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!

Not Just an Issue for Teenagers

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

 

The Problem with Self-Harm Statistics

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

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

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

 

Issues for Adults who Self-Harm

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

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

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

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

 

My Experience of Self-Harm as an Adult

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

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

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

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

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

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

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

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

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

 

The Curse of Speaking Out about Self-Harm

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

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

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

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