Beware Easy Narratives

If you read about mental health, sooner or later you will come across the Mental Health Cinderella Story. This type of story has a simple narrative: person suffers from mental illness, then finds a magical treatment or coping strategy and recovers, living happily ever after. It masquerades as a positive story about mental health because it supposedly gives hope to people who are suffering, but it can actually make people experiencing mental health problems feel pretty shit.

Grey and pink clouds

The problem with the Mental Health Cinderella Story is its simplicity. We all need to simplify stories about our lives — it’s natural and necessary — but we need to be aware of the effects of simplification and the inherent biases involved.

 

Oversimplification is demotivating, rather than empowering.

Most Mental Health Cinderella Stories are intended to be inspiring, yet they fail. Why? Because they portray the experience as black and white, glossing over the struggles and hardships. They present a certain treatment or coping strategy, such as antidepressants, CBT or walking, as a miracle cure. As soon as the miracle cure is adopted, they make linear progress towards complete recovery.

These stories rarely acknowledge that the treatments or coping strategies used can be difficult for many people with mental health problems to access. They don’t mention that many people experience awful days, weeks and months while using the “miracle cure.” The focus is on the evangelistic promotion of the particular “miracle cure” they have adopted.

Imagine how it feels to read such stories when you are already using the “miracle cure”, plus several other treatments and coping strategies, yet you are still struggling to manage your mental health. 

I’m relatively well, compared to what I have experienced in the past, yet Mental Health Cinderella Stories make me feel like a failure. I find myself wondering what’s wrong with me, that I haven’t made a full recovery when I’m doing exactly what this person recommends? Why do I still experience terrible days, whereas this person doesn’t?

 

The storytelling bias.

The truth is that some people’s experiences of mental health problems do align to the Mental Health Cinderella Story. They struggle, then they find a way to cope which enables them to make a full recovery and, often, never experience mental illness again. Good for them — I certainly don’t want them to suffer for the rest of their lives! The problem is, these types of stories are reported far more frequently and visibly than the messy, complex stories which resemble a lot of people’s experience of mental health issues.

My theory is that many people, especially those who haven’t experienced mental health problems, like to read or hear these stories because they are reassuring. They think, whether consciously or subconsciously, “it’s okay if I become mentally ill, because I can do what this person did and recover quickly by running/eating healthily/having a certain type of therapy.” It’s frightening for them to consider experiences, like mine, in which mental health issues have  massive, long term effects on people’s lives.

Nobody likes to think that they could try their best to improve a situation and still fail. Yet it happens. 

It’s frightening. It terrifies me, having lived through times when I believed everyone around me was cruel for not helping me to die, because I was suffering so much and nothing I did seemed to make a difference. However, ignoring reality isn’t the answer — which is what happens when the media tell certain stories, but not others.

 

Look beyond the sensationalist headlines.

One of the most frustrating aspects of the Mental Health Cinderella Story is that they are not always as simple as they are depicted. When you look beyond the clickbait headlines, a more complex story often emerges. Unfortunately, this message gets lost behind the sensationalism and perpetuates the myth of the “miracle cure.”

The stories are edited to fit the Cinderella arc, forcing experiences into discrete shapes and overlooking inconvenient aspects like relapses and factors other than the “miracle cure.” Many of the stories feature people who have resources which put them in a better position to effectively manage their mental health: financial security, supportive partners, understanding employers, access to various leisure groups and support services, etc. They are predominantly white, heterosexual,  middle class, educated people with traditional families. Yet none of these privileges is acknowledged in the Mental Health Cinderella Story, because the emphasis is put on the “miracle cure.”

If you don’t fit the same profile, or don’t have access to similar resources, these stories are more likely to evoke despair than hope. You come to the conclusion that the miracle cure hasn’t worked for you because you aren’t the “right” type of person.

 

Look for the motive.

A lot of Mental Health Cinderella Stories are selling something. Literally. People tell unrealistic versions of their stories because they want you to buy a product or service they are offering.

The product or service varies — I have seen the Mental Health Cinderella Story used to sell cookbooks, therapy sessions, online courses and books — and may not be obvious. For example, people tell their story to urge you to visit their website and then offer goods/services via the website. They claim to provide you with the “miracle cure” that worked for them.

I don’t have a problem with people selling stuff — there’s nothing wrong with trying to earn money — but I do have a problem with the overwhelming predominance of the Mental Health Cinderella Story and its unrealistic, narrow portrayal of mental health problems.

When you read these stories, be aware of what the author is trying to sell. Bear in mind that the story rarely (if ever) represents reality.

 

Be responsible when you tell your story.

I encourage everyone who has experienced mental health issues to tell their stories — we need much wider representation of different types of stories, from a much wider range of people. However, when you choose how to present your story, think about the effects it may have on people who are struggling with their mental health. Show them the truth, in all its messy, inconvenient and terrifying glory. Show them that there is hope — but you don’t need a miracle cure to find it.

Realise that the obstacles you have faced, and continue to face, give meaning to your story. Tell people about your challenges: days when your mood plummets for no apparent reason, the pain and isolation you felt (or continue to feel) at various points in your life, panic striking during routine activities, the times when your coping strategies make no difference, people in your life not understanding why you can’t do certain things or why your mental health fluctuates, not being able to do the things you enjoy (or not enjoying the things you do), wasting hours trapped in negative thought patterns, being too scared to leave the house…

Also remember that the challenges make your achievements all the more poignant and inspiring, as much as you would prefer not to be forced to cope with them. Tell people why you are proud of being able to do activities others find easy, after not being able to do them during worse periods of mental illness. Walking the dog on your own is a big deal when you have been unable to do it for ages. You should celebrate these seemingly-small achievements, as well as the big ones.

Most of all, beware of any stories about mental health which have a simple, easy narrative. “Happily ever after” is for fairy tales. You may recover fully from mental illness and you may be happy for the rest of your life, but there will still be problems and challenges. Conversely, you may struggle with your mental health for the rest of your life, but there can still be joy and triumphs amongst the struggle.

Tell your stories and seek out real, complex mental health stories. Try different treatments and coping strategies to discover what works for you and don’t be surprised if their efficacy fluctuates. Don’t place all your hopes on a “miracle cure” which may or may not work. Find real hope — it’s out there, but not in an unrealistic Cinderella story.


 

Changing Routines

I have come to realise that daily habits and routines make the most difference to my mental health. Big events have an impact of course, for better or worse, but the accumulative effect of the hundreds of tasks and mini-tasks I perform every day is greater. Which is why a drastic change to my daily routine has led to a recent improvement in my anxiety and depression.

Autumn sunrise

I started getting up at 5am.

Typing that sentence feels weird. I am not a “morning person”. I don’t bounce out of bed full of energy and joy, ready to meet the world. In fact, most of the times I had seen 5am in the past were a result of insomnia and/or staying up late.

I always thought of myself as a night owl; working late at night was normal for me, especially when writing fiction. On a good day, I only hit snooze once or twice when my alarm went off at 8am. If I dragged myself out of bed before 9am, I was doing well.

However, I kept reading that getting up early was a Good Thing. Loads of very successful people credited an early start for making them more productive. I began to wonder if it would work for me.

Then, one Tuesday about 6 weeks ago, I accidentally woke up early. I think it was around 5:45am. I was thirsty, so I decided to get up and go downstairs to have a drink. My brother later said “why didn’t you do what I do and drink water in the bathroom, then go back to bed?” I’m not sure of the answer. I suppose reading about the benefits of an early start made me think “I’m awake now, it’s an opportunity to experiment,” but it was subconscious.

I liked being up early, so I set my alarm for 5:30am the next day, then at 5am a few days later. I have been getting up at 5am since — yes, even on weekends.

 

Getting up early means I start my day with an achievement.

I always felt a bit crap rolling out of bed somewhere between 8am and 9:30am. If I overslept for longer, I felt like more of a failure. I was wasting a large chunk of my day dozing — my sleep quality was generally poor, but hearing my parents and brother leave the house in the mornings disturbed my sleep patterns even more, so I never felt well-rested.

It wasn’t an ideal start to the day and I never felt properly awake until noon. Anxiety and/or depression often cause me to procrastinate, so I would often reach mid afternoon without having done anything constructive. This feels crap, too, so the anxiety and depression would worsen and I’d be lucky to get anything done.

Now, getting up early is an achievement. I feel like I’m embracing the day, instead of hiding away from it until I summon the motivation to get out of bed. My mum and I have recently begun walking the dogs early as well, so that’s another item ticked off the to-do list before 7am. It sets me up for a more productive day.

 

It initiates an upward spiral.

When you have a long term mental illness, a lot tends to depend on momentum. When you are having a good episode and feel better, it’s easier to do more things which can improve your mental health. On the flip side, it’s easy to get into a downward spiral where you feel progressively worse and therefore are less able to do anything, let alone adopt positive coping strategies.

Getting up early helps me to initiate an upward spiral at the start of every day. Achieving this one, tiny goal makes my other goals seem achievable. It means I’m more likely to put on my SAD lamp, meditate, so yoga, write, read… All of those self-care activities which seem simple when you feel well, but are easy to neglect when you feel crap.

It’s important to note that I still don’t bounce out of bed. I don’t press snooze anymore, but it takes some effort to get up. I find it relatively easy only because it’s worth the effort.

I feel awake by 7am nowadays, which means I take less time to wake up, but I’m certainly not energetic and focused at 5am. I try to use the time to plan my day and do those simple self-care activities I mentioned. I think this makes a big difference to my mood, because I used to switch the television on as soon as I got up — often in the hope that it would distract me from symptoms of anxiety and depression.

The first hour after I get up gives me the opportunity to “check in” on how I feel and decide what I want to achieve over the course of the day. If I feel more anxious or depressed, I know I need to cut myself some slack and prioritise self-care. If I feel pretty good, I can prioritise work tasks and medium to long term goals.

 

My routine is still a work in progress.

Getting up at 5am has shaken up my whole routine and helped me make improvements, but it’s very much an experiment and there are areas in which I need to make more effort to change. I’m gradually building better habits, partly motivated by considering who I want to be, but there are many habits I need to tweak, transform or drop altogether.

The biggest change has been my mindset: I feel more ready to face the world. Even if most of the world seems to be asleep when I wake up!

 

The Hard Slog

I try to do something towards one of my goals every day. I split my big goals into small chunks, just as everyone advises and I try to hold myself accountable. But it’s bloody hard to stay motivated sometimes.

Winding lane

Having no clear pathway causes self-doubt.

With some goals, you don’t know what will work for you. You can predict what might work, based on how other people have achieved similar goals, but there is an inherent lack of certainty. This gives rise to self-doubt and a lack of confidence, which makes it difficult to keep focused.

It’s easier when there is a clear structure to follow, such as a course syllabus or training plan. You can try to create your own structure (which I do), but maintaining confidence in an untested plan is challenging.

 

Progress can be excruciatingly slow.

You may have a clear pathway to your goal, but when you are progressing so slowly it feels like you aren’t moving, it’s easy to give up. You think you should be moving faster. Other people are moving faster, you believe, so you are failing compared to them. You try to focus on yourself without comparing the inside of your life to the outside of other people’s, but it’s tough.

The only way to get through this feeling is to ensure you really want to achieve your goals. When you want something badly enough, you can bear more than you realise.

 

A lack of milestones and/or external success can be dispiriting.

I know you shouldn’t rely on external validation, but small successes are great confidence boosters and reassure you that you are on the right path. When it’s been a while since someone has acknowledged your progress, your motivation suffers. When it feels like ages since you last hit a milestone, it’s hard to keep going.

The answer, of course, is to concentrate on the intrinsic rewards of whatever you are doing to work towards your goals. Enjoy the process, the journey. The cynic in me thinks that would be easier if success was guaranteed, but experience tells me this is a good strategy. There are immediate benefits to activities like writing and exercise, for example, though they are steps towards a bigger goal.

 

Usually, the best option is to keep going.

If you are passionate about your goals, the idea of quitting is unbearable. The only option is to keep going. It’s hard work, you feel shit a lot of the time and you often convince yourself you will never achieve anything, but it’s better than giving up.

However, that doesn’t mean you should beat yourself up when you fall short of your hopes and expectations. Working towards a significant goal is worthwhile. It doesn’t matter if your progress is slow or if days pass without taking steps towards your goals. Just keep going.

Overinvesting Spoons

I recently wrote about spoon theory, which is one of those concepts which everyone on the internet seems to be talking about when I arrive late to the party. Like bullet journaling and WhatsApp. Last week, I briefly chatted about spoon theory with a friend who blogs about her experience of MS, and she pointed out that you can overinvest spoons. You think you are setting yourself up for success by investing more spoons in activities which should lead to long-term gains in spoons, but the returns diminish and you don’t get your stainless steel dividends.

Spoons

This got me thinking and led to some interesting questions…

 

How many spoons should you invest?

If you get 12 spoons on an average day, what should be your investment strategy? It’s probably impossible to invest all of your spoons, but if you tried to do so, you would neglect your current needs. You need to do things which are necessary for your health and wellbeing today, which includes taking care of basics like eating proper meals and activities which bring immediate pleasure, like reading or chatting with a friend. If you don’t address your current needs, your spoons will deplete at a faster rate than you receive any dividends.

So imagine you can take care of your basic needs with 6 spoons. Should you invest the remaining 6? It seems sensible, since it could lead to a lot more spoons in the future. However, it also means you aren’t making the most of the spoons you have today by enjoying what you can spend them on. Imagine you have £150 of disposable income after paying your bills for a given month. Would you put it all into a savings account? No, because it would make you utterly miserable. It’s the same with spoons: you need to find a balance between saving and investing.

Personally, if I had 6 spoons left over, I would try to invest half and spend half on activities that make me happy. Spending 2 and investing 4 could work, but would be pushing it. Spending 4 and investing 2 is also a good option. I would keep a similar balance if I had more spoons, for example, if I had a really good day and there were 12 spoons left over, I would try to invest 6 and spend 6.

While this seems like a simple strategy, as with many issues concerning long-term illness, it raises some complicated questions…

 

Which activities count as investments?

You may enjoy many of the activities which give you more spoons in the long-term. Walking, for example, is something I find pleasurable and which improves my energy and mental health in the long-term. Activities like this are a mixture of spending and investment. It’s a bit like buying something you intend to use and enjoy in the short-term, but will sell for profit at a later date – like a classic car or limited edition fashion item. You have to decide what percentage of the spoons you spend on these activities count as investment.

This can vary on a daily basis. Some days, walking feels like more of a chore (usually when it’s raining), so instead of being 50% investment, it’s more like 75%. Other days (often in late spring sunshine), walking feels like more of a leisure activity and only 25% investment. As I keep saying in blog posts, finding what works for you will be down to trial and error.

Assessing the investment value of various activities requires being honest with yourself. Don’t kid yourself that specific activities are investments if you haven’t experienced any returns. You can still enjoy these activities, but as pleasurable pastimes. Conversely, some activities seem like they should bring more short-term enjoyment than they do and are actually more of an investment. For me, this includes social activities – I feel like I should enjoy them more than I do, because “normal” people seem to, but anxiety prevents me. Some social activities are more of an investment in my support network and confidence than pleasurable experiences – even if I have fun while participating in them.

If this all seems complicated, it’s because it is! Living with long-term mental illness can make even the simplest things complicated. In terms of spending spoons, it’s like investing in a wildly fluctuating market every day.

 

Are bigger investments better than smaller ones?

Different activities, including investment activities, require different numbers of spoons. This is a basic tenet of spoon theory. But when it comes to investing, is it better to choose a single activity which uses all the spoons you have available for investment, or should you spread your spoons over a few different activities?

Financial advisers would tell you that it’s generally better to have a diverse portfolio, which seems to favour spreading your spoons over more activities, but some high-spoon activities offer very high returns. I try to balance variety with investment in a couple of high-spoon activities. The variety may not be apparent on any given day, but I try to include several different activities over any given week.

My go-to high-spoon investment is exercise. It helps me feel better than anything else I’ve discovered so far and improves my mood in the short-term, as well as increasing my fitness and energy in the long-term. I invest in exercise most days, so I try to invest my remaining spoons in low-spoon activities like meditation and using my SAD lamp. Other low-spoon activities include listening to music, texting friends, reading and drawing.

High-spoon investment activities are useful tools, but carry a higher risk when you spend more spoons on them. Over-exercising, for example, can lead to exhaustion and injury – which means you get no dividends and will have fewer spoons each day for several weeks afterwards. Finding a balance is vital.

 

What can you do if you overinvest?

Prevention is obviously better than cure, but if it’s too late, you can take steps to recover and ensure you don’t overinvest again. First, consider what went wrong. Did you overinvest in a single high-spoon activity? Did you invest too many of your spoons without spending enough? Did you neglect your daily needs in favour of investing spoons? Don’t beat yourself up; try to understand what happened and why.

Secondly, take care of your current needs. You may need to sleep more, cut back on work or rely on others for more support. Figure out how you can do whatever you need to feel better right now. Spend all of your spoons on basic needs or enjoyable activities – hold off investing for a while.

When you begin to feel better, learn from your mistake and start investing slowly – one or two spoons a day, maximum. Sometimes it can feel so good to recover from a bad episode that you want to rush into action, but that will lead to an all-or-nothing cycle, which is unhealthy at best and can be extremely damaging. Also focus on activities which are a mixture of investment and short-term gains, like gentle walks or eating healthy, delicious meals.

 

Avoiding overinvestment can be difficult.

When you have a long-term condition, especially if you are ambitious, it feels like everyone else is sprinting ahead and you’re stuck in the slow lane. It’s tempting to push yourself too hard, especially when your health improves and you feel better than during worse episodes. Even when you know holding back is sensible and necessary, it can feel like you are making excuses not to pursue your goals at full throttle.

Thinking about spoon theory has given me a useful framework which helps me manage my mental health better. It was created in order to explain the impact of chronic illness to people who don’t understand what it’s like to experience long-term health problems, but it can also clarify the way you think about your own health. Using spoon analogies enable me to treat myself with more compassion and less judgement.

I think it makes me appreciate the spoons I have more, too. I wish I didn’t have to think about how many spoons I have every day, but I’m grateful when I have more spoons than I had at my lowest points.

Who Do You Want To Be?

Decision making can be difficult, especially when complicated by mental health issues. I can spend hours weighing up pros and cons, finding logical arguments for and against all possibilities. Sometimes it’s helpful; mostly, it leaves me stressed and confused. In Originals, Adam Grant discusses how some people take an alternative approach to making decisions, instead of weighing up the consequences: “Rather than looking outward in an attempt to predict the outcome, you run inward to your identity. You base the decision on who you are – or who you want to be.”

Sunrise sky

When I read this, I realised I have started to make decisions using this approach – but not consistently. I trekked to Machu Picchu because I want to be the type of person who pursues her dreams. I’m starting a part-time Psychology BSc next month because I want to be someone who has a comprehensive grounding in the subject, using my knowledge to engage with other people who have mental health problems in more effective ways. However, these are “big” decisions within a limited timeframe (though hopefully with long-term effects). What if I applied this philosophy to different kinds of decisions?

Creating Habits Based On Who You Want To Be

I have started to think more about my daily routine and how, in an ideal world, I would live my life on a daily basis. It’s tempting to fall into “if only…” thinking when you do this: “if only I had more money, I would exercise more.” “If only I had a better home, I would bounce out of bed earlier in the morning.” “If only I had more time, I would write more.” You can easily convince yourself that your “if only…”s are absolute truths, but on closer examination, they are excuses.

You can find ways around most obstacles – if you prioritise finding solutions. Sure, doing everything you want might be easier if you had more time, money, support, etc., but not necessarily. If you don’t think an activity is important enough to prioritise it right now, chances are you never will. You will use your extra time and money to do other things; perhaps things you already do and don’t consider particularly important, like shopping and watching television.

I realised I could think of hundreds of excuses, many of them based on my mental health problems and lack of money, but what’s the point? I would be avoiding improving my life. It makes no sense.

So I examined the habits I would like to adopt, without giving myself permission to make excuses, and discovered something interesting: I could adopt most of them right now. Nothing is stopping me from getting up earlier, spending a larger proportion of my time writing or exercising. Nothing is stopping me from doing more yoga or eating more healthily. I could moan about how much easier it would be if I had a big house with a gym, personal trainer and private chef, but what would that achieve?

Asking myself “who do I want to be?” every day is helping me to adopt better habits. I have been getting up at 5am for the past month, having believed I was a cast-iron night owl for years, and am more active than ever before. Writing more and eating healthily are works in progress, with the former more successful than the latter. I feel better for changing my habits and more focused on my goals.

 

Should You Keep Who You Want To Be Realistic?

Asking yourself who you want to be is powerful and most people aren’t ambitious enough in their goals, but I do think it’s useful to keep the vision of who you want to be rooted in yourself as you are. Trying to act like a completely different person can be intimidating and demotivating. You should believe your goals are possible – even if others disagree.

For example, I don’t think it would be helpful to envision my ideal self as someone with perfect mental health (assuming there could ever be such a thing!), because mental illness will always be a big part of my life. Even if I manage to recover completely, the years I have spent mentally ill have had a huge impact – in positive ways, as well as negative. Instead, I want to be someone who manages her mental health as effectively as she can, with help and support from others as needed.

On the other hand, plenty of people use superheroes as role models and are inspired rather than deterred. It may be impossible to emulate their heroes in every way, but they have fun trying and focus on goals they can achieve, such as adopting a similar attitude or prioritising values they share. As I often find myself saying, you need to find what works for you. Trial and error takes time and energy, but it’s worth the effort.

The key is to choose a version of yourself who inspires you to take action. If you’re constantly thinking in the back of your mind “I could never be like that”, you’re undermining your goals. If who you want to be is similar to who you are right now, consider whether you are selling yourself short by not setting big enough goals. It’s fine to be content with your life – if this is you, congratulations! – but many people tell themselves they’re content because it’s easier than taking action.

 

So, Who Do You Want To Be?

What would you do, if you could do anything? What attitude would you have? How would you spend your days? Who would you spend time with? What would you contribute to the world?

It’s easy to ignore these kinds of questions, but have a go at answering them – you might surprise yourself. If the answers seem strange or too difficult to achieve, don’t dismiss them. Write them down and keep hold of them. Think about them. Read about people who have achieved similar goals. Review your answers after a month or two and check your immediate reaction: do you feel excited, amused or scared? Or apathetic? Having an instinctive emotional reaction – even if it’s negative – is a sign that you should consider your goals.

Asking who you want to be also highlights what you don’t care about – which may surprise you. You might realise that some of your hobbies aren’t as enjoyable or rewarding as you thought. You may discover your current career goals are based on what you thought you should do, not what you want to do. You may reconsider aspects of your life which never seemed to be an issue before.

Asking who you want to be can be a way of resetting your compass. You might be on the right path, or you could decide to make a detour. It helps you reassess your situation, figuring out which changes to prioritise and appreciating what already works for you. Try it and see what happens!

Spoon Theory

I recently read about a simple and effective way to explain the impact of chronic illness to people who have never experienced long-term health problems: spoon theory. Spoon theory was created by Christine Miserandino as she tried to make her friend understand the debilitating effects of lupus. Her friend struggled to appreciate how everyday activities left Miserandino exhausted. She tried to sympathise with her challenges, but couldn’t empathise – until Miserandino grabbed some spoons as they ate in a diner and developed her theory.

The Basics of Spoon Theory

The original article is well worth a read, but this is the concept: spoons are metaphors for units of energy/ability and people with various chronic conditions, illnesses and disabilities usually have a limited number of spoons each day. When your spoons are “spent”, you are unable to do more activities. Even activities which seem simple to healthy people, like getting dressed or cooking dinner, use up spoons.

This means every daily activity has a trade-off. If you start the day with 12 spoons and use 3 getting dressed, showering and eating breakfast, you have 9 left for the rest of the day. Cooking dinner will use another spoon, ditto getting ready for bed, so that leaves 7 spoons remaining for the middle of the day. If you meet a friend for lunch, that could use 3 spoons, maybe 4, If you want to do a couple of hours of work, that might take 4 spoons. So what do you do?

You want to do both, but if lunch uses 4 spoons, it leaves 3 spoons for work – which means you will have to cut corners. Maybe you will be lucky and lunch will take 3 spoons; but you also might be unlucky and have to negotiate bad traffic on the way to meet your friend, meaning lunch uses 5 spoons. 6 if the traffic is bad on the way back. What do you prioritise? Work or lunch with a friend?

People who haven’t experienced long-term illness will probably think it’s no big deal – surely you can somehow find another spoon so you can do your work? Or do your work tomorrow? But your spoons are always limited. You only have a certain number each day. The number may vary, depending on the intensity of your symptoms, but you can’t magic extra spoons out of thin air. You can decide to postpone activities until tomorrow, but you can’t guarantee how many spoons you will have tomorrow. You may have a good day and start out with 17 spoons. Or you may have a bad day and start with only 5 spoons. How do you plan around that uncertainty?

 

Spoon Theory and Mental Illness

Spoon theory is useful in explaining how mental health issues can limit your life. It’s reductive, but that’s the point – it’s a way of simplifying the complexities of long-term health problems so they are easier to understand. I think of my spoons in terms of both energy and ability because anxiety and depression affect these factors, which also merge in the form of mental/emotional energy.

To explain what I mean, it’s easiest to use the spoon analogy. When I cook and eat dinner alone, it uses 1 spoon. If I invite a friend to my house, it takes 2 spoons because of the added anxiety using more energy. If my friend takes me to a familiar pub for dinner, it will take 3 or 4 spoons – more if it’s busy. If we go to an unfamiliar location, it uses at least 6 spoons. If we are joined by someone I have only met a couple of times, it uses an extra spoon. If someone I have never met is invited, it takes 2 extra spoons. If we are in a small group, a couple of extra spoons are needed; a large group takes 4 or more extra spoons.

So if a friend invites me to dinner in an unfamiliar location and invites a big group of people, including a few who I don’t know very well, it would require at least 12 spoons.

Let’s say I have 12 spoons on an average day. Can I go out to this dinner? No. Because I don’t have enough spoons to get ready, let alone travel to the restaurant and carry out my normal everyday activities. On a good day, I probably have 20 spoons. I can go to the dinner and probably cope, but it will limit the rest of my daily activities.

The problem is, when a friend invites me to such an event, I don’t know how many spoons I will have on that particular day. I can accept the invitation and hope for a good day, but the odds are against me. If I accept the invitation and it turns out to be a bad day, with only 6 spoons, I will have to cancel.

 

Can You Ever Use Spoons You Don’t Have?

What if I get invited to a very special event, like a wedding? Can I still go, even if I don’t have enough spoons? Yes – at a huge cost. I have pressured myself to go through with plans when I haven’t had enough spoons and it always has dire consequences. The best case scenario is it leaves me with a very limited number of spoons for the next few weeks. However, it usually leads to my experiencing worse symptoms – panic attacks, self-harm, harmful thoughts – which affect my mental health for weeks, sometimes months, afterwards.

When you try to use spoons you don’t have, it’s like spending money you don’t have and can’t pay back straightaway: you get charged interest and the amount owed increases rapidly. It’s very stressful and seldom worth the price paid in the end.

For this reason, I avoid accepting invitations to events which would use a lot of spoons. I hate having to cancel plans, because it makes me feel like a crappy, unreliable friend. I know I’m ill and can’t completely control my symptoms, but it still feels awful. The exceptions are special events, like weddings and christenings, which I would try to attend at all costs.

People struggle to understand how “borrowing” spoons takes its toll. They see me push myself to undertake challenges, so they think I can always push myself without ill effects. They see me act (vaguely) normally at a party for a few hours, but they don’t see me burnt out and suffering for the following week.

Sometimes it’s worth the price to try to “borrow” spoons, but it risks a great deal. I have to weigh up how bad I’d feel about missing an event or not undertaking a challenge against the probable effects.

 

Can You “Buy” Extra Spoons?

While you can’t magic spoons out of thin air on any given day, you can prioritise activities which will (hopefully) give you more spoons in future. Exercise helps me gain extra spoons, for instance, but I can’t determine when I receive the extra spoons. Going for a walk today (2 spoons) may give me an extra 3 spoons tomorrow, or an extra 5 spoons next week. But it might not.

Mental health management involves a lot of trial and error, as does spoon management. Broadly speaking, activities which improve your health and give meaning to your life will give you extra spoons in the long-term. But prioritising these activities can be difficult, because they require spending spoons which might be better spent on activities which give you pleasure and have other beneficial effects in the short-term. Choosing to prioritise activities for long-term effects is like investing money: you know it’s the sensible option in most cases, but buying something you can have and use right now is more appealing!

 

Spoon Theory Going Forward

I have only started considering my mental health problems in terms of spoon theory, but I think it’s already helpful. It can help me explain the reality of my daily life to people who haven’t experienced long-term health problems. It also enables me to view my difficulties with more compassion. When I’m unable to do something – especially something which seems easy – it’s not my fault for being useless: it’s just because I don’t have enough spoons today.

#Support4September

I started volunteering for The Project at the end of last year. It’s an East Devon-based organisation which runs peer support groups for young people aged 13-24 with mental health issues. It also provides mental health training and workshops, for schools, businesses and the general public. Lots of people choose to support specific charities/organisations because they have directly benefitted from them in the past, but I wanted to help The Project for the opposite reason: I wish it had been around when I was a teenager.

Support The Project

Giving Hope

A couple of days ago, I had an Instagram exchange with a parent whose child is on the waiting list for one of The Project’s groups and she made a comment which resonates with me (and probably many other people): “The Project gives hope to families.”

When I was a teenager, nobody spoke about mental health. There were no local organisations available to help me and my mental health problems were dismissed as “only stress” by teachers. I wasn’t diagnosed with a mental illness until I was 18, because I didn’t tell my doctor about all my symptoms – I believed they were somehow my own fault and I was embarrassed to mention them. Instead, I was treated for recurrent throat infections and tension headaches caused by stress (and, with hindsight, depression and anxiety). Social media didn’t exist and mental health was rarely mentioned in the press or on television.

The fact that The Project exists is a big deal. It shows young people with mental health problems that someone cares – and they are not alone.

The Project gives hope to many people affected by mental health, including parents/carers, who have their own monthly peer support group. It helps young people and families across East Devon, South Somerset, West Dorset and beyond. It raises awareness of the issues surrounding mental health and equips people to cope better and support others with mental health issues.

In my role as volunteer Writing and Communications Officer (a title chosen for me, not by me!), I’m trying to help The Project get more publicity so that it can spread mental health awareness and help more young people. When I was 18, I thought my life was over. Mental illness had prevented me from going to university as planned, I struggled to find a job (and to keep the job when I found it, since my mental health caused a high rate of absence) and felt I had nothing positive in my life. The help available from the NHS was limited and I was patronised and dismissed. A psychiatrist even told me that the only treatment options available were for “serious conditions, like schizophrenia” – despite the fact I had attempted suicide and was still feeling suicidal.

I don’t want today’s young people to have the same experiences. The Project gives them somewhere to go, someone to turn to, support to access. The Project tells each and every young person – whether or not they attend the support groups – that they matter. Their mental health and wellbeing are important. They deserve support.

 

An Inclusive Approach

One of the things I love about The Project is that young people don’t need to be diagnosed with a mental health condition in order to attend the support groups. Some have mental illnesses; others are struggling with mental health issues like bullying, bereavement and exam stress. While I’m frustrated when medical diagnoses are regarded as labels, I think the priority of all people and organisations involved in mental health should be to reassure and support anyone who is struggling. The Project does this: there are no hoops to jump through or boxes to tick. If your mental health is suffering, the solution is more important than the reason.

The solution The Project offers is holistic and flexible. The peer support groups are informal, relaxed and friendly. Nobody is pressured to talk about their feelings – or to do anything they don’t want to do. Every session involves at least one activity aimed at giving young people life skills and tools they can use to manage their mental health, but participation is optional. The activities are varied: cooking, arts and crafts, stress management techniques, music and group discussions have all featured.

Mental health can affect all aspects of your life and all aspects of life can affect your mental health. The Project not only acknowledges this, but embraces it.

The Project Needs Support to Provide Support

You may have seen on social media that The Project has launched a crowdfunding campaign, #Support4September: http://www.crowdfunder.co.uk/theprojectyp It aims to raise £15,000+ during this September, which also marks The Project’s 4th birthday, so The Project can continue providing all of its services for another year.

The Project receives funding from Comic Relief, but needs to (at least) match the amount of money it’s given by Comic Relief in order to function. It cannot survive without the generosity of its supporters. Raising the money needed is difficult and The Project needs all the help it can get. Please donate to the #Support4September campaign and spread the word to everyone you know – by supporting The Project this September, you will help to support young people all year round.

The value of giving hope to young people with mental health issues and their families cannot be underestimated. During dark times, The Project is a beacon to those in need of support. To keep it shining, please visit http://www.crowdfunder.co.uk/theprojectyp Thank you.

For more information about The Project, please visit http://www.theprojectyp.org.uk

 

Not Just an Issue for Teenagers

There is more awareness about self-harm nowadays than when I was a teenager – and rightly so. However, self-harm in adults is less visible and under-represented in the media. The stereotypical depiction of self-harm involves a teenage girl and there are few depictions of self-harm which demonstrate the diversity of people affected. People who don’t fit the stereotype, such as males and adults, can feel ignored, excluded and isolated.

 

The Problem with Self-Harm Statistics

Self-harming behaviours are often secretive, meaning they can continue unnoticed – even by close friends and family – for years. Statistics are reliant on people attending hospital emergency departments as a result of self-harm, or presenting themselves to their GP or another medical professional. It is known that the issue is under-reported, but nobody is sure to what extent.

I tried to research self-harm statistics for this blog post and discovered that they focus overwhelmingly on children and teenagers. The most comprehensive and accessible information I could find was a NICE guideline document: The short-term physical and psychological management and secondary prevention of self-harm in primary and secondary care. It raises a lot of concerns in how self-harm is addressed, including incidents of people being “told off” by doctors and nurses.

This suggests a key reason for adults, in particular, under-reporting self-harm: fear of being judged. If medical professionals have such patronising and ignorant attitudes, how can we expect the general public to be empathetic?

 

Issues for Adults who Self-Harm

Self-harm is one of the most stigmatised mental health issues because people who have never experienced it struggle to understand. It seems illogical: it is a coping mechanism which causes physical injury. Because self-harm is misunderstood, it’s difficult for sufferers to confide in others. Many people react with shock and unhelpful comments like “don’t do it” and “what do you want to do that for?” This can leave the person experiencing self-harm feeling worse.

To change this situation, the first step is education. There are many grassroots organisations doing great work to raise awareness of self-harm and other mental health problems, including The Project, where I volunteer. I recommend attending a mental health workshop or training course so that you can discuss the issues involved as you learn. However, a good starting point to learn the basic facts about self-harm, and how to access help and support, is the Mind website.

Unfortunately, the portrayal of self-harm as something which only affects teenagers and young people has led to sufferers thinking they should have “grown out of it.” This makes it harder to discuss self-harm, even with people you trust, and prevents people from accessing treatment and support services.

LifeSIGNS, a charity whose aim is to create understanding about self-injury, has an interesting article on the issues which affect adults who self-harm. The comments underneath are particularly effective at helping adults who self-harm to realise they are not alone. The article refers to shame and secrecy (but is a little dismissive, in my opinion), which is a massive issue – especially as self-harm in adults is rarely addressed by the media and support services are often aimed at teenagers and young people.

 

My Experience of Self-Harm as an Adult

I last self-harmed at the beginning of May, about three and a half months ago. I don’t think I have mentioned it on this blog, because although I am pretty open about my mental health, I still find it difficult to talk about self-harm. In particular, I find it difficult to discuss recent self-harm.

I’m a lot more open than I used to be. For years, I worse long sleeves in heat waves and never exposed my scars to anyone outside of my immediate family. I have come to view my scars not as sources of shame, but as symbols of strength. I have experienced mental health problems and self-harmed for two decades, yet I’m still here. I have managed to do things I thought were out of my reach, despite struggling all the way.

If anyone asks me about my scars nowadays (which is very rare, I think because people recognise them as self-harm scars whereas there was less awareness when I was a teenager), I tell the truth. I cringe when I remember the excuses I used to make: when a friend asked about scratches on my arms when we were changing for PE, I said I fell into some brambles when picking blackberries! I don’t think she believed me, since all of the scratches went in the same direction… But now, I don’t feel the need to hide my history of self-harm.

Yet my attitude towards recent self-harm is different. I feel more ashamed of recent scars and wear long sleeves when the wounds are still fresh. I hate talking about specific incidents. I avoid mentioning it at all.

I think this attitude rests on two facts about my current situation:

1. I self-harm far less frequently than I did from the age of 13/14 to 22. There have been periods of several months and more (I think over a year at one point) when I didn’t self-harm. While this is progress and symptomatic of my coping better, I feel worse when I do self-harm because it feels like failure.

2. I’m older. I can logically acknowledge that self-harm affects people of all ages and would never judge other adults who self-harm, but I feel I should have stopped by now. It should be something I used to do as a teenager but have left behind as I matured. Like drinking Bacardi Breezers.

I want to be more open about self-harm (recent and historic), but it’s difficult to discuss in our current society. People seem to understand anxiety and depression far better than self-harm. Perhaps this is because the emotions and behaviours associated with anxiety and depression are better known and commonly experienced. For example, while most people do not experience anxiety to a debilitating degree, they do know what it feels like to be anxious and can extrapolate from this experience to empathise with people who experience anxiety disorders. Fewer people have experienced the compulsion to harm themselves in order to ease emotional distress.

The trouble is, there is a circularity inherent in this issue: in order to create a more understanding and compassionate society, more people need to speak out about self-harm and other mental health issues. However, until society is more understanding and compassionate, this involves risks and is therefore a daunting prospect.

 

The Curse of Speaking Out about Self-Harm

One of the most prevalent myths about self-harm is that people do it for attention. Most people who have experienced self-harm – or know someone who has experienced it – can recognise that it’s ridiculous. The majority of sufferers go to great lengths to hide self-harm and some put their lives at risk, refusing to seek treatment because they are ashamed and afraid of being judged. However, some people believe the myth – which means as soon as people begin to speak out about self-harm, they are accused of seeking attention.

Leaving aside the question of whether one person’s “attention seeking” is another’s cry for help, self-harm is an issue which needs attention. On both an individual and an abstract level. People who self-harm are more likely to attempt and complete suicide than the general population. Self-harm also involves a lot of emotional distress and silencing people who self-harm exacerbates their pain.

I wrote this post not because I want sympathy or attention for myself, but because I don’t want other adults who self-harm to feel alienated. Some teenagers who self-harm may stop when they become adults – but some of us can’t. Others begin self-harming as adults. Nobody deserves to feel ostracised and unsupported because they self-harm. Nobody deserves to be “told off” by medical staff because they suffer from a mental health issue.

So yes, please give attention to everyone who self-harms – including adults. Attention in the form of accessible treatments and support, compassion, empathy, accurate media depictions and increased awareness of self-harm.

Changing Tides

It’s the end of summer and everything feels distinctly autumnal. I’m particularly sensitive to this feeling because my mental health usually dips over the winter months, plus there are a couple of major beginnings and endings on the horizon.

Seascape

An Ending

I’m approaching the “end” of my current novel. I have been rewriting it for several months and hope to have it in decent shape within a month. Of course, the “end” will hopefully be the beginning, if I’m fortunate enough to attract an agent. If I’m even luckier and get a publishing deal, there will be a lot of extra work ahead, including more rewriting and editing.

Yet completing the novel means letting go. It means exposing it to readers — potential agents, publishers, competition judges, editors, perhaps people who decide to buy the book (if it gets published). I will have to send it out into the world.

My main concern isn’t receiving criticism of my writing: I’m used to criticism and rejections, which are inevitable for every writer. In fact, I prefer getting constructive criticism rather than a vague “not for us” rejection. I like to know how my writing comes across; how I can improve. I want to get better at writing and critiques are essential if I am to improve.

I suppose I’m worried that the novel might have no potential. That I’m wasting my time trying to write novels. There might be a fear of moving on to the next and trying to apply the lessons I have learnt. What if I can’t improve? What if I never write a publishable novel?

Perhaps the real problem is the uncertainty. If a time traveller from 2020 (or beyond) told me my current novel was terrible and never published, I would just shrug and move on. I would consider it a time-consuming but worthwhile exercise, helping me to learn my craft — like my last attempt at writing a novel. If the time traveller told me it got published and was reasonably well received, I would be ecstatic. I don’t like not knowing.

Ending a major phase of any project makes me feel reflective. I question my goals and achievements. I fence with self-doubt. I worry that I won’t complete the next phase, that things will go wrong or that I’m just not good enough. Mental illness takes these normal feelings and blends them with my symptoms, creating a lot of turmoil. It can be intense, but I can ride it out.

 

 

A Beginning.

I will start my Psychology BSc with the Open University in October. I’m excited, but also nervous — which I suppose is normal. It’s a big commitment, since studying will form a large proportion of my life for the next 5 years, but it’s also incredibly important to me.

I wouldn’t be so nervous if I didn’t care. I’m worried that my mental health will affect my studies because I want to learn as much as I can. I don’t want to put my studies on hold or scrape through by the skin of my teeth. I want to be able to engage with the material and complete assignments to the best of my ability.

I’m especially wary because of past experience. When I did my Film Studies BA, a decline in my mental health in the final year (not helped by also being diagnosed with a serious eye condition which could lead to blindness) meant my grades dropped by 10%. I went from being on course for a 1:1 from the first semester, earning a Dean’s Commendation in my second year, to getting a good-but-disappointing 2:1. I know I should be proud to have done so well when facing tough challenges, but it’s frustrating when my mental health prevents me from doing my best.

I appreciate the irony of worrying about my mental health affecting my degree, when my experience of mental illness has motivated my decision to study Psychology. I’m fed up with repeating the same patterns, battling and working like mad only to fall short in the end. Yes, I do the best I can in my particular circumstances, but that’s not very reassuring when I know I’m capable of more.

I hope studying Psychology will be a fresh start. My mental health is better (in general) than it has been for a long time and I have good coping strategies. Grades and results aren’t as important to me nowadays — instead of setting out to prove something to myself (and/or others who doubt me), I want to use what I learn to help myself and others.

 

Adjusting

I want to change my life, which involves a large degree of uncertainty and a lot of learning to cope with the effects. The changing seasons emphasise how life follows cycles; how natural it is to change direction and evolve. However, accepting — even embracing — the inevitability of change doesn’t make it easy.

When you have mental health issues, it feels like your whole life is filtered through them — determined by them, at the worst points. It’s annoying and frustrating. It can make you feel sad, angry, hopeless. I often wish I had never experienced mental illness.

But… without experiencing mental health problems, I doubt I would have tried to write a novel or studied the subjects I’m truly passionate about at university. I often feel like I’m not living a full life, because mental illness prevents me from doing so many “normal” things, yet many perfectly healthy people lead half-lives and don’t follow their dreams. They limit themselves and don’t set goals or take risks. If I didn’t have mental health issues, I think I may have been one of those people.

 

 

Refighting Battles

One of the most frustrating and exhausting aspects of having a long term mental illness is you have to fight the same battles again and again. It’s not like a video game, where you pass a level and never have to retake it. Just because you manage to do something one day doesn’t mean you can cope with it the next.


Winding lane

It’s like Groundhog Day without a clear learning curve.

Symptoms of mental illness can fluctuate a lot. I know I mention this a lot, but it’s one of the core truths that people who haven’t experienced mental health problems find difficult to grasp. Even on a “good” day, you have to battle symptoms. They may not be as intense as they are on “bad” days, but they are still present.

Today, for instance, I went for a walk on my own (well, with my dog) for the first time in a while. I haven’t been walking him in the daytime during the summer because it has been either far too hot or raining. People who aren’t familiar with mental health issues might think I found this easy: it has only been a couple of months since I last went for a walk alone, I walk the route with my parents all the time and my mental health has been gradually improving since spring. I should have no problems, right?

Actually, I felt anxious. It took me several hours to work up to doing it and my mind generated a plethora of excuses and unnecessary worries. I felt better when I started walking, but I was still nervous. I kept thinking something bad might happen, that I would get hit by a car or fall over. I worried about meeting other people and feeling incredibly awkward if they tried to make conversation. I ruminated on whether it was too hot for the dog to be out, because the sun started shining despite the low-ish temperature. I was bombarded by symptoms of anxiety.

I shall reiterate: today is a good day. I enjoyed my walk and managed to break out of my negative thought patterns several times. I felt better for tackling the challenge. The point is, I may always have to cope with my symptoms. There may be a day in the future when I can leave the house without planning in advance and feeling anxious, but I’m not counting on it. I have to refight the battle every time I go out alone.

 

And there are many battles to refight.

Many of the things I do on a daily basis take effort. By writing this blog post, I am battling against anxiety and depression: my mind is filled with thoughts like “Why bother writing? It’ll be terrible no matter how hard you try” and “nobody is going to read it anyway”. I battle through because a). I enjoy blogging and writing about mental health, and b). I know there is a chance that my experiences may help other people to understand mental health problems or, if they are experiencing mental health issues themselves, to feel less alone.

I have to accept that these battles need to be refought over and over. It’s annoying and frustrating. It makes me sad and angry. It’s a real bitch. But the alternative is doing nothing.

Refighting battles is hard, but necessary. Many of the battles seem ridiculous, like motivating myself to eat proper meals instead of crisps, but I have to keep fighting. I know each battle takes me closer to achieving my goals and leading a better life, but it doesn’t feel like that when you are out on the battlefield.

 

Yet every battle you win makes you a little stronger.

I certainly don’t feel stronger every time I get through a mundane challenge, but getting through each battle gives me a little confidence. There are times when I get so distressed that even if I win the battle it doesn’t seem worth it, but these comprise a small percentage of my battles. The learning curve might not be clear, but it’s there — hidden under all the fluctuating symptoms. Every battle won imparts a lesson.

Today’s lesson is this: sometimes it feels pointless to refight the same battles because there is no clear indication of progress, but like a character in a video game, you are gaining experience points. I just hope I level up soon!