WSJ - Bibliotherapy: Reading Your Way To Mental Health

This morning's Wall Street Journal has an article about bibliotherapy, using books to help a patient to get and stay healthier. My mother was a great believer in bibliotherapy, believing that the right book at the right time had great healing powers.

Note: the article may not be available to all readers. If you have problems getting to the article, please let me know.

From PostSecret.com

Nice kitty

My Way News - Oscar the Cat Predicts Patients' Deaths

Waiting for the phone to ring

I like my primary psychiatrist. He's personable, savvy, and smart. He's also busy, often too busy. Unless I come to my appointments well prepared, we can spend most of the 15-minute session setting our context from the last meeting. (Nearly all of my appointments are 15 minutes long and focus on medication management.) Usually, he's very good at getting back to me on the phone, within a couple of hours. On occasion, however, I can wait a day and sometimes two before he calls. (If there was a real crisis, I could go to Emergency Mental Health.) Nevertheless, it's a long time to wait.

It's also difficult to wait by the phone. When I called on Monday, I provided my home phone number because I was going to be at home for the rest of the day. Today, however, I have errands to run. So, I have forwarded our home phone to my cell phone. We have this nifty software service from Verizon called iobi. With iobi, we can manage our incoming calls - forward, block certain numbers or people who have masked their caller ID information, review voice mail online, and a bunch of other stuff. There's no problem that can't be made more complicated by a piece of software.

More on Fox News

Fox News security hole exposes 1.5 million users' personal information - Wikinews, the free news source

When last I wrote ...

I noted that I was having a tough time after my ECT last Monday. Well, the tough time stretched out for pretty much the whole week. I've been able to do physical work, such as filling my car with wood from my father's house, bringing it home, and stacking it in our back yard. That's been good work. I try to remember to put the wood bark-side up so that the rain will run off.

The rest of the time I try to work on tasks that are similarly focused. I'm making my way through the paperwork needed to apply for Social Security disability. I have most of the information that I need. I'm waiting for reports from my doctors and I'll need to get a copy of my birth certificate. With some good luck, I might be able to file my claim this week.

I made a promise to my doctor that I wouldn't become a viewer of the Jerry Springer Show because my doctor said that he's seen other patients deteriorate after even a few episodes. I did watch the Fox News Channel while I was having my lunch today. Mr Springer is going to have to step it up a notch if he's going to keep pace with these folks. I turned off the TV and tried to read the rest of the Sunday papers.

Overall, the toughest part is trying to deal with multiple activities that require decisions, what's call multitasking by some workers and context-shifting by nerds. If I can schedule one thing at time, I can usually keep my feet under me. Additional things to do, however, don't always have the courtesy of stepping nicely into the queue. And then, well, here I am again.

A Simple Cure For Anxiety And Depression - Depression

A Simple Cure For Anxiety And Depression - Depression: "Ultimately, anxiety and depression are culturally-induced patterns of thinking that can be overcome through a deliberate cultivation of awareness."

This is at the core of the mindfulness practices that we learn in the stress reduction classes. While this article, IMHO, overstates the ease with which these practices can be applied. ("...,the cure is simple, quick, and free."), it's good to remember that we can, to some extent, take charge of our own recovery. Depression, like many other diseases, can rob us of the ability to do the things the things that we need to do to get better.

Take it easy on ECT - World of Psychology

A good summary of some of the issues around ECTs.

Take it easy on ECT - World of Psychology

A hard day follows

It's not uncommon for me to have a tough day or two after an ECT. I don't know why it happens, but it does. I woke at 12:30AM, snoozed for a bit on the couch between 2 and 4, and snoozed again a couple of times between 6 and 9. I can't tell if I'm sleeping badly because I'm low or low because I've been sleeping badly. At any rate, today is not a day to work with sharp objects.

This was the first time that I missed one of my stress reduction classes, but I'll be able to attend the evening class on Thursday. The classes have been quite a bit of help, giving me a firewall that helps prevent me from spiraling too far down. One of the techniques, a three-minute breathing meditation, is particularly helpful because I can use it almost anywhere at any time.

So, what does a hard day look like. Well, I've described depression as being wrapped in a wet, wool blanket. The effect is both frustrating and wearying on body, mind, and spirit. What I get done happens slowly, often with missteps that consume time and energy. On such days, it's important to dial back the expectations for the day, invoking the three-thing rule: try to do three, and only three, things for the day.

My three things:

• Pick up and stack another load of wood.
• Schedule a service appointment for my car.
• Think of the third thing to do.
  

All goes well.

The only noteworthy part about this morning's ECT is that I was very tired afterwards. We arrived home at 11:15. I had my breakfast, read a bit of the Sunday Times, and went up for a nap. I woke 2½ hours later. I feel good, but won't try to do anything too demanding physically or mentally.

In a couple of weeks, I'll call the hospital to schedule an appointment for mid-August.

Short, sharp shock

I have an ECT scheduled for this morning. We're on a monthly schedule now, quite a change from the twice-weekly regimen that I was following when I started in November. The only hard part about the preparation is that I can't have my morning coffee. (Nothing to eat or drink after midnight.) They'll bring me coffee and toast afterwards.

The overall process has become routine, which is a good thing. Sandra drops me off at the hospital at the appointed time. The woman at the reception desk greets me by name, verifies the information on the form, asks me to sign a consent form, gives me a yellow paper ID bracelet, and walks me to my room. I turn on the TV (CNN), get changed into the johnny, and lie down on the bed. A nurse's aide, who also greets me by name, takes the vitals. In a few minutes, the nurse will come in to review my chart, ask me who will be picking me up, and gets an IV in place. When it's time, the nurse gives me a shot of Robinul to clear my sinuses. The nurse's aide then wheels me to the same-day surgery unit where the fun happens. Usually, they're finishing up with the previous patient, so I might have to wait a few minutes before it's my turn.

A 12'x8' room fills up quickly when you add a hospital bed with yours truly, two anesthesiologists, the psychiatrist who flips the switch, and all that gear. They double-check to make sure that I am indeed the right patient and that I know why I'm here. (Not in the metaphysical sense, but do I know that I'm receiving an ECT today.) With a blood-pressure cuff on one arm, cardio monitors stuck to my chest, I'm ready for action. I receive an IV shot of caffeine (to help with the seizure), followed by a muscle relaxant and the anesthetic. The doctor puts an oxygen mask on my face and tells me to take deep breaths. In a few seconds, it's lights out, Lucy.

Twenty minutes or so later, I wake up in the recovery room. They'll ask if I have a headache., which I don't. The most discomfort that I've had was some muscle soreness, feeling as though I've been bounced around. I mention that at the next procedure and they will give me a bit more muscle relaxant. They monitor me for about 10 minutes and, then, call for the nurse's aide to bring me back to my room. More vitals, the aforementioned coffee and toast, more CNN. The nurse tells me I can get dressed and then calls Sandra. While waiting, we review my post-procedure instructions - no driving or operating machinery, no heavy lifting, resume regular diet, etc. I'm to call the hospital to schedule my next ECT. When Sandra arrives, I get into a wheelchair and the nurse's aide brings me to Sandra's car.

If you're a nerd and depressed, ...

For the last six months or so, I've used a numeric scale to track my mood, energy level, and mental sharpness. I started out using a modified version of the pain scale that medical professionals often use to assess pain. I gave each day a number on a scale from 0-10, with 0 meaning no problems and 10 being fully incapacitated. Initially, Sandra and I used that daily number as a part of our evening discussion about my day. I also used it with the various doctors to give a concise answer to the troubling question, "How are you?"

Later, I found that 0-10 was too wide of a range, so I started using 0-7. I keep these numbers on the family calendar and in an Excel spreadsheet, also noting any other events such as a change of medications or an ECT.

My worst number has been a 6, my best a 2. The running average has been trending in the right direction, from an average of 4 in April to 3.5 recently.

A few observations on this method of tracking:

• The number is a highly-subjective composite number. Ideally, I would have separate numbers for mood, energy, and cognition. This method, however, was easy and allowed me to answer a simple question, "What's your number?" with a simple answer, "3.5."
• When I was going to work, I found that that a 3 was the minimally acceptable number for me to function. If I tried to work on a 4 day, I'd find that I'd make a lot of mistakes or just stare off into space, unable to make decisions or complete tasks.
• I found that I would typically have a couple of tough days after an ECT, but would then get better than I had been before the treatment.
• I will probably start tracking my sleep hours as well. Early-waking has been a chronic problem for me for quite some time. A couple of days of waking at two or three in the morning will eventually translate into troubled days.
  

The spreadsheet is easy to maintain and the resulting chart updates itself. I can make a copy available if you're interested.

You wanted to sleep?

You wanted to sleep? This getting hit on the head lessons.

Last night's medication night was too string. Half-dose tonight.

There's always an answer that's simple, quick, and wrong.

My doctor and I had a good conversation this morning. I was prepared, with notes about how things have been and questions about what's ahead. We agreed on one slight change to the meds in the hope that it might help me sleep through the night. (I've been waking at two or three in the morning quite often.) He aslo suggested a couple of other changes, but left it open for a bit more research and reflection. With one medication (Wellbutrin), doubling the dose raises the risk of one particularly nasty side effect, seizures, tenfold.

"This," the doctor said, "is never going to be uncomplicated."

For the past month, I've had more good days than bad. The tough times usually barge in with little warning, but they haven't lasted as long nor have they been as severe. We're encouraged that things are moving very nicely in the right direction.

Of course, if we keep reading, we'll find articles such as this one from the July 3^rd edition of the Wall Street Journal.

First!

Welcome.

A bit of explanation. For more than three years, I've maintained a journal called A traveler around the world of work. (I've changed the title a couple of times to reflect changes in my work status.) After mingling topics related to work, my two cents on various topics, the camp, and depression, I think that it's time to reorganize my posts into three general categories, each with their own blog location:

• The original RoasterBoy blog includes topics related to work and other items of interest.
  
• This blog includes topics and links primarily focused on depression. See the sidebar for an explanation of the title of this collection.
• The View from the Cove blog will include topics related to our camp and life on the lake.

All of this will no doubt require more tinkering as we move along, so I ask for your patience. Please let me know, via comments in the blog or by email, how well you think that this is working.

Again, thanks for reading.