Depression

It Starts

97 Days to Go

After three weeks off and a typically over-indulgent Christmas period, the hard work has begun, as I’m now two weeks in to my London Marathon training. Last week was slow, but I managed to do 30 miles this week, including a hill sprint session and an icy 11 miler along the river yesterday morning.

I’ve been pleasantly surprised by the lack of damage caused by yuletide festivities, so all in all I’m off to a promising start.

I’ve also started my fundraising drive for MQ, so if you would like to sponsor me please follow this link. If you do, you will help fund critical research into a wide range of mental health conditions, including anxiety, depression, ADHD, autism and PTSD.

Many of MQ’s research projects relate to young people, including its latest study on the link between bullying and mental health. Despite the fact that, on average, three children in every class have a diagnosable mental health condition, 7 out of 10 young people do not get sufficient help.

In terms of my own issues, the most interesting statistic is that 75% of those with a mental health condition start developing it from an early age. It is thought that bipolar (if that is what I have) can have genetic, biological and environmental factors, so it may be that I have always had it, was always going to have it, or some biological pre-disposition may have been triggered by one or a number of life events. It certainly became more of an issue after I had my first child, but I’ve always had the feeling that there was something not right with me.

With hindsight, it is tempting to attribute certain feelings or actions to mental illness (in fact, I tend to use bipolar as an excuse for every time that I’ve acted like a dick), but I guess there is no way of knowing for sure. I definitely should have received medical help before I did, but how early? Could the breakdown have been predicted, or even prevented, and if so when? The latter seems unlikely, taking into account another MQ statistic – that on average it takes 10 years for an accurate bipolar diagnosis, so I’ve still got a long way to go.

By donating to MQ you can help answer some of these, and many many other important questions on mental health issues, so here’s the link again.

New Beginnings

“The splendid thing about falling apart silently…
is that you can start over as many times as you like”
– A Thousand Flamingos, Sanober Khan

Despite promising (threatening?) to write more often in my previous post, it’s been six months since I even checked my blog. Why? The short answer is that I’ve had a lot on, but never one to give a short answer, here goes.

Although I’m currently laid up with an injury after another epic stunt of mal-coordination (more on which later) I’ve just started an exciting new chapter in my life, which also marks a new era for my favourite hobby/obsession.

As a result of a change of job and a move to the Cotswolds, for the first time since I started running I have access to a wide variety of routes and terrains, and have the stability and time to commit to a running club.

Rather than the mean streets of Peckham, my closest route is along the unspeakably beautiful Thames Path, not far from the source. I’m now dealing with stinging nettles and cows, rather than traffic and scallies with fighting dogs. My new employer also has a very active running club, including free fitness classes tailored for runners.

The change of lifestyle (including more sleep and regular routine), and finally getting my medication right, has made me feel better than I have in as long as I can remember. Although it’s early days, and being all too aware that my condition means that I am always one very small step away from things seeming too great, or very very bad, life is good.

So far, so positive. However, the reason for the gap in writing is that things have been pretty bad, both in life and in terms of running, for the majority of the intervening period between posts.

In fact, as far as running is concerned, only a couple of months ago I was not sure that I wanted to run again. I had completely lost the love, only putting my trainers on when I had no choice, mainly due to Southern Rail’s complete ineptitude.

As a result, I pulled out of the Pembrokeshire Coastal Trail and the Marato Dels Cims, despite being in the best physical shape than I had ever been, and just stopped running.

It all started so well. The training plan from my coach, Robbie, was brilliant; I saw an improvement in my fitness and performance after pretty much every run. I found the structure and flexibility of the personalised plan more beneficial than I thought I would, particularly the tempo sessions. Doing sprint work was, for me, like a trip to the dentist – unpleasant, very likely painful but ultimately very good.

As the race got closer, however, I started to use training as a stick with which to beat myself. I became obsessed with running further and faster, so much so that even Robbie told me that I was doing most of my sessions too quickly. And although he was on hand to adapt my training plan on a daily basis I convinced myself that I could not afford to miss a session.

As my mental health is so intertwined with running, it’s difficult to tell whether this was a cause or just a symptom of a wider problem. It was certainly adding to the anxiety caused by a possible job and house move, and to the normal stresses of modern life, all of which I was not coping with very well. I was becoming increasingly withdrawn, my moods erratic, and to be honest it almost proved too much for my incredibly understanding and supportive wife.

Thankfully, we did not let history repeat itself. Rather than let the problems spiral out of control we hit them head on, admitting that something drastic needed to be done. So we spent a lot of time overhauling the way that we worked together as a family, I left the only career that I have ever known, and we moved out of London for an altogether different life. No less radically for me, I also took a break from running.

As will be evident from the above, it seems to have worked. As with the rest of my life, I’m now enjoying every run. Well, almost.

On only my third run in the country, I was coming up to the final gate before heading back onto the short stretch of road to home. Distracted by a large black and white animal that I think country folk call a “cow”, I put my foot on a loose rock, sprained my ankle and went head first into the metal gate. I limped home, blood pouring from my head and knees, and my ankle swollen to about three times the size. A week later I’m still limping, and sporting a particularly fetching black eye, which would be embarrassing at the best of times, but being only two weeks into a new job I look particularly ridiculous.

But, despite the mishap, I’m now feeling super-motivated, and ready for the next challenge. Once I can walk again, of course.

MdMB Part I: Ain’t No Mountain High Enough

“It is not the mountain we conquer, but ourselves”
Sir Edmund Hillary

As a kid, I was obsessed with Christmas. I’d plan it for the family in February, invite Nan and Granddad in March, and then start my letter to FC by June at the latest. By November it was all I could talk about, but every year, without fail, I would get sick the week before. I normally spent the 22nd and 23rd in bed or throwing up, and the rest of the family would worry that I’d ruin Christmas.

I always made a miraculous recovery on the 24th, and by Christmas Day it was like I’d never been ill. I’d been so nervous and excited about the big day, that I made myself sick.

After all of that, you would think that 25 December would be the best day of the year for me. After the initial excitement it was actually when I was most miserable. I’d built it up so much that it was always going to be an anti-climax, and by the time lunch was finished, I was already mourning the fact that it was over, and that by the time next Christmas came along everything would be different.

As you will know if you have read any of my previous posts, my approach to the Mont Blanc Marathon was very similar, so both Camilla and I were worried that the event would not live up to expectations, and that the comedown would be sharp and severe, as it was after my first Ultra in 2013 (Falling Feels Like Flying).

Thankfully, it went better than I ever could have imagined, and was one of the best experiences of my life.

As soon as we got close to the Alps I understood what Lizzy Hawker had said to me a few weeks before (Training Weeks 8-10), as I instantly fell in love with the mountains, and the only negative thought I had was to question why the hell it had taken me so long to get here. I was completely mesmerised by Mont Blanc, and could have quite happily sat and watched it for the whole weekend, if I had not found myself in a running geek’s paradise.

Every other shop in Chamonix seemed to be a sports shop, and it’s the only place where I haven’t had funny looks for wandering around in quad guards, calf guards and long socks, particularly as so many people were here for one of the races. There was also a good chance of bumping into an ultra-running legend with Seb Chaigneau, Max King, Emelie Forsberg and Killian Jornet, among others, in action. I think I may have gone a little tweenager at a One Direction concert at one point, as Camilla threatened to make me an “I’d go gay for Killian Jornet” banner.

The events started at 4am on Friday with the 80km and the Vertical Kilometre in the afternoon. Saturday was the mini-cross (cutest race I have ever seen), 23km cross and the 10km, with the marathon finishing off the weekend on Sunday. Every race was impeccably organised and incredibly well supported, even for the pack of 80km finishers running through the town at 10:30pm, the 7-year olds on Saturday morning and the start of our race at 7am on Sunday.

The six of us that made team Up & Down Runner (I got them t-shirts so they had no choice), were involved every day, with Charlotte and Charlie doing the Vertical Kilometre on Friday and joining Camilla in the 10km on Saturday, and with me, James and Andy doing the marathon on Sunday. This helped my preparation greatly, as it not only kept me busy, but seeing the incredible support at each race and sharing the relief and elation of finishing made me even more excited, and less nervous about the challenge itself.

Admittedly I did let the nerves get the better of me on Saturday night, but when I woke up at 4.30 on Sunday to eat breakfast they had all gone. Aided by an unexpected and touching note from our host for the weekend (who also happens to be my boss), I succeeded, possibly for the first time in my life, to block out all of the negative thoughts; the panic that I had not done enough training, the likelihood of breaking an ankle or falling off a ledge and the inevitable post-race crash. Whatever had happened before, and whatever was going to happen during the day, was irrelevant, all I could do was start at the start, and keep going until I stopped, and try to enjoy myself while doing it.

I’m going to put a detailed race report in a separate post, as there is far too much to say here, but as many of you will know already, I completed the race in 6:54:10, a devilish 666th out of the 2012 finishers, and I enjoyed every single minute. Me, the person that had never been near a mountain before, runs like a chicken, hated running up hills, consistently found new and more stupid ways to injure himself (Injury), that is scared of “mushrooms and Moomins and hedgehogs”, at least according to Freddie* and that, less than 18 months ago, would have ended his life if he was not a prisoner in his own bed.

I hope that this doesn’t come across as a lame attempt at false modesty, as I only mention these things to show that you should never underestimate yourself – if I can do this, imagine what you can do.

Admittedly, I could not have done any of this without the right medication, therapy, and the support of friends, family, and indeed all of you that are reading the blog. But, on the start line and for those 7 hours, it was mainly just me against myself (or Alan, to be precise). Have I beaten him? No. But with each step I was winning, and all that matters now is that I keep focusing on putting one foot in front of the other.

*He’s right about the Moomins. What the hell are they, why does Little My live with them and what is the big-eyed fisherman all about?

Mind Control II: Overcoming Alan

“If you have HIV or cancer or athlete’s foot you can’t teach them anything.
When Ashley Stone was dying of meningitis, he might have known that
he was dying, but his meningitis didn’t know. Meningitis doesn’t know
anything. Buy my illness knows everything I know. That is a difficult
thing to get my head around. But the moment I understood it, my
illness understood it too.” – Matt Holmes, from The Shock of the Fall
by Nathan Filer

Since I read Man’s Search for Meaning (http://bit.ly/1Eag3f6), I have been trying to work out how I could use it to combat my own depression. The thing that I have struggled with is whether, when I am at my worst, I retain the last “human freedom”, or can depression be defined as the inability to choose one’s response.

In my first post (http://bit.ly/1zGnn78) I described my breakdown as a complete loss of control of my own mind. How could I have had a choice, if I had no control over my own thoughts? Then again, I also felt that suicide was inevitable, that I would not be able to stop it. If that was really true, then how am I still here? Did I still have the ability to choose? Was I able to regain control, even for a split second, or did I have control all along? The problem is of course that I have no way of ever knowing for sure what happened, let alone what I was thinking at the time.

The quote above, from Nathan Filer’s moving and uplifting novel The Shock of the Fall, is written by the 19 year-old schizophrenic narrator Matt Holmes. Not only does this seem to describe one of the inherent problems in diagnosing, treating and even understanding mental illness (i.e. the fact that it is impossible to be objective about, or sometimes even describe your symptoms), it has been a useful weapon in my constant battle to stay in control.

Obviously, schizophrenia is very different to depression, but thinking of my illness as an “it”, or even better a “he”, can be very helpful in recognising when I am suffering, and most importantly giving me an early warning to seek help. This idea was brilliantly articulated by Niall Breslin, well-known Irish musician and former gaelic football and professional rugby player, in a powerful and brave speech about his experience of general anxiety disorder. If you have not seen it yet, you really should: http://bit.ly/1A50rIL.

In the speech, “Bressie”, as he is better known, explains how he personalised his illness, gave it the worst name he could think of, and fought back by doing things that he knew “Jeffrey” would hate, which, as Jeffrey was a part of him, meant facing his own fears.

I have fully adopted this approach, although my depression is called “Alan”. Not only is this an incongruous name for something so powerful, but I imagine my depression having the voice, social skills and worldly experience of Norfolk’s most famous son, Alan Partridge. Although I am not going to buy a Mini Metro, or support the pedestrianisation of Norwich City Centre, I know that the two things that my Alan hates most are writing openly and creatively about himself, and running up mountains.

This is perhaps why the blog has been such a release for me, and a massive turning point. Like Bressie, my life has become so much brighter as a result of telling the world about my experiences, and the incredible response that I have received has only made me wish that I had done it sooner.

This is not to say that anyone with mental health issues should do this. Everyone’s story is different, and all I can do is tell my own. More importantly, this is only a very small part of my treatment. I am very, and unashamedly, reliant on fairly high doses of medication, regular therapy, and having so many people looking out for me.

Moreover, there is not, as far as I am aware, a cure for my illness, and my life will be a constant battle for control. At the moment, I seem to have the upper hand, but can I promise that I will never be back to where I was at around 5:30pm on 7 February 2014? No. But what I can promise is that I will do everything in my power to keep Alan from Bouncing Back.

Mind Control I: The Last Human Freedom

“Between stimulus and response is a space. In that space is our power to choose a response. In our response lies our growth and our freedom”
– Dr Victor Frankl, Man’s Search for Meaning

Of all of the quotations that I have, or will, post on my blog, this is probably the most powerful. Dr Frankl was an Austrian psychologist and concentration camp survivor, who lost his father, mother, brother and pregnant wife to Auschwitz.

The German title of the book gives a much better idea of what it is about: “trotzdem Ja zum Leben sagen: Ein Psychologe erlebt das Konzentrationslager”, which roughly translates to “…to say Yes to life none the less: A psychologist experiences the concentration camps”.

The main message that I took from the book is that situations, circumstances or people can take away everything a person has, except the “last of human freedoms”; the ability to choose his or her attitude, to be “worthy of their suffering”.

To even survive what Dr Frankl had to endure, to rise above the unimaginable horror, let alone use it to create a school of psychotherapy that is still used today to treat a number of illnesses, is incredibly empowering. One of the main tenets of his theory, logotherapy, is that life has meaning in all circumstances, even the most miserable ones.

It was only while reading the book that I realised that I had received this message before, and in the context of running. In 2012, I ran the Paris and Edinburgh Marathons in aid of the fantastic charity Freedom from Torture (http://freedomfromtorture.org). Many of its clients have been through horrific experiences, yet were able to establish a new life, and use what they had been through to help others, much like Dr Frankl.

I have used their example to get me through many a race or training run: to ignore the feeling that I can’t run another step or that I should never have started in the first place, and to remind me that whatever it is that I am experiencing, it is most definitely not torture.

I am reluctant to link the suffering of concentration camp inmates and torture survivors to running around two of the most beautiful cities in the world. What makes me do so is one of the other powerful messages from Man’s Search for Meaning, which has been instrumental in helping me come to terms with my illness.

One of the most misunderstood aspects of depression seems to be that a person needs to have a reason to be depressed. Compared to most, I have nothing to be “depressed” about. I have a stable, supportive family, a good job, nice house, great friends, a beautiful, loving and supportive wife and two boys who I could not love any more. If people can live through persecution, torture, poverty and other extreme physical or mental suffering, how weak and cowardly must I be to be unable to cope with another day?

This does of course ignore the fact that depression is an illness, and in my case most likely caused by a chemical imbalance, so is in a way a “physical” rather than “mental” disorder, like diabetes or asthma. At times I find it very difficult to remember or even believe this, particularly when I am feeling low, but I cannot argue with Frankl’s conclusion that:

“…a man’s suffering is similar to the behaviour of gas. If a certain quantity of gas is pumped into an empty chamber, it will fill the chamber completely and evenly, no matter how big the chamber. Thus suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore the “size” of human suffering is absolutely relative.”

This seems to me to be essential in combatting depression, both for the sufferer and those around them. For the sufferer, one thing that he or she should never do is feel guilty or ashamed, or compare his or her situation to anyone else’s. As importantly, no-one should assume that an objectively “good” life makes a person immune from depression or suicidal thoughts. Spotting the signs can be very difficult, particularly for long term sufferers that have become adept at hiding the inner turmoil, but talking openly, and reducing the stigma around depression and suicide, can, and indeed have been incredibly effective.

As described in the Guardian last week (http://bit.ly/1FohyM4), the NHS is running a number of pilot schemes to reduce the stigma surrounding suicide, based on the incredibly successful programme in Detroit, which has reduced suicide by 82%. What someone suffering from depression needs most is professional medical assistance, in many cases (such as mine) it will take a family member, a friend or a colleague to get this.

Moreover, even a stranger could be the catalyst needed for a sufferer to get help, or to divert him or her from taking the final step. The details of my darkest hour are for another post, but what I can say is that a woman who I had never met, and am very unlikely to meet again (particularly as I can’t really remember what she looked like), saved my life with the smallest act of kindness.

07/02

“a man devoid of hope and conscious of being so has
ceased to belong to the future”
– Albert Camus, the Myth of Sisyphus and other Essays

Friday 7 February 2014, around 18:00.
Sitting at my desk (not unusual), staring at my screen.
Looked around, surrounded by piles of paper and coffee cups (also not unusual).
Photos of my wife and two boys looking back at me.
Got to focus. But on what?
Why are my hands so cold?
Right, no more messing around, just get this done and then go home.
Why is my hair wet, and what the hell is wrong with my hands?

Trying to get myself to concentrate, or think about anything at all, was like trying to start my first car (an H-reg Vauxhall Nova Flair). Turning the key pumping the accelerator, adjusting the choke, a splutter, then silence. Try again, still no luck. Panic setting in, what if it never starts?

Like my beloved Nova, all of a sudden my brain kicked into life with a roar. As soon as the noise died down it hit me, I had just come back to the office, but had no idea where I had been, or for how long.

It was at that point that I was forced to admit, for the first time, that something was very wrong, although I would only fully understand how wrong when I eventually worked out where I had been, and what I nearly did.

Up until 18:00, 7 February 2014, I had been convinced that I was a perfectly healthy, and very lucky person, the only problem being that I was too weak, too stupid and too selfish to function as a normal human.

And so it was, after 36 hours of blind panic, I found myself in bed, violently shaking but otherwise convinced that I could not move, even if the bed spontaneously combusted.

One of the best descriptions I have read of depression is that it is not the presence of sadness, but the absence of hope. For me though, at this point, it was the absence of anything at all, except for alternating feelings of panic and exhilaration that I had completely lost control of my own mind.

There has been a lot written about the state of mental health care on the NHS, but for me there is no better illustration than the conversation I had with NHS Direct, while I was lying in bed, shaking and terrified. I was really only asked one question by the nurse and the doctor, and that was whether I was imminently going to harm myself or my family. My honest answer to this was no, but this was not because I did not want to, in fact hurting myself was all I could think about, but because I felt incapable of getting out of bed.

I was thus informed by the doctor, and these words will stay with me forever, that NHS Direct “can only deal with urgent cases, and yours is not a priority…”. I was told to that I would have to wait to see my GP, despite the fact that my appointment was nearly two weeks away, and my wife had already asked for urgent help due to her concerns about my mental state and my denial of the situation.

From that point on, thanks to a swift intervention from my incredibly compassionate employer, and Bupa’s fantastic mental health team, my “non-urgent” case was taken out of the NHS system altogether.

I am painfully aware how lucky I am for this, and for the unerring support of everyone around me, particularly as many who suffer from mental health issues, particularly men of my generation, are not so lucky. I am prone to melodrama, but in this case I do not think that it is in any way an exaggeration to say that it saved my life.

In addition to lots of running geekery, I am going to write a bit more about how I got to this point, and what I am doing now to stop myself from getting there again, which is really unavoidable, as running and my mental state are now fully intertwined.