Posts Tagged ‘CBT’

Black Dogs and Guitars

31/08/2014
The Scream by Edvard Munch (1863-1944)

The Scream by Edvard Munch (1863-1944)

Someone once told me I was lucky to have Bipolar Disorder rather than Clinical Depression; they felt that having Bipolar Disorder was easier to cope with because, in their misguided opinion, at least the Depressive episodes experienced with Bipolar would have some light at the end of the tunnel. While that may be true, on the surface, while you are experiencing a depression associated with Bipolar Disorder, or anything else for that matter, it makes little difference if you are fairly certain it is going to end in a day or an hour: for the entire duration of the episode it feels as though you are being dragged through the darkest pit of Hell. The journey cannot end soon enough. The longer the episode lasts the harder it becomes to endure, the landscape of your thoughts take on a bleak, dark tone; all you want to do is hide from the prospect of human contact hide until the pain dissipates, until the light manages to poke its head through the seemingly impenetrable clouds once again.

For the past few weeks the Black Dog of Depression has had its jaws firmly latched its onto me, and I have been on that journey through the pit, albeit against my will. This is not unfamiliar to me, to be sure, but that does not make it any easier to cope with; it just means that I am painfully aware of what is happening to me, as though I were a well prepared roast, watching itself as it is about to be carved up and served to hungry guests for supper, all the while powerless to intervene, to stop the violence about to be done to itself. In many ways a Depressive episode is much like this: it allows a person to see things happening to themselves, but robs them of the ability to act upon what they are seeing, as though their mind has been set in an epoxy or some sort of resin and cannot respond as quickly (or at all) as it normally would. The thinking process is not only painfully slowed down so that it becomes difficult to formulate an intelligent response to someone when they ask you a question (which is one of the reasons I actively avoid speaking to people when I’m in this state), but your comprehension of even the simplest things seems to go flying out the window.

Things, concepts, ideas: that which you had a clear grasp of the day before the Depressive episode began now look to you as alien concepts; they make absolutely no sense. If you do manage to decipher them, having wracked your brain to the point that you’ve triggered your Migraine to the point that it is blinding you, it dawns on you that whatever it is you’re looking at is not what you wanted in the first place, leaving you back at square one, which brings me to my perverse desire to compose while in this state. I say perverse simply because it seems incongruous that creativity should have anything to do with such a bleak, painful episode, and yet, when I am struck by this pernicious illness I turn to creative endeavours as my salvation, knowing from past experiences that these episodes usually result in an increase in my creative output. One might almost describe my output in these times as verging on hypo-manic in nature, and that would be an accurate assessment of the situation were it not for the fact that my mood is in such a depressive state.

schumann2

Robert Schumann (1810-1856)

As I’ve mentioned in previous posts regarding creativity and Bipolar disorder, my creativity is not predicated on an elevated mood, which is a good thing considering how quickly my moods change (as well as how often they change… but that’s another story, for another time). While many people with this disorder have found their greatest creative flow accompanying a period of hypo-mania, such as Robert Schumann who composed in white-heat episodes of creativity and then experienced prolonged episodes of creative silence, I tend to find that my greatest inspiration flows from a mild-depressive state. At least, that’s what I used to think, until this current episode struck. Of the many ways this Depression could be described, “mild” is not one of them. There have been times over the past two weeks when things have seemed desperately hopeless, but … it is a lie.

You have to remember (I have to remember, and I have to remind myself of this every day, every hour, whenever I am experiencing a Depressive episode) that Depression is a profoundly effective liar: Depression will try to convince you that your troubles are far greater than they are, that what you do is not worth anything, that you have no talent, that … well, you get the idea. Depression will use anything it has against you, tossing false evidence against you in an attempt to create its ultimate victory: Despair. Once it has created Despair, once a person has lost all hope of the episode from ending, the battle is virtually lost. The next step is often suicide, and I have seen too many beautiful lives destroyed to allow myself to listen to the whispers of this hoarse demon as it tries to convince me that I have no talent, or that I’m not able to do anything with my abilities as a composer.

In the midst of this Depressive episode, as difficult as it has been to cope with due to the increased pain from the fibromyalgia and Migraine, I managed to complete to compositions for the classical guitar. The first piece is a dark piece, reflective of the mood I was in, though it is not a “depressing” piece. It is called Sonata Apocalyptica, a single movement piece in sonata form, which is about 12 minutes long (perhaps a bit longer, depending on the performer who has a Cadenza to improvise). The second piece, which was completed only last night, on 30 August, is called Perpetual Kaleidoscope and has a Spanish flair to it as it explores two types of the popular guitar technique known as “tremolo” (one is a the traditional three-note tremolo while the other is a two-note tremolo, played pmi using the open “G” string as a drone). This piece is between 7 and 8 minutes in length.

Length is never something that is of particular interest to me, but in this case I find it interesting that in the depths of a severe Depressive episode I managed to compose approximately 20 minutes of music in about 6 days. If there was ever a doubt to the connection between this affective disorder and my creativity, let this put it to rest, once and for all. On several days during this episode, for example, thanks to the nature of the Depression, it was possible for me to sit in one place and compose for almost the entire day. I had almost no interest in food and ignored virtually all interactions with others. When I wasn’t composing I used the music in my mind to drown out the lies of the Depression as it tried to whisper Despair to me in the quiet of the night. Filling my mind with ideas for the piece I was writing pushed aside enough of the blackness for me to get through the time when I was not actually composing.

Now the pieces are completed and the Depression has not (yet) passed, which raises the issue of another type of depression which I have often experienced, a type that often comes at the conclusion of projects: my doctor and I call it “Post Creavit Melancholia”, which may be understood much in the same way as “Post Partum Depression”. The problem is that the Depressive episode from Bipolar Disorder does not differentiate itself from Post Creavit Melancholia (PCM), leaving the individual unaware of what they are experiencing (it would be so much easier if Depression ran an inner dialogue as it tormented you, letting you know the nature of its origins … “Tally Ho! PCM here: good work on that last piece! Sorry to say that I must now make you pay for that bit of inspired work … hope you don’t mind, not that it would matter if you did.”). Suffice it to say, it does not really matter what causes a Depressive episode, what matters is the journey through the darkness: getting through to the other side. Getting through unscathed. Each episode is a war unto itself, each day a battle to be won; ground may be lost from time to time, but it is the overall battle, the ultimate victory over the disease that is important for us to focus on: a Depressive episode will end, we will win the war.

When diagnosing a Depressive episode one of the important elements to consider is the duration of the episode. While a “Clinical Depression” may be defined by a length of at least 2 weeks, the reality of living with Bipolar disorder means you can conceivably experience a Depressive episode that lasts from several days to only a few hours. Size is not an issue when dealing with Depression: if you are attempting to navigate the darkness it does not matter if the journey takes an hour, a day, or a week; for the duration of the journey you are at risk of losing all sense of connection to humanity, all reason to continue living, of falling into the depths of despair, of choosing to end your life rather than persevere through the end of the darkness. This is where it is vitally important to rely on the tools that you have learned along the way to use against the Depressive episode. You may have to fight to remember what you have learned, but it is worth the battle.

As I wrote in my last post, one of the things Depression robs an individual of is perception, but it also steals insight. While you may know something quite well while you are not experiencing a Depressive episode, add the Big D into the mix and suddenly a simple mathematical equation that you could do with your eyes closed feels like Rocket Science … you may as well have been asked to calculate the sixteenth figure in the Fibonacci series (which happens to be 987, in case you were wondering). The point is, when someone is living through a Depressive episode they cannot always see the forest for the trees: they may know that this is something that is going to pass, that it is a temporary situation, but during the episode, during the isolating darkness in which they’re experiencing both physical and mental pain, a mental anguish that can barely be described by any existing vocabulary, it really does feel as though it is going to go on forever … and that is the beginning of Despair. Perception is off-kilter and the lack of insight into how to cope with what is happening to you has to be dealt with on an idea to idea basis: you cannot allow a single negative idea to go by unchecked, you have to pose an intellectual counter offensive against the lies being waged against you, and that is part of what composing does for me. It serves as my personal Cognitive Behavioural Therapy by redirecting my intellectual energy away from the negative thinking towards something positive. It may not end the episodes early, but it helps to keep the darkness at bay, and that allows me to live.

The alternative is unthinkable.

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Adventures in Recovery

14/06/2010

Living with Bipolar Disorder is an ongoing challenge that I have been facing for the past twenty years. The constant mood swings make day to day activities arduous tasks, all for the simple reason that I can never know from one day to the next what my mood will be like at any given time, making advanced planning an exercise in frustration.

Thanks to the care of a very dedicated physician and a team of health care professionals I have learned many strategies for coping with this disease, and a cocktail of medications has also helped to bring my symptoms under control, but the cycling from hypo-mania, agitation, and depression still continues with annoying regularity.

A few years ago I discovered a new form of therapy, an additional treatment protocol to be added to my existing recovery plan that consisted of medications, relaxation exercises, regular appointments with my doctor, and maintaining a healthy diet. This new protocol was simply named Dr Seuss.

Now, before you get the idea that I’m immersing myself in the fantastic stories of Theodore ‘Dr Seuss’ Geisel, that’s not the case at all, though that might not be such a bad idea. No, Dr Seuss is my cat, and my therapist. Even as I write this, on paper (my laptop having been temporarily shunned so that he may have full access to my lap) his loaf-like form is stretched out upon me.

My cat therapist, Dr Seuss. Truly, the sweetest thing.

All curled up, he has no idea how much his presence in my life serves as a balm to a troubled spirit; as his unconditional love, supplemented by cat cookies, regular feedings and cleanings of his litter box, go a long way in keeping the darkest moments to a minimum and allowing the light to shine once again.

While there are different therapeutic routes available to someone living with an affective disorder, including medication, CBT, and psychiatric rehabilitation, there is one form of therapy that has recently become part of my recovery plan that has had greater benefits than any other: cat therapy. My cat, Dr Seuss, has become an integral part of my recovery process in ways that I could not have imagined when I first brought him home from the pet store almost three years ago. While I may have provided him a home he has provided me with more than he can ever know.

My recovery began ten years ago when I was diagnosed with the illness I had been living with for over fifteen years; an illness that still causes annoying disruptions to a life that sometimes seems more out of control than in. A combination of medications and regular appointments with my doctor has helped as recovery strategies. I also participated in psycho-education programs for several years, learning to recognize symptoms and learn about goal setting and other coping mechanisms for dealing with mental illness, but none of that has been able to compare with the therapy provided by Dr Seuss.

When I spend even a few short moments in the presence of Dr Seuss, a cat with a gentle spirit unlike any that I have ever encountered in any cat that I’ve ever seen before, I experience a sense of calm and joy that supplants all other emotions. It is impossible for me to feel bad when I am with Dr Seuss, he destroys negative emotions the same way the sun melts ice. If I feel depressed and pet him the dark feelings seem to melt away, flowing out of my hand, sliding off of his slick black and white fur.

Seuss reclining - his favourite pose


There is something transcendent about being in the presence of this gentle creature; even after the worst of days it only takes a few minutes in his presence and I can feel myself calm down in a way that would not have been possible without the use of medications. What is really significant about this ‘pet therapy’ is the way Dr Seuss gets me to stop looking internally all the time. Rather than focusing on my own emotional state I have to make sure that I’m taking care of his needs as well, something that requires me to look externally. Some days it would be very easy to stay home and hide from the world, but if I did that, I wouldn’t be able to go to the pet store and get the necessary supplies that I need for my little friend.

By taking care of a creature that only wants to return my love with love (when he isn’t engaged in his favourite activity, that being sleeping) it becomes possible to see that there are things in life that are more important than the universe centering around the ‘me, myself, and I’. Of course, some may not be ready for such drastic ideas, those being the ones for whom the self is too much to let go of and for whom suffering has become a profession, but that need not concern me for now. Thanks to the help of my little doctor, and the continued work that I’m doing with my other doctor, coping with bipolar disorder has become something that I can see myself living with, something I couldn’t say so easily ten years ago.