After my recent ankle arthroplasty I struggled with the expected pain, a lot of it but it was bearable. I was working hard at my physio and doing more, she told me I would obviously experience more pain but it really wasn’t feeling right, she told me to persevere but I don’t think she really understood how much pain I was in. I may have a low pain threshold but I have a very high pain tolerance. I experience a lot of pain, I just get on with my life but that doesn’t mean it’s ok or that I’m ok with it! It’s hard to know where to draw the line, how do you know, when you’re rehabilitating, how much pain is too much pain? I was pretty much told, I should keep exercising but absolute agony was the line at which I should stop!
Speaking to a colleague about his painful knee has had me thinking. He was injured 4 months ago and because he didn’t make a fuss when he first went to A&E he’e been through months of pointless pain, finally culminating in an MRI that concluded he needed surgery. He’s been thinking he should have made more of a fuss, if only he’d limped into A&E stating he was in agony, he would have had an MRI within days and surgery so much sooner. Those of us that don’t complain so often don’t get what we need.
I’ve been wondering if I was experiencing more pain than I should have been but my physio said it was fine, to be expected.
I was beginning to think I would be in pain for the rest of my life and I was beginning to get to used to the idea that I may never run again. Disappointed, doesn’t even begin to come close.
I saw my surgeon last week and he had a different opinion, I should NOT be in so much pain. Steroid and local anaesthetic injection on board and…I’m pain free, I can’t quite believe it!
When my physio said “repeat this exercise 20 times”, I do it 60 times and she says “good”, to be honest, I don’t think she was used to patients actually following through with their exercises but I’m so desperate to get better I thought the more I did the better…I can’t help wondering I shouldn’t have been doing so much exercise, I guess there’ll be no way of knowing.
Anyway! Today, on a totally pain-free ankle, I (with more measured advice from another physio) tried running for the first time in 5 months, it was for 1 minute at a time and I’m so excited that I didn’t feel any pain. This is the first time for many years I’ve run with no pain!! So excited, it’s unreal!
I have promised my husband I won’t push it. I will stick to 1 minute at a time for 2 weeks and increase it so slowly I’ll feel like I’m running backwards! But the hope is, I will be back running properly within a year!
My husband knows I’m likely to want to push myself. For starters, I got on the treadmill earlier and said to myself I’d to 2 x 1 minute stints, I ended up doing 5… it’s not don’t any damage and I’m still pain-free but I really cannot push it! I cannot risk needing more surgery.
We started talking about whether I need an incentive…for every week I’m “good” and stick to the slow build up plan, is there anything that would help me stay focused? We discussed all sorts of things but it occurred to me, what more incentive do I need than to look after my health?
Why do we always need incentives? When people are giving up smoking, it’s suggested they put the money they would have spent on cigarettes in a jar so that they can spend it on a big holiday or some new clothes, there has to be something to aim for. It’s the same with people trying to lose weight, for every pound, there has to be some material reward. Reducing the chances of long term life limiting illnesses just isn’t enough!
Our health gains are intangible and it’s like they’re just not enough.
I’m so proud of my 60-something mum who has just completed a couch-to-5k program and has done a couple of Parkruns, being one of the fastest women in her age category! That’s what I want to be doing in 30 years time, but I won’t be if I don’t look after my bones and my joints now, what more incentive do I need?!
Seriously, if I want the best chance of avoiding further surgery and to be running in my 60s, I need to take it slow and steady so that’s what I’m going to do, no other incentive necessary!
Low self esteem can be a painful condition and many of us suffer in silence, unaware of the damage being done, unaware that there is a way out.
Throughout my mental health journey, I was asked numerous times if I had low self esteem, I would struggle with this question. The definition of self esteem is:
“Confidence in one’s own worth or abilities; self-respect”
Since I did not believe I had any worth or abilities, how could I possibly have confidence in them? I did not believe there was anything about me to respect. Therefore, the question baffled me because if there is nothing to feel good about how could I rate it as low or high? It’s only since my self esteem has improved have I realised how rock bottom it was and I had previously been viewing myself through a distorted lens. Once the cycle of low self esteem started, add in mental illness and you soon reach no self esteem!
We build a picture of ourselves and our self esteem grows from a combination of the following:
Experiences at home, school, work and in the community
How other people react to you and treat you
Illness, disability or injury and how those around you cope
Your own thoughts and perceptions
Culture, religion and societal status and role
Problems associated with low self esteem include:
Feelings of fear and anxiety – an all consuming fear of doing something wrong, looking stupid.
Isolation and avoiding new situations – these things can feel too overwhelming when you assume you won’t be able to cope.
Staying quiet and not sharing thoughts or ideas, not initiating conversation – anything to avoid looking bad, stupid of inept and avoiding rejection.
Underachieving and lacking ambition for fear of not coping or being rejected,
Or overachieving – constantly working inordinately hard to prove worth and competence to self and others, striving for perfection and perceiving failure if it’s not achieved.
Seeking or remaining in destructive relationships through fear of not managing alone.
Depression – persistent low self esteem with negative self-talk can lead to other symptoms of depression such as low mood, not sleeping, poor appetite etc
Hypersensitivity – assuming negative thoughts from others leads to being on the look out for these signs that confirm these fears. These could lead to acting on a sign that wasn’t perceived accurately (for example a compliment will sound sarcastic). Sometimes people will throw out “tests” to see what people think of them.
Lack of assertiveness – anxiety and fear can lead to difficulties sharing feelings and asking assertively for needs to be met. This can lead to people being passive and being “walked on”, which can lead to a build up of pressure and aggression being expressed as being defensive, sarcastic, brusque or even rude. Putting other people down (not necessarily deliberately maliciously) may be a way of covering up a low self esteem. Being passive-aggressive is common, examples include being manipulative, planned tardiness, throwing out cues for others to pick up on and gossiping.
Obsessions or addictions can be a way of coping or covering up. From workaholic behaviour through to developing serious mental illness such as anorexia or obsessive compulsive disorder with intrusive thoughts etc
Behaving in a needy way, relying on others for direction and trying to please others.
None of these are meant to be criticisms but it’s helpful to know that people behave in all sorts of ways, unintentionally, in order to manage such a negative feeling. It may be helpful to realise that you have low self esteem and that how you’re managing it is having a negative impact on you and the people around you. If you notice other people’s behaviour is annoying, unhelpful or irrational, this may be the tip of the iceberg and it might be worth thinking about whether their self esteem is playing a part, the real root may be hidden.
My lack of self esteem was mostly internalised and exaggerated as I turned to self punishment.
I became depressed, used self harm to manage my emotions and hid inside anorexia to manage strong negative feelings about myself. Once I was on my road to recovery and I was able to reflect on some of my unhelpful thinking I became very aware of my fear of arrogance – my overwhelming fear of my head being too big had pushed me so far in the other direction I was suffering for it! A balance is important. (Arrogance is unattractive, and while some people may think it’s got them places, I never want to venture down that path.) I can be assertive while using humility to keep arrogance at bay!
It is really important to boost your own self esteem and the self esteem of those around you and to avoid unhelpful coping patterns. Here are some tips:
Stop comparing yourself to others – a trap a lot of us fall into, thinking it helps us know where we stand but it’s unrealistic as we’re all unique with different abilities and strengths. Get to know yourself rather than thinking you need to be the same as someone else.
Don’t strive for perfection – some people believe only God is perfect, others believe it does not exist. Being OK with “good enough” was one of the best things I ever did for my recovery. Don’t get me wrong, I love my perfectionistic streak (it’s part of who I am) and I can turn it on if I want to but I keep it in cheque!
Make mistakes – it’s natural, it’s the way we learn and it’s fun! They will happen, there’s nothing we can to avoid them so we may as well enjoy them! Apologise if necessary, learn what we need to, treat yourself with compassion and move on – that’s the most important bit!
Focus on the things you can control – focusing on our worries and the things we can’t control leads to a downwards spiral of negativity. Instead, if we look at what we CAN change not only will we feel better but we’re more likely to actually achieve what we want.
Talk to yourself in a positive way – imagine recording a repeater tape with “I’m no good, I can’t do this, I’ll never achieve anything” – if you didn’t believe it in the first place, you will after a very short time! This is what goes on inside the head of someone with low self esteem. Instead, we need to replace it with “I can do this, I’m an OK person” etc. Work out what you want and tell yourself you can do it! If someone you know has low self esteem, make sure you are their positive repeater tape – without prompting tell them they are lovable, tell them what they’re good at, tell them they’re unique.
Do things you enjoy and help others do the things they enjoy – having low self esteem makes you focus on the things you’re no good at. For once, just relax and do something you know you’re good at – go to the park and read a book, spend some times stroking your cat, make a smoothie, do some weeding. Anything! Helping other to find something they enjoy has its rewards – it will improve their self esteem and you might find something new and fun too!
Breaking out of low self esteem can be hard. It’s especially hard if its become habitual to behave in these ways over years and years. But improving self esteem will improve every aspect of your life! Feeling better about yourself will mean you will be able to:
Communicate better, which in turn improves relationships, from intimate relationships to work colleagues to acquaintances.
Manage challenges better – challenges come along, they can defeat us or make us stronger depending on how we approach them.
Managing illnessbetter – one of the biggest improvements I’ve seen is that when I’m unwell I’ve started asking for what I need instead of assuming I don’t have a clue and hoping other people will know better than me!
Get what you want out of work – being honest about whether you want to achieve highly, be a CEO or whether you want something else – don’t let your self esteem dictate whether you over or under achieve!
Have a healthy work-home-life balance – everyone’s different and needs/wants different things out of life. We should not allow our self esteem to allow us to be dictated to by others. Working out what works for us as a unique individual is vital for a healthy life!
If low self esteem is caught up in mental ill health, external support will be vital, recovery is tough but I wouldn’t give up my journey for anything. I’ve learnt so much about me and those around me, my life has been enriched by the experience. Wherever you are on your journey or whether you’re journeying with someone else, I hope my blog has helped in some way.
It is part of the human condition to need to feel loved/wanted/accepted. How we communicate this with each other is more complicated than you would think.
When mental illness clouds our mind, it affects the way we think, feel and behave. It permeates every aspect of life especially relationships.
I’m not just talking about intimate relationships. What happens when one half of a friendship/relationship struggles to know what they’re thinking and feeling? Although we may know (on an intellectual level) that’re we’re loved, actually communicating it to each other is important. We all give and receive love in completely different ways and while one person may think they’re communicating love brilliantly, the message just may not be getting through. Words of Affirmation – this is where simply using words is best. Not just “I love you” but also “you look beautiful”, “I’m glad you’re in my life”, “I’ve had a good time with you today” are all ways of appreciating the other person. Acts of Service – where doing is important. It may be tasks around the house such as cooking, cleaning or shopping. Or it may be watching/listening out for what the other person needs, when they shiver, offer them a jumper or a blanket. For some people these things come incredibly naturally, for others, it will need to be a conscious effort. Physical Gifts – giving and receiving gifts for some people is the ultimate communication of love, whether it’s a few wild flowers picked from the garden or an unexpected new car, often the size isn’t important, it’s the gesture that matters. Quality Time – easily forgotten as a form of communication. It’s not usually important what’s happening at the time but it’s the quality that matters. For Steve and I, putting our phones/iPads/laptops to one side is the key. Physical Touch – while sex may be important in an intimate relationship, a touch on the arm, a hug or a peck on the check may be important parts of all relationships.
Trying to communicate with someone who is mental unwell can be very difficult; words may fall on deaf ears, acts of service go unnoticed, gifts ungratefully received and touch may be unbearable. It can also be very difficult to spend time with someone who is unwell. When unwell, the distorted thoughts and feelings lead to behaving out of character and rejecting any thoughtful gestures.
It’s important to remember there is still a person underneath (no matter how buried in illness). They still have the same fundamental needs – try to think about what they usually like. Try to ask the person what they need/want – this can be very tricky as within the gloom it’s very difficult to know. But if they say “I fancy a cup of coffee”, that’s a start, or if they say “I don’t want to talk”, perhaps say “do you mind if I just sit with you, we don’t have to talk” – at least then the silence isn’t awkward, it is the presence that is communicating “I care”.
When in hospital, my Mum cleaning my flat, taking my washing and a gift of contraband Pepsi Max went a long way to helping me feel loved. Quality time is a really hard one, I really appreciated visitors during my hospital stays but I would get incredibly tired and didn’t really want to talk, I had a friend who would bring a simple game to play, that was ideal! Cards and texts also meant a lot to me when I was most unwell. The odd arm around my shoulders from a nurse would also help me feel that they cared.
As the ill person, emotions and feelings can be very confusing. When I was overwhelmed with the thoughts that those around me would genuinely be better off without me, I thought the best way to communicate my love for them would be to remove myself from the world. When less unwell I had to remember that these people were hurting too and I wanted to make an effort to show them love and be grateful for them sticking by me. When low on money (as most ill people are) I would try to make gifts for people instead. Abstract love may be difficult but sticking to the facts can help. If someone’s visited, no matter how hard it had been, saying “thank you for coming” is important; if I found the words “thank you” were too hard, I would write a text.
For either the perspective of the ill person or those around them, communicating love can be very difficult but with a bit of insight as to what’s needed it is possible. It may be necessary to say “I need to hear that you love me”, an immediate response maybe “I love you” but what’s really important is follow this up with the love language that works for that person.
Discover your love language here. It’s important, not only to know how you give and receive love but how those around you give and receive love. If I’m running around doing acts of service because I express my love in that way, there’s no point in me doing any of it if my other half doesn’t know I’m expressing my love in this way and that I’d find it amazing to receive love in this way. Remember, even if you do not usually communicate love in a particular way, if you put yourself out and the other person feels love from it, that’s what matters!
Remember our love language can change so do the test often, the results may not be the answer to everything but if it sparks up conversation with those you want to communicate with, that’s great!