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Sunday, January 29, 2012

Saturday, January 28, 2012

Wednesday, January 25, 2012

Tuesday, January 24, 2012

Family plays Blues together

I am so proud of our talented family. The Mad Martins from Adelaide are using family time and their musical talents to play blues together.
Just love 'Slow Blues', Hannah's 'Be what you wanna be' and Rory's 'Are we there yet?' Great piece of work in the studio you guys...

Friday, January 20, 2012

Sunday, January 15, 2012

Great self-help videos for young people - from the UK

I think its good that someone is making these videos - they may educate staff as much as young people. They are a bit glossy, and the comments on each video reflect a mix of like versus not like. The accents sound like they emanate from Manchester.

Friday, January 13, 2012

Challenging my Depression (4)

Much has been written about Aaron Beck’s cognitive triad within depression – that ‘I’m no good’, that ‘the world is no good’, and ‘none of that is going to get better’. OK I know there is much more to the theory, and that Beck’s work goes much deeper into how our minds control emotion, so what I am about to write may seem superficial to some purists, but who cares?
Let me start with our world. Whichever way you look at it, and whether you are depressed or not, our world is looking very shaky and subject to immense and rapid changes that appear to be out of control. The recession we are not quite out of keeps threatening to reappear, and seems to have been caused (as so much is) by greedy people thinking they are really clever, and needing so much more than a few million dollars to live out the rest of their empty lives. Countries all over the world are billions, if not trillions, of dollars in debt, and politicians seem to have little ability to control further increases. There has been a shift of power from the west toward the east, that is India and China, who seem to be able to engender growth, maintain better stability, and (at least for the moment) lend money to the profligate west. Look, the shift may be a good thing. Let’s face it western countries seem to have made such a mess of things – perhaps someone else should have a try. And eastern countries are based much more on the family as the unit of importance rather than the individual focus – me, me, me – of the west. That might be a really good thing.
I don’t really have a view about some of these things. I watch the television news, which is always skewed towards death and destruction – “Ooh isn’t it awful?” (and then has a heart-warming story from somewhere close geographically, about 20 minutes from the end, just to make us all feel better). I can’t influence any of that. For instance the changes going on in the middle east are cataclysmic, but there is nothing that I can do to influence the path of peace. I have to watch from a distance and contain my worries about escalation to world conflict. I don’t believe ‘my vote’ has any currency or any influence. You wonder how countries run themselves when all politicians do is argue every day, often on fatuous grounds, until they all end up looking like raving loonies. I don’t have a voice in this country; I certainly don’t have a voice in any other country.
Well hang on.... My world is not just about the fact that everywhere seems in self-destruct mode. Actually my world is about my family – my extended family - and how they are coping with their lives. In particular its about how my wife and I manage our day to day lives, continue to love and support each other, and maintain some patterns of life that keep us reasonably happy. Its about my work – my clinical work and how I bring my experience to bear to help others make the changes they want, my teaching and how this might influence clinicians to become the best they can become, my research programs and how these might create new knowledge to help those who struggle with despair, my staff and how we can help them to become better clinicians, teachers and researchers for the next generation, the journal I edit and how it can publish new thinking on prevention of ill health, wellness, and mental health promotion.
You see what I have done here... I can’t change things I can’t change. But I can influence things around me. I can use the best skills I have with my patients. I can think hard about the essence of our work, and teach people in the best way I know how. I can think through the implications of our research, make sure we publish what we can, and then work out where to go next. Within my own little world, I can do... So, I will do...
If I thought of all the big stuff that is going on, I would get really depressed. It IS awful, and I wish it were not. It IS depressing, but I refuse to let it wreck my little circle of life. In challenging my own depression, I have to keep that world stuff out of my mind as much as I can. Well, how do you do that while you are watching the evening news? You have to be clear that other people’s (or peoples’) problems are theirs. They have to take their own decisions, do the best they can for their own people and their own country. And the politicians? Actually they make me laugh. I find their wriggling antics highly amusing. They are all grandstanding, strutting stages that are often too big for them, always looking for some clever angle to ensure they stay in power next time. I enjoy watching them just to see what silly things they get up to next. Its always good for a laugh – and laughter is very good medicine to help me challenge my depression.

Thursday, January 12, 2012

RUOK? seems to have got the question right!

There is massive national enthusiasm for RUOK? as a process. RUOK? Day is a national day of action to prevent suicide by stopping little problems turning in to big ones. In Sep 2011 we reached 58% of Australians. How will you contribute next September?

Wednesday, January 11, 2012

Sunday, January 8, 2012

Challenging My Depression (4)

I will be coming back to some of the issues I have already raised; to look at them in more depth. But at this point I want to talk about music. I have to admit I am not a musician. I was a choirboy for 12 years, and used to be able to sing well, even when my voice changed to tenor, and later on to baritone. More recently, however, the medications I take for prevention of asthma have had an impact on my vocal cords, so if I sing, I embarrass myself, or I end up coughing and gasping for breath. I do keep trying, but mostly when I am on my own. I did try to learn the cello for a couple of years, but got RSI in my left wrist - so that was pretty much the end of that.
I do have a residual keen ear for music. And music has played an important part in my challenging of my depression. The main opportunity is when I am on my exercise bike, which I do two or three times a week. I set up the iPod with noise reducing earplugs, find something that interests at that moment, and away I go. I have listened to Rolling Stones, Foo Fighters, Nirvana, Queen, Clannad, The Cranberries, Bond, Jacques Loussier, Gerry Mulligan, Bill Frisell, EST, Bach Cello Sonatas, Mozart's Horn Concerto, Philip Glass, Nico Muhly, Ravi Shankar, Alistair Fraser and Emma Haas, and lots of Crowded House. There is some influence from the style as to how quickly I peddle, but so what? At the end of 40 minutes I always need a recovery rest for 20 minutes, so I lie down and go on listening - and often fall asleep with the music still playing.
Whatever the music, my mind ends up feeling at peace. Any problems with muscles, pain, tiredness seem to float away. My legs may be temporarily less under control from the sustained effort of peddling, but I feel good in myself. The background I suppose is that the exercise is not just rebuilding muscles and fixing up my body image, but it also floods my brain with those chemicals we all crave - endorphins. The music seems to help me do the exercises I have to do, but also seems to have a very similar effect to that produced by the exercise - stress, frustration, tiredness, sadness, worries about work projects all seem to be more settled. Problems seem less worrisome, and solutions to every day things come to me much more easily. I guess being more settled like this is something to do with mindfulness, a sort of meditativeness induced by the music.
Look (or perhaps listen), I am not saying that you can treat depression with music alone. But it is a crucial part of recovery. Listen to lots of music - vary the styles to reach different parts of the brain and access a wider range of memory. Use your earphones so you don't drive others mad.
You still have to seek help, and make sure you are getting the best professional care you can get.
Add it to the list of things you can do for you. Don't try to be too choosy - "I just can't decide what to listen to" "Its too many things to think about" "I can't make lots of decisions when I feel like this" "I don't need the hassle". Just reach for the first CD and put it on. Spin the dial of your iPod and see what comes out. You can always switch to something else.

Friday, January 6, 2012

Challenging My Depression (3)

What if even the most severe depression were just a state of mind?
OK I have written a couple of posts on this now, and there are some questions to be answered. The first is whether I really do know anything about depression. The second would be whether I have really felt that utter despair that goes with ideas that life is not really worth living. I guess if the answer to either or both of those is 'No', then what I have to say is not really authentic - that is I am talking out the back of my neck! So here goes...
I have been a doctor since 1967, started training in psychiatry in London 1968-69, did 5 years as a general medical practitioner in the community, completed the Australian formal training program in psychiatry (RANZCP) in 1975-79, and was in private practice as a clinical psychiatrist from 1982-86, seeing 600 new referrals over 4 years. I moved back into public clinical services in 1986, and have been a clinician and academic ever since. I keep up with the literature, but do not believe everything I read. So, can I recognise the most serious despair, and diagnose depressive illness? You bet! Have I treated and managed people over the longterm and seen them reach remission? You bet; the longest clinical processes I have managed were 15 and 16 years respectively. Both are still alive and flourishing. Do I know about suicidality? Well its a long story for another day, but I believe I do.
Do I prescribe for depression? Not in every case, and I tend to be old fashioned and use drugs I know rather than all the new variants that really don't seem to be any advance on stuff I originally used in the 70s. I am cautious and careful. In addition I have a strong belief that even serious depression is driven by our life experience, day to day problems, and our interactions with those around us. Even if you prescribe as a psychiatrist, I believe you are duty bound to ALSO do all the work to assist change for all those things driving the problem.
Now the other side of the problem. Have I ever been depressed or despairing? Of course. There were several times in my early youth when I felt isolated and under pressure and despairing, and then again later in married life there were times when I got to the point of asking if life was worth living. Of course, the last two years since being paralysed have been at times challenging in the extreme - and you can read about some of this in my serialised chapters of the book 'Taking Charge' (see earlier posts 2009-10). To begin with, lying flat on your back with no movement below the waist, no control over waterworks and bowels, and nobody appearing to know what had happened was not fun.
Was it clinical depression - that is genuine dinky-dy with all the bells and whistles depression? I certainly was utterly miserable, felt totally under the control of others, could think of no solutions to my predicament, lost my appetite (very rare for me), could not get to sleep, woke early in the morning with reality pressing in, wondered whether it was my fault that I had been paralysed, had no energy, lost interest in all sorts of bits of my complex life, and at times just wanted to die to solve the problem. Was it clinical depression? You judge for yourself? Did I admit to it? No. Did I seek help? No. Is that stupid? You bet. Did I think antidepressants would help? No. Can you believe that? I would not necessarily advise you to do things my way. In the first place I would seek some sort of help.
Seeking Help Saves Lives
So what began the change in me? See Challenging My Depression (1), where I had acupuncture and the next day saw a glimmer of hope. And then I began to write every day - just little bits or odd notes. Then I began to see all sorts of odd things as funny. Hysteria? Hypomanic defence against depression? No just bureaucracy and the way it treats human beings so poorly. So I alternated between laughing at lots of stupidities, and then getting angry, and then being determined to write down the story in the form of a book. I called that getting even - not for the paralysis, but for all the petty things that happen when you are a patient or in a wheel chair. So, do I know about depression; you be the judge.
Oh, and if you are reading this, and do suffer from depression SEEK HELP, and MAKE SURE YOU GET TREATED RIGHT.
More next time...

Thursday, January 5, 2012

Challenging My Depression (2)

What if even the most severe depression were a state of mind?
Even when you are the most depressed you can ever imagine someone being (that is, 10 out of 10), there are all sorts of stupidly ordinary things that YOU CAN DO that will gradually have some impact on you state of mind. You just want to stay in bed, to sleep, perchance to die quietly without anyone noticing. It does not work like that. Just get up... OK, if you can't do that, wait until you need to go to the bathroom, then get up and go. Now do three things. The first is to wash your hands as you would just as a routine. Then clean your teeth. Yes, I know it sounds stupid, but it is part of what we do every day, one of life's little routines, and that clean minty taste washes the sourness of depression out of your mouth. Swill the residual toothpaste out of your mouth, and have a look at your teeth. There you are, you are looking at yourself in the mirror. But also you are smiling... well sort of smiling... OK, you are grimacing. But you are using some muscles you may not have used in a while. Now poke your tongue out and look at that. It is probably a bit coated, and may need a bit of a scrub with the toothbrush, Do that, gently, and then poke your tongue out at yourself again to see whether it is clean enough. Now look at your teeth again with a little grimace. Feel stupid? OK, but somewhere in that routine you may just have found a small smile at yourself, at what you have become, and how strangely life is treating you. Or you may just have grimaced at the thought of some highly trained, slightly stupid, shrink telling you to clean your teeth! But it is practice for the next bit.
Now even if you have not had a shower, put some clothes on. OK, I know, you may have slept in your clothes from yesterday, Doesn't matter. Get up and walk out of your bedroom. Go to the kitchen and make a cup of tea or coffee. These stimulants actually do begin to get the sluggish mind working again. But what I want is for you to have left the bedroom and DONE something. Now, if there is someone in the rest of the house I want you to do something else that sounds stupid. Go and show them your newly cleaned teeth. Its not for them, and its not to show them you are a good boy or girl and have actually done something, its a bit more practice with those muscles round your mouth. OK it might feel like a grimace, but with any luck they will smile at you. As humans, we mirror others - that is we copy (sometimes in a small way) the movements that they show us.With a bit of luck they will show a hint of a smile. A good strategy is to smile back. Then you can tell them how some strange paraplegic shrink suggested you clean your teeth and then show someone. With any luck both of you will smile. It may not instantly cure your despair, but it is a small beginning.

Monday, January 2, 2012

Challenging My Depression

Having been paralysed from the lower chest down, I can tell you that I have been depressed - from time to time seriously so. Yet I am here, and within the limits of my residual problems, I flourish. I have been reading the Twitter List #Depression, and if you put to one side the advertising to various somewhat ordinary sites with very repetitive and boring information that does not offer real help, there are all sorts of cries for help alongside all sorts of strange information that does not really offer help.
The key question is "What can YOU do to help yourself?' Look, if you are worried about your mental health, then you really should go to your personal doctor and get checked out.
Seeking Help Saves Lives
But even when you have had a medical or psychological checkup, you still need to do lots for yourself. Just sitting down in front of the television having taken your antidepressants WILL NOT WORK. And the intriguing thing is that the more you actually do, the better you feel. So I thought I would share one or two ideas with you related to my own struggle to stay sane when you suddenly cannot walk. I will post as regularly as I can with more ideas.
The first is related to physical movement. There was a time in hospital when I literally could not move a muscle below my lower chest. The Physiotherapists assessed my status, and demanded I keep everything moving passively. That is I had to pull my floppy legs up with my hands, and perhaps reach down and move each of my toes. After some Acupuncture on the third day I felt sensations that had not been there for days - which gave me a burst of hope. The very next morning I could move my left big toe - only about a couple of millimetres each way, but it moved. I wept and laughed at the same time. Every time I thought of it, I exercised that toe. Next day it moved more, and millimetre by millimetre I gained strength. It took a year of struggle for me to get most of my muscles working well enough for me to walk well without aids, and I still need to keep my exercises going or I slide back. But with each small triumph, each new muscle I got to do what it was supposed to do, I gained just that small bit of hope, and gradually my confidence returned.But walking is basic to being a human being, so I am determined to keep walking every day of the rest of my life.
So what is the lesson here? Never lose hope. However depressed you believe you are, DO something - even a little tiny physical something. (If you can, turn the bloody television off and go for a short walk. Next day go at least ten metres further). Every time you do it, it will make you smile, or even laugh and cry together. Who cares? Each small triumph tucked into the mind's bank will put you back on the road to mental wealth.

On Being Online

My new editorial at the online journal Advances in Mental Health looks at differences between Online Data, Information, Knowledge and Wisdom, and why each is important. Intrigued that Google wants to hold all human knowledge online, and seeks to take up all human wisdom.

Sunday, January 1, 2012

Opportunity presents itself

So here we are in 2012. This is the 503rd Leap Year. Very auspicious for change. So what are you actually going to do to change you? What are you actually going to do to change your environment? What are you actually going to do to change your piece of the world? The best wishes and champagne and fireworks are over. What now?