Tag Archives: mental illness

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

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.