis is key to medicating appropriately. Three years ago I swallowed my first antidepressant. I've been on four different antidepressants since then: Citalopram made me anxious and suicidal; mirtazapine tranquillized me, took away my mental agility and made me fat; cymbalta was a love affair but it's affects were short lived and eventually we grew apart; fluoxetine made me aggressive in high doses, in lower doses it helped me bounce along the bottom of the mental health sea.

My working life these past 3 years has been a train crash. The hold this illness has over me makes me unreliable, anxious, fearful, socially awkward and completely without resilience to everyday stresses. I've gone from a £45k salary to living on benefits. I'd like to be well enough that I can work a year without another major depression tripping me up.

A year of uninterupted work growing my business. A year without my weight ballooning or shrinking under the influence of medication. A year without suicidal daydreams. A year of being a father and husband. A year without conspicuously missing seasons ... without a major depression.

It's been a while since I allowed myself to dream ahead a whole year. That is what this hour with a psychiatrist means to me.

White Rabbit

My mother just returned from Hajj, a religious pilgrimage, a sort of Glastonbury for Muslims. Since returning she has told me that I need to stop this, by which I think she means stop being mentally unwell. She tells me I need to go back to work, because I need to be a good example to my son, Xavier. If I read between the lines I think the suggestion is that I’m not a good example to him right now.

She visited too. I couldn’t explain why, but whenever my parents visit they typically insist from the outset that they cannot stay. My father will often sit in the car, outside the house; perhaps he’ll smoke a cigarette. Or, on occasion, he will stand on the door step. With only the most persistent of encouragement, will they both come in, and even then they both always refuse to remove their coats. Actually the whole thing becomes quite exhausting, because every step from leaving the vehicle, to entering the house, to taking a seat, to accepting a cup of tea, requires such reserves of energy and encouragement on our part. It is a scene fit for the stage, couched in comedy. Every attempt to make them feel welcome and comfortable is met with some retort about how brief this visit will be. This is made all the more comic if one takes a moment to survey the sedentary lives my parents lead. They have lived in this region for nearly thirty years, but still know little about its scenic beauty. A walk for them is what one does travelling from the dairy isle of the supermarket to the bakery section. And between walks they watch extraordinary amounts of television.

Anyhow, her visit to us was brief as always. On this occasion my father didn’t come in. My mother sat down but kept her coat on. She didn’t make much by way of conversation. She did prod my stomach and tell me I am fat, something she said I needed to sort out. She gave Xavier a few inappropriate presents, the sort that uniquely combines plastic, noise and violence.

Both Alicia and I couldn’t help but notice how well my father seemed whilst my mother was away. He came across as carefree, energetic, spirited and joyful. Now there is a marriage I might never understand.

It’s been a positive week and I continue to recover, with the expected ups and downs. To myself I say, surround yourself with passionate people, everybody else can wait for now.



6 Years of Alicia

Educating Otherwise

Xavier, our son, will be five years old this November. His experience of formal education thus far has been attendance at a local playgroup for three mornings a week. In England, the next step for a five year old is school, but not in Xavier’s case. The Education Act 1996 defines the parents duty as "... to cause (the child) to receive efficient full-time education suitable to his (or her) age, ability and aptitude and to any special educational needs he (or she) may have either by regular attendance at school or 'otherwise.” So in Xavier’s case, I guess the operative word there is ‘otherwise’, because we are not planning to send him to school, at least not right now.

Our decision to educate our son out of school is something of a conversational minefield. We have many wonderfully understanding and supportive friends, but outside this circle I become rather uncomfortable talking about it. There are all sorts of reasons for this social discomfort: For one I don’t want our decision to be taken as a criticism of parents who choose to send their children to school; secondly, I really haven’t taken to the look that passes over some people’s faces when you tell them; and thirdly this invites the question of ‘why’ and I haven’t figured out the simple way to answer that with integrity.

It is not the radical decision some may think and there is a growing trend towards educating children away from school in this country. With some things we have a habit of thinking that they are the same the world over; it’s difficult to imagine them being any different to what we know. For example, if I asked you all to show me your wedding ring, you might think all married men and women pointed to the same digit on the left hand, the magical ring finger once believed to connect directly to the heart by the vena amoris and thus be a symbol of one's love. However, in a few European countries a Greek Orthodox bride will wear her wedding ring on the left hand before the marriage ceremony and transfer it to the right hand after the wedding. Likewise, children the world over do not all start compulsory schooling at the same age.

Whilst the journey through a fixed curriculum starts as young as four in England, children in sixteen other European countries (including France, Germany and Italy) are still at play, where the school age is six onwards. Perhaps more surprisingly - in Finland, a country regarded as having the highest educational standards in Europe, children start their compulsory education aged seven, and spend much fewer hours in the classroom than their English counterparts over their educational lives. So at this point in Xavier’s life, one could hardly justify raising an eyebrow at educating him out of school.

But this is England, and the shape of our modern day education system has risen up from the antiquated politics of the industrial revolution. Only two hundred years ago England argued virulently against the education of the poor for fear it would teach them to despise their lot in life and make them idle. One hundred and fifty years ago privileged girls who were lucky enough to be receiving an education had to make do with a curriculum aimed at preparing them for social display and companionship. Mean while, the Protestant work ethic of industrialized England set its poorer children to work under the strict regimes of the factory system, and to uncertain futures in the bowels of our coal mines. English children were a cheap source of labour for the industrialists and factory owners.

The demand for a more capable, ‘useful’ child worker; the demonization of the poor; warped religious attitudes to work and pleasure; an established upper class education reluctant to modernise its curriculum and purpose; an educational curriculum for the masses tempered by a fear of educating the poor; a narrow view of intellect conceived by our university system of educating; an era in which all that was to be learnt existed between the covers of books, in the head of a teacher, in a building called a school house; all of this is the mould from which today’s English education has been cast… and all this is what is wrong with education in England today.

All these tensions are evident in the way we organise our schools like factories and our children into batches of products grouped by age. Evident in the way our politicians still battle between an education for the masses or the preserve of an elite. Evident in the hierarchical way schools value and compartmentalise their subjects. Evident in the way each institution sees its purpose to be a stepping stone to the next institution. Evident in the way young people are directed towards futures that are perceived to be useful for our economy. Evident in the way the childhood joy we have for creativity, drawing, singing, dancing and music is quickly extinguished by a pressing timetable of more ‘important’ pursuits. Evident in the balance of power between educational institutions and children. Evident in the way the process of academic inflation has made a masters necessary where once a degree would do. Evident in the way we medicate our children to be like other children.

I’ve met many talented teachers in my life, but this is what they are up against and this is no criticism of them. Education, as an institution in this country, is dancing out of tune to the music. Anyone who is really interested in learning, would not choose to start with a model of schooling as we know it. And thankfully, English law permits that we don’t have to.



Tick Tock

I am on the climb upwards. These depressive episodes are like descending into a deep cleft in the Earth, being swallowed up by the dirt, followed by a climb up a slippery, brittle, shale elevation – the steps forward interrupted by frequent backslides of smooth, broken rock. I am enjoying the advances and despite the instability of the ground beneath my feet, I am able to look down, and see that I am making good progress. I am functioning now, even though that might be within the confines of my own home in the main. Functioning is to leave the bed and the bedroom, shower and dress, prepare meals and communicate. Actually I’m more than functioning. I have been taking the dogs for walks each day, and I have taken on chores around the house, starting to get things tidy again. I’ve spent time with my Xavier and Alicia, cooked for them and cared for them both - as they did for me.

I am still taken away each day by my own thoughts, the rumination of depression, starts are stalled, progress is halted, activity suspended, energy evaporated, but each time I am now able to get going again, eventually. I am able to ‘talk myself away from the edge’ in a way that seemed completely impossible these past months. Months! Has it been that long? The suspended life of the depressive… so deep inside thought that not even the clock can be heard ticking, counting second after identical second of cocooned existence.

All those months ago my GP made a referral after I found myself in his office again, head in hands. I think you’ll know from reading here that I have been willing throughout the fight with each depressive episode. Each time practising what I have learnt, and learning more along the way. Each time making realisations and changes to protect us, my family and I, from depression’s destructive influence. I have been a good student, so it was in frustration that back then I approached my GP to discuss another slide downwards. Reading across these posts it is astonishing to see how I have changed since that first big crash, and how much we have changed the way we live our lives as a family. Depression and our fight with it has destroyed a career and created a business, brought us closer together as a family, brought understanding friends into that family, left unsympathetic relatives out in the cold, threatened us with financial ruin but opened our eyes to different, more fulfilling ways of living, slowed the pace of life. Where we once strove for happiness that came in the form of successful shopping trips, now we strive for good health and moments where we can be ourselves, together as a family. Hang onto your good health if you have it; you will miss it if it abandons you and it is worth more than you realise.

On Wednesday somebody called from the Health In Mind team to do an initial assessment over the telephone. This service provided my cognitive behaviour therapy in the past. They’ll consider what we discussed and come back to me in a week. It’s a little frustrating to be telling them the story all over again, from the start. It's a long story. I’m not looking for more CBT and I hope that isn’t where they are going. As I say, I was a good student and I use the CBT learning where I can. But, given the cycling nature of these depressive episodes and how hard we have worked to stay well, I want to know if my diagnosis is correct. Depression comes in many forms. If it is bipolar disorder for example (what used to be called manic depression characterised by highs and lows) it will be medicated differently.

All I know is that I have to press quite hard right now to get help. Health professionals, understandably, don’t always appreciate the landscape of things beyond one's health. Emotions aside, this most recent episode of depression has taken us close to the edge financially, missed mortgage payments, suspended utility bills, bank charges. Our tiny reserves were used up fighting the difficult times before that. We have communicated and renegotiated payment plans for what we now owe…and the pressure is on to be well and working hard to claw our way back. Tick… Tock… If and when depression strikes again, our financial position will become even more challenging - how challenging will just depend on its timing. That is the backdrop to our story and it gives us a sense of urgency... to be proactive, diagnosed and treated correctly and on a path towards health, or if not, at least to have a better understanding of my ill health so we can plan our lives accordingly. I have frequently swung between health and major depression for several years now, and it's taken its cumulative toll on us. We are flexible, we are a family of fighters, and we have fought unpredictable event after event. We're just being smart, there isn't much left in the tank now and another fight would really hurt us bad. Its time to look to the corner for some help. Let's hope they appreciate what sort of shape we are in.