Taking It In Your Stride

“Just take it in your stride.” Good advice, right? Nobody wants to be derailed by obstacles and challenges. However, those of us who have mental health problems can find it difficult (often impossible) to take things in our stride.

Even small and/or anticipated problems can knock us off course. Setbacks seem to confirm the negative beliefs we hold or have held about ourselves:

“I am a failure and always will be.”

“I’m not good enough.”

“I can’t cope.”

We feel people are judging us for making mistakes or not being able to cope with our problems. Our thoughts can spiral out of control, so that a tiny setback leads us to think our entire lives are catastrophes.

 

So how can you help someone gain perspective?

First of all, please don’t contradict what they are saying. You may think you are showing the person concerned that they don’t need to worry, but minimising and dismissing other people’s problems is unhelpful and potentially harmful. They are already judging themselves for not being able to take the situation in their stride; suggesting their problems are unimportant and they are therefore overreacting piles on more judgment. It may not be your intention to belittle them, but that’s how your words can be perceived.

By not being sensitive to how the person in question feels, you imply that their emotional reaction is the problem. This can be easily translated as “I am the problem”, thus confirming their negative beliefs and leaving them feeling worse.

Instead, try a more compassionate and productive approach:

1. Acknowledge how they feel. They are entitled to their emotions and none of us can control our emotional reactions, though we can learn to control how we express our feelings, emotions and thoughts. Don’t start giving advice straightaway — listen.

2. Try to understand their perspective. Keep listening. Ask questions to clarify how they feel. Try to connect and empathise, so that you can learn why they believe the problem, challenge or setback is a disaster.

3. Support them. Let them know you will help in any way you can and reassure them that they can improve the situation. If they ask for advice, give it, but don’t dictate what you think they should do. Ask them questions which help them consider their options and plan their own course of action — if they feel able to take action.

 

Check your language.

An issue I have encountered a lot when talking about my problems is people dismissing my concerns, often implying that because my life has improved since my worst periods of depression and anxiety, my current situation shouldn’t bother me. I’m sure most people don’t intend to make me feel worse, but many phrases which are supposed to be reassuring can have darker implications.

For example, “look how far you’ve come” can be motivating if someone is in a positive frame of mind, but can also be interpreted as “you should be grateful for the improvements in your life and not expect more.” I find it especially patronising when spoken by people who have led relatively “normal” lives, usually when they try to tell me that my current situation is better than I think — as though I have no right to be frustrated about my mental health, financial situation and living with my parents.

Other phrases which people think are motivating or reassuring, but actually leave a lot of us feeling worse, include:

“There are plenty of people worse off than you.” True, but there are many people better off than me — including the people who like to “remind” me that things could be worse.

“Things will change soon.” Maybe, but often nothing significant seems to change for years on end.

.”You’re lucky to have X.” Again, braodly true, but when X is my dog or parents who haven’t chucked me out on the street, it feels like whoever says this is scraping the barrel.

Before you try to reassure someone, consider:

1. Are they in the right frame of mind to hear this without misinterpreting it? Often, people just want to be heard. They aren’t expecting you to solve their problems or give them a pep talk. They may want to vent or express their emotions without being told they should feel differently.

2. Would hearing this actually help them? In most cases, especially when emotions are high, the answer is no. When I’m depressed, the most inspiring stories can make me feel worse because I feel so pathetic and unable to change.

 

What can you do if you can’t take things in your stride?

Try to stay afloat. Practice self-care and do what you can to stop things getting worse.

If you can, that is. Sometimes problems and setbacks can make us feel as though we are drowning and we can’t stop struggling. Instead of letting go and hoping we rise to the surface, we try to cling to things in desperation — though clinging to them will keep us trapped underwater for longer. We cling to unhealthy relationships, harmful habits and negative beliefs. We can keep clinging, or we can let go and accept our current situation.

Acceptance is bloody hard, but it’s the only way we can stay afloat. And unless we learn to stay afloat first, our attempts to swim against the tide and change our lives will keep sucking us under. It’s a lesson I’m learning over and over.

Berating yourself (and the world in general) gets you nowhere, because you get sucked down into the same old negative thought patterns. Practicing self-care and self-love lead to acceptance. Unfortunately, as the word “practice” suggests, it’s difficult to learn to love and care for yourself, so you need to pay attention and take active steps on a regular basis.

If you feel unable to cope, please seek help and support. Your GP is a good first port of call, but there are also various helplines, therapists and counsellors. Talking to a trusted friend or family member and asking them to help you access appropriate sources of support is a good idea.

 

Long term strategy.

When you have chronic mental health issues, feeling blown off course by life events which others seem to take in their stride is a frequent occurrence. I think the trick is to recognise when you need to stop swimming and float for a while.

Doing this can feel like you are taking a step backwards, but it actually prevents you from losing progress.

Constantly swimming against the tide is exhausting, so we all need a break sometimes. If you are experiencing mental health problems, you may need more breaks than other people — perhaps more than you would like — but it’s essential to float when you need to float. In fact, it’s the best strategy for your long term success and fulfilment.

Self-care helps you to swim further in the long run 🙂

Choosing Is Hard

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

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

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

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

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

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

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

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

All potential choices may seem undesirable.

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

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

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

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

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

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

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

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

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

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

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

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

Your choices may have unexpected consequences.

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

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

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

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

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

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

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

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

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

Limboland

I haven’t posted an update on what’s happening in my life recently, for a simple reason: nothing much has been happening. I don’t want to bore everyone, but I also realise that if I want to talk about my mental health problems in an honest and open fashion, I have to include the times when I feel stuck in limbo.

My mental health has been pretty stable for over a month, which is good in many ways — but it also means I don’t feel it’s improving. It’s a frustrating situation, because I feel well enough that I want to change things but not well enough to make drastic changes. All I can do is take small steps and hope my mood improves when spring finally arrives.

It feels as though everyone else is surging forward in life and I’m stuck.

Don’t get me wrong — I’m grateful that my mental illness is better than it was before Christmas and know from experience that I could be feeling far worse, but my day-to-day life is 90% struggle and I’m sick of it. I feel like I’m working hard to improve my life, but not getting the results I want.

I’m trying to focus on the things I can work on right now: writing more, doing my OU course and improving my fitness. However, the usual worries about finding paid work and not having enough money replay in the back of my mind on a constant loop. It’s stressful and bloody boring.

I think I’m getting better at self-care though, which is something positive. In particular, forcing myself to be active helps a lot — I was too subdued to walk the dog on Saturday and it sent my mood into a downward spiral. When I make myself go for walks, I usually feel better for it. As well as having a neurochemical effect, doing exercise gives me a psychological boost: I feel like I have done something worthwhile. In my own small way, I have achieved something.

I think I just have to accept how I feel, though I wish things were different.

I can manage my mental health, but I can’t fully control it. All I can do is keep going and hope things improve.

Prepare to Talk

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

Speech bubbles

 

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

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

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

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

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

Here are some examples:

• To let my friend know I struggle with anxiety

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

• To ask my mum to help me get counselling

 

2. Prepare for unexpected outcomes — positive and negative.

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

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

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

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

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

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

Mind

Samaritans

Young Minds

 

3. Feel proud of yourself.

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

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

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

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

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

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.

Accumulating Expertise

Living with long term mental health problems involves a lot of trial and error. While some treatments and strategies have a high success rate in general, the only way to find out what works for you is experimentation – repeated experimentation. Strategies can vary in their effectiveness, both across time and in different situations. Some treatments are more difficult to access than others, such as talking therapies, which can be all but impossible to secure over long periods of time unless you can afford to pay for a private therapist or counsellor. Sometimes life gets in the way of your ability to implement strategies. During particularly bad episodes, nothing seems to work.

 

Capturing Information

One of the most challenging aspects of mental health is its pervasiveness. It affects every area of your life: career, finance, relationships, fitness, etc. – all of which also affect your mental health. Combined with fluctuations in symptoms, these factors make it difficult to assess the effectiveness of the various treatments and strategies you use to manage your mental health. Pinpointing correlations is difficult, let alone determining potential causes and effects.

Recording information about your symptoms, treatments and coping strategies presents more challenges. When you are experiencing a bad episode, symptoms saturate your everyday life and making notes is the last thing on your mind. When you feel relatively well, recording information seems like an unnecessary hassle. Achieving any level of consistency is improbable.

There are also benefits and disadvantages to different types of record keeping. Writing in a journal is my preferred method, because it helps me to process my thoughts and feelings. It captures a lot of rich, complex information and gives me insights into my mental health which would not otherwise be recorded. However, using a journal takes time to write and more time to review. Since the information is purely qualitative, it can be difficult to measure progress or decline.

Another popular method of tracking mental health is using a system which asks you to rate your mood and/or other symptoms at regular intervals. You can do this through using an app or one of the questionnaires used by mental health professionals, such as the Warwick-Edinburgh Mental Wellbeing Scale. Bear in mind that when an assessment tool is designed to be used by professionals, it may not be user-friendly or suitable for self-assessment. If you would like to try the Warwick-Edinburgh Mental Wellbeing Scale, the NHS has a handy guide for using it to assess yourself: http://www.nhs.uk/Tools/Documents/Wellbeing%20self-assessment.htm

The main drawback of using a quantitative rating or tracking system is that the information captured is reductive. It tells you nothing about the context of your symptoms, unless you make additional notes. These systems are best used in combination with qualitative information – at the very least, noting which treatments/strategies you are using and any major contextual factors, like whether you have been having family problems or have an important deadline looming. However, it provides measurements which you can evaluate over time to spot patterns and determine which treatments/strategies work for you.

Full disclosure: I think tracking your mental health with quantitative methods is a great idea in theory, but it hasn’t worked for me in practice. I used an app called Moodtrack for a while and it was useful – when I remembered and felt able to use it. It allows you to make notes when you assess your mood, so you can record other symptoms, any activities in which you are engaged, external influences, current preoccupations… anything which you think might have an impact on your mental health. The information is easy to review, but doesn’t give me the same insights as journaling. Neither does tracking my mood and symptoms improve my mood in the short term, whereas using a journal makes me immediately feel better.

 

Research and Development

Finding the strategies which work for you involves a vital first step: being aware of potential strategies. You can learn about what works for other people from a variety of sources, including books, forums, blogs, social media and chatting – just beware of people who portray a certain treatment or strategy as a miracle cure. Most people find they have to use a variety of treatments and strategies to manage their mental health, although one or two strategies may be at the core of their approach.

Try to keep an open mind when considering strategies; often, activities which seem insignificant or a little strange can have a big impact. For example, meditation is frequently dismissed as being too hippy-dippy or a waste of time, but scientific studies and anecdotal evidence testify to its efficacy. You may not realise the value of a strategy until you stop doing it, which is what happened when I failed to use my SAD lamp regularly last winter. It’s fine to give up on strategies if they are too time-consuming or otherwise impractical, but commit to giving them a fair shot first.

Choose one or two strategies at a time: trying to incorporate too many at once is tricky, puts you under too much pressure and makes it difficult to tell which strategies (if any) are having a positive effect. Start with the ones which you think might make the most difference to you, or which are easiest for you to implement. Activities which don’t need any special equipment, like walking and meditation, are good starting points. Strategies which can be done inside your home also tend to be more accessible, like mindfulness colouring and yoga.

Anything you can do to make it easier to try certain strategies is a great idea. This could mean exercising with a friend for support, joining a class to keep motivated or setting reminders on your phone for self-care activities. Think about what you need. What are your particular preferences and obstacles? Selecting strategies which you believe you will enjoy is a good way to ensure you keep doing them long enough to assess their effects. Think about how you can increase the enjoyment factor of specific strategies, such as listening to your favourite music when you run.

Keep reading about mental health, but remember that you can find strategies which can help you to manage your mental health in other fields. For example, I find that decluttering lifts my mood and helps reduce my anxiety. I also feel better when I watch films, read and study. You may discover that different strategies work at different time, so have another shot at strategies which previously haven’t worked for you to see if anything has changed. This was the case for me with running: I tried it in my late teens and hated it, but now use it (along with other types of exercise) as one of my core strategies.

 

Expectations and Judgments

Mental health problems can be unpredictable. Everything can be going well and then, without warning, your symptoms worsen and your mental health plummets. It isn’t fair and you think there must be a logical reason for the decline, so you blame yourself. Maybe you didn’t implement your strategies as well as you could have, or you think you should have done more. You expected your mental health to improve or remain constant, but it didn’t – so you judge yourself for failing to live up to your expectations.

In an ideal world, you would be full of self-compassion and never judge yourself, expecting nothing and accepting everything with gratitude. That obviously isn’t going to work in real life: it is normal and natural to feel frustrated, angry and disappointed when your mental health dips. We grow up with the myth that if we work hard, we will be rewarded. We don’t like to be reminded that this isn’t always true, especially when we are the ones disproving the myth. Mental illness sucks precisely because you can everything to the best of your ability, incorporating coping strategies and seeking treatment when needed, only to slide into another awful episode.

I haven’t found a solution which enables me to control my expectations and stop judging myself – but I’m better than I used to be. You have to keep reminding yourself that you are not to blame for your mental illness. You have to try to enjoy the relatively good episodes and appreciate them. Most of all, you have to keep hoping you will get the balance right.

 

Achieving Balance

Managing long term mental health conditions is a balancing act. There will be times when you wobble and times when you topple over; the trick is learning how to regain balance. Picking yourself up after a bad episode is horrible. It feels like all your hard work has been erased and you are back to square one. But this is never true.

Every time a bad episode knocks you off balance, you learn something. It can take a long time to realise what you have learnt, but it is true. Every time you dust yourself off and manage your mental health well enough to see infinitesimal improvements in your symptoms, you learn something. Maybe you learn that you are stronger and more resilient than you believe. Or perhaps you find support in unexpected places, from new friends or acquaintances who have always been at the periphery of your life but now step up to help. You might learn about which values contribute to your wellbeing, finding hope in creativity, generosity or nurturing.

I think experiencing long term mental health issues is a process of learning. You are accumulating expertise about yourself and your particular mental health problems. You learn about what feeling mentally well means for you and which strategies help you get there. You learn to notice when your symptoms worsen and you need to increase self-care activities. You learn when to ask for help and what help you need.

You learn a lot about other people, too. You learn that some people are insensitive bastards who spread negativity wherever they go. You learn that others are ignorant and have no idea what impact their words and behaviour have on vulnerable people. You learn that some people are spiteful and will use your mental illness as an excuse to bully and abuse you.

However, you also learn that a lot of people are kind and caring. There are people who dedicate huge amounts of their time to helping you, both in official capacities and through friendship. You learn that your true friends will listen without dismissing your problems or telling you about people who are worse off. You learn who you can rely on for support during the darkest times, when you can’t even trust yourself.

Most of all, you learn a great deal about yourself when you experience mental health problems. It forces you to examine your life and what you would like it to be. You learn that you can cope with more than you thought possible. You learn about true strength, courage and confidence, which are not about presenting yourself as imperturbable and indestructible, but are about following your own path even when you feel like giving up.

Accumulating expertise in your own life is hard work and difficult, but brings many rewards. It helps you deal with the bad times, but also helps you seize opportunities during the good times. It helps you to recognise your vulnerability as strength and develop empathy for others. It helps you to live your life.