Monday, January 25, 2016

It's Complicated.

In about two weeks will come the date when, two years ago, I started walking. Prior to that I lost interest in reading, writing, TV and film … okay, let’s round that up: I lost interest in my life. I walked in desperation to keep depression at bay while I got over the death of my wife. Yes, I kept depression from crippling me by walking, but I wasn’t achieving much more than a holding action. When I stop walking it comes back, when there are extra stressors in my life it comes back. But is it depression? Is it really? Because I have now been reading about ‘complicated grief.

In psychiatry, complicated grief disorder (CGD) is a proposed disorder for those who are significantly and functionally impaired by prolonged grief symptoms for at least one month after six months of bereavement.

I thought I grieved and grieved enough. However, because of the circumstances of Caroline’s death I spent an awful lot of time suppressing the images, just shoving them out of my mind. I walked and exercised to the point of exhaustion. I cleared the house of items related to her – just retaining some keepsakes in a wardrobe, out of sight. I can hardly bear to look at pictures prior to 2014. Now, in just some brief exchanges with some therapists, I learn that maybe, despite all the crying, I have not processed my grief and it keeps coming back to bite me.

The symptoms are, apparently:

Intense sorrow and pain at the thought of your loved one
Focus on little else but your loved one's death
Extreme focus on reminders of the loved one or excessive avoidance of reminders
Intense and persistent longing or pining for the deceased
Problems accepting the death
Numbness or detachment
Bitterness about your loss
Feeling that life holds no meaning or purpose
Irritability or agitation
Lack of trust in others
Inability to enjoy life or think back on positive experiences with your loved one

A lot of these apply to me. However I don’t get intense sorrow at the thought of Caroline because I have quite effectively shut such thoughts down in my mind. Nor do I focus on the death or have intense longing, for the same reason. I shut it all down, zilch, nada, not going there. So is the reality with me ‘Complicated grief’, that all the stuff I locked away in rooms in my mind is festering? Is it the case that it is not depression as such, but time to house clean my mind?

I’m forever searching for answers. I’ve tried hypnosis, meditation, am learning mindfulness, positive thinking, forced laughter and smiles, processing my positives, positive visualisations … though the one thing I still don’t want to try again is the one provided by our pharmaceutical companies. Despite all this, last week I lost 5 - 6 days to ‘depression’. I was fighting it hard but then it fought back even harder. I crashed, completely. Nothing was any good, nothing would work, everything was shit. My weight dropped by 9lbs, I started smoking again (but with the ecig I am easily stopping again), I spent most of my time sitting in a chair staring into space, feeling like Hell. I started taking Citalopram, but I only took 2. This ‘depression’ came again these last two days. Despite my resolution not to I took a Citalopram – I felt it was my only option.

Time I think to try something else, as well. I’m now booked in for CBT, but that might take some time. I’ve contacted some local therapists and await their response. But I’m also going to try something else. I’m going to make myself remember. And that starts with the photographs you see here.

Wish me luck. 


Kirby Uber said...

I have never heard of this, this complicated grief. this makes alot of sense, to me, personally.


All the best Neal. I hope the photos are the start to you remembering the good times.


Swainson said...

Good luck Neal.

Kristin said...

Thanks for sharing your journey. You've posted so few pics of Caroline over the years it was nice to "meet" her today. Thank you.

I also wonder, if the grief process is harder for guys under circumstances such as yours? Because of societal expectations it's generally accepted that the guy will pass first and when roles are reversed, there isn't the support system in place to help him cope?

NebulaBooks said...

Complicated Grief does sound like a very complicated issue. Every challenge is just another way of the universe offering us an opportunity to overcome and to improve ourselves in someway. Keep fighting and keep winning. All the best luck, Neal.

joshua said...

Complicated Grief is a tough cycle to break and process through- keep up the work on it. Good luck on this!

And for Kristin above in the comments, I work in a pretty large hospital and I can tell you that mental health in all forms tend to be somewhat neglected, and grief gets even less support, then on the lower end of that male grief isn't addressed adequately enough (there is stuff there).

It's a very tough place to be in for anyone, and depending on where you live, it might not be something anyone can help with, which is very disheartening to think about. The facility I work in has recently gotten a nice boost in MH, but will be shifting those patients to our sister facility and they will be getting a massive boost in the next year, so that is good. People will finally be getting treatments and help long since needed. Hopefully this'll be a trend in more places.

roy taylor said...

Sounds like you may have just reached your lowest level. That's when regeneration of happiness starts,slowly at first,but without effort or therapy.

yodinator said...

I wonder, do you think it might help to write about Caroline? I'm not suggesting on this blog necessarily, just offering a random thought - that may provide some form of catharsis...?

Keep on keeping on mate.

Alpharius said...

I do wish you the best of luck - and while I have no idea what I can do to help, I'd certainly do whatever I can.

Neal Asher said...

It is a complicated thing because it can come out in other ways. You don't think your grieving, you think you're getting angry, depressed, anxious, apnic attacks and other things besides about some unrelated issue. But no, it's all that shit coming back to haunt you.

Yes, yodinator, I may well start writing about this. I couldn't a year ago.

David said...

Congrats on getting scheduled for CBT. I would recommend that you decline any offer to do it on a daily basis. I spread mine out on a bi-weekly basis so that it took about 4 months but I can't see any issues with doing it weekly.

When you really put some effort into CBT it can be a challenge, but then that's the point - to challenge and change your current thought patterns. You'll need time between sessions integrate them, to think about what you've covered, and to both procrastinate and then do the "homework". Some procrastination is normal, it can be hard looking that far into yourself. I just can't see how anyone could change their thought processes in a matter of two weeks.

I hope it works for you. It helped me tremendously, just not enough to avoid Zoloft. SSRI's and CBT can and do work synergistically for those with treatment-resistant depression. SSRI's suck but they beat the alternative.

Best wishes on this journey.

Unknown said...

Simply my best wishes, Neal.

Tim said...

Good luck with this Neal, hope this will wok for you. Judging from all the comments on this and other blogs, there are a lot of people out here on your side, rooting for you, Go Neal !!!

Peter Brown said...

I do wish you luck Neal. Remember that Citalopram takes a week or more to bed in before it starts to flatten things out. As an outsider, its certainly a positive move that you are consciously moving yourself forward with the pictures above. My daughter died 3 months ago, and I also find the random (non-grief-related) emotions surfacing a scary thing, especially when you realise that it is in fact completely related to your grief, just unconciously. As a previously "rational" person, I also find not knowing how I feel very scary. Feels like I'm possessed by something/someone sometimes.

Keep fighting and I'll see you on the other side.

Miles Campbell said...

Good luck, Neal. One thing i have noticed throughout your blogging about this difficult time is your utter unwillingness to give in. Whilst i don't suffer personally, my wife does and she has tried all sorts of different strategies. Her personal regime consists of some CBT, writing stuff down when she's catastrophizing to expose her thoughts triviality and meditation sessions (15 mins every evening before bed) and these seem to work for her. You will get through this, i'm sure. Just keep fighting!

uncletigger said...

Very best of luck Neal. You seem so strong, that it is kind of daunting to me to think about. I wish I could be sure I was able to deal with things half as well as you have.
I have been re-buying your books, mate, because a niece read Polity Agent off my shelf, and was TOTALLY blown away by the "realism" of your fiction and her enthusiasm re-awakened mine, so I have been buying them, reading and enjoying them, and giving them to her.

Maybe a useful trend?. :)

uncletigger said...

On a different note, I am AMAZED at the forward rake on the mast of the little sloop in that photo. I guess it is some kind of local rig, it would be a figure of fun/concern here on Auckland harbour. " Oi, mate, tighten yer backstay, all your gear is going to carry away forward ! "

mark dawson said...

I lost my wife of 35 years to bowel cancer in November 2014 and the past 14 months have, like your battles, been the most sad, demoralising and intense I have ever had to face, Depression, anxiety, lack of enthusiasm for activities or interests, they all roll around but thankfully occur less now than before. You are doing the best you can so keep plugging away and you will get there. It will be painfull because we never get over the death of a loved one, but it will get easier as time passes. You just keep on keeping on and stay active, get out and about if depressing thoughts start. You will get there but none of us widows and widowers are unscathed. No one ever wants to join the club but do anyway.. just know she is in a better place and painfree and watching over you..when you fill up with grief ball it up and throw it away.. and try to destress the mind and body.

Mark O'Neil said...

Complicated Grief Syndrome is real beyond doubt.

A psychologist I spoke to once said that it’s not the depression so much as how long it takes for you to “bounce back”.

You have had a hellish two years - something terrible happened to somebody very dear to you.

It’s hard for people who haven’t had something like this happen to them to understand.

My only measure is the way I felt when a close friend committed suicide a few years ago, I was seriously down for over a year, even now my coping mechanism is to try and not think about what happened.
not the best idea really but It’s my form of “mindfulness” I suppose).

Caroline was your wife and friend and much more – surely your entitled to feel like you do.

We all hope your new strategy works and you start feeling better soon.

For your fans who have read your blog over the years please know that your posts have deeply affected us – we feel for you and would do anything to help you feel better.

I hope I don’t sound like a wanker - but we love you mate.

Your novels have brought us much joy over the years.
Know this – you are up there as one of the best Science Fiction writers ever.

The world needs you.
Good luck from us all.

Thud said...

You have the thoughts and good wishes with you of so many people you don't know, good luck.

David G. said...

Time does not heal,
It makes a half-stitched scar
That can be broken and you feel
Grief as total as in its first hour.

from Words About Grief

Steven Popelis said...

Seconding this. Antidepressants take weeks to months to build up to therapeutic levels. Obviously they're not going to instantly make you happy (unless you're taking amphetamines or something) but they do take an unusually long time for you notice any benefit. Also, as you'd know, the first few weeks are the times you're going to get the worst side effects.

Another thing is there is so many different types on the market now (snri, ssri et al) and your dr might recommend something else besides citalopram that suits you better (you can literally get sample packs for most antidepressants)

God, I sound like a drug rep.

Steven Popelis said...

Seconding this. Antidepressants take weeks to months to build up to therapeutic levels. Obviously they're not going to instantly make you happy (unless you're taking amphetamines or something) but they do take an unusually long time for you notice any benefit. Also, as you'd know, the first few weeks are the times you're going to get the worst side effects.

Another thing is there is so many different types on the market now (snri, ssri et al) and your dr might recommend something else besides citalopram that suits you better (you can literally get sample packs for most antidepressants)

God, I sound like a drug rep.

Jinja said...

Good luck with the CBT, I was skeptical of it at first but it really worked for me. I thought of it as reprogramming around a mind glitch. It's not quick, but I was fortunate enough to see step by step progression with each session. I hope you do too.

Good luck reprogramming that computer in your head.

Neal Asher said...

I am not taking the anti-depressants. The whole point about grief, as far as I can gather, is that you must experience it, you must go through it, you must not block it. I mentally blocked mine because it was just too painful. I realize that I put our entire life together to the back of my mind. Effectively forgot it. Anti-depressants are just another way of not feeling, another way of avoiding, just as alcohol is and any other drugs. You must be raw and you must take it, live it, go through it.