Category Archives: Mental health

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.

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

Multiple speech bubbles

Thinking about suicide? Are you stupid?

TW – Trigger Warning – suicide theme.

Apologies – this title is deliberately provocative. Please be reassured, this is a carefully considered blog looking at the language used when talking about suicide.

I was recently listening to a podcast where someone was talking about their experience of mental illness and they said this:

People say “did you want to commit suicide?”, well, yes, I did want to but I never, I was never at a point where I was stupid enough to think that if I go then my family and stuff is just gonna be like, “oh well, he was alright weren’t he, let’s crack on”. I always knew that, even when I was in my lowest places.”

(We’ll gloss over the fact that “commit” suicide is no longer used since that’s related to when it was a crime, there was a disclaimer at the beginning of the podcast apologising for this language!)

I know he’s not suggesting suicidal thoughts are stupid, he’s admitting he had them, but he appears to be showing a lack of understanding about what actually happens inside the mind of someone when they’re seriously contemplating suicide and it’s language like this that perpetuates the stigma surrounding suicide.

I know it was probably a flippant, off the cuff remark and I don’t want to target him but I feel when talking on a podcast, you’re in a position of influence and I want to use this example to talk about the wider subject, we all need to carefully consider the language we use.

When someone’s mental illness is so severe that suicide feels like the only option, they have got to a point where their mind is not able to think with their usual clarity and logic. From an outside perspective we can see plenty of reasons to stay alive but the chemicals in their brain have altered in such a way that their thoughts are not their own.

When in the depths of depression, your mind persuades you that your family and friends would be better off without you. You may think you’re a burden or you’ve become a person no one would want to live with. So, far from it being a stupid thought, it feels prudent to consider your impact on others and take yourself out of the picture.

The pain of depression has been described, by some, as one of the worst pains a human being can experience. Suicide is not just as easy way out but it may feel like the only option to escape the unending agony.

It’s incredibly sad to think about a person at such a low point but I’m being blunt about the reality because this is how powerful the mind is, it grinds down your self esteem and suicide feels like a legitimate (even logical) way out.

Speech bubbles with question marks in

Sometimes suicide is spoken about as selfish, as though the person is only thinking about the relief they will gain, that they are not considering the hole they will leave behind. Knowing incredibly beautiful, compassionate people who’ve died by suicide, selfish, is not a word I was use to describe them.

If you find yourself feeling anger or bitterness towards a loved one who’s died at their own hands, this is natural; it may feel logical to consider them selfish to have escaped the situation, leaving you to pick up the pieces. I’m not saying your feelings are wrong, if you’re feeling them, by nature of the fact they exist, they are acceptable. However, it may be helpful to consider whether these feelings are keeping you stuck and whether forgiveness maybe a step you need to consider in order to free yourself.

I have also heard people say they “don’t have the guts” to complete suicide. It is very unhelpful to use this language. Talking from experience, it is difficult to think about deliberately putting yourself through pain but, as previously explained, thinking clearly and logically are not possible at this point. It can feel as though it takes bravery but when I’ve got to the point of carrying out a violent act, it’s been a case of reluctantly giving up the fight for life and giving in to the voices telling me to end my life. This was not in a passive way, but in an active “I can finally take some action, do something about my situation, to make it better for everyone”.

It did not take bravery or guts, nor was it selfish, it was simply a symptom of my mental illness.

I know, we will all, on occasion, be clumsy with our language, make mistakes and say things that are less than sensitive, I know I will! But it’s important we’re open to considering how our language impacts others and how we can improve what we say to lessen stigma and improve communication.

If you, or someone you know, is feeling suicidal or expressing suicidal thoughts, please seek help from your GP or other care provider. In the UK, you can call the Samaritans on 116123.