Accepting Struggles

One of the hardest aspects of long term mental health problems is spending a significant proportion of your life struggling with stuff which comes easily when you are at your best. Some things I may never find easy: crowds, dealing with inconsiderate people and talking to strangers will probably remain nerve-shattering experiences for the rest of my life. I’m not talking about pushing at the boundaries of my anxiety––I’m talking about mundane tasks which aren’t a challenge on days when my mental health is adequate, but become next to impossible when my symptoms increase.

Studying is the most obvious example which comes to mind. Usually, I can tackle reading and note-taking with no issues. Even on days when leaving the house seems insurmountable, I can do a little studying and feel as if I have done something worthwhile. However, common symptoms of depression (which I experience) include loss of concentration, lethargy and lack of motivation. There are some days when I take out my textbook and struggle to take in any information.

Last week, I spent four hours trying to write notes on a chapter of my psychology textbook. I had already covered the material, highlighting key points and making margin notes, yet I struggled to get anything down. After producing a few measly pages of notes (and my style of note-taking is loosely based on mind mapping, so there aren’t many words to each page), I gave up.

Years of negative thinking patterns have programmed my response to giving up: I beat myself up for being useless, lazy, worthless, stupid, incapable of basic functioning… you name it! What was the effect of this negative self-talk? Did I become more productive and sail through my to-do list? Er, no. I spent a few days feeling even worse than usual––which, considering I have chronic depression, is pretty bad.

My mood has shifted this week and there has been a positive effect on my productivity. With relatively little effort (compared to last week), I have completed most of the tasks on my high-priority to-do list. To put this in perspective, my average for the past couple of months has been completing approximately one third of my highest priorities each week and accomplishing little else. I’m delighted to be having a good week and try to ignore the voice in my head which tells me I don’t deserve to feel productive or that I need to get ahead now because, before long, something is bound to go wrong and mess things up. However, it’s hard to accept that there can be such a difference in the space of a single week.

I can’t control my symptoms on any given day. I repeat this often, because it’s a concept which a lot of people find difficult to understand. “You were fine the other week” they say, when I’m having a panic attack in the supermarket, or “You can write thousands of words some days, so why not every day?” But despite understanding the concept, I myself struggle to accept the reality.

Planning to have a “good day” when a deadline is looming or I have something special organised doesn’t work. I tell myself it’s important to finish this task ASAP because it will make me less stressed in the long run, but piling on the pressure just makes things worse. If I could plan all my bad days, it would be very convenient––I could choose to have them all during the summer, when I’m not studying, or dot them throughout the year and be prepared each week. Unfortunately, mental illness––and life––doesn’t work that way.

I’m learning (and relearning) to accept my bad days, because trying to fight them makes everything worse. Instead, the best strategy is to let go of my plans for the day and give myself what I need, whether that’s a run to boost my mood, resting to improve my wellbeing or reading to seek inspiration. Last week, once I had wasted a few days feeling terrible, I stepped up the self-care by feeding myself more nutritious meals and countering the negative thoughts using CBT techniques. I still didn’t feel amazing, but it was better than nothing.

I also realised my initial reaction to my improved mood and productivity this week wasn’t helpful: feeling angry and frustrated about feeling so awful last week was pointless. Instead, I could frame this week as a reminder that good days will always come again. They might take their sweet time in coming––sometimes months––and be too few when they do arrive, but they will come.

I hope these intense, prolonged struggles won’t be part of my life forever, but if they never go away then I need to accept them. Fighting them doesn’t work––it’s like trying to wrestle water. Moreover, if I do spend the rest of my life shackled by my mental health problems, I need to dredge my struggles and find something positive amongst the dross. I guess that’s what I attempt to do with this blog––thanks for reading!

The Work of Wellness

I recently read a book called How to Come Alive Again by Beth McColl, which has led to me thinking a lot about a subject which doesn’t get discussed often enough: the work involved in managing chronic mental illness. One of the book’s strengths is its acknowledgement that readers will have varying levels of functionality and these may fluctuate a lot, even over short periods of time, yet everyone has to work hard to try and maintain or improve their mental health. Some days, this means challenging ourselves and flying through a list of tasks. Other days, it means forcing ourselves to do basic tasks like drinking some water or getting out of bed. It’s all work.

A lot of people take this work for granted. If you haven’t spent years struggling with your mental health, it may be difficult to believe that simple activities are hard work for some of us. You may not understand how taking a shower can sometimes seem like a gargantuan challenge. You might wonder why people who have mental illnesses can’t just “pull themselves together” and carry on like a “normal” person (a viewpoint I have, unfortunately, encountered many times). But doing these things can be hard work. Mental health problems can drain us of energy, motivation, self-belief and a thousand other things which would enable us to cope better. Things which many people don’t need to consider when tackling mundane tasks.

Working on yourself

Managing one’s mental health also involves extra work, such as addressing complex issues and engaging in activities which have a positive neurological and/or psychological effect. Last week, some counsellors of my acquaintance were talking about their work and mentioned that many clients expect counsellors to fix their lives for them. Instead of embarking on counselling to work on their issues, they seek a quick fix. As one of the counsellors said, “I can’t fix their lives for them. I’m not magic.”

I was fascinated by this conversation, because I have received counselling at different points in my life and had never approached it as a quick fix. In fact, the NHS counselling I have received in the past is often criticised for being too brief to be effective in the long term: six sessions, the first of which is an introduction rather than a proper session. I went through two or three rounds of this with different counsellors and it was a sticking-plaster solution which helped me feel slightly better for a few weeks, only to deteriorate when I encountered more challenges. I had been given neither the support nor the skills to negotiate life as someone who has mental health problems. This started to change when I was given a year of drama therapy, which enabled me to work through a lot of personal issues.

I have also received longer-term counselling (around nine or ten months) from a local charity in more recent years and I was grateful to be given the opportunity to learn coping skills, including how to be more supportive of myself. The counselling itself was hard work, but putting what I have learnt into practice is an ongoing slog. I need to learn to be more accountable to myself now I don’t have anyone to check I’ve done my “homework” each week. Learning not to judge and criticise myself is also a constant challenge—I worry I’m not pushing myself enough and accuse myself of being lazy, even when I know I’m doing my best.

Tailoring your work to fit you

The work I do to manage my mental health is very personal—not so much private, but adapted to my own needs and preferences—and probably looks different to what many other people do. It has been a long process of trial and error which is still ongoing. I have also changed my approach at different points in my life, depending on what is most effective at any specific time.

The biggest difference in my approach over the past eight years is the prominence of exercise in managing my mental health. I started walking on a treadmill, because I was too scared to walk outside alone. My intention was to get a little fitter, because I had been very inactive for a couple of years and my lack of fitness was beginning to scare me. I had no idea it would lead to the decision to replace medication with exercise and if I had started getting fit with that intention, I probably would have been disappointed because it took around four years to reach the point where I could consider reducing my antidepressants.

Medication is another thing people consider a “quick fix” yet, like counsellors, antidepressants are not magic. They rarely work instantly—it can take several weeks to see an improvement, which is normal—and it may take some experimentation to find a variety and dosage which works for you. However, even when I found antidepressants which helped me, I didn’t experience the complete turnaround in mood expected by some people: they simply took the edge off my depression, which meant I could do more basic self-care tasks and work on improving my mental health.

All of these things seem so ordered when I write about them: counselling, medication, exercise and other coping strategies all organised into discrete boxes, all tracking a linear progression from “worse” to “better”. The reality is very different. My symptoms fluctuate a lot and the treatments I have used have been both effective and ineffective at different times.

I emphasise this point because reading about other people’s mental health can create false impressions, especially since many of us can’t write about our experiences during the worst times so write with the benefit of hindsight. These paltry lines of writing represent over fifteen years of struggle following my diagnosis of anxiety and depression; especially during the eight years before I was diagnosed with BPD (borderline personality disorder) and could finally make sense of the symptoms which didn’t fit with anxiety and depression. I don’t think I could ever fully convey my experience and while I can make sense of chunks in retrospect, other aspects I will never understand.

It might be tempting to take some things out of context and to make assumptions about the decisions I have made about managing my mental health. For example, many people assume I disagree with anyone using medication because I have stopped using it myself, whereas I actually credit antidepressants with keeping me alive. Without medication, I would not have been able to access therapy and counselling. I would not have started exercising. I would not have been able to do a large proportion of the work I need to do on a regular basis in order to maintain and (hopefully) improve my mental health.

So, what does this work involve?

My current mental health management plan prioritises exercise: strength-based gym classes and dog walking constitute its core, but I add running and yoga when I feel able. Exercise has a strong impact on my hormones and neurochemicals, which is why I have found it effective as a direct replacement for antidepressants (though not without its drawbacks). I also find it very powerful psychologically, as feeling strong and fit helps me feel more prepared for life’s challenges and I gain a sense of achievement from every workout.  Focusing on strength and fitness means I approach exercise with a healthy attitude—it’s not merely a way to control my weight through burning calories and I know that over-exercising would risk injury without providing extra benefits for my mental health. My exercise plan also gives my life structure, but without forcing me into a strict routine which I would be unable to follow when my symptoms fluctuate.

Regular exercising makes it easier to practice self-care, as it means I have to shower often. Basic hygiene may seem simple and non-negotiable if you have never had depression, but showering less often is one of the key signs I’m relapsing. Ditto with changing bedsheets and wearing clean clothes. This might manifest in subtle ways—leaving it a few days between showers but making the effort when you need to go out or be around people—and may never progress beyond this point, but it can get worse. Sometimes it can feel pointless to make the effort to shower, because your illness prevents you from leaving the house. I have been in this position and yes, I might have felt better if I had showered more often, but I was in a lot of emotional pain and had no energy. Nowadays, self-care tasks piggyback on my exercise routine: I shower more, so I change my sheets more and wear clean clothes more often. It also helps me sleep better, which further improves my mental health.

A lot of the work I do to get/stay well comes under the umbrella of “stress/anxiety management”, which is my way of describing a variety of techniques I use to varying degrees. Goal-setting and planning are key strategies for me, because they help me to focus and stay vaguely motivated. I use breathing exercises when I feel particularly anxious, including 7-11 breathing (inhale as you count to 7, exhale for 11) and box breathing (in for a count of 4, hold for 4, exhale for 4, pause for 4 and repeat as needed). Venting my current stresses on paper also helps me feel better, especially if I can identify action points which could reduce or solve the problem, and I sometimes use a few CBT (cognitive behavioural therapy) techniques I have learnt over the years.

None of this work is easy, especially when my symptoms worsen, but there are some areas with which I struggle a lot. Nutrition is difficult because I’m prone to emotional eating and often grab food which is convenient rather than healthy. My diet is generally healthier than at any other point in my life, but I sometimes slip into unhealthy habits—a situation which is not helped by my gallstones symptoms. Perhaps I will be able to prioritise nutrition in future and do stuff like meal prep and batch cooking every week, rather than intermittently, but it’s not something I’m rocking at present and that’s okay—I try to do what I can and I may fall short of my goals, but I’m doing my best.

Considering the macros along with the micros

Most of the work I have detailed is done at the “micro” level: small tasks performed on a daily or weekly basis. This type of work is what fills most of my days. When things are going well, it helps me feel in control and gives me the ability to enjoy my life. Doing the “micro” work also puts me in a better position to handle the “macro” work.

The “macro” work is the big picture: what I want out of life, my long-term goals and mental health management from a higher perspective. Again, this work is very personal. My priorities are my writing career, inspiring other people with mental health issues to chase their dreams, owning my own home (which seems impossible) and having fun along the way. Your priorities may look very different. My current priorities are different to the ones I have had in the past and will have in the future—they are subject to change, but they emerged from my values and I use them to guide me.

Keeping sight of the “macro” work can be extremely difficult when you have mental health problems. When you are struggling to get through each day, you can’t think about long-term goals. Yet, there’s a paradox: keeping my long-term goals in sight reminds me why it’s worth struggling through the days, why it’s important to keep working on self-care and the other “micro” work which helps me feel better. It gives my everyday life a sense of purpose.

I have learnt to revisit my “macro” work on a regular basis (at least once a month) for this reason. It makes my life meaningful and it makes the small steps I take each day meaningful. Do I get frustrated when I seem no closer to achieving my long-term goals and pushing through my daily wellness work feels like a massive challenge? Of course! I’m human. I wish I didn’t have to deal with mental illness every single day of my life, but it’s the material I’ve been given and I have to mould it as best I can. Considering the “macro” work also reminds me to check for progress, no matter how small, which I might overlook. For example, submitting a short story or making an extra debt repayment. My progress may be slow and excruciating, but it’s still progress.

You control your own work

Nobody can tell you what to prioritise in order to manage your mental health—trial and error is the only way to find out what works for you. It’s annoying when we would all prefer a quick fix, but it’s the nature of mental illness. Just in case you need me to point out the obvious, this also means you can’t dictate what other people should be doing to improve their mental health. You don’t know their struggles. It might be easy to judge from afar and when we find something which works for us it’s tempting to evangelise, but we don’t know what will help other people. You don’t get to decide what treatments and coping strategies someone else tries—they do.

You get to decide what you try and how to determine whether it’s effective. For instance, you may find something which helps you, but is too difficult to implement or access on a regular basis. You need to consider the costs and benefits of different types of work. Some of my current strategies would not have worked for me at other points in my life. For example, I tried to exercise at many different times, but struggled to create a routine—I could only establish some structure when I was well enough to attend gym classes. I still get anxious when I go to gym classes, but the benefits are worth this cost and if that changes, I would have to reconsider my situation. Likewise, the CBT techniques I find helpful nowadays were introduced to me in my NHS counselling sessions and didn’t help at the time. It’s important to keep trying new—and old—things to find out what works for you and your lifestyle right now.

I am not magic. I have to put a lot of work into managing my mental health and trying to get well. Sometimes I make progress, but other times I seem to regress and wonder why I bother making the effort. However, I’m learning that when I keep trying to do the work of wellness, moments of magic come into my life. Half an hour of feeling enthusiastic and joyous, rather than anxious, when I’m chatting with a friend. A moment of gratitude when a butterfly crosses my path. Three solid hours of working on a project which could turn into something. These fleeting moments might seem insignificant, but there have been times when I experienced nothing good or positive for weeks on end. Nowadays, if I remember to look, most days contain a little magic.

Contingency Planning

I submitted my final assignments for the Open University modules I’m studying this year well before the deadlines and I’m going to explain why I don’t consider this a Good Thing. The last two assignments are End of Module Assessments (EMAs) which are supposed to be analogous to exams, so there are no deadline extensions. Since my mental health is unpredictable and my current physical health even more so, I had to make contingency plans in case my mental health plummeted or I had bad gallstone attacks in the weeks before the deadline. It’s a coping strategy I wish I didn’t have to implement, but I have learnt that this degree of flexibility is necessary for me.

Notebook

Preparing to be thrown off course by my mental health is an integral part of goal setting. In this case, I had to get ahead when I felt well and finish the previous two assignments, with deadlines in April, as soon as possible so I could focus on the EMAs. It was pretty intense, but ensured I had several weeks to work on the EMAs. Do I really need several weeks’ leeway? Absolutely. My health can easily become a huge issue without warning. My mental health can go into freefall and the scariest aspect is, sometimes several weeks wouldn’t have been enough leeway.

I was lucky this time around. My mental health has taken a downturn recently, but I could work around it.

What does “working around” my mental health mean?

Put simply, it means doing whatever I can, whenever I can. It’s how I live my life. Some days I can function like any other person and be very productive; some days I am unable to do anything other than slump on the couch, my mind whirring but producing nothing. Most days are a mixture.

Living with mental health problems is difficult, so I have had to devise coping strategies which work for me and help me to be more productive. These include:

  1. Identifying my priorities at any given time. When mental illness limits the number of hours I have available to work (or do anything else), I need to know the best way to spend those hours.
  2. Being super-organised. Depression and anxiety affect my memory, so I write everything down. I need to know my goals and break them down into tasks. I put these tasks on my to-do list, which is divided into high, medium and low priority tasks for each week. I also have a future to-do list, for tasks I can’t or don’t want to complete at the moment.
  3. Being flexible. Because my mental health is unpredictable, scheduling tasks on specific days doesn’t work very well for me, so I try to avoid it unless it’s absolutely necessary. I sometimes allocate tasks to certain days, but I don’t beat myself up if I can’t stick to this plan.

I wish I didn’t have to use these coping strategies. I would love to be able to plan to work on my EMAs for a few weeks before the deadline, like most other people, but no possibility of an extension means I need to prepare for ill health.

This also applies to all other aspects of my life.

I’m sure some ignorant people assume I can do non-work tasks without making contingency plans and these are probably the same people who think mental illness is just an excuse to avoid work, but my mental health affects all aspects of my life. I have had to cancel countless enjoyable activities. For every night out I’ve had with friends, there were five I had to cancel at the last minute and hundreds I never planned because I knew I couldn’t handle it. When my mental health dips, I struggle to do anything, including leisure activities I can do at home, alone. During these periods, I can’t even read or concentrate on watching a film.

I used to feel incredibly ashamed of being forced to live this way. Many friends slipped away because they didn’t understand why I couldn’t go out like a “normal” person and often struggled to leave the house at all. They got bored with hanging out at each other’s homes when anxiety prevented me from going to the cinema or a café. However, as I get older, I’m learning to accept that this is the way it has to be. For now, at least. If so-called friends can’t accept my mental health problems, they can thank their lucky stars they’re not in the same situation and fuck off.

I wouldn’t have chosen this life of constant contingency planning, but I’m learning to make the best of it.

I’m getting better at controlling the things I can and letting go of whatever I can’t control. Better, but nowhere near perfect! I still get frustrated with myself, the universe and life in general, but I keep working towards my goals. My aim is simple: improvement. My life probably won’t change completely anytime soon, but most days are bearable and I’m proud of the goals I’ve achieved.

I can’t celebrate submitting my EMAs early, because I wish I didn’t have to rely so heavily on contingency plans, but I’m proud that I submitted them. Two years of my part-time Psychology BSc down, three (hopefully) to go!

Choosing Is Hard

If you read about mental health, wellbeing and/or self-improvement, you have probably read a lot about ‘choice’. A lot of the information is true and basic common sense: our choices do determine our lives, no matter what has happened to us. We can choose how to react to life events, including mental illness. However, what the rhetoric often misses out is that making these choices is bloody hard.

For a start, you might not realise you have a choice. Mental illness makes you believe you are powerless. Depression, anxiety and other conditions change your thought patterns. You think you are useless, worthless, hopeless. You think your life is pointless. These thoughts often spiral out of control so all you can see is the negative fog of your illness.

I have certainly felt like this – I still do, during bad days or weeks. In the past, this mindset has lasted for months on end – perhaps years – and I truly believed there was no way out. I didn’t know I had a choice, even when I made choices like going to the doctor and taking my medication. I did those things because my parents said I should, not because I thought I could be helped.

Any discussion of ‘choice’ should acknowledge the vital roles of opportunity and support.

If you have no support, making choices is more difficult. You have no reassurance that you are doing the right thing – assuming it’s possible to identity ‘the right thing’. There is always an element of risk in making different choices, because results are never guaranteed. Without support, this risk often feels too high and you are too afraid to change, because you don’t know whether anyone will have your back if you fail.

Professional support, from doctors, counsellors and/or therapists, is very valuable. Sometimes, it feels like they are the only ones who have a degree or understanding and want you to get better, as opposed to wishing you would keep the status quo even if it’s painful for you. However, professional support works best when it is complemented by support in your personal life, from family and friends. If you have little support from those who are closest to you, it is more challenging to make decisions which might have long term benefits but cause discomfort (or even pain) in the short term.

Having support in other aspects of your life makes a difference, too. At work, for instance, you have more options when you have a supportive employers, managers and colleagues. They have the scope to offer opportunities which unsupportive people will not, such as training and mentorship. It also helps if you know you can have time off when you need it, without worrying that you will face a formal warning when you return to work (which happened to me, when I was employed by a certain supermarket).

Other sources of support could be accessed through education, hobbies and groups. Unfortunately, mental illness tends to narrow your life and makes you withdraw from these potential sources of support, which means it can take a great deal of effort to continue pursuing an interest or attending a class. During my worst episodes, I feel unable to do the things which help me feel supported and purposeful.

All potential choices may seem undesirable.

How do you make choices when all of the options have massive drawbacks? Sure, at least one choice probably has the potential to lead you in the direction of long term success, fulfilment and/or happiness, but it may also have huge risks involved. For example, I used to be too scared to walk my dog on my own. I had walked the route thousands of times over the years, often on my own, yet the idea of walking out of the house alone terrified me. Why? Walking on my own had numerous potential benefits, including enjoying the countryside and improving my mood, but it also carried the risk that I would have (another) panic attack in public.

Every time I have had a panic attack in public, I have experienced humiliation on top of the dread and discomfort which every other panic attack brings. It had an impact on my mood and other symptoms for weeks afterwards (sometimes months) and led to more restrictions in my life, such as not going out at all when I had previously been fine with my friends or family members. It also affected my confidence, meaning I would avoid doing anything which might result in failure.

So my options were: go for a walk alone and risk a panic attack which would have a devastating impact on my mental health, or stay at home and risk nothing other than living the rest of my life feeling bad but not as bad as I might feel after a panic attack. Neither option was desirable. Especially during times when I was experiencing a lot of panic attacks, so the chance of having one in public was greatly increased.

I was only able to make the choice to go for a walk on my own after receiving a lot of treatment and support, including medication, therapy and counselling. I also had people in my life who understood enough to help me, instead of forcing me to make certain choices before I was ready.

It’s hard to keep making choices without seeing results.

Many of the choices we make do not have instant effects. Some do not reveal their full effects for months or years. This makes it difficult to choose certain courses of action and to keep going after you have made the initial decision.

Often, I only realise the effects of my choices in hindsight. Something reminds me of how life used to be and when I compare it to my present, I can see which choices have led to the difference. Several years ago, I was extremely unfit. I was at university full time and prioritised my studies over everything, because I believed I had something to prove after assuming I would never have the opportunity to pursue a degree. I walked less, especially after I passed my driving test just before starting the second year, and did no other exercise. Walking to and from the car park was a challenge because I had become so unfit.

Nowadays, I am pretty fit: I walk every day, go to three gym classes a week and try to run at least twice a week. This did not happen overnight. The first choice I made was to buy a treadmill, so I could walk inside (as previously mentioned, I could not walk outside alone at this time). I started walking very slowly and for short periods of time. It felt pathetic, being challenged by an activity I used to find easy, but I gradually built up my speed and distance. Looking back, those first walks on the treadmill represented some of the best choices I have made. But at the time, they were painful and frustrating because my progress seemed slow. Choosing to keep walking was difficult and if I did not have the treadmill, I doubt I would have persevered.

I could only make the choice(s) to continue walking because I was in the right headspace and had the right opportunity (access to credit so I could buy the treadmill). When you don’t have the right mindset, support and opportunities, it is extremely difficult to keep going.

You may not see the full impact of your choices for a long time.

Related to the previous point is the fact that the consequences of your choices, good and bad, might not be apparent for years. Looking back, I realise that I made a lot of mistakes. Every time I stayed at home because I felt too anxious to go out, my world got a little smaller and darker. Each time I struggled on my own instead of asking for help, I became more anxious and depressed. Would I have made different decisions if I knew the full effects? Maybe, but I did the best I could in the circumstances.

It is important not to blame yourself or other people for past actions taken in good faith. While the choices made might have led to an undesirable situation, most of us believe we are doing the right thing when we take those decisions. Every time I stayed at home, I thought I was sparing my friends and family the embarrassment of my anxiety symptoms. Each time I refused to ask for help, I believed I was sparing people from my causing them trouble or inconvenience. We are all experts with hindsight, but we should never forget how it feels when you make poor decisions because you think they are for the best.

Your choices may have unexpected consequences.

Your choices may have unforeseen effects, whether positive or negative, which can be difficult to cope with or understand. When you are trying your best to make positive changes in life, it’s difficult to respond to one of your choices backfiring.

Sometimes, your choices create problems because other people don’t understand your perspective. They may think you are causing unnecessary stress for yourself by choosing to pursue a certain goal. They may accuse you of being selfish for spending your time and money on your own priorities, instead of the things they think should be prioritised. When considering people’s reactions, it is important to remember that they have their own issues and sets of beliefs. Their responses say more about them than you.

Dealing with the unexpected can be hard. When you make choices, you often assume they will have specific consequences and unforeseen effects can make you question everything. The fear of unexpected consequences may cause indecision for some people: it may seem illogical, if you believe they can improve their lives through making a certain choice, but they may feel more comfortable sticking with what they know, even if it is making them unhappy. Their behaviour might not make sense to you, but trying to understand rather than berating them is more likely to enable them to change. People in this situation need support, not judgement.

Making the ‘wrong’ choices doesn’t make you less worthy of love, support or respect.

Some people talk about others making a ‘choice’ to do something which has negative effects, without considering whether they had any support or opportunities to make a different choice. It’s easy to judge and, unfortunately, many people who judge have experienced difficulties themselves and believe others should be able to overcome their problems simply because they themselves did. Their attitude is ‘I managed to cope, so why can’t you?’

There are, of course, a number of potential answers to this question. Different people have different life skills, coping abilities, levels of self-esteem, supportive factors in their lives, etc. Often, these differences cannot be appreciated by those on the outside. Someone who seems to have everything going for them, such as a good job and family, may have very low self-esteem and believe they are unworthy of the positive changes they can make. Somebody who appears to have supportive parents may actually be undermined by them at home, when nobody is there to witness it.

If you have helped yourself by making good choices, please don’t judge those who are not ready (and might never be ready) to do the same. You are not superior to them.

If you have made and/or continue to make poor choices, try not to judge yourself. You deserve support. You deserve a better life.

The bottom line is, making choices can be difficult and many people feel unable to choose courses of action which will help them in the long term. Judging and punishing people in this situation helps nobody. It is unlikely to persuade them to change their behaviour; in my experience, it makes them feel more wretched and more likely to make poor decisions. We all have a choice, but we might not feel able to choose.

Prepare to Talk

I’m writing this post because to tomorrow is Time to Talk Day and while I think it’s a great way to raise awareness about mental health issues, we also need to acknowledge that talking can be difficult. Some of the comments I have read on social media point out that trying to talk is not always a positive experience. It’s sad and infuriating, but true. With this in mind, here are my tips for preparing to talk about mental health…

Speech bubbles

 

1. Decide on your aims before you start the conversation.

What do you hope to get out of talking? Help and support from a particular person? More understanding in general?

What do you want to talk about? There are many topics within the broad subject of mental health. Picking one or two will help you steer the conversation.

Often, conversations will go in a different direction to what you anticipated, but having a clear set of aims and objectives in your mind will help you to start talking. It’s also helpful to use your aims as focal points, so you can return to them if the conversation starts turning in a direction you find uncomfortable.

Deciding on your aims needn’t be complicated: you can stick to one simple aim. 

Here are some examples:

• To let my friend know I struggle with anxiety

• To tell my colleagues that having time off for depression doesn’t mean I’m lazy

• To ask my mum to help me get counselling

 

2. Prepare for unexpected outcomes — positive and negative.

Some people may not respond to your conversation in the way you would like. There are loads of reasons for this: some people refuse to acknowledge mental illness out of fear or ignorance, some avoid talking about mental health because they have their own issues and are uncomfortable discussing them and other people will have a million other reasons.

The best way you can prepare for the unexpected is to try not to take anyone’s response personally. If someone refuses to listen, it says more about them than it does about you.

I know that’s easier said than done, but try to decide on an action plan in advance. How will you react if the person says something offensive? Or if they just aren’t interested? Put your needs first — it’s fine to walk away.

Time to Talk Day isn’t about being a martyr; it’s about starting the conversation. It’s not your fault if others don’t want to participate and you don’t need to “fight for the cause” by trying to extend the conversation when you might as well be talking to a brick wall.

It also helps to prepare for positive responses. I’m always delighted when my openness persuades other people to talk about their mental health issues, but it can be challenging when you don’t know what to say. As a minimum, tell people to go to their local GP if they have any concerns. This is the best initial course of action overall, so try not to put them off by sharing any negative experiences about seeking help.

It can also be helpful to point people in the direction of some good websites if they want to more information or support. Here are a few of my top recommendations:

Mind

Samaritans

Young Minds

 

3. Feel proud of yourself.

Speaking out is hard. It’s brave. Starting a conversation about mental health is an achievement — even if it doesn’t turn out how you wanted.

You might feel discouraged by a negative experience, but please keep on trying. The negative experiences are symptoms of why we need to talk and keep talking: there is still a lot of stigma, ignorance and apathy in the world.

If your experience is positive, please share it with others. It can be a flickering light in the darkness to people who have lost hope and think have nobody to talk to.

Also remember that there are plenty of ways to “talk” so you can join in even if you feel uncomfortable talking in person. Blogs and social media are a great way to start “talking”.

Keep starting conversations and we will break down the stigma — one talk at a time. Good luck!

Self-Care: Simple and Complex

Self-care is a popular topic — and for good reason — but it tends to be oversimplified. 90% of the posts about self-care I see on social media don’t mention any of the issues involved. Lists of “100 acts of self-care”  make good clickbait and seem fun to share, but for many of us with mental health issues, they are intimidating and patronising.

All too often, self-care is promoted as a simple solution to mental health problems. The tasks advocated seem easy — to people whose mental health is relatively good — so we are told there is no excuse for not doing them. It’s rarely acknowledged that these “simple” tasks are almost impossible during bad episodes of mental illness.

There are exceptions to this glib approach to self-care, usually in social media posts and other materials produced by mental health organisations. The Blurt Foundation is particularly good at promoting self-care whilst addressing how difficult it can be and has a good self-care section on its website. However, many people and organisations have a lot to learn about how to present self-care in ways which are relevant to everybody.

Since it’s self-care week, I thought I would take the opportunity to discuss why self-care is more complex than it appears — especially for people, like me, who experience long term mental health issues.

 

There are different types of self-care — which vary in accessibility.

A major problem with any list of self-care activities is that a proportion of them will be difficult for many people to access or complete. When you see “20 easy ways to practice self-care” as a heading, bear in mind that none of them is easy for people experiencing mental illness and many will be impossible for people whose symptoms are moderate to severe. The ability to perform these tasks may also vary over the course of time — even from one hour to the next.

During the worst episodes of my mental illnesses, I was unable to do many of the “simple” self-care activities which people recommend most frequently: preparing a healthy meal, writing in my journal, seeing friends, going for a walk… In fact, the only act of self-care I was able to complete most days was getting out of bed. Usually because I needed to let the dog out.

You can try to practice self-care during relatively bad episodes of mental illness, but it’s important to select tasks which are appropriate for your current symptoms and situation. Getting dressed, taking a shower and making yourself a cup of tea are all acts of self-care which can make a difference to how you feel. They may seem ridiculously easy to someone who hasn’t experienced severe mental illness,but are very difficult when you are at your lowest ebb.

Tailoring your self-care plans to your current symptoms means they won’t always make sense to other people. For example, when my anxiety is bad but my depression is relatively good, I can do “difficult” tasks at home (cooking complex recipes, introspective exercises, running on the treadmill) but struggle to do anything outside, even a task which I have done many times before (walking the dog, going to the supermarket). You don’t need to explain yourself, but make sure you don’t judge yourself when other people express the assumptions and judgments they make about you. Mental illness isn’t logical.

Some of the activities depicted as self-care are so fraught with issues for people with mental health problems that they can leave you feeling worse. Anything which involves unfamiliar situations/environments/people, for example, is incredibly stressful for me. Getting a massage is not an act of self-care for me; it’s a situation which provokes anxiety when I think about the possibility! Going out for afternoon tea is a treat, but I don’t consider it self-care — allowing myself to be quiet and inactive for a few days afterwards to recover, however, is self-care.

Varying definitions of self-care are inevitable, especially when people have different mental health issues and different symptoms. For this reason, it’s important to define what self-care means for you. It’s also helpful to have different self-care strategies in place for different times/situations, depending on your mental health.

 

Sometimes self-care means not doing something.

Giving yourself permission to opt out of events and activities which could cause you distress and/or make your symptoms worse is a form of self-care. It’s a way of protecting yourself. Putting your needs first is not selfish — it’s necessary. Some people may accuse you of causing problems, but taking care of yourself is your main responsibility.

I feel guilty for refusing invitations, but I know the consequences if I go along with something which causes me more stress and anxiety than it’s worth. The people who really care about you will try to understand. They will see that you’re not being difficult for the sake of it and while they may be disappointed by your decision, they won’t hold it against you.

Another aspect of self-care is not getting caught up in other people’s emotions and judgments. If you explain the situation clearly and they take offence or accuse you of being selfish and manipulative, it’s their problem — not yours. Set boundaries in place and refuse to be drawn in. Stand firm on what’s right for you — it won’t be easy, but it’s easier than dealing with the consequences of not protecting yourself.

A note to anyone reading this who doesn’t understand why someone with mental health problems would refuse an invitation: events and activities which seem pleasurable to you can provoke a lot of anxiety and negative emotions. You may believe a party means only a few hours of discomfort for someone with anxiety, for example, but this is not the case. Instead, it means days (sometimes weeks) of anxiety beforehand, which may cause unpleasant symptoms like indigestion, diarrhoea and tension headaches. The “few hours of discomfort” actually feel like torture to someone with anxiety. When the part is over for you, it’s not over for someone with anxiety — they are left exhausted for at least a week and often ruminate on every little detail, worrying that people thought they were rude because they were too nervous to speak or that they embarrassed themselves in a million different ways. When someone with mental health problems refuses an invitation, please don’t try to guilt trip them into changing their minds — accept that they know what’s best for them and try to empathise.

A paradox in self-care is that sometimes not performing an act of self-care is self-care. This means recognising when a certain activity won’t deliver the benefits you hope, for example, forcing yourself to do a vigorous workout when you are already tired. Give yourself permission to do what you most need right now, even if that’s lying on the couch for a while.

 

 

Self-care doesn’t negate the need for help and support from others.

Self-care is not a substitute for mental health treatments and services, though it can form an important element of mental health management. It complements treatments like medication and talking therapies, which in turn can make it easier to practice self-care. While self-care is about taking care of yourself, it doesn’t mean you should struggle alone instead of getting help from other people.

Self-care is often presented as taking responsibility for yourself, but it’s seldom acknowledged that being able to take responsibility for yourself is a privileged position. You need to be well enough to practice self-care. Most people who experience mental illness need support from other people, in both personal and professional capacities — which should not be a source of shame.

Unfortunately, the language used in many social media posts, blogs and articles about self-care is careless. It implies that people who are unable to practice self-care are unworthy of help from other sources. Some people write about self-care as if it is “the answer” to our mental health crisis, which is untrue and potentially harmful.

Self-care is not a substitute for treatment or support. It’s a habit which we should all try to develop, whether or not we have experienced mental illness, without judging those who are unable to practice self-care. It can help us to achieve and maintain good mental health, but is not the only way to manage mental health.

 

Self-care needs to be practiced with self-compassion.

It’s not about creating a to-do list of tasks you “should” be doing, which often makes you feel worse. Don’t berate yourself for not being able to do certain tasks. Don’t feel guilty if a day, a week or a month passes without you being able to practice self-care. Do what you can, when you can.

Self-care starts with self-compassion and vice versa. When you believe you deserve compassion, you are motivated to practice self-care. When you practice self-care, you realise you deserve compassion.

Self-care is effective because it engenders self-compassion, leading to a positive spiral which changes how you feel about yourself. I realised this a few years ago, when I started making the effort to apply body lotion every week. My main motivation was getting rid of the dry skin on my knees, shins and elbows, but after several weeks I noticed it was beginning to change how I felt about myself and my body. It forced me to connect with my body, which I had always regarded with disgust, and taking time to do something for myself was powerful — it raised the possibility that myself and my body were worthy of time and effort.  A simple task shifted my mindset.

 

Self-care is not part of a reward/punishment system.

Self-care is not something you need to earn the right to practice: everyone deserves it. It’s not a reward for acting or feeling a certain way, or for doing something specific.  Conversely, it’s not a way of punishing yourself for not doing, thinking or feeling something different.

It’s about accepting yourself as you are, right now, and doing something to improve your mood, health or wellbeing. You don’t need to earn self-care or ask permission. You don’t need to tell anyone about it or keep it hidden. 

Neither is self-care a way to cancel out unhealthy or self-sabotaging behaviours. It’s not a column on a balance sheet, giving you permission to punish yourself as long as you counterbalance it with self-care. It’s not an excuse for not tackling unhealthy and harmful habits. It’s separate from your mental health issues and symptoms, although it influences your mental health in positive ways.

 

Check your self-care expectations.

Self-care is important and can have a big impact on your mental health and wellbeing, but it’s not a miracle cure. The effect is gradual and accumulates over time, especially as practicing self-care becomes a habit. It might make you feel better immediately, but it might not.

I find the best policy (for me) is to approach self-care with hope, but not expectation. I know there are possible benefits to any given act of self-care, but I don’t take them for granted. Most of the time, there are immediate benefits — often the satisfaction of completing a task! — but these are bonuses.

The long-term impact of self-care is also unpredictable and not guaranteed. Some of my self-care activities have produced positive results after months (or more) of seeming to have no impact; others have been effective after a short time. Many activities appear to be pointless until I stop doing them, at which point I notice my mood drops and other symptoms worsen.

I always find myself repeating that managing mental health involves a lot of trial and error, but it’s especially true for self-care. What works for you is often surprising. Something frivolous, like painting your nails, can have a bigger impact than it seems to merit. Other activities, like eating healthily, take so long to have an impact that it’s easy to get demotivated and give up. I think approaching self-care with the spirit of curiosity and experimentation is helpful.

The most powerful aspect of self-care is the act itself: by performing self-care you are telling yourself that you matter, you are valuable, you are worth the effort. And you are right!

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.

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.

Mini Self-Care Strategies

We all know the importance of “big” methods of managing mental health, such as medication and exercise, but it’s easy to overlook the impact of “small” coping strategies. Mini self-care strategies typically take little time and effort, but make a significant impact. But because they seem so small, their importance is easy to downplay — you figure skipping them won’t really matter, ignoring the cumulative effect.

Journal

Acknowledging the importance of mini strategies is the first step.

It took me ages to figure out that the gaps in my journal were not only a symptom of my mental health declining, but also a contributing factor. When I write in my journal regularly, I feel better. Even if it’s just a few lines.Now I recognise how journalling helps me manage my mental illness, I know I need to prioritise it.

Observing patterns in your mental health is an effective way of working out which mini strategies work best for you. You can also experiment, trying new strategies and noting changes in your symptoms. Consider the impact of all your activities — even if it seems unlikely they affect your mental health.

 

Find ways of fitting mini strategies into your life.

Some people respond well to putting tasks on their to-do list (or must-do list), or scheduling them in their planner/calendar. Writing it down reminds you that these mini strategies are important and you should make time for them. However, some people can feel pressured by doing this, which may negate the benefits of the strategies.

The best way of making time for mini self-care strategies is to build them into your routine and make them a habit. For example, I write in my journal when I go to bed — it has become part of my routine, just like brushing my teeth. Piggybacking tasks onto established habits is very effective and easy to implement.

 

What counts as a mini self-care strategy?

Anything which makes you feel better in the long term and which can be done in a short amount of time. Note that these tasks could take much longer, if you choose, but it’s possible for them to have an advantageous effect in 5-10 minutes per day. Obviously, this will vary from person to person, but here are some examples:

• Journalling

• Listening to music

• Meditation

• Sketching

• Yoga

• Reading

• Knitting/crocheting

• Texting/calling a friend

• Gardening

 

Remember to do what works for you.

Perhaps your mini self-care strategies seem a little strange — or completely crazy — but it doesn’t matter, as long as they work for you. The crucial issue is developing the self-awareness to observe what works over a number of days or weeks; sometimes it will feel like your mini strategies aren’t helping, especially if your mental health symptoms fluctuate a lot, but it doesn’t mean they aren’t working in the long term. Stick with it and make notes.

Also keep track of how you feel before, during and after activities which you wouldn’t necessarily associate with self-care. I find that spot of decluttering is beneficial, for instance, although I wouldn’t consider tidying an activity I enjoy — at least, not while I’m doing it!

Don’t underestimate the effect of returning to activities you haven’t done for several weeks or months. Many of my self-care tasks were neglected over winter, when physical illness took its toll and caused a deterioration in my mental health, and I was surprised at how effective simple, little activites were in helping me feel better.

As always, there will be some trial and error involved to find what works for you. But once you find effective strategies, they are vital components in your self-care toolkit.

 

9 Months After Antidepressants

It’s been about 9 months since I completely stopped taking antidepressants, so I thought I would write an update/ponder on the issue. What follows is a summary of my experience and the issues it has raised.

Pill packets

There has been no dramatic change.

Browsing the internet, you would be forgiven for thinking that people fall into two categories: those who are anti-medication for mental illness and those who advocate taking anything you can get. The impression you get from this divide is that coming off antidepressants after over a decade will have a drastic effect – either you will feel awesome all the time or you will crash back down to the worst manifestations of your mental illness. This did not happen for me.

In fact, not taking antidepressants feels the same as taking antidepressants. I still get bad days, but I also have many good days. Managing my mental illness is a learning curve, but I’m finding and implementing more coping strategies. My hope that I would drop a lot of weight instantly did not (alas!) come to fruition. It turns out my fat has more to do with comfort eating and (lack of) portion control than medication…

Please note that I did not suddenly stop taking antidepressants. I discussed it with my doctor and gradually reduced the dosage over approximately 4 months, regularly meeting with my GP throughout the transition

 

It’s a personal choice, not a political statement.

I don͛t fall into either of the categories mentioned above: I’m neither anti-medication nor fanatical about antidepressants. Like most people, I suspect, I regard antidepressants as a useful tool which should be used to treat mental illness when it is needed and effective. My definition of “need͛” is when mental illness is affecting your ability to function”normally” which will be different for everybody, because it depends on what “normal” means for you. I also advocate using antidepressants in combination with other treatments where possible and appropriate, especially talking therapies.

I have no agenda in choosing to stop taking antidepressants. I decided it was something I would like to try for myself, to see how I coped without them. I’m not urging other people to do the same; nor am I urging them to keep taking medication.

Choosing whether or not to take medication – any medication – at any given time is a personal choice. I don͛t judge people for taking antidepressants, which is partly why I find it difficult to respond when people congratulate me for stopping my medication. A lot of people try to place a moral value on taking or not taking antidepressants, but this is unhelpful and damaging. You are not letting anyone down or doing anything wrong by taking medication. Neither are you letting anyone down or doing anything wrong by choosing not to take it.

You have to do what works for you. For me, that has involved a lot of trial and error in finding the right type of antidepressants and the right dosage at various times in my life. If you (and your doctor) think you might benefit from medication, give it a fair shot – and don’t expect it to work miracles. The media loves to call antidepressants “happy pills” but they rarely have the effect of increasing your mood to that extent, let alone giving you instant happiness in a deep, meaningful way.

You may experience side effects, but you may not. Some people claim that the possible side effects are a strong reason not to take antidepressants, but this disregards the fact that for many people,
side effects are mild and/or temporary – or may not manifest at all. You also need to weigh up the side effects against the benefits of medication, as with medication for physical conditions.

Personally, I believe the side effects I experienced were minimal compared to the improvement in my mental health. In fact, the only major problem I have had with antidepressants is certain types and/or doses not being effective. Seek advice from your doctor, be prepared to experiment and ensure your expectations are realistic.

Withdrawal symptoms also vary a lot from person to person. I didn͛t notice any, so can’t comment much on withdrawal symptoms in relation to my own experience, but it’s something you must
consider when deciding whether to stop taking antidepressants. I waited until I was sure I could cope with any withdrawal symptoms before coming off medication; I needed to know I was in the frame
of mind where I could recognise them as physiological or neurological effects, rather than personal affronts, and seek help if required. Again, it’s a case of experimenting to see what works for you – you may need to reduce your dosage more slowly in order to reduce and cope with withdrawal symptoms.

 

Antidepressants are an important part of my story.

I don’t think I would be alive without antidepressants. They took the edge off the worst points in my life and got me through. I still had really bad episodes of depression, including times when I was suicidal, but they would have been worse and longer without antidepressants – as I found out when I was in my late teens and came off medication too soon because I felt ashamed that I needed them. That͛s why nobody should try to shame someone for taking antidepressants: not taking them could put their life at risk.

Antidepressants provided me with a useful stepping stone, allowing me access to other ways of managing my mental health. Without them, I would not have been well enough or motivated enough to discover strategies which I now find useful, like exercise and meditation. I would not have been able to access treatments like drama therapy and counselling, which have had a massive impact on my wellbeing.

I have been able to achieve long term goals because I have taken antidepressants. I would not have gotten through university without them or learnt to drive. Even trekking to Machu Picchu last month would not have been possible if I hadn’t taken antidepressants; I could only go out walking alone to train because medication boosted my mood enough to make it a possibility in March last year. I will reap the benefits of antidepressants for the rest of my life, even if I never take them again.

 

Stopping antidepressants is an achievement.

I have recently been able to acknowledge that coming off medication is an achievement: not in itself, but because it͛s a sign that I’m managing my mental health well. This is a marked contrast to the attitude I had in my late teens, when I was first diagnosed with depression and thought I needed to stop taking antidepressants no matter what the cost. Back then, I was preoccupied with trying to convince everyone I was fine and terrified of the stigma surrounding mental illness. Nowadays, I battle that stigma and realise it͛s okay to admit that I need help.

This change of attitude is critical – it means that when my mental health dipped at the end of last year, I sought help. I had the confidence to ask for the type of help I wanted (counselling), without either returning to medication or ruling it out. I also recognised the importance of the strategies which had enabled me to stop taking antidepressants, returning to them as soon as I was able.

My initial response to being congratulated for stopping medication was to be defensive. I thought it meant people were judging me for needing antidepressants. I have come to realise that their congratulations are shorthand for “well done for managing your mental health on your own terms and working hard to get to this point.” It acknowledges my strength throughout my journey, rather than implying I used to be weak.

I was also wary about accepting congratulations because I was afraid I would relapse. I regarded coming off antidepressants as an experiment, rather than a milestone. However, I was believing a fallacy: that people would rescind their congratulations if I returned to medication. Again, I was placing the emphasis on the antidepressants rather than my own frame of mind and efforts to self- manage my mental health. People were congratulating me for reaching a point where I could experiment with not taking medication; even if I take antidepressants again in future, I have still attained the achievement for which I am being congratulated.

 

My experience doesn’t imply judgment of others’ experiences.

I struggled to be proud of coming off medication because I was afraid it would be misconstrued as judgment of both myself and others for taking medication in the first place. That isn’t true. In fact, I believe people should be congratulated for deciding to take antidepressants, as well as deciding not to take them, because asking for and accepting help is difficult.

I’m glad I was able to stop taking antidepressants because it was the right decision for me. It͛s not the right decision for everyone. I’m not under the illusion that it makes me a better person or better at managing my mental health than someone who takes medication. Comparing people in this way is unhelpful and cruel, because mental illness varies from person to person – especially when many of us have been diagnosed with more than one condition. Even when symptoms appear similar, the causes and effective treatments can be vastly different.

 

It’s still early days.

9 months seems like a long time in some ways, but represents only 5% of the time since I was first diagnosed with a mental illness. It͛s less significant when you consider that I was experiencing symptoms for at least 5 years prior to my diagnosis. My mental health has improved over the past couple of months, but I don͛t know what the future will bring – I could deteriorate and need to take antidepressants again. If I do, it won͛t signify failure.

All I can do is wait and see what happens, managing my mental health as well as I can in the meantime.

These 9 months have been challenging, but they have also been revelatory. I have coped better than I thought I could, both with little things like walking on my own and big things like trekking to Machu Picchu. I discovered that I can survive a bad episode without medication. I realised how big an impact physical activity has on my mental health when illness prevented me from exercising. I learnt the importance of small acts of self-care, like eating proper meals and making sure I do things I enjoy.

Most of all, I found that not taking antidepressants is not much different to taking them – for me, at this point in my life. There have been no miracles and no disasters. Just me, living and coping as best I can on my own terms.