It Can Happen to Anyone

February 2014   Comments

One of the most effective ways to improve our understanding of mental health problems and mental illness — and thereby reduce the associated stigma — is to speak out. Canadian Nurse acknowledges RNs Ashley Peterson, Mallory Jeffrey, Mary-Lou Hamill and A.J. Cleary for their courage in agreeing to share their stories.

Ashley Peterson, RN, BSN, CPMHN(C), is an outreach nurse with the Acute Home-Based Treatment Team, Vancouver Coastal Health. She was first diagnosed with major depressive disorder in 2007.

Reaching out

When I first began experiencing depressive symptoms, I thought that because I was a nurse I could manage on my own. That was not the case, of course, and by the time I finally did reach out for help, my family doctor felt that I needed to be admitted to hospital. Getting help early is important, but it’s not necessarily a magic bullet. I began to have symptoms again after feeling healthy for almost four years. I was restarted on medication and, three weeks later, I was back in the hospital.

I have had four psychiatric hospitalizations, two of which lasted for two months. I have received care that has ranged from excellent to terrible, and been asked questions that ranged from insightful to uninformed and judgmental. I have chosen to be open about my illness and the stigma with my colleagues and with the clients I educate about mental health.

Most individuals are entitled to confidentiality when it comes to their health information, but this is not always so for nurses who have a mental illness. My employer was made aware of my illness because of reporting requirements in my province. I experienced stigma for the first time when I returned to work following a psychiatric hospitalization. Some people believed that they now had the right to question my competence. My every move was supervised, my charting was reviewed and all medications I gave were double-checked. A re-entry process that was supposed to ease me back into work and protect my health turned into a probationary period.

There should be no “us versus them” attitudes among nurses when it comes to mental health problems. Having a mental illness does not make me less able to care for my clients when I am well. It does not make me less intelligent. It does not mean that I can’t make ethically sound decisions. It does not mean that I am violent or dangerous. It does not mean that I am selfish or looking for attention. Having a mental illness does not make me less of a nurse. In fact, I think I am more empathetic and less judgmental than ever before.

I encourage those who believe they may be experiencing symptoms of mental illness to get help. Mental illness is not a sign of weakness, and it’s not something that happens only to other people. It can be managed, and it does not preclude us from achieving happiness and success. I am a nurse, a daughter, a sister and a friend, and I have a mental illness. And that is OK.

Mallory Jeffrey, BN, RN, works for alberta health services. she experienced postpartum anxiety after the birth of her daughter.

Falling through the cracks

The delivery was fast, painful and terrifying. In hindsight, I believe both my husband and I may have suffered some mild post-traumatic stress. He refuses to talk about the delivery to this day, and I spent months rehashing it in my mind.

I had been given information on the signs and symptoms of postpartum depression to watch for and what numbers to call. At the five-week mark, something was off. I was not depressed but felt flat, and I was not bonding with my daughter. I wasn’t crying all the time, and I didn’t feel sad. However, my need for order shifted into overdrive. If my schedule was thrown off, the entire day spiralled into chaos.

I did not tell family or friends how I was doing. I was assessed for sadness, but no one asked me about anxiety. I would have an anxiety attack over something minimal, and then when my anxiety abated I was so exhausted emotionally that I did not have the energy or will to give either of my children the love and affection they needed. I wouldn’t leave my colicky baby with a babysitter because I was terrified the sitter would shake her. The reality was that I was afraid I might shake her myself because I was so overwhelmed.

After about four months, my husband said, “I think you have postpartum depression.” I ducked the question and snapped, “You don’t know what it’s like to be home alone, making sure everyone’s needs are met.” But he persisted. It took many conversations before I finally admitted I was not OK.

It was at this point that I started to come out of the pit. Once we realized what was happening, my nursing background helped me recover. I explained to friends and family that I was struggling. I began exercising regularly and ensuring I got more sleep. I practised positive thinking and techniques to decrease anxiety. For the first time, I felt joy in seeing my daughter smile and enjoyed cuddling her.

We were lucky. Had my husband not confronted me, there is no saying how far things could have gone. I was too close to the problem to realize how much I needed help or even how poorly I was coping. I think many families would benefit if partners were made aware of the warning signs of depression and anxiety. As well, I believe that new mothers should be assessed for anxiety after discharge during well-baby checkups.

Today, falling behind schedule no longer makes me feel like the world is shattering. I still feel consumed by anxiety at times, but now that I am aware of it, I know it will pass. My children have a mother who is much more self-aware and patient.

Anxiety caught us by surprise. I did not see the warning signs. My husband did, and our hope is that we have raised awareness of a gap in how we currently assess women postpartum.

Mary-Lou Hamill, RN, is a community nurse in eastern ontario. She has had serious bouts of depression during her 35 years in nursing.

Feeling support, meeting with stigma

I experienced my first breakdown when I was working on a medical pediatric ward. I was in charge that night but suddenly found myself unable to function. I couldn’t think clearly, let alone make a decision. A caring nursing supervisor recognized my distress and relieved me of my responsibilities, brought me to her office and made the necessary call to my family physician, ensuring that I would be seen the next day.

I was off work for a month, during which time I saw a psychiatrist and received the appropriate treatment. Upon my return, most of my colleagues were supportive and understanding, but I do recall overhearing a whisper from one of the nurse managers, who said she didn’t understand how others could work with “someone like that.” The remark cut me deeply and caused me to start questioning myself, undermining the progress I had made.

Some years later, I was struggling with a heavy caseload in my job as a community nurse. When it all became too much for me, I would drive over to the side of the road and weep. Usually I could pull myself back together, but one day I had a breakdown right in the middle of a busy day. I notified the supervisor and explained that I could not see the remaining four clients on my schedule because I needed to get to my doctor right away.

He put me on sick leave for three months. A few days later, I had a call from the supervisor, asking me to come in to the office. I was not doing very well, but I went to the appointment. The senior manager was in the room, too — her demeanour stiff and cold. She accused me of abandoning my clients, then demanded I sign a release form allowing her access to my medical records. I was bewildered by what she was saying but slowly began to realize that she didn’t believe I was really ill. I remember feeling so humiliated about crying in front of her. Completely defeated, I signed the form.

Thinking about this over the next few weeks, it came to me that she would not have made this accusation if I’d been in a car accident and was lying injured in the emergency department. I hadn’t wrecked my car, but I had indeed had a crash.

I was able to go back to work part time after three months. My colleagues were incredibly supportive. Gradually, I regained confidence and was able to take on a full caseload. I have enjoyed my work and functioned well during the past five years. I am thankful for my spouse, family and friends. I speak frankly about my mental health when it is appropriate to do so. I have learned to recognize the triggers that could send me on a downward spiral and know what measures I can take to avert such an incident. I never take for granted the stability I feel today, knowing all too well that things can change.

A.J. Cleary, RN, is a critical care nurse in Vernon, B.C. At the age of 33, he was diagnosed with attention deficit hyperactivity disorder.

Losing interest in everyday life

As a child, I couldn’t stand being at school. I was always getting into trouble, and spent my time daydreaming and talking to anyone within earshot. I didn’t want to take turns or listen to others. Little was known about ADHD then, and it was not a common diagnosis. My parents, both of them health-care professionals, believed my ability to sit and play with G.I. Joes and Lego for six hours straight ruled out any possibility of my having ADHD. I was always a C student, and as I got older my teachers took to writing “not living up to his true potential” on my report cards.

I did have some successes. At 13, I was introduced to mountain biking. It was an instant obsession. It wasn’t long before I was competing in downhill racing, eventually at the highest national level. I loved taking risks and pushing myself to the limit. Cycling held my attention and gave me confidence.

I begged for better marks from a few high school teachers to achieve the average required for university admission. In first year, I passed some subjects but failed math, chemistry and physics. My second year was somewhat better, but I was struggling. I was more interested in playing pool, dropping quarters in the arcade or wandering around in the library. I got through it, but I had no idea what I wanted to do with my life. I went from computer science to biology to psychology, then decided to apply to nursing school.

Being accepted in nursing was the best thing that ever happened to me. The courses were engaging and I was able to focus on studying. Early on, I got a mark of 86 on my first exam in anatomy. When I called my mother to tell her, she asked me to check the name at the top of the page to make sure the exam paper was mine.

I continued to excel in the more clinical subjects. After graduation, I pursued critical care nursing. I moved to Calgary and worked in intensive care units at Peter Lougheed Centre and Foothills Medical Centre. I loved every minute of it. The sicker the patient, the better I performed. But if the case was not interesting, I didn’t do my best work. Before long, the thought of a whole day with nothing exciting to do filled me with anxiety. Eventually, I began to get restless even when the assignments were challenging.

I met the woman who became my partner, and we decided to move to Vernon. I transferred to the emergency department because I felt that the ICU in my new hospital was not a fit for me. The experience was a disaster. I loved my co-workers, but there were too many distractions in the ED. I easily becoming frustrated with any situations that were out of my control. I would leave work angry, then go home to my partner and rant for hours. She worked in the same department but didn’t share my feelings about it. I felt unsupported and unheard. I began to hear criticisms about my Internet use at work: I was somewhat oblivious to what was going on around me. I wasn’t covering all the bases. I was getting sloppy and appeared to others to be lazy.

At home, having to repeatedly remind me to begin or finish tasks and household chores was exhausting for my partner. I saw her as another mom, who constantly criticized me and made me feel that nothing I did was right. I would focus on a project at the start for eight hours straight, only to stop five minutes short of completing it. I spent a week doing a renovation on my house but left one of the baseboards untouched for the next six months. I couldn’t explain why, and the idea of getting help hadn’t occurred to me.

After three years, I left the ED and returned to the ICU. I worked hard at keeping everything looking good, performing as best as I could. After about eight months, my attention wavered. I began to question whether nursing was for me — maybe I could try welding instead! I was falling behind, and my co-workers noticed.

I started to isolate myself at home and distance myself from friends. The thought of trying to stay interested while we hung out caused me anxiety. My relationship with my partner was strained, I didn’t like my job, and I was losing interest in the things I enjoyed most in life. I wondered about depression. My co-workers remarked that I wasn’t myself. I made sure that my patients were safe, but I was not managing my assignments acceptably — baths were not getting done and lines were not getting changed. I was surfing the Internet to excess, looking at the same few pages for an hour straight, then seeking the next interesting thing to look at.

My manager received a complaint about my Internet use from a concerned co-worker. My computer account was audited, and I was in trouble.

She called me one Friday morning. She wanted to meet on the following Monday and asked me to bring my union representative. I was devastated, and my head began to spin. How had it reached this point? What was wrong with me? How could I have let my co-workers down like this? I sat alone at home the entire weekend, just thinking about what a terrible person I had become. I even began to wonder if life was worth living. I wasn’t eating or sleeping much. I couldn’t concentrate long enough to put together a meal.

When Monday morning came, I was a wreck as I sat down with my manager and an HR representative. When my union rep arrived, they showed me my Internet use stats. I immediately broke down. “I need help,” I said. I told them everything, and right away the stern expressions on their faces softened. At that moment, my life changed. I was a grown man, in tears, falling to pieces in front of people who barely knew me. My manager told me to grab my belongings and go home. “This is about you, and no one else,” she said. “Take as much time as you need. Get some help.”

My doctor saw me the following week and diagnosed me immediately as having ADHD, based on my history and a clinical assessment. Apparently, mine was a classic undiagnosed case. When I told my mother, she felt responsible for not having had me formally diagnosed. I know she had been trying to avoid giving me a label, and I’m grateful to her for it.

I started the medications. Almost immediately, every task I had tried to put off became easy to accomplish. My mind was finally clear, my thoughts no longer jumbled. My head was finally above water. I had never before been able to organize my thoughts so well. My meds allowed me to grab thoughts one at a time and process them. I could plan a task and execute it; it was as simple as that.

Four weeks later, I had my life back and returned to work. I have no regrets about the past, and I look forward to proving that those comments on my report cards were wrong.

About the artist: Tomas Illes is an Edmonton artist who works primarily in acrylic and oil. He joined the Out of the Shadows Artists’ Collective in 2003 and has since maintained a very active painting practice, exhibiting his work in both group and solo shows in Edmonton and across Alberta.

Bratislava 3
"This scene captured my interest while on vacation in my place of origin, Slovakia. I inserted office towers into the image, even though they are not really there. This ties my childhood dreams together with my reality as an artist living in Edmonton".

‒ Tomas Illes

Dave Gahan (Paper Monsters)
"Listening to Depeche Mode as a teenager inspired me to paint the singer Gahan, allowing me to connect my memories from the 1980s and bring the music back to life through paint. Art and music evoke memories from the past. They bring clarity and thoughtfulness into my artwork today.”

‒ Tomas Illes

For more information on the program, contact Erin Carpenter, occupational therapist, or Cathy McAlear, recreation therapist, at 780-342-7754.

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