Holiday in a caravan - Please Don't panic

holiday noun 1. brit. a time spent away from home for rest or enjoyment

Yeah right. The 2 weeks I spend in Tuscany are not restful and some of it is really not enjoyable. Holidays with toddlers are really just a change of scene with some extra helpers. Its not lying on a deserted beach, reading a novel and getting a good tan. It's the first time we've been abroad as a family and I don't travel well. I'm a sickie traveller and usually have to sleep most of the way.

The children love the flight and find the whole travel thing a novelty. I just find it terribly stressful, worrying about children running off, bags going missing, losing my medication, trying to behave appropriately with my in laws - oh yes and getting in "The holiday the mood."  Thankfully we all arrive together, with everything and get to the campsite with no trauma's. Actually, its really nice.Me and my cynicism. We are all staying in the same caravan which is a bit disconcerting. I get a little self conscious about noises, smells and the nearness of my husbands parents. He is fine with it, but its all a little up close and personal for me. As long as my mother-in-law doesn't offer to wash my smalls it'll be ok. Considering we are in a caravan, I've not yet had a psychotic episode and obsessive cleaning is not on my mind. Well thank god for that.

When you have depression everything is more stressful than normal, so it takes me about 4 days to recover from the shock and get into my holiday stride. I also need to adjust to living with other people. It does feel a bit like intensive farming all that squeezing into a small place and feeding from a shared trough every couple of hours. Nobody has actually mooed yet, but its been close. The weather is warm, there is a lovely swimming area and the kids have an amazing time. I  though still feel disconnected, and I have to work hard at becoming immersed in whatever we are doing on any given day. Although I feel better, I begin to realise that I have limitations and I cannot do things the way that I used to. I get tired very quickly, stress makes my mood dip and other peoples irks and foibles can really upset me if I allow them too.

We go on structured day trips (I can't do spontaneous or rolling with it in my current frame of mind) and see some absolutely stunning towns, architecture and rolling hills and vinyards. Tuscany is breath taking. Everywhere you go there is history, culture and community. Children are not pariahs in restaurants and town centres, and as our boys are blond and blue eyed, every Italian thinks they are heaven sent cherubs. We all manage to slow down, and finally I beging to enjoy without effort.

Then on a wet day trip out at the leaning tower of Pisa I get lost . I must have got taken up inside my own head too much, the tower really, really leans and the surrounding basilicas are stunning. And, as I turn around to ask where we are going for lunch, nobody is there. I suddenly feel total panic and my breathing becomes rapid. I stare frantically at thousands of faces of all races and cultures, but none of them are recognisable. My heart is hammering and I'm trying not to become hysterical.  I start running up and down and trying to retrace where we had been up until that point, but I'm not getting anywhere. I've got no money, identification or phrase book with me. I am completely alone. I start to cry uncontrollably like a 5 year old. I remember getting lost in the town centre when I was a child and thinking that I would never see my mother ever again. It is a feeling beyond terror.

And then my mother-in-law is standing in front of me, asking me where I have been. She sees my tears and holds me until I can get it together. She is comfort itself. I am relieved beyond measure and the spell of fear is broken and a soothing calm covers me. I'm grateful for her silence - she doesn't chide me for my silly outburst. It's at this point I realise that I am still prone to over reaction and that I am sensitive and very easily unsettled. I also promise to never walk anywhere on my own again. Ever, ever, ever!

The holiday rolls to an end and although I've had some very difficult episodes, the overarching feeling is of happiness. I have made it through. I've wound up my father in law about his mistake of chopping up raw garlic thinking it was a big spring onion, I've been entertained by my husband in a hire car, the boys have learnt to swim and I still love and care for my mother-in-law even when she is as moody as me. Excellent.

Bring on the return to work.

Trudging up the slippery hill to freedom

So I keep plodding along, as this is the pace I can manage. The weight of my life has been reduced, as though my depression basket has had some items taken out of it. Its easier to carry it without intrusive thoughts, paranoia and suicidal thinking. The further up the hill I go the more I throw onto the roadside and as April ends I feel very positive. Don't get me wrong, I'm not skipping along, swinging my basket like red riding hood!

I think at one time I believed that my mood would have long periods of unchanging stability, but actually what I am beginning to see is that my moods are like the ocean. There is sometimes a buoyancy and I ride high, or the winds whip up a frenzy and I'm tossed hither and thither. There are a plethora of undercurrents that can snag my feet or completely drag me down. I have to accept that I will never be the Hindu cow, serene at all costs with no blips. I am reassured by the rhythm of the tides and embrace that I will always be changeable. Feeling rubbish for 2 days doesn't mean I'm going to have a terrible relapse. I have to keep every day as my focus and not project wildly about the what ifs.

I talk to my cpn about a possible return to work and how that would happen. She warns me to return at a snails pace and if anything starts to go wrong, to phone her or my psychiatrist. I must not put myself under any unnecessary pressure and my employers must create a stress action plan. Do these people not live in the real world? I work for a local authority!! I am a plankton - they are the whale. I am probably going to get eaten alive. But, I have to go back. Stopping work altogether is not at option at this time.My biggest worry is what to say to people, because they will ask, they will be interested and gossip is most peoples favourite pastime at work.I also hate the thought that people will treat me with pity, or have to walk on egg shells around me. Its a difficult balance to strike and I decide to go the route of honesty, with a big dose of self deprecating humour and hope for the best. Maybe I should get a statement T-shirt that says, "Slightly mental, treat with care" or "Madness isn't contagious".

But before I get to any of that, I have to negotiate my first ever holiday abroad, with my husband and 2 toddlers, a plane journey and my in-laws; to Italy; in a caravan.

Slowly, slowly, catch the monkey

You really have to persevere if you want to clamber your way out of the mire of depression. My psychiatrist Darren gives me some top tips to be going on with. The first is what he calls, "Sleep hygiene". As odd as this sounds, apparently people generally sleep quite badly and maximising your quality of sleep is essential. He bars me from any activity in my bedroom other than sleep and adult play time. I'm not allowed to watch TV, read, or do anything else that is non-sleep related. I have to keep the room very dark, and slightly cool with a thick warm bed cover. I must wear warm pajamas and refrain from stimulant drinks or over activity before getting into bed to sleep. Just to remind you here, I've got 2 small children who completely disregard any rules about sleeping and will interrupt you with various ailments, sleep difficulties and hideous early waking. Its going to be tough, but I'll give it a go.

I'm also told that I should try very hard to push through my fatigue, paranoia and lack of motivation and still try to do things. The idea here is that spending too much time, hiding away from the world, makes you forget how to go out, interact with people and generally how to live normally. My world has defiantly shrunk since being depressed and off sick from work. I sit on the sofa with my Winnie the poo hot water bottle and stare at the TV whilst dvd's play. I can't really pay attention or take anything in, and I keep falling asleep all over the place.

SO, I give myself a task to do every day. Go out and but a coffee somewhere, try to meet up with a friend, go out and do something in the garden. What this does is stimulate my neurotransmitters and gets me going a bit.I find it hard to make eye contact with people, and any kind of conflict sends me running to the hills in tears, but, I promised myself that I would try. I still manage to do cutting and sticking with the kids, take them to soft play areas and the like, and it truly is exhausting as I have to put so much effort into doing standard stuff.

But its paying off. Learning about your body and mind as a depressive takes time and practice. Things change. Your internal landscape shifts, your priorites are totally different and you have to make allowances for the fact that your brain chemicals are malfuntioning. Some days are a write off and I just cannot get it together and I have to sleep all day, but on the whole the balance of good days versus bad are levelling out, and my fear of returning to the living hell I've been inhabiting seems to be fading.

People speak to you in a whistful reminiscent style, as if you've been away on holiday and they are remembering who you are. And now you're back. Loved ones hold their breathe and hope the recovery will be permanent or at least long lasting.We all stand on the edge of happiness and gaze at it with longing and know we are moving toward the prize. Its within touching distance but its still just out of reach. Its frustrating at times, but I signed up for the entire journey, so I will chase my happiness with vigour and determination. The black dog can take a running jump.

Flippin heck I'm getting better!

Well wouldn't you know, after 4 weeks the medication has kicked in and as if by magic, the horrors in my mind subside, I feel less like I'm walking through treacle and I actually laugh with feeling. Its an improvement for sure, but its not perfect just yet. I can breathe without forcing  myself to take a breath, the light doesn't appear too bright to see and food tastes better. I begin to realise that I've been living like a television, switched on to standby and waiting for someone to press the "on"  button on the remote control. I am popping and fizzing a bit, the picture is still fuzzy but its there, and its in colour.

Its a novelty to be able to wake up in the morning and actually feel like you have have slept, instead of waking up with your stomach falling through the bed, and the dread and fear of the coming day penetrating your every fibre. I dare to hope that I may actually continue to improve and one day, be able to rejoin the human race. I  become fully aware, for the first time, how ill I have actually been. Its a frightening truth to comprehend and I fear a relapse into the well of despair.

Depression makes you feel that you have been away somewhere and in recovery you are experiencing a homecoming and a new reconnection with the world around you. Sylvia Plath wrote, "I felt my lungs inflate with the onrush of scenery—air, mountains, trees, people. I thought, 'This is what it is to be happy.'" ( Sylvia Plath, The Bell Jar, Chapter 8) The doorway of your chest opens up and you feel cleansed of the blackness.A weightlessness forces itself amongst the tangled ropes holding you down and you feel truly free.

I want to celebrate and rush into my life with eagerness and excitement, but I am told to have patience and prudence as my illness is unpredictable and mercurial. I must hold it in check with the correct balance of respect and disdain. I must try to take back some control of the beast, face it head on and not let it chase me back in to insanity. The work begins now.

My psychiatrist is called Darren

He does have a full doctors title, but his first name is Darren. It just doesn't sound like a name for a psychiatrist. I used to have fish called Trevor and Alan. That wasn't quite right either. I expected Jasper or Dr Farnworth St.John Smythe or something posh and unpronouncable. He's very calm and quite small. Its funny the things you remember about people. I once worked in a hostel for homeless women, and one lady had webbed feet. Nobody had ever noticed before until I mentioned it. Anyway, I get a full 45 minutes going over my assessment information and discussing what I am willing to do in terms of recovery. I am a patient that is willing to go to any lengths for recovery. I have a husband and children whom I love and want to be emotionally, mentally and practically available for. Some patients do not want to take medication, or have therapy or talking treatments, or even engage with psychiatric services. Some are so ill that they can't do any of the above even though they would like to. Being controversial here, some people actually prefer being ill to being well. On some level it works for them as they get attention, people caretake for them and its easier than facing a long and arduous battle back to sanity. Recovery is hard work, sometimes painful and upsetting and takes committment. And courage.

Lets take a snap shot here about the term, Insight. Insight is your ability to see the truth of your situation, a perception and intuition about the reality of your circumstances. Throughout the whole of my journey I have had insight, even in the darkest psychotic moments.  I have a gripped onto the distant reality and remained objective. Its been an absolute Godsend and I feel pathetically grateful for it. However, knowing whats going on with your thoughts doesn't stop them sadly. Knowledge is not power. If I had lost that insight, I may well have ended up in hospital, away from my family. That was not what I, my CPN or my psychiatrist wanted.

SO we have our chat and a am given a diagnosis of clinical depression and OCD, of the Pure O variety.
"‘Pure O’ [...] is a form of OCD that is distinct from traditional OCD in that it features no outward manifestations; instead, both the anxiety-inducing obsessions and the relief-seeking compulsions of OCD take place only in the mind. With ‘standard’ OCD, the compulsions manifest as physical rituals, for example excessive hand-washing, checking or cleaning. With ‘Pure O’, the compulsions manifest as unseen mental rituals, but they are compulsions nonetheless [...].An example of ‘Pure O’ would be a person who suffers with distressing blasphemous thoughts or someone who fears harming or abusing loved ones but does not engage in any overt compulsive rituals."(http://www.ocduk.org). Thoughts are just that. Thoughts. Doesn't mean you are an axe murderer just because you thought about it.

The problem is you believe that you might do it even though you really don't want to. The thoughts will always go against your value system, which is why it is so hideously anxiety provoking. Pretty much your own mind plays nasty tricks with you and induces enormous anxiety and fear. Its like living with a snuff video in your mind the whole time. Also, the lower your mood, the more aggressive the intrusive thinking. I'm told I need to increase my citalopram to 60mg (the maximum dose) as its proven to stop the mind horrors. He also suggests, after a period of stability that I attend cognitive behavioural therapy, and at some point possibly psychotherapy. He tells me I am going to be in psychiatric services for a while. "What's a while?" I ask. "3 to 5 years" he says.

I get back into my car and sob my heart out.

The lives of others

Being a depressed person usually means that there are family, friends, colleagues and relatives that live around you. They too have to live with the illness. The way they experience your illness can be incredibly varied or unexpected. I think that there are certain types and here I shall list a few. Those suffering with:

a) Denial - Life for them goes on as normal. They see that you look ok, so they choose to believe that you are ok. They have a naive confidence that it'll just go away if you ignore it for long enough. Frustrating for everyone involved. Also, this causes a sense of confusion for the depressed person as they wonder if they are truly invisible.
b) Embarrassment - If  you hold a personal opinion about depression that involves thinking all it takes to recover is self will and determination, people think you are just a lazy, difficult and self piteous moron. They are embarrassed by your sickness. These people tend to think they'll catch it from you if they stand too close.They also tend to think that mentally ill people aren't something to do with their life - it happens to "Other" people; people who deserve it; poor people.
c) Competitors - This is the group that tell you that they are much sicker than you, and do psychosis one upmanship. They talk at you and don't listen with empathy. These offenders can trigger feelings of resentment and feel that their own experience is belittled and not important. Its incredibly dismissive and you then have to avoid them.
d) Voyeuristic - These people like to vicariously peep into your head and find out the nitty gritty of your mental ill health. They parade as genuinely interested people but then you realise it's tickling some kind of weird fantasy for them. These are the people that then go off and talk about you as their token mental health accessory. You know, whilst chatting at a party "My psycho friend says...".
e) Non-believers - This is a scary group of people who think that depression isn't real. They tell you what you are doing wrong in your life. They are the ones that insist that medication is poison, and you are just not trying hard enough. They tell you misery is optional, and you should just try harder to be happy. Its all your fault. These are the people I want to savage with sarcasm or punch in the chops.Do you tell tell people with asthma or diabetes that they are making up? Just try breathing a little less erratically my love. I think not.

Thankfully, amongst the crowd of unhelpful idiots, lay the loving friends and family who try to help and support you. They genuinely care about your recovery and want to learn what depression is all about. They are usually concerned and confused. Their loved one seems to have taken a personality sabbatical, and some odd and very melancholy spirit seems to have taken over. Its baffling and shocking. It's incredibly difficult to accept as your loved one is no longer the person you knew. They are a shell of their former self and nothing seems to help very much. If the depression goes on for a long time it can seriously damage a relationship if handled without due care and attention. If your loved one is now demotivated, fatigued, slightly more chubby than they were, tearful and reactive, lacking in positivity and depressed constantly, they are not great company. People do decide to give up, unless there is a good reason to wait it out. Like having children, a genuine commitment to the relationship and a desire to seek solutions for both the depressed person and their loved one.Or stupidity....

It is almost like an overwhelming grief that both parties are unceremoniously plunged into. You either have to paddle like mad and keep paddling, or, succumb to the demons and everything goes to hell.You have to find a way through the unpredictable maze that has been forced upon you. If you don't you can both get lost in anger and self pity which places a rather nasty wedge between you. The real journey begins when you start to get the right help.