mental health

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.

Just a Marketing Gimmick?

“Trails are like that: you’re floating along in a Shakespearean
Arden paradise and expect to see nymphs and fluteboys, then
suddenly you’re struggling in a hot broiling sun of
hell and dust and nettles and poison oak…just like life”
– Jack Kerouac, The Dharma Bums

As you will have noticed, I’ve not posted for a while. Alright, you probably haven’t, I’m not getting delusions of grandeur, at least not regularly.

After the race I took a training break, so apart from a run in Seattle (I only managed the one – the beer is too good there), and blacking-out in Sydenham while trying to run off a virus, not much has happened in the last few weeks.

I did do a sub-19 minute 5km race at the start of July (The Great City Race, again), which I should’ve been happy with, but as I missed out on a PB by 8 seconds, despite starting near the front, I’m still a bit annoyed about it.

I also won an entry into the Snowdonia Trail Marathon, and race gear from Scott (massive thanks to Scott and Climbers Shop in Cumbria), but annoyingly I forgot that I’d entered and couldn’t make the race, so gave the place to James and shared the kit with him. I did keep the free shoes though, mainly because they were called “Trail Rocket”, and from what I’ve seen so far this is a fair description. I wasn’t that sorry to miss the race, particularly because of the torrential rain (see picture of James below) and because James, as a former local, got a far better time than I ever could, which I’m claiming as a result for team Up & Down Runner, and therefore me.

To be honest though, the main reason for not writing is that I’ve not been feeling great recently; a combination of inevitable post-race comedown, not looking after myself properly and, well…if I knew exactly why then I wouldn’t need the drugs.

Talking of drugs, I was corralled by Camilla into seeing the psychiatrist again, because of my volatile moods, extreme forgetfulness (see above) and because I’ve developed a side-effect (whether of the meds or old age) of falling asleep at the slightest provocation. Great on long haul flights, not so good in meetings, or while driving…

The outcome of my session was more medication on top of the two that I’m already taking, which I think now means I’m officially on a “cocktail” of drugs. On the other hand, maybe I already was, as, after all, a martini, screwdriver and snakebite only have two ingredients. Perhaps the latter is stretching the definition of “cocktail” too far – can’t see Bond ordering it shaken or stirred, unless he was in a student bar Bristol in 2000, and it was my round (unless he fancied a Southern Comfort and Lemonade instead).

Sorry, got side-tracked. Actually, the most important thing that came from my session with the doctor was that he has, CONFESSION ALERT, never definitely diagnosed me with bipolar disorder.

Although many of my symptoms support the diagnosis, and I am on medication used to treat bipolar, which seem to be working on the whole, I am not quite bipolar enough for a certain decision.

This is the story of my life – got the basics right, work hard and show a lot of promise, but don’t quite have the flair to get to the top. As I said in my first post, if I do indeed have bipolar disorder, I am the most boring sufferer in history, unless my “Maserati moment”, as Dr. Craig calls it, is still to come.

The other issue, which is more general, and far more interesting, is that in many cases a definitive identification of a mental illness is very difficult, or even impossible. There’s no test or scan that you can do for depression, so doctors may only have the testimony of others, or evidence of the most unreliable witness possible, the sufferer, on which to base the diagnosis. It also seems, at least to a psych-idiot like me, that very little is known about the workings of the brain compared to every other part of the body. A good example of this is that two out of the three drugs that I’ve been prescribed are predominantly used to treat other ailments (epilepsy and psychosis, respectively), and although there is apparently lots of evidence to prove that they ease bipolar symptoms, it’s not yet been fully established why this is so.

Maybe this is also why it can make mental illness difficult to understand; at times there can be no sign that anything’s wrong, and even when there is it can just seem like an over-the-top, but not completely unwarranted, reaction to an everyday situation.

Do I need a label? It would certainly makes things easier, and I could pretend that I was a misunderstood creative genius, but it seems, at least medically, that it really only makes a difference in the drugs prescribed, and I’m fine with trying anything that works.

So, there you go, “Up & Down Runner” may be a complete fraud; a cheap marketing gimmick. Please forgive me, but “Up & Down, But Not Consistent with a Diagnosis of Bipolar Disorder, But Then Again Maybe It Is, Runner”, would not be quite as catchy, or fit on a t-shirt.

Right, I’m off to buy a Maserati.

NB: I know that the photo at the top does not really relate to the post, it’s just the best photo of me that I have…

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.

Training Weeks 3-4 Faster Than a Speeding Train

“A weird time in which we are alive.
We can travel anywhere we want, even to other planets.
And for what? To sit day after day, declining in morale and hope”
Philip K. Dick – The Man in the High Castle

Last week was a very important step in my training and my recovery, both from the hip injury, and the breakdown. For the previous 18 weeks or so, I had spent most mornings sitting, and declining in morale and hope. In other words, I had been trying to get to work, through London Bridge, travelling on Southern Rail.

I am about as certain that I will get to my destination relying on a train to London Bridge, as I was when driving in my aforementioned Nova. Not only did it have difficulty starting, but the wheel once snapped clean off the axle. Thankfully, no-one was hurt, although the flying wheel did bisect the central post of a wooden fruit & veg stall at the side of the road.

As a result, I was very relieved to get back to running into the office last week. The route, from my home in East Dulwich to my office near St. Paul’s Cathedral, is between 6-7 miles, and after three years of experimenting, I have found a way to keep off as many main roads as possible, use pedestrian crossings where I can’t avoid them, and even learn the phasing of the traffic lights. A map and stats from my normal route can be found by following this link at Garmin Connect, if you’re interested.

There are a number of other advantages to run commuting, most of which are listed in the May edition of Runner’s World, and are fully covered on the fantastic Run2Work website (https://www.run2work.com/), where you can also find tips, suggested routes and can even find a group to run commute with. I think that they are worth repeating, even though it breaks my own site rule of not giving advice:

easy training miles – a few people have asked how I find time to train with a busy job, two children and a blog, and the answer is simply that I run to work. It takes me less time than it does to use public transport (hence the title to this post), so is actually a net time saver, and I can get up to 30 miles a week in just by getting to work;
great start to the day – I can get to my desk feeling awake, relaxed and smug, rather than claustrophobic and irritable;
it’s cheap – not only do I avoid paying expensive train/bus/tube fares or fuel for the car, but my suits, work clothes last much longer as I don’t have to wear them to and from the office;
it’s consistent – I know that on an average day I will get to the office in 52-54 minutes from home, but if I need to get there a bit quicker it is (almost) completely within my control;
it’s good for the environment and stuff;
improves my sense of direction – which, as I have mentioned before, is very important; and
get to take the scenic route – I get daily reminder of what makes London the greatest place in the world. I have posted a photo gallery of my run into work (although admittedly I did not take all of the photos while running), which shows how I get to experience natural beauty, the most multicultural and diverse 1/2 mile in the world (Rye Lane), a large cross-section of Londoners, both human and non-human, historic, iconic buildings and a developing hyper-modern city.

Admittedly, run commuting is not without its drawbacks. It takes some forward planning to make sure that you have the right attire in the right place. Thankfully I have not yet had to wear trainers to a meeting, or go trouserless, but I now have a very large collection of cheap cufflinks, and a few hastily purchased shirts. You obviously also need showers at or near the workplace, unless you really don’t like your colleagues.

I’ve been lucky enough to work in two offices that have decent facilities, apart from a dodgy lock on a bathroom door, which once left me face to face with the head of my office, wearing only a mortified expression. Needless to say he never looked me in the eye again.

The other drawback, at least as far as my current training is concerned, is that there aren’t many mountains between East Dulwich and the City. With Mont Blanc now only 9 weeks away, I should really try to run up some hills.

Running, Hills and Bipolar

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Welcome to Up & Down Runner, a blog about two of the three aspects of my life that have come to dominate all others, running and mental illness, and how I am learning to use the first to get control of the second, and indeed help me be better at the third, fatherhood.

After a disastrous 2014, I am determined to make the following years better, which for me means pushing myself to do things that I never believed myself to be capable of – running up mountains and writing honestly about my life.

The blog is part diary, part training log for my various running challenges, with the odd list, gear review, race report and rambling opinion piece.

NOTE: I do not profess to have any expertise in any of these two subjects, I am very much a middle of the road runner and bi-polar sufferer. Indeed, the only prize I am likely to win is an award for most boring person with bipolar – the sensible and constantly petrified side of my nature has so far kept me away from spectacularly public displays of mania, or any sparks of creative brilliance (I’m no Byron, Fry, Cobain or even Kerry Katona), but perhaps this blog is my way of addressing the latter.

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.