Tuesday, 12 August 2014

The elephant in the room


There will be a lot of talk in the coming days in the media about depression's version of the elephant in the room -- suicide.

As most of you already know, Robin Williams, the immensely funny comic and gifted actor, took his own life yesterday at the age of 63.

I've enjoyed his work since he shot to fame in the late '70s playing a manic alien in the sit-com Mork and Mindy.

Although he was initially known for his comedic work -- his stand-up routine once being referred to as Dostoevsky on acid -- he moved seamlessly into serious acting. I still find his role as the boarding school teacher Mr. Keating as one of the best performances I've ever seen.

After one of his students commits suicide, Williams sits at the student's desk and opens one of his books before crumpling with grief.

It turns out the grief he displayed in that scene was not far off from his real grief that lay inside, mostly invisible to the general public. (It starts at 2:30 of this clip)


 

Williams struggled with substance abuse (mostly alcohol but also cocaine in the 1980s) and depression for more than three decades. He recently spent time in rehab, once again for alcohol.

And for reasons that would only make sense to his shattered brain, Williams decided enough was enough. He hanged himself with a belt after making what appears to be an unsuccessful attempt to slit his wrist with a pocketknife.

Williams' riches, fame and talent were not enough to keep his depression at bay. And this should serve as a sharp reminder of how insidious mental illness is -- it can destroy someone inside while the person on the outside seems relatively normal.

So let's talk about the elephant. 

This may not be easy for some of you to read, but it's important we talk about it, mostly because it is hardly talked about at all. For example, when was the last time you saw an obituary list suicide as the cause of death? It happens all the time but the stigma and shame attached to it are so strong, it's usually not listed as a cause of death in obituaries but you can usually figure it out if the family requests donations for mental health agencies like the Centre for Addiction and Mental Health (CAMH).

I've been told point-blank by some people when I've broached the subject, I shouldn't talk about it. They think it's fine and good to talk about my depression but if I admit publicly to thinking about suicide, that would damage my reputation permanently and make people think differently of me.

To that I say I've been open about my illness to try to reduce the stigma attached to it. To ignore suicide would only serve to paint a partial picture and it would also be a disservice to everyone who has lost their battle with depression. Those who survive have to tell the stories of those who don't.

Statistically, there are about 3,500 suicides in Canada each year, and it is the 10th leading cause of death for both sexes and seventh for Canadian men. It falls just below colon and breast cancer in terms of overall causes of death.

That means that depression and/or substance abuse-related depression kills 3,500 people each year. If these deaths were caused by, for example, a new type of virus, you can bet there would be screaming headlines and a concerted effort to find a cure or at least try to treat the symptoms in an effort to save lives.

However, the stigma attached to depression -- let alone suicide -- is so strong, many (if not most) people don't want to talk about it.

I have had recurrent major depressive and generalized anxiety disorders for most of my life, accentuated by four major breakdowns at the ages of 18, 22, 29 and 39. The first one lasted several weeks, the second and third ones for several months and the third one for more than two years.

Despite that I have never attempted suicide. 

But I have thought about it, thousands of times over the years, going so far as to plan how I was going to do it. This is referred to in psychiatry as "suicidal ideation." In fact, it was the overwhelming desire I had to kill myself as an 18 year old that lead me to finally admitting to my parents how sick I was. It was the first time I asked for help.

Luckily, I was still thinking just clearly enough to know I was a danger to myself and that I needed immediate crisis intervention.

The same scenario played out in October of 2011, leading to my first hospitalization for depression.

You will no doubt hear in the coming days from those who don't understand that Williams committed a selfish act.

How could he be so selfish, the old refrain goes, and do that to the ones he loves?

For those of you looking for some sort of complex reason, I'm here to tell you there isn't.

People with mental illness kill themselves for very simple reasons.

The main one is to stop the pain they feel to the very core of their being.

Because, you see, depression is not just about mental suffering, it is also accompanied by physical suffering. At my lowest point, a week after being released from hospital, I looked like I had aged 20 years. I walked with a stooped shuffle, drawn in on myself, the lines of pain etched on my face.

When my brother saw me then for the first time in months, he burst into tears, my transformation was so dramatic.

Those of us seeing the world through the prism of depression see death as the only release from our pain. 

'I've tried medication, therapy, exercise, everything,' we think. 'I'm never going to get better. I'm tired of putting my family and friends through this.'

These thoughts are easily counter-balanced when we're feeling better (You won't always feel this way. It will lessen, just as it has in the past. You would hurt the ones you love, not relieve them of any burden.) but when depression has us in its jaws, these more realistic thoughts don't come easily, if at all.

Then there are the times a person with a mental illness will pass through a crisis in which they have talked about suicide and then rapidly improve and seem normal to others. They may even seem happy. 

This is a very dangerous and deadly sign. It can mean the person, in a moment of clarity, has decided they can't go back to feeling depressed.
British author Virginia Woolf touched on both of these reasons -- ending the pain and avoiding yet another relapse -- in the note she left for her husband.

Dearest, I feel certain that I'm going mad again. I feel we can't go through another of those terrible times. And I shan't recover this time. I begin to hear voices, and I can't concentrate. So I am doing what seems to be the best thing to do. You have given me the greatest possible happiness. You have been in every way all that anyone could be. I don't think two people could have been happier until this terrible disease came. I can't fight it any longer. I know that I am spoiling your life, that without me you could work. And you will I know. You see I can't even write this properly. I can't read. What I want to say is I owe all the happiness in my life to you. You have been entirely patient with me and incredibly good. I want to say that everybody knows it. If anybody could have saved me it would have been you. Everything has gone from me but the certainty of your goodness. I can't go on spoiling your life any longer. I don't think two people could have been happier than we have been. V.


After writing this note, she went outside, filled her pockets with stones, and waded into the River Ouse.

She was 59.

******************

If someone you know has talked about suicide, take it seriously. They are not looking for attention, nor are they trying to be overly dramatic. Talk to them about it and, if you feel the person is a danger to themselves, call your local mental health crisis line or 911.




Tuesday, 17 June 2014

Sunrise

It was 365 days ago today that I dragged my sorry arse off the couch, put on a pair of old running shoes and headed out for a "run."

Although I was only able to run for 60 seconds before having to walk, little did I know how far those first plodding, gasping steps would take me.

I was at a very low point. Not my lowest, but pretty close. I was still severely depressed, wracked with anxiety and overweight. I was eating for comfort, gaining weight because of it and then feeling bad about the weight gain. So I'd eat for comfort. And so on.

After a physical and a mild scolding from my doctor, I looked up a Couch to 5K program and started running.

It wasn't easy. In fact, for the first several weeks I was miserable. I'd also adjusted my diet, cutting way back on junk food and journaling every single morsel I ate.

Slowly I started seeing results, both physically and mentally.

The weight started to fall off and I had more energy.

I began looking forward to my runs as a way to reduce the stress I was feeling being on disability. I liked it so much, I ran hundreds of kilometres straight through the winter, in snowstorms and temperatures as low as -30. I think that's one of the things I'm most proud of.

Over the last 12 months I've also:
  • Lost 30 pounds (and kept it off)
  • Run more than 1,500K
  • Run a half-marathon
  • Run a distance of 15+K 32 times
  • Run a distance of 21.1K+ 15 times
  • Run a distance of 30K+ 3 times
Yesterday I ran my first sub-30 minute 5K.

Plus I've completed close to 1,000K of mostly trail cycling, including three 100K rides.

Losing my mom last December was earth-shattering but I have no doubt I've been able to manage it due to my family's support, my medication and therapy, my new-found love of endurance training and the support of many of you.

I also have no doubt it was my new-found appreciation of fitness that helped me crawl out of the mental pit I had been stuck in for more than two years.

Did it cure me? No. There is no cure for recurrent major depressive disorder. But it did -- in part -- push the darkness back enough for me to turn my face to the sun again.

I'll be running my second official race this Saturday in the Barrie half-marathon. Claire will join me by running in the kids fun run.

It's nice to feel the sun again.

Monday, 5 May 2014

Failure

"Failure is not an option." -- Gene Krantz, Apollo 13 flight director*

It turns out failure is an option.

In fact, it's always an option, as I found out today. 

I planned to run 42.2K, the distance of a full marathon. My longest run to this point was 32K. I'd also done 30K, 26K and about a dozen 21.1Ks since I took up running last June.

I had to pack it in today at 26K. It was my second attempt at running a 42.2. The previous time I had to quit at 25K.

Everything seemed optimal for the run. I took a week off to taper my training. I loaded up on carbs the day before. I went to bed early and I felt great this morning. It was warm enough for shorts and there was very little wind.
I even posted on Facebook about my attempt in a way to add a little more motivation. Kind of like Cortez burning his ships to motivate his men to greater exertions in conquering. When there's no way back, you're more apt to forge ahead with greater effort.

The first 10K were fine, although I did experience some numbness in my left foot. I kept my pace deliberately slow so I would have plenty of energy for the second half. 15K came and went with no issues.

It wasn't until I hit the half-way mark that I started to run into some problems. Well, really just one problem.

My brain.

Instead of focusing on small goals, like the next two kilometres, I started to think about the whole remaining distance. And once I started thinking about how far I still had to run, I couldn't stop.

I tried some of my old mental tricks. I thought about mom and how tough she was in the face of all her illnesses. I thought about how badly I wanted to finish and visualized crossing the finish line at my driveway.

None of them helped.

So, for the second time, I had to be rescued -- this time by my good friends Paula and Dave. Paula ran the Mississauga Marathon yesterday. I'm so proud of her.

But as I was sitting on the stairs of a Masonic Hall on St. John Road in Innisfil, all I could think of was how I had failed yet again. And that lead to me thinking about how I didn't get that job last week. Which made me think of how long I've been off work. Which overwhelmed me with hopelessness.

See a pattern? This is how someone with depression spirals downward in a few seconds.

This time, though, instead of letting it get the better of me, I started to think about the nature of failure.

We live in a world that doesn't like to admit failure. Oh sure, we talk about learning from our mistakes, we may even work in a place that pays lip service to encouraging employees to admit mistakes as a way of improving the organization. But let's be honest -- few people like to admit failure and some will even go to great lengths to cover up or minimize a personal failure.

Did I fail today? If my goal was to finish 42.2K then, yes, I did fail.

But as Dave and Paula pointed out on the drive home, there are other ways of looking at it. While I may have "only" run 26K, Dave asked me to consider how far I've come since last June when I started running. Back then I could only run for 30 seconds at a time. Now I can run for hours at a time.

I was also running solo. In a race, you get inspiration from spectators, other runners and there are plenty of distractions to keep your mind occupied along the route. Today it was just me, a GPS watch and the seemingly never-ending road.

So, considered in a larger context, today could be viewed as a more qualified success, rather than abject failure.

I applied that same thinking to last week's job interview. If I was to measure success by being offered the job, then I failed.

Another way of looking at it is that it was my first job interview in more than four years. It was also the first time I was back in a professional setting in more than two years. Considering how ill I was just a year ago, it was a fairly big deal to be able to handle the pressure without caving.

The lesson in all this?

I was told over and over again in therapy to be kinder to myself. As my counsellor told me, "You need to talk to yourself like you would to a friend."

My wife Paula is very good at helping me remember this, saying I'm always too hard on myself. Her and Claire are my biggest fans and make me feel good about myself.

I would never call a friend a failure for not finishing a race or not landing a job.

Time to start talking to myself as a friend.

*Kranz never actually said this, although the quote was attributed to him in the movie Apollo 13.


Tuesday, 29 April 2014

Stigma

I had a job interview Monday.

I didn't get it.

While I'm disappointed -- it's the first interview I've landed after sending out about 30 resumes -- I'm not looking for pity. I'll pick myself up and move on.

(For those of you who don't know, I'm now unemployed for the first time in 16 years, having resigned recently from my previous employer.)

However, the interview itself lead me to think about a few things regarding my mental illness.


As happy as I am that former Olympian Clara Hughes is out there banging the drum to reduce the stigma around mental illness, I've got to think disclosing your condition when you're, well, Clara Hughes, elicits a much different reaction than when you're, say, me.

There are some facts about me that are very public, some that were made public by myself, some that were made by others.

Regardless of how they were made public, they're out there.

And the number one fact is...I have a mental illness, namely recurrent major depressive disorder. I've had it for as long as I can remember and I will have it the rest of my life. There is no cure.

For most of my life, I was ashamed of my condition and did the best I could to hide it (never very successfully I might add). I hated who I was and I surely didn't want to let anyone see the true me, the one who didn't care if he lived or died many days, who wished for death on the really bad ones.

I could get by in polite society by putting on a brave face at work and in public and only take the mask off when I got home.

However, there came a time at my two previous jobs where my illness was starting to impact my work and it was noticed by my managers.

In both instances I disclosed my illness to try to help them understand why I was acting the way I was.

In both instances it made things worse.

I was told by one manager not to use my depression "as a crutch."

I was asked by another -- after I had come back after some time off -- how I could assure them I wouldn't relapse.

I asked him if he would ask a cancer survivor that question.

He didn't answer.

Which brings me back to my interview. It was made public in an ongoing court case in which I was tangentially involved that I was off work on long-term disability. It's a matter of public record and if you google me, it comes up on the first page of search results.

While I know a prospective employer can't ask you why you were on disability, they are surely going to wonder why I was and why I didn't return to my employer when I recovered enough to return to work.

And this is where the stigma associated with mental illness rears its vicious head.

If I said I was diagnosed with cancer, underwent treatment, beat it and was looking to get back to work, I would -- more than likely -- be praised for my heroic fight and recovery. I doubt it would be held against me (and would you really want to work anywhere where it was?)

Let's now substitute "cancer" with "major depressive disorder." Given my experiences with disclosing my condition, I wouldn't hold out hope on a positive outcome. 

For some reason, most people don't want to see the brain as an organ, no different from a pancreas or a heart. It can become ill just like any other organ, but most people treat that illness differently from, say, diabetes or heart disease.

You may ask, "Why not just hide it if it's going to hurt your chances?"

Two reasons.

First, it's a matter of public record. If I don't address it and someone in HR did a google search on me, it would look like I was hiding it.

The second reason is far more important.

For too long I lived with the crippling shame of suffering a mental illness, afraid people would think I was unstable, dangerous, crazy.

For too long I kept my condition secret from all but those closest to me.

Never again.

I have a mental illness.

If someone can't accept that then that's someone I don't want in my life.

I am who I am.

And, after 42 long years, I can finally say that's someone I don't hate any more.

Sunday, 13 April 2014

Sunrise

October 19, 2010.

"I want to die. I can't keep living like this."

That's one of the few things I can remember thinking the day I was discharged from Royal Victoria Hospital's mental health ward after a four-night stay.

Almost everything else from that time is black.

I had driven myself there straight from a full-blown meltdown at work. I had been sitting in a meeting with about 30 other people and an overwhelming feeling of doom descended on me. I had been struggling for months to keep it at bay.

I was failing.

I had started a running program -- not the one I started last summer and have kept up to this day -- but a half-hearted effort to try something, anything, to stop the depression I was in from deepening.

My anti-depressant medication had already been increased to the maximum recommended daily dosage and my medical team -- my mental problems being so significant I actually need a team -- had started me on anti-psychotic medications. For reasons still unknown, they can work as augmenters, making the anti-depressants more effective.

I tried Abilify and Olanzapine. The first turned me into a zombie, the second into an anxiety-soaked basket case.

I had just started a third one, Seroquel, but it hadn't reached therapeutic levels yet.

So the darkness deepened.

I fled the meeting and hid out in the back of the lunch room, curled up on a sofa, trying not to completely lose it.

That's when the thoughts started racing through my mind.

"You've suffered far too long. This is no type of life to live. People will understand."

Thinking like this seems entirely rational to someone in the depths of depression. That's because it acts as a filter and distorts everything -- everything -- in your life, making it all seem so desolate, desperate, despairing.

I was able to reach deep down to an area of my brain not completely saturated by the negative thoughts to realize I was in serious trouble.

I made my way to my car and drove myself directly to RVH.

When they asked me why I was there, I explained my history of depression and that I was thinking of hurting myself -- something mental health care providers refer to as "suicidal ideation." It means you're thinking about ending your life because of the pain you're in but you haven't planned a method or taken steps to carry it out.

Next up was a psychiatrist who asked me some questions. I learned later that he rated my Global Assessment of Functioning (GAF) score at 20 out of 100. According to the GAF index, a score between 11 and 20 means "Some danger or hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication."

I was presenting with most of the signs of major depressive disorder.

Difficulty speaking. Irrational and racing thoughts. Thoughts of hurting myself. Flat affect. Loss of enjoyment of activities I would normally enjoy doing. Anxiety. Moodiness. Short temper. Overeating for comfort. 

And on and on and on.

The psychiatrist and counsellor both agreed I needed to be admitted. My dosage of Seroquel was increased.

Before I was sent upstairs, my mom and dad arrived with a bag Paula had packed for me -- a change of clothes, a toothbrush, a book or two. I remember the look on mom's and dad's faces when they entered that little room in ER -- they were scared. We all cried. They told me I was making the right decision before it was time for me to go upstairs.

Since the ward was full, I had to spend the first evening in one of the locked "safety" rooms. It is monitored by camera 24/7.

The first night I slept 12 hours before my psychiatrist awoke me, annoyed none of the nurses had done so earlier.

"You need to get up and take part in the group activities," he said.

That was the last thing on earth I felt like doing. But I didn't have much choice in the matter so I shuffled, stooped over, to the activity room. Even though I was only 40 years old, I now had the posture and gait of an old man. There were mornings I had to literally crawl on my hands and knees to get from my bed to the bathroom in the morning.

The activity we had to do was to go through old magazines -- some dating back to the 1980s -- and cut out words that we wanted our future to look like and turn them into a collage.

All of us cut out similar words.

Words like hope, family, health, happiness, joy.

I wish I could remember more of my time there but most of it's lost.

A few of the things I do remember:

I remember talking to Paula on the communal phone (5-minute limit) on the second night and bursting into tears when she said her and Claire were having a pizza and movie night. Tears of sadness that I was missing it, tears of rage for all that depression had stolen -- and would continue to steal -- from me.

I remember sitting in an armchair and staring into space for what seemed like hours at a time over the weekend because there were no group activities.

I remember seeing a young woman who couldn't speak because of the strength of her depression. She would stand all day near the nurses' station and stare at everyone with eyes wide with terror.

I remember feeling something resembling happiness when I was ruled stable enough to leave the locked ward for 30 minutes so I could get a coffee downstairs. No caffeine is allowed on the psych ward floor. 

I was eventually discharged after four days and although I wish I could tell you I was on the mend, I actually had further to fall before I was able to climb. I spent the next month at home, struggling to do jigsaw puzzles I had borrowed from mom just to keep my mind from spinning out harmful thoughts. My brain was so sluggish I would stare at the puzzles for hours on end, trying to make sense of them. I felt like I was losing my mind.

But slowly, ever so slowly, the sun began to dawn on my shattered, blackened brain.

The medication started working again. Almost two years of therapy gave me new insight and new tools to help fight back the depression.

I started running last June and am closing in on 1,300 kilometres run, basically the equivalent of running from my front door in Barrie to the waterfront in Halifax.

Because of the fight I've fought and the help and encouragement I've received from my family and friends, I've managed to take off the lenses of depression that made me not want to live another day two long years ago.

Today when I was out for my run, I marveled at the air moving in and out of my lungs, the power of my legs as they kept a steady pace, the fog over the rapidly melting ice of Kempenfelt Bay, the warm wind hinting at a promise of spring, the thought of Paula and Claire waiting for me at home.

Today was a good day to be alive.

Monday, 24 March 2014

The devil's in the details -- Part 2

“Every man is guilty of all the good he did not do.” ― Voltaire

Kurt Cobain once wrote a song called 'Oh, The Guilt.'

Based on the title alone, it could be an anthem for us depressives.

That's because inappropriate feelings of guilt are one of the most common symptoms of depression.

In fact, guilt is one of the first -- if not the first -- feelings I can remember from childhood. I felt guilty about everything, especially anything that had to do with accomplishments or praise.

I was put into the advanced reading group in every class I was in, starting in kindergarten.

And in each and every case, I felt guilty like I didn't deserve being advanced.

"I'm not smart," I would think in a panic. "I don't belong in this group."

Those feelings of guilt have stuck with me right up until today, so ingrained in my thought patterns they may as well be entwined around my DNA.

It's like having your own chorus following your around declaring you as guilty, kind of like when Zod was declared guilty by those floating heads in Superman II. 

As I got older and experienced academic and professional success, I would grow increasingly uncomfortable.

"I'm a fraud. They're going to find out I'm stupid and I'll be exposed for everyone to see," I would think.

Praise from teachers, managers or peers was painful. I was wracked with self-doubt, self-hatred and non-stop anxiety.

I would also self-sabotage. I had one professor who would constantly praise me in class. One day we were explicating a poem that contained the word 'sepulcher.' He asked the class what the word meant. As he scanned the crowd I slunk lower in my seat.

"Oh for God's sake Jason, help us out," he finally said.

"A tomb," I croaked.

Which is exactly what I felt like climbing into at that moment. His praise continued throughout the term. He would read passages from my essays. He would call on me over and over again.

And the feelings of not being worth his praise became too much for me to bear.

So I did what many of us suffering from depression and anxiety do -- I burned my own bridge. I stopped going to class for weeks at a time. I missed so many classes he called me to his office to find out what was going on. I told him I was thinking of quitting school, just a couple of months short of earning an honour's degree.

He sent me to see a counsellor.

But the damage was done. I wasn't invited to the year-end barbecue he held for his favourite students.

More importantly, I felt he now saw the real me, the one not deserving of his accolades.

So where does all this guilt come from?

Simple -- low self-esteem. I feel myself to be so worthless, I am filled with such self-hatred, I am largely incapable of accepting compliments or praise because I don't believe a word of them.

I think people are just being nice or polite when they express admiration of my writing or guitar playing.

"They wouldn't compliment me if they knew what I was really like inside," goes the refrain inside depressive's brains.

I am still consumed with guilt surrounding the death of my mother.

I feel guilty for not calling 911 earlier on Christmas Eve. Maybe if I did, they would have been able to stop the infection that eventually destroyed her already weak body.

I feel guilty for not spending more time with her while she was still alive. I'm ashamed to say there were days I didn't go visit because I didn't want to listen to her talk about how much pain she was in.

I feel guilty for leaving her alone in that house with her fear and anxiety when she was faced with her own mortality.

Although we never told her in those final days her acute care had been withdrawn, she knew.

I saw it in her face when she looked at the picture of her grandchildren and she would sob, "My beautiful girls."

She cried when she looked at the picture of her family I had brought to the hospital.

She cried when I described her backyard to her to try to cheer her up.

She cried because she knew she was dying.

And she wasn't ready.


Rationally I know I have nothing to feel guilty about when it comes to mom's death.

But thinking rationally about something doesn't stop me from initially feeling that guilt right to my core.

And I suspect it never will.

Wednesday, 12 March 2014

The devil's in the details -- Part 1

It hath been often said, that it is not death, but dying, which is terrible.
HENRY FIELDING, Amelia

Read more at http://www.notable-quotes.com/d/death_quotes.html#tvxMZViDIEKdBK3F.99
It hath been often said that it is not death,
 but dying, which is terrible. -- Henry Fielding, Amelia
It hath been often said, that it is not death, but dying, which is terrible.
HENRY FIELDING, Amelia

Read more at http://www.notable-quotes.com/d/death_quotes.html#tvxMZViDIEKdBK3F.99
It hath been often said, that it is not death, but dying, which is terrible.
HENRY FIELDING, Amelia

Read more at http://www.notable-quotes.com/d/death_quotes.html#tvxMZViDIEKdBK3F.99

Today I am going to pull back the curtain on a nightmare.

One showing only.

I'm doing this for a few reasons.

First, there are a lot of things doctors won't or don't tell you about what to expect after a diagnosis of terminal cancer. There is plenty of information on what to expect physically after a cancer diagnosis.

Mentally, not so much.

Second, writing about these things helps me deal with them. This particular issue has been slowly eating away at me for the last several months. 

Mom was officially diagnosed with Stage IV non-small cell carcinoma of the lung in October.

However, it was earlier during a routine scan in September to check up on her bowel obstruction, they first detected a lesion on one of her lungs.

We lost mom the day she received that news.

Not physically. Up until her final days, she still looked pretty much the same. Gaunt from being fed intravenously for the previous 18 months because of the chronic blockage of her bowels, but otherwise no huge changes in her appearance.

No, we didn't lose her physically.

We lost her mentally.

And, looking back at the last four months of her life, that was one of the hardest things about her diagnosis we -- and she -- had to deal with.

I think deep down mom knew something was wrong with her -- on top of the lupus, the bowel problems, the fibro and the Reynaud's -- and it deeply impacted her mental health.

After finding out she had a lesion on her lung, the change in her personality was rapid.

We began noticing she was having trouble finishing her sentences.

She would repeat herself.

She cried in my arms one day because she couldn't remember her grandmother's name.

Matters came to a head in October when my brother Christopher called me from her house. He was there to take her to a doctor's appointment.

My brother, who never seems to be bothered by anything, called me.

"I think something's wrong with mom. I can't get her out the door for her appointment," he said.

"What are you talking about?" I responded testily since his monotone delivery didn't seem to match what he was trying to tell me.

"I mean, she's sitting on the floor and she's not speaking," he said.

"But I was just there yesterday," I protested. "She was fine."

"Well, something's wrong," he replied.

"I'll be right over," I said, running for the car. I was there in less than five minutes.

Chris was bent over mom who was sitting on the floor of the hallway near the front door. I knelt down to get to her level.

"Mom? What's wrong?"

She looked at me and looked so confused. She tried to talk a couple of times but nothing came out.

"Mom? Do you know who I am?" I asked as the panic rose in my throat.

She looked terrified.

"Call 911," I told Chris. I was afraid she was having a stroke.

"Okay mom, I'm going to help you back to the couch. We're calling an ambulance," I said as I helped her off the floor.

While we waited for the paramedics, she spoke a few words which made little sense.

The paramedics arrived and took her vital signs which were normal. She was not able to communicate with them so they rushed her up to the hospital.

We followed and by the time we saw her about 30 minutes later her condition was slightly improved, but only slightly.

All she would say, over and over, was "I'm fine."

We told the attending physician about the lesion on her lung -- which, at that time, had not been officially diagnosed as cancer -- and he suspected a couple of possibilities.

One, was a stroke. The other was brain cancer.

They did an MRI on mom's head and, as we joked with her later, found nothing.

We then found out that it is common for recently diagnosed cancer patients to experience depression, anxiety or both.

And that's when I realized what I saw in mom's eyes when she sat on the floor -- I saw myself.

She was experiencing all the symptoms I had experienced when I was at my most ill -- the inability to focus, finish sentences and, sometimes, even speak.

Mom was experiencing extreme anxiety in the face of a possible cancer diagnosis.

When she eventually got the official diagnosis, her mental health worsened. For a long time she couldn't even say the word cancer.

Eventually she was able to and this is the "conversation" I would have with her several times each visit.

"I have cancer."

"Yes mom."

"It's not curable but it's treatable."

"Yes mom."

"I'm going to fight this tooth and nail."

"I know mom, I know."

Fifteen minutes later we would say the same things again as she had already forgotten talking about it with me.

Even though dad would lay out her medication on the counter with instructions on exactly when to take them, I would arrive in the afternoon to find she hadn't taken any of them.

Mom began obsessing over things like her medical appointments, clutching the calendar in her hands and staring at it blankly.

There were times her anxiety was so bad she asked me to leave.



"I hope you're not angry," she would say with tears in her eyes.

Knowing all too well how overwhelming the simplest of things can be when you're in the midst of an anxiety attack, I told her I understood.

Mom also began exhibiting another symptom of depression and anxiety, irrational fear.

In a tiny voice, trying to speak through her tears, she would tell me she was so scared. When I asked her about what, she would say, "Of losing my house."

In mom's depression- and anxiety-wracked brain, her thought patterns were completely irrational. She was afraid the insurance company would cut off her long-term disability payments (she was already on LTD for her lupus) and she would not be able to make payments and the bank would foreclose.

She would also tell me she was afraid she wouldn't live to see Christmas.

I tried to help her by doing an exercise I learned in therapy -- it's called cognitive behaviour therapy or CBT for short. Basically, you write down your irrational thoughts and then counter them with more realistic, rational ones.

For example, I would get mom to write down "they're going to cut off my disability because of my cancer diagnosis" with the more realistic "they're less likely to cut my disability because I have another disability on top of my previous one."

And, as for the dying before Christmas, we wrote "no doctor has given me a prognosis of less than 30 days to live."

And so on.

Initially it seemed to give mom some comfort. When I would come to visit, she would be holding on to that piece of paper, repeating the rational responses over and over like a mantra. The paper was shiny from being handled so much.

Eventually, however, even that bit of therapy didn't help.

Mom sunk deeper into depression and anxiety.

She would talk about getting "stuck" in negative thoughts and couldn't get out of them. She would sit for hours at a time doing nothing but experiencing those negative thoughts over and over like a broken record in her mind.

And I wept with frustration at the bitter irony that the woman who stood by me and held me when I went through the worst of my depressions was suffering the same thing.

And there was nothing I could do to make it better.