Exhaustion

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

Regardless of who you are, we have all had times when we wake after few hours sleep and spend the rest of the night rolling around the bed getting angry with ourselves because we cannot get back to sleep. But imagine if this pattern became a routine and you know fully well, that when you go to bed within a few hours you will be awake again repeating the events of the night before. But what makes matters worse is that the resulting tiredness effects moods, concentration, thoughts and even appetite. So, your body ends up lacking nourishment and craving rest. Like an alcoholic or a drug user craving their new fix an exhausted person desires rest. Yet, unlike the drink/drug user there is no ready access to gaining support. When it is announced that you are suffering with fatigue all is offered is having a lazy day on your day off. But it not as simple as that. The lead up to exhaustion is more complex than just getting your eight hours sleep at night. There are overlapping and related factors that need to be considered.

Same problem, different name.

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

Like depression or domestic abuse, men fail to either recognise the signs or fail to admit that the problem exists. Indeed, following simple research I have found that exhaustion is extremely dangerous and is actually deadly. In some cases, exhaustion is a sign of an underlying disease, including cancer, low thyroid, anemia or other metabolic abnormalities, such as adrenal insufficiency. Exhaustion is commonly seen with depression and is a possible side effect of many prescription drugs, including beta blockers, muscle relaxants and mood stabilizers. However, given that depression also tends to involve lethargy and detachment, some have argued that burnout is just a stigma-free label for depression. In her book, Exhaustion: A History, Schaffner quotes one German newspaper article that claimed burnout is just a “luxury version” of depression for high-flying professionals. “Only losers become depressive,” the article continued. “Burnout is a diagnosis for winners, or, more specifically, for former winners.”

Suffer

Exhaustion, by any name, is hardly a new phenomenon. In the 1800s, women were said to suffer from hystero-neurasthenia, or “nervous exhaustion.” Triggers included excessive amounts of exercise, cohabitation, brain work and worries over motherhood, according to an 1887 article in the Journal of the American Medical Association. Women were also at risk if they worried too much about “impending or actual misfortune.”

In the 1950s, around the time women were having “nervous breakdowns,” scientists published research showing that it was, indeed, possible for business executives to suffer from exhaustion. Today the term burnout, which is characterized by emotional exhaustion, is recognized in Europe and is a common concern among those who work in the medical or humanitarian aid fields.

Four humours
Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

When Schaffner explored the historic literature, however, she found that people suffered from extreme fatigue long before the rise of the modern workplace. One of the earliest discussions of exhaustion was written by the Roman physician Galen (129 –  216 AD ). Like Hippocrates (460 –  370 BC), he believed that all physical and mental ailments could be traced to the relative balance of the four humours – blood, yellow bile, black bile and phlegm. A build-up of black bile, he said, slowed the body’s circulation and clogged up the brain’s pathways, bringing about lethargy, torpor, weariness, sluggishness and melancholy. Although by modern standards and knowledge we now know it has no scientific basis, the idea that our brains are filled with a tar-like liquid certainly captures the foggy, clouded thinking that many people with exhaustion report today.

By the time Christianity had taken hold of Western culture, exhaustion was seen as a sign of spiritual weakness. Schaffner points to the writing of Evagrius Ponticus in the 4th Century, which described the ‘noonday demon’, for instance, that leads the monk to stare listlessly out of the window. “It was very much seen as a lack of faith and a lack of willpower – the spirit versus the flesh.” Schaffner also discovered a case of a monk compulsively and restlessly seeking out his brethren for idle chit-chat rather than engaging in useful employment – Is this not too dissimilar to the way that 21st-century sufferers may find themselves compulsively checking social media?

Modern views – class struggles

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion

Religious and astrological explanations continued to abound until the birth of modern medicine, when doctors began diagnosing symptoms of fatigue as ‘neurasthenia’. It is now understood that nerves transmit electrical signals, so perhaps someone with weak nerves may therefore dissipate energy like a badly insulated wire. Intellectual figures from Oscar Wilde to Charles Darwin, Thomas Mann and Virginia Woolf were all diagnosed with neurasthenia. Doctors blamed it on the social changes of the industrial revolution, although delicate nerves were also seen as a sign of refinement and intelligence – some patients languished with pride in their condition. As stated previously, exhaustion is associated with success. To give it another comparison the rich are eccentric but the poor are mad.

In modern, industrial nations, a problem is that the main treatment for exhaustion — sleep — is often seen as laziness and being lazy is a barrier to productivity. In 1960, the average adult received a luxurious amount of sleep at eight and a half hours sleep a night. Today, most people get by on an average of less than seven hours, and a substantial proportion sleep less than six hours, according to National Sleep Foundation data.

Inevitable?

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion
But are periods of lethargy and detachment as inevitable a part of human life as head colds and hunger? There is no doubt that exhaustion is a pressing concern. A study of German doctors found that nearly 50% of physicians appeared to be suffering ‘burnout’, reporting, for instance, that they feel tired during every single hour of the day and that the mere thought of work in the morning left them feeling exhausted. Interestingly, men and women seem to deal with burnout in different ways: one recent Finnish survey found that male employees reporting exhaustion were far more likely to take extended sick leave than burned out women, for instance.

Like I have said at the begining, we have all had these moments. But to live with exhaustion is extremely difficult. Even more so when those around you do not have any idea what it is like. There have been times that I know I could not get through the day without a moments rest. In fact, the need to just stop often outweighs the need for food or drink. The need to sleep overshadows everything around me. As a result, a zombie like status emerges and the recognition of the world around you no longer makes sense or even exists. A sense of heaviness emerges and as a result the simplest of tasks literally sap any reserve energy out of you. Alongside the feelings of weariness also comes feelings of emotional despondency, disillusionment and hopelessness.

Although few countries tend to diagnosis neurasthenia today, the term is often used by doctors in China and Japan – again, with the occasional accusation that it is an alternative, stigma-free way of labelling depression.

Distinct

Keith's Story - Male Victim of Domestic Abuse & Depression Exhaustion  

In general, however, the two conditions are generally considered to be distinct. It is generally agreed that depression entails a loss of self-confidence, or even self-hatred or self-contempt, which is not the case for burnout, where the image of the self often remains unbroken. The anger felt in a burnout is generally not turned against the self but rather against the organisation or persons who are seen as the cause of the problem (for example, work or the ex). Nor should burnout be confused with chronic fatigue syndrome (CFS), which involves prolonged periods of excruciating physical and mental exhaustion for at least six months.



Some data suggest “vital exhaustion,” or a state of excessive fatigue, irritability and hopelessness, can be a risk factor for heart attacks and death. Dutch researchers found that people with high vital exhaustion scores were three times as likely to suffer a subsequent heart attack, perhaps because it increases blood clotting.

I suppose I could give you some obvious advice and suggest you visit the doctor should you develop these symptoms over a significant period. Indeed, you should. But the battle to disassociate ourselves from any form of illness seems to be the norm for many people. In essence, I should state that tiredness does indeed go hand in hand with depression. The two factors together, however, are a burden of which carries a heavy weight upon a daily existence and routine. True fatigue cannot be cured by sleep alone like telling a depressed person to pull themselves together. To me that is the same as telling an obese person to think themselves thin.

Anxiety After Abuse

Keith's Story - Male Victim of Domestic Abuse & Depression Anxiety After Abuse

Anxiety is a good thing. It stops you from heading into dangerous or unusual situations. It is a normal reaction to things that we dread.  For example, as a teenager, I always felt anxiety before entering the exam hall. As an adult, I get anxious everytime I have to have a blood test – I just hate needles. I have known other people become anxious if they spot a spider within close proximity. Everytime I get anxious my mouth goes dry, my breathing increases and I feel light headed. Sometimes I sweat and I can hear my heart racing. But this is normally a short lasting period of panic.

There is nothing wrong with any of this. It’s good and it’s natural.

But what is life like when anxiety takes over everything?

Earth shattering legacy

Keith's Story - Male Victim of Domestic Abuse & Depression Anxiety After Abuse
Shattered

I have given this some thought today. The only example I can give is that after an earth quake (depression) there is always an after shock (the anxiety). After having my personality shattered I then started to question what I knew or understood. This led to having anxiety about doing normal everyday things that I had previously taken for granted.

My anxiety gave rise to other psychological problems. Such as:

These feelings became a problem when they were too strong to deal with. My anxiety generally made my life difficult and making choices even harder.

Domestic abuse and anxiety

Following research, it has been established that sufferers and survivors of domestic abuse experience increased levels of anxiety. Living in constant stress or fear can indeed create a constant raised level of anxiety.

I always lived in fear of what I would expect to find when I got home from work. The above examples of how I felt (dry mouth, increased heart rate and so on) was often a characteristic of my journey home. However, I could also add the churning feeling inside my stomach. Once home, I would feel anxious about her ever-changing moods and behaviours. This anxiety was a result of living in fear. And this living fear became a habit which increased my anxiety and depression. And so, the constant cycle continued.

Keith's Story - Male Victim of Domestic Abuse & Depression Anxiety After Abuse

Constant high anxiety

When I found that my living conditions were stressful I had no opportunities to off load, other than going to work. I was not allowed out on my own and I had to contact my partner at least three times a day when I was at work (sometimes I had to include a photo so she could see I was in uniform). I had no opportunity to relax or de stress. Also, I couldn’t socialise with friends or family and so had no escape from the captivity I found myself in. What was worse was that a home should be a haven yet it became my prison.

However, what I found once I had left was that the same levels of anxiety still existed. I had learnt that following the lack of support I had received, and the lack of help from the authorities the world is a dangerous place. I felt vulnerable and often experienced nightmares. In effect, the life I had led remained after leaving the environment. Now, I have become accustomed to the feelings of fear and vulnerability even though I was no longer living under that regime.

Further research found that people who are exposed to any form of abuse or persecution, tend to develop extreme social anxiety, or/and stress related illnesses. Sadly they can also develop confusion over their own identities.

Anxiety after domestic abuse

Lasting effects

Keith's Story - Male Victim of Domestic Abuse & Depression Anxiety After Abuse
Lasting effects

Emotionally abused people can experience post-breakup symptoms similar to post-traumatic stress disorder (PTSD).

I worked out I had PTSD after taking a walk one afternoon.  I heard a song that she used to like and my mind was rushed back to a moment I heard it in the kitchen. This time in the kitchen was when she said she was going to have me killed. Other occasions also cause PTSD such as smells, colours and even types of cars. My mind would associate these ‘items’ with periods of stress and unhappiness. As a result it took me a while to try and do normal things like listen to certain songs. Even shop in certain supermarkets. I no longer visit certain places, not only for the fear of bumping into her but because these places have so much association with the cause of my problems.

Anxiety has left me hesitant although I am able to often hide it well. My anxiety has taught me to be even more suspicious of authority or kind actions by others.

I know that this will be overcome. It has to. I have a lot of support in place and I have created nice, easy personal goals to give me a level of achievements of which to reflect upon. The abuse left a long dark shadow that created, depression, PTSD and anxiety. With enough light and reflection this shadow will recede and I will be able to replicate the person I eventually want to be.

PTSD Following An Abusive Relationship

Keith's Story - Male Victim of Domestic Abuse & Depression PTSD Following An Abusive Relationship

Making sense of PTSD

Having now left an abusive relationship I found that struggles began in other areas. PTSD (Post Traumatic Stress Disorder) became a daily (and nightly) problem. For me this didn’t make any sense, here I was now free of any form of abuse -although I was struggling with depression. Yet I was experiencing all manner of ‘flashbacks’. Furthermore, there was no initial trigger or understanding why they were happening. The worst was waking up following a bad dream thinking she was in the room with me.

Having to admit to being a male victim of domestic abuse (especially sexual assault) was extremely difficult. Perhaps these episodes of PTSD was a way of venting this frustration against a world of whom I considered did not care – this was enforced and endorsed by the police who failed to react or support me in my claims.

Keith's Story - Male Victim of Domestic Abuse & Depression PTSD Following An Abusive Relationship
Flashbacks hurt

My experience of PTSD

Enduring any length of abuse whether physical, emotional, sexual or psychological will leave some form of mark. Some domestic violence survivors, like myself, will suffer PTSD. Suffering these emotions does not indicate any form of weakness.  I have had to deal with my PTSD which has made me relive my ordeal through flashbacks and nightmares that have interfered with my ability to function normally on a daily basis. This has often left me tired or uninterested in doing daily activities. Further symptoms are listed below

The symptoms of PTSD can include

  • Intrusive memories of the abuse – this can come following certain songs or smells or even being in certain places at certain times. There are no strict rules to this – it can just happen anywhere at any time.
  • Loss of interest in other people and the outside world – I found that I isolated myself from friends and was happy to stay indoors.
  • Insomnia (see my post on depression and sleep)
  • Agitation – I found that I would often jump at the slightest movement by other people
  • Depression – (see my article on depression)
  • Overwhelming feelings of sadness, fear, despair, guilt or self-hatred. I questioned my self worth. If I could allow one person to do these things to me what was my true worth?
  • Physical pain that migrates throughout the body. I experienced headaches and joint pains.
  • An inability to imagine a positive future (why depression makes you feel guilty)

Following research I found that these symptoms will last for at least a month and can occur either directly after the trauma, or be delayed, beginning six months, a year or 20 years after the abuse has ended.

 Treatments

Everyone recovers at their own pace. As a minimum you should be seeking help and support from your doctor.

Keith's Story - Male Victim of Domestic Abuse & Depression PTSD Following An Abusive Relationship
Medications.

I had to move to temporary accommodation and as a result I registered with the local GP there. I must stress that from the outset they were fantastic. She took the time to listen to events and and aftershocks. I was prescribed medication for both my depression and my sleep problems (see my relationship with medication).

My work supplied and paid for counselling sessions. Initially, I was cautious about sharing my thoughts and experiences with a complete stranger but she allowed me to work at my pace.

Afterwards

I wondered if the effects of abuse would ever go away. Yes, I am still jumpy at times and I still experience thoughts following certain triggers but I recognise these now and can prepare myself for this. I have not fully recovered but I sense a certain amount of freedom from PTSD. There was a time when I stayed silent about the abuse but a part of my recovery was to share what happened either with friends or by writing it down (via this blog), medication, counselling and a slow recognition of my own self-worth.

http://www.thehealthsite.com/diseases-conditions/ways-to-care-for-a-loved-one-undergoing-ptsd-k0717/

Dealing With PTSD Symptoms After Leaving Abuse

When depression makes you feel guilty

Keith's Story - Male Victim of Domestic Abuse & Depression When depression makes you feel guilty

Depression stops you from getting things done

When you are deep in to your depression everything is difficult to do. As a result nothing gets done. These leads to a feeling of worthlessness and guilt.

What is guilt and shame?

Guilt is a feeling of regret or remorse. It could be a result over what you have or have not done in the past. Shame is thought to result from the feeling of being judged by those around you.

These feelings can be normal. But when it comes to depression, these feelings can become magnified and distorted. In many cases depressive guilt and shame can become toxic and threaten our mental health and well being.

Feelings of guilt for ‘wasting time’

I came across an article today that I wish to share.

The article covers, with great clarity, how it feels to suffer when you don’t want to.

Paragraph of note

A key point she shares is the following;

I already have all these regrets of not doing anything, of thinking about the things I could have accomplished had I not convinced myself it wasn’t worth it and just stayed in bed. The guilt is another physical being that holds me back. I feel bad for not being a “normal” person with a “normal” life. Instead, I just stare at the ceiling as the guilt eats away at me.

My feelings of guilt and shame

I have a mixture of feelings. I felt guilt for allowing the abuse in my relationship to have happened. A feeling of shame that I didn’t stop it or share what was going on with other people. These feelings had left me exhausted and in the early stages I found I was treading water just to keep going.

How common are sleep problems in depression?

Keith's Story - Male Victim of Domestic Abuse & Depression How common are sleep problems in depression?

Depression and Sleeping

Depression is often connected to problems with sleep. It can either be too much sleep (hypersomnia), or too little sleep (insomnia). There is also some debate about whether it can be the cause of weight gain and/or weight loss. This blog considers all of these factors and the benefits of medication, namely anti depressants and zopiclone.

It has been estimated that more than 80 per cent of people suffering from depression have problems with their sleep, usually not getting enough . However, I have found that during my periods of depression I sleep more.

Being tired effects everything

This type of tired is like a constant state of exhaustion, which takes over your body from top to toe.  It starts from the mental exhaustion from the daily battles you have inside your head. It affects your emotions, causing hypersensitivity and complete numbness and running the emotional gauntlet in between. Having to constantly explain or justify why you’re tired is exhausting in itself.

Being tired stops you being focused

Being constantly tired makes you feel weak and vulnerable. It makes every decision harder to make and often means not being able to think clearly or focus on the things you previously took for granted.

How do I manage my sleep problems?

I find that my sleep regime is dependant upon the events of the day and my general mood. There are, however, two major considerations that help me sleep;

  1. Going to the gym. This has been beneficial for a number of reasons. Firstly, it offers a routine.Take a look at my blog entitled I’ve been busy keeping myself busy – a good way of feeling better?  I tend to go in the morning and then have the afternoon to ‘get things done’. Secondly, it was highly recommended as a form of treatment as the body produces ‘feel good chemicals’ into the body following a good work out finally, it gives me an appetite when I leave otherwise I probably wouldn’t bother eating.
  2. Medication. It took a while for my medication to work but this is a well known consideration when taking anti-depressants. In my case I found that it took about four weeks and an increase in dosage. Read my blog called My relationship with Sertraline. Is it ok to consider medication?  and Being a bloke means you can’t take medication

Sleeping patterns of somebody with depression is very different to normal sleeping patterns:

·         It takes much longer to get off to sleep

·         The total sleep time is reduced

·         There is little or no deep sleep

·         REM sleep occurs earlier in the night

·         There are more frequent wakenings during the night, which may last long enough for the person to be aware of them. The person wakes up earlier in the morning and can’t get back to sleep, even if feeling very tired.

What can I do about my sleep problem?

For those of you who are finding it difficult to sleep it can be extremely distressing. Fortunately, there are a number of things that you can do to try and improve your sleep.

Sleep problems – mind

Below is some general advice for anybody who has difficulty getting to sleep.

·         Get into a routine with your sleep times. Get up at the same time each morning, even if you have not had a good night’s sleep. Don’t sleep during the day, and don’t go to bed early to try and get more sleep – you are likely just to lie in bed thinking over problems. Go to bed in the evening when you are tired.

·         Take some physical exercise during the day. This helps to make your body more tired in the evening and makes it easier to get to sleep. . Exercise is good for you physically, and there’s also research that suggests that exercise can have an antidepressant effect. Take a look at my blog entitled I’ve been busy keeping myself busy – a good way of feeling better? 

·         Avoid exercise in the two hours before bedtime. This is because exercise ‘activates’ the body, which can make it difficult to get off to sleep.

·         Avoid watching disturbing or violent films prior to bedtime.

·         Avoid drinking caffeine (tea, coffee, cola) in the evening after 6pm. Caffeine is a stimulant and can prevent sleep. Drink no more than four cups of tea, or of coffee, or cans of cola in a day.

·         Drink herbal teas or milky drinks such as Horlicks in the evening. Herbal teas don’t contain caffeine and milky drinks have been shown to be as good as sleeping tablets for many people. However, be aware that chocolate or cocoa milk drinks often contain caffeine.

·         Avoid heavy meals in the two hours before bedtime. It can be extremely difficult to get off to sleep with a full stomach.

·         Avoid alcohol in the evening. While alcohol is sedative, it is not a good idea to try to use it to sort out a sleep problem. This is because alcohol does not lead to normal restful sleep. In addition, alcohol causes you to pass increasing amounts of urine, which further disrupts sleep. Unfortunately, a significant number of people with depression develop an alcohol problem from using alcohol to help them sleep.

·         You should associate your room with sleep: avoid having a TV or radio in your bedroom. For similar reasons do not check your mobile phone in bed or work on your laptop.

·         Your bedroom should be warm and familiar with a comfortable bed and duvet, etc. Ideally, the room should be decorated in a relaxing way. This all helps in associating the room in your mind with restful sleep.

Zopiclone

Keith's Story - Male Victim of Domestic Abuse & Depression How common are sleep problems in depression?

During my professional life I came across Zopiclone a number of times. I was aware that it was normally prescribed for insomnia but had never put sleeping problems and depression together. I did find that early on following my arrest I was subjected to regular flashbacks of events that happened during my relationship with my ex. Initially my GP was hesitant to prescribe zopiclone but we concluded that it was worth a try to help me get some form of sleep and rest.

Zopiclone is usually prescribed for the short-term treatment of insomnia. Long-term use is not recommended, as tolerance and addiction is known to occur.

How have I found Zopiclone?

I’ve been lucky with Zopiclone as I have managed to avoid some of the well known side effects. These are listed as being dizziness, nausea and vomiting,  headache, confusion and nightmares nightmares. However, be aware that just because they work for me doesn’t necessarily mean they will be right for you.

Is having a lack of energy a sign of depression?

More than 90 percent of depressed people experience overwhelming loss of energy. This can cause a person to stay home and avoid social interaction, and prevent a person from starting or finishing projects, maintaining previous interests, or exercising. The effects of diminished energy compound the effects of depression, when work, school, and family obligations are compromised. Also, lack of activity results in loss of muscle tone, muscle mass, and, eventually, bone mass. In turn, these effects lead to degeneration in physique, strength, and physical well-being.

Can depression lead to weight loss or weight gain?

When depressed people lose the energy it takes to accomplish basic tasks, important needs such as eating are compromised. Many depressed people lose their appetite, which results in erratic eating habits and missed meals. Subsequent weight loss may result in nutritional deficiency and mental and physical sluggishness. Some people with depression have an increased appetite and gain weight. These people are usually the same who oversleep.

Manage your sleeping patterns

Problems sleeping are therefore, normal when it comes to dealing with depression. It does need to be managed otherwise it can create problems in other quarters and this may lead to an ever decreasing circle of despair and problems. Go and speak to your GP and have a go at trying out the gym.