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Ron - Interview 17

Age at interview: 62
Age at diagnosis: 27
Brief Outline: Ron first experienced depression in his mid-20s, precipitated he thinks by drug use as well as anxiety resulting from growing up with an alcoholic father. Peer support programs helped Ron to recover from this first depression experience. However his divorce at age 49 prompted the first of a series of further episodes. Antidepressants, ECT, and Ron's own efforts to recover have helped. He now accepts that he is susceptible to anxiety and depression and is confident he can deal with this.
Background: Ron is a community mental health worker who lives alone with his cockatiel. He is divorced but is in another relationship, and has an adult son from his first marriage and a close circle of friends. Ethnic background' Scottish / Irish.

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Growing up with an alcoholic father has had a long term and significant effect on Ron’s mental health, although it took him a long time to recognise this. Ron describes himself as having been anxious from a young age, and later being the kind of person who avoided conflict and was preoccupied with pleasing and being accepted by other people.
 
As a young adult, Ron backpacked around Asia. This was an enriching and challenging experience, however during this time he experimented with drugs and found that this heightened his anxiety. Aged 27, while visiting his grandmother in UK he experienced ‘frightening and compulsive thoughts’ over the course of a week which prompted him to visit a GP. He was diagnosed with depression and prescribed antidepressants, but given no explanation of the condition or treatment. 
 
Although Ron’s obsessive thinking settled down, his anxiety persisted despite the medication and in fact got worse, manifesting in poor sleep and poor eating patterns. He then returned to Australia, told his parents of his depression, and moved back in with them for three months. During this time, Ron was struggling to complete basic daily tasks, and spent most of his time sleeping. A turning point came one afternoon when he found himself thinking that he no longer wanted to live. His parents’ dog chose that moment to jump on him and lick him, which kicked a switch in Ron’s brain and made him realise he did want to live, but a different life. He located a community-based peer support group for people living with mental illness in the phone book, and the following week attended his first meeting. 
 
Ron’s experience with this group was transformational. For the first time, he was in a setting in which he was understood, accepted, supported, and encouraged to make positive changes in his life. Within a year, he had re-acquired his daily living skills, found a job, and bought a motorbike. In short, he was ‘back to normal’, albeit still anxious. Over the following decade Ron married, had a son, and worked in different jobs. However, his anxiety still gnawed away at him and at the suggestion of his GP he joined a support group for people living with an alcoholic. This was another very helpful experience, as it shed light on the impact of having grown up with his father being an alcoholic.
 
In the course of his depression, Ron was hospitalised and given ECT as well as antidepressants. He has mixed feelings about ECT but has found it and medication to be helpful in kick-starting his recovery process. He usually stops medication once he feels better, as he doesn’t like the side effects. Ron also believes that he needs to take responsibility for his own recovery through exercise, mindful thinking, meditation, spending time with close friends and family, and his job with the same mental health peer support organisation he once benefited from as a member. This self-reliance both helps him recover and maintain his self-esteem as he believes that the health system can be very disempowering of people with mental health problems. He is continuing counselling and mentoring sessions with a psychiatrist, gradually reducing the dosage of antidepressants, and working on prevention. 
 
 

Ron was aware of the importance of incorporating regular physical and mental activity along with...

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But moving your body, moving your limbs, is really, really important. So whether it’s just walking down the street, walking to your letterbox, walking around your suburbs, going to the gym or anywhere else uh and doing it regularly, at least, you know, three to four times a week for over 30 minutes works for me and uh that’s what I'll do. And I’ll be going - doing that today, this afternoon. So it’s a habit that I do and it does after - even though I don’t feel like it I know that after I finish I will feel different and I feel stronger and healthier and a sense of achievement. 
 
So these are just routines that I build into my life as part of my day to day living and they’re ordinary things. But meditation certainly, or mindfulness, certainly is a major factor that I think is helping with prevention and exercise and diet but also having fun, you know, looking for enjoyable experiences and having a rest occasionally. For me, as a person who does too much, or over works, just sitting in this room and looking out the window and not feeling I have to get up and dust the uh, the knick knacks or whatever, is amazing. I can choose just to rest. 
 
 

Ron recommended taking a proactive, critical approach towards understanding depression and its...

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Firstly understanding what depression is, in terms - but just what does the word mean? And what’s the physical, emotional, even spiritual sensations a person will go through with “depression”, or clinical depression which seems to be different than other depressions. So understanding what’s happening to you is really important. And then understanding that it will pass, like the weather, it changes. Understanding what are my choices in terms of taking any medications, what I could do in terms of my physical health as well, like as I said before, on exercise, and even working on my brain through mindfulness, that - all those things that I actually have experienced and I know work, or are there for me. 
 
And even just the word depression itself, and it's just, again it’s just a word, and not realising that I am a depressive. I’m a just a human being, going through the human condition and occasionally uh being overwhelmed by life and not having the resources to overcome that. And that's letting go of stigma, I don’t have any shame, as I’ve said before, and uh I have a lot less baggage, (interviewer’s name), a lot less baggage, even just moving here I left a lot more stuff behind. And I’ve continued to do that, 'cause I can’t take any of it with me, and I don’t want it because it collects dust as well [laughs].
 
I think the most helpful thing is uh something that’s been thousands of years old - ‘know thyself’. I think it’s actually written on one of those old Greek temples somewhere. Know thyself. And you have to actually get help to do that, initially with helpers, it could be doctors, could be friends, could be books, know yourself, and understand yourself and understand your behaviours and thoughts and feelings. And, and secondly having choice and choosing to try things differently, choosing not to just stick with the authority, 'cause the authorities will always be authori- can be authoritarian and tell you what to do and this is it. 
 
 

Ron was critical of impersonal, insensitive attitudes towards people with mental health...

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Yes but it’s also the reality that, uh oh either with, with your, with a doctor, who’s another authority figure, that they are the authority figures and we look for authority, we look for guidance, we look for the experts of knowledge and we believe them usually. 
 
And uh I remember once I was giving a talk in a pub - you know, public or private hospital and this drug executive came in promoting a new antidepressant, or anti psychotic, and he started a conversation with all these nurses and others, because I was giving a, a talk also, an in-service to staff, and he started off by saying and looking at the group, ‘How many psy - how many psychotics do you have today? How many uh schizophrenics are here at the moment? How many of this and how many of that?’ And I was thinking, is he asking this lot, the nurses and the doctors, of - how many of those are psychotics and schizophrenics? Of course not, he was asking about the, the, the patients out there.
 
And uh I thought, how impersonal is that and that attitude, it’s really horrible, and in fact uh when the person had finished, he sat down and he brought all his show bags and, you know, umbrellas with the drug company thing on the brand and cups and, and all these freebies that the staff grabbed and put in their show bag and I said, ‘Well look I can’t beat that, I have nothing to offer you but hope’. And you know, and I did say to them, ‘So none of you admitted to being a psychotic or a schizophrenic or a depressive?’ And there was silence in the room. I said, ‘Well, you know, I’ve had episodes of depression in my life but I’m not a depressive, you know, I’m a person’, and I left it at that. 
 
So the system itself does depersonalise people and removes hope because we believe the experts. From early childhood we, we believe our mother and father, then we believe our kindergarten teacher or our ministers and all these people, or our policemen, all these authority figures can influence our lives, if we haven’t got the courage to find our self and to challenge that belief and become - uh believe in our self. And we, we - the laws help us to do that, the Mental Health Act and other laws help us do that. But many of us don’t even know they exist or know that they, they’re there to help us. 
 
So it’s really about empowerment and part of the work I do now is trying to let people know you have a right to use your power, you have, as a citizen of this country, you have rights. But you also have responsibilities as well and that, sometimes they’re hard to do, to be responsible and to speak out. So - but that’s the choice all of us make, some of us lose our mental health because of it and that’s very sad. 
 
 

Ron questioned the usefulness of labelling mental health conditions as in his view it can allow...

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And no-one’s really ever died of, for example, panic attacks, which I had gone through - I didn’t mention that before but I had probably a year or so of really bad panic attacks and I grew out of that, because I realised that it was just panic and uh occasionally I had to stop the car because I was afraid that I would be - get so panicky I would run off the road or crash or something. And thankfully I've realised I’ve beat the bluff in that way.
 
So yeah , your sense of self diminishes the more you just see yourself as a depressive or a schizophrenic or as a, you know, eating disorder, because people often are labelled that and they become that and they live down to it. And that - they make that as an exc-excuse, ‘Well I can’t do anything because I’m a bipolar two, there’s my excuse’. And then people will say, ‘Okay,’ and they don’t challenge us to live above that. I don’t believe that.
 
 

Ron discussed his preference for psychiatrists who are open-minded and treat their patients as...

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And consequently over the years I’ve met doctors, some doctors who’ve uh told me a lot more and uh also had their own views about things, and different views, very different than conventional wisdom too. To the point that the person I see now is even questioning the word depression and working on mindfulness. And of course I’ve seen, you only have to Google that, mindfulness based can be something or other, that's become a, become a, a new sort of modality and a franchise almost. So again, it just reinforces to me that the jury is still out about this thing we call depression. 
 
So some of those doctors and professionals and professors are in high places with high influence and they’re authorities. So I think it’s all part of the human condition. So the doctors - and they’re all male by the way, except there was one female doctor, in fact my doctors I have now, uh the three, there’s a psychiatrist who I’ll see as my mentor and my coach in mind, mindfulness and there’s two women doctors who look after my bodily and maybe also psychological needs too. but they’re all open people that I can challenge and I can say no to, that aren’t just, just swallow the pill. I, I actually ask, ‘Do I need this and why?’ And uh I have a relationship with them, so I’m grateful I have that. You know, we can choose our hairdresser, we can choose our doctor, we can choose the person who services our car, we don’t have to stay with one person, many people stay with the same doctor on the same medication for 30 years and never think they can actually change, well, you can. 
 
Of course if we reduce the need then there will be a lot less jobs for doctors and psychiatrists and all those other healthcare people out there who make their whole living off the misery and struggle and suffering of people. But that’s okay, [smiles] maybe they can become balloonists and uh, you know, uh design uh saunas or something, I don’t know. 
 
 

Ron thought antidepressants were mainly helpful at the beginning of recovery process.

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So medication has its place but it’s only really probably at the beginning of the recovery process. Some people may need to be on medications all their life, uh especially if they have a lot of fear about breaking down again, maybe that’s just another issue they can deal with, but I don’t have that fear. But I still have to trust the experts and maintain the medication for a reasonable amount of time after, just in case. 
 
So you don’t take medication all the time?
 
No I haven’t, I haven’t continued to take it, in between these episodes I’ve got to the point of, [uses left hand to illustrate a gradual process] very slowly, gradually, with correct supervision, with my doctor, gradually coming off it. And uh this last episode I had, beginning of uh this year, and I’m now back on a medication, but I do, and I have discussed with the doctor, that in time I’ll probably have to stay a lot longer, this time because of the, the a - more short, severe, acute experience I had. But - we are talking about, already have reduced it a little bit. So there is - it’s a process we all have to go through, but I need to do other things besides medication. Exercise regularly, meditation, looking at problems in my life and trying to resolve them - the conflicts that we all have. 
 
 

Ron accepted that his numerous hospitalisations for depression had helped him, but had...

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Uh… well, as you were speaking the thought came into my life and I visualised back in a (city) public hospital and realising how little control you have, even though I was a voluntary patient, I wasn’t scheduled, but how little control you have in the day to day running of that place and what happens to you. You’re really at the beck and call of the doctor who comes at a certain time, or whenever, or the system and the timetables and, and you really lose, when you’re in a institution, you lose that ability to choose when you want to eat, when you want to sleep, where you want to go, can you go outside.
 
And it is not a very - it’s not a good, not a very good experience, it diminishes you as a person, you become just a - I don’t know what the word is - but it’s very hard to maintain your sense of self in an institution where everything is more or less uh dictated to you because they are the rules, they are the procedures and the protocols. And even, even the acts of kindness that could be given to you by staff are limited because they’re not allowed to show that, so there’s not much caring, or there’s actually not much hope, I don’t think. Because people follow an ideology, the medic - a medical model that says this is this and this will always happen and - but that’s not true.
 
 

Ron reflected on his experiences with ECT.

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I think it was factors of, of in a public hospital about the bed. About actually, you know, occupying a bed and there wasn’t enough improvement, I was basically pushed into, into uh accepting ECT, because the medication wasn’t working. Uh, and I did, because of the pressures to - because I was occupying a bed and they didn’t see, the experts didn’t see, any improvement.
 
So - and in fact I do know, having studied this st-, stuff and looked on the internet now that sometimes depressions can just lift of their own accord and change and move and each one of them is different. So we don’t all fit a, a, a timetable or a routine. But there’s still always demands for beds and that’s probably forced me into using and choosing uh to have ECT. 
 
The experience of ECT was probably coloured by One Flew Over the Cuckoo’s Nest. And [clears throat] even though the actual experience of modern electro-convulsive therapy’s not like that film, [nods] it’s still a pretty scary experience. And yes, it's after the procedure there’s always the memory loss and confusion and I think you’re treated differently than other patients in the hospital, you’ve had ECT so you must be really worse, the worse ones, or something. And it’s often used as a last resort and literature shows that too. So although I don’t have any shame now, but I used to have more shame about having ECT' ‘I must be really sick if I have to have ECT’. 
 
But I think it, possibly again, if under a - in a different regime where people could stay longer in hospitals or have different activities or a whole range of things that they were available for them, that maybe I wouldn’t have needed to have it, or even just having time to go through the experience might have made a difference. But certainly there’s more stigma with people with ECT and people rarely talk about in groups or in public or whatever. So there’s stigma within stigma as well.
 
 

Ron appreciated the safe and non-judgemental atmosphere of the support group that he attended for...

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But I went and they didn’t abuse me like my father, they didn’t nag me like my mother, they understood and they said, ‘Yes, we've had these types of symptoms and behaviours and yes it’s uh - we call this - called depression and, it’ll take time to get well, just keep coming back and that’s your practical task’. Which I did, I went back the next week and the next week and it took me probably six weeks to even start to feel safe and comfortable enough to even talk about personal issues, which is quite good. I started to trust these people who I had never met before.
 
They affirmed, my self esteem improved as I started changing and demonstrating this stuff, they just didn’t affirm me because I was there, they affirmed me when they saw me change. To act differently, speak differently, talk about what I was doing, oh, you’ve got a job now, that’s fantastic Ron and, you know, you might feel anxious but keep doing it. So they did that grad - slowly, gradually and those support groups supported me but they didn’t do things for me. I still had to do the work, I still had to work with myself, it’s an ordinary thing, but they would affirm me.
 
 

Ron thought that suffering and joy went hand in hand and described this as an enriching state of...

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So when you start - when a person starts to take charge of their life and be responsible with - for their life, not controlling their life because that may be another form, is that then you open up a whole lot of consequences and a whole lot of possibilities. And of course there’ll be, there'll be pain and suffering in there too but there may be that great opportunity for joy and for freedom and, you know, all those other wonderful things, because you really need both sides of the coin, you can’t just have one, just have all joy and peace, we need to have the other side too like night and day. 

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