This week (18th May) is Mental Health Awareness Week 2020.
Let’s be honest, 2020 is not going how any of us thought it would! Some of our lives have changed beyond recognition, we had little warning and few of us had much influence over the changes!
How do you really feel about it all?
I have an extensive mental health history of severe depression and anorexia; recently I had anxiety and stress added to this list (stress isn’t a diagnosis but inability to manage it has a profound impact on ones health). I take medication and have had therapy to get me to a good, healthy place but I’ll always have a vulnerability to becoming ill if a number of factors aren’t controlled.
I’ve written various blogs in the past about how to maintain mental well-being. I’ve discussed the importance of being honest and how talking about feelings makes them less scary and more manageable.
As a society, we use the phrase “how’re you?” or “are you alright?” as a salutation and don’t really want the other person to go into detail, however, it’s at times like this (when the world is uncertain), when asking how each other are is of vital importance.
When I say “how’re you?” I always mean it and will always set aside time for the other person if they need to open up.
Unfortunately I have not always had the same afforded to me… I continue to struggle to open up, but knowing how important it is, I try to, then when the other person doesn’t respond or invalidates my feelings, I’m crushed. But when someone does really listen, it means the world to me.
Right now, you might be loving lockdown because you’re being permitted to stay inside and do what you want when you want. On the other hand you might be feeling angry, depressed, anxious or guilty because there’s so much out of your control and you’re being stopped from doing the things you want and need to do.
All feelings are valid and need to be expressed.
A silver lining to come out of this pandemic is the mental health is now on the agenda every day. The year, mental health awareness week is about kindness. Asking how someone is, meaning it and really listening to the answer is the simplest kindness you can offer and what’s great about it is you can do it on the phone, by text, by video chat or in person, socially distanced!
You don’t need a mental health diagnosis to look after your mental health. By being more open about how we’re feeling, it’s a good step towards being able to talk about more issues around mental illness.
I write blogs to share my experiences. When a psychiatrist diagnoses depression, they’re looking for a specific set of symptoms described in the DSM V or the ICD 11 all or most of the time over an extended period:
Diminished interest or pleasure in activities
Decrease or increase in appetite
Subjective slowing down of thought and movement
Fatigue or loss of energy
Feelings of worthlessness
Diminished ability to think or concentrate and indecisiveness
Thoughts of death, suicidal ideation without a specific plan, attempted suicide or planned for suicide.
I understand the need to be able to diagnose in this way but this is not how people experience depression. I’m writing this blog to give some insight to what it’s really like to be inside the mind of someone struggling with symptoms of depression.
In reality, people experience the following, jumbled and apparently nonsensical feelings:
I don’t want to make a fuss but I’m worried about how I feel
I feel sad, frustrated, angry, scared and numb at the same time
Sometimes I feel happy and then I feel confused and guilty
I feel lethargic and then I beat myself up for being lazy
I cry about everything and nothing but then sometimes I can’t cry when someone tells me something sad
I feel completely exhausted, during the day all I want to do is sleep then at night, I can’t sleep, I just lie awake
I’m not interested in going out, I won’t enjoy it and I have nothing interesting to say so what’s the point?
I don’t have any friends and I can understand why, I wouldn’t want to be my friend
I just want this pain to stop, it’s a pain like no other
I feel like I’m falling down a black hole, like my life is meaningless, is there any point?
I’m scared I’m going to lose my job, I just get a feeling I’m doing it all wrong
I can’t seem to do anything right
My life is fine, I should be happy but I feel like everything is falling apart
Life feels like a slog, I don’t think there’s any point in going on
I notice other people laughing and realise I’m not but the next day I can laugh and I don’t know what’s different
I wish I could go to sleep and not wake up
It’s the job of the GP or psychiatrist to take these experiences and attempt to make sense of them to see if a diagnosis of depression fits. A diagnosis is important so that appropriate support and treatment can be given. Symptoms of anxiety, psychosis, personality disorder, obsessive compulsive disorder, eating disorders or other psychiatric conditions overlap so it’s important to understand what the symptoms are in order to offer the right support.
I always like to offer some hope in my blogs. I’m living proof that from the darkest times, if you surround yourself with the right people, do whatever it takes (therapy, counselling, medication) it may not be easy or simple but recovery is possible.
Looking back over your life, what do you see? Do you find yourself in similar positions over and over? Do you find yourself thinking “oh, here we go again!”? Do you wonder why people seem to treat you badly? Do you repeat the same behaviours time and again?
I like to work hard, I’m not one to ask for praise or seek promotion, I’m a grafter, I take on jobs other people don’t like, I just put my head down and get on with it – I think these are fairly acceptable characteristics. Unfortunately, on multiple occasions in the past, I’ve found myself in a difficult position where I’m not respected, my need are disregarded and I’m not able to stand up for myself and say that I feel my good nature is being taken advantage of. I struggle to be assertive, this is my responsibility and something I need to continue working on.
Common “self-sabotaging” life-styles include people who frequently end up with abusive partners. This blog is not about self blame. Self-blame is also a common way we can be our own worst enemy, are you someone who doesn’t even listen to what went wrong, you’re very quick to jump in with “yes, yes, it’s always my fault…”? Self deprecating habitual language crushes your self esteem in a self perpetuating cycle. What happened might have nothing to do with you but you’re so caught up in blaming yourself you don’t learn! (No, that’s not another thing to blame yourself for!)
Disclaimer: Since I am a counselling student blog writer with life experience, not a psychologist, this is purely a short reflection that might help people see some unhelpful behaviours in themselves that they could think about changing for the better, nothing more, nothing less.
Maladaptive schemas are core behaviours or patterns of behaviour that we use repeatedly throughout our lives. Schema modes are emotional states that are triggered by bad memories or disturbing, offensive or upsetting life situations. More detail on schema modes can be found here.
When something bad happens is your immediate reaction to feel angry/annoyed, scared/anxious or empowered? Of course, it will depend on the situation, each of us will have different “triggers”.
Something I really struggle with is having responsibility for something that, I perceive, could go wrong. This triggers anxiety in me that’s off the chart because it reminds me of times when I had people’s lives in my hands. As a doctor, managing a crash response (just because you happened to turn up first) means thinking quickly, making life saving decisions and being assertive while reacting to a changing situation. As a junior doctor, you’re doing this with very limited knowledge or experience.
How do you cope with change? Not many people say “oh, I love it!” Some do, but not many! Some people are able to embrace it and see the positives while others will fight to the death to keep things as they were. The latter will claim “why fix what ait broke?” Or “it’s always been done this way” or “it’s fine as it is”, without realising that there are good reasons to upgrade or modernise an old system.
Most of us can accept that some changes are necessary but we’ll all struggle. Do you manage the change by keeping quiet and just doing your best even though you’re struggling? Do you seek approval for how well you’re coping? Or do you take your struggles out on people? Do you feel out of control and seek control in other forms (food, alcohol, exercise, keeping busy)? How do you ask for support? What do you do if that support isn’t forthcoming? Do you blame others or blame yourself?
How do you cope with conflict? Do you prefer to brush it under the carpet? If you can’t see its not really there, right?! Or do you like a blazing row where you say all sorts of things you wouldn’t normally say and stuff the consequences? Best to get it all out even if you say things you don’t mean, right?!
Are you someone who tolerates bad treatment without expressing what you need? Or do you prefer to dominate a conversation so that you always get what you need, no matter what? Do you criticise the other person? Do you prefer to disconnect when over-whelmed?
If the managing change or conflict makes you feel particularly emotionally (one way or another), this is what’s called a “trigger”. We’re all coping with a lot of change at the moment (understatement) so it’s a good time to try something new! Remember that you’ve got a scared/vulnerable, angry/frustrated and/or impulsive child inside you that needs nurturing.
We will all have different things that trigger repeated behaviours so think back over your life, what it is that locks you into similar patterns? Do you seek validation? Are you fearful of responsibility? Do you need control? All sorts of things can trigger bad memories – working it out is step one of being able to stop yourself running down the same path over and over.
A health adult will nurture and validate their inner vulnerable child but set limits for an impulsive or angry child. If you’re insightful and you catch yourself saying “here we go again”, you don’t have to continue down the same street; you can slow down, pause, take a slight look left or right to see if you could do things differently. Sometimes it’s just a case of taking a deep breath and saying to ourselves, “I’m going to try and handle this differently…” before you act.
Covid-19 sweeping the globe has far reaching impacts much greater than the virus itself. Spending more time with some people and less time with others may have brought about deeper connections or volatile clashes. None of us survive in isolation; are you managing to connect using technology? What coping mechanisms are you using, be honest with yourself – are they working?
It’s not always easy to see how our behaviour is affecting ourselves and those around us – we might not even be able to see that we’re making repeated mistakes! Of course, I’m going to advocate counselling or therapy – as Plato put it “A life unexamined is not worth living.” A therapist is not there to fix things for you but they provide the space and may help you see things from a different perspective.
My various health conditions are meaning I’m feeling incredibly vulnerable at the moment. I panicked yesterday because I missed a phone call and I catastrophised (yes, that’s a word!) that all sorts of terrible things were going to happen. 25 minutes of anxiety ensued as I tried to sort things out. If (at the point I realised I’d missed the phone call) I’d taken a couple of deep breaths, grounded myself, taken 2-3 minutes to write down my course of action and realise the worst was not going to happen (and if it did, I would cope with it), I wouldn’t have had to manage 25 minutes of raging anxiety.
An important message:
I’ll just pop back to an opening comment regarding self-blame and guilt. I’m aware this blog is read by a lot of people coping with mental health conditions and (as a rash generalisation) self-blame and guilt are familiar feelings for the likes of us!
“Oh, I always do this, why am I such a(n) *****?” (Insert your preferred derogatory term.) It feeds the belief that we are useless/terrible/hopeless and will perpetuate the cycle and we will continue behaving in the same way. If, however, we halt this thought with “I made a mistake, I can do better” we’re giving ourselves a way out of the cycle. If it was just a mistake then I am not a failure, maybe I could do better next time – leads to you doing better next time.
Be kind to yourself!
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