I’ve used affirmations in the past, as a form of self-help, but I don’t think they worked. I’ve read self-help books – some classics, others more questionable – and I’ve repeated a thousand times that everyday in every way I am getting better and better. But I admit I lacked belief, and belief is core to an affirmation being effective.

Many people view affirmations favorably, including some readers of this blog. There are others who take the opposite view. I’ve read one or two articles recently that say they are detrimental, to the extent that falling short of an ideal, over and over, will impact a person’s self-esteem.

Scott Adams takes up the subject on his blog today, and it gave me reason to smile.

I have a long-time friend who is always full of energy, enthusiasm and goodwill. It sounds sickening but it’s not; without fail he’s a pleasure to be around. Whenever I ask him how he is, he always replies “fantastic”, “brilliant” or “top of the world”. Does he use affirmations? I don’t know. But after reading Scott Adams I think he has a chicken-and-egg thing going!

My computer screen is so busy. I often have multiple programmes open, the screen bright and distracting. I find it really irritating, so I make a change. I find this software programme that keeps my screen black and I can only see the programme I’m working on. Sorry, it’s Mac only. My toolbar is blacked out as well. Nothing but the program I’m using now. My thoughts slow to a reasonable speed. My little system is great.

Sometimes it’s just little things that we do routinely that we need to change. It doesn’t have to be major upheaval to make a big impact on your well-being. Think about the routine things that make you groan. Can you do these in a different way? I don’t read Lifehack, but plenty of people gather ideas there.

Anna hates unpacking the shopping. She has no problem spending 2 hours getting the things but hates the 15 minutes of transfer. She now brings bags in one at a time, and unpacks each one before she gets another from the car. It never becomes overwhelming. (We all have our peculiarities).

Our latest, greatest little system change has been forcing the kids to tidy their rooms before they can watch the computer or TV. Every day. Wow. We live in a different house.

Feel free to share your little systems below.

If you want to rationalize then the place to start is your goals and values. What is really important to you? How are you going to spend your allotted time on earth?

In my view “simplifying” is synonomous with “removing clutter”, and there are 3 kinds that I take to.

1. Physical clutter

When I buy something it owns me, not the other way around. My time, energy and effort goes into looking after it. What can I throw out instead? If this is you, then ask yourself what something will do for you every time you’re about to buy. Will it add to your life somehow? Or will it quickly become obsolete and a burden?

2. Lifestyle clutter

Are you committed to so many activities that you rush from one to the next, often running late and feeling stressed? Do you work back each night, bearing more and more of the workload? Do you find it hard to say no to new committments? Busyness is the new disease of the western world, but we, especially we, need to wake up and smell the roses. The stress of a rushed life is much harder for us mentally ill people to bear. We need to straighten our priorities, learn to say no, set reasonable schedules and not feel guilty about it.

Over the last few years I’ve learned the beauty and power of the word “No”. It’s OK to say no, and I’ve found that it actually garners respect. Everyone has to set boundaries on their life, but boundaries are only respected if you hold firmly to them. We need to focus on the most important things in our lives, like key relationships or spiritual growth.

3. Mental Clutter

I often have lots of things buzzing around in my head, but nothing gets my full attention, and nothing gets finished. (No doubt my love of strong, locally grown coffee is partly to blame.) When I start to feel overwhelmed I ask my wife to help me gain perspective. We work out the things that I actually need to do, not just things I’ve compulsively collected in a real or imagined to-do list over the previous fortnight. Some of the things are so menial, but they get put on a list and find a corner of my cluttered mind in a weak or manic moment. All of these have to go, so I can feel in control again. This has a wider application, as many depressed people have the same feeling of loss of control. I know that my very worst depressive episodes have been accompanied by this. Putting my mind into some kind of order, or decluttering, is a great help.

More reading:
http://zenhabits.net/2007/08/peaceful-simplicity
http://zenhabits.net/2007/09/simple-living-simplified
http://www.slowdownnow.org/

My son is allergic to green peas and his reactions are life threatening. He is intolerant to a lot of other foods as well, and as we’ve found out, so am I.

We changed our family diet some years ago now, for the sake of us all. I used to cheat, but I also kept track of my diet, and after a while my wife noticed that when I ate certain foods I would become very depressed 2 days later. (Almost to the hour.) Unfortunately chocolate was the worst! She mentioned this bizarre discovery to our allergy specialist who said “Yes, food does cause mood swings!”

Food allergies and intolerances are very different things. Food allergies trigger the immune system, and the sufferer’s body reacts, for example with swelling or hives. Food intolerance is about thresholds. You can eat the foods that you’re intolerant to, but you’ll have a reaction if you go over your threshold. Food intolerance is very common; much more than people seem to realize.

The reactions can be amazing. In me the intolerance causes depression. My wife feels bloated and lethargic. The kids get aggressive and irritable. Other people report anxiety, panic attacks, suicidal thoughts, obsessive compulsive behaviour and even social phobias. Migraines and stomach aches are also common.

So, avoid the colours, flavours and preservatives! Yes. But normal fresh foods also contain natural chemicals like salicylates, amines and glutamates. Many people eat these in abundance, and even on their own they can cause plenty of problems. The chocolate I eat may be free of colors, flavors and preservatives, but it is very high in natural amines which causes me plenty of grief.

If you eat problem foods every day, and take the symptoms of intolerance for granted, then you may be missing something that is key to your mental health. If this could be you, then it is really worth following it through.

Our family kept to a strict chemical-free diet for some years to remove the problem foods. A common way for an allergy specialist or dietician to test for the culprits is to prescribe a strict chemical free diet for a few weeks until symptoms disappear. They will then give a series of oral “challenge tests” to see which food chemicals and artificial additives are causing problems.

I once took aspirin as a challenge, and it won. Apparently aspirin is pure salicylate, and it sent me out of my tree.

More information:
RPAH Allergy Unit
Food and Mood Guide

I’ve just read a very helpful article at Psych Central that is in the same vein. Helping Someone with a Mental Health Concern is written by psychiatrist John M. Grohol. Of particular interest to me are his insights on effective listening and empathizing with a mentally ill person. It is invaluable advice for someone in a caring role.

To read the article click here.

It may be counter-intuitive but I’ve come to believe that depressive episodes are predictable if you know the things that trigger them and you can pick the early signs. That knowledge has helped me stay well for long periods of time. But this recent episode came as a big surprise.

The brain is arguably the most nutritionally sensitive organ in the body, so food plays a big role in maintaining its health. As I’ve mentioned before I have some food intolerances. But I don’t break out in hives, I break out in irrational behavior. In a similar way, many people react with mental meltdown to excessive coffee, alcohol, too much or too little fat, additives like artificial colors, flavors and preservatives and many other things. Red cordial and kids don’t mix, for example.

I’ve been taking the same multi-vitamin for about 3 years, due to nutritional advice specific to my diet (or lack thereof). It has a different formula to most multi-vitamins. In particular it contains a high dose of the B group vitamins.

So I ran out of these harmless, benign, unimportant pills about 10 days ago, and discovered that the manufacturer had gone out of business and the line had been stopped.

That first evening, after not taking the multi-vitamin in the morning for the first time, my mood tanked. I was puzzled by it, but I didn’t make a connection with the vitamin. Over a week later I started on a new, similar product, and shazam! I’m back to normal.

Here is the nutrient breakdown:

Recommended Daily Intake Vitamin B6 (Australia and New Zealand)

RDI 1.3 mg
Upper Limit 50 mg

Multi-vitamins

Macro M 5 mg
(original one)

Men’s Ultivite 30mg
(new one)

I don’t know what my normal daily intake is, but on the day my mood dropped I had reduced my B6 intake by 4 times the recommended daily amount, and the day I went up I had increased it by over 20 times. Now that’s interesting.

As an aside, the Nutrient Reference Values for Australia and New Zealand has an excellent calculator that will give you all of your RDI values by sex and age at the click of a button.

It is well-established by research that B6 is a commonly, perhaps the most commonly, found vitamin deficiency in people with depression. It has a crucial role in putting the final touches on serotonin production, serotonin being one of our favorite mood-enhancing neurotransmitters. There’s no coincidence there.

But the jury is still out on whether increasing B6 will relieve symptoms or by how much. I have my own anecdotal evidence based on a one-person trial in my home, but that won’t convince the medical community.

And the bad news? Only one person in five consumes an adequate amount of vitamin B6.

The major sources of vitamin B6 include: cereal grains, potatoes, bananas, vegetables (carrots, spinach, peas), potatoes, milk, cheese, eggs, fish, pork, beef.

Sources and Further Reading

Factsheet of Vitamin B6
Medline Plus (US National Library and National Institutes of Health)

Develop a Personal Pyramid Plan
United States Department of Agriculture

Healthy Eating and Depression
Mental Health Foundation

Mind Guide to Food and Mood
Mind (National Association for Mental Health UK)

Nutritional Supplements
McMan’s Depression and Bipolar Web

Foods to Fight It
Dr Melvyn Werbach

I’ve written a lot about being a caregiver in my last 4 posts, but in this one I’d like to share with you the book that really saved my own sanity. It is “Loving Someone with Bipolar Disorder” by Julie A. Fast and John D. Preston.

In the first few months after James’ diagnosis I read a lot of material to educate myself. The problem was that most of it was factual information on depression and bipolar, but it didn’t tell me how to manage practical things like James’ irritability. The info simply described the symptom without ideas for its management.

From pages 1 to 2: “This book can provide you with the tools you need to be a resource and support for your partner instead of a crisis manager and constant caretaker.” This is exactly what I needed!

The book was written specifically for caregivers. Julie Fast has bipolar disorder, as does her partner of 10 years, and the result is a book with real insight.

At its heart is the idea of creating a holistic treatment plan.

The first aim is to develop a symptom list that you can use to identify when your partner’s behavior starts to change. Once that has been worked out the second aim is to create a “what works list” to treat those symptoms before they progress to a full blown episode. The third step is to work out what triggers the symptoms in the first place. These are often outside events, situations or behaviors that once modified or eliminated really make your partner far more stable. Once you understand the triggers well, then the goal is to stop the mood swing from starting in the first place. If it does start then the “what works list” comes into play.

Of course this strategy requires recording your partner’s behavior over time e.g. by keeping a journal.

The rest of the book focuses on the needs of the caregiver. (Obviously your partner achieving greater stability is already a significant help).

The chapter on “Your Emotional Response” starts you on the road of looking after your own needs. It discusses issues like anger, grief, guilt and feeling trapped. For me, it was almost a springboard for seeing a counselor.

The chapters on work, money and sex cover practical issues that cause distress. They were all helpful chapters, but for me the chapter “The Hard Truths” had more impact. This chapter really lays it on the line and forces you to face the reality of your relationship. Are you prepared to stay with your partner if things don’t change? Tough reading.

My favorite chapter is “The Bipolar Conversation”, which teaches you how to avoid pointless fights when you partner is baiting you. The book ends with “Laughter and Joy”, an inspiration to leading a normal life again. From this I learned to structure in happy times in our lives.

A brilliant book. It may be about bipolar, but the application is much wider and relevant to all mood disorders. It would greatly help any caregiver living with a depressed partner.

Here is the link to the book on Amazon (not an affiliate link).

So we drove that way and the mattress stayed on for about a mile before sliding. We checked it, and checked it again, and continued like this until we were nearly there, when a truck passed us with speed and the mattress flew off altogether. (Queen size by the way.) The twine was still intact, but the mattress handles were shredded. So we eventually limped in to the dump, mattress carefully balanced on top and hazard lights on. It was a funny experience and we had a lot of laughs.

I’ve written about this because it says a couple of things about how I handle my role as a caregiver.

Know the limits of what your partner or friend can do
Removing a mattress was overwhelming for James. He put it off, and ignored it, and put it off some more. The reason was that the task – mental as much as physical – was insurmountable to him. It’s quite different from laziness, as anyone with depression will know. But the mattress was stopping me from getting to my wardrobe and it had to go. My frustration was building up, despite knowing what was going on in James’ mind. I decided to just do it myself rather than let it become a big issue. That’s not to say I’m being a doormat. When I stop and think about it I recognize what’s happening under the surface and take a practical approach.

My support network is crucial
I have a small network of friends who will help me in this sort of situation. Through bitter experience, I know that some people are understanding about mental illness and others are not. My close friends are. I also know not to wear them out, so I share my problems around. They give the emotional support I need when I’m not getting it at home. They let me vent, they help me in practical ways, and they still share good times with me. They also think highly of James even though they know how awful he can be. That’s very important to me. I’m very fortunate as a caregiver to have supportive people around me. I know that many people are struggling along without much help. I can’t emphasize enough how important it is to develop those supportive relationships, for friendship, for emotional support and for practical help for things like moving mattresses.

My mental health is crucial
I have to be proactive about having time out, having a break from the intense times, and even some fun. I used to feel guilty about this, but it’s actually wise to keep looking after your own health. My family are good with giving me practical help, like taking the kids, when I need to do something on my own.

Learn to forgive and grieve
It’s easy to feel sorry for myself, but I’ve learned to forgive and move on. James forgives me for a lot of things too; it’s not a one way street. I’ve had to mourn the life that I thought James and I were going to enjoy together. He is not at all like he was when we married. But I always remind myself that I should be thankful for what we have, and what I have, and not dwell on what we don’t have, and to pray on all occasions.

Click here for the fifth and final post in this series, Loving the Person You Care For.

The basic idea is to identify things that work well for you in your fight with depression. Things like taking your prescribed medicines, therapy sessions, exercise, meditation, massage or relaxation. There are many possibilities.

In my Points Plan I’ve also included things that are reliable triggers for my depressive episodes. These are having a bad argument with someone (major trigger), not getting adequate sleep for days on end, or any kind of very stressful situation.

As you can see from the table I’ve allocated points to items according to their impact on my health. The only exception is medicine, which I’ve downgraded even though it’s crucial for me. It’s too easy to pick up those points each day.

The maximum amount of points in my table is 140 each day or 980 for the week. This is before deducting points for the triggers. I’ve set my aim for the week at 50% of total available points. If I can reach this then I’ll increase it next week. It might be worth adding in a reward for some motivatation.

I honestly think if I can consistently reach such a target, then I am well on the way to more stable health. And by relying on a range of positive strategies, I won’t be pinning my hopes on any single one.

So I’m off to do some exercise – something I haven’t done for months now – but it’s at the very top of my list.

If you want this simple template I’ve saved it for download as a Microsoft Excel file.

One of her important points is that it takes an awful lot of work to get better and then stay well. I agree wholeheartedly. It seems that those who actively participate in their treatments have the most success in returning to and maintaining good health. They are active in learning about the illness, in locating resources, in finding the right treatments, and they are determined to pull things around. It doesn’t help to be passive about depression.

Therese’s experience of nearly giving up on traditional medicine rings true. For the first few years of being treated my family doctor experimented with various drugs with little success. I was fortunate to find a great psychiatrist on my first attempt, but it involved a good dose of my own research. When my doctor suggested a psychiatrist I declined and asked him to refer me to the one I had chosen. I know that most people don’t have the time or inclination to do this, but it was important for me as the point in which I became active in my treatment. I had been labeled “treatment resistant” for too long.

I would point out that when medicines are used it is not just about finding the right drug or mix of drugs, but also making the right diagnosis in the first place. This sounds very basic but misdiagnoses are very common. It is awful being treated for the wrong mood disorder.

Therese has developed her system very purposefully. Remaining healthy requires a plan; much more than passive acceptance. I definitely suggest you try her 12 steps, with some shaping to suit.