Mood Changes: Looking for Signs

The sign reads, “You are now leaving Utah. Welcome to Colorado!”  The map on the front seat of the car and the sign tell us that we are leaving one state and entering another. If only we could have a guide to mood changes that were so clear.

People with mood disorders often describe symptoms “sneaking up on them,” something like this: I think I’m okay, don’t feel depressed, just tired, gee my family drives me wild, I wish my coworker would be quiet, OhMyGod – I am depressed. How did that happen?

Mood changes are by nature tricky. We are trying to assess ourselves with the organ of perception itself. In the midst of depression, folks often cannot recall feeling well. They may intellectually know but can’t remember the feeling of well being. The same is true regarding well being. When symptoms subside, people often doubt themselves. Was I really depressed? Maybe I exaggerated how bad I was feeling. It is at this point that people may decide to go off their medication because “it isn’t doing anything.”

In acute phases clients may be asked to fill out daily mood charts in detail. Keeping up this degree of record keeping can be cumbersome. So what works? How can a person check in with themselves in a way that is effective and increasingly so with practice?

Idiosyncratic Mood Change Indicators

That’s a mouthful isn’t it? And what the heck does it mean?

It means that most people with a mood disorder can report subtle changes specific to them.

Changes in relating to everyday activity:

Examples: I stop making my bed, procrastinate about doing the laundry, forget to feed the fish, stop answering the phone, can’t stand to listen to music while driving.

Physical quirks:

Examples: some people report jaw tension, a particular feeling of clumsiness, changes in diet, cravings or digestion, a flatness/tightness to facial expression. A number of people have told me that there is a distinct change in the tone and quality of their voices that they and loved ones can recognize almost immediately. Some folks notice changes in their visual perception- the world literally looks grayer, less vibrant.

Activities that are only engaged in during a mood change:

Examples: conflict with particular people that only tends to happen under the stress of symptoms, driven behavior that isn’t easily interrupted (like playing computer solitaire for endless hours, to the exclusion of a regular rhythm of sleeping, eating, and engaging), stopping at a convenience store for candy bars, buying Red Bull.

The Short List

I often encourage clients to write this mood change indicators on an index card and carry it in their wallets or tape inside their medicine cabinet. When the question comes up “how am I doing, am I getting depressed?” the index card is a place to start.

Self assessment in the middle of change is difficult.

The ability to pull out a good map and take a quick look can be immensely helpful.

Recognizing mood changes sooner can promote empowerment. “I see what is taking hold and can be proactive.”

It is another step to taking the symptoms less personally and be able to work with and master them.

The Short List can be shared with practitioners. It can become a tool for clear, short hand communication about the flow of mood states.

It can decrease the float time of feeling isolated and confused about what is happening and hasten the mobilization of support.

Pulling it all together

Sara has had numerous bouts of depression. When she is feeling well she is a wonderful free lance writer, enjoying her work and the connections it brings. Her short list looks something like this:

Changes in everyday activity: I stop washing my face and brushing my teeth before bed because I feel too tired and it just feels like too much work. I wear three or four outfits over and over.

Physical quirks: My jaw feels tight and it is effortful to smile. My smile feels false in a particular way.

Activities that are only engaged in during a mood change: I go to fast food drive thrus.

I close the curtains in the living room.

Now when Sara has the thought that she might be getting depressed she uses her list as a quick look in the depression symptom mirror.  She brings consciousness to subtle changes that she was able to rationalize and sweep away in the past. Those cues are now her call to self care and action. (See article called Sitting Small)

Take a moment to consider and begin your short list of mood change indicators. Add to it as you notice these subtle cues.

Part 3 of a 3 Part Series

Reflection: Coming to Stillness

“So Frank, how was your week?”

“I don’t know. The day or two after our meeting I thought a lot about what makes a good day and what is important to me but I don’t feel like I got much done. I don’t even remember what I did exactly.”

“That’s fine. Let’s take a look at your schedule from the week. It’s a perfect opportunity to work with reflection. That’s when we pause before moving forward to see where we’ve been.

“In this high speed, high activity world of ours it is easy to feel like we are being swept away or flooded. After a week of activity it is helpful to take the time to come to stillness to appreciate our journey and to correct our course as needed. Interestingly enough it is a time of self acceptance.”

Week in Review

The first step in reflection is to peruse your schedule. Allow your mind to recall how time was spent, the weather, people you spent time with. Allow the items on your schedule to blossom, expand. Allow the details of your days to reemerge. It can be helpful to jot notes.

Now circle the times that were satisfying. Circled items could be something like this:

• great hike on Sunday
• got that report done at work on time
• my child’s softball game was a blast to watch
• lots of thunderstorms – really enjoyed them
• delicious strawberries for breakfast
• I’m loving my yoga class, the teacher is awesome

Now look at what didn’t work as well as it could have. What felt out of synch.

• felt embarrassed when I was late for the team meeting at work
• had 2 glasses of wine after yoga class,didn’t feel good, couldn’t sleep
• felt out of it at work the next day which was the day of the team meeting!
• don’t feel like I connected with Jen this week – “us” time needed?
• feels like the summer is moving too fast- camping trip? longing for something
• wish I had more time to hike

At this point you may have a visceral sense of what your week has been like. It is likely that you will have ideas about what you want to include in the week to come.

It might look something like this given the above examples:

• I want to schedule hiking, yoga and at least one softball game
• I do not want to drink wine after yoga class!
• Talk to Jen to see how we can spend time – workout? movie? dinner in the mountains?
• maybe when we spend time we can talk about doing something special as a family
• pressure is on at work with a project deadline so I want to pay attention and eat and sleep really well.

What’s right?
What are the relationships between things?
What am I moving toward?

Frank looked thoughtful and alive.

“This is interesting. I came here feeling tired and vaguely dissatisfied. Like I had somehow failed. Now I feel more relaxed, in focus. I have a clearer picture of my life and its ok.”

“Great. I also do this practice every week. What I often notice is that places that I have judged myself harshly soften as events melt back into context and flow. It tends to leave me feeling challenged and excited about the week ahead.”

“Exactly,” said Frank. “Can we summarize what we just did so I can remember it when I am doing it on my own?”

“Okay. Here’s the short version:

Reflection, coming to stillness: taking the time to contemplate the week
What’s right, what’s been satisfying, what has worked: circle satisfying items
What are the relationships between activities: notice patterns
What do I want to move toward: what do I want to try next week

How is that, Frank?”

“Routine, rhythm and reflection makes a great package. I feel like I have a lot that I can keep working with over the weeks to come. Can I invite Jen to join is in a few weeks so that we can look at this as a couple and a family?”

Part 2 of a 3 part series

Rhythm: Weaving together Meaning and Every Day Life

Frank came into his next session both excited and frustrated.

“I am actually doing pretty well with the basics at this point. My sleep has improved a lot since I first started meeting with you. My wife is great about taking care of meals so I have a lot of support. But this feels so kindergarten to me. Just keeping up with the basics isn’t enough,” Frank said.

Routine is the foundation. Let’s spend some time today talking about rhythm.
Rhythm can feel like graceful movement thru the course of a day. You’re not expecting too much or too little of yourself. There tends to be a variety of activity: taking care of the ordinary details like washing the dishes, having some sense of connection with others, activity that is infused with personal meaning, time to relax, time to play. Let’s look at this together.

What makes a really good day?
“Frank, try to remember a day that at its end you fell into bed with a sense of deep satisfaction,” I suggest.

“Hmm. Well, I can remember a day last summer. I got up early on a Saturday because I agreed to take a bike ride with my friend. The air was cool. I enjoyed my friend’s company and felt happy that I had made the effort to get up.

“Then when I got home I remember plopping on the couch with my kids and some of their friends who had spent the night. We watched Bugs Bunny. Then I worked with my wife in the garden for a couple of hours. We had a chance to chat and also had long stretches of silence. It felt really good to be working together.  We took time to admire the garden and anticipate our luscious crops.

“I fell asleep in the hammock listening to the Rockies game in the late afternoon. And we made burgers with the kids in the evening.

“You know it’s funny, I would not have thought of that day if you hadn’t asked. It was no big deal but I do remember feeling really satisfied.”

“Great example, Frank. I continued,  “Most of us know very well what a good day feels like. We don’t always take the time to notice what the key ingredients are. On any given day we can look back and know if it was satisfying or if something was missing. We may wish that we had exercised or taken time to be with another.”
Columns A, B, and C

So imagine 3 columns:

Column A = immediate. It is all that stuff that we do to keep our lives going. Mowing the lawn, paying the bills, emptying the dishwasher,
going to work.

Column C = dreams and meaning.  It might be that you someday want to write that great novel you’ve been thinking about, or sail the world, or start a foundation for kids in need, or join the Peace Corps or take a training to become a yoga teacher or go back to school. It’s the list that expresses who we are and what we feel we have to offer the world.

COLUMN B =
WEAVING TOGETHER OF A  AND C

To use the above examples, it means that I would perhaps schedule writing time or make a point of taking a sailing class or have a regular yoga practice. With great intention I am aware of what is meaningful for me and I take time to make it an important part of my schedule.

“Wow,” Frank commented, “now I know why Bugs Bunny felt so good. I often feel guilty that I don’t spend enough quality time with my kids. That day without much effort, I felt like a good dad.”

“Good point. Our meaningful activity doesn’t have to be monumental. It simply has to have that lift of satisfaction: I am doing what I want to be doing. Remember when we talked about Unifying Principles? Unifying Principles help us to remember and incorporate what is important.”

Frank wondered aloud, “ So why do you feel this is especially important for people like me with mood disorders?”

“Because the pattern can be painfully exaggerated with mood disorders. If someone is living in Column A in survival mode and Column C seems like shattered, impossible dreams then Column B, the weaving, can be almost non-existent. Like you said in the beginning, just getting by with the basics isn’t very satisfying. We all need a sense of meaning and satisfaction.”

“When I am depressed and not functioning very well, I don’t have much energy. I feel guilty if I spend the little energy that I have on things that mean something to me like going sailing. But if I do, I feel so much better, at least for a little while. I think I am beginning to understand why I can give myself permission. How the weaving of good stuff helps to create that rhythm you were talking about.”

“You don’t need to ask me twice,” said Frank. “I’ll work on a recipe for a good day and column b and see you here next week.”

Betty says to herself, “Oh lord, I am so behind on things.  How do other people stay on top of everything?  Today I’ll get as many items checked off my list as I can whether they are top priority or not.  Oh God, I never got around to the taxes, and it’s April 14th!  I always put them off because I’m afraid I won’t do them perfectly.  I’ll be up most of the night again…”

A name for this way of living is …
“Survival Mode”

Mood issues affect the frontal lobes of the brain.  The frontal lobes help us envision the future, and they control planning skills.  People with mood challenges or those of us who grew up in a chaotic environment often have time management problems.  Being late to appointments, procrastinating, or feeling constantly too busy are all natural brain symptoms of depression.  They aren’t symptoms of being lazy or bad.  It’s not personal.??Survival Mode’s mantra is:  “I’m doing the best I can.  I’m doing the best I can.”  Doing the best you can is more about coping and getting by than choosing how to spend that day, or week, or year.  Choosing feels a lot better than coping.

DOING WHAT WORKS

If you would prefer to be the person who is on-time, who doesn’t procrastinate much, and who can say no to others’ requests when they don’t work… there is a helpful phrase: Doing What Works.??Doing What Works is a way of taking back our power of choice from the habit of Survival Mode.  Magic even seems to slip into some of the empty spaces when we’re willing to let go of a frenetic pattern of coping.

BEING ON TIME

It feels so good to get to an appointment early and be able to relax for a moment in the waiting room with a magazine or catch up on a couple text messages.  Planning to leave for the appointment 15 minutes earlier than you are used to has so many good effects.  The voice of Survival Mode whispers, ”But I can’t spare those extra minutes!  Oh, I have a few minutes until I have to meet Joe.  If I drive fast I can squeeze in one more errand to knock another thing off the to-do list, which is making me so anxious.  I’m just keeping my head above water here!”??The voice of Doing What Works tells the truth:  “I hate being late and I hate speeding!  I’ll leave early and take that article that I need to read for work in case I have a few extra minutes.”

PROCRASTINATION

Bob knows he has a tendency to procrastinate, but he’s been working on it this last year. ??He looks at his to-do list,” Wow, there’s a ton.  What’s going to work realistically?  What are the three most important items this weekend – even if they aren’t the easiest?  Taxes, clean the house (so it’s done a couple days before the dinner party to prevent a last-minute freak-out), and get in some exercise. ??“Of the three items, I know I am most likely to put off doing the taxes – because I’m afraid of making mistakes – of not doing it right.  I will get up my guts and do the taxes first.  Yuck.  Then I’ll ask my friend Joe to look them over for errors.  I can picture that it will feel so good when I’m done.”??Doing tasks in order of priority contributes to a life that works and is not stuck in survival mode.

SAYING YES OR NO

Beulah is cooking dinner for her family when the phone rings.  It’s Fredrina from the local chapter of United Way.  She asks if Beulah can host the annual 100-person cocktail party fundraiser.  “It’ll be graaayt.  You can even make those little handmade croissants and everything!”??The voice of Survival Mode whispers:  “Oh God.  I have to do it.  Jeannie has done it for the last four years.  I don’t want to, but I just can’t say no.  It’s for charity!”??Buying time before we say yes or no can be invaluable.  Beulah says to Fredrina, “You know, let me get back to you tomorrow with an answer.”  Pausing can help make space for choosing What Works.??That evening Beulah thinks to herself, “This is a stressful time for my husband Bill with all the lay-offs going on at work. I know I would like to say yes, but realistically I will go into a frenzy to host this year.  I have a feeling in my gut that it isn’t going to work given my family’s health and happiness are my priorities.  Maybe next year….”??The next day Beulah calls Fredrina, “Fredrina, I don’t think I can swing it this year.  But can I bring two or three dishes to take pressure off whoever does host?  I would love to do that.”  Doing what works…..??Experimenting with doing what works can be scary at first, but the pay-off can be huge for living more satisfying days.  It’s worth a try….

* MY GRATITUDE TO A WISEWOMAN FRIEND FOR SUBMITTING THIS WONDERFUL ARTICLE.

Part 1 of a 3 part series

Routine: Creating a Container for Mood Changes

Frank groaned and rolled his eyes when I suggested that we work with his schedule.
Schedule almost qualified as a dirty word in Frank’s personal dictionary.

“I don’t want to write down the stuff I am not doing. It’s bad enough that I am not doing it.  I don’t want to hit myself over the head with my failures.”

“Frank,” I say, “we’ve got to start somewhere and we’ll be in this together. We are not looking for success or failure but we are looking for WHAT WORKS.  And specifically what works for you. You are being dragged around daily if not hourly by your mood changes and reactions. Let’s start building a container for all of that. Let’s start working with ways to soothe your brain and help you to stabilize.”

“It kind of scares me,” Frank says. “If we schedule every minute of every day I think I’ll just shut down.”

“Good point Frank, So would I ! So let’s start with some basic pieces and adjust and correct our headings each week.  You have already started, in fact. You’re sleeping better, getting up earlier instead of at noon. That’s the most basic and perhaps the most important routine – night and day. Sleep and wake.”

“Yeah, I don’t feel like I am falling apart all of the time now – just some of the time.
Big progress,” Frank says, almost rolling his eyes again.

“It is progress. You don’t have to believe me right now, but good sleep is the foundation for everything else in your life. Let’s look at your morning routine. How do you start your day?”

What is Routine ?

Routine is the skeleton of schedule. The bones. The days and the hours have an identity beyond our current mood or thoughts. Bedtime. Mealtime. There’s a children’s song about the days of the week. Monday we wash our clothes  Tuesday we iron the clothes, Wednesday we sweep the floor and so on. There is a structure that holds us. For many of us that structure may be built around a job or children. Show up at 8 am for work. Pick the kids up from school. Routine is the repetition of daily or weekly activities as a discipline that we come back to again and again.

Why is Routine an Important part of Recovery from Mood disorders?
When there is a disturbance in mood and thoughts, it is incredibly easy to get lost and walk in circles. For example, people with depressive symptoms often tell me they lose track of time and can’t get themselves out of the house. Their experience of their day can feel very ill defined and blurry. Some of the folks with bipolar disorder describe to me losing all perspective when something interesting or potent crosses their path. A sense of priorities is dropped like pick up sticks scattering.

Routine becomes what we come back to – our landing pad if you will. Have you ever been in the midst of a really strong emotional reaction but had an activity scheduled. Like meeting a friend or an exercise class. What you might have stewed about for hours, suddenly dissipates or at least softens as you engage in activity.  We shift our attention. We move on. Our energy shifts.

Let me be clear. I am not saying that mood disorders can be fixed by a shift of activity. However we can begin to train our brains to come back to routine and give ourselves some relief in the process.

What might some of the aspects of routine look like?

Frank is starting to take interest in this idea of schedule. As we discuss his life he recognizes that he frequently feels lost in his day. He recognizes that he spends a great deal of time trying to decide what to do and fretting about whatever his is not doing.

“So what might I look at first?” Frank asks.

“Here are some ideas to start with,” I say.

*WORKING TOWARD GETTING UP AT THE SAME TIME EVERY DAY

*WORKING TOWARD GETTING OUT OF THE HOUSE IN THE MORNING AS A WAY OF CREATING CONTRAST AND AN OFFICIAL START TO YOUR DAY

*HAVING  AND SCHEDULING MEALS

*ALLOWING TIME FOR TRAVEL AND TRANSITION IN YOUR SCHEDULE
*MORNING  AND EVENING ROUTINES THAT YOU MOVE THROUGH IN THE SAME WAY EACH DAY

“I’ll give it a try,” says Frank, “Let’s meet next week to see how it goes.”

Look for Part II – Rhythm in the next newsletter.

Making med taking easy at the beginning of the year.

For folks who take medication for depression (and just about any other condition) there are some important ways to take care of yourself. It’s estimated that about half of us have a difficult time taking medication as prescribed for a variety of reasons. The beginning of the year is a fine time to look at your systems and backups for taking medication regularly.
1. Who is prescribing? Did the doctor take a thorough history before prescribing? As you began medication did the doctor monitor you closely and schedule follow up appointments to monitor your progress? In other words do you feel your provider is trustworthy and conscientious? We may hesitate to take meds that we don’t believe were mindfully prescribed.
2. If you are thinking about discontinuing a medication, consult with the doctor who prescribed it. Abrupt changes can be difficult for our brains. And with some medications, weaning down slowly is extremely important.  Be kind to your brain.
3. Know that as with all of life, we go through seasons and changes. You may find that a dosage of medicine that worked well in the Spring needs to be tweaked as winter approaches. This is another reason to have an ongoing relationship with your doctor – to make these adjustments.

Read more
4. There is not a medication that cannot be broken through. What I mean by this, is that if you start feeling better this does not mean that you can drink alcohol, stay up late, and work 12 hour days. The medicine does not work by itself. How you live and take care of yourself is a huge part of the formula. This is extremely tricky because for many folks it does not feel like a cause and effect relationship. Eg, it didn’t seem to have a negative effect when I had that margarita with my burrito on Saturday.  But a margarita, a sleepless night and a stressful day at work can destabilize.

5. Use med minders, those little boxes with the labels for the days of the week. The five minutes per week that it takes to fill it are worth the many moments of wondering, “did I take my meds this morning,” and finding yourself dumping out the contents of the prescription to try and do the math to figure out if you did. Medication compliance is a big issue across the board. Develop a habit that makes taking the meds simple and automatic. If you are regularly missing doses, it can make it much harder to tell if the meds are working.
6. Be prepared for the unexpected. Whether it is a snow storm or you decide to stay overnight at a friends house, having some back up meds with you is a really good idea. Some folks like to keep a dose or two in the glove compartment of their car. Others have a key ring with a capsule on it that can hold a day’s worth of medication.
7. This one is a biggie. Anytime you pick up a prescription, immediately mark in your calendar one week before it is due to run out. Please, please, please don’t wait till you are out and then wait another 2-3 days for a refill. Weekends and holidays can delay requesting a refill from your doctor. Try not to run out of meds if at all possible.

8. Okay, if despite all of your best intentions you do run out, call your doctor or the doctor on call and/or your pharmacist. Sometimes the pharmacist can get an order for a 3 day supply to tide you over.
9. Make peace with your medicine. If you are confident about the effectiveness of the medication, are taking it consistently, keeping in touch with the prescriber and lifestyle is generally wholesome then hopefully there is room to relax. Much of non-compliance or abruptly going off meds has to do with not working this through and setting up systems of support.

She feels worried and guilty about all that is not getting done and at the same time wants to watch old sit com reruns for about a year and forget everything. Oh man, it looks like it’s time to sit small.

Paula has lived with bipolar disorder for a number of years. She recognizes that she is moving into a period of depressive symptoms.  Paula does well most of the time, but stress, a new relationship, seasons and light changes- who knows maybe even the alignment of the stars- can throw her moods off balance. She has learned over time, and painfully, that these mood changes weave in and out of her life. She used to hope that she would simply one day be cured. She still hopes that deep inside.

In the meantime she has strategies.  Paula has become a master of recognizing these changes and putting her sitting small plan into action.

What is Sitting Small?

Sitting small for Paula is catching a significant shift in mood state (for Paula hypomania or depression) and putting a proactive plan in place to ride it out. It generally takes practice and mastery over time. It includes first and foremost, recognizing the signs and symptoms.

We’ll use the analogy of a bad case of the flu. Not because it is an an accurate and comparable illness, but it is a simple example that most of us are familiar with. For instance, we might note to ourselves, “I’m not feeling so hot- I wonder if I’m coming down with something.”

There can be many aspects to sitting small. We’ll look at four key areas.

Bubble of Time: our physical state demands our attention. The usual schedule is suspended
Soothing Environment: are there groceries in the house? Is the environment tidy?
Team on Call: a core person or group of people to lend support and maintain contact with.
Mind Practice: disciplines for directing the traffic of thoughts

Let’s look at them one at a time…

Bubble of time
When Paula is experiencing depression she feels low energy and paralyzed. The smallest tasks can feel herculean. In this state, she experiences waves of worry and concern and becomes increasingly self critical about her inability to perform the most basic tasks.

The Bubble of Time is marking a boundary, much as most of us would if we woke up with a nasty case of the flu. I give myself permission (because I have little choice) to have the flu, and put all other concerns aside until I feel better. There is a shift in perspective to everything can wait. I don’t have to make decisions, show up. I might even need some help. Depending how severely one is ill with the flu or depression the time frame might be one hour at a time or one day at a time. It is surrender to what is.

Soothing Environment
Soothing Environment is chicken soup for the soul. Is there food in the fridge? Is my bedroom warm and comfortable?  Do I have some movies to watch?

One of the tricky parts with depression is riding the mood changes that color everything you do see and think. That can be a challenging pathway. As mentioned above there can be a desire to shut down, sleep it off. But often this is not advisable in the midst of symptoms. Too much sleep, too many naps can further distort nighttime sleep patterns. Paula knows from experience that if she gives in to the depression, she can’t focus herself.

Paula knows she needs a rhythm of gentle activity, restful activity, contact with trusted others. She has her sitting small activities at the ready.

Her all time favorite is coloring books. She has beautiful books of mandalas and stained glass and tropical fish. She also loves music and will use her sitting small time to reorganize her music collection and to create unusual mixes of cds. Sitting small is when she repairs clothing and hems skirts. She has sets of dvd’s of one hour episodes of shows she likes. She knows from experience to stay away from violence, intensity and sorrow in her viewing material.

Team on Call
Paula, through trial and error, has developed a team. Her tendency when she is depressed is to isolate, to gut it out alone. She now knows she needs a small core group to know that she is depressed, to stay in contact with her, and to support her. Initially her parents were the team. Mom would bring groceries and meals. Dad would schedule visits and bring his own sitting small books to read and quietly keep company.

Over time, Paula has been able to expand her circle of support. She has a friend who walks her dog, Charlie, when she is unable. A girlfriend makes short visits and brings nail polish to paint Paula’s toes. The people in Paula’s life have found simple quiet ways to be available and connect without overwhelming. Paula has become a master at saying what she needs.

Mind Practice

Mind can run wild when we are sick and this is especially true with mood disorders.
Negative, self critical thoughts can overwhelm. There are fundamentally two aspects to Paula’s mind practice. She names the negative thoughts; “oh I am experiencing those awful thoughts that come when I am depressed.”  Sometimes this countering voice is loud and clear,sometimes it is a whisper. Her other practice is to give herself permission to distract herself with the simple activities named above. She has learned to be patient with herself while she rides out the symptoms.

Summary
At this point we can almost see the pieces coming together. Paula has recognized her symptoms and most importantly has named that she needs to sit small. She has set up her environment to support her. She has notified her team that she is sitting small. And she has a discipline to work with her mind as she rides these changes in mood and functioning.

For Paula, sitting small has given her a sense of knowing how to take care of herself, positive action she can take in the face of what is often a difficult storm to weather. Her sitting small practice helps her to move through and out of depression sooner and with more resiliency.

Big Rocks First

A teacher puts a gallon jar on the desk and sets a pile of fist sized rocks next to it. She asks the class how many rocks they think will fit. As they call out their guesses, she places one rock after another in the jar. When she asks the class if it is full, they reply with a resounding “Yes!”

But wait she says. Then she brings out a container of gravel. The smaller bits of gravel lodge amongst the larger rocks. Next, sand poured into the jar slides into the spaces between the rocks and gravel. Finally water is poured in to fill the jar to the brim.

What’s the point ? If you were to do it in reverse the big rocks wouldn’t fit.

(*please note: after writing this article I saw this time management story attributed to Steven Covey in his book First Things First)

What does this have to do with Unifying Principles? The big rocks represent what is most important to us. The gravel, sand and water are the activities of daily living that surround the more deeply meaningful activity.

This simple demonstration encourages us to plan and prioritize the important stuff first. The dishes will get done, the garbage will get taken out. But your exercise routine, time to paint, write poetry, practice piano, take a hike with a friend, meditate, play crazy eights with your kids….

I invite you to take a moment for reflection. Think of a week when you were able to put the big rocks first.  Usually there is a sense of bodily satisfaction from engaging in what holds meaning.  As an added bonus, the “filler” material is often more satisfying as well.

For me, writing this newsletter is a big rock. And I fully expect that grocery shopping and cooking later today will be enhanced by having taken the time to be creative, to be of benefit and to express myself through writing.

Getting to Know Your Big Rocks

To start to name the big rocks we can explore three categories:

*Self Care
*Contact
*Meaning

Self care includes those things that nourish us (not to be confused with “shoulds”), physically, emotionally, mentally and spiritually.  Physically we might do yoga or take walks or jog. Emotionally we might feel restored by time to reflect or share with a friend. Mentally a little Sudoku or learning a new skill might do the trick. And spiritually, prayer, centering, meditation, time in nature can all restore and renew.

Contact is fairly straightforward. And yet, I want to be explicit. Contact isn’t just showing up at a party or having lunch with a friend. It is a feeling of connection when you go to a party or have lunch with a friend. It’s when you walk away from that lunch with a smile of satisfaction, walking away feeling more energized than when you entered. Think back over the last week. What are the moments or events that have been life giving in that way?

If I reflect on this question, I see myself wrestling on the family room floor with my son playfully trying to pry some m and m’s from his hand.

I see myself having an amazing meal at a new restaurant with my best friend sharing deeply, laughing heartily.

I see myself meeting with a group of students that I supervise. One of them is taking a turn at leading us through some visualizations. I feel a warm glow, sitting back and appreciating the gifts each student brings to the group.

I see myself stopping in to say hello to an office mate who is making a fresh flower arrangement. A few words exchanged, a quick hug.

And Meaning?

If you were to be sent to a desert island with three people, three books and three objects what would they be? Would you take your partner or the Pope. The Bible or Mark Twain or a book of poetry? A basketball or a bottle of fine scotch or your family photo album?

Contemplating these questions helps us to play with and clarify our big rocks of meaning. Considering meaning and purpose each week helps to keep us on track feeling alive and coherent. When we regularly contemplate these questions, meaning begins infuse our day to day lives.

Summary

BIG ROCKS FIRST
*SELF CARE
*CONTACT
*MEANING

What does the word depression mean?

Unfortunately it means too many things to too many people. We use the word to describe a passing mood, grief over a loss, genuine sadness, times of pensive hunkering down to figure out life. And we use it to describe a serious and treatable illness that meets clinical criteria.

As with many medical conditions, if you haven’t experienced or witnessed it firsthand it may be difficult to understand. Hence, the “why doesn’t he just pull himself together,” or
“she’s lazy and doesn’t care” or “in my day we pulled ourselves up by our bootstraps” or “I wish she’d just snap out of it” are comments people suffering with depression may hear.

So in the medical world, practitioners may use terms like clinical depression or neurobiological depression. This indicates a level of life disruption that is beyond the normal range of mood or reaction.

What kind of disruption are you referring to?

At the most basic level, is the person having significant difficulty functioning in their day to day roles, e.g., work, school, relationship, parenting? The depressed person in many cases will not immediately realize they are depressed. They will apply to themselves with even more intensity the “why can’t I just snap out of it?” mentality. It is not unusual for someone with depression to see themselves as bad or deeply inadequate or a failure.

What contributes to this disruption might be noted in a few particular areas.

1. A pattern of sleep disturbance:

This can manifest in a number of ways: trouble falling asleep, disrupted sleep, waking very early in the morning and not being able to go back to sleep and sleeping too much.

People with depression may say that they don’t ever really feel rested. Or that they can’t wind down to get to sleep. Generally we are looking for a pattern over time, not one or two restless nights related to a specific worry.

2. Difficulty with memory and concentration:

Most people with depression will express that they feel foggy, unfocused, mentally sluggish. Doing tasks that require concentration are often a struggle.

I often hear statements like these:
I used to like to read but just can’t put my mind to it anymore. I just keep rereading the same paragraph over and over.
The mail has piled up because I can’t decide what I need to pay attention to and I just get overwhelmed.
My spouse took over all of the finances because I wasn’t tracking expenses and kept getting overdraft and late fees.
It takes me forever to get out of the house. I keep forgetting what I need and two out of three days I can’t find my car keys.

3. Irritability:

Cranky, edgy, overwhelmed. These are just a few of the words I hear to describe irritability. Another word I like to use is overstimulation. It can feel like too much is going on at too fast of a rate.

I wouldn’t think of going to a Rockies game or a concert. I don’t even want to go to restaurants- it’s just too noisy.  It makes me want to crawl out of my skin.

I used to love listening to music. I don’t listen to music at all now. If someone else turns on the radio I can feel myself getting edgy. I just want to get away.

I snap at people. Things that didn’t use to bother me in the least are all of a sudden a big deal.

So let’s put it all together.

Imagine for a moment that you are unable to get a good night’s sleep. Bedtime comes and you feel tired but no matter how tired you feel you wake at 3:00 am and can’t get back to sleep. You drag yourself out of bed and skip breakfast, are frustrated that you didn’t do laundry so don’t have clean clothes to wear. You are not ready for the 10 o’clock meeting at work. You can’t find your car keys so you are ten minutes late and realize when you arrive at work that the meeting is at nine and you double scheduled. Basically you are waiting for the day to be over so you can retreat to your lair.
Again, this is not a one day event. We all have our bad days. This occurs over a span of time, day after day.

Back to Susan

Susan knew something was wrong.  She didn’t feel like herself. She made an appointment with a psychiatrist that Tina recommended. It was scary but she needed some answers and she didn’t want to waste any more time.

The doctor interviewed her for over an hour. At the end, he gave Susan some choices. The doctor told Susan she exhibited all the signs of depression and that it was very likely she could respond to antidepressants. Susan tried the medication and in about eight weeks was feeling much more like her old self: her sleep improved, she wasn’t so irritable and she started enjoying her life again.  Susan isn’t sure how long she will need to take the medicine; she will talk to her doctor about it when the time is right.

Summary

To distinguish from all of the casual uses of the word depression it can be helpful to use the terms clinical depression or neurobiological depression.  This indicates a significant disturbance in day to day functioning.

This disturbance is likely to be seen in:

Disturbance of sleep
Disturbance of memory and concentration
Irritability

These areas of disturbance are the ground of depression. We will look at more aspects of depression in additional articles. But it is enormously helpful to understand these basic areas when considering if you or someone you know might be depressed.

Who am I? Where am I? And what do I want?

The roar of competing demands is loud, excruciatingly loud in our culture. Work, family, primary relationships, friendships,  maintenance of ourselves and everything we own all require our attention.  We have more access to more information, choices and things than we can possibly process.  I heard an informal survey on a morning radio program that more than 70% of us think we will “have more time next week.”

Most of us are externally driven. I often ask clients and students to show me their schedule books. Invariably, they first list the places they have to be, where someone else is expecting them to show up. Work, dental appointments, classes- all of  this is  listed first and often it is the only type of material in a day timer. Take a random sampling. Ask ten people if you can have a look at their appointment book. I’ll bet nine of ten will only record the “have to’s”. It’s a never ending ride of one commitment to the next and the next and the next and all of the in between spaces are a blur of filler.

So what do I want

So in any given day, week, season what do we want? What do we deeply want? What do we simply want? Do we even know how to recognize what it is that we want?

These are the questions that lead us to our personal unifying principles. Looking into the core of this matter takes us to a place where dealing with time and space can be an elegant art form, an expression of our true selves. And much less of a painful big deal.
(No I am not kidding!)

Let me give you a couple of examples. If Harry decides to go to graduate school to fulfill his dream to become an oceanographer that, for the time he is in school, is a huge unifying principle. It will allow him to study long hours, get up early in the morning for class, perhaps live frugally and accrue a mountain of debt without hesitation and quite possibly have a grand time doing it. If Celia loves to bike race, then several workouts per week and spending her weekends racing makes complete sense to her. There is no sense of wanting to be somewhere else. The sense of clarity and connection takes us over and through the details.

I know a very busy administrator of a independent living facility for elders. He could easily work 70 hour weeks. But his clarity is imperturbable: he knows he is committed to being with his family in the evenings. It is most important to him and he doesn’t want to miss one spaghetti night or game of Monopoly. So he finishes his day every day at 5:00 p.m. And he is an absolutely outstanding administrator and community leader.

Hey, did you forget the question: what do I want?

Okay, maybe a little. But I am making a point about this idea of unifying principles.
We know a lot about what we want, but our lives start living us. We are propelled through the world. It’s like we are on a six lane highway trying to drive, read a map, and check the exits all at once. “Oops, was I supposed to turn there? Oh well, got to keep moving.”

So here’s a list of questions to ask yourself to start to move into this territory of unifying principles.

What expresses my true nature?
What gives life meaning?
What gives me joy?
What is my heart’s desire?
What are my values?
What am I passionate about
What are/have been my dreams?
What is life giving, makes me feel really alive?
What is most important to me?
What makes life satisfying?
What makes my body and being go “aahh, that is good”?

Take time to consider these questions and to let your mind wander. You might return to sweet memories, sensory memories. Often we find unifying principles in the parts of our lives that shine. Another way to access unifying principles is to take a tour of your home. Joann has an enormous tv and loves to watch the NFL games with a raucous group of friends. Joe has a CD collection and a stereo system that is amazing. Any one walking through his door will be offered a short concert. And the opportunity to watch the rapture on Joe’s face.  Think about visiting a friend’s home and the fun it is to see what books and magazines they have, what food they like, the artwork on the walls.

On the other hand crisis or tragedy can bring what is important into focus in a split second. We can all think of parents who lost children and came through the experience with a mission to spare other parents and children the same fate by educating or starting foundations.

When I know what I want, what happens next?

To use the six lane highway analogy, when we have had a chance to look at the map, choose our destination and sketch out a route, the journey is much more satisfying, not to mention less stressful.

Obviously, unifying principles come in varying sizes. What kind of tea I would like at this moment and what kind of mark do I want to leave before I die is an approximation of the range. And unifying principles aren’t static. They change with circumstances, stage in the life cycle and so on. It’s a dynamic situation.

The most direct way I have found to work with unifying principles is in conjunction with  a weekly schedule. I recommend a regular scheduling meeting with yourself. Gather up your calendars and those pamphlets and fliers for good movies or interesting events. Give yourself the gift of time to relax with it. The objective is not to squeeze it all in but to begin to find a satisfying rhythm and balance of life.

So one of my wants this week was to write this article. I listed it as one of four unifying principles for this week. I gave it a space in the schedule. And I looked at why it wasn’t already written. I found that on several occasions I got detoured when I tried to write at home so I am at the public library until it is time to pick up my son from school. I have to tell you I am having a great time.

Another unifying principle for me this week is “Explore generosity”.  Today I had the very satisfying experience of sending a birthday card to an old friend who isn’t expecting to hear from me. I sent a thank you and a gift card to an acquaintance who did a favor for our family. I got stuff from Hobby Lobby earlier in the week and have had a grand time making Valentines and biscotti.

The practice of unifying principles and scheduling is ongoing. There is no sense of setting a schedule and sticking with it month after month, year after year. We don’t seem to be built that way. So each week, we take the data we gleaned from the previous week and use it to inform the coming week. Our unifying principles tend to become more precise and poetic over time, our lives more coherent.

Summary

There’s a wonderful book by Wayne Muller, called Sabbath that talks about the various sacred rhythms of activity and rest, engagement and solitude. He compares it to breathing in and breathing out. It is not a secret that far too much of the time too many of us are simply forgetting to breathe out fully, completely, blessedly. We live too often by default, plopping ourselves in front of the tv, sleeping,eating, filling space, waiting for the next bus of scheduled activity, where someone or something will take us there. The switch is on or off and there’s not much subtlety in between.

Working with unifying principles is a way to begin to weave everyday life with what is important, what is meaningful. It is a practice that deepens over time and tends to create greater coherence in life and life purpose.

There will be more articles about unifying principles and schedule, especially as it relates to working with depression.

And if you are ready to get started here is an outline of the practice. Enjoy!

The Practice…….UP’s and Schedule

What is. Enter the bones of work, school, and appointments. This is an opportunity to remember, to calendar items of interest, to download details. The working of the clay, the sketching in of the basic details and shapes on the canvas.

Points of focus. Many of these will arise in conjunction with number one. These may be priorities for the week, but not have a specific time frame as yet. It is the opportunity to ask, “How do I want to spend/focus my time this week?”

Unifying  principles. What is the theme, slogan, image, energy? What will you come back to during the week? It may be one umbrella UP or several areas. The range is from concrete to poetic. The more specific the better. A good UP usually creates a bodily response of letting down, relaxing, sighing. One of my all time favorites is “Trust the unfolding of this day.”

Live the week. Notice what works, what doesn’t. Most of us have time distortions about how much we can accomplish, and about how much unanticipated activity occurs. Transition time is often forgotten.

Bring a review of the week to your scheduling meeting with yourself. How did it feel? What parts of the week were satisfying? What are the moments of pure appreciation that you would have missed were you not taking the time to review.

Lather, rinse, repeat.