The Black Dog

A black dog is how Churchill thought of depression. He stole the phrase from Samuel Johnson who in turn drew on older images of black dogs as the harbingers of death or the Devil. The comparison to a black dog, for this reason and others, is not inapt. Dogs loyally follow you everywhere, they occasionally bite and are always underfoot.

Last week I had to get myself going to a three-day conference out of town.  I knew I had exactly two hours to drive to the conference, and leave myself enough time to get a bite to eat and get myself settled. The conference was set to begin at 1300. I left at 1055. I really didn’t want to got, though I knew I would meet up with friends I hadn’t seen in a long time, and have an experience that would be both meaningful and engaging. Before I went, I fiddled around nearly up the the last minute before I finished packing, washed and got dressed. As I saw my reflection in the mirror I looked at myself critically. I looked exhausted. My face was puffy and I had large circles under my eyes.

I thought: Okay, now it’s official. I’m depressed. The Black Dog is back and I know it well. Lack of  sleep, no motivation, poor appetite, withdrawing from social interaction, and so on.

I’ve been diagnosed with major depression in the past. My history goes back a long way. I know in my case it’s strongly seasonally associated. It will peak in March and April, before magically disappearing in May and in spring sunshine. Some years are better then others.  In the past two or three years, I haven’t been depressed at all. In 2003 and 2004 it was so severe I had suicidal ideation. In 1987 I couldn’t, literally, get out of bed for a month. My Grade 5 teacher was so concerned about my sudden silence she sent a note home to my mother. The Black Dog’s been at my heels a long time.

For health care professionals depression is a condition that is doubly damning and isolating. The stigma associated in a normal social context is bad enough. If live the life typical of the middle class, you really think you have absolutely no one you can confide in. You don’t want to be The Clingy Friend With The Issues. Seeking care from your GP is embarrassing. Your employer will accuse you of malingering or worse. And so it goes.

But if you’re a health care professional, forget about it. You are totally alone, and you feel like you’re totally screwed. Professional stigmatization, we all know, is far worse than social. We are much harder on our colleagues with depression than our patients. You don’t want to be known as that “crazy nurse”. Depression, like any mental health issue, becomes tied up with fitness to practice issues, so disclosure to any professional becomes problematic. Professional regulatory bodies are concerned with patient safety, and will take effectively — though in fairness, not officially — a punitive view of any mental illness under the guise of protecting the public. There are, needless to say, very strong disincentives not to seek treatment, in short, to suffer in silence.

The fact that I can only write openly (and safely) about it as an anonymous nurse-blogger says a lot, volumes and volumes broadcast by loudspeaker, in fact, both about our society and how we care for each other.

I know what I need to do and what will help. Exercise, ADLs, diet, so on and so forth. A week  puttering in the garden in April will do wonders. I cope. I don’t bother with my GP anymore: I love him dearly, but it’s too embarrassing for the both of us. Talking to him about it is like telling your father about your sex life. At work, I misdirect my colleagues. “You look tired,” they say. I tell them I haven’t been sleeping well: not a lie, exactly. But not the whole truth, either.

It will pass. I know this in my head, but secretly my heart is afraid it won’t, and I will have nowhere to turn.

But I’m thankful there is no suicidal ideation this time.

I wonder sometimes how many other health care professionals are in the same cage of social and professional shame. And I fear for them too, living with their own Black Dogs.

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  1. #1 by anonymous on Friday 12 March 2010 - 0850

    I live with my own black dog. Have had serious, deep depressive episodes since I was around 12-13 years old. Have attempted suicide. Have had suicidal ideations. I’ve been on antidepressants since I was 20. I’m now 36. I still go through deep, dark periods, but they usually aren’t very long lasting, thanks to the meds. Sleep? What’s that? Chronic insomnia. Have tried a variety of meds to help with sleep – nothing works for a nice, solid 7-8 hrs of sleep — which makes everything so much worse when you cannot get a restful sleep. Also have fibromyalgia. I don’t talk to my coworkers about my depression or my fibro.

  2. #2 by JennJilks on Friday 12 March 2010 - 0936

    This is a familiar story. After I moved to care for mom, mom died, I was teaching anger management students, driving 65 km to work @ daily, coming home to check that mom was still breathing, dad was getting daily radiation treatments (which my brother drove him to TO for), I had moved, left my husband 430 km away to sell the house.

    My employer did not understand my issues. I ended up on LTD. I can totally understand how you feel. Mental Health issues are misunderstood, denied and ignored by employers. I had very poor counselling from my union. I ended up taking early retirement, which has had a $ impact. It sure takes a tool, doesn’t it?

    In your field, doubly so. I can empathize. Writing helps, they say. http://thankyourteachers.blogspot.com/2010/01/use-of-autobiography-as-therapy.html
    Take care.
    We need you, but no more than you need to take care of yourself first.

  3. #3 by shrtstormtrooper on Friday 12 March 2010 - 1514

    I haven’t personally experienced a black dog (which, by the way, makes me think of Harry Potter – the Grim was a black dog one would spot and then who bad things inevitably would happen to), but I have many, many family members and friends who do. It’s tough – no other way to describe it. There is still such a stigma attached to just the word, and I can only hope that with enough awareness and understanding, people can learn that depression isn’t something to be hidden and ashamed of.

    At any rate, here’s some good happy Spring thoughts sent your way – I appreciate you and everything you write about. I would want you to be my nurse any day.

  4. #4 by AnonymousRN on Friday 12 March 2010 - 2034

    I think that more people have spent time with the Black Dog at one time or another than folks would expect. Some don’t know it, others are afraid or ashamed to admit it. That doesn’t make it any better tho….

    I hope that the Black Dog is only a small puppy and quickly grows into a happy sunny golden lab. :)

  5. #5 by Art Doctor on Saturday 13 March 2010 - 2248

    I hear you, and understand how hard this must be for you too.

    I also live in Toronto and can relate to your feelings on the weather. It is certainly more difficult during the spring right now when the weather is less-consistent than the reasonably mild February we had.

    It helps me to just increase the amount of fruit and vegetables I eat, because the markets and grocery stores have more variety at this time. I also take a B-Complex once a day because of the shift from dry to warmer, moist weather, and it has some Inositol, which helps with mood. I’m not gonna preach but frankly, you have to look after yourself because you deserve to feel happy and I love reading your blog! No one else can write like you because I would read their blog, and I’m not.

    Take joy in the little things, give yourself small, healthy rewards on a daily basis, half-smile, take breaks when you can, write out affirmations for yourself, decline negative, personally-attacking comments on your blog—there’s no truth in those comments. You deserve to feel well! All the best.

  6. #6 by Wanderer on Sunday 14 March 2010 - 1157

    The black dog and I are very well acquainted. It’s interesting though, at my work, many of us are dealing with this and are rather open about it. No stigma, we take it as a matter of fact. We work nights, live in a dark dreary state, deal with depressing life and death issues day after day and several of us speak openly about it. But I understand, that feeling of being alone, the lack of “oomph”, all of that, it’s no fun.

    Know that bright and sunny days are coming!

  7. #7 by Dr Dean on Wednesday 17 March 2010 - 1104

    I agree with wanderer above, the stigma of depression is lifting-with daily commercials about it here in the states, with the new meds being advertised. Kinda like ED meds (Viagra, Cialis) a few years ago, got impotence on the front page….

    Personally, I have the blues occasionally, and it runs in the family, with a father and grandfather committing suicide.

    I have found benefits for myself in intensive aerobic exercise, and fish oil caps three times a day.

    I also make sure I take time off regularly for battery recharge.

    Good luck-you are not alone….

  8. #8 by nat PSW on Thursday 18 March 2010 - 2125

    Your Blog is a Must Read. Every segment of health care is affected by depression, exhaustion and stress. Your blogs enlighten and make us all feel less alone. Thanks for being real. Keep on with your writing.

  1. Dog Depression

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