Racing down the Col de Portet d’Aspet on the fifteenth stage of the Tour de France on the 18 July 1995 the Italian rider, Fabio Casartelli, crashed on the 17% descent. He died of head injuries on his way to hospital. The winner of the individual road race at the 1992 Olympics was 24 years old.
HIs death shook the peleton. The following day his team mates were gifted the stage win, crossing the line together. Three days later Lance Armstrong – four years away from the start of his domination of the Tour – dedicated his stage win to his dead team-mate raising his eyes to the skies, his fingers pointing to the heavens.
Most people, whether they are fair weather cyclists, or lycra – clad weekend club wheelmen (or women) will agree that it’s climbing hills that is hardest. But that’s not the whole story. Casartelli’s death shows us that it is fast descents that are most dangerous, and require, perhaps, the greater bike handling skills.
I can attest to that. I regularly exceed 35 mph on descents across the South Downs while touching my brakes is all that is preventing me from touching even faster speeds. On these descents I have a good view of the road ahead for at least 400 metres, and they are quiet routes.
But it’s not safety tips that I am writing about this time.
Instead, what I will focus on this time is a descent of a different order altogether. I’m talking about the descent into depression.
It’s important to realise that the descent into a depressive episode varies a great deal. For me it has been a slow, creeping journey, a descent with barely perceptible (to me) changes. Difficulty sleeping, irritability, forgetfulness, and a slowness in all things. For others, it can resemble a steep descent. This is often what happens to people who suffer from severe, frequent, mood swings. The ‘high’ phase quickly followed by a steep drop into the well of depression. For people who have been diagnosed with Bi Polar 1, this cycle can happen as often as four times a year. Psychiatrists call this ‘rapid cycling’.
Like a cyclist descending in a zig zag path down the side of a mountain, unable to see what is around the corner, and travelling at eye – watering speeds, things happen so quickly it is well-nigh impossible to take effective action to stall the steep drop in mood.
From my point of view, the exhilaration of a high mood is like a heart – racing descent. However, it is has often meant that this exhilaration is accompanied by a depression to mirror these ‘fast feelings’.
As I have said before, these are called ‘mixed symptoms’.
One of the difficulties that people who are slipping into a depressive episode have is how to manage their lives, as even the most mundane of tasks and responsibilities become too much to cope with. An effective way of coping with these times is to take some action when we are feeling at our best; before things start going wrong.
In the world of mental health recovery this process is called making a Wellness Recovery Action Plan: a W.R.A.P. So, what’s involved? There’s no right order to set about putting together a Wellness Recovery Action Plan, however you may find it useful to look up the work of Mary Ellen Copeland in this field.* It is designed to be a living, working document one that you share with people who support you. If you are going to have a stab at writing one of these it’s important to discuss it with people who you feel can support you when times get tough. People who might be included as ‘supporters’ might be family members (although I recognise that not everyone has a family that can offer support), friends or neighbours. They might be people who are involved in supporting you with mental health challenges, like a G.P., Mental Health Worker, Community psychiatric Nurse, or Psychiatrist.
I’ll come back to how these people can have a helpful role shortly. First – and you may find it helpful to ask some of these supporters to help you with this part – write down what you are like when you are at your best. This can be difficult at the best of times, that’s why it may be helpful to ask other people about what they think you are like when you are at your best.
The next step is to think about what you are like when things are starting to get difficult. Questions that help to work this bit out might be: Is my sleep affected? Am I sleeping less, finding it difficult to get to sleep, waking too early, or sleeping a lot more than unusual? Am I becoming forgetful, finding it more difficult to concentrate than usual? In the past when I have started to become unwell I lose insight into how am behaving. This has meant that I have made unforced errors at work, including being uncharacteristically insensitive to people.
It’s important to remember that everyone’s situation is different. The examples I have given are fairly common, but they may not apply to you. One weird sign that I am going off the rails is that I start thinking in French. Weird, because it’s not my mother tongue, I don’t live in France, or even know any French people. So, my point is that these things are highly individual, often unique.
The next step is the point when the process begins to focus on hard stuff.
Triggers. What is it that sets us on a downward (or upward, in the case of mood swingers, like me) spiral? A is for alcohol. Although it may not be popular for doctors to raise this subject it is important to be aware that alcohol is a depressant. It may temporarily lift one’s mood, but ultimately it has a depressant effect. Furthermore, most drugs used to treat psychological disorders will include the advice to ‘avoid alcohol’.
Common triggers may include stress, and unwanted changes, such as moving house, unemployment, or challenging working lives. A word of warning, thinking about triggers can itself provoke difficult feelings – so if you do decide to work on a Wellness Recovery Action Plan, be kind to yourself. Don’t do it all at once, and try not to dwell on this section as you put it together.
As you can imagine, we are now in grim territory. The next part of the Plan is where friends and supporters come in.
Crisis; when things start to break down. Once again, this is different for everyone. If you are working, this might be the point when you have to take time off work for an extended period. Last year I was off sick for five months, and even then I returned to work too soon, and ended up having to take off another month later on. It’s at this point you may need to give permission to trusted supporters to take care of your financial affairs. It might include paying bills, contacting creditors, and making sure the basics are taken care of. Is there food in the house? Has the cat been fed, the dog walked? Who else needs to know what has happened?
In order for any W.R.A.P. to be effective it is important to emphasise that it needs to be shred with key supporters, nd not filed away. It is important that it is a working document, one that is revised and updated depending on changing circumstances.
Do not stand at my grave and weep,
I am not there; I do not sleep.
I am a thousand winds that blow,
I am the diamond glints on snow,
I am the sun on ripened grain,
I am the gentle autumn rain.
When you awaken in the morning’s hush
I am the swift uplifting rush
Of quiet birds in circling flight.
I am the soft starlight at night.
Do not stand at my grave and cry;
I am not there; I did not die.
Mary Elizabeth Frye (1905 – 2004)