Professor Cummins from Deakin University has been researching the well-being of different societal groups for the last 6 years. The studies measure the degree to which different people are satisfied with their lives.

In the most recent study (October 2007) 3,750 caregivers were asked questions about health, relationships, safety and community involvement. A caregiver was defined as someone who looks after a frail, disabled or mentally ill relative.

According to the study caregivers have the lowest level of well-being of any group in the community. Further, the rate of moderately depressed caregivers was found to be 56% (general population is 6%), while almost 40% exhibited severe or extremely severe depression. As you can imagine the typical caregiver suffers a high level of dissatisfaction with life. And this is even in the presence of mitigating factors like a high income or being in a relationship.

This is tragic stuff. It really highlights to me the importance of looking after yourself as a caregiver. Have boundaries, have breaks without feeling guilty, maintain some part of your life that is separate from the person you’re caring for, build a support network (formal or informal), or join a support network, and find somewhere to fit in a bit of fun.

As a caregiver you need to stop yourself falling in a heap. You need to be resilient to mental illness, and you are far more effective in giving care to another if you remain healthy yourself.

I have been fortunate to interview Alistair McHarg by email.

Invisible Driving is unusual for its fast paced manic narration. It gives the reader a great insight into the flighty, grandiose, irritable thoughts that the bipolar person experiences. You’ve carried it off beautifully, which probably makes it unique. What were the challenges in writing in this way?

As far as I know, the book is unique and unprecedented in this respect. My goal was to take readers inside the experience of mania, so they could see it, hear it, and feel it. I began writing without even knowing if this was possible. The greatest challenge was that I wrote it when I was “back on earth” so I had to mentally return to that manic place in order to recapture the speech patterns, intensity, and cracked logic. In doing so I risked sparking yet another episode. From a literary standpoint the technical challenges were immense – mania is another world, the language had to give readers a visceral sense of that strange place.

Writing the book must have been an enormous project. Can you describe your motivation?

It was a massive, difficult project. My motivation was a newly discovered instinct for self-preservation. I had led a life of self-destruction up to that point. It had become painfully clear that if I didn’t get a grip on Manic Depression, it would literally kill me. (Indeed, I realized that it was something of a miracle I was still alive.) The ordeal I had just experienced was so catastrophic that I resolved to do whatever needed to be done so as to assure there would be no repetition. I had no clue what Manic Depression was all about, but I understood that I had to find out so I could deal with it.

What possessed you to face and relive the misery of your illness to write the book?

At first it was a matter of personal archeology. I wanted to go over the events and write about them while they were fresh in my mind. The details were so unbelievable; I desperately needed to capture them, if for no other reason than just to make sure it wasn’t all some hideous dream. At some point an angry, vengeful determination was born, I wanted to drill down to the very core of this experience and reveal it entirely, the delirious humor, pain, magic, and intensity. It had been costly on many levels, and I became fierce about making it pay me back in self-awareness. It did, but not without a fight.

Towards the end of the book you wrote “From too high to too low, and back again, now I spend time solidly in the middle.” Was there a change in you that acted as a catalyst for recovery?

Absolutely, a sea change. I had always been a shy, reserved person – insecure, private, afraid of being known – and a stranger to my own feelings. The episode cracked me open like a pinata at a child’s birthday party. In “acting out in totally involuntary ways I unmasked myself, I had no secrets left; the private fears that ruled me were racing the streets like rampaging demons. Writing about those manic months was a grueling tutorial in what truly made me tick – an unpleasant revelation but an invaluable one. Seeing myself as damaged helped make it possible to forgive myself, which, in turn, made it easier to love others.

What positive things have resulted from your illness? Is Invisible Driving an optimistic book?

Anyone can be happy when things are going well. But in Invisible Driving you have the story of a man who faces his worst possible nightmare and emerges on the other side having gained his manhood, his courage, and his humanity. Indeed, Manic Depression has been a gift for me, and my battle with it a story of redemption and spiritual growth. In a very odd way I owe this illness my life, it taught me how to enjoy being me. As I wrote, and came to embrace the illness as part of me – not some alien invader – I began to relish the process of painting it out in all of its hypnotic fire and ragged glory.

It’s an excellent read. Try the first chapter of the book in Part 2 of this post, or pore through the excellent reviews on Amazon.

A one-legged chicken from the south of Wales has recently recovered from depression.

Lily is not your everyday chicken. She sleeps on a cushion in the kitchen of a two bedroom terraced house and she eats spaghetti bolognese. Her owner Vicky Mills says she struts about as if she rules the roost – “she really thinks she’s top of the pecking order”.

Lily damaged her leg in an accident with barbed wire. In an attempt to save the leg Vicky spent £2,000 on 7 operations, but the money was spent in vain and vets were forced to amputate. Lily didn’t require a prosthetic limb, making do instead on one leg. Apart from falling over occasionally when scratching, she has managed well.

Lily was diagnosed with depression shortly after losing her leg, due to separation anxiety during the day when the Mills’ were at work. Treatment was straight-forward. TV. All day, every day. She quickly returned to good health and resumed laying eggs.

The vet who diagnosed depression was not available for comment.

A common symptom of bipolar disorder and biological depression generally is a steadily improving mood during the day. It’s more than “not being a morning person”. It’s a symptom.

I took this photo in the morning a few days ago. Unfortunately for me the original is on the left, and it is unadulterated except for a bit of work on my lips. It’s always a shock to see yourself in a photo.

I fixed up the image on the right late in the afternoon to reflect how I was feeling then. It’s more what I look like normally, I hope.

The term “split personality” conjures up all sorts of negative images that people say belong in past times. I like the term because it speaks truth to me. I have three personalities that are discrete and very different, and although two of them aren’t healthy they are still very real.

I’m interested to hear other people’s views. Do you view your depression or mania as a separate personality? Do you separate your illness from your true self, or does it define the real you?

• Two out of three people suffering from depression do not seek or receive proper treatment.
• 92% of depressed African-American males do not seek or receive proper treatment.
• Depression affects over 50% of nursing home residents.
• Depression is among the most treatable of psychiatric illnesses. 70 percent of those suffering from major depression can fully recover if properly treated (World Health Organization).
• 80% to 90% of people who receive treatment for depression show improvement.
• An estimated 50% of unsuccessful treatment for depression is due to non-compliance with medicines.

• Major depression is about four times more likely in people with chronic back pain than for the general population.
• Amongst chronic pain sufferers music can help reduce the pain by more than 20% and can alleviate depression by up to 25%.

• One in four families has at least one member with a mental disorder
• Pre-schoolers are the fastest-growing market for antidepressants. At least 4% of preschoolers in the U.S. (over a million) have clinical depression.
• Antidepressants stimulate the growth of new neurons in the brain. So does exercise.

• Depression happens to strong, not weak people.

Until now research on this issue has been thin on the ground. However a new paper, published in the August 2007 issue of Psychological Medicine, is a helpful addition.

In the study 10 per cent of men and 14 per cent of women who were finding work stressful during the period of research experienced their first episode of depression or an anxiety disorder. Women with the highest psychological demands from work were 75% more likely to suffer a first episode than women with the lowest demands. For men it was 80%. Psychological demands included long hours, pressure and lack of clear direction.

The study was conducted over a one-year monitoring period, with about 900 males and females aged 32.

By the way, which occupation do you think is most stressful?
Firefighter
Police officer
Train operator
Teacher
Librarian

Apparently librarian.

I think you’ll agree that you can be mentally ill and fabulously talented at the same time.

Pablo Picasso
Weeping Woman, 1937
(Schizophrenia)

Caspar David Friedrich
Cloister Graveyard in the Snow, 1810
Destroyed during WWII
(Clinical Depression)

Jackson Pollock
Blue (Moby Dick), c. 1943
(Bipolar disorder)

Adolf Wolfli
Irren-Anstalt Band-Hain, 1910
(Schizophrenia)

Edward Dayes
The Fall of the Rebel Angels, 1798
(Bipolar disorder)

Edvard Munch
Evening on Karl Johan, 1892
(Bipolar disorder)

Henri de Toulouse Lautrec
La Toilette, 1896
(Clinical Depression)

Claude Monet
Le dejeuner (The Lunch), 1873
(Clinical Depression)

Vincent Van Gogh
Bench in a Wood, 1882
(Bipolar disorder)

Mark Rothko
Slow Swirl at the Edge of the Sea, 1944
(Bipolar disorder)

Claude Monet
Waterlillies, 1907
(Clinical Depression)

Pablo Picasso
Figures on a Beach, 1931
(Schizophrenia)

What is Music Therapy?
It’s an established therapy for a wide range of conditions. According to the American Music Therapy Association it is used to alleviate physical pain, elevate mood, assist relaxation, induce sleep, and lessen muscle tension. As a treatment for an illness like depression it is an adjunctive therapy, that augments the other treatments being used, but doesn’t replace them. It focuses on reaching therapeutic goals, which sets it apart from straight music entertainment or education.

Who are Music Therapists?
Degree qualified allied health professionals, trained in music therapy, music, psychology, behavioral sciences, disabling illnesses, and a spattering of other things. They are normally part of a wider team of health professionals, working in general or psychiatric hospitals, nursing homes, community mental health centers, rehabilitation centers, prisons and schools. There are also plenty of music therapists in private practice.

How Does it Work?

I don’t know. Honestly. It confuses me no end and I would need to sit in on a session to get a good feel for it.

Here is the best explanation that I’ve found, from the Association of Professional Music Therapists.

“There are different approaches to the use of music in therapy. Depending on the needs of the client and the orientation of the therapist, different aspects of the work may be emphasized. Fundamental to all approaches, however, is the development of a relationship between the client and therapist. Music-making forms the basis for communication in this relationship.

As a general rule both client and therapist take an active part in the sessions by playing, singing and listening. The therapist does not teach the client to sing or play an instrument. Rather, clients are encouraged to use accessible percussion and other instruments and their own voices to explore the world of sound and to create a musical language of their own. By responding musically, the therapist is able to support and encourage this process.

The music played covers a wide range of styles in order to complement the individual needs of each client. Much of the music is improvised, thus enhancing the individual nature of each relationship. Through whatever form the therapy takes, the therapist aims to facilitate positive changes in behaviour and emotional well-being. He or she also aims to help the client to develop an increased sense of self-awareness, and thereby to enhance his or her quality of life.”

Does it Work?
It’s been the subject of study for a long time now, and there is no doubt that it is effective for a range of illnesses (in combination with other therapies). The evidence is a bit light-on for depression, for lack of robust studies, although there is plenty of empirical evidence to suggest that it helps. Based on the description above, I expect that it is highly dependent on the individual. As with most every treatment many depressed people would benefit from the therapy, and many others wouldn’t.

Would I try It?

In a word, no.

Links:
The American Music Therapy Association
Canadian Association for Music Therapy
British Society for Music Therapy
Association of Professional Music Therapists (UK)

“HR Executives Rank Mental Illness #1 for Effect on Indirect Costs”
Innerworkings: A Look at Mental Health in Today’s Workplace Survey, May 2007

A 2006 study published in the American Journal of Psychiatry found that an employee with depression averaged 27.2 lost workdays per annum from absence or poor functioning on the job, and an employee with bipolar disorder averaged 65.5 days.

It is clear that mental illness has a huge impact on employers. It costs them billions of dollars each year from decreased productivity and lost work days.

In the “Innerworkings” survey nearly two-thirds of the Human Resources respondents estimated that at any given time, 3% or less of their employees suffer from a mental illness, and one-quarter said less than 1%.”

From the American Journal of Psychiatry study the number is actually closer to 8.2%. The Innerworkings respondents are well off the mark.

What effect does this have? Clearly CEOs and Human Resources Managers need to focus more of their attention on this immense need. It is in everyone’s best interests.

If you need to convince an employer about the problem then a good way to do it is to point to the bottom line. A tool reserved just for this purpose is the Productivity Impact Model developed by the HSM Group.

The purpose of the model, or calculator, is to give a realistic picture of how depression impacts on a company’s profitability. It takes just a few steps to calculate the amount of time and money lost, and the great thing is that the assumptions underlying the model are based on prior research studies. It’s not wild, ballpark guessing.

How does it work?

Using a company’s size, industry, location, and age / gender breakdown, it estimates the number of people in the company with depression. Then by taking a range of values for workdays missed, total wages and benefits, and additional medical costs, it provides output for days lost across the company over a year, total “replacement” costs to cater for those lost days, and total extra direct medical costs.

The output is persuasive, and it would surely get the ball rolling if placed in the right hands.

• 40% of workers reported their jobs to be very or extremely stressful
• 25% viewed their jobs as the largest source of stress in their lives
• 26% said they were often or very often burned out or stressed by work.

A study by University of Melbourne researchers last year found that job stress accounts for 1/3 of depression cases in women and up to 1/3 of cases of cadiovascular disease in men.

These are amazing statistics.

The answer to tackling stress at work is two-fold. Firstly you can push to make changes to the job itself – a big picture approach. You need to have a clear idea of what is going wrong. The following table may help if the problem isn’t readily apparent.

Try to identify the causes of your stress, and work out what you would like to change to eliminate them. If you can discuss your problem with your manager he or she may be able to make immediate changes. If the source of stress is your manager then that’s another kettle of fish! See if there are procedures in place to deal with this. If there aren’t any then perhaps you can talk to an employee representative, HR department or Employee Assistance service.

Don’t be reluctant to talk about stress at work. No employer should subject their employees to work-related stress. They should take it as seriously as you do.

Changes to You

Secondly there are changes that you can make that you have complete control over.

• Make a to-do list. Organize your work to feel more in control. It’s easy to stop worrying about a future task if you record it on a list. Only record the tasks you are definitely going to do, not the long-term projects that are always on the backburner. Make sure you include a couple of things that you’ve already done, to get you off to a good start.

• Cut down on caffeine. Caffeine gets the adrenaline hormone pumping through the body and causing “fight or flight” alertness. This is stress in itself, so it heightens any other stresses that you are also dealing with at work. Drink lots of water and keep your brain well-hydrated.

• Exercise during the day. Regular exercise decreases the production of adrenaline which reduces the stress response. As a bare minimum go for a walk outside during your lunch break. Perhaps find a new place to buy lunch a few blocks away. Exercising outside of work hours will also help to cut your stress level during the day.

• Take breaks from your computer. It sucks the life out of you, so by the end of a long day you’re feeling irritable. Get away from the computer and connect with real people every now and then.

• Slow down. Do you rush to work in the mornings? Simplify things so that you’re not over-committed and rushed. Can you get up 15 minutes earlier for a calmer trip to work?

• Don’t forget to take vacations. The company won’t collapse without you (unless you own it).

• Work shorter hours. Limit your work day to what you agreed to with your employer. Working long hours is one of the main causes of work-stress. Protect your time and say “no” to requests that place unrealistic or unreasonable demands on you.

• Rise above office gossip. Gossip is almost always negative, it brings people down and undermines relationships. Avoid difficult people. Instead find positive, energetic people to be around. Deepen friendships that are positive.

• Create a relaxation routine. When something unexpected comes up you can deal with it without being stressed. A routine may be something simple like deep breathing exercises, a quick relaxation technique, a walk around the office or outside, a trip to the water cooler or a chat with someone.

• Take mini-breaks during the day. Use your relaxation routine to good effect. Make sure that you move around away from your workspace.

In my own experience most managers are willing to make at least some changes if you present them with the problem and a solution. If stress is impacting your health then it’s a high priority, and you need to be proactive. As for the changes to your own life? They will all make a positive difference so they are well worth adding to your work day. Don’t become another statistic from stress at work!