Write-Off Weeks

Last week was a struggle. Why? Because my anxiety and depression were worse than “usual” (which gets redefined regularly, depending on the variety and severity of symptoms I experience over a several weeks or so). That’s it. Nothing bad happened. I just felt worse.

A lot of people find this hard to accept: how can someone feel significantly worse for no apparent reason? I find it hard to accept, though experience teaches me again and again that it happens.

I have given up trying to analyse every fluctuation in my mood, because often there is no reason for changes in my symptoms. Even when I can pinpoint potential reasons, I can’t be certain whether they are causes or correlations — sometimes “reasons” are present but don’t affect my mental health. Winter, of course, presents its own litany of potential reasons — cold, wet, dark… Yet my mood isn’t always constant throughout winter.

I’m trying to be more compassionate towards myself and practice self-care, so I didn’t pressure myself as much as I have in the past. I gave myself permission to do whatever I could, even if that meant I did nothing. I focused on my priorities, but didn’t have the energy to fulfil all of them. In fact, the week was pretty much a write-off.

I feel guilty for neglecting my work, studies and volunteering, but part of me realises I could have done nothing more. Actually, I managed to go to all of my gym classes and walk the dog on my own, despite the heightened anxiety, which means the week was more of a success than it felt at the time. I tend to be strict when it comes to exercise, because it’s one of the main ways I manage my mental health. Skipping a session leads to more depression and anxiety; it also makes the next session much harder to do, creating a downward spiral.

I’m focusing on combining self-compassion with being strict about completing activities which help me to manage my mental health in the run up to Christmas. Christmas is difficult for me, but I also love it. I like the sense of togetherness and celebrating the days getting (gradually) lighter again. I like making time to watch films and bake. I love Brussels sprouts, cinnamon and tinsel. I enjoy buying presents and seeing colourful lights everywhere.

Yet some aspects of Christmas aren’t easy to deal with. I get frustrated when I make an effort and other people can’t be bothered, despite being far more able than me. It’s not a fun time to be single either, though at least I don’t have to deal with someone else’s family as well as my own! I shall be referring to my Christmas Survival Guide (and Part Two and Part Three) to help me through.

I have been feeling better since Friday, so I wonder if getting November out of the way has helped. November is the worst month of the year, in my opinion, so it’s always hard to cope. My plan is to concentrate on the things I like about this time of year and look forward to 2018.

I’m also in a reflective mood, brough on by the combination of the end of the year and my final counselling session on Friday. I have achieved a lot this year, but it hasn’t made a great deal of difference to my daily life. I’m still earning next to nothing and relying on working tax credits. I still have an enormous amount of debt. I’m still stuck living with my parents. I still have mental health problems which convince me I’m worthless and better off dead.

Yet trekking to Machu Picchu and being an integral part of a crowdfunding campaign which raised £15,070 for The Project have given me touchstones. I have achieved significant things this year and nobody can take them away from me — not even my mental illness. 

I may not have transformed my life, but I have completed a long-held life goal and made a difference. I have inspired at least one other person to chase her dreams — despite also struggling with mental illness. I may not feel confident a lot of the time, but I think my self-esteem has improved and I’m more willing to take on challenges.

I need to remind myself that while some weeks, or even months, will be write-offs, it doesn’t mean my life as a whole is a write-off.

Losing Spoons

The past couple of weeks have been difficult for me, mainly because I have been losing spoons.

The Spoon Theory is an analogy which helps explain how long term illnesses or conditions can deplete one’s limited energy. It was created by Christine Miserandino, who explains it here. I have previously written about my interpretation of Spoon Theory here and here. The basic concept is that everyone has a limited number of spoons, or units of energy, and when your spoons are limited by an illness or condition, you need to be very selective about how you spend them.

Spoons aren’t guaranteed.

The number of spoons available to you on any given day can vary — sometimes a lot. For example, on a good day I might have 25 spoons whereas I might have only 10 on a bad day. Most days, I average 15-20. The problem is, I don’t know how many spoons I will get in the future. This make planning problematic…

It’s a bit like getting paid a daily wage and never knowing how much you will receive. The amount sometimes bears a resemblance to your actions, i.e. the “work” you do, but there often seems to be no correlation. All you can do is invest, save and spend your spoons wisely — or rather, in what you hope is a wise way!

My current issue is that the number of spoons available to me, on average, have dropped over the past couple of weeks.

I partly expected this, because I attended two very important but anxiety-inducing social events a couple of weeks ago. As I have explained before, even when social occasions have been pleasant and enjoyable, it takes me a few days to recover.

However, the effect has been more dramatic than I anticipated. I think I may be fighting off a cold-type virus, as I have been tired and achy recently and sometimes my throat is scratchy. My mood has dipped too, as it is wont to do at this time of year, so my depression is absorbing more of my energy and motivation.

Accepting low spoon levels.

Having fewer spoons sucks, especially as I had been getting into a good routine with my writing, Open University course and volunteer work. Unfortunately, getting upset about the situation just uses up more spoons! It’s frustrating, because I feel like there should be a reason for losing spoons — perhaps I did something wrong or neglected some of the activities which give me more energy — but I can’t find one. It’s part and parcel of experiencing long term mental health problems.

The most annoying aspect of having few spoons to spend is being forced to narrow my priorities further than usual.

Having little energy means I have had to neglect very important parts of my life, because I need to prioritise my mental health first and foremost, followed by my work. I have no other option. I hate having to do it, but I can’t spend spoons which aren’t available to me.

It’s hard not to feel anxious about this state of affairs. I feel guilty for havig to cut back on my volunteer work and not seeing my friends very often. However, anxiety costs more spoons so I’m trying to avoid stressing out about the situation, since I have very little control over it (though that’s easier said than done!).

Moving through the mist.

All I can do is keep moving, even when my way is obscured. Giving in to frustration is detrimental — it won’t help myself or the people I think I’m letting down. I also try to remind myself that I’m not as depressed and anxious as I have been in the past: I may have fewer spoons, but at least I have spoons.

I will make an effort to acknowledge and appreciate what I am managing to do, though I wish I could do more. I submitted my first Open University assignment today, after neglecting it for the past few weeks. I wish I had been able to prepare it over a longer period of time, instead of writing it over the few days before it was due, but I’m glad I got it done.

I hope to get more spoons again soon, but I’m coping with the number I’m getting — which I suppose is good.

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!

Season of Mists

This picture sums up what mental illness feels like for me.

Mist behind gate

You can see nothing behind the gate, because it’s obscured by mist. If I tell you there is usually a picturesque view of trees, fields and a farmhouse, you have to either take my word for it or wait until the mist clears to see whether I’m right. For now, all you can see is the mist.

It’s the same when people tell me I can manage my mental health — or recover — enough to live the kind of life I want. To live my version of success, fulfilment and happiness. I can’t see past the mist, so I don’t know whether they are telling the truth.

It’s difficult to believe the mist will clear.

Even when I know what is behind the mist, i.e. my current life as I experience it when my mental health is relatively good, it’s hard to keep faith that the mist will clear. Or to believe, if it does clear, that the view will not have changed.

Part of me is always thinking “you can’t rely on anything” — every time I think I have something figured out, it has a tendency to fall apart. This isn’t always true, to be fair, but it has been true often enough in my experience that I tend to default to thinking everything will go wrong because that’s easier to deal with than the disappointment when I get my hopes up.

Long term mental illness wears you down that way. You think you can outrun it by working hard and using your coping strategies, but sometimes it catches you anyway and you lose stuff. Stuff like jobs, money, friends, self-esteem, confidence.

The mist is always ready to descend.

When things are going relatively well, you can’t fully relax or be optimistic because the mist is still hanging on the horizon. In a matter of minutes, it could creep up on you and obliterate the landscape.

With that in mind, I try to keep going in the right direction — even when I can’t see far ahead.

I use my compasses (life values like creativity, compassion and curiosity) and I hope that my next steps will become — and remain — clear.

Sometimes they do. Other times I’m wandering in the mist, lost, scared, alone and confused.

So when I talk about being scared of getting ill again, I’m not talking about the sniffles or feeling a bit subdued — I’m talking about the mist descending and obliterating everything in my life.

Mellow fruitfulness.

I keep reminding myself that according to Keats, autumn is not only the season of mists. There are blessings, which I try to seek out. I think I should think of my life in the same way: the mists may always be waiting to close in on me, but my life and experiences can still be fruitful.

 

Winterproofing

I tend to think of the clocks going back as a negative event: winter has always been a difficult time for me, bringing both physical illnesses and a decline in mental health. The past two winters have been particularly awful. Last winter, I was ill for nearly four months solid, with the flu, throat/chest infections and other viruses wreaking havoc. I couldn’t use the coping strategies I had put in place, as even the easiest took too much effort. My depression and anxiety got worse.

Sunrise

This year, I hope things will be different — but last winter has taught me that you can do almost everything “right” and still succumb to illness. 

There has been one benefit to the clocks going back that I haven’t appreciated/experienced in past years: the lighter mornings. Since I get up at 5am nowadays and take the dogs out around 6:10am, the change is obvious. We could walk up the lane again this morning, after being forced to take a different route (with streetlights) for the past few weeks. As you can see in the photo, the sunrise was glorious.

Prioritising Self-Care

While I can’t control everything, I am making sure I stick to my coping strategies and self-care activities. In particular, I am being strict about using my SAD lamp and exercising. I know it probably seems ridiculous to people who don’t understand how important these activities are in managing my mental health, but it’s necessary.

Sure, I feel like I’m being awkward when I tell my friends I can’t go out on the evenings I have gym classes, but I don’t want to risk damaging my mental health. My routine, combined with the physical exercise, helps me stay healthy. When I feel guilty for being so selfish, I remind myself that when I got ill last winter, I couldn’t socialise for weeks — being unavailable a few evenings a week is preferable to being unavailable throughout the winter months.

I’m also being stricter with strategies which I should implement more regularly/frequently than I do at present. Wanting to avoid a repeat of last winter is a great motivator! I’m trying to eat healthy meals, even if I eat junk as well, and making an effort to meditate. I know I could do better, but stressing out about not doing better is counterproductive…

Finding Pleasure in Winter

I have being trying to focus on my strengths and the positive aspects of my life recently, so I’m trying to take the same approach to winter. It can be difficult to appreciate the pleasurable side of the cold, wet and dark months, but it’s not impossible.

Winter creates the perfect atmosphere for reading ghost stories, which I enjoy. It’s also a good backdrop for hot chocolate, warm puddings and spicy curries. Brussels sprouts are in season, which I adore (seriously) and I can watch films or read without feeling I should be outside, enjoying the sunshine.

I like a lot of things about Christmas, too — though it can bring its own challenges. Seeing Christmas lights when walking the dogs, buying presents and listening to cheesy Christmas songs are all fun. It marks the winter solstice, so brings hope that spring will come. The days will get longer again and it feels like I’m progressing with the changing seasons — in theory, anyway! In the meantime, it’s back to ghost stories and hot chocolate.

Facing Down the Fear

I’m terrified of getting ill again. I dread feeling like I did last winter. However, worrying and getting stressed will only increase the likelihood of getting ill.

Instead, I’m attempting a more pragmatic approach. I will do everything I reasonably can to avoid getting ill (hence I got a flu shot last week, for the first time!), but I can’t beat myself up if I get ill. Whatever will be, will be.

It’s the same old story, really: there is no point in worrying about stuff which might or might not happen. Of course, knowledge and practice are different things — especially when you have anxiety…

I refuse to fixate on whether or not I will get ill. In fact, I accept that I probably will get a few viruses and colds. I accept that my depression will become more difficult to manage. But I can focus on what I’m able to do and put contingency plans in place.

Coping with winter is difficult, but I’m not completely powerless. I can choose to accept the possibility of illness while doing my best to keep it at bay. It’s my best chance of staying mentally and physically healthy.

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!

 

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.

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!

Subdued

I have been feeling subdued and demotivated over the past week. There’s no particular reason; it’s just the nature of depression.

Subdued meerkat

But the nature of depression, even after 15+ years, is frustrating.

I’m sick of it. I know, on a logical level, that the low mood will pass at its own rate. I know I can do all I can to practice self-care and use coping strategies, which will help reduce the impact of my dip in mood. I know this is a challenge I have to deal with, perhaps for the rest of my life, and I just have to do my best to achieve my goals when the cloud lifts a little. Yet knowing all of this doesn’t make life easier.

I feel quite useless when my depression gets worse. I have no energy and can’t work towards my goals — certainly not as much as I can when I feel better.

 

The only option is acceptance.

I can’t change the fact that I struggle with mental illness. I can try to manage it as best I can, but my coping strategies and activities won’t always be enough. And that’s okay.

It has taken me a long time to start thinking of my mental health as an aspect of my overall health, rather than a reflection of my shortcomings. I know plenty of people still regard mental illness as weakness — and I know they are wrong, because it takes incredible strength to keep going when your symptoms prevent you from living life on your own terms.

So I will try not to be so harsh on myself as I carry on through this drop in mood. I will do what I can, when I can — and try not to stress about the slowness of my progress.

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.