Stopping The Tablets

I have stopped taking my anti-depressant medication. 

I started taking it two and a half years ago when I began to feel so sad and bleak through my grief for Ruby that I felt I was a burden, a weight too much for Claire and Tom and for whom life, after their initial raw pain of losing me, would surely be more pleasant if I wasn't in it. 

The medication literally saved my life. After a ropey fortnight getting used to it (the tablets tired me out so much that on the first day I took one I fell asleep at the lunch table in a restaurant) it worked exactly as originally designed- the humid fug lifted, my limbs were lighter, colour returned to my perception. I felt less sad, more able to cope, less irritable, insightful. I stopped having near-obsessive repetitive thoughts- a line in a song, a fissure in a rock, a right-angled desk corner. I could exhale fully having previously kept my lungs quarter full of air for what? Running away? To fight?

On anti-depressant medication I experienced rational sadness, rational tears and a rational breadth of emotion. Everything was manageable- difficult decisions, tensions, my patients, my mum's death in February this year, even my grief for Ruby. I could relax and I could laugh and I was normal. 

I had decided that 2017 was to be a pivotal year. I made resolutions to which I have remained faithful, in the main. I decided to run Belfast Marathon in May and put in four months of near-daily hard graft to achieve this. My mum died, suddenly, in February (I doubt I will ever write about it in this blog. Anathema to my profession as a mental health nurse some things are best left unspoken). The fourth anniversary of Ruby's death was in May, one week after the marathon, and it was more difficult than I had anticipated compounded my Mum's death and post-marathon blues. 

But throughout these physically and mentally demanding months I planned to stop my medication. I was confident in my coping mechanisms, confident that I was "better" and "back to normal" so, with guidance from my GP I very gradually reduced my doses until I swallowed, with no fanfare of note, my 

final tablet ( I was originally taking 20mg of citalopram so I alternated between 20mg and 10mg per day for a week or so then reduced it to 10mg per day for for nearly two weeks then 10mg every other day for a week or so then I just stopped). 

It is more important than most people realise to be measured and patient in a reduction regime. I knew I would be sensitive to negative stimulus and that I would be delicate so I have tried to maintain a sense of self-reflection and I have kept my environment warm and supportive. 

For the first week or two off the tablets I was pretty wobbly. I was very irritable, I lost my temper easily, I became impatient. This was a huge change from the last two and a half years but Claire reminded me that was the old me returning and that I could be a pretty grumpy bugger at times prior to starting the tablets.

Now, three weeks down the line, I have calmed a little and have placated myself. I have kept myself distracted and creative, two activities that I know work well for me. I look to the simple things for meaning- my sunny cycling commute into town, the rain and the trees when I run, my son's hugs, my wife's tenderness.

It is liberating that I have no worries about remembering tablets every morning. But it is constrictive that the ease of coping with stress has dissappeared and that a greater psychic effort has to be employed to get by, day to day.

In other words, normal life. 

Simplicity

I've had some serendipitous conversations in the last week that have made me realise I must be subconsciously considering the simple things in life. 

Jazzy John, a friend, practises kendo, the sword-fighting martial art of the samurai and is passionate about Japanese culture. He told me recently about the importance of simplifying my life, as he has with his. He expressed the virtues of letting go, of reducing the quantity of possessions and working toward defining what is essential in life. He wears the same clothes every day and has the same simple routine every day because his mind is therefore less cluttered and able to make the most rational and accurate decisions when it really counts. When he moved into a small flat with his partner he had to reduce his possessions so he held each one in turn and asked himself "do I have use for this or do I have a connection to it?" If the answer was no, he threw it out and he has, so far, regretted none of those decisions (my personal mantra when it comes to possessions is "is it useful or beautiful?" and if it is neither then it goes to the bin/ recycling/ charity shop/ given away. By "useful" I also mean psychologically or emotionally useful, ie. something that makes me happy or content such as my records or photographs). 

When Jazzy John fights at kendo he has one major rule- relax. When he tenses up his teacher spots it immediately and screams at him- "RELAX". No progress can be made otherwise. 

I spoke to another friend recently, Mark, about a martial art he attends, Brazilian Jiu Jitsu, which involves wrestling and grappling. There is a persistent quality of the loser in any bout- they don't relax. The winner is the one who detects the almost imperceptible muscle tension of their opponent and knows when to squeeze, to grip or twist. The winner keeps it simple, they unclutter their mind, realease the tension in their muscles. 

A work colleague has recently completed her final exams to become a personal trainer. She wants a tattoo relating to her new profession and asked for ideas. The answer was immediate to me- samurai, blossoms, koi carp, crocuses. She should turn to the Japanese art of bushido and its seven tenets- justice, courage, mercy, respect, honesty, honour and loyalty- to help express her drive, her empathy and her wish to empower others. 

A friend, Andy, and I were discussing the nature of early philosophy which was germinated in questions about how to live. In many schools of philosophy the key is one of simplicity- question everything, put humans at the centre of your world, do no harm, have courage, be flexible and so on. We echoed the conversation I'd had with Jazzy John about Japanese culture and about the beauty found in the deceptive simplicity of Japanese paintings and poetry. Some paintings may have taken weeks or months of planning and may have been painted as a series but there would be one final piece that is representative of the idea. And that final piece might be made of only two or three lines with only two or three colours but could be understood easily and have a great depth worthy of reflection. Similarly there is often a great deal of preparation in creating a haiku, a Japanese poem, but it ends up 17 syllables long. 

The most poignant haikus can be understood immediately but can then be used as a model, a framework, to extrapolate thoughts and to explore ones own ideas. 

The most poignant and simple schools of philosophy, humanism for example, can be used as a framework to understand so much in life. 

The simplest ideas can be used to live well (ask yourself if your actions do any harm and whether they directly or indirectly add to the total sum of human flourishing). 

Consider and reduce. Consider, reduce.

After Ruby died four years ago I shattered and broke into the tiny constituent parts of what makes me me. Then I had to rebuild myself from this complicated mess into what I wanted to become (bearing in mind restrictions that I had little control over such as genes, gender, body shape, fitness levels, finances, etc). What am I reduced to, what counts in my simplified life, what is left after distillation? 

For me, this is what is left: simply it is love, tenderness, subjective beauty, taking no bullshit, being utterly unafraid, learning, advocating for and empowering others, awareness of my privilege as a white, able-bodied, middle-aged, straight, cis-gender male, self-reliance, being silly and doing no harm. 

Reflections on a marathon

I ran Belfast's marathon three weeks ago. 

I had never run one before and had been training for four months after running purely for pleasure for four years. I had never run with anyone, not even a 5km training run. I ran the marathon to raise money for a local cardiac charity (Northen Ireland Chest, Heart and Stroke) and to challenge myself to such a distance. I knew those 26.2 miles would be tough but certainly no tougher than any aspect of trying to deal with serious cardiac problems such as the ones Mum and Ruby had to deal with.

I started training hard in January. I investigated the right training programme for me, joined a gym and got stuck in. I completed training runs twice each week, never for fun, always hill repeats or speed-work, did one long run each week, gradually increasing my distance mile by mile, and attended the gym twice each week to focus on core strength and flexibility. 

In February Mum died suddenly from a heart attack. I kept training. I was distracted. 

Shortly after the funeral my aunt, Mums sister, died. I kept training.

The fourth anniversary of Ruby's death was approaching. I kept training. 

The marathon was one week before Ruby's anniversary. It was only three weeks ago but every day since then has given me new insights and new reflections to consider about my health and my life, about Mum, about mortality, about self-determination, about autonomy and about many other things. It has been an unusual and confusing time. 

I have only run three times since then- my interest has massively waned- once was a wonderful trail run over the beautiful and much loved Blacks Mountain, the second was a boring, ugly pavement run that was so disheartening I nearly stopped to call a taxi home, the third was a joyful run/hike around the Belfast hills yesterday with a backpack full of camping equipment, just to test myself. I have found new interest in other activities I am investigating, namely hiking, trail running and wild camping. I am a little worried about losing my love of running as I have heard of many similar accounts of post-marathon passion loss but I greatly hope it is temporary. I've never been very good at anything apart from running. 

I now have time to grieve about Mum and my aunt. I don't know if I am grieving. I don't know how much conscious focus I need to apply to work through it. I don't really know if, while seemingly distracted with training, I have already worked through things. I don't even really know how sad I am. I know I'm not right and I know I feel that depression, or something like it, is following me ready for me to slip up. There are shadows near me where there should be none. My efforts are only just enough to keep the balance. 

After the marathon I recovered surprising well, testament to my gym attendance I have been told. My recovery was relatively short even though I was physically wrecked- my legs were weak and very sore all over, I had many unexplained bruises that needled me for days and, worse of all, the soles of my feet were badly bruised and damaged so I could barely walk. I had large blisters that became infected and which still hurt now, three weeks later (I ran wearing the thinnest of running sandals- Mexican huaraches- instead of shoes in a style known as "barefoot running" which was totally unsuitable for Belfast's potholed, sharp-edged tarmac). 

It is only now, three weeks later, than I am beginning to appreciate the psychological damage that may have been done during than race. If it can exhaust and injure my body in the way it did then it makes sense I should be affected in other ways. But the mental impairment, like the blisters, heals with time. 

I can't guess other changes that will happen as I continue to reflect on my experiences but there is one thing I am absolutely certain of- I need to keep moving. Hill running, hiking, camping, cycling, strolling, ambling.

This is key, movement. In uncertain times such as these the only certainty is that movement always helps. I may never run a marathon again, life is different now after such an extraordinary experience, but I will do other things with my time as long as I keep moving. 

Cave Hill, Belfast, yesterday

1463 days without Ruby

Ruby died four years ago today. That's 1463 days since I last saw her- four years including a leap year plus two days away on that school trip in Scotland. 1463 separate days to think about her. 

Some of those thoughts lasted 24 hours to the absolute exclusion of everything's else- food, water, air (so it felt). On busier days some of those thoughts were only minutes long- I appreciated being distracted enough to continue normal daily life, at times, and at other times I wept with the guilt at only thinking about Ruby once, briefly, that entire day. 

Sometimes Ruby has stomped into my mind without an offer and my legs were unable to remain straight, I dropped to the floor paralysed with the pain of immensity (being overwhelmed is an extraordinary experience- knowing an absolute absence of self-control because of disabling grief is humbling and potentially dehumanising. In time though, ironically, grief became a humanising force that galvanised my closeness to others and made me me feel somehow more human than I was). At other times, thoughts of Ruby have been barely perceptible but I have been content knowing she is always at the corner of my mind, linked to the grief that colours me, never too far away. 

Sometimes I have wanted to join her. At other times I cry with the joy and good fortune that I am in love with my wife and son so much that I can live and cope and carry on. 

Sometimes I feel like the sun is dying. At other times my heart aches with love remembering the times I discussed photosynthesis with Ruby, the importance of bees or how to navigate using the stars. 

1463 days is a long time to not see your child. I remain without her. 

Distraction or avoidance?

As the marathon I have been training for creeps closer, now only a few days away, I have become increasingly stressed. I know why this is. It is due to a combination of the death of Mum in February, the four year anniversary of Ruby's death on May 8th and the sudden death of my aunt (Mum's sister) only a few weeks ago. My marathon training over the last three months has been trying and tiring and has been such an immense distraction that few other things have been allowed space to affect me. My stress levels have increased as this potentially immense sporting achievement looms over me as I simultaneously attempt to compartmentalise my sadness. 

I think I have been fooling myself into thinking that my training has been a distraction in the way that a social activity might be a distraction if I'm sad. But this isn't sadness, this is grief. And when it comes to grief you have to put the hours in.

Grief won't process itself behind the scenes of a jolly diversion (as sadness can) but will linger and lurk, seeping through any facade that is created to cover it up until you are forced into confrontation. If left untackled grief creates an unstable and crumbling foundation for any future emotional resilience. Future stresses need not be too great to create tremors in our minds, fissures in our psyches. Seeing this written down has made me realise that my diversion tactics- the distractions of marathon training- have not been entirely successful and that my reactions to recent events are yet to affect me. It's in the post. I have a lot of mental work ahead of me. There are specific issues that need to be addressed when my run is over- I need to consider how I am coping with Ruby's anniversary, I need to consider how I feel about my aunt's recent death, I need to consider my Mum's recent death.  

Post-marathon I will need to put in place a plan of active consideration and recovery, I will need to do what works. For me this means being entirely honest and open about how I feel, arranging to see close friends for non-alcoholic evenings, good food, good coffee, putting no self-imposed restrictions on crying or expressing fragility, exercising for fun (not as training) and about creating time aside to reminisce Mum, my aunt and Ruby. The essence of my coping plans are rooted in the appreciation of the basics- friendship, love, food, play, the luck I possess and the achievements I have realised. As a good friend accurately opined when I told him I felt like my mind had been shattered after Ruby died, maybe these are the basic building blocks for my mind, for my life, with which I was to rebuild myself. 

I have not been through a period of distraction recently but one of avoidance. And post-marathon is the time to turn headlong into the wind. I can handle it, I've seen worse. 

Marathon running and why my body is amazing

Five years ago or so, shortly before Ruby died, I started to seriously consider my health and age for the first time. Not long after this I became vegetarian and have also kept an eye on my ingested food and gin calories (I had stopped smoking a few years before then- I went from a heavy 30 roll-ups-a-day to zero in one day, cold turkey). I was motivated by a colleague from work, George, who had started running not long before and was not only reaping obvious physical and mental health benefits but wouldn't shut up about it. So I bought the cheapest kit I could, downloaded the NHS "Couch to 5k" podcast, joined the local gym and jumped on a treadmill for the first time in my life. 

I loved it. I found the training quite an endeavour but it was manageable and, most importantly, achievable. As the nine week programme of walk/run/walk/run/walk intensified I was running 20 minutes non-stop by the end of week six and this was when I left the treadmill, waved the gym a happy goodbye and started to run outside. 

This was a life-changing event for me, my rebirth as "a runner". I have run without any major injury for nearly every week since then. I have run on my birthdays, on Christmas Day, at midnight, with a hangover, with a cold, through snow, on holiday, up hills, on roads, barefoot. I ran within a month of Ruby dying and within a week of Mum dying- I had to, I was compelled- I run to stave off depression and to maintain a consistent plateau of wellness. 

In January this year I started training for the Belfast marathon. I had been running two short runs and one long run of around 10-15 miles each week but it was time to crank up the energy and really push myself. So I then caught two nasty bugs and was out of action for a month.

But a month ago I joined the gym again, learnt how to use free weights and machines and set up an intense training programme. I attend the gym twice a week for strength and stability training plus once more for hill running (the treadmill again but the runs are short and very intense) and I have one long run outside at the weekend. The long run has been deliberately extended by 2 km each week so even though I was running a regular 18-22 km until last month, I ran 32 km (20 miles) a few days ago, the longest I have ever run, which is the typical maximum training distance that a first time marathon runner would aim for. 

So I am at my training goal, 20 miles. I hope to complete this distance two of three more times and then have an easy week or two before the marathon. I will continue to harbour fantasies of completing ultra-marathons (races over 26 miles, typically 50 to a hundred miles or more) but, for now, the marathon is in my sights. 

My training path has been, as far as I am aware, typical but has also been surprising in some ways- my gym membership, anathema as it always had been to the old me, has proven its cost. Certainly I get out what I put in and I have seen and felt obvious changes within only a few weeks, my stamina increasing and flexibility improving. Most startling of all is the ease with which I have increased the distance on my long run, 2 km week after week, although the muscles and tendons in my feet have struggled to keep up- my soles are bruised for days after each run and I have to hobble and stretch to recover. 

Rest days are considered "active rest" days. I perform a series of gentle stretching exercises for all major muscle groups, use a foam roller to help muscle recovery and carry out a set of lower leg strengthening excersises, useful for barefoot running. I don't actually run in bare feet very often but it is the term denoting a style or form of running signified by a forefoot strike as the foot reaches the ground instead of heel-striking, typical of most runners. Forefoot striking is the oldest and most natural way of running and, when not totally barefoot, I run in huaraches, Mexican running sandals which are, essentially, a thin layer of hard rubber held onto the foot by a strap. They do away with the sharpest of stones and broken glass but let me feel underfoot as if I wear nothing  at all. Traditionally they were made from cut up car tyres. 

Having never been a fan of my body I am now much more respectful as to what I never thought it could achieve. I have had no serious injuries during the entire time I have been running (only one twisted knee and one sore foot putting me off for a few weeks each) and, after an MOT by my GP recently and a thorough medical assessment at hospital prior to elective surgery (that in the end wasn't necessary) I know that, although my BMI would suggest I am "obese" I am in very good health and can outrun almost everyone I know. I am extremely appreciative of my good health and the physiology that will allow me to run a marathon, something only 1% of people have done. My joints can hold up my obese body for mile after mile, in comfort and in fact for fun. My bare feet will cover the distance that my hunter-gatherer ancestors have filled their days with for two million years. My obese, wobbly, middle-aged, greying, balding flabby body is amazing. It is aesthetically embarrassing but anatomically awe-inspiring and for those particular reasons, in those ways, I love it.

Baring injury I might just make those 26.2 miles on 1st May. 

Sisyphus

Sisyphus was a Greek mortal whose wiliness angered the gods so much that when he died and had to be forcibly taken to the underworld his particularly fiendish punishment entailed rolling a boulder up a mountain to its summit. It may have taken only a few days, months or maybe even years but, however long it took, however great the toil, when the rock reached the summit it would roll down to the bottom again. Sisyphus begin again, rolling the boulder back up the hill only for the same thing to happen. This would continue for eternity.

His condemnation does not lie in his upset and depression at his task (he does not, after all, refuse the activity and we can assume he is actually compelled to complete it) nor the sheer physical labour he exerts. His punishment is not that he has been given a task to build something at the top of the hill and sees his goal thwarted. 

His torment is eternal, his damnation complete, because of the sheer futility of his task. The boulder goes nowhere up the hill, it goes nowhere down the hill, it has no purpose, no reason (it is easy to imagine why treadmills were originally designed as such a hideous form of punishment in Victorian times. All that energy going to waste, the futility of the activity). Here is the hellish oblivion he must endure- to put effort into nothing, forever, for no reason. 

If purposelessness like that of Sisyphus' is a definition of eternal hell then surely the opposite- purpose and direction- is one meaning of a reason for living, for heaven on Earth, for happiness. Maybe there is no real value for immediate satisfaction or gratuitous sensory pleasure in our lives but, instead, we should demarcate who we are and our reason for being based on our role and objectives. 

If my happiness is based on my productivity, what should I produce and what is my role? According to the Greek gods my existence has meaning insofar as it has utility. How, therefore, am I best utilised in the brief time I have here in Earth?