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.

Setbacks and Balancing Acts

I haven’t blogged for a long time and there are usually two reasons: either I’m ill or I’m very busy. Both apply to my recent absence. I have started a new job, which I’m very pleased, excited and anxious about! It’s only six hours a week and temporary, but I want to do my best and have a significant impact, as I will be working with young people on an art project exploring mental health. My studies with the Open University continue, which is a heavy workload because I’m taking two modules (60 and 30 credits) this year and it gets very intense when deadlines are close together. In case this wasn’t enough upheaval, The Universe decided to throw a spanner into the works…

Balancing wood

I have been experiencing a lot of abdominal and middle back pain since October, along with constant nausea and some other symptoms. At first, I thought I had gastritis because I’m prone to getting bad gastritis, but some of the symptoms didn’t fit and the pain didn’t subside like it normally does. Last week, an ultrasound scan confirmed I have gallstones.

While it’s good to have a diagnosis, after three months of not being sure what was wrong, knowing I have gallstones doesn’t stop them from disrupting my life. A lot of people reacted to my suspicions that I had gallstones by saying “ooh, that’s very painful.” Now I know I have them, I can confirm that yes, they are extremely painful! I’m seeing my doctor next week, but in the meantime I spend most of my day with heat pads clamped to my upper abdomen and middle back/shoulder blades.

The gallstones are disrupting my life in general, making it difficult to establish a routine — which is something with which I struggle most of the time anyway, having to work around my mental health problems. They also stop me from following my exercise routine, which I depend on to manage my mental health, meaning the depression and anxiety have been taking hold. It’s been a stressful few months, for various reasons, and my physical health is preventing me from using some of my main coping strategies.

It’s easy for people to say I shouldn’t worry and to take it easy, but regular exercise is crucial for my wellbeing. When I stopped taking antidepressants, I replaced them with physical activity. Exercise has loads of neurochemical and psychological benefits which are essential for me to cope. Being unable to go to classes or run because I’m curled up in a ball of pain and/or vomiting has huge implications for my mood over the following days and weeks.

So I have been struggling.

The sporadic exercise and odd eating patterns have taken their toll: I have gained weight and am around 10lbs more than I was in October, when I reached my lowest weight of 174.5lbs. I use the word “around” because I’m extremely bloated and my weight varies a lot. I can be anything between 180lb and 190lb on any given day. I feel fat and puffy. It’s difficult to keep things in perspective and not feel like I’m undoing all my hard work.

I’m also painfully aware that gallstones can be caused by weight loss, which feels like a punch in the gut. For the first time in my life, I have been losing weight with a healthy approach — a healthy mindset and a healthy eating plan. I haven’t lost weight quickly or followed a high protein diet, both of which are associated with gallstones. Health was one of my main motivations for losing weight, as I have a close family history of heart disease and type 2 diabetes, which I would like to avoid. I did everything “right” and perhaps it’s stupid and immature, but I feel as if I’m being punished.

Balancing everything is very difficult. I’m trying to practice self-care and focus on the positive aspects of my life, but it’s hard. I feel as though I’m being dragged backwards just as things were beginning to go well.

Logically, I know the improvements I have made cannot be undone, especially by gallstones and a dip in my mental health. I’m still managing to work and study, thanks to both having very flexible hours. I have made it to most of my gym classes, although it’s frustrating when I have to cancel one. Gaining 10lbs is hardly slipping back into my old ways when I’m 60lb lighter than I was at the beginning of last year and over 100lb under my heaviest. I know plenty of people struggle much more than me, but it’s frustrating to see my progress slow or halt when I want to rush forward.

I’m trying to think of this period as a sidestep off my path (to recovery, achieving my goals, leading a life worth living, etc) rather than slipping backwards. I need to take the time to recover and do what I can, instead of pressuring myself to chase down more goals. In fact, my goals for 2019 are all continuations of what I have been doing: losing weight/getting fitter, working on my writing and trying to improve my finances. Sure, I wish I could achieve them all at top speed, but slow progress will still get me where I want to be.

I love setting goals, chasing my dreams and challenging myself, but sometimes we need to step aside and take a break. To maintain our position instead of risking harm by pushing on, regardless of how much it hurts. Strip everything back to your priorities and do what you can, instead of stressing about what you wish you could do.