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Work Capability Assessments and Mental Health

A judicial review in May found that the WCA (Work Capability Assessment) was unfair to those with mental health problems. The case brought by two anonymous people suffering from mental illness highlighted the problems evidencing an inability to work for those suffering depression. For five years in the late 1980s I escaped the need for an assessment. I was lucky that my mental illnesses had not resulted in more than about 6 months off work at a time. On the two occasions I had extended sick leave from teaching I was lucky enough to get a period of full pay followed by a period of half pay. I struggled back to work and walked through treacle for a year before resuming my normal fast-thinking self. I was expert at hiding what was going on inside my head.

When I broke down immediately after taking early retirement, my debility meant that I could not apply for jobs – in fact it was the prospect of an interview in a town I did not know and a disastrous attempt at agency work while ill that sent me spiralling downhill. I had refused to take ‘sick’ retirement which would have given me a higher pension as I wished to avoid being labelled. So I had a small teachers’ pension, a couple of lodgers and nothing else. With a mortgage and the associated on-costs my budget was not just tight, it was strangled.

So I was relieved to get what was known then as Incapacity Benefit which softened the financial situation.  There was talk of having to attend an interview and assessment after six months so I prayed I would feel well enough before then to take up some occupation. I had recovered sufficiently in the past so positive self talk told me there was no reason why this should not happen again although I felt  despair on a daily basis.

But what to do was the problem. I was in hospital for two weeks under a section and then expected to attend a day clinic and see a doctor once a week. Finding a job was impossible under such circumstances. But, the daily interaction would, no doubt, help my mental state and I missed the daily contact of understanding colleagues.

Even now, nearing the end of 2013, there seems to be no ‘in between’ in that murky stage of recovery and the leap from unemployment and employment can feel like standing at Beachy Head. What can mental health patients do to get back into the workplace? If your job has been held over for you then you are one of the lucky ones and, hopefully, your employer will allow you to go back on a very part-time basis and build up your hours. The truth may have to be faced, though, that work – or at least full-time work – may not be right for you. My own teaching occupation is challenging and stressful and brings into play performance anxiety, a state not conducive to mental healing.

So, the recuperation stage is a good time to re-evaluate your chosen career. But, changing your occupation while struggling in recovery is not only difficult, it is impossible. Learning new procedures and working alongside new and probably unsympathetic colleagues who are all so sharp and ‘in the flow’ can make you feel worse. In 1996 I witnessed a fellow ex-patient struggling on a local supermarket till and my heart sank. She was in obvious distress, with her brain unable to cope with simple instructions. I subsequently vowed to avoid that route although as a teenager I did work in a   shop and loved it.

But changing career takes courage which is lacking at the lowest times of depression and patients need to get well first. Meanwhile there are forces at work determined to make life difficult for you.

In the autumn edition of Single Step, the magazine from Depression Alliance @DepressionAll, Andrea Twist cites her own difficulties applying for ESA (Employment Support Allowance). The process requires that applicants have considerable insight into their mental health condition which, when you are unwell, is absent. She found it impossible to apply on her own behalf and required help from a local advice worker. Completing the application form was distressing as the process brought home to her how depression had devastated her whole life.

Andrea cites the experience of another sufferer. Anthony, who experienced being asked questions such as ‘can you tie your own shoe laces?’ and ‘can you wash yourself?’ At no stage were open questions used such as ‘how does depression affect your life?’ or ‘what causes it?’

If I had been asked any of the above in 1996 I would, like Anthony, have scored zero points and been deemed capable of work but I could still not form a sentence or get through a morning routine in the short time necessary to get out of the house by 8.30. My concentration was non-existent, my memory poor and I lacked the co-ordination to use a keyboard which had previously been my strength.

It is clear that more needs to be done to make WCAs more mental-health-friendly. When out of work, those with depression have exceedingly low self-esteem, little hope and poor communication skills. Let’s hope that after the result of the Judicial Review in May processes and interview procedures will be re-assessed and more appropriate questioning used.

Meanwhile, as usual, those with depression will have to be their own advocates or find someone to act for them. If faced with a WCA you should do the following to ease the difficult time ahead.

1                 Spend time writing down how your mental health condition affects your everyday life, your ability to manage money, shop for yourself and run your home.

2                 Compile a timeline of your mental health history and your working periods. You probably have a better work record than you think.

3                 Write down what has contributed to your illness in the past if it concerns work. Examples might be working to unreasonably tight deadlines, unsympathetic employers, shift work, lack of exercise. 

4                 List how you are working towards recovery such as following a simple daily routine, attending day time groups, walking, swimming, meeting supportive friends and using your local library to borrow books on your condition.

5                 Gather evidence of your condition such as GP reports, psychiatric notes and reports. Rethink Mental Illness is asking that the DWP take over this responsibility so here’s hoping they are successful.

6                 Visit or contact your GP, CPN (Community Psychiatric Nurse), support worker, facilitator of a local support group you have attended. They may provide letters.

7                 Take someone with you to the assessment to take notes and speak for you if you become distressed.

8                 Join a local support group (Depression Alliance has lists) to show willingness to work with your condition.

9                 Finally DO NOT play down or minimise your condition. This is something sufferers of depression tend to do.

10              Never use phrases like ‘I’m fine’ or ‘Its ok’.  You are NOT fine and it is NOT ok.

In October an appeal lodged against the decision was dismissed. It remains to be seen what will transpire with damaging cuts which can devastate the well-being of depressed patients, even life-threatening.

Depression Alliance http://www.depressionalliance.org/  Membership is £24 a year (£5 if on benefits). This website lists support groups in different areas of the country. More about support groups in another post. You can write or email for an information pack.

Depression Alliance
20 Great Dover Street
London
SE1 4LX
Email: information@depressionalliance.org

I blog regularly about mental health at  www.dicastlewriter.wordpress.com and welcome comments. You can also follow me on twitter @dinahcas

Andrea Twist blogs at www.andreatwist.wordpress.com and you can follow her @andrea_twist

If you are unemployed you can view www.inmyshoesnorthlondon.blogspot.co.uk  which has contributors who write on unemployment.

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DEPRESSION AND DYSLEXIA in students

There is no doubt that a link exists between dyslexia and depression. I spent many years between 1996 and 2007 assessing young people in Further Education for dyslexia. The language they used when describing their difficulties and school experience mirrors the language used by those who are clinically depressed. Self-descriptions such as ’I thought I was thick’ or even, worse, ‘I was treated as though I was thick’ and, yes, some teachers used the word. Unbelievable though this may seem there are still some teachers who lack a clear understanding about the difficulties the dyslexic student faces.

Then there are references to how they apply themselves to their work. Reports abound with ‘must try harder’, ‘need to work harder’. The bright youngster who can answer questions orally and take part in classroom debate fails to impress teachers when he or she does not produce written work which matches their oral knowledge. They are then so easily deemed lazy. But as I have frequently told students and teachers, ‘if you find something difficult you are not to keen to repeat the experience.’ After all how many of us have tried a hobby or activity and given up because ‘it’s just not me’ or ‘it was too hard’ or even ‘I am not cut out for that.’ Well the dyslexic pupil is ‘not cut out for academic work. They find it so hard – the different brain connections of the dyslexic brain mean they have to work four times harder than their peers and tire easily. Yet, they have a thirst for learning and perseverance to match.

Students report acute embarrassment when asked to read aloud. At school, my dyslexic partner would drop pencils to the floor and disappear beneath the desk to retrieve them in the hope his turn to read would be missed. Asking a dyslexic pupil to read aloud can lead to later taunting by his peers and the subsequent bullying can send the child into deep depression with sometimes disastrous results. Parents of children who are struggling at school need to be aware of problems that may occur at school.

Dyslexic children worry more than other children. They worry constantly they will make mistakes and this causes extreme stress, another pre-cursor to depression. They find school or college stressful, declare they never understand fully what they should be doing, do not have time to write down the homework and are often in trouble as a result. Negative emotions and anxiety make the dyslexic difficulties worse. Spelling deteriorates further, reading slows down and written output dwindles to a trickle. A vicious cycle follows of stress, anxiety and inefficiency. Unfortunately the dyslexic usually tends to do things the hard way. Negative emotions include confusion, embarrassment, lack of confidence, frustration, and anger.

What the student or pupil needs are coping strategies which will ease the learning load and awareness of their strengths which can compensate for their weaknesses.To reduce stress, encourage your child or teenager to relax. Teach them yogic breathing and encourage counting on the in breath and the out breath. This counting pushes negative thoughts out of the mind. Exercise also reduces stress so encouraging teenagers to take up active outside activities will help. When I hear of a child or teenager denied play or break time because of a poor result in an essay or spelling test I can feel only sadness. The very activity which can help them learn in the following lesson is being denied them. The dyslexic needs more, not fewer breaks and more, not less, exercise.

A negative term dyslexics face is ‘failure’. Failing does not have to be negative as long as it is seen as a temporary blip on the path to success. Even non-dyslexics fail sometimes at some tasks. There is always another chance, a new school, a new subject, a new teacher, a new-found interest and even a new academic year with work which may not be so challenging in some areas.

 

Some well-adjusted students with dyslexia I have met as an assessor in Further and Higher Education are those whose parents arranged an assessment during their primary school years followed by either extra help at school or a specialist private tutor. These students have been aware early on in their education of their strengths and weaknesses and the true nature of their difficulties. Those who have gone undetected have no understanding of why they are struggling and live with constant nagging doubts as to their abilities. An assessment at sixteen can be an enlightening experience and change the student’s attitude to study and life in general, especially when an IQ test has shown that they are actually very bright. If a student appears depressed and is falling behind, it might be advisable to screen for dyslexia just to be sure. 

 When teaching a dyslexic student some aspects of CBT (Cognitive Behavioural Therapy) can be employed by re-framing some of the more negative language with alternatives thus reducing damaging self-talk.

 

For example the student who says

I am always making lots of mistakes’ can be encouraged to say instead

I do make more mistakes than other students but I can learn to check my work.’

 

Rather than say

I’m hopeless at spelling’ say

I am not that good at spelling but I am better than I was and keeping a personal spelling dictionary will help me improve.

 

Rather than

I can’t do exams’

say

‘I am learning revision and exam strategies which will help me in exams and I will learn to use my extra time for reading through my work and checking.’

 

Modifying language can bring about a change in self-perception and raise confidence. With sympathetic and constructive approaches by both tutors and parents, the dyslexic teenager can begin to produce work which reflects his true ability. There is no cure for dyslexia and students will need to use strategies throughout their education and working life. However, with understanding on the part of parents and teachers, the demons of depression can be kept well at bay.

 

Further Reading

Dyslexia: A Teenager’s Guide, Dr Sylvia Moody

 

Bi-polar and anti-depressants – a bad mix?

A couple of weeks ago in my blog on mental health and my challenging bi-polar I mentioned that I was not on anti-depressants any more. A friend emailed and expressed surprise ….. and …… admiration.

The truth is that I now know I should never have been taking anti-depressants in the first place and the fact that I have been on them almost continuously since 1992 is down to the medical profession.

I am not sure when I was diagnosed with Bi-Polar II. It was either 1989 or 1992, the dates of my two mid-life breakdowns. I spent two years on Lithium along with anti-depressants but the Lithium stunted my emotions so much that eventually I was taken off the drug with the phrase ‘ok you have been well for a time now.’  That was in 1994. I was left on the antidepressants – Lofepramine – but, after making a big decision to take early retirement in 1996, I broke down again. At one point during this episode, I was at home, newly discharged, with no-one around and a few glasses of wine sent me ‘high’. When I took myself back into the Mental Health unit I was taken off the anti-depressants until I ‘came down’. I was ignorant of the effects of the drug on bi-polar patients and, at that time, little information was given to patients.

For years I struggled with horrendous, puzzling mood swings despite being on anti-depressants. A casual remark from an acquaintance that anti-depressants make someone with bi-polar go manic sat in the recesses of my lack of understanding but never left my mind.

Once or twice I asked my GP if I could be weaned off the anti-depressants but was told that after a few episodes a recurrence is highly likely and therefore it was necessary to remain on the drugs. I was even allowed to ‘manage my illness’ taking an extra tablet if low but never told to cut them down when high. I did eventually work this out for myself but this inadequate medical advice meant that I lived a rollercoaster life and some rash decisions, made in manic states, almost ruined my life.

Earlier this year I suffered kidney failure following a severe infection and the build up of the drugs in my system caused a manic episode. I sang so loudly in hospital staff reckoned they could hear me in town. Along with a few other ‘high’ patients I laughed myself silly when a fellow patient, who would have been better suited to Live at the Apollo, described his raucous and fairly dangerous behaviour prior to admission. Even his description of his attempted suicide didn’t stem our giggles. That night we thought staff and relatives were all idiots and that we in-patients, sat in various strange states of dress and unkempt hair were actually the sane ones in a mad mad world.

I was familiar with the ‘queuing for drugs’ routine twice a day and noticed that the Lofepramine no longer appeared in my little pot. I always question my medication but over a period of 3-4 weeks never really found out why I had been taken off them.

I was still fairly upbeat in my first month at home and then a few upsetting events sent me plummeting. I asked the CPN and the registrar if I could be put back on the anti-depressants and then saw the top man in the community team. He said he was sure I had been taken off the Lofepramine because I was ‘manic’. He suggested I continue attending the support group and go on a refresher course on coping with bi-polar and my medication could then be reviewed.

Soon after returning to my support group, a local GP came to talk to us about the medical perspective and the Practice procedures for dealing with depression. (see later post). I asked him about this issue at the end of the evening and he explained how the anti-depressants can kick your mood higher when the bi-polar naturally takes you to a higher mood. He also explained that, when my kidneys failed, the drugs in my system would have built up and not been excreted which is why I went manic after the kidney failure.

This short conversation alleviated my concerns and put in plain words how physical illness can interact with bi-polar. Also, I now know why the anti-depressants were discontinued.

After 24 years! Why couldn’t this have been explained years ago?

And …… seven months on, I am still off the anti-depressants and, far from being low, I’m happy, sociable and motivated.

Finally, a warning. Of course, everyone is individual and it was the medics who discontinued the drug. If you have mental health problems you should never stop taking your medication unless under medical supervision.

BIRTHDAY TREAT

Last week I celebrated yet another birthday. I would prefer not to count them but see them as an excuse to do enjoyable things and treat yourself for one day of the year, although in my struggle with depression, I have got much better at having ‘treat’ days and doing things I enjoy doing rather than the things I feel I ought to do. We all have things we have to do like the washing, ironing, washing up and shopping but now that I practise Mindfulness even these tasks provide pleasure.

 

Following a trip to London for Proms in the Park I have been bothered with a pain in my shoulder and have woken in the night with pins and needles in my arm and fingers. I have had this before after carrying heavy teaching and assessment materials for considerable distances on a college campus so I immediately linked it to this trip.  We decided we could do without our wheelie cases and survive with a back pack each. The weather was unpredictable so my backpack filled quickly topped up with lots of goodies for the picnic in Hyde Park. In London we found our hotel in Bayswater was not as convenient as we thought and we walked long distances with back packs attached.

 

On my birthday  I decided another broken night was one too many and telephoned my local therapy  treatment favourites (The Bay) to see if I could have a massage that day.  Unsurprisingly they were fully booked up but they managed to get an independent  complementary therapist to come in half an hour early to see me at lunch  time.

 

Mindfulness teaches us not to live in the past or future but to live ‘in the moment’ and focus on the present. It does include planning for the unexpected so we are not ‘thrown’ by events. I therefore decided I was just having a back massage and did not expect to be relieved of my painful shoulder, which the googling told me was a trapped ulnar nerve. Lowering expectations is known to relieve stress, depression and anxiety.

 

This was the best 30 minutes I have spent since becoming ill last April as Allyson persuaded me to return to yoga and emailed links to local yoga classes. I have now cleared my lounge rug to a yoga-friendly zone and undertaken some independent practice prior to tomorrow’s class. She was also exceedingly understanding about a mental health illness I have had for 24years.

 

Allyson is prepared to ‘mix and match’ her therapies so she can, for example, combine some Reiki with a back massage which I have not always found with other practitioners.

 

You can look at her website

www.equilibriumholistics.com, email her on Allyson@equilibriumholistics.com

or phone her on 07977 519141

This post first appeared on my BlogSpot site on 23 September 2013

EFT – Emotional Freedom Technique

This post first appeared on my BlogSpot site around March 2012

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EFT – Emotional Freedom Technique

This is taken from the website of  Christine Bosley-Collins, AET,BCMA, Reiki Master who is an experienced Energy therapist offering holistic treatments in Emotional Freedom Technique (EFT), Dowsing for Health and Answers, Mediumship Dowsing, Dowsing tuition, Allergies/Intolerances and their Remedies, Reiki, Chakra Balancing/Aura work.  She is based in Swanage and has worked with EFT in Performing Arts, Media, Public Speaking, Sports Performance, Motivation, Personal Development and Stress Management.

Christine trained for three years with Stephen  Coburn BEM EFT – ADV. MBCMA.DS Dip Vib Med, who was originally trained in the  USA by the founder of EFT Gary Craig.EFT Dorset EFT often works where nothing else will and has a high  success rate.
It helps cure innumerable problems such as:

 

  • Stress anxiety, trauma, panic  attacks 
  • Fears and Phobias – examples, fear of  dentist, flying, heights 
  • Addictions – examples, smoking, chocolate,  over eating, anorexia, bulimia 
  • Pain management, IBS, anger  management 
  • Headaches, Tension, PMS, Relationship pain  and conflict

It is an incredible tool for self help  with:

 

  • Confidence and self esteem issues 
  • Self empowerment 
  • Spiritual blocks 
  • Motivation 
  • Confidence 
  • Self belief 
  • Weight loss 
  • Stopping Smoking

EFT works on the premise that ‘The cause of  all negative emotions is a disruption in the body’s energy system’.
EFT  really makes a difference and the healing benefits are amazing.
EFT is  like an emotional form of acupuncture but without the needles! It is powerful  but gentle and often works where all other treatments have failed.
It  does not rely on a belief system and will work on anyone, including  babies.
It is common for clients to experience rapid relief from pain in  less than half an hour and emotional problems such as anxiety are often fully  relieved in just one session.
If you have a problem that is personal or  private then EFT is perfect for you. I can help without needing to know what the  problem is.

 

See her website on  http://www.facebook.com/l/UAQH555r3AQH4V_qmW9ar1f2Z3NrNosSqpoWuOI4etHm19A/www.soulhealing.me.uk

 

Depressed? Read yourself well.

I have collected books on how to cope with depression for what seems like forever.  For years I thought I would find the answer inside a book. I never discussed my purchases with others but occasionally offered a few books to someone on the point of desperation. My bi-polar was hidden away, secret, never talked about, the books, like men’s magazines in a newsagents, on a high shelf hidden amongst tomes on diet and health and fitness, particularly yoga.

Inwardly I thought that that I must be an ‘odd’ person who bought books on insanity rather than fiction or celebrity memoirs. The books remained gathering dust only perused when I was low and felt the need to revisit some well worn advice and inspiration.

While depression takes away the pleasure of reading, seeking out solutions can be a useful way to pass time when you do not feel like socialising. Also it is good to ‘read for health’ when well.

Recently I have been clearing out cupboards, files and bookshelves. I visited my local library but unfortunately they will only take books less than five years old, even if they are a donation. Seems a shame really as these books hold words of wisdom many mental health workers or service users would find beneficial.

Clearing my ‘mad’ books was therapeutic as their presence was a constant reminder of past periods of inactivity and stunted emotions. My first reaction was to bin them or even ceremoniously put them to the stake like a bad witch.

However, after hearing a doctor talk about various methods of treating depression, the subject of ‘bibliotherapy’ came up. When questioned, he said, he would give a list of books to a patient to take to the library. This was a revelation to me as the only time I have been offered a booklist was when I was waiting for a course of CBT (cognitive behavioural therapy) and needed to see a psychotherapist for referral. At that time, I was recommended books on Mindfulness. This, in 2006, was news to me. I had heard of meditation and been helped in relaxation techniques at various points in my illness but the big M word was news to me.

Suddenly I didn’t feel an ‘odd ball’ any more. I could give myself permission to buy or borrow a book and attempt some re-education to improve my mental health. Doctors and therapists recommend books so, far from feeling a failure for needing such literature, I feel good about it.

And that is how, when I cleared my bookshelves the other week, I collected all my old ‘mad’ books – they filled a large carrier bag – and took them to my local support group. I walked home later empty handed feeling happy that someone may be helped by my donation.

From experience I know that the chances of the books reaching the right people if donated to a charity shop are slim. Most are well-thumbed and some have brown tinges on the leaves. These would most certainly find themselves in a recycling bag and never see the light of day in the living rooms of the depressed and anxious.

So which books did I donate? Some examples are Living in the Light by Shakti Gawain, Overcoming Depression by Paul Gilbert, The Book of the Mind, Raj Persaud, Why Am I Up, Why Am I Down (Understanding Bi-Polar, Roger and Elizabeth Granet, An Unquiet Mind by Kay Redfield Jamison.

Books that I have kept on my shelf are Full Catastrophe Living, and Wherever You Go, There you Are, both by Jon Kabat-Zinn, and both recommended by the psychotherapist in 2006. I also have Dr Gillian McKeith’s You Are What You Eat and a simple guide to Cognitive Behavioural Therapy by Dr Stephen Briers.

A book I have often borrowed from the library but, for cost reasons, do not possess is Mind Over Mood, (changing how you feel by changing the way you think).  This is also a self-help guide based on Cognitive Behavioural Therapy. More on CBT in a later post.

If you are struggling with depression or debilitating mood swings which can take over your life, books mentioned on this post are all available through your local library. Take my advice and avoid Amazon purchases. Reserve your books online and get an email when they are ready for collection.

There is no need to be depressed AND poor!

HIGHS AND LOWS

Having struggled with two to three months of wading through treacle as I navigated the downside of my bi-polar, I began to feel my mood lift in July when the better weather and some family activities became enjoyable once more. However, I was still sleeping ten hours a night and not waking until 10am most mornings. The will to get up and enjoy the sunshine was just not there so I was rarely up and moving before about 11am. I consoled myself with the view that much as I was losing a good part of the morning I was, once I was up, making the most of the day. I began swimming in the sea, treating myself to ice creams as I read my latest library book on the sea front, initiated outings and enjoyed family visits. The bottom of the trough seems to trundle along for ever but when we look back it was often a shorter period of time than we thought. A mood and activity diary helps here.

In August I began to feel pleasure in activities returning and my energy levels began to rise. September was also a good month. However, I am aware that I have an abundance of energy at the moment, am full of ideas and confidence. The problem now can be that I agree to take on responsibilities or work commitments and socialise to such an extent that eventually when the mood drops I will be unable to sustain the activities. The usual pattern is to begin backing out of meeting up with people, hiding away, giving up doing things after which I suffer a damaged self esteem and considerable guilt which combines to bring on a further depressive episode.

But I am learning. Whereas in the past I bumbled along and let my moods control me, now, although there is not much I can change about my condition, I am more aware and avoid falling into some of the traps of the past.

There is much written about combating depression but not that much about managing the highs.

Gone are the years I sat up wide awake at night writing poetry until I lost sense of reality. My medication now ensures I do sleep a good eight hours. I do always take my medication. Tip 1.

Tip 2. I take myself to bed slightly earlier with a milk drink and a book. This helps me wind down from some of my more frenetic activity. I take my tablets earlier in the evening so there is no danger of staying up until the early hours.

Tip 3. I keep off Ebay and internet shopping sites. If I begin to plan purchases I tell myself not to do anything for a week. If I still need it after that time, then I probably will get it if I can afford it. A week allows me to think about whether I really can afford something. The answer is often that I can’t.

Tip 4  Since my last illness in April, I have agreed to discuss large purchases with at least two of my three daughters. On a course I attended this was called ‘The Rule of Three.’ But little things mount up. However, at this time of year I can satisfy the spending urge by shopping around for early Christmas presents – money I would spend later in the year anyway.

Tip 5. If I do go shopping I leave all tags on my purchases and keep receipts and bags. Then I take time to mull over what I have bought and often return items I feel were a mistake. Charity shop purchases ensure mistakes are not too expensive.

Tip 6. I drink camomile tea and take natural calming remedies such as Kalms.

Tip 7. I pace myself with my activity and take time out to sit and watch television programmes. Decorating is one of my activities when I am in an over active state so I set myself easily achieved targets so that I do not keep going on regardless. I take time out to sit and eat meals, check on my Facebook newsfeed and my emails. My return emails are always much longer in these phases.

Tip 8. I have friends and family who monitor what I am up to. One friend knows to phone my partner if my emails are excessively long and fail to make sense. My daughters asking ‘what have you been up to lately?’ is their way of finding out if I am doing more than usual.

Tip 9. Since discovering Mindfulness, I can switch over to a calmer state of mind. Also by practising this daily, I do not store up unhappy, negative thoughts which might spur me to write inappropriate emails or make bad decisions when I am high and over confident.

Tip 10. I do not drive when I am in a highly excited state. Bus and train travel is relaxing as we have to just ‘go with the flow’. There is nothing we can do to speed up the journey and there is the opportunity to read or write on my laptop, both relaxing activities.

In April I was taken off my anti depressants because I was in a manic episode. I am managing well without them and the moods are more stable. More about this in a later post.

Let’s face it we all like the highs and it is, after all, the chance to get a lot done after months of inactivity and lack of interest in daily tasks or pleasurable activities. All those jobs that we neglect when we are depressed can now be completed. It is good to remember in the down phase that it passes and eventually everything will balance out.

We just need to avoid hasty, impulsive activity until the mood drops back to a more normal level.

 I say ‘normal’ but what is normal anyway?