I’ll be happy when…

  • I’d be happy if I found a new job…
  • I’ll be happy when I get a promotion…
  • I’d be happy if we had a bigger house…
  • I’ll be happy when I retire…
  • I’d be happy if I could get pregnant…
  • I’ll be happy when my family’s complete…
  • I’ll be happy when my children leave home…
  • I’d be happy if I could lose weight…
  • I’d be happy if I found a partner…
  • I’d be happy if I wasn’t chronically ill…

So many of us spend our lives chasing happiness around as though the next big thing will be the answer. Unfortunately, we often find that when we arrive at what we think will produce these magical feelings, we don’t feel happy and we need to set the next goal.

Ambition is good, aiming to achieve the next goal and believing it’s possible is how we better ourselves. However, pinning our hopes of happiness on achieving this next goal doesn’t work!

It’s as though happiness is always over-there-somewhere, this intangible thing. The reason we never quite achieve happiness is because we think happiness comes from something outside ourselves. But happiness must come from within.

Person standing on a very tall ladder reaching into the sky

I spent my teenage years and young adult life thinking I would be happy when I achieved the next stage of becoming a doctor. Unfortunately, each stage was never quite as I imagined and always brought a lot more stress. On top of my faulty belief, I was also depressed. Mental illness requires support and/or treatment from a trained professionals. If you think you, or someone you know is mentally ill, there’s no quick fix, I urge you to seek appropriate help. However, anyone can re-frame the beliefs we have around happiness (thinking it’ll come when some goal is attained) and we can, almost overnight, feel happier.

What if your current situation was ok? What if being: in education, in your current job, single, childless, your current weight, in your current state of health, wasn’t fraught with judgement? It’s what you think about your current situation that’s getting in the way. What if you could find contentment which, in turn, could mean happiness?

People who are unhappy with their weight are generally judging themselves as greedy or lacking in self control. People who are unhappy at work might be judging themselves as underachieving, perhaps comparing themselves to peers. People unhappy with their relationship status judge themselves as unattractive, undesirable, failing in some way. Someone who’s childless may think they’ve failed in some way.

What you’re doing right now, your current situation, is part of your journey, it is shaping you, developing you, strengthening you. Judging ourselves is cruel, unhelpful, unnecessary and only leads to unhappiness!

Person lying on the ground smiling broadly with a dog by their side

Maybe you’re not precisely where you want to be but that’s ok.

Being content is not an excuse for apathy. If changes need to be made or you desperately want something, you can still strive, but if you stop judging your current situation it’s amazing how much more energy you have to fight for what you want!

Most of us have a friend who was single, very “keen” for a relationship… wasn’t it when they stopped behaving so “keenly” that they found love?! And, how many people have got pregnant the moment they stop trying?!

Once we’re ok with being who we are and where we are, we become happier and funnily enough, change becomes more possible!

Some people become stuck in mental illness, often using maladaptive coping strategies over and over. Often they’ll feel angry with themselves for “doing it wrong”. Thoughts such as “if only I could sort myself out” or “if only I was a better person” or “if I had better support” are very common vicious cycles. But what if these could be re-framed as “I’m doing my best” and “I have some support I could use”, the picture looks different. Of course, I know it’s not as simple as that but being ok with who we are and what we’ve got can free us up to see where and how small gradual changes can be made.

Why am I running a marathon?

Some of you will know I’ve spent the last little while training for a marathon and it’s coming up fast so I thought I’d share a few things I’ve been reflecting on! Firstly, why the heck am I doing it?!

Because I want to!

Group of mixed sex marathon running

Ever since I can remember being aware of what a marathon is, I have wanted to do one! I can’t quite put my finger on why, I just remember seeing it on television and I thought it was amazing to be able to run that far; it seemed as though finishing it led to a huge sense of achievement and so much positivity surrounded the whole event. Whether people run for charity, in fancy dress or for personal goals, everyone has one target, the finish line! While it’s a solitary pursuit, there’s a fantastic sense of comradery! Having done a couple of half marathons the buzz produced by the spectators is great, complete strangers come to cheer you on. Everyone wants everyone to achieve whatever goal they’ve set themselves! That goal may simply be to finish while others chase records.

It’s now or never!

Over the years my health has let me down. Chronic mental and physical illnesses have taken their toll on my body. After a failed operation on my ankle a couple of years ago, my surgeon has said the next option is to fuse my ankle joint. While it will be possible to run on a fused ankle, I know the rehab process will be long. To put off the operation as long as possible I’ve been fitted with an orthotic that keeps my ankle joint rigid; currently this keeps my pain to a minimum and allows me to run.

I have fibromyalgia, currently an incurable condition that tends to get worse rather than better. I also have degeneration and various arthritic changes in my cervical and thoracic spine, which, again, are getting worse, not better! I’m on a waiting list to have injections into my spine to help with the pain, I’m currently managing with multiple painkillers and frequent chiropractic sessions.

I’m using this window, before another ankle op is absolutely necessary, to achieve my dream. My body is crumbling (some people don’t believe me because I’m really good at covering up how much pain I’m in but it really is!), the longer I leave it, the less likelihood there is of me achieving this! If I tried waiting for optimal health, it’s never going to happen so it’s now or never!

Things I’ve learnt

  • Fuelling while I’m running – having run a couple of half marathons without eating, this came as a bit of a shock but it turns out the body can only store enough glycogen to keep you going for about 1.5 hours. I’m going to take a lot longer than that so it’s been an interesting part of training to work out what to eat, when and how! I well and truly hit the proverbial wall about 2.5 hours into my first long run… I don’t want to experience that again! (Good to experience it in training rather than the real thing though!). Fuelling correctly before running is to ensure the glycogen stores a jam-packed. I’ve been having fun cooking more varied meals!
  • It’s a good idea to smell soya milk before using it to make pre-run porridge – turns out, soya milk goes off. I had no idea and it tasted fine in my porridge… until mid 18-mile-training-run my tummy was very very unhappy, ‘nuff said… again, good job I experienced this mid-training run and not in the real thing!
  • My mind is incredibly strong – even when achy and exhausted, I’ve proved again and again, I can keep going. I may not be fast but I can keep going. That unforgettable 18 miles I mentioned above? I finished that run! Just shows what you can force your body to do when you want to/have to! I keep going when it’s tough using a few mantras in time with my footsteps: “you can do this” or “just keep go-ing” – the 4 syllables helps keep my rhythm going. My body may not be great, it’s going to hurt but it’s going to be the power of self belief that carries me over the line.
  • Rest is just as much a part of training as running is – I’m finding as I taper down my miles (a important part of any training schedule) when I do run I’m feeling stronger. In my younger years when I’ve not followed any training plan, I’ve pounded the streets day-after-day-after-day, not achieving anything but exhaustion. Unfortunately my sleep will never be the best quality (due to fibro) but resting for long enough is required for muscles to recover.
  • Podcasts are fantastic – lots of people like running to music but I find it difficult as I tend to run to the beat even if it too fast or slow for me. However, I’ve been entertained during the long hours on my own by some great podcasts. The subject matter of some of these may surprise you but I think I’ve learnt the atmosphere created by the banter matters more to me than the theme (in no particular order): You, me and the Big C: Putting the can in cancer – fantastically funny and serious but above all honest conversations around the subject of cancer, Wellfar – podcast tracking marathon training with Amy Hopkinson, Sh**ged Married Annoyed – Rosie and Chris Ramsey taking an honest look at their married and answer listen questions, Something Rhymes with Purple – a fun discussion about our bright and colourful English language with etymologist Susie Dent and Giles Brandreth, Scummy Mummies – an hilarious look at parenthood, Deliciously Ella – a down to earth conversation about mental and physical health, David Tenant Does a Podcast – revealing but relaxed conversations with the gorgeous David Tenant at the helm. One thing I would say is I’ve found running is compatible with neither laughing nor crying…!
  • There’s a lot to remember before setting out on a long run – while you’re remembering to put on suncream and sunglasses to position blister plasters, carry water and food, you’ve got to decide on a garment to carry everything, you’ve also got to do the right warm up, I have to remember to warm up my ankle before putting on my ankle brace as my ankle muscle still try to work (despite being braced) and they get tight. It took me a long time to decide on a comfortable hair-do for running – to low plait has it – not too tight but not too loose! Remembering to charge my headphones is essential too!
  • A new brace solves the blister issues – I was told each orthotic would last 9-12 months of normal use. But, I’m, erm… thwacking it through marathon training! My 6 month old brace was causing awful blisters, fortunately, my orthotist ordered a new one, no questions asked and my new one is doing a grand job!
  • It’s possible to stick to a plan and be flexible at the same time – I mapped out my training programme in front of a computer. I’m usually someone who sets a plan and sticks rigidly to it but that would have been a recipe for self destruction so as the weeks went by I found small adjustments and made it more suitable for my weekly commitments and how I felt my body was recovering from long runs etc.

Never have the following sayings been more true:

If you think you can or think you can’t, you’re right” and

If you want to you’ll find a way, if you don’t want to you’ll find an excuse”!

If you’re thinking you might want to run a marathon…keep both of these in mind!

Female running down a track between a line of trees

Training for a marathon is no small feat, it takes time and discipline. My husband has been a saint, giving me the time and space I need, he’s even been water-boy on occasion, tracking me around the beautiful Hampshire countryside providing water and sustenance. I’m being selfish, this dream is all about me, feeling good about myself and nothing else. I know there will be many people there raising money for charity or doing other honourable things but I spend the large majority of my life doing stuff for other people so this is just for me. It’s really hard to admit this because I don’t think I deserve it, but that’s exactly why I’m doing it, to prove to myself, I am worth it!

Treating mental illness is trial and error

The Locum psychiatrist looked enraged when I pointed to the BNF and said with a heavy heart “I’ve tried everything in there.”

(The BNF is the British National Formulary for medicines used in the UK by all doctors, pharmacists etc as the medicines bible. It has all tried and tested drugs listed with their uses, dosages and side effects.)

I was experiencing another dip in my depression, my current anti-depressant was not working and I’d checked my copy of the BNF, there wasn’t really much else to try unless I was prepared for almost certain weight gain (which I most definitely was not – I was on a waiting list for treatment at an Eating Disorders Unit for my anorexia – I did not have any support at the time!)

The psychiatrist didn’t like a) that I knew what I was talking about (they like to hold the power and control and sadly some feel threatened by my medical degree) and b) I was presenting with “treatment resistant” depression. This phrase is used when it is felt that various treatment avenues have been exhausted and the depression remains. Looking back at this particular appointment, a short admission would have been useful but it seems this psychiatrist decided that would be too much hassle. Despite me having spent the entire appointment in floods of tears, I was sent home with no change in drug regime, no additional support and no further plan. The negligence of this psychiatrist aside, treatment resistance is an incredibly difficult phenomenon to tackle and the spiral of hopelessness can be disastrous!

There is, however, research currently being undertaking into the genetics of mental illnesses. For example, the Genetic Links to Anxiety and Depression* (GLAD) study is based at King’s College London. Therapygenetics is using genetics to predict treatment response in mental health conditions. While I’d heard of research into the trying to find genes “responsible” for various mental illnesses (a hunt that’s proving to be futile), this shift to looking at what our genetics can tell us about what treatment options are more likely to work is relatively new.

Recent research* showed 80% GPs admitted they treat mental health problems as a progress of trial and error. They try one approach after the other, based on what is available in their area and their own experience. This is not just frustrating but could be fatal for some who’re suffering with suicidal thoughts, they might not have time to try one drug after another until they find the right one. New research could enable doctors to finesse their prescribing so the patient can get the most effective treatment, for them, as soon as they are diagnosed.

My story did not end with being let down by a Locum psychiatrist – fortunately, on this occasions I had a good friend scrape me off the floor and supported me over the next couple of days until I could see my GP, and I eventually got to see the eating disorders team, then the psychotherapist who changed my life, and the rest, as they say, is history. To date, I’ve been on, maybe 10 anti-depressants, a few anti-psychotics and a couple of mood stabilizers; I’ve also worked with about 15-20 psychologists and therapists who all believed their approach was right for me. Fortunately, my current anti-depressant has been working for about 8 years (I did come off it, but went back on it!) and I continue to use skills gained from various therapies but it was individual systemic therapy from someone with specialist knowledge and experience in eating disorders that was right for me.

Just imagine if I’d been able to give a sample of saliva 20 years ago and from that, I’d been able to access the right drug and therapy treatment immediately!

Some research is finding genes that implicate how we respond to both negative and positive environments. It is noted that people with a particular gene variant are found to be highly sensitive to adversity, they also respond particularly well to social support and positive life events. This research, with children, looked at different outcomes of individual CBT, group CBT and parent-led CBT. Being highly sensitive to environmental influence led to a good response to individual therapy, whereas those who were less sensitive had similar outcomes to each course of therapy. This is just one example of where a generic variant could possibly predict outcomes to different therapies.

Biological, social and psychological Venn diagram with mental health a the the centre.

But let’s hold fire a minute. We’ve always known all mental illnesses have a bio-psycho-social cause; that is, there are elements of nature and nurture, our genetics and our environment that can lead to development of a mental illness, so doesn’t it follow that we need to take all of this into account when treating an individual? If we run off into the genetics trap, thinking we can pinpoint the ideal treatment with a mental illness, we’ll forget that they will bring with them a whole host of environmental and psychological factors that will influence their ability to engage and benefit from any given treatment.

Camilla Kong*, a Senior Researcher specialising in psychiatric genomics at the University of Oxford has a background in moral and political philosophy and an interest in the ethical issues raised by genetic research in mental health. She has concerns about us focusing entering on a genetic level, she says “It is quite a reductive explanation…that diverts our attention from the person as a holistic being who is impacted by relationships, life history, structural inequalities and environment and social issues.” She is also concerned with stigma and the assumption that diagnoses are life long and incurable. The biogenetic explanation lends itself to fatalism and works against the therapeutic alliance and hope. Of genetic research she says “I think researchers over-promise – they have to, to attract funding – but even if academic institutions pay for the research, and the results are more measured, public expectations are still very high and the more nuanced findings are ignored.”

Whenever we talk about genetic research, there’s the shadow of eugenics. Kong wisely warns us, as we learn more about genetics, “It’s not that we shouldn’t do it, but we need to be very critically aware of the reasons why we are doing it.”

Perhaps what we can learn from my story is that sometimes finding the right medication and therapy takes time and this time is valuable, I learnt a lot as I went along, some things can’t be rushed! It saddens me that (in the UK) there’s a such a push for everyone to travel on the conveyor belt that is IAPT (Improving Access to Psychological Therapies) – now there’s a service that only partially living up to its name. Access has been improved, no matter what your symptoms or history, if you present with mental health problems, you qualify for 6 sessions of CBT in IAPT, this will be the answer for some but there’s no room for flexibility or individualisation. I was involved in some work to train therapists to recognise when the basic IAPT programme wasn’t going to be enough and how/what treatment to refer patients onto but NHS funding for tertiary mental health services is still floundering; scarce resources mean long waiting lists, leading to people with moderate mental illness becoming people in mental health crisis.

For every cancer patient, £225 is spent on research. For every mental health patient, the equivalent figure is £9**. It’s great that some money is being spent on research but so much more is needed. It concerns me that to attract funding outcomes are being over promised and we all know that the media always sensationalise research results. What we really need is some down to earth longitudinal studies that will back-up the need for particular groups of patients to have long term therapy while others may benefit from shorter, specialised therapies. We then need the funding to train GPs and enough tertiary services to provide appropriate support.

*Information and quotes from Therapy Today Volume 29, Issue 10 – Nature and Nurture, Catherine Jenkins.

** MQ Mental Health