Better Mental Health Magazine Issue 1 by BMH Magazine

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MAGAZINE

a look inside

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topics Featured in this issue 4 6 14 16 22 26 36 42 48 54

Welcome, from the Editor What mental health is really about Schizophrenia in a snapshot We look at the impact of depression on the family Exposing the mental health myths Depression has many facets, these are some of them Learn how a clinician views depression Life in a city impacts stress levels Tips for reducing stress Creating a mentally healthy workplace

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contents

real People and real experiences 10 Peter Robb talks about living a bipolar life 65 Sam Williams shares some of his poetry 72 Writer and artist, Polly, opens up her life 92 Victoria shares her Cyclomathic experience 104 A life of anger before Robyn was diagnosed

make Wellbeing part of every day 66 Get your head around mindfulness 70 Ten tips to better wellbeing 76 Love a pet for better mental health 80 Ingrid and Lauren share their pet stories 82 Know the impact of whatâ&#x20AC;&#x2122;s in your food 86 Games are fun but also good for the mind 96 Think better, feel better, sleep better 110 Regular physical activity for a better mind

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the editorial If you enjoy reading this issue, buy it in print at www.bmhmag.com/store

Better Mental Health Magazine Issue 1 ISSN: 2204-1966 (print) ISSN: 2204-1974 (online) Better Mental Health Magazine is published by Aporia Media Pty Ltd, PO Box 1579, Strawberry Hills, NSW 2012, Australia. While every effort has been made to ensure that the information in this magazine is accurate and up to date, it should not take the place of medical advice from your doctors or other medical professionals. The purpose of this magazine is to offer information of a general nature. This may or may not apply to you or your situation. The publishers believe all material in this magazine to be correct at the time of publication. They cannot, however, provide guarantee of this and do not accept liability in the event of any information later proven to be inaccurate. Personal submissions do not necessarily reflect the opinions of the publishers. This magazine is copyright. No part may be reproduced by any process without written consent of the publishes, other than any fair dealings for the purpose of private study, research, criticism or review, as permitted under the Copyright Act. Magazine design concept by Cyan Loves Magenta BMH Mag App developed by GGA Digital Australia. Subscriptions available through http://www.bmhmag.com Copyright © Aporia Media 2014 ACN: 154 564 100 contact, engage and share with us through: w: www.bmhmag.com e: contact@bmhmag.com fb: facebook.com/bmhmag g+: google.com/+bmhmag tw: twitter.com/bmhmag p: pintrest.com/bmhmag li: linkedin.com/company/bmhmag

This may be little longer than your usual editorial. But it’s the first issue so you might be interested in why we’re here. And I have a lot to say. In part, it’s the story of BMH Magazine, in part, it’s my story. Better Mental Health Magazine came about while I was writing technical magazines for a niche publisher. A friend, and clinical psychotherapist, dreamt up the ridiculous idea of writing a magazine dedicated to maintaining and improving mental health. I discussed the idea with a number of publishers. It was an interesting idea but not considered viable by niche publishers and too challenging for large commercial publishers. Which was reasonable. Mental health is a difficult topic, more taboo than religion or pornography. He had a great idea — an important idea — that was destined to be no more than that. But mental health was personally important. I have my own interests, my own disorders, my own experiences. I knew, and I understood, what he was trying to achieve. It wasn’t until I was in my late thirties that I had been diagnosed. Suddenly, so much of my life made more sense. I’m glad I found out when I did. I wish I’d known sooner. It’s possible that many aspects of my life would have been different. And that’s when I suggested that I publish it myself. We started work feverishly and it was going well. However, my personal life was a mess. My dysfunctional relationship fell apart and so did I. Work on the magazine, and everything else, stopped. Then, one day, I woke up and everything was fine. In reality it took months. I was

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determined to get my life together. What may have appeared a miraculous change came about through medication, therapy, an incredible vacation to a third world country, taking up yoga, learning about mindfulness, meeting new people socially (including my now wife!), finding peace in reflection and prayer, a significantly improved diet, a reduction in alcohol, an increase in sleep and, most importantly, the incredible support of a few close family and friends. Unfortunately, my friend no longer wanted to pursue the magazine. That should have been the end of it. But we had progressed so far with concept, content, design and layout. And it was now even more personally important. I understood that mental health is so much more than mental illness. I learnt that my own mental health was significantly impacted by nutrition, exercise mindfulness and many other factors. More importantly, I had connected with others with their own passion for, or experience with, mental heath. I was participating in conversations with people who had experienced significant trauma, people with multiple conditions, people who were caring for others, people who were just trying to live a better life. I started to receive submissions from people. People with incredible stories. People who, like me, wanted to help people understand more about mental health and wellbeing through their own experiences. All of these were incredibly moving and inspirational. They were the reason that BMH Mag had to continue. And now, here we are, our first issue

and it’s over to you. Thank you for reading this. Thank you for wanting to understand or share or improve lives through better mental health. Through all this, I’ve learnt that we are not alone in our own mental health or that of the people close to us. I’ve learnt that even the term mental health raises a shroud of stigma and derision. I’ve learnt that there are times when I can openly talk about my own condition and experiences and times when I shouldn’t. I’ve learnt that we all may need a little help sometimes. And I thank those people who were there for me when I needed that help. This magazine is dedicated to them. I also need to thank my parents, Ruth, Julie, Ian, and Simon who were there when I needed them most. I especially want to thank my wife, Alejandra, for supporting me through this, for understanding what I want to achieve and for believing in me and Better Mental Health. You’re reading this now, because of her support.

Luke Myers

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start at the beginning caring for our mind is as important as caring for our body. The first step is understanding that mental health and wellbeing is important for everyone. Even you!

Let’s get something clear. Mental health is not mental illness. It is not crazy, or insane or psycho or schizo or any other word people use. If you bought this magazine, you know that already. If it was given to you — or you picked it up by mistake — keep reading. Better Mental Health Magazine aims to cover a range of topics relevant to mental health; mental illness is only one small aspect of that.

mental illness Using the words of Martin Gore, ‘everything counts in large amounts’. The large numbers around mental illness mean that it should count. Right now, one in four people have a diagnosed mental illness. That’s 25% of the population, wherever you are in the world. Fifty percent, that's every other person, will experience a mental health issue at some time in their life. Approximately 1% of people will have a schizophrenic episode in their lifetime. That may seem small, but that's one person in every one hundred, or over three million people in the United States alone. More than five million people in the US and nearly one million in the UK have dementia. The National Alliance of Mental Illness defines mental illness as ‘a medical condition that disrupts a person’s thinking, feeling, mood, ability to relate to others and daily 6

functioning’. This last part is particularly important. A mental illness may relate to feelings, such as being happy or sad, but it is significant enough to impact our ability to function normally. Many people with a mental illness still function but many may, and often do, find it more difficult than most. You may know people with a mental illness and not even be aware. Serious mental illnesses include conditions such as bipolar disorder, obsessive compulsive disorder, depression, post traumatic stress disorder, anxiety, schizophrenia. Some people experience more than one serious mental illness. Importantly, mental illness is treatable and manageable and recovery is possible. This may include medication, as well as counselling, more intense treatments, or lifestyle changes.

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mental wellbeing Mental health can mistakenly be used as a nicer way of saying mental illness. But it’s completely different. Mental health and wellbeing, or mental wellbeing, are about a person’s ability to cope with life. Our level of mental wellbeing determines just how well we cope, whether we just get through or thrive. Wellbeing is a slightly vaguer concept than illness and can be described in different ways. The World Health Organisation describes it as ‘the state in which the individual realises his or her own abilities, can cope with normal stresses of life, can work productively, and is able to make a contribution to his or her community’. Not everyone necessarily fits all these ideas and not always at the same time. We don’t always contribute to our community as much

mental illness is treatable and manageable and recovery is possible as we might like. We might be unemployed. But the important aspect is knowing that we have the ability to do so. Wellbeing is not the same as being happy or being happy all the time. Life happens! And it’s not always happy. Normal, everyday things, can be difficult. A night of poor sleep, a bad day at work, being stuck in traffic, household chores, raising a family, interacting with a partner, or myriad other things, can get in the way of sitting back, enjoying life and just being happy. However, a person’s level of mental wellbeing directly impacts how we deal with these, or any other everyday aspect of our life.

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How we cope and respond is determined by our mental wellbeing. Are we angry or accepting? Do we go through the same routine every day or see opportunities to make changes to improve things? Do we get over it or let things build up until they are unbearable? Improving our wellbeing means that we can not only get through life but make the most of it. Wellbeing is achieved and improved differently by everyone. In the most basic ways, it means maintaining a healthy body and mind. How? This is up to you. It could include any combination of physical activity, continued learning, meditation, mindfulness or yoga practice, counselling, maintaining a balanced lifestyle, connecting with family and friends in a positive way, reducing stimulants, and eating well.

resilience Resilience, or psychological resilience (which makes it sound a lot more official), can be seen as a step-up from mental, or even psychological, wellbeing. Where wellbeing is concerned with our daily experiences,

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resilience is how we cope with the significant things — stresses, traumas and adversities — that can happen to anyone at any time, often without warning. The death of your partner, losing your job, or learning you have a serious illness are all difficult, often traumatic, experiences. A serious or significant negative event will have an equally significant negative impact on our mental health. It would be strange if we weren’t impacted by traumatic experiences. However, a person’s level of mental resilience directly affects how we deal with these, or any other, unexpected major event in our lives. Do we become depressed? Do we have difficulty deciding what to do? De we get angry? Do we eat more or less or drink more and more often? Or do we have gratitude for what we had, and see that there could be a positive future despite a current situation? Our psychological resilience makes the difference to our outlook and our ability to move forward in positive and healthy ways. Some people are naturally more resilient than others. However, anyone can take steps to improve their psychological resilience.

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It would be strange if we weren’t impacted by traumatic experiences Maintaining close relationships with family and friends, maintaining a healthy lifestyle with good nutrition and physical activity, accepting those things that can’t be changed, looking for positive ways to improve a negative situation, particularly taking a longterm view, developing self awareness and ensuring your own needs are met. These are some of the things that improve resilience. Practicing mindfulness (keep reading) can certainly help improve resilience. These things aren’t necessarily easy. They may take a lot of work and you may need help, which is where counselling can be incredibly beneficial.

mindfulness Mindfulness is becoming an increasingly discussed aspect of mental health and wellbeing. Through a heightened level of mindfulness, we may able to manage a diagnosed mental illness in a more positive way. We can improve our mental wellbeing and increase resilience. So what it is? It’s a form of mental state that is achieved (or aimed for) by trying to maintain focus on the here and now, on the present moment. It involves acknowledging a situation or feelings, accepting them — whether good or bad — without judgement and moving forward in a positive way. It does sound a little like Zen Buddhism, which is okay because it’s derived from Buddhism. Mindfulness is similar to meditation. Any activity can be done mindfully by fully focusing on, and experiencing, the moment. By not being distracted by the thousands of other things going on around us, we are better able to embrace a situation, good or bad, as positively and successfully as possible.

physical health What does physical health have to do with the brain? Just about everything. People with chronic or severe illness tend to also have mental health issues or difficulty finding mental wellbeing. Which is reasonable. Research has shown a link between diabetes and depression, for instance. The other side is also true. Those who are more physically well (such as fitness, nutrition, and sleep), tend to have better mental health, or are better able to deal with mental illness. Total wellbeing is affected by physical and mental wellbeing and they impact each other. Maintain your body, and you will be better able to maintain your mind!

if you have a brain, if you have a mind, mental health affects you

mental health Mental health is universal. It affects all people, of all ages, of all nationalities, of all socioeconomic situations, of any gender and all sexualities. If you have a brain, if you have a mind, mental health affects you. You can choose to exercise and be as fit as you are able, with or without any preexisting physical conditions, or you can choose not to. You can choose to be prepared to make the most of any situation, no matter how bad, with or without a diagnosed mental illness, or you can choose not to. Living well, living life to the best that you can, is as much about your mind and your mental wellbeing, your mental health, as it is your health, fitness, entertainment, family, work, career. It’s just as important. We all deserve a long and healthy life, and that starts with better mental health. Learn to give your mind the attention it deserves. 9

A Personal perspective The main street of Surry Hills, a grey sky threatening rain, a passerby yelling at no-one in particular, a homeless man asking strangers for change, may not be the best backdrop to talk to someone about their mental health. Or it might just be the perfect setting.

Can you tell us a little about your particular mental health condition? I’ve been thinking about that since we first spoke and tried to write it down to prepare. It’s a simple enough question, and answer, but I found myself writing pages of response, then needing to take a break, then returning to write more. I’m bipolar and, in a really simple way, that’s what it’s like. Bipolar disorder can often be misdiagnosed or even go undiagnosed for years. When did you first realise you had bipolar disorder? Recently. I was originally tested for autism when I was five, when I became withdrawn. I developed epilepsy at 13 and was on heavy medication for that. It worked at suppressing everything, so anything else was pretty much unnoticed. I knew there was something wrong with me then. I definitely had epilepsy but I knew there was something else. 10

people

Better Mental Health magazine talks to Peter Robb about his life, family, work and mental health.

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At 37, I was incorrectly diagnosed with depression. I was prescribed anti-depressants, which had an immediate effect of making me feel better. Long-term treatment of bipolar with anti-depressants, however, subdues the moods but heightens the main issue and makes the manic episodes worse. It wasn’t until 11 years later that I was correctly diagnosed with bipolar disorder. The difficulty in explaining your condition is that it’s very personal. Not in the sense that I can’t talk about it, but that mental health is all about you. It’s how you experience your particular condition. Other people, not even the medical profession, can really understand exactly what it’s like for you. As a 14 year old boy, it’s hard to talk to people about it. I’d talk to my GP and try to explain that there was something wrong, about my moods or my manic feeling, about the medication not being right. But a GP wasn’t prepared to talk to me because I couldn’t possibly know anything about it. I wasn’t qualified to know what was going on with my own mind. I lost a lot of trust in the medical profession then, as a result of them not explaining my seizures or telling me what to expect. I was diagnosed and medicated but on my own.

“I’ve raised two wonderful and well-adjusted children”

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Do you still have similar experiences? No. Now that I’m an adult, and I’ve learnt so much about my condition and my mind, I can choose not to return to a doctor who doesn’t understand. I know what I have, what my treatment is and what the impact is and where I want to go. I’m intelligent and lucid enough to have an educated discussion about my condition. Unfortunately, not all healthcare professionals are comfortable with that. So I don’t return to them and find someone who is. I’ve looked at other treatments, exercise, yoga, meditation, cognitive therapy, but they’re not right for me. By my age, I’ve learnt how to deal with this. I’m still searching for the right balance in life. I’m still searching to be the best person I can, but I’m doing that in my own way and I’m happy with that. I’m who I am because of my personal experiences living with a mental health issue and I’m quite happy being me. I’ve considered going off my medication, because I

people sometimes do miss the highs and lows. I can achieve so much when I’m on a high, and even the sadness that comes with a low is an incredibly creative time. But the mania is too extreme for me to live a ‘normal’ life, and that’s what I want more. My wife, my kids, my work are all important. So I find a balance that is right for me. Do you talk openly about your mental health? I’m happy to talk about it, especially when it’s someone who may have their own issues. Talking about it is really important. If we can’t talk about it, then it will go untreated and that’s not good for anyone. The difficulty is that people without mental health issues need to know that a person can have a condition but still be able to operate at a normal level. We’re normal people with what’s considered an abnormal mind but we live and work a very normal life. You’re married and have two adolescent children. How does your condition affect your family? Some people who know about my bipolar disorder are surprised that I’ve raised two wonderful and well-adjusted children. Actually, I’m surprised myself sometimes. I really hope that they’ve inherited their father’s good characteristics. It has been hard though. As a child with epilepsy, extreme emotions could trigger a seizure, so you learn pretty quickly to shut down emotional responses. But I had to fit in. I wanted to be a partner and a parent, so I had to be more personal and expressive. Just learning to smile at my baby when changing a nappy was a struggle; it wasn’t natural for me and I had to work hard at it. My family is my main indicator of when I’m going to have a manic episode. I can usually tell when I’m going up but down is more difficult. At work, with my work, it’s not uncommon for emotions to get strained. But at home, when I become frustrated or snappy with my kids, then I know I’m heading down. The reality is that it’s really difficult for a person to deal with someone with these types of issues, especially the need for solitude. It takes an extraordinarily special person to put up with knowing that they won’t be able to get through to you, but to stand by you anyway. 13

who are you calling SCHIZO? Biploar disorder and schizophrenia are two very distinct disorders. The word schizo can still be heard used as a common insult, used for someone who has significant mood variations; someone who appears calm one minute and angry the next which isn’t actually a schizophrenia symptom. Schizophrenia is a spectrum disorder. This means that across the various symptoms, people are affected differently. Some people may experience very minor symptoms, which have little or no impact on their daily lives. Others, may not be able to function independently and require permanent care. A number of disorders with their own subtypes exist on the spectrum. In fact, “schizo” could prefix schizophrenia, schizotypal personality disorder, schizophreniform disorder or schizoaeffective disorder. So, the next time you hear someone use the term “schizo” be sure to ask them exactly what disorder they’re referring to!

Living Situations outpatient support (14%)

Very Quick Facts

 Approximately 1.1% of people will have a schizophrenic episode in their life 20  – 30% of people with schizophrenia only have a few short episodes

 Schizophrenia does not mean having a “split personality”

 Life expectancy is reduce by around ten years It  can be treated with medication, hospital care and rehabilitation Symptoms May Include  Hallucinations  Delusions  Disorganised thinking  Social withdrawal  Dulled emotions  Very disorganised physical behaviour

group home (11%)

But not necessarily all of them and some may only occur for brief periods

assisted living (10%) nursing home (8%)

with family (14%)

hospitalised (6%) incarcerated (5%)

independently (28%) 14

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homeless (4%)

about

Mental Health Warnings

(and why we don’t include them)

Like many other topics, mental health media coverage is governed by a number of voluntary codes of practice. These include how mental health should be presented, the use of certain terms, the way to refer to conditions or people and the recommendation to include contact numbers for services, particularly help lines. Most countries have one, sometimes more, codes of practice with somewhat similar guidelines. While we support these guidelines, and add our own, we decided not to include “warnings” in each article. The entire magazine is about mental health. It is not a glossy fashion, news or entertainment magazine with a random article about an unfortunate or inspirational life event. To include references to the relevant services for all international readers would make

little sense and add no value. Listing all services for all countries would be a magazine in itself. In very practical terms, we considered that if a person is at an extreme point and needs immediate support, they probably won’t be picking up a magazine for a light but informative read. If we’re wrong, and you are considering harming yourself or someone else, or are in danger of being harmed, then stop reading now and contact your local support line, medical practitioner or emergency services. We hope you understand our decision to take this approach. If you have any questions or concerns, please contact us at contact@bmhmag.com. Luke Myers Editor, BMH Magazine

Safety First If at any time you are concerned about your safety or wellbeing, or that of your children, a friend, or a loved one… you NEED help and assistance. Your first point of call is to phone your local emergency number. You can also call your local hospital and ask to speak with the Psychiatric Team. Often, this will open the door for an individual or family receiving help, support and understanding. It’s not about “getting locked into a system”. Rather, try to think of it as “unlocking” what may be a very difficult and scary situation. Receiving help will shift things. Remember: NO-ONE deserves to be in an unsafe situation. 15

FAMILIES and

DEPRESSION People donâ&#x20AC;&#x2122;t live with mental health problems in isolation, even when they do feel alone. ruth myers

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We’ve all heard the word depression. It has become a familiar term in the modern dialogue. We hear about it on the radio, we even see it played out on family and mainstream television shows. Depression is no longer a “flavour of the month” word that people throw about, but is a term which is becoming embedded in our psyche. This is most likely because we know, or know of, someone close to us, or perhaps we ourselves, have experienced or are living with depression. Because of the identified need to address this common mental health illness, you may now have a deeper understanding of what depression is, but let’s just clarify the term.

From down to depression

We wouldn’t be human if we didn’t feel sad at times. Sadness is a normal emotional state experienced in response to an event

or memory. Just feeling sad does not stop an individual or group from maintaining productivity or the desire to perform activities or be a part of society. Sadness is a temporary feeling. Depression on the other hand, is an overwhelming and debilitating illness which significantly interferers with an individual’s cognitive, emotional and/or social ability. A person experiencing depression may not necessarily display all the signs or symptoms associated with depression, but this doesn’t mean they are not depressed. To help make this clearer, let’s look at some of the feelings that may be experienced when suffering from depression. According to the Black Dog Institute (specialising in understanding and providing support for depression), there are a number of signs and symptoms of depression. If you, or a family member, are experiencing these better

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symptoms, that may be reason enough to seek help because you may be suffering from depression. If you are reading this and ticking one, some, or all of the signs and symptoms and thinking to yourself, ‘yeah, I do that, but I don’t think I am depressed,’ then take this into consideration. If your feelings are not shifting (remember, sadness shifts and is temporary), or if any of these are impacting your ability to be constructive or interfering with your desires, your relationships, social networks and are persisting most of every day for two weeks or longer, then it would be beneficial to seek help. This does not necessarily mean that you have depression. A clinical mental health assessment should be considered. A general practitioner can perform that assessment and, in some cases, provide treatment, or make a referral to a mental health specialist. This may lead to medication, it may mean counselling, or it could highlight a physical condition that needs attention. Whatever the outcome, seeking a medical assessment can only help.

You are not alone

You may feel alone, but you’re not. Although some of the symptoms may be shared, there are however, different types of depression such as Postnatal Depression, Major Depressive Disorder and Dysthymia, though all fall under the category of a mood disorder. Having depression may be due to a chemical imbalance in the brain, it could be a reaction from the impact of a distressing event, or part of an illness, such as chronic fatigue syndrome, or a past trauma. Gaining an understanding of what is specific to you is especially important as it 18

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SIGNS AND SYMPTOMS ❏ Lowered self esteem ❏ Change in sleep patterns ❏ Change in mood control ❏ Varying emotions during the day ❏ Change in appetite and weight ❏ Reduced ability to enjoy things ❏ Reduced ability to tolerate pain ❏ Reduced sex drive ❏ Suicidal thoughts ❏ Impaired memory ❏ Poor concentration ❏ Loss of memory and drive ❏ Increase in fatigue ❏ Change in movement ❏ Feeling out of touch with reality may impact on the treatment and help that you receive. Baby massage for example has been found to be extremely helpful when helping women with Postnatal Depression, but wouldn’t be a treatment suggested for someone with Major Depressive Disorder. The more information you and your family have about depression, and what is specific to the type of depression you have, then the more equipped you will be in coping with life when things get tough. This means that you and your family can continue to grow together rather than feel isolated from each other. In saying that, personal and family safety

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Pain and Suffering

You may have heard the phrase “suffering from depression”. Many people describe their depression this way. Depression isn’t fun. It’s an emotional feeling that is overwhelming, isolating, dark and sometimes quite scary. A person with depression is in emotional pain. If the depression is evident to others, especially our loved ones, we may feel worried, confused and helpless ourselves. When you have an understanding of depression, you know that a person is unable to “snap out of it” — remember, depression is different from the emotion of sadness. Thinking someone is able to just “snap out of it”, even saying that to someone, may make the person feel even more isolated and a problem to others and less likely to seek help.

Avoiding the last resort

Although not everyone who is depressed may think of ending their life, it is for many, a very real and common thought. A person may not want to die, it’s just that the pain and suffering felt is so overwhelming, or the fear that they are placing worry on others feels too much to bear, that suicide feels like the solution and an end to the pain felt. Of course, it is not a solution. If a person commits suicide it leaves family and/or friends in a state of despair, and may lead to depression in others. This, of course, is not the intention of the person who is depressed. If you are depressed, and reading this, remember

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that the impact of suicide on others is devastating, and I am sure that you would prefer to prevent emotional pain on others. If you feel you are unable to talk about the feeling of suicide face to face with someone, please call your local or national support line. Often talking about your wanting to end your life is enough to shift the feeling until you receive further help.

Children are not immune

As a parent you naturally want to protect your child, so if someone close to the family is experiencing depression, we sometimes may think it is “too much heavy stuff” to involve the children with. Children are great at picking up the energy of the environment. They are also

the impact of suicide on others is devastating vulnerable at hearing and seeing things that you may not want to expose them to. If a family member is depressed, you can bet that children will notice that things are not quite right. This can be a confusing and worrying headspace for kids. When children are aware but do not have an understanding of things, it doesn’t mean they are not affected, it usually means they have more questions! The best way to help your family is to open up the communication between the members of the family. Thankfully, there are many places that can help you with this and by contacting specific organisations that 20

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focus on how to talk with kids in a way that is developmentally appropriate for each child. This will help lift some of the pressure, and therefore you won’t be feeling overwhelmed about how to start talking about depression with your family. Generally, when a child has a parent or family member who has depression, it helps them to have information about their parent’s illness. It may be enough for example for a child to understand that a parent’s mood swing is not because of something the child has done, but a symptom of their parent’s illness, and knowing about what the illness is, they may need help with practical issues, such as some extra help with schooling and kids also need someone to talk with — and guess what? That person may not be you! It’s a good idea to work with your child in knowing who else they feel they can talk to. It may be a teacher, a helpline, a close friend.

Safety first

Everybody has the right to feel safe. If at any time you feel you are not safe, it’s vital that you receive immediate help. Call emergency. You may feel hesitant, but it’s better to be safe than dead, right? Staying in an unsafe situation, even when that situation is not present 100% of the time, can lead to situations which are potentially emotionally destructive. Prevention is the key but if you are already in a cycle of negative behaviours which are impacting on the safety and wellbeing of your children or yourself — it is time to get help.

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Myth: Mental ill ness is lifelong lost cause and is a Fact: As many as 8 in 10 peop suffering from le a mental illness effectively retu can rn activities if they to their normal treatment. Belie receive appropriate person has a m ving that once a en they have it for tal health disorder, lif response. The re e is a common that people with ality, however, is and do, get bett mental illness can, er may require re . Some conditions gular treatmen t, people live full and productive most lives.

Myth: People with mental illness are crazy Fact: Mental disorders, similar to physical disorders (such as heart or liver conditions) are genuine medical illnesses. Clinical research has shown genetic and biological causes for mental disorders, and they can be treated effectively.

Exposing the myths

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Myth: Mental health problems, such as depression, are a sign of failure or weakness Fact: Mental health has nothing to do with failure or being weak. It can affect anyone at anytime. Various combinations of factors affect mental health, any of which can be treated effectively.

Myth: Some soci o-economic grou ps are more likely to experience m en tal illness Fact: Mental he alth problems ca n affect anyone an d no-one is imm une to mental health illness. Mental illness does not discriminate an d can affect peop le of any age, se x, income, culture or educational background.

Although campaigners have been educating the general public that mental illness is like any other form of illness â&#x20AC;&#x201D; to be healed by appropriate treatment and the right environment â&#x20AC;&#x201D; mental illness still evokes considerable stigma. Many misconceptions arose because of the previous approach of institutionalising people with mental illnesses. The Mental Health Council of Australia, one of the leading organisations dedicated to mental awareness, believes that, due to these prejudices, not enough resources have been made available to mental health, leaving many people to suffer undiagnosed and untreated. This is a global problem. These are some of the common myths surrounding mental illness.

Myth: Medications are the only treatment to treat a menta l illness Fact: Although medication s play an important part in overco ming mental disorders, other forms of treatment, such as psychotherapy, me ditation, and exercise play an equa lly important role. Finding the right tre atment, or combinations of treatmen ts, is the key to optimal mental health.

isorders tal health d Myth: Men to treat are difficult has us research Fact: Vario lth mental hea shown that vely ti c e an be eff disorders c s mbination treated. Co y, ing, therap of counsell and n io it , nutr n o ti a ic d e m imple sleep are s r e tt e b n e ev ing for improv treatments lth. mental hea better

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Myth: Mental illness is the result of bad parenting Fact: This terrible myth ha s persisted for far too long. Today, it is no longer accepted that psychologic al symptom are necessarily the outcome of an unhappy childhood. There are many causes, which may be activated at any time in a personâ&#x20AC;&#x2122;s life. A traumatic incident, a stressful environment or even natur al aging may impact mental. Blaming the past wonâ&#x20AC;&#x2122;t improve the future.

re l Illness is ra Myth: Menta illness is very Fact: Mental at tistics show th common. Sta ve ne in every fi more than o sed o n g ia d a ave people will h roblem within hp mental healt s. e m ti fe their li

Myth: All mental illnesses are the same

As many as

8 in 10 people living with a

mental illness return to regular activities

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Fact: Similar to physical illnesses, there are various types of mental illnesses. In fact, there are over 10,000 diagnosable mental disorders have been described. These include depression, anxiety disorders and dementia. Each mental illness has its own symptoms, effects and treatments.

esses Myth: People with mental illn are dangerous and violent Fact: People suffering from en serious mental disorders are oft th my The ed. frightened and confus dia is often promoted by the me istics focussing on negative character of mental illness. Sadly, media that rarely presents positive stories h wit highlight recovery of people mental illness.

The flannel flower is Australiaâ&#x20AC;&#x2122;s symbol for mental health

the flannel flower was chosen due to of its ability to survive in Australiaâ&#x20AC;&#x2122;s harsh climatic conditions, which reflects our need adapt to the challenges of daily life

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make mine a decaf Just like a good coffee, depression comes in different styles and strengths

Depression is the most common mental health issue across the world. It is estimated that as many as 150 million (thatâ&#x20AC;&#x2122;s 150,000,000) people globally have a form of depression. This is not to say that 150 million people all have the same symptoms or even the same types of depression. Far from it, in fact. Saying someone has depression is a bit like walking into a cafĂŠ and asking for a coffee; what type of coffee, which size, and do you want anything with it â&#x20AC;&#x201D; what specific form of depression, how severe is it and are there additional conditions? better

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major depression Major depressive disorder is a severe form of depression. It is sometimes also called clinical depression or unipolar depression. It is characterised by a depressed mood or significant sadness that lasts for a prolonged period, which is generally expressed as more than two weeks. We could experience a loss of appetite and subsequent weight loss, or an increase in appetite, a loss of energy, insomnia or other difficulty sleeping, heightened anxiety and an inability to feel happier. When experiencing major depression, we tend to lose interest in regular work, family or social activities.

dysthymia Dysthymia is a recurrent or prolonged mild form of depression. Although technically â&#x20AC;&#x2DC;mildâ&#x20AC;&#x2122; many of the symptoms are the same as major depression but experienced at a lower intensity. As this is prolonged, experienced over time, it can have debilitating effects. As this condition drags on, our energy levels decrease, general wellbeing is reduced, and regular activities become difficult. Many people with dysthymia feel that they have always been down and that it is just their normal state. When experiencing dysthymia, we may also experience chronic pain, headaches and exhaustion for no apparent reason, which only increases other symptoms. For this reason, it is important to have it diagnosed and treated, as it can develop into major depression.

bipolar disorder Previously called manic depression, bipolar disorder is no longer considered a depressive disorder but, as it has depressive states, itâ&#x20AC;&#x2122;s included here. It displays the typical symptoms of major depression but also has significant mood swings. This results in extended periods of feeling high (the manic) and low (the depression). Although less common, some people experience a mixed state of being high and low at the same time. When experiencing a high, we tend to be more creative, full of energy, ideas, plans and a level of invincibility and the 28

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we may experience chronic pain, headaches and exhaustion for no apparent reason

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when we’re up, there’s no need to discuss our feelings and when we’re down, we can’t bear to

belief that we have the ability to accomplish anything, even if that is potentially harmful activities that seem like fun at the time. During a low state, however, we experience the depths of many of the major depression symptoms, with feelings of inadequacy, the inability to face another day, or even suicidal thoughts. A common difficulty with recognising bipolar disorder is that when we’re up, there’s no need to discuss our feelings and when we’re down, we can’t bear to. When we’re up, everyone thinks our life is perfect but, when we’re down, we become reclusive, so few people see that side of our condition.

psychotic depression Possibly the most severe form of depression, psychotic depression includes the typical major depression symptoms wrapped up in the symptoms of psychosis. Fortunately for most of us with depression, this form is relatively uncommon. The psychosis symptoms may include hallucinations (seeing or hearing things that are not there), delusions (believing something that you would typically consider wrong or unbelievable) and paranoia (feeling that one or more people are against you) and more extreme feelings of guilt. With this form of depression, we usually experience additional or more severe physical symptoms, such as acute insomnia, serious changes in appetite, exhaustion, headaches and general pain. Psychotic depression is extremely unlikely to go away or even lessen without physical treatments such as antidepressants.

atypical depression Just to make it all that little bit more interesting (or confusing), some people may experience atypical depression. When this occurs, our symptoms are not typical of those associated with depression. For instance, symptoms may include appetite increasing instead of decreasing, or being more tired rather than having difficulty sleeping. However, a person may have a combination of typical and atypical symptoms. 29

mental health severity When we order our coffee, we might want it to be weak, strong, or have a double shot. While we don’t choose the strength of our depression, it also has varying degrees. The degree or strength of the depression is called its severity. The severity of depression, like most mental illnesses, typically falls into one of three levels.

Mild depression Mild depression often goes unrecognised, undiagnosed and untreated as the symptoms are not necessarily thought severe enough to suspect depression. People with mild depression often believe they are just down, or that it’s just life, or they are simply not a happy person. Making that assumption, they do not discuss it with their doctor and it goes undiagnosed. However, early diagnosis and treatment can prevent it from developing into a more severe form of depression. While the symptoms are mild, they are still recognisable and do impact daily life. Typically, people with mild depression have less interest in activities that they would have previously enjoyed, can be more irritable, and is less motivated towards work, family or social activities. But, they can still function, albeit at a lower than optimal level. It’s not quite the same as needing to service your car, but it’s close; the car runs, it gets you where you need to go, but it’s just not as effective or enthusiastic about it. Treatment for mild depression can be as simple as lifestyle changes, such as regular exercise, improved diet and better sleep. Other activities, such as meditation or yoga have also been found to help. 30

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Moderate depression Moderate depression has a much greater impact on daily life. Typical characteristics include a lowered selfconfidence, loss of interest in activities they would have normally enjoyed, low or no motivation to perform necessary work, family or activities and heightened emotional responses to situations. Moderate depression is often recognised by the individual or the people close to them. However, it can often be attributed to being a result of an event (such as puberty, menopause, a mid-life crisis, work stress, unemployment, or relationship problems, or any other life changes) and not recognised for what it is and not discussed with the person’s doctor. Often, the symptoms of moderate depression can have spiralling effect. Even if we are performing at our previous level, the depressive effect of lowered self-confidence heightens the self-criticism and reduces our belief that we are capable of performing well, therefore we couldn’t be, so we might as well not bother even trying. This further reduces our motivation and perpetuates the spiral. Add to this the effect of heightened sensitivity, where a previously acceptable comment is now taken as a personal criticism or attack, which further reduces self-confidence and the pushes the spiral further down. Imagine your car’s clutch cable snaps — you can still drive but only in one gear and the longer it takes to do something about it, the worse your entire engine will be damaged. While natural therapies and lifestyle changes can improve moderate depression, medication is usually a necessary part of recovery. The difficulty is that, as the depression worsens, the lifestyle activities become more difficult (if not seemingly impossible) and have a reduced benefit. The medication should alleviate this feeling, allowing a person to make positive changes in alternative areas.

Severe depression Severe depression (also called Major Depressive Disorder) has the highest impact on a person. It is typified by a significant or complete loss of self-esteem, a sense of uselessness or lack of worth, feelings of guilt and is often accompanied by considerable distress, agitation or emotional extremes. People with severe depression will find it difficult, if not impossible, to participate in work, family or social activities. Even when we try to hide the symptoms of severe depression, it is often recognisable to people around us, even if not necessarily attributed to depression. The encompassing effects of severe depression mean that it takes over every aspect of a person’s life. While not necessarily the case with everyone, people with severe depression are more likely to consider, or attempt, suicide. This is understandable as the condition causes the person to have little or no self-worth and a belief that things could never improve. In the severely depressed mind, this is seen as doing those around them a favour by lessening the burden they are causing. And this will not improve without effective treatment. But remember that not everyone with severe depression considers suicide an appropriate alternative, and even those that do may never attempt it. Not everyone who likes coffee wants a triple shot before breakfast and even those of us who do, may never actually have one. Professional help is extremely important for a person with severe depression. It’s like the entire engine falling out your car — it can be fixed, but you won’t get anywhere at all until it’s taken to a mechanic. Treatment usually consists of medication alongside other treatments, such as counselling and, as the condition is more under control, diet and lifestyle. Major depression should very much be considered like a major disease. It will not go away by itself and, while left untreated, it may worsen and have increasingly harmful effects on other parts of a person’s body and life.

What you do today can improve all your tomorrows Ralph Marston

responding to situations Some forms of depression are ‘situational’, as they occur due to problems with an external situation (that is, not purely internal to the mind). Remember, though, that depression is a complex disorder. It is unlikely to occur due to a single situation or event, and not everyone in the same situation will experience depression. However, with particular personal and environmental conditions, these forms of depression may arise in specific situations. Antenatal depression occurs during pregnancy. Around one in ten women may experience antenatal depression while pregnant. This may be caused by the hormonal changes during pregnancy, changing financial situations, a sense of lost independence, or changes to relationships with family and friends. It may be more likely when there is a personal or family history of depression.

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Postnatal depression occurs in approximately one in seven women after giving birth. As well as the causes of antenatal depression, this can also be caused by lack of sleep, lack of physical or emotional support, hormonal changes during childbirth and while lactating, a lengthy or difficult labour, or feeling exhausted. This can be heightened when the mother feels that she is not a “good enough” parent.

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Lack of sun in winter can cause heightened depression

Post traumatic stress disorder (PTSD) is a set of conditions in reaction to events a person has experienced or witnessed that have threatened their own life or safety, or that of other people around them. It is a normal reaction to direct or indirect trauma and may result from recent events or events in the personâ&#x20AC;&#x2122;s past. It may also occur as a result of life-changing events. While many people may be exposed to traumatic events, not all will experience PTSD. Of those that do, nearly half will benefit from treatment. Up to 80% of people experiencing PTSD may have associated conditions, including anxiety, depression and alcohol or other substance abuse.

Premenstrual dysphoric disorder (PMDD) is a condition in which a woman experiencing irritability, tension, and the symptoms of severe depression before menstruation. The symptoms are similar to those of severe depression but only occur (usually) in the week leading up to menstruation. The condition is far more extreme and lengthy than those experienced with premenstrual syndrome (PMS). Although the cause has not been identified, it is considered linked to hormone changes and a personal history or anxiety or severe depression. Between 3% and 8% of women experience PMDD.

Seasonal affective disorder (SAD), most common in winter and particularly in the northern hemisphere, is believed to be associated with the reduced exposure to sunlight. It is believed that when sunlight hits the back of the retina, it shuts down the process that impacts sleep and mood affecting chemicals in the brain. So, less sunlight means more of the chemicals are produced. People affected by SAD tend only to experience the symptoms during winter.

when to act If any of this seems at all confusing, there is a really simple message to take from it. If your usual patterns of mood, appetite, tiredness, irritability, attitude to work, family, social events or life in general, change significantly or for a prolonged period, talk to your doctor. If you have noticed that change in someone else, encourage them to talk about it, to you, to someone close to them or to their doctor. In most cases, the sooner condition is properly diagnosed and treated, the lower the impact, and the faster the recovery.

a clinical view of

depression dr werner sattmann-frese PhD

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Depression is the ‘common cold’ of mental illness. It is the term used in psychiatry to describe “when the lowering of mood becomes relatively persistent and begins to interfere with a person’s ability to cope, either with work or study or personal relationships, or when the mood state is a source of substantial distress that is regarded as abnormal” (Schweitzer and Parker, 2007).

According to the Diagnostic and Statistical Manual of Diagnostic Disorders, also called the DSM-5 and referred to as the Psychiatrist’s Bible, this is the case when a person struggles almost consistently for more than two weeks with lowered mood. better

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describing depression People in the grip of this condition typically suffer from a persistent loss of self-esteem or self-worth, are far more self-critical than is socially useful, and are often afflicted with a strong sense of guilt. The signs and symptoms of this syndrome include a significant loss of interest in common activities, often including good diet, exercise and personal hygiene, a significant reduction in the ability to experience pleasure (anhedonia), a loss of hope, and an uncontrolled fluctuation between euphoric states and states of low self-regard and despair in the case of a bipolar condition.

a wide range of complex and interrelated factors cause depression Biological features often include significant sleeping disturbances such as insomnia or hypersomnia. Other biological features include loss of weight or compulsory and compensatory eating patterns, and somatic agitation such as compulsive handwringing. The sense of guilt typical for the emotional state of depression usually manifests as self-blame and strong remorse for past activities that have apparently caused others hurt and 38

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grief. Predictably, people who have struggled with this condition for a long time experience an increasing sense that suicide would be a useful solution for themselves and for people around them — which is never a rational or reasonable solution but a clear indication that immediate professional help is needed.

searching for causes The clinical experiences of health practitioners and findings of researchers demonstrate that a wide range of complex and interrelated factors cause depression. This biopsychosocial view of depression — and many other physical and mental health problems — contradicts the understanding still held by many psychiatrists that the condition is simply caused by genetic factors, neuroendocrine abnormalities, and a dysregulation of neurotransmitters (the part of brain responsible for sending messages between cells). Most psychiatrists base their work on the currently favoured integrative model, which suggests that stress exacerbates the effects of genetic and developmental factors. Unlike most psychiatric texts in which “the first and last object is to manage the patient by managing his symptoms” (Virden, 2009), clinicians are increasingly concerned with creating a meaningful understanding of the emotional and physical state of depression. Using perspectivism as a philosophical underpinning,

featur e depression is described here by employing social-critical, traumarelated, somatic (factors relating to the body), and functional (our own life context) perspectives. Biochemical implications have varying contributions and effects on top of the clinical perspectives described here.

harmonisation systems generate and maintain wellbeing and emotional integrity

trauma-oriented perspective The trauma-oriented understanding of depression acknowledges and uses the body of recent research that links depression with early experiences of insecure attachment and, in more serious cases, with abandonment, neglect and abuse. Using object relations and attachment theory as frameworks of reference, this research associates depression and many other conditions with the self-development deficits resulting from developmental traumas. Research undertaken with almost 10,000 patients in 1998 by Felitti and his co-workers established that: â&#x20AC;Ś persons with histories of being severely maltreated as a child showed a 4 to 12 times greater risk of developing alcoholism, depression, and drug abuse, attempting suicide, a 2 to 4 times greater risk of smoking, having at least 50 sex partners, acquiring sexually transmitted disease, a 1.4 to 1.6 times greater risk for physical inactivity and obesity, and a 1.6 to 2.9 times greater risk for ischemic heart disease, cancer,

chronic lung disease, skeletal fractures, hepatitis, stroke, diabetes and liver diseaseâ&#x20AC;? (Siegel, 2003). Psychotherapists and counsellors frequently experience that these results also apply to people who have not been abused or neglected as such, but who have grown up with parents highly stressed from internalised feelings and societal pressures. These insights are now spawning an emotional revolution that is shifting the emphasis from cognition to affect. Panksepp writes that: The cognitive revolution, like radical neuro-behaviorism, intentionally sought to put emotions out of sight and out of mind. Now cognitive science must re-learn that ancient emotional systems have a power that is quite independent of neocortical cognitive processesâ&#x20AC;?, (Integrative Psychological and Behavioral Science, 2008). Ovtscharoff and Braun have established that the healthy and loving interaction between the newborn and the mother acts as a regulator 39

of the child’s internal homeostasis. A healthy newborn–mother interaction ensures the normal development and maintenance of synaptic connections during the establishment phase of brain circuits. Thus, early developmental influences may affect our ability to cope in trauma related situations in later life.

somatic perspective Body-oriented psychotherapists, who integrate the talking cure with an understanding of the intimate links between body and mind, acknowledge the relevance of the trauma-related background but also emphasise the role of the body in this condition. Central to this view is the understanding developed by Wilhelm Reich that muscular tensions serve to keep traumatic experiences unconscious, a process he called muscular armouring. We can see this mechanism in action when we consciously or unconsciously brace ourselves on the expectation of pain and discomfort, for example in the dentist’s chair. Muscular tensions, together with armouring of the connective tissues achieve this repression of feelings by fragmenting the flow of subtle energy in the ‘bodymind’. This may sound strange to people in Western societies. However, such an understanding of energy and energy flow has a very long tradition in Eastern cultures that use Tai Chi, 40

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Yoga, Kum Nye Chi Gong, and many other ‘energy distribution’ and harmonisation systems to generate and maintain wellbeing and emotional integrity. Depression, in this view, results from an energy fragmentation and accumulation that lock the depressed persons into the ‘prison of their bodies’. Suitable bodywork exercises are usually able to generate energy flow and provide crucial emotional relief in a short time. The outbursts of feelings that are often associated with this relief demonstrate the strong links between early traumatic experiences and depression.

functional perspective In her book, The Gift of Depression, Dr Lara Honos-Webb suggests that depression is meant to stop us in our tracks when we lead emotionally unsustainable lives. It is a challenge to review our core beliefs about life and to replace unsustainable perceptions, beliefs, and behaviours with more emotionally, socially and ecologically sustainable ones. Many of us may find such a positive and psychologically non-critical view of an ‘illness’ challenging and difficult to embrace. This only demonstrates how much our conscious has been shaped by the current modern paradigm by a science that often lacks meaning and purpose. Honos-Webb’s view is in line with the views of progressive psychosomaticists who emphasise that pain and suffering serve to draw our

featur e attention to what is lacking in our lives. In the case of depression, following from this perspective, what is lacking is an internalised self-image of being worthwhile and unconditionally lovable. It is important here to understand that the so-called ‘usual self’ that depressed people have apparently lost is really the disintegration of a false or ‘compensated’ self. This is the breakdown of a mask or persona that has disguised the deep lack of a coherent self, as self-psychologists would put it. The decompensation — to use a term used by psychiatrists in the past — of this persona caused by experiences that overwhelm the compensatory buffer system takes them into a state of regression where they are once again in touch with their painful childhood reality. This is most dramatically visible in the profound state of depression labelled as psychotic and delusional. A good example here is a wealthy man with millions of dollars in his account who is fully immersed in the feeling of being in financial difficulty. He will be labelled as psychotic and delusional when measured with the yardstick of objective reality. Such measuring, however, is a grave empathic error because it misses the point. A more productive and useful starting point for a healing journey is the understanding that this man has exhausted himself through years of desperately accumulating wealth in the erroneous belief that this wealth will provide him with a stable and

empathically attuned counsellors and therapists can sow a seed for real change embodied sense of self and a sense of emotional integrity. Empathically attuned counsellors and therapists can sow a seed for real change and healing by using this breakdown of unrealistic and defensive belief, thereby instilling hope for a future life with emotional integrity. The alternative is often a lifelong struggle to control the surfacing feelings with psychopharmaceutic drugs.

moving forward The perspectivist approach described above demonstrates that depression is a complex condition that cannot be sufficiently explored from within one particular frame of reference. This also means that there is no panacea, not a single intervention that is able to make the condition redundant. A holistic approach, that an increasing number of people with depression currently pursue, may be a more realistic and successful solution in understanding and managing depression. 41

stress in the City

living life in a modern city can create a whole world of stress and anxiety zern liew 42

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How are you feeling right now? Are you tense? Have things become a bit too much? Are you worried about not being able to finish everything you need to do today? Are you wishing that everyone would be quiet and leave you alone? These are all common signs of stress. A small, healthy, level of stress can keep us on our toes and help us rise to challenges. Extreme stress, on the other hand, makes us feel threatened, panicky, and helpless. City living, whether in the heart of a city or its outlying suburbs, has many more contributors to a stressful life than living a rural or country setting. A Scientific America study found that â&#x20AC;&#x153;people who live in cities are more likely to have a mood or anxiety disorderâ&#x20AC;?. With more than half the worldâ&#x20AC;&#x2122;s population living in cities, the impact of city life should be considered when maintaining our mental wellbeing.

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The Stresses of City Living

Prolonged exposure to stress has been linked to the triggering and worsening of many health problems. These include cardiovascular disease, gastrointestinal disorders, sleeping disorders, anxiety, depression, autoimmune diseases and skin complaints. Unlike most physical ailments, stress tends to be cumulative. Deceptively simple daily stresses can build up over time into a seemingly sudden

nervous, psychological or physical reaction. Stress reduces our ability to think clearly and rationally, make sound decisions, prioritise, or even act at all. Ordinary situations can turn into an emergency, which then feeds back to create even more stress with even more serious consequence. So let’s look at some common, and increasingly significant, environmental factors that affect our levels of stress just by living in a city.

density The proximity to work and services is considered an advantage of city living. But with vast majorities of people seeking this advantage, the resulting high density environment can be detrimental to our wellbeing. Just being in close quarters with lots of people can be stressful. A New York Academy of Medicine paper said “living in urban environments impacts specific regions of the brain that deal with stress responses”. High-density living also blurs the boundary between the private and the public. It is just too easy to become involved with each other’s business, deliberately or otherwise, without the sense of care and community that provides a positive support of our mental health. 44

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excessive stimuli Cities are noisy and brightly lit places. A neighbour’s loud music or arguments, traffic, construction work and sirens are typical noisy stressors. Street lights, car headlights, highly lit advertising and the general glow of a city, are common sources of excessive light. Exposure to the long periods of light in the city can affect our sleep-wake pattern, and consequently our mood. City living also exposes us to physiological and neurological stressors such as vehicle exhaust and organic waste. Our cities are saturated with the visual, aural and cognitive stimuli of advertising. Many of these ads play on our insecurities, create ever-escalating aspirations, and shout stressful immediacy with assorted versions of Hurry! Limited stock! Act now! — all of which affect sense of our wellbeing.

competition and materialism Being surrounded by more people invariably means greater competition. We fight to compete for everything from jobs and childcare places to endof-year bargains and parking spaces. Where there is competition, conflict and the attendant stress is never far away. Over-working to improve or just maintain our material goals is another city trend. An InsuranceQuotes.org article reported that “up to 34% of adults don’t take their vacation day” as well as voluntarily reducing their lunch breaks and working extended hours. We are easily stressed by the loss of control over our work commitments, without taking the breaks we need for recovery.

pace, change and uncertainty More competition increases the pressure on us to do more with less. Our work, social and family to-do lists often seem endless. Work cut-backs threaten our sense of job security and increase the pressure on us to take on additional responsibilities. City dwellers experience change more explicitly, with buildings appearing and disappearing seemingly overnight for example. This fast pace prevents us from pondering the deeper issues such as purpose and meaning. Lack of purpose is a source of stress and the stress makes it difficult to step back and be mindful of our lives.

disconnection The longer our to-do lists, the more activities we are involved in, the more commitments we make, then the less time we have to engage in meaningful, happiness-engendering activities. No wonder many city dwellers feel disconnected and isolated. The pace of city life also gives rise to shallow, ‘areyou-useful-to-me?’ relationships – like the “sweetie darling” stereotype portrayed by the BBC comedy Absolutely Fabulous. It may be funny, but it’s not fun. With the increasing population density, we lose our sense of community and become disconnected from society. That sense of isolation creates an increased level of stress.

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two faces of stress the bad Stress has been touted as ‘the silent killer’. Many say for good reason. While a moderate level of stress can be beneficial, too much stress is not good for anyone. High levels of stress has been linked to mental wellbeing issues as well as the more common physical impacts, such as heart disease, high blood pressure and susceptability to infectious disease. Severe or prolonged stress can cause tension, headaches and

migraines. It can make sleep difficult, broken or ineffective, or cause prolonged fatigue. Or appetite can change – with an increase or decrease. Chronic stress can also increases the risk and the duration of depression and anxiety if not managed. Current research suggests that childhood stress can impact the brain’s development

the good Stress isn’t all bad. Our bodies actually need a healthy level of stress to function normall, and to survive.

Research suggests that stress actually boosts our immune system, helping ward off sickness such as a cold. Mederate stress can also improve the heart’s normal function. Stress increases adrenaline, and excitement. It also enables our fight or flight response. This is what makes us jump away from oncoming traffic. Stress, and the chemicals it produces, is an important aspect of a healthy mind and body – when taken in moderation.

Stress can improve motivatation and help us get things done. The stress of facing a challenge often drives achievement. The related stress can also boost memory, further increasing our ability to achieve.

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treat pre-existing conditio

making us feel even worse than we normally would. The better we feel physically, emotionally and mentally, the better we are able to cope with additional stressors in a y. rational and reasonable wa al de to ing try are When we Certain pre-existing with pre-existing ailments y, iet anx conditions, such as and conditions, weâ&#x20AC;&#x2122;re less depression, claustrophobia equipped to cope. Seek and agoraphobia, or high-existing and treatment for any pre ir blood pressure, migraines the uce red to s ion condit even the common cold, can impact on your ability to d ate rav agg be aggravate and manage additional stress. by the stress of city living,

Many of us are mostly mentally healthy, but we might still have pre-existing conditions. These could be cal, emotional, mental or physi uce red can ich any of wh our ability to cope with the ng. additional strain of city livi

change our thin

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Cars, people, ev en pavements are po cracked te but hopefully min ntial, or, threats to our sense of sa fety. Our bodies are cond itioned to defend against po te threats. Unfortuna ntial tely, our body cannot imm ed differentiate betw iately een real and imagined th reats and responds with th e physical and neurological su instinct. With regu rvival lar ‘threats’, our mind is cons tantly onedge, increasing our stress. Many of us go th rough life on auto-pilot and, as a result, often get caught up in situations with ou it. All change be t realising gins with awareness. Regu larly stopping to take stock of our feelings and thoughts thro ug day is a good star hout the t. Over time,

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we will better un derstand how experience and respond to different situatio ns.

Changing the way we think can help us avoi d stress by evaluating sit uations differently and w ith clarity. Living with more fa thinking and belie ulty fs such as “I am in dang er” attract bad luck”, and ‘I or our own personal co llections of similar defensive thoughts, increases stress. Cognitive behaviour therap y — where we write down an d rationally challeng then e the thoughts and be liefs we have about each situa tion — can be an incredibly effective way of resetting our thin create a calmer m king to in the assistance of d. Seeking a qualified therapist is a go od start.

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take breaks With busy work, social or education schedules, taking our children to after-school activities and weekend sporting events, helping out our family and friends, then paying bills and doing housework, life can be pretty non-stop. Just thinking about all the things we have to do and fitting them all in can be incredibly stressful. Regular breaks gives us the opportunity to step back from the constant go of city living.

Allowing ourselves to have ‘me-time’ is important. This could be reading a magazine, taking a relaxing bath, having a massage, lying on the lounge and mindfully listening to our favourite CD. You could even try forcing yourself, and your family, to stop everything and go away for a few days or as simple as spending the afternoon at the beach or having a picnic. Getting ‘away from it all’ really does reduce the stress.

l stillness

cultivate menta

flect on the great way to re d an on ugh a specific ro ed th fe y or think da City living can r te g openly to a tal chat situation. Talkin amplify the men r heads. unsellor can ou confidant or a co that’s already in es iti tiv ac ily da t be useful too. Thoughts abou vigating na s, re su g our es pr d an r day l stillness, freein builds ta ou t en ou M ab ng ki ‘noise’ it traffic, thin mind of all the y we’ve had, ters this un ahead or the da opping and co ly , direct up sh l ta en m g aside the time makin noise. Setting all common e ar ts lis o -d ities, such as to for simple activ tion or yoga, ’ we have with ita ‘conversations ed conscious m to this the e in creating ourselves. Add e er th d an ty can be effectiv stillness. ci sy bu a of es l nois a level of menta al walk — h for one mind su ca can be too muc ing us more a ng ki ta Even ak or some — to deal with, m ic . ithout mus ss w re st to le tib iet park can suscep time-out in a qu oment of s es en ar am of aw help us create Those moments tside of and give our ou ss ne ep ill st st l us ta ts en m also le r fo from the noise r emotions mind a respite ourselves and ou perspective. side, us. e around, and in a more objectiv can be a nal Keeping a jour 51

improve our eq Our EQ, or Emotional Quotient, is the measure of our emotional intelligence, which is an indication of how well we can identify, assess and deal effectively with emotions. Just as importantly, it also relates to our ability to recognise and respond appropriately to other peopleâ&#x20AC;&#x2122;s actions. Given that we are emotional creatures, good EQ is the basis of positive interactions and minimises stress brought on by conflict. While EQ can be quite a complex, and

sometimes debated, measure of our ability to cope in situations, it is another useful tool to use in reducing stress. It helps us step away from situations and immediate responses and improve self-awareness, healthy boundaries, peopleâ&#x20AC;&#x2122;s motivations (including our own), empathy, communications, and conflict management skills. All of this helps us respond in a more positive way and reduce situations that would otherwise increase stress.

choose situations consciously

We all respond differently to situations, based on our own experiences and everything else that may be going on in our life at the time. Sometimes we donâ&#x20AC;&#x2122;t get to choose when something may cause stress, such as being rear-ended by another when driving.

Other times, we have greater control over our situations, such as leaving home a little earlier to avoid gridlocked traffic. With an awareness of what stresses us, we can choose to take actions that help avoid those stressors. 52

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Consciously choosing to engage in less stressful activities and avoiding those that we know will be stressful will help eliminate, or at least avoid, unnecessary stress. This means being aware of what triggers heightened stress for us and actively developing plans and techniques to minimise those situations. We should learn to empower ourselves to choose work and life situations more deliberately. You may even find that the stress of fighting the sales-season crowds to save $10 may be too high a price for your mental wellbeing.

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make a sea change

Sometimes, a big lifestyle change may be the most with effective way to dispense . go e on in all ss stre a lot of the r ove t ge you ce on tâ&#x20AC;&#x2122;s Tha It initial stress of the change! n, mo com and y, is all too eas tic to get caught up in the hec re lifestyle and take on mo because we expect it of ourselves. ed We are constantly surround r ou on s nd ma de g sin by increa e com be n eve can and time sed addicted to the stress cau ke ma we nts me by the commit ile Wh . ers oth and s to ourselve ht, ug tho ng nti dau a be y it ma y taking a huge side-step ma d. de be whatâ&#x20AC;&#x2122;s nee

This could mean changing jobs or reducing the number of social and other n commitments. It could eve g vin mo as tic ma be as dra to a smaller city or country town. This aptly named sea-change or move to the us country, not only removes but , city the of ss stre the from new y irel places us in an ent our environment with none of . nts me mit com previous ss We are then able to reasse ly on and ant ort imp what is nt take on a reasonable amou ht mig We of healthy stress. even replace the buzz of the city with the thrill of new experiences. 53

Good Mental Health is

Good Business

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A physically and mentally healthy workplace improves the working conditions, wellbeing and productivity of employees. And thatâ&#x20AC;&#x2122;s good for business. Zern Liew better

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“What do you do for work?” is a question we are often asked socially. For many of us, work is more than just a job — it shapes our sense of worth and identity. A 2008 University of Sydney study found that full-time employees work an average of 44 hours per week and one in five people work more than 50 hours a week. We spend a significant part of our days at work and a large portion of our ‘personal’ time engaged in work activities or even just thinking about work. It is not surprising, then, that work has a significant impact on our overall mental health. A challenging topic at the best of times, mental health, is an especially loaded subject in the ‘professional’ world of the workplace. Yet, asking for time off for a sports injury is perfectly acceptable but taking leave to deal with anxiety is unthinkable! 56

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More than “Just Business” When a senior bank manager was asked about his emotions at work by one of the authors of Emotion at Work, he replied “I don’t have any emotions at work, neither positive nor negative ones, I am professional”. This denial and suppression of emotions is one of the many myths around ‘being professional’. We are not supposed to take anything at work personally, because it’s just work. The opposite, however, is rarely true. We regularly take our work, and our work stress, home with us, which impacts our overall physical and mental wellbeing. This can lead to increased levels of stress that do affect our work environment. In some cases, turning into anxiety, depression or even ‘work rage’.

Over time, constant small stresses — the ‘harmless’ little put downs for example — build into major problems. According to Lawyers Weekly, an Australian information service, over one third of all Australian lawyers will, at some stage in their careers, suffer from depression. Over 10% of people in the nursing and care profession suffer from depression. In the US, suicide rates of surgeons is around 40 per 100,000, which is double that of the average population. And if you think that being a student is easy, consider that nearly 20% of students (with comparable figures internationally) suffer from depression.

Work rage is not ‘just business’. A 2000 CNN report found that 42% of US workers experienced yelling and verbal abuse and 10% said they work in an atmosphere where physical violence has occurred.Mental health related workplace events, such as office shootings are dramatic and extreme events —but not isolated. The impact of daily stresses may be harder to spot without immediately visible symptoms, however. So we push on, allowing situations to intensify and escalate until we break down or blow up. 57

Stress is known to trigger and exacerbate a variety of problems, including cardiovascular, gastrointestinal, skin and mental health disorders.

The cost

42% of US workers experienced yelling and verbal abuse 58

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Poor workplace mental health costs businesses money. In the US, the estimated cost to business arising from mental health related issues is at least $100 billion, resulting from 35 billion lost work days, according to Harvard University Medical School research. The Workplace Bullying Institute estimates that workplace bulling costs business as much as $180 million a year, with one in four employees claiming to have been bullied in the workplace. In Britain, it has been estimated that 70,000,000 working days are lost every year due to mental health issues. This amounts to ÂŁ30 billion a year from lost production, increased recruitment and high absenteeism.

featur e In Australia, a Medibank Private study found stress-related absenteeism and presenteeism (turning up to work sick) cost employers over $10 billion a year. The Australian Productivity Commission found that workplace bullying and harassment costs employers approximately $15 billion a year. In 2005, the fourth European Survey of Working Conditions found that stress was experienced by an average 22% of working Europeans. In 2002, the annual cost to the EU economy of work-related stress was estimated at EUR 20,000 billion. With figures in many countries of around one in four people living (and working) with a mental health condition, it is possible that any of your staff or colleagues are one of them. While efforts to assist employees with mental health issues are inconsistent, the mental wellbeing of all staff should be a high priority for all employers, whether or not they suffer from a mental illness.

Innovation and Agility A mentally healthy workplace looks remarkably similar to one that is innovative and agile, two hot topics for operational and strategic management for improving business performance. So, if being innovative and agile can help

productivity, good managers should use these same factors to improve the mental wellbeing of the workplace. Creativity: We need to feel safe — psychologically and physiologically — to be creative. Mihály Csíkszentmihályi, known for his work on creativity and happiness, described the following conditions for creative flow: clear goals, complete concentration, immediate feedback, autonomy, and ensuring ability is matched with the challenge. Resilience: Mentally healthy people are naturally more resilient. They cope well with change and are able to cope with the unexpected. Although this is difficult for a manager to achieve in current times of economic challenge and uncertainty, it is increasingly important for the same reasons. Productivity: A 2005 Medibank Private study found that healthy employees are three times more productive; they are positive, motivated, and more committed. Productivity has always been a goal for business but the pressure for increased productivity has often ignored the reality that a mentally healthy workplace drives productivity. Instead, the isolated drive for increased output worsens the mental wellbeing of employees and reduces productivity. 59

Quality: W. Edwards Deming, the father of Total Quality Management, recommended that organisations “drive out fear” and “break down barriers” in order to improve quality. Mentally healthy workers are more able to own their mistakes and report problems without fear, improving responsibility, the desire to perform well and increasing overall quality. Talent: A mentally healthy workplace attracts and retains talent. Despite convenient justification of treating staff as disposable production resources due to generational differences, employees increasingly expect more beyond just the job and the pay. They look for softer aspects such as respect, flexibility, sustainable practices, supportive co-workers and pleasant work environments.

LEVELS OF STRESS

Relationships: Leading business thinkers, including the authors of The Cluetrain Manifesto, have identified ‘relationships’ as the business tool of the connected age. A mentally healthy workplace naturally engenders healthy relationships — inside and outside the company. Fostering good relationships minimises conflict and enables effective collaboration and learning. Social Responsibility: Ultimately, creating a mentally healthy workplace is the socially responsible thing for businesses to do. Many organisations, particularly corporations and larger businesses, have made commitments to Corporate Social Responsibility initiatives. This should be more than planting trees and donating to charities. CSR must start internally, which means looking after the best interests of your staff, and that includes their mental wellbeing. high levels of stress, with extreme fatigue/feeling out of control

63% low levels of stress

5% 32% source: StressPulse Results – 2012 http://www.compsych.com/press-room/press-releases-2012/678-october-29-2012

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constant but manageable stress levels

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Change for the Better As employees, we can actively choose a healthier workplace. As business leaders, we can choose to create such a workplace. The question is, do we create that workplace before all our best people choose to work somewhere else? In recent times, more businesses are recognising the importance of workplace mental health. Telstra, an Australian Telecommunications company, has a mental health strategy that is centred on building awareness and support throughout its ranks and has dedicated a Strategic Plan solely to Mental Wellness. In Canada, the Toronto East General Hospital has a comprehensive series of policies and procedures specifically targeting mental health. The Communications Workersâ&#x20AC;&#x2122; Union in the UK has worked with the

Royal Mail Group and British Telecom to create policies and practices to instil a culture that reduces the stigma of mental illness. Large international companies, including Unilever, Cisco Systems, IBM and DuPont have implemented wellness policies. Workplace culture is difficult to change at the best of times. But the workplace environment is a good place to start if we want a healthier, more committed and more productive workforce. Organisations such as Beyond Blue (Australia), Work Ahead (Ireland), Time to Change (U.K.), Partnership for Workplace Mental Health (U.S.A) and European Network for Workplace Health Promotion (E.U.) have excellent resources for employers who want to improve the mental health of their workplaces.

CAUSES OF STRESS people issues

juggling work and personal life

34% 18%

workload

lack of job security

9% 39%

source: StressPulse Results â&#x20AC;&#x201C; 2012 http://www.compsych.com/press-room/press-releases-2012/678-october-29-2012

signs of a mentally healthy workplace

Common Workplace Mental Health Issues  Depression  Anxiety disorders  Panic attacks  Stress-related disorders  Despair  Anger  Nervous breakdowns  Burnouts  Bullying and harassment  Loss of self-confidence

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Leadership: Good leaders define the culture that builds great workplaces engaged and present  The leaders are engaged with the people and the work.  Leaders are present and available, with an open door policy in practice, or follow the principles of management by walking around. authenticity and clarity  The leaders have good selfawareness and practice a “do as I do” approach.  The intention and purpose behind the work is clearly defined and communicated, understood and shared.  Work is calm and purposeful, with emergencies the exception rather than the rule.  The atmosphere is supportive and collaborative. sound talent management  People really want to work there for the job and company, not just the pay  Staff turnover is negligible.  Candidates are selected rigorously, with a strong focus on cultural fit and emotional intelligence.  There is a clear policy, understanding and reinforcement against the unacceptable behaviours of bullying and harassment.  The remuneration practice is well understood by all, and clearly tuned to encourage desired behaviours.

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Respect: A mentally healthy work culture is one built on respect for the individual and workplace reasonable expectations and hours  Tasks are designed to match the skills of individuals, to maximise flow and minimise stress.  Workaholism is actively discouraged; people take breaks and usually go home on time. embrace diversity  People have permission to be vulnerable; it is ok to say “I don’t know” and “I need some help”  Expressions of individuality are visible.  Everyone feels they are treated fairly and equally.  People feel they are valued for their contribution  There is a real sense of collective belonging and camaraderie.

treat people like adults  There is no yelling or any other abuse behaviour.  There is no fear; people don’t feel afraid to act or speak out.  There is personal responsibility and accountability, not blame or placating people to avoid conflict.  Individual autonomy is encouraged, expectations are set and understood, and people don’t ‘get in trouble’ for making mistakes.  Knowledge and ideas are shared openly and people are trusted with information.

Comfort: modifying our surroundings

to suit us, creates a sense of ownership and belonging

encourage personalisation  Workspaces are personalised with an individual’s items, such as phtographs on display, and stickers on computers.  Virtual workspaces are personalised, with custom screen backgrounds, icons and behaviours.

Safety: worklplace layout defines

private, public and interaction places, which affects how we interact with one another

relaxing and efficient  There is laughter and people carry themselves in a relaxed manner.  There is no overcrowding, so people are not breathing down each other’s necks.  Workspace positioning and the use of modesty and privacy screens provides psychological safety.  The layout supports people and the work, with convenient location of facilities and amenities. code compliance  The space complies fully with building, fire, access and other standards.  Furniture is ergonomically sound.  There is no exposure to environmental and air-borne pollutants.

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provide variety  There is a good mix of stimulating and restful spaces, set up with the use of colour and furnishings.  Communal lunch or kitchen areas, breakout rooms and lounge spaces are available.  Indoor and covered outdoor areas for meetings or informal gatherings. positive sensory environment  impove the sensory perception of the workplace through moderated light, temperature, sounds and smells  The lighting is appropriate to the tasks at hand and is comfortable without being harsh.  Glare and reflections from computer screens and windows are minimal.  Natural light and windows are accessible or natural airflow is available.  Temperature and humidity are maintained at comfortable levels.  Disruptive noise is minimised.  Unpleasant smells are neutralised.

people

Sam W

illiam

Learning to Fly Give me the time sky. to dance across the to stars. rs So, I can link meteo ch the Milky Way rea I as ile So, I can sm iliar spot to lay. A response to my fam Serene reminders another day. to keep going untill sun The positivity is my th. adding the warm vagance And, providing extra And, intelligencepulsive jump. to my fast pace im n planets ow my of A learning rs. of problems and fea ful pockets nd mi t ou g nin ea Cl ease. with an exhilarated

The howl The wolf howls at the moon sending a wish fo r her to hear. Despite his moa n He reminds himse lf of the light to keep a optim istic sphere. The Sun shines br ight creating a warm th. It’s his imaginatio n in flight or positive creativ ity leading him no rth. His head is in the sky willing his feet to the ground. He needs a sign that it will come back around. His lone fur will ke ep him warm, even if it don’t co me. It is a universal sig n of life’s reform A peace in what ’s meant to be.

Feather by Cloudtail on flickr

, A feeling of freedom , by fly As my wishes long lacked. with the hope they A recovery of pride Yet, even in his dr ce eams, One of self substan he will still howl . ce an og arr nd fo r sure. without bli chasing meteors A trip that begins in confidence . I and ends with real lf. auty of being myse ylvania in be e s tru n n As I find the e P ity

ivers stern rthea Haven Un the last o n m Lock spent nd fro -five a riting from ds. I have s trying to y t n e tw ics hW ll kin m alway . I am us top ’ y of a Englis lliams degree in and poetr nt styles. I s on vario i W ce r n am ere . I am S d a bachelo n for fictio many diff creating pie my works ferent io ll e in s dif y a s iv t g a jo o e u t p n in c o re ab ea .Ie writ flair v lf d a d e e e s h n iv d y I a it 2011. rs reading d better m add a pos e open-min an ea d to to b few y e my craft ry har te others t I . v le o impr pire peop and educa s e that in to influenc e I striv of life. ts aspec

Mindfulness

forbetter health mental Mindfulness has become a hot topic recently, with even British members of parliament and corporate managers taking part in mindfulness training courses. Nina Bradshaw explains mindfulness and how simple it can be. NINA BRADSHAW

Nina is a mental health social work practitioner in the UK. She is qualified in Cognitive Behavioural Therapy and group work therapy, and delivers Mindfulness groups in her workplace for individuals experiencing mental distress. Sheâ&#x20AC;&#x2122;s building her career and likes crafting, walking her dog, and practicing mindfulness. And she fits all that around her recurrent clinical depression.

wellbeing

hear about mindfulness and it sounds like a good thing. But what exactly is mindfulness? And how can it help us to maintain mental wellbeing in our everyday life?

As a concept, mindfulness, is a form of meditation taken from Buddhism. Some people may imagine this as sitting in a Spartan room, legs contorted in the lotus position, chanting ‘ohmmm’. Others may associate the concept of meditation with hippy-dippy new age stuff. But when the ultra-conservative UK newspaper The Daily Telegraph recently ran a feature on mindfulness, it started to reach the mainstream. Mindfulness was first adapted from Eastern traditions by Dr. Jon Kabat-Zin, who began his Mindfulness Based Stress Reduction approach at the University of Massachusetts in the 1970’s. He, with others, went on to develop Mindfulness Based Cognitive Therapy (MBCT), to treat depression, and many others have used the concepts in various forms to treat ailments ranging from chronic pain to borderline personality disorder. With its emphasis on paying attention in the

moment, mindfulness advocates a move away from our usual automatic mode of living. We so often live life on “auto-pilot”, doing things without thinking about them, without experiencing them. Do you ever notice when you drive a familiar route that you have arrived at your destination without even noticing you were driving? This is auto-pilot. Mindfulness asks you to come out of auto-pilot and consciously pay more attention to what is going on in the here and now, taking note of what is going on moment by moment. As Jon KabatZin says, ‘all we have are moments’.

we so often live life on auto-pilot Then we may ask why mindfulness is so effective in treating such a range of conditions. The idea is that, by paying attention to what is going on now, we cannot dwell on past experiences or hurts, or worry about what is better

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reduction in the symptoms of anxiety and depression going to happen in the future. With a focus on non-judgemental awareness, mindfulness asks us to acknowledge our current thoughts, feelings, sensations, pain or worries, but not to get caught up with them. This focus on curious detachment allows us to disengage from the things that are causing us concern. This is not to say that we ignore or dismiss these concerns, but we don’t engage with them in the usual way. How is this done? The easiest mindfulness technique involves focussing on the breath. Simply allow yourself to concentrate on your breathing. Breathing slowly and noticing the breath as it goes in and out, feeling the rise and fall of the abdomen. This, in its most basic form, is all it takes to be practicing mindfulness. Every time we notice our mind losing focus, and drifting towards our normal thoughts, the aim is to acknowledge this — but not judge — and gently bring our attention back to the breath. Another exercise is to eat a raisin ‘mindfully’. This involves taking to time to notice its particular smell, to feel its texture, to let it rest on the tongue, think about its taste, allow the time to roll it your mouth and feel how its texture is different on your tongue, slowly bite into it… And keep going, one tiny action at a time, experiencing each sensation until you’re done. Another is a body scan meditation, where you sit or lie still and consciously scan your 68

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whole body focussing on each part of the body for a few seconds in turn from your toes to the tip of you head. In research studies, mindfulness has delivered a 20% reduction in the symptoms of anxiety and depression. In asking people to concentrate on the here and now, and not judging or engaging with our normal ‘stream of consciousness’ thinking, mindfulness can help people feel calmer and behave more compassionately towards themselves. Any activity can be carried out mindfully. It is possible to do mindful walking, where you focus on and notice what is going on around you, and pay attention to the body’s movements as you walk. We can carry out simple tasks mindfully, such as mindful washing the dishes, or even mindful ironing! All it involves is paying attention to our movements, to that act of filling the washing up bowl or the iron moving over the sheets, to the sounds, the smells, the textures, heat or cold, or anything else we can be aware of in that activity alone. When your mind wanders onto anything else, don’t be critical, but gently bring it back to the here and now. Mindfulness is certainly reaching a far wider audience than previously, and it looks set to stay around for some time. Mindfulness is a simple concept, but does require a little practice to appreciate its benefits. A ten minute breathing meditation a day over a few weeks is all it takes before a noticeable difference is experienced. Practicing mindfulness improves mental and physical health for most people. Practiced regularly, it can reduce general stress levels and improve our interactions with others, even in difficult situations. Everyone can benefit from practicing mindfulness.

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mindful meditation Sit or lie in a comfortable posture. If sitting, let your shoulders drop, but keep your spine erect. If you feel comfortable, close your eyes. Bring your attention to your body, noticing the sensations of your body as it makes contact with the chair or whatever you are lying on. Spend a few minutes noticing the sensations in your body.

This short breathing exercise is adapted from Jon Kabat-Zinâ&#x20AC;&#x2122;s, Full Catastrophe Living: How to cope with stress, pain and illness using mindfulness meditation to get you started. Why not give it a go?

Bring your attention to your abdomen, noticing as it rises and expands on the in-breath, and recedes on the out-breath. Keep your focus on the breath, being with each in-breath for its full duration, and with each out-breath for its full duration, as if you were riding on the waves of your own breathing. Count each breath, counting one on the in breath, and two on the out breath, until you reach a count of ten, then start back at one again. Every time you notice your mind has wandered off the breath, notice what it was that took you away, and gently escort your attention back to your breathing. No matter where your mind wanders to, no matter how many times your mind wanders, it could be a thousand times, simply bring it back to your focus on the breath. Being aware that your mind has wandered and gently bringing it back is as valuable as it is to remain aware of the breath. Continue this through, counting each breath in and each breath other, reaching ten and starting again, for ten minutes. Take a moment to remain motionless, then gently return to your day. 69

5 Sleep well 4 Maintain a healthy diet

Studies suggest that a healthy diet improves mental health. Try to eat a balanced diet that includes green leafy vegetables, fruits, wholegrain cereals and diary food. These are rich in Vitamin B, which is vital to a healthy brain function and nervous system.

3 Learn to relax

Relaxation is another effective activity for improving mental health. Relaxation techniques could include deep breathing, meditation, massage, a hot bath or spending time with family and loved ones. These help your body and mind recover from stress and anxiety and prepare for a more positive day.

2 Think fit

Challenge yourself intellectually. Mind games, such as Sudoku, jigsaw puzzles and quizzes give your brain an opportunity to explore, examine, enquire and stay fit. Read a book or magazine. Take a short course. Take your mind out of its comfort zone and feel it strengthen.

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Stay fit

Exercise has positive effects on brain and overall mental health. Studies suggest that a 30 minute exercise delivers more oxygen, boosts serotonin (an anti depressant) level and other neurotransmitters that alleviate mood in the brain. You donâ&#x20AC;&#x2122;t need a hard core gym workout. Simple exercise such as swimming or walking the dog is just as beneficial.

mental health

Neurochemistry studies suggest that a good nightâ&#x20AC;&#x2122;s sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability. (In other words, sleep good, no sleep bad). An adult human body needs at least 7 hours of sleep a day. So get plenty of sleep. Having trouble sleeping? Then take another look at tips 1, 2 and 3 to improve sleep.

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6 Grab some water

7 Be sun-sensible

The human brain is composed of 70 per cent water and needs to be hydrated frequently. Water improves mental function and research has shown that it is difficult to focus or concentrate when dehydrated. Buy a reusable bottle, fill it up, take it with you and drink it regularly. You may be surprised by how alert you feel.

Moderate sunshine has an alleviating effect on mental health. The sunâ&#x20AC;&#x2122;s ultra violet rays stimulate the skin to produce vitamin D. A number of studies have shown a link between a low level of vitamin D and an increased risk of depression and other mental disorders. You donâ&#x20AC;&#x2122;t need to be tanned but you should aim for regular exposure to the sun.

10 tips to improve

mental wellbeing

8 Reduce alcohol

While alcohol may provide temporary relief to all manner of problems, growing evidence suggests that alcohol increases the risk of prevalent mental health conditions such as depression and anxiety. And waking without a hangover is a much more positive start to the day.

9 Pat a pet

Studies have shown that pets enhance both physical and mental health. They provide companionship and can increase your overall level of happiness, which further improves mental health. A simple exercise such as walking a dog plays a significant role in easing symptoms of depression, stress and anxiety.

10 Talk

Talk to friends, family or a therapist about your thoughts and feelings. It gives you a chance to be listened to, reflect on your thoughts and emotions and work through issues or concerns. Other people may not have all the answers but, like oil on a rusty hinge, talking helps to open the door to emotional and mental wellbeing more smoothly. 71

Polly Fielding tells us her personal account of managing mental health through art that also touches others dealing with their own mental health and recovery. She also writes and tweets about mental health. She is a wife and a mother. And she lives with borderline personality disorder.

‘I’m Terry, the occupational therapist. Would you like to come to the art room with me?’ Her calm tone was soothing but I was in no mood to respond positively. My abusive childhood had finally caught up with me when bullying at work resulted in a complete emotional breakdown. ‘I’m no good at art,’ I told her bluntly. My self-esteem was at rock bottom. ‘You don’t have to be,’ she encouraged gently. ‘Just give it a try. You can leave any time you wish.’ Reluctantly, I accompanied her. If nothing else, it would make a change from staring endlessly at the bland walls of the psychiatric ward. Terry showed me a variety of materials and invited me to experiment freely with whatever took my fancy. I splashed paint onto paper and used a few pencil crayons, before opening a box of brightly coloured pastels. I made a few marks on a piece of paper, rubbing at them with my finger, idly watching the colours merge easily together. To my surprise it felt quite satisfying and absorbed my attention until lunchtime. The following day, I returned with a getwell card my sister had sent me. It depicted a sailing ship against the backdrop of a richlyglowing sunrise. I began using the pastels to copy it. I didn’t notice the passage of time, intent only on conveying the sensations stirred in me by this scene, totally immersed in the moment. Terry was generous with her praise for my efforts, but I could see only the bits that hadn’t worked out and took no pleasure in the result. I did, however, ask her if I could borrow some pastels and continue working on the picture back in my room. At least while I messed about like this, the long hours seemed slightly more tolerable. That evening, during visiting time, as my husband, Dennis, walked down the corridor

people

towards me, I held up my completed picture. ‘That’s amazing!’ he exclaimed. ‘Did you really do that unaided? I must get it framed.’ His encouragement was just what I needed to explore this medium further and over the next few months I persevered daily, working from the many photos he brought in. Gradually I discovered different ways of working with pastels to create the effects I wanted. I began to derive true enjoyment from blending the vibrant colours until I achieved the desired results. Dennis bought a scanner and produced copies of my art, which I used to brighten the bare walls of my small bedroom. Slowly, determinedly, I worked my way back to a somewhat healthier frame of mind, though it was a long time before I was able to appreciate any of my pictures the way others seemed to. Back home, Dennis, keen to build on the therapeutic effects my art was having on me and convinced of signs of a burgeoning talent, converted the tiny summerhouse in our garden into a miniscule art studio, complete with electricity. Twelve years further on, I retreat there to add to the hundreds of images I’ve completed

to date — sunsets, landscapes, seascapes and poppies being among my favourite sources of inspiration. Wherever we go I take my camera, ready to snap any memorable scene. And recently, I’ve taken up portraiture. At times, depression and negative emotions still feel overwhelmingly powerful and allenveloping. Yet when I steer myself towards my little wooden haven, turn on relaxing music, fill my diffuser with calming oils and mindfully put pastel to paper, my world becomes a blaze of colour. My brain focuses on exploring and developing new skills with a medium that holds increasing fascination with the passing of time. At that moment, nothing else is important. I’ve retained a childlike curiosity and excitement about pastels, the feel, the use, even the sight of them. Gazing at a vast array of every conceivable shade of each colour of pastel sticks and pencils in an art shop has much the same effect on me as a sweetfilled counter on a young child. Perhaps this is because I had never picked up a pastel before my breakdown, possibly it’s due to the fact that people appear to take pleasure in my creations and value my humble efforts. better

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Whatever the reason it’s something I can usually manage, even at my lowest ebb. There are days when, unable to focus my attention long enough to read, write or hold any sort of coherent conversation, I stay at my easel from morning till night in a universe where nothing other than my craft exists. The ability to concentrate on a piece of artwork whilst in an emotionally unbalanced state remains intact. The task is visual, spatial and non-verbal, it does not involve interacting with other people and can be tackled unaided. My son has set up a website for me and he delights in showing me positive feedback from people who know nothing about me and

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must therefore, he points out, have bought the work on its own merits and not out of pity as I’ve sometimes suggested. As I write, I have just received an email from a sergeant in the Royal Army Medical Corps, who was so happy with the ‘Poppies In A Cornfield’ picture she had bought and framed for a friend and colleague, that she is requesting another copy. In an extremely moving account, she explains how she and her friend worked in the Trauma Teams in Iraq and Afghanistan, dealing with horrific injuries to British soldiers and local civilians. On her return to England she suffered frequent panic attacks, was unable to work and is receiving ongoing post traumatic stress disorder counselling. The poppy picture, she writes, not only provides solace for her friend but has become a ‘shrine’ for herself. Contemplating the scene, she finds a degree of peace and at the same time is reminded of those whose lives they were unable to save but whose names she is determined to remember. She describes it as a tremendous comfort and says it is helping her regain her mental health. Packaging up a complimentary print to post off to her, I reflect on the important part art now plays in my life and the impact my picture is having on this brave woman’s recovery. What started as my therapy has now become hers. And it all began with Terry’s invitation to an occupational therapy session. When I emerged from several months in psychiatric care I had no employment, having taken early retirement from teaching whilst in hospital. I also had no self-confidence. I wasn’t even sure which planet I was on as I was still being highly medicated. Eventually, though, I weaned myself off most of the medication and felt able to organise and structure my thoughts more clearly. That was when I decided to write about how I had reached this point.

people My writing has invariably worked when I’ve drawn directly on personal experience. I once tried to write a short story about a woman trying and failing to conceive a baby; but with children of my own I could have no concept of how it must feel to be infertile and the result was totally unconvincing. I had, on the other hand, had success with writing about my experiences of living with haemophilia. Writing about this blood- clotting disorder enabled me to finally come to terms with the condition in my own child and help other parents in the process. What if I could now put pen to paper about my encounters with the mental health system? Perhaps it would go some way to dispelling the stigma attached to the diagnosis of borderline personality disorder that I had now acquired. Whilst writing about my feelings didn’t solve my problems it did help me clarify and understand them and develop a modicum of self-compassion. And I didn’t hold back. I wrote about my unhappy childhood and the self-harm that began at the age of twelve, I recounted my experiences over the years – good, bad and downright ridiculous – with mental health professionals. Then I recounted the painful process of letting go of the pain of my past and how I learned to cope constructively and mindfully with my powerful, often negative emotions and my self-destructive impulsive urges. In part, I began writing about my emotional difficulties in an attempt to break my long-held taboo of talking about my emotional problems. For so long I had felt compelled to keep my hurt hidden, my feelings of isolation, neediness, despair… locked away where no-one knew about them. I wanted other sufferers to know that they are not alone and I wanted to give them hope. During the past two years I have also been part of in-service training courses for mental health professionals, speaking freely about my encounters with the mental health system and talking about the importance of the therapist/client relationship. My input includes a no-holds-barred question and answer session. I set out to actively engage my audience, creating a shared experience, using mindfulness exercises and discussions about what constitutes excellent and poor practice. I have been heartened by the feedback which indicates an increasing openness on the part of professionals to think much more flexibly when treating their patients. 75

a personâ&#x20AC;&#x2122;s best friend Companion animals are not just fun to have around. They are also good for our mental wellbeing. Ruth Myers explains the benefits that pets bring to our wellbeing Since the beginning of time, humans have interacted with animals. Throughout history and in modern life, we have developed even closer relationships with animals, which has led to a deeper awareness of ourselves and others. Today, we have a greater appreciation for the positive impact that animal companionship can make on our health and mental wellbeing.

bonds beyond words For many pet owners, a relationship is formed which exists beyond words but speaks volumes. It is a language of trust, love and a deep friendship. Images in folklore and media commonly depict the unspoken but understood relationship between animal and human. But, just by watching the images or hearing the story, we understand that relationship. In Australia, we have the story of the dog who sat for days on his tuckerbox (Australian slang for lunch-box) awaiting his ownerâ&#x20AC;&#x2122;s return from a cattle drive. Americans saw the deep friendship between a boy and his dog in Lassie. The movie War Horse depicts the bond between a soldier and his horse. In the Italian folklore, Companions of the Forest, animals are teachers as well as companions. Even Michael Jackson sang about his beloved pet rat, Ben. We may not be able to describe the relationship that exists with our pets as well as we might want to. The closest

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we find could be, ‘my dog’s my best friend’ or ‘I love my cat’. But these are same terms we use with people. We often struggle to find the words to express the deep and unconditional relationship we have with our pets, other than to put it in human terms.

the impact of attachment

attachment relationship between ourselves and our pets. That sense of dependence and interdependence creates a boost to purpose and wellbeing. In some cases, the needs of our pet is what gets us out of bed in the morning and, sometimes, that all we need to move us through another day. At other times, the unconditional affection of a pet, the smile and excitement when we return home, is a much needed boost to our own happiness after a hard day at work.

The term attachment in psychology refers to the emotional bond and relationship style between significant relationships. Developmental psychologist John Bowlby reducing isolation (1907-1990) had an interest in examining the relationship between animal patterns In a paper written for the 2009 RSPCA of behaviour and the correlation to human Scientific Seminar, Maggie O’Haire states, behaviour, such as an infant’s cry to signal ‘Pet owners spend enormous amounts discomfort. His particular interest was of money, time and energy on creatures observing the impact of attachment of the that seem to give nothing in return – but mother-child bond and what occurs when companion animals do give a lot in return, attachment is severed or displaced. in that they can remarkably enhance human health and wellbeing’. Many hospitals and Animal behavioural scientists are looking nursing homes for instance, use Animal further into the theory of attachment Assisted Activities (AAA) to increase a relationship between animals and humans patient’s wellbeing and stimulus. Animal and its effect on the psychology, health assisted interventions and behaviour of are regularly to both animal and We learn about people assist the mental humans. But for through the care of our health and quality many of us, we are of life for persons pets already deeply aware with developmental, of the existence of better

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neurological, social and psychological impairments. Interaction with animals is successfully improves a person’s wellbeing is because it decreases isolation from others. Whether a person is in an aged care home, a hospital, or is feeling depressed – no matter what the situation is, an animal forces us to interact with others. From taking a dog for a walk, going to the vet, buying their food, looking after our pet increases social interaction with others and this could mean taking small steps at shifting our thinking and feeling positive.

you have a friend

how pets can help us recover from depression  reduces social isolation you’re often forced to interact with others when walking a dog  teaches you how to nurture  caring for a pet can help you learn how to care for yourself  gets you moving exercise such as brisk walking is known to lift your mood  companionship helps you feel connected to another living thing

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The positive effects of having a relationship with an animal are not isolated to hospital patients or the elderly. Many people talk of the happy and excited response from their pet when their owner returns home and we have heard the term “man’s best friend” to describe a dog. Whether we live alone, or as a family, our pets reduce our sense of isolation and help connect us to others. If we take a dog for a walk, we may say hello or strike up a conversation with someone. We share, we interact, we learn about people through the care of our pets. But this works both ways. Not only do we feel companionship, so too do our pets. They reward us with their loyalty and friendship and that look in their eye that says “I love you”. Public pet based events create a sense of community amongst animal owners, many of whom would never interact without the convenience of a pet to create an excuse to talk to one another. The global Bring your Dog to Work Day, Australia’s Million Paws Walk, California’s Annual walk with the Animals, Toronto’s Camp PawsWay for young animal lovers and London’s annual Pet Show are just a few examples. Many of these are simply community events, many other raise awareness and funds for animal welfare

wellbeing programs. Regardless of the purpose, getting out with our pets broadens our opportunity for human interaction.

caring for each other Feeling depressed can limit our drive to take care of ourselves. Normal routines may be neglected when the weight of depression consumes normal thought processes. Owning a pet often helps to us to push past negative feelings and maintain daily routines. If we are caring for our pet, we are more likely to continue to take care of ourselves. Pets, rely on us to provide their basic needs of food, shelter and security. The depth of the relationship is then increased when we offer love, attention and kindness, and in doing so, we develop compassion and respect for our pets and other animals. It is quite common for people living with depression to experience feelings of guilt and remorse. However, when we are able to think and feel deeply for others, including our pets, we are more likely to be compassionate, gentle and accepting of our own personal health and wellbeing.

Until one has loved an animal, a part of oneâ&#x20AC;&#x2122;s soul remains unawakened Anatole France

While writing this article I have thought a lot about my dog Charlie, who passed away nearly two years ago. When we took him to the vet, we made the decision to put Charlie to sleep. Before he was administered his final needle, I asked to have a few moments alone with him. Charlieâ&#x20AC;&#x2122;s eyes appeared sad, as if to say he knew what was happening, and he wanted to stay with us forever. Perhaps that was my perception; grief will do that when our love runs deep. I held him close and told him how much I loved him and thanked him for being such a special part of my life. We cannot underestimate the huge impact that our pets have on us and the value they have on our mental health and wellbeing. The unspoken language between humans and their pets is worth more than a Pulitzer Prize! 79

Ingrid’s Story Media producer Ingrid Raoul is living proof of the benefits of having a pet. About 17 years ago she was living alone, unemployed and taking a lot of drugs. "I was depressed, and had been for a long time. I wasn't interested in anything. I often couldn't get out of bed. I didn't eat much. For a long time I led a mainly nocturnal, hedonistic existence.” Ingrid says during this time a friend offered her a kitten saying the creature would otherwise be sent to an animal shelter. "I'm not sure what made me do it but I decided to take the kitten, even though I wasn’t sure I could look after him. From the moment I said “yes” and took him home, I was committed and things began to change.” Ingrid says caring for the kitten, she called Tybalt, meant she was forced to live in a way she hadn’t for a long time. She started getting up in the mornings to feed him, she left the house during the day to buy cat food and she began to interact with people she usually wouldn’t, such as vets. She says her self-confidence improved and she felt more respected by others because she now had a purpose. Almost immediately her attitude to herself changed. “I started caring for myself as well as the kitten. Looking after him showed me I could care for myself as well as others as well as others.” And the changes had a greater impact. “A couple of months after I got Tybalt I actually went and sought professional help for my depression”.

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Lauren’s Story For Lauren Woodfield, an Executive Assistant, her Groodle, Benson, made an enormous difference when she suffered both a redundancy and a significant health problem. After seeing GPs and naturopaths for months because of stomach pains and bloating she was eventually diagnosed with a benign ovarian tumour. “I’d only just got married,” she says. “Until we knew how much the tumour had affected my reproductive organs it was extremely stressful.” “Then we got the puppy. And even though I felt I’d lost a part of myself, having Benson helped so much. He was so fun, loving and sweet. He was just always there. He brought me back down to earth and kept me going.” We know that forming loving and kind human relationships is important in alleviating depression. We also know that the bond between people and their pets can have a vital role in nurturing ourselves and even leading us out of depression. Lauren believes that, even as a puppy, Benson seemed to recognise when she was stressed or sad by lying next to her prodding her with his nose. “I believe they pick up on how you’re feeling,” she says. “And you can’t ignore them, you have to get up and go for a walk and look after them. When I was made redundant my boss was really nice and said ‘go home and sit on the deck with Benson and have some ciders.”

the joys of

FOOD

In the same way that the right food can improve our mental health, the wrong food can adversely affect it. 82

Most people know, suspect, or have been told that health and mental wellbeing are improved by eating well. Fresh fruit and vegetables, small portions of lean or white meat and fish, nuts and whole grains are all good for our health. But we need to look a little deeper to understand whatâ&#x20AC;&#x2122;s inside food and how that impacts us. our complex body Biochemistry is a terribly complex subject handled by terribly smart specialists. But, in very simple terms, also called biological chemistry, it is the study of the chemical processes in living things. It deals with things such as proteins, carbohydrates, amino acids, fats and the

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effects they have on biochemical activities and metabolism. In the same way that biochemistry has been used to better understand medical conditions, it is also important to mental health. Research has shown that, during a depressive state, biochemical changes do occur in our bodies. These changes include a reduction of vitamins such as niacin (vitamin B3) and an increase in free radicals (which have been linked to cell breakdown and aging). By eating foods that have the right types of proteins, oils, amino acids and carbohydrates, we can significantly affect our mental health. Note the key word ‘affect’ — eating the right foods will help improve mental health and increase the benefit of other treatments, while eating the wrong foods will adversely affect mental wellbeing.

the good in good foods Fat is bad, right? Carbohydrates are bad? Protein is good? Chocolate is bad? Fish is good? Dairy is… who even knows? As incredibly broad generalisations, most of these assessments are true (except perhaps dairy, about which everyone has an opinion). But when we look a little more closely, the generalisation can be quite harmful to mental health. Instead, we should know what’s in particular foods and the effect they will have. Nutrients improve our body’s wellness, repair and growth. Foods high in vitamins B1 (thiamine), B2 (riboflavin), B3 (niacin), B6 (pryidoxine) and B9 (folate or folic acid) are ideal. These improve methyl metabolism, which improves healthy cell

regeneration, which has been linked to reducing depression. Similarly, a lack of these nutrients can worsen depression and feelings of wellbeing. Brown rice, whole grain oats, cabbage, bananas, avocado, soybeans, broccoli, beef and chicken are some of the highest sources of these nutrients.

we should understand what’s in particular foods and how that affects us Fats are an essential part of our diet. But not all fats. Unsaturated fats, particularly polyunsaturated fats are “good fats”. Omega-3 fatty acids are polyunsaturated fatty acids that, amongst other things, build the brain’s cell membranes, which helps reduce depression. Research has also suggested links between low levels of omega-3 fatty acids and increases in depression. The scientific and medical communities are not absolutely certain that omega-3 fatty acids may have a direct link to depression, particularly on its own. However, as part of broader treatment and a healthy diet, research results have been encouraging. Our bodies cannot create omega-3 fatty acids, so we have to ingest them through food. Fatty fish, such as salmon and tuna, walnuts, canola oil and flax seeds are excellent sources of omega-3. Amino acids are the building blocks for proteins, which are essential to the body’s better

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development. While there are many different forms of amino acids, the most relevant to mental health is tryptophan. This helps promote sleep and reduce anxiety, panic, obsessions and depression. It also affects serotonin levels, which are the neurotransmitters relaying messages through the brain, and linked to mood and depression. Foods high in protein are typically rich in amino acids. These include eggs, meat (beef, lamb, chicken), tuna, quinoa, soybeans and dairy. Antioxidants help neutralise free radicals. These can reduce mental functioning by oxidising cells (think of it like your brain cells rusting), so they should be neutralised, and that’s what anti-oxidants do.

omega-3 fatty acids may have a direct link to depression Foods rich in antioxidants include pecans and walnuts, cranberries and blueberries, beans and artichoke hearts, lean meat, onions and garlic, tea and red wine (in moderation, of course), fresh vegetables and (the good news) dark chocolate. While raw cacao beans are better, dark chocolate with a high cacao level is also good – and chocolate is a recognised “feel good” food.

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Good foods gone bad For some time, “junk food” has been linked to depression. It’s not necessarily that the food in “junk food” is a problem. Fish and potato (chips) are good for mental health and the protein and iron in the meat of hamburger patties is especially good. The issue is more about the way the food has been prepared. Typically, “junk food” is high in trans and saturated fats which, unlike “good fats”, have been linked to depression. A white hamburger bun is usually high in processed sugars and white flour, which are less than ideal carbohydrates. If you love your takeaway food, think twice about what you order. You don’t necessarily have to stop completely, but reduce the fried food and mass produced food. If you’re particularly sensitive to what’s inside the food, perhaps avoid takeaway food and stick to foods where you know what’s inside.

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Expert Advice The simple things about diet and nutrition just make sense: eat more fresh fruit and vegetables and lean meat or legumes. Other details, such as the impact of particular foods on medication or other treatments, can be far more complex. When combined with additional conditions, such as diabetes, Alzheimer’s disease, heart or other organ disease, or allergies, it turns into a complicated topic to address safely. If you want more information about your diet and the impact on depression or other mental health and medical conditions, seek professional advice. Start with your doctor or an accredited practising dietician or nutritionist.

ental health caution!

If you’re inclined to search the d internet for information on foo e sur be ’ll you and depression, lly to find articles with wonderfu od ‘Fo as h suc promising titles, ods to cures for depression’ and ‘Fo n’. beat depressio acle These sound like fantastic mir or g din cures, but can be mislea even negligent. If you have, or suspect you have, depression, seek the advice of a medical practitioner.

While diet may help reduce ere depression, even to a level wh is it l, ima the effects are min on its unlikely to be a miracle cure ents atm tre of n own. A combinatio . may be necessary

playing mind games experts say that a daily dose of your favourite puzzle, quiz or card game can boost brain activity with far-reaching benefits fiona marsden

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Think back to your childhood, when you pored over jigsaw puzzles, played Monopoly or Scrabble, and learned basic card and memory games. While it may have seemed like you were having harmless fun, experts say you were doing much more. You were laying down connections between brain cells and, potentially, creating a hedge against the effects of dementia and other age-related brain changes.

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giving nature a helping hand “As you get older, it’s natural to experience some decline in cognitive processes like memory, concentration and problem solving,” says Debbie Anderson, a Brisbane-based neuropsychologist in private practice. (Neuropsychologists specialise in assessing and treating brain function). “However, research has made a strong case that cognitively stimulating pastimes, coupled with good general health, are significant factors in adding to what’s known as cognitive reserve”. Essentially, this means that mind-based activities, such as puzzles, board games and card games, activate your brain’s networks and build up a kind of buffer. This means that when your brain begins to experience age-related deterioration, you’ll be less susceptible to its effects. The good news is that it’s never too late to harness the benefits of playing mind games. One 2010 US study found that participating in mentally stimulating activities at age 40 was more important than a person’s level of education in determining later-life cognitive reserve.

build a buffer against the effects of age-related brain changes 88

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creating social connections What about mind games you play with other people? Does playing Scrabble, bridge or chess deliver more benefits than solo pursuits like crosswords or Sudoku? According to Anderson, playing in a social setting doesn’t necessarily benefit your brain function any more than playing alone, but it can boost your state of mind. “Participating in mind games with others ensures you’re not only mentally active, but socially engaged,” she says. This may have an indirect effect on brain function. A 2010 Irish study of people over 65 showed that loneliness and proneness to boredom were associated with reduced cognitive function in their later years. Anderson adds that playing socially may temporarily alleviate some effects of stress, anxiety or depression. “It can help you see that there’s something else in life,” she says. “You may not be talking about your problems as such, but by simply communicating with others, you can achieve a more positive frame of mind.”

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living in the real world Playing mind games can be valuable for children, helping them learn the rudiments of acceptable social behaviour such as patience, communication, showing respect, taking turns and applying rules. Mind games can also have an educational value. In 2008, a US study found that playing numerical board games increased pre-schoolers’ proficiency in skills like counting and recognising numerals. When it comes to online games, the message is a little more mixed. Anderson points out that some of these games have a positive social

message that encourages planning and helping other people. However, she acknowledges parents’ concerns that the time young people spend on online games is time that could be spent on reading, schoolwork or outdoor activities. “I’m also concerned that when children and teenagers socialise online instead of face-to-face, they miss out on nuances like facial expression and non-verbal communication. Spending a lot of time online could create an unrealistic kind of social interaction.” Above all, have fun! “Stick to activities you enjoy,” says Anderson, “so you won’t become discouraged.”

top mind game tips If you’re budget-conscious, accessing mind games needn’t be expensive. Try crosswords, find-a-word puzzled and Sudoku books, or solve the puzzles in your favourite newspaper or magazine. You can also access mind game websites and apps through a computer with an internet connection, or a smart phone. If you have children, make mind games an opportunity for social interaction. Encourage regular family board game nights, watch quiz shows, or work on a jigsaw puzzle together. Participate in radio quizzes to keep your brain ticking over, or enrol in a daytime or evening course to learn a game like chess or bridge.

getting started You don’t need to spend hours playing mind games to build up your cognitive reserve. According to neuropsychologist Debbie Anderson, 20 to 30 minutes is enough to reap the benefits. “The main thing is to do it regularly, daily if possible.” Making this commitment is a bit like starting a physical exercise program. “Challenge yourself,” says Anderson, “but don’t overwhelm yourself. Start at a level you can be successful with (for example, a lower level Sudoku) and then work up.” Since different mind games activate different aspects of your brain function, it’s a good idea to play a wide variety. “Something like Sudoku requires a lot of concentration, because you have to think about all nine numbers at once,” Anderson says. “Solving crosswords pulls information from your memory banks, whilst board games and card games can boost strategising skills.”

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connect

Victoria Over the past ten years, Victoria has used her personal experiences to support students with their own mental health. With qualifications in psychology and socialogical criminilogy, she has a keen interest in the social, emotional and legal impacts of mental health. Victoria tells us how she has learnt to manage her own disorder.

Through understanding her own disorder, Victoria has provided support to school and university students in learning to manage their own mental health and wellbeing

I have tried to write this piece about myself several times now over the last few months. It doesnâ&#x20AC;&#x2122;t seem like much, really. A thousand odd words to explain yourself and your own mental health condition. Easy enough, you would thinkâ&#x20AC;Ś but not quite. A few years ago it would have been easy. I wrote an online blog about me, my condition and how it

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affected my life. For nearly two years, anyone on the internet could read about my highs and lows and all the bits in between. Back then, a thousand words was nothing. But there was a difference, one big difference to having to do it right now. Back then, I was totally anonymous. I had a pseudonym that allowed me to write about my life

was actually necessary, shouting at those closest to me and feeling completely lost. One evening friends found me in the street not making much sense. At the time, I thought it was just something that eighteen year olds went through. As I got older and all these things — and more — continued to happen I could no longer deny that

“ I found myself crying for no reason ” and my work and my condition, and now I am trying to write about me as me and I’ll admit, I have struggled. Don’t get me wrong. I’m not ashamed of my condition. It has actually helped me a lot in the last sixteen years. Although I didn’t get a full diagnosis until 2008, when I was nearly thirty, I had known there was something different about me since I was 18. I found myself crying for no reason in supermarkets, not sleeping for weeks on end, drinking more than

something was a little amiss. I couldn’t find any help so, like a lot of people, I learnt to live with it. I learnt my own stress points, I learnt to notice and react to my own signs — pacing, changes in speech patterns/ pitch/tone, wringing my hands, feeling lost or scared, sleeping more or not sleeping enough. I learnt to manage the episodes of highs and lows that followed on a regular basis. I managed to learn a lot more about who I was and better

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who I was becoming by understanding my own patterns and regulating my moods with no medical input and no real support then or since. It hasn’t been easy and I will admit that I don’t always cope so well. In fact, at times, I describe it as being in hell, but I have dealt with this myself and dealt with all the problems that it brings to me and everyone else around me. It has strangely supported me so I could help others at times in their lives when mental health was a dark and frightening place. While working in schools, I was able to assist children as young as fifteen who were going through the early stages of depression in an already stressful environment. When working at University, I was privileged enough to be able to guide young adults in often worrying situations by sharing my own experiences and explaining to them what may be happening in their own head. It has been extremely helpful to other people and I can say with certainty that I wouldn’t be who I am today without it, nor would I have been able to support as many as I have if I was ashamed. But has that made writing this any easier? No! It doesn’t help that I have what is cosidered one of the ‘scary’ conditions, Cyclothymic Disorder — which you have to admit sounds scary as well as a bit of a mouthful. It is considered scary 94

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because there is no ‘neat box’ in which you can put the symptoms, neither manic or full depression, neither constant or timed, they come and go, they can last hours/days/weeks and explode out of nowhere. It is a condition that is neither considered ‘normal’ or necessarily identified as bipolar disorder, so it can go undiagnosed by medical professionals and unrecognised by families. They often think it isn’t strong enough to be a mental health problem and it could be confused with someone being just very moody. I do know that it’s difficult to explain to someone else how it truly affects you, and I know from personal experience how hard it is for a loved one to be able to ‘help’ you when you can’t tell them what’s wrong or what to do — like many mental health issues. So did that make it any easier to say to write? No! Despite the current exploration of mental health, the current studies by governments and funded by organisations, and increased media exposure, it’s still one of the lesser known conditions. Mine is still something that is left out of most mental health work because it’s not severe enough. Does that then mean that I don’t have a mental health issue? No. I have a mental health issue which, for me, is difficult and painful and dark. Yet it is

people

also joyful and intriguing and helpful to others. So does that mean I have the courage to tell my family and friends about it as me? Unfortunately, no. Despite that, I am not ashamed of my condition. I’m proud that I have been able to help people on the start of their own journey. I’m proud that I am better able to manage my condition on my own as the years progress. And I’m proud to say that I understand myself a little better every day. But am I able to say that to other people as me and

a brief look at

I understand “myself a little

better every day

”

not just a name on the internet? Not in a thousand words, it would seem. And maybe still not in person. But I guess this is a good a start as any. I am me and I have a mental health issue, so deal with it because I know I am.

Cyclomythic Disorder

People with cyclothymic disorder have periods of dysthymia (or depression) and hypomanic episodes (elevated moods and activity). This puts cyclothymic disorder within the bipolar spectrum category in the DSM-5. These mood changes impact a person’s ability to lead a stable life. This will often impact relationships, work and career, maintaining enthusiasm for personal activities, and sleep patterns. In some cases, it can progress to bipolar disorder. It is only diagnosed as cyclothymic disorder if the symptoms for similar disorders, such as schizophrenia related disorders, are not more appropriate. However, if the symptoms can be attributed to something else, such as a

physical ailment, it is less likely to be diagnosed. Some people are also more likely to have sleep disorders or attention-deficit/hyperactivity disorder at the same time. While the disorder is diagnosed more often in women than men, this is possibly because more women than men seek advice, as it is considered to be as common for men as women. It is considered to affect 0.4 to 1 percent of the people. Cyclothymic disorder can be experienced by adults and children. While it can be difficult to identify, it is also difficult to live with. Acknowledging the symptoms, seeking early advice and sticking with treatment can help make it manageable. 95

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catching

zzzs

for mental ease

research shows that enough quality sleep contributes to

better mental health adrienne gross better

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What’s free, available to everyone and leaves you feeling refreshed? Okay, you might have been thinking of something else that goes on the bedroom, but the answer is actually plain-old-cotton-socks sleep. getting physical We’re supposed to spend a third of our day in the land of nod but, for many that’s as decadent as a day spa. On the physical level it’s not until our body shuts up shop with the flu or some other ailment that we allow ourselves bed rest. Indeed, why should we spend a third of our lives with our eyes closed when that time could be better spent earning money or having fun? Because, in the long term, sacrificing those eight hours has a positive affect on the other sixteen. The physical effects of lack of sleep, or sleep deprivation in extreme cases, can be obvious and not at all pretty. These could include baggy eyes, lack of concentration and increased likelihood of weight gain, becoming sick or having accidents. However, lack of quality sleep also affects your mental health in both the short term and long term.

almost 1 in 5 people sleep less than 6 hours a night

According to a sleep study released by the George Institute for Global Health, young people who have less than five hours sleep per night are tripling their chances of developing a mental illness compared to those who experiencing eight to nine hours. As for adults, chronic sleep disruptions lead to negative thinking and emotional vulnerability. The answer is clear: better sleep can help you with your mental wellbeing.

why don’t we sleep enough? The amount of sleep a person needs depends on a range of factors, such as age, gender, and lifestyle demands. Typically, adults should aim for seven to eight hours, and young adults should aim for eight to nine hours, of quality sleep a night. And yet, almost one in five people sleep less than six hours a night.

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The main reasons why people donâ&#x20AC;&#x2122;t sleep enough include: Parenting. A new baby typically results in 400-750 hours lost sleep for parents in the first year. While new parents may not even notice the loss of sleep or broken sleep each night, it adds up â&#x20AC;&#x201D; and just wait until the little darling starts teething! Sleep disorders. In many western countries, around 10% of adults experience sleep disorders, such as insomnia and sleep apnea. The International Classification of Sleep Disorders recognises 88 abnormalities relating to sleep. Distractions. The ever-increasing availability of modern distractions, such as the internet, social networking, television, gaming, radio, and work accessible on your phone, give us plenty of reasons to resist having an early night. Existing mental health disorder. Sleep problems are particularly common in patients with an existing mental health condition. These include anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder.

consequences of poor sleep So, is poor sleep a cause of mental health problems or a symptom? This can be affected by a wide range of factors, such as a personâ&#x20AC;&#x2122;s personal situation or mood at a particular time, general health, other stressors in life, or existing conditions. Whether to prevent or reduce mental health problems, better sleep is the key to mental wellbeing. The short-term effects of poor sleep on mental wellbeing include increased likelihood of: becoming depressed and then more likely to stay unwell over the next twelve-month period thinking more about suicide and dying by suicide, if someone with depression, than those who are able to sleep normally having poor performance at work, with 44% of employees surveyed in research responding that they were likely to be in a bad mood at work as a result of poor sleep.

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The long-term effects of poor sleep on mental wellbeing include increased likelihood of: developing major depression, backed by a study which found that where people reported a history of insomnia, they were four times as likely within three years to develop depression than normal sleepers. retaining and increasing negative emotions, memories and thoughts preventing people with post traumatic stress disorder from benefiting from fear-extinguishing therapies.

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sleep improves mental wellbeing Good quality sleep improves mental wellbeing in prevention and treatment. But how exactly does that happen? In a Harvard Health paper, the authors describe how the deepest stage of quiet sleep produces physiological changes that help boost immune system functioning. For the mind, the stage of REM sleep (that’s when you dream) enhances learning and memory, and contributes to emotional health. Studies have also discovered that sleep disruption affects levels of neurotransmitters and stress hormones, which in turn affect the brain by impairing thinking and emotional regulation. Sleep can also help prevent and reduce the effects of mental illnesses such as depression and bipolar disorder.

having better sleep Research shows that that quality sleep is good for your mental health, but for most people, getting more sleep, and better sleep, is not as easy as it seems. You may not have control over children waking you up, or loud neighbours deciding Tuesday night is perfect for a noisy party. However, there are actions you can do to sleep better. Having good quality sleep may mean making lifestyle changes and, if necessary, applying behavioural strategies, psychotherapy, and perhaps medication. Cognitivebehavioural therapy (CBT) has been shown to achieve a 70–80% success in improving the sleep for people experiencing chronic insomnia. When simple lifestyle changes don’t improve sleep, then it’s time to visit your doctor for advice or referral to a sleep specialist.

lack of quality sleep also affects your mental health in both the short term and long term

Whether your interest in sleep is to prevent mental illness or to treat an existing condition, good quality sleep can help you achieve mental wellbeing. Take the actions that suit your lifestyle to achieve quality sleep. 101

Improving Your Sleep daily schedule Morning Switch to exercising earlier in the day, or at least more than 3 hours from bedtime — and if you don’t exercise at all, think about starting! It’ll tire you out making it easier to get to sleep and have a deeper sleep

Six hours before bed No more caffeine, and that includes tea and chocolate.

Two hours before bed Eat a small, light dinner, which means no ingredients such as cream, fat, sugar, and chilli. While alcohol might help you get to sleep, you’ll wake up too soon. For smokers, your last nicotine fix should be no later than this time.

Half an hour before bed Write a list of your tasks to do and any worries you have, so they’re not clogging up your mind

Bedtime Try to make your bedroom as dark and quiet as possible and with a moderate temperature This should be between 18 – 30°C, adjusting to 23 – 25°C for older adults. Make sure you have a light but warm blanket.

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making time to sleep

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Ease into your new sleep pattern by going to bed 10 minutes earlier each night for a week Go to bed when you’re tired instead of watching TV or reading, as these activities keep your mind active and bombarded by stimuli Any change won’t happen overnights, so give yourself at least 30 days to notice a change in sleep pattern. Behavioural changes, also called ‘Stimulus Control Therapy’, can be applied with the assistance of a trained therapist Set your alarm and get up at the same time every day, even on weekends! Don’t nap during the day until you have established a regular sleep pattern Try to use your bedroom for sleep (and other bed related activities), not for reading, televisions, exercise, or work Try to get to sleep within 20 minutes, but if you can’t, then get out of bed and return when you are sleepy

still need help? Meditation: Breathing exercises and imagining a calm scene can help you fall asleep. While playing music may help you relax, it can also discract an already busy mind. Try a relaxation or meditation CD or even take a meditation class.

CBT: Not being able to sleep can increase

Natural therapies: In teas, infusions

your doctor about temporary medical solutions for ongoing sleep problems. But be aware that some sleeping pills, such as barbiturates, can actually suppress REM sleep, which may be harmful over a long period. They also tend to lose their effectiveness within 3–14 days of continuous use.

and baths, try Valerian, Passionflower, Jamaica Dogwood, Chamomile are a few of the various herbal remedies for insomnia. Note however that some remedies should not be used while pregnant or if you have depression, and can interfere with some medications, so check with your doctor.

stress and anxiety, often worsening the situation. Cognitive behavioral therapy is a possible option. Going to a therapist can help people with insomnia adjust their behavior to feel confident about their ability to fall asleep.

Prescription medication: Talk to

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Mental Illness is not a dirty word... In a world where labels matter, Robyn Hall redefines mental illness instead of letting it define her.

I am ready to tell this story. It’s possibly a good idea to grab a coffee and sit down. I’m afraid of the dark. I’m not ashamed to admit it. Ever since watching The Sixth Sense, I’m uneasy when alone and low on light. Donnie Wahlberg cuts a sobering image: naked except for a greyish pair of sagging y-fronts, quivering and hunkered, cloaked in despair as he hisses ‘Do you know why you’re afraid when you’re alone? I do; I do.’ Don’t get me wrong; I don’t see dead people. But I do feel stuff, I feel a lot. Sometimes, when I need to pee in the night, I look to every gloomy 104

corner, expecting to see a dark figure, motionless, watching me stumble around with a full bladder and terrible night vision. There is never anything there, but it doesn’t stop me from looking every single time. I’m also afraid of space. I’m much more afraid of space. I don’t mean just, like, the space underneath the tallboy, with all the pet hair dust bunnies, odd socks

sense of despair “ Thewas tangible ”

people It started when I was a little kid. I would lie in bed and try to wrap my brain around space. I would think about our solar system, and then what contained that, and then what contained that, and then what contained that. Then my brain would pop and I would gasp, feeling all of a sudden very very very small, and I would shake my head to get the thoughts out and start all over with something much more manageable, like the TV show Monkey and whether Tripitaka was a boy or a girl. Ever since then, I hated learning or thinking about space. I imagined being out there and something catastrophic happening. I imagined myself being separated from my pals and floating off into nothingness, nothing to grab hold of, no possible way to claw myself back. I would die alone, cold and without any books. It wasn’t the first or last time I’ve been afraid of being alone. This is Robyn – this is me!

and a dog food can that rolled under here after Bettie the bulldog stole it from the recycling and licked it clean. I mean the space that you can only visit with a rocket, that place where nobody can hear you scream. I’ll be the first to admit it; it’s a stupid fear. I know that. The chance that in my lifetime someone will force me to go into space is ridiculously minute, yet the thought of feeling the effects of a complete lack of gravity and seeing the earth in its entirety makes me feel sick to my stomach. Yuck.

All my life, I’ve been very different from everyone else. I know it. I’ve felt it, I’ve been told it, and I’ve revelled in it. I learned to be not only ok with it, but very proud of it. I’m actually quite proud of the fact that I’m able to be proud of it, because it has been a very challenging state of mind to achieve. Being a bit odd, individual or unique is one thing, but the day a doctor slapped a label on it became quite another. ‘You have moderate depression and stress, and extreme anxiety’, he stated without any perceptible element of emotion, ‘I will give you some medication for this.’ So he sent me off with a prescription in my hand and a big fat cloud bobbing over my head. better

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I went home in a daze, collapsed on the bed and cried my eyes out, repeating ‘I don’t wanna have depression’ over and over. The first thing to surprise me was the way my partner reacted. She told me that having depression and anxiety, to her, is the same as having asthma and that as long as I learned how to manage it, it shouldn’t be a problem. So, I Googled. I Googled depression, I Googled anxiety, I Googled Prozac

were the days “ There I couldn’t get out of bed except to pee ”

and then I Googled cats that say ‘oh no no no no’ just for good measure. I feel a certain kinship with them now; since wandering into this depression caper I have found myself chanting that same melancholy mantra from time to time. Allow me to describe a little of what I went through before finally going to

see a doctor about my behaviour… I’d always been a bit strange. Many people who know me would probably be surprised to find out that I have had — at certain times in my life — a nasty temper. I’ve never taken it out on anyone else, but I sure have punched a lot of stuff. I’m not proud of it; neither am I ashamed, as I understand it now. I’ve punched walls, doors, windows, fences, tables, cupboards, cars, dirt, beds, water, a fridge and my own face. The most painful one is the face, ‘cos that hurts both your fists and your face. The second most painful was the time I punched a shop front window and broke my hand in two places. The least painful was actually the fence. You might be reading this and thinking ‘Why would you punch stuff? Were you drunk?’ Yes, sometimes I was. Sometimes I wasn’t. The common denominator isn’t alcohol; it’s frustration.

This is my partner, Mercedes – with me! 106

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My frustration came from all sorts of things, and for the most part, I felt like it was somebody else’s fault. As it turns out, it was completely mine. This year, it all came to a head. This year was definitely the year for punching my face. It’s the weirdest thing. If I was having a confrontation with my partner, and I felt like it was going nowhere and nothing was being resolved, I would notice a feeling of helplessness

people creep in like rolling fog, silent and sombre, somehow quite final. The sense of despair was tangible for me, and it built up very quickly, like a filling bathtub. You keep checking and checking it and it’s nowhere near deep enough and then all of a sudden it has overflowed and a river is running through the house carrying all sorts of debris in its current. I would be very calm and quiet and then all of a sudden BANG it was too much to handle and my fists would be flying at my own face. It was like a pressure release and a ridiculous malfunction at the same time. I felt very small inside my mind, like a shy child hovering at the back of a room, as some awful invisible puppeteer turned my own body against itself. I imagine it was quite scary to see, and thankfully it always signalled the end of the fight, because my partner couldn’t stand to let it go on. So there was that. Then, there was the endless striving for perfection and the endless guilt because, naturally, perfection is never actually realised. There were the days I couldn’t get out of bed except to pee. There were the days I forgot to eat. There were the times that I would suddenly find myself wedged into a corner, scrambling to become as small as possible, covering my head and screaming for my partner to get away from me until my voice was hoarse and I could scream no more. So, yeah, it was less than ideal. I felt crazy. I felt very unlike myself, or at least the impression of myself that I had come to believe. All my partner said to me was ‘I

don’t care what’s going on; we can get through it together. It’s only going to be a problem for me if you don’t go do something about it.’ So, I did, and thus began my conscious journey through mental illness.

if we changed “ What mental illness to

emotional difficulty?

”

The first thing I had to do was wrap my brain around what it meant to have a name for what I was feeling. I hit a hurdle immediately when I was doing this reflecting. I found myself wondering why I had to ‘wrap my brain around it’ at all. When I was constantly feeling sick in my tummy, I went to the doctor to get to the bottom of it. After many unsavoury tests, they told me that I had IBS and that my intestines had trouble processing sugars. I was glad to know that, because then I knew how to stop the pain in my belly, end of story. Why was I so intent on ‘wrapping my brain around’ mental illness? Why was it even an issue? I had an explanation about why I was behaving so strangely, now I had to start to work towards addressing that behaviour. Why was I worrying about telling my family, my friends? Why was I worried about my roller derby team and league finding out? Why was I worried about my reputation? Why was I okay with my sporting mates knowing I suffered from asthma but not quite okay with 107

“

Mental illness is not a dirty word, but ignorance is

”

telling them that it was actually, more accurately, twenty-five percent asthma, seventy-five percent anxiety? The only answer I could think of was that there is a generally-held view by a lot of people that having a mental illness is somehow taboo. The more I thought about this and the more I learned about depression, anxiety, PTSD, ADHD, bipolar disorder and many other things, the more it irritated me. The fact is, anyone, anyone has the capacity to feel depressed or anxious. Why is it that when a label is applied to it as a ‘condition’ or ‘affliction’ instead of simply an emotion it’s a whole different kettle of fish? Imagine a person who identifies as ‘perfectly fine’, with no physical or mental health issues. Imagine their parents die in a horrible car crash. Imagine their partner leaves a week later. Imagine all of their hair falls out from the stress. So preoccupied with everything going, they trip on a crack in the sidewalk, face plant, chip both front teeth, and discover their health cover actually doesn’t include dental. That person may feel depressed, and rightly so. It would be weird if they didn’t. And take anxiety. It’s a perfectly natural emotion. Imagine you are snorkelling and you look up to see a big black fin 108

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approaching. The feeling that hits you first would most likely be anxiety. So why is it that if it’s simply an emotion it’s okay but as soon as someone is diagnosed with a mental illness, it’s a very serious, mysterious and scary thing? That’s not a rhetorical question; I don’t know the answer and I’m asking you why. In my case, it seems that a few things were going on. Apparently, my serotonin reuptake function was on the fritz and was whipping away all my delicious happy juice too quickly. Enter Prozac, one of many serotonin reuptake inhibitors on the market. Also, I had developed a couple of behaviours in childhood that had become so ingrained in my psyche that I had no idea they were ruling my life with an iron fist. Enter my shrink — a person with years of training in psychology — who helped me to identify these behaviours and reorganise my thinking. Enter my recovery. He reckons I won’t need to be on medication forever, but even if I do, I decided a long time ago that I don’t care. Like a person whose pancreas doesn’t produce enough insulin, if my brain doesn’t balance things properly and I need a little help to regulate it, then hurrah for the twenty-first century. As far as I’m concerned, I don’t feel ‘ill’. I didn’t feel ‘ill’ when I was stuck in my bed and afraid I was going to be sent to an asylum a la American Horror Story and be skinned by Bloodyface. I just felt that something was not right and that I needed to figure out what it was. So, is

people it the term itself? Is it hearing the words ‘mental illness’ that makes people edgy and triggers them to wonder if the person in question is going to have a psychotic episode and chase them down the street, all flailing arms and banshee wail, wearing undies on their head? It seems so extreme to me. Mental illness… I feel like for me, and potentially lots of other people, it’s not so much that I’m ‘mentally ill’, but much more like I’m ‘emotionally confused’. The term ‘learning disability’ was changed to ‘learning difficulty’. Why? Essentially they mean the same thing. Was it because of the stigma attached to the former? What if we changed ‘mental illness’ to ‘emotional difficulty’? Would society as a whole be a little calmer about it? Would consumers be more ready to admit what they’re feeling to their friends, colleagues and families? It isn’t going away, and I’m ok with that. I know that my asthma will always play up depending on the season. I know that my stomach will hate too much sugar and milk forever. I know that if I don’t give myself at least the simplest of routines, I’m prone to suffer a lack of motivation which, unchecked, can easily creep into depression territory. What I’m not ok with is meeting people every day who are hesitant to admit that something’s going on because they feel that to admit it will change things forever and hold them back. All it would do is ensure that they are more in touch with their own bodies and personalities.

Roller derby Robyn - that’s me!

I hate space. So, I went and saw Gravity with Sandra Bullock and the delightful salt and peppery George Clooney. I was petrified. I shook and gripped my partner’s hand so tight she went ‘ouch’. But I got through it and only looked away from the screen twice. I’ll go back to see it again, just for good measure, because I am stronger than my fear and I am stronger than a label. Mental illness is not a dirty word, but ignorance is.

Robyn is a Peer Support Worker, studying her PhD in creative writing and believes that writing is invaluable for self-reflection and healing. She lives with her fiancé, three dogs and two cats. She loves to work on their house, write, draw, play roller derby and be tattooed. She has been diagnosed with Depression and Anxiety with elements of social anxiety. She has a weakness for killer pythons. 109

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Exercising your right to better mental health While the physical health benefits of exercise are well documented, less emphasis has been placed on the benefits to mental wellbeing. Being physically active can enhance mood, promote feelings of wellbeing, boost libido and improve overall quality of life. While some conjecture remains, the majority of health professionals feel that exercise can have a positive impact on both mental resilience and specific mental health conditions such as depression and anxiety.

Exercise each day can keep both your doctor and your psychologist away Lynn Gunning better

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improving your self-worth Exercise can reduce weight, boost fitness and build stronger muscles. What is less well recognised is the improved self-confidence and ability to think more clearly and effectively that flows from being active. Professor Debra Rickwood from the University of Canberra has a strong interest in promoting strategies that build strong mental wellbeing, including physical activity.

I take a brisk walk most days. When I don’t do, it I feel terrible

“The mechanism by which exercise works is not established,” says Rickwood. “Trials show there are beneficial effects of exercise, some directly, though more likely indirectly. Exercise leads to an increase in serotonin levels in the brain, which has a similar impact as anti-depressants. Vigorous exercise releases endorphins. Exercise is effective in treating and alleviating mild or moderate depression”. “Exercise can reduce other risk factors, too. It helps with sleep, it has a distractive or meditative effect, helps increase energy levels and it provides people with structured activity in the day. By exercising, many people feel more in control — which is inherent in reducing feelings of helplessness. Often, they are so immersed in the activity that they don’t think about the things that are concerning them,” Rickwood concludes.

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the impact of exercise Stress relief is a key benefit of regular exercise. Many people feel this ‘time out’ from their daily lives is both an opportunity to burn off daily frustrations and a way to work through challenging issues. Some consider their workout a form of meditation; time to switch off and focus on breathing or the rhythmical movement of arms and legs. Serotonin is an important neurotransmitter chemical in the brain that contributes to a range of functions, including the sleep/wake cycle, libido, appetite and mood. Regular exercise, and the resultant increase in physical fitness, alter serotonin levels in the brain and can lead to improved mood and feelings of wellbeing. In this way, exercise can act as a form of anti-depressant. Exercise promotes the release of ‘feel good’ chemicals in the body called endorphins. These are credited with improved mood and feelings of satisfaction and relaxation. As exercise can engage people in physically demanding activities, it may leave people more physically tired at the end of the day and therefore better able to fall asleep at night. Feeling better about themselves and recharging regularly help people to keep up their energy levels. If someone isn’t sleeping well, evidence suggests they are more likely to be in poor health and have trouble managing other health conditions. Exercise has been shown to enhance restful sleep, increase vitality and decrease daytime sleepiness. Insomnia is a classification of sleep disorders in which someone has trouble falling asleep, staying asleep or waking too early. Acute sessions of moderate aerobic exercise can decrease levels of anxiety and improve sleep quality in insomniac patients. While many people opt to work-out indoors, for those who exercise outdoors, there are added benefits. Being in sunlight helps maintain your body clock, which impacts on your sleep patterns. Research has shown that higher vitamin D levels are correlated with a decreased risk of depression. Vitamin D levels are improved by getting ultraviolet-

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By exercising, many people feel more in control

light exposure, which is easily achieved by exercising outside. In addition, having the opportunity to commune with nature and breathe fresh air can also enhance feelings of relaxation and wellbeing. Exercise can also be social. The interaction from walking with a family member or co-worker or playing a team sport can improve connectiveness and promote a sense of belonging. It may also give someone the chance to develop friendships and talk through any concerns. If you need more evidence, look at what successful mental health professionals are doing. Professor Rickwood certainly practices what she preaches. I take a brisk walk most days. When I don’t do it, I feel terrible. If I walk each day, I sleep better, I feel less ‘gluggy’ and I get outside – I’m not stuck in my little box.”

exercise as insurance Exercise could be considered to offer individuals protection from mental health issues. An inverse relationship has been reported between exercise and depressive symptoms. Compared with inactive people, people who undertake light physical activity are 24% less likely to exhibit depressive symptoms. This rises to 50% less likely for those who are moderately or vigorously active. In addition, research has suggested that exercise may be useful in helping prevent panic attacks and related disorders by attenuating high anxiety sensitivity. There is a negative correlation between exercise and depression regardless of your underlying health status. In patients suffering from chronic diseases such as heart disease, cancer and arthritis, those who exercise regularly show fewer symptoms of worry, apprehension and nervousness. Exercise appears to have a calming effect. In these individuals, exercise sessions of greater than 30 minutes are better at reducing anxiety than shorter sessions.

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Exercise away Anxiety Modern life presents a vast array of stressors. Many of these are much more complex than the fight or flight response programmed into our DNA. Stress is usually perceived as a bad thing, yet positive stress stimulates us and can foster growth, development and an ability to innovate and embrace change. When stress exceeds our capacity to cope or meet the demands of daily life we can start to exhibit signs of anxiety. Exercise of more than 20 minutes duration has been found to reduce anxiety levels. The reduction could be due to exercise reducing muscle tension or providing a distraction from the source of worry. Another theory is that the heightened arousal caused by exercise, stimulates the subsequent release of chemicals that produce a calming effect.

Exercise away Depression Depression is a psychological state associated with feelings of hopelessness, defeat and a lack of joy. While the average person feels unhappy or in a low mood from time to time, a depressed person feels this way much of the time. Clinical depression is characterised by an ongoing loss of optimism and joy, disturbed sleep, changed appetite and mood disorders. It may become so severe that an individual needs help, such as counselling or medication, to cope with day-to-day life. Studies have revealed that regular aerobic exercise can be used as an alternative to medication. A reduction in depressive symptoms is best achieved when exercise is done three or more times per week for 15 or more weeks.

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Getting Started Starting and sticking with an exercise routine can be a challenge. Here are some steps that will help.

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Consult your doctor. Before starting any new or different physical activity, seek the advice and support of your to your doctor or mental health provider. If you have pre-existing medical or mental health concerns, it’s a good idea to ensure your exercise plan fits in with your overall health, and mental health, plan. Professional medical advice ensures that your best intentions give you the best possible outcome.

Set realistic goals. Our aim is to establish a regular exercise and fitness routine, not to beat world records or push ourselves beyond our own physical limits. The worst thing we can do is start, work too hard, and give up or even injure ourselves and be forced to stop. By being reasonable and realistic about our capabilities, our limitations and our goals, we are more likely to establish a routine that is achievable and sustainable.

Do what you enjoy. We all enjoy different types of activities and different activities will suit our particular lifestyle and daily routines. Pick exercise activities that you are actually likely to enjoy. That could be a brisk walk after work or an early morning swim, maybe walking the dog, sitting on an exercise bike, playing tennis with friends during lunch or shooting hoops with your kids after school. Don’t worry about what other people do, find the activity that you enjoy, find a time that you can build it into your routine, and you’re more likely to stick to it.

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Change your thinking. Exercise is not a chore or another burden we have to add already heavy schedule. It is an opportunity to be more active, to get away from the everyday, to improve our physical and mental wellbeing. If we take it gently and see it as something good we do for ourselves, a way of being kind to ourselves, a reward for all dealing with the effort and stress we have in our lives, then we are more likely to embrace and continue exercise.

Remove any excuses. It’s much easier to find reasons not to do something than to actually do it. Perhaps you don’t have the time for the gym, so go for a walk during a lunch break or walk part of the way to work. Maybe you’re too self-conscious, so exercise with a friend or at home. If you can’t afford fancy exercise equipment, try swimming or jogging. Focus on the possible and stop putting off exercise.

Celebrate success. Even small successes help us keep going. Tells your family, friends and workmates when you exercise. Let them know how good it feels. Be proud of the positive actions you’re taking to improve your wellbeing. And don’t ever dwell on the days that you just can’t get motivated or the times you can’t meet your goals. We’re all human and some days are better than others. A lapse is not a failure and it’s not an excuse to give up. Praise yourself when you do exercise and remember how good that feels, then keep going when you can. And praise yourself for that! 117

Uplifting Activities A regular dose of exercise can significantly improve both your mental and physical health. Different types of exercise may be more suited to your particular state of mind.

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Aerobic activities

Outdoor activities

Social activities

These are exercises that raise your heart rate and get you puffing. Five sessions of 30 minutes of physical activity a week is referred to as health enhancing physical activity. Common aerobic activities include running, walking, cycling, swimming, aerobics and spin classes.

Pursuits that get you outdoors and exposed to nature and sunlight include hiking, kayaking, rock climbing and mountain biking. They provide distraction from daily concerns, a calming environment and exposure to the beneficial effects of ultra-violet light.

Team sports, small group activities, or classes such as boxercise, martial arts training and dancing involve lots of social interaction. These can be beneficial in increasing social connections, boosting mood and providing motivation.

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