Post breakdown: 50 symptoms of stress

So, I started work again yesterday, or at least 50% of work for a couple of weeks.

I can’t say it feels good to be back in the office, though it does feel good not to be signed off sick any more and claiming money for not doing anything.

Yes, I know, I was sick, and that’s why we have a social safety net. This was one of the biggest problems for me though – I couldn’t seem to allow myself to feel OK about claiming sick pay for a mental illness. I suspect this comes from years of indoctrination via various media that mental illness of any kind is not “real” illness, and stress and anxiety are just things that weak people suffer from. Lets not even get into what “hitting the wall” or “having a nervous breakdown” must say about my useless persona.

If it happened to anybody else I would be telling them the exact opposite of these things, but it happened to me, and I can’t seem to do that.

What I would like to do-now that I’m feeling able to string a couple of sentences together again-is remind people to pay attention to what their body is telling them. There are a myriad symptoms of stress, and it’s best to listen when they start to show up. Trying to “push through them” because it’s “just a tough week” and “it’ll get better soon” will only result in you landing in the same place that I did. Maybe not soon, but eventually.

Your body knows what it’s talking about, and it talks through these symptoms.

Having had a lot of time to think, I’m pretty sure I’ve been under an increasing amount of stress for about the last 13 years. Every time things have got bad I’ve tried to push on through, which only has the effect of increasing the stress level I regard as “normal”. When things have got too bad, I’ve changed job, which has helped for a while, but isn’t exactly a long term strategy (not when you have to start explaining a row of jobs that lasted less than 2 years each on your CV).

So please, please, please. Read through the list. If you find you have a fair number of these then stop and evaluate your life. Slow things down a bit before your body decides it’s going to do it for you.

Here is a fairly comprehensive list, taken from here: http://www.stress.org/stress-effects/

1. Frequent headaches, jaw clenching or pain
2. Gritting, grinding teeth
3. Stuttering or stammering
4. Tremors, trembling of lips, hands
5. Neck ache, back pain, muscle spasms
6. Light headedness, faintness, dizziness
7. Ringing, buzzing or “popping sounds
8. Frequent blushing, sweating
9. Cold or sweaty hands, feet
10. Dry mouth, problems swallowing
11. Frequent colds, infections, herpes sores
12. Rashes, itching, hives, “goose bumps”
13. Unexplained or frequent “allergy” attacks
14. Heartburn, stomach pain, nausea
15. Excess belching, flatulence
16. Constipation, diarrhea, loss of control
17. Difficulty breathing, frequent sighing
18. Sudden attacks of life threatening panic
19. Chest pain, palpitations, rapid pulse
20. Frequent urination
21. Diminished sexual desire or performance
22. Excess anxiety, worry, guilt, nervousness
23. Increased anger, frustration, hostility
24. Depression, frequent or wild mood swings
25. Increased or decreased appetite
26. Insomnia, nightmares, disturbing dreams
27. Difficulty concentrating, racing thoughts
28. Trouble learning new information
29. Forgetfulness, disorganization, confusion
30. Difficulty in making decisions
31. Feeling overloaded or overwhelmed
32. Frequent crying spells or suicidal thoughts
33. Feelings of loneliness or worthlessness
34. Little interest in appearance, punctuality
35. Nervous habits, fidgeting, feet tapping
36. Increased frustration, irritability, edginess
37. Overreaction to petty annoyances
38. Increased number of minor accidents
39. Obsessive or compulsive behavior
40. Reduced work efficiency or productivity
41. Lies or excuses to cover up poor work
42. Rapid or mumbled speech
43. Excessive defensiveness or suspiciousness
44. Problems in communication, sharing
45. Social withdrawal and isolation
46. Constant tiredness, weakness, fatigue
47. Frequent use of over-the-counter drugs
48. Weight gain or loss without diet
49. Increased smoking, alcohol or drug use
50. Excessive gambling or impulse buying

 

10 things to do during a nervous breakdown

Now that I’m signed off work for stress, or “nervous exhaustion”, or whatever they want to call it, I technically have time to do all the things that I don’t normally have time to do: write, paint, train, read etc. Basically, I have an extremely limited supply of spoons right now!

Unfortunately, the things I can do are rather limited. With the internet being a bit list-focused, I thought I’d compile my own list of things that you can do when suffering from some kind of mental exhaustion.

10. Fold some laundry

This is about as mentally taxing as it gets for me at the moment. Usually it’s kind of a zen task, but now I start getting antsy after a few minutes and have to move on to something else.

9. Stare at the walls / out the window

I can do this for unspecified lengths of time, and then not quite be sure how long I’ve been sitting there.

8. Read the same paragraph multiple times

Ideally I would be able to catch up with some of the books in my reading pile. As it is, it’s taken me a little over 2 weeks to get through a book that would normally have taken me about 2 1/2 hours. I can read the words, but the meaning just sort of slips around my eyes and out of my ears without ever touching my brain.

7. Watch half en episode of something on Netflix

My concentration doesn’t extend further than half an episode of Walking Dead, or something similar. Even then, it’s a bit like reading, and I can really only remember the highlights and none of the subtle plot points that are going to be important later on.

6. Try and maintain a blog/twitter presence

I started this blog and the twitter account to try and help people in the same situation as me by letting them know they’re not alone. It seems like a cop-out to stop when I’m having severe problems. That being said, it’s not easy; I’m up to here and I’ve been writing this for at least 24 hours now, even though I pretty much know what I want to write.

5. Search the internet

Generally for phrases like “nervous breakdown recovery”, or “anxiety heart attack”. It doesn’t help.

4. Over-react

I’ve found myself over-reacting a lot and shouting at Twitchy sons #1 and #2. OK, they weren’t exactly behaving themselves, but I feel like I’m on a hair-trigger and there’s nothing I can do about it.

3. Worry about lack of money

Since I’m not working, I’m not earning. Yes, I do get some sick pay, but this isn’t going to cover the mortgage or any of the bills.

2. Cry

This can happen anywhere: just sitting on the sofa, in the middle of the supermarket, sitting at traffic-lights. Anywhere. I don’t even understand what I’m crying about half the time.

1. Nothing

Always going to be top of the list this one. Whether I’m sitting on the sofa, lying in bed, standing in the kitchen or just sort of huddled in the foetal position, you can always do nothing.

OCD awareness week – What can we do?

So this week is OCD awareness week (and do take a look at the 3 links there if you’re not familiar with them – there’s a lot of good information there). There are plenty of questions that need to be answered, but to me, one of the biggest is “How can we get people to understand what OCD is?”

If you do a hashtag search on twitter for #OCD or #OCDproblems, you’ll find a myriad of tweets from people that think having a tidy room is OCD, or liking their phone icons to be organised is OCD. For a few choice tweets I’ve picked out so far check out my Misrepresentative Tweet of the Day series, which basically always seems to end up with a tweet about OCD. I have found a few about Tourette Syndrome, Aspergers, Autism etc. but the OCD tweets always seem to be the most ignorant.

It’s not even that the people that tweet these things don’t suffer from OCD, so they can’t understand. I think perhaps in some cases they may well have a mild version of it. It is, after all, a spectrum disorder. The problem is that they do not understand that it is a spectrum disorder, and that at the other end of said spectrum lives are ruined.

I think in a lot of cases the people that tweet things like “I’m so #OCD” along with a picture of shoes lined up in a row simply don’t understand that the “D” in OCD stands for “Disorder”. Wikipedia defines a mental disorder as:

A mental disorder, also called a mental illness or psychiatric disorder, is a mental or behavioral pattern or anomaly that causes either suffering or an impaired ability to function in ordinary life (disability), and which is not developmentally or socially normative.

Let’s just review that: a pattern or anomaly that:

causes […] suffering

or:

[causes] an impaired ability to function in ordinary life (disability)

I do not think that organising your shoe rack or cleaning the kitchen after you’ve cooked causes you suffering, or constitutes an impaired ability to function in ordinary life. On the contrary, I would congratulate you for being organised – your life is probably easier because of it.

Genuine OCD sufferers, on the other hand, may well need to organise their shoe cupboard. They may also need to do 1001 other things, which they also need to create a detailed list for, and end up completely paralysed and unable to do anything. Having OCD does not mean your house/room is clean and tidy. Often it can be quite the opposite.

In my case I have a different set of symptoms. I don’t need to clean, though when I do I need to do it “properly” (meaning that it doesn’t get done so often because I know how long it takes when I start). My biggest problems are intrusive thoughts, the necessity for symmetry, and problems with certain tactile sensations (never buy a cushion without letting me test-touch it first – it will likely end up on the floor every time I sit on the sofa!) My problems are minor compared to many.

So, are you obsessive if you organise your wardrobe? Maybe. Are you compulsive if you feel the need to make sure the kitchen is clean? Possibly, though no guarantee. Is this a disorder? Nope, no, not a chance, no way. Not by itself. Not in isolation. Not without other serious symptoms that actually impact your life in a seriously negative fashion.

Please, please, please, think twice before using the #OCD or #OCDproblems hashtags. There are people that genuinely have a disorder (according to the definition above), who have serious problems in their day-to-day lives because of OCD. Every time you use one of those hashtags you dilute the public perception of OCD just a little bit more and spread the ignorance just a little bit further.

Without public understanding and acceptance life becomes a lot more difficult for genuine sufferers, so help them out and use the tags to promote some real awareness during OCD awareness week.

Where do we (compulsively) draw the line?

My Misrepresentative Tweet of the Day series has highlighted one thing for me. On Twitter, if somebody is going to misunderstand one of the conditions I suffer from, it is OCD.

Interestingly, I note that when it comes to products, Tourettes is up there as well. To that end I am going to start a Misrepresentative Product of the Day as well.

As I read through the tweets though, an interesting question comes to mind: where do we draw the line for what is OCD and what isn’t? It is a spectrum disorder after all. Some people have it to a crippling degree, and are unable to leave the house (whether due to fear of contamination, because they can’t finish cleaning, or because they are simply crippled by the amount of things they have to prepare in order to do anything, meaning that nothing gets done). Others – myself included – have it to a much lesser degree, and though it is frustrating, energy-sapping and often embarrassing, we can function as well in society as anybody else.

So where is this mystical “lower limit” that means people who like a little bit of order in their lives are misrepresenting the condition by using the #OCD tag on Twitter? It drives me nuts when pictures are hanging crookedly, but the shoes in my cupboard can be thrown in any which way. When I was a programmer and designing screens, everything had to be pixel perfect, but is this in itself enough to constitute OCD? I don’t think so – I’m not even sure if that kind of perfectionism is related to my OCD. Probably, but who really knows?

I think, for me, the line comes when the behaviour starts to cause discomfort for the sufferer. Needing your shoe cupboard to be organised, or your apps to be lined up nicely on your iPhone is not OCD (not by themselves at least). You just like things to look neat. You do not suffer in any way, nor would anybody else really notice.

Of course, if you have more severe symptoms that do cause you distress and discomfort, then perhaps these smaller things are a reflection of the condition as well.

Please though, if you do not have serious symptoms, do not use the #OCD tag when Tweeting. By all means make a joke of it, but don’t make a joke of OCD when you don’t understand it.

What is Tourette Syndrome?

It’s probably worth at this point defining some terms, since a large part of the problem is that most people aren’t aware of what Tourette Syndrome, or any of its co-morbid friends, is really all about.

Well, I’ve got news for you: there really is no such disease!

Yup.

The National Institute of Neurological Disorders and Stroke (NIH) defines Tourette Syndrome as:

… a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics.

Which is of course a pretty good start. It then goes on to talk about common symptoms, whether people can control them, and a whole host of other information that I wish pretty much everybody on the planet was aware of.

The bottom line though, is that it’s a condition about which we don’t know very much. TS itself is defined in the DSM, but it’s basically a collection of symptoms that seem to belong together rather than a well-defined condition, and since every sufferer probably has their own collection of co-morbid symptoms it would probably be hard to define a “textbook” patient.

This reflects the (non-genetic version) of the definition of “Syndrome”. As defined by Wikipedia:

A syndrome, in medicine and psychology, is the collection of signs and symptoms that are observed in, and characteristic of, a single condition.

Once we throw OCD and Aspergers into the mix as well, both of which are also mostly a collection of symptoms that are grouped together for convenience, and both of which are fairly common amongst Tourette sufferers, we end up with a mish-mash of symptoms that is hell for the patient, but very hard to label.

We’re also in the realm of Autism Spectrum Disorder with all three of these conditions, and a lot of the symptoms come down to a matter of degree.

Of course labels serve a very useful purpose: they let doctors and experts talk about the problems in a wider context; they allow fellow sufferers to form communities and talk about their experiences; once a label is applied it can make it much easier to obtain treatment. So I am not against labelling in that respect. In fact I think we need to if we are to make any progress. As long as we are prepared to revise our definitions of those labels the more we learn about them (aka. Science!)

The downside of labelling is that it can create stigma. In the worst cases it may even deny people access to the care they need, or the insurance they need in order to get that care.

This is why it is so important that everybody understand what is involved in mental illness. It is, for the most part, invisible (OK, so I spend a fair amount of time wishing my tics were invisible, but they are the exception rather than the rule).

Look around you now, who do you see? Which of those people has a mental illness? Who has OCD? Who is depressed? Who suffers from crippling anxiety attacks? Who is anorexic or has PTSD? Which of those people is on the autistic spectrum, has a genius level IQ but falls apart in social situations? Who is the new mother with postpartum depression?

There is no way of knowing.

Mental illness affects a huge number of people, and the more it is understood, the less it is stigmatised, and the easier it becomes to talk about it openly and help those who are suffering.

I will leave you with the image I use for my Twitter account, as I think that sums it up quite well and is most probably worth a lot more than the 600 or so words in this post.

 

Energy, elephants and spoons (Part 2)

When I wrote part one of this post it was Friday morning, and I was feeling a bit low on energy reserves. Now it’s  2pm on Friday afternoon and I have nothing left to give this week. My body won’t sit still in its skin, and my chest feels like I’m trapped under a piano. Not a good combination.

The problem is the same as usual, I’ve used up all my energy too early, and I know that I’m going to have to go and deal with Twitchy Sons #1 and #2 later on. This may end badly as it is unbelievably hard to be patient when I feel like this.

But it does bring me to the next part of this post, and since that’s been sitting in my head trying to get out since I wrote part one this morning, I’ll see if I can at least get it down here.

I dealt with the elephant portion of the post, so now onto the spoon part, which has to do with management of energy reserves. I first heard of the spoon explanation from a disabled friend of mine, and it’s true that it’s probably more relevant for physical disabilities and illnesses, but I think it’s a valid way to explain mental exhaustion too. First, I’ll link you up to the original spoon post. Go away and read this, then come back to me.

Spoon Theory, by Christine Miserandino

Feeling enlightened? Good. Now let me explain how this applies to my circumstances. There are two significant differences, but the basic concept is the same.

Firstly, it’s not really a daily cycle. Just sleeping doesn’t give me back huge reserves of energy, so I don’t wake every morning with a drawer that’s reasonably full of spoons and then lose them all during the day. I might get a couple of spoons back overnight, but that’s about it. I’d say it’s more of a weekly cycle, but then this also depends on how the weekend has been and sometimes I can start a Monday morning with a very low spoon supply.

Secondly, although I lose spoons when I have to do certain things, each spoon also only lasts so long before it vanishes and I have to start on the next one. This is primarily due to trying not to think about elephants.

So apart from pachydermic thoughts, what saps my energy and what gives it back. Well, the lists are pretty simple.

Things that take my spoons:

• Pretty much everything

Things that give me some extra spoons:

• Being by myself

Since the majority of my time is obviously taken up with stuff on the first list, and I rarely get to do any of the stuff on the second list, I think you can see where the problem lies.

One other major difference between my type of mental exhaustion, and the physical problems described in the original article, is that when I run out of spoons it may well look like I have too much energy, not too little.

My tics start coming out in force and I just can’t focus on acting “normally”, I become more anxious than usual, my feet start jiggling around, as does the rest of my body – basically I think my body is looking for the escape routes and getting ready to run as soon as it gets the message to my brain, which isn’t listening because it’s just too tired and full of elephants.

Energy, elephants and spoons (Part 1)

No, I’m not going to talk about Uri Geller, the famous spoon-bending fraudster. This post is about personal energy reserves.

First, I’d like to talk a little about how I think my condition affects my energy levels. This is pretty much my own personal theory, so it could be way off base. There may be other reasons for why I have problems sometimes that are totally unconnected with any of my diagnoses. There may be, but I think it’s unlikely.

among competing hypotheses, the one with the fewest assumptions should be selected. Other, more complicated solutions may ultimately prove correct, but—in the absence of certainty—the fewer assumptions that are made, the better.

– Ockham’s Razor, as defined by Wikipedia

So in the absence of said certainty, here are my musings on the subject.

Tourette Syndrome and Obsessive Compulsive Disorder are tiring. I spend every waking minute of every day trying not to twist my face into odd shapes, wink at people, dance down the street to avoid the cracks in the pavement or otherwise make strange body movements that “regular” people might find odd, or worse, cause them to ask me what the problem is. This is mentally exhausting.

Let me try and put this in a way that regular folks might understand (I’m going to need a term for these so-called “regular folks”, I can see that … let’s go with “norms” for the moment. I think that’s been used sufficiently often in various fiction – usually some kind of dystopian sci-fi – to be a valid term, even if I don’t really think there is any such thing as “normal”). I’ll use a common example that I’m pretty sure almost everybody will have heard before.

Don’t think about this!

Don’t think of an elephant.

What are you doing now? Thinking of an elephant perhaps? Stop it, I told you not do that.

Would you like a cup of tea? Are you thinking of an elephant? You are, aren’t you? Cease and desist immediately. There is no elephant.

Milk, sugar, elephant?

… you get the gist.

Imagine if your entire day was like this. Everybody you met told you not to think of an elephant in pretty much every sentence they used. The only time it was safe to think about elephants was when you were completely alone, and even then, you don’t really like elephants and would prefer to spend your time thinking about sunshine and chocolate cake.

Mmm … elephant shaped chocolate cake.

My day is like that. All the time. Every day. Only the elephant is my tics and compulsions, and they don’t just get thought, they express themselves externally in a way that is visible to other people (and damn, do I feel that other people can see them!)

If I’m sitting at my desk at work I am trying not to twist my face into a strange shape, curl my lip or wink at other people in my office. If I’m in a meeting I might be constantly fighting the compulsion to rearrange my legs because one has touched the table leg and the other one hasn’t. You can only do that so many times in a meeting before people start asking you if you’re OK.

It. Is. Relentless.

Then when I’m lying in bed at night, in the dark where nobody can see me, I still have the vocal tics and the compulsive thoughts/anxiety about events that really aren’t worthy of any brain-power (more on these another time).

I’m not sure how much of this is tied up with the Aspergers diagnosis, and how much is Tourettes or OCD, but it’s irrelevant. The point is that my brain never switches off as long as I am awake. Never. And even when I want to sleep, I often can’t for exactly the same reason, so most of the time I am tired from lack of sleep as well as general mental exhaustion.

All of this is on top of a wife and 2 young children (hereafter referred to as Mrs. Twitchy, Twitchy Son #1 and Twitchy Son #2, even they do not have any kind of diagnosis – though I think Twitchy Son #1 is on the spectrum somewhere – again, more of this another time), a house, a full time management job in the IT industry and all the other things I think I should be doing (OK, that’s yet another post in itself … I need to keep a note of these!) These things by themselves are enough for most people.

Now try doing everything while not thinking of an elephant!

(Continued in Part 2)

 

Tourettes is not just tics – In words

As a follow up to the previous post, where a picture is worth a thousand words (or, if I’m being a little obsessive, a picture with 76 words is worth a lot more words – we’ll see how many this post runs to).

It’s hard to overstress the light-bulb moment, when you realise exactly what it is that you have, and that it accounts not only for those irritating physical manifestations that plague your life on a minute-by-minute basis, but also for large parts of your personality in general. It’s an enormous relief to be able to explain to yourself why you did certain things or behaved in certain ways, when they made little to no sense to you at the time.

Not that I am suggesting that a Tourettes diagnosis should be routinely used as an excuse, or that one should suddenly “become” the diagnosis and identify every single action with it. That way – I feel – lies madness. There is also the underlying question about free will, and this is something I’d like to touch on in a future post, so I won’t get into it here.

The fact is though, that if you have Tourette Syndrome, then you almost certainly have co-morbid symptoms of something else, be it OCD, Aspergers, ADHD or any one of dozens of other possible diagnoses. Quite how these symptoms tie in with Tourettes, and how we should really be describing the whole spectrum is a horribly complicated question, and not one that has been satisfactorily answered yet.

In my case, when I discovered how all these things hang together, I realised that it probably also accounted for a number of bouts of depression over the years, as well as a few, erm … shall we say “quirky” personality traits.

I don’t think – and perhaps I’m wrong here – that most people (and I mean most non-sufferers) are aware of these connections. I do think that perhaps if they were then life might become a little simpler for the sufferers.

So spread the awareness. Join the FB page (https://www.facebook.com/TouretteSyndromeAwareness – not my page, but it is where I got the image). Let’s get the information out there!

Tourettes is not just tics