I’m currently recovering from a terrible episode of gallstones pain — well, it was a few of my worst episodes strung together over a few days and the first really bad episodes I have had since February, so a shock to the system. To clarify what I mean by “bad”, it involves me writhing on the floor in agony. The day after the last bad episode, my pain was still intense enough that I couldn’t bear to move unless it was absolutely essential. However, the most frustrating part of the experience was that it’s my own fault.
Okay, I didn’t ask to have gallstones and it’s not my fault that the current NHS waiting lists are ridiculous, thanks to the government penalising consultants for working overtime, so I haven’t had my gallbladder out. Maybe I wouldn’t have developed gallstones if I had stayed a healthy weight all my life, but overeating was how I dealt with my mental illnesses and one of the few coping strategies which was accessible to me during the years when I was scared of leaving the house alone. However, my recent painful episode could have been avoided if I had paid more attention to what was happening.
Since mid-May, I have relaxed my diet. I still want to lose another 20-30lbs, but a few other things took priority and stress took over during the final 2 months of my temporary job. I wasn’t eating a huge amount, but I was eating crap: more refined sugar and processed foods, fewer vegetables. I should have listened to my body as my gallstones became “noisier” but I pushed on, focusing on work and eating junk to deal with the stress (old habits die hard).
Fast forward to a couple of weeks ago and I realised that not only was I experiencing the worst episodes of gallstones pain I’ve had in a while, but my mood had plummeted. I needed to take control of my health.
I also had a minor epiphany: when my gallstones pain and mental health were better than they had been in ages, in March and April, I had been following a diet which limited processed foods and cut out sugar. I was also eating a lot less wheat. Feeling desperate, I decided to go back to basics and cut out junk food, processed food, wheat and refined sugar as much as I could. The worst that could happen, I figured, was that it would make no difference to the pain and I would get better nutrition.
Thankfully, my change of diet was very effective. Within 4 days, I felt well enough to return to kettlebells class (taking it easy). Within a week, I was no longer taking painkillers. After 10 days, I no longer needed to constantly use heat pads and lavender oil to reduce the pain. In addition, my mood improved — which could be due to the psychological effects of feeling a little more in control, as well as the change in nutrition. Nothing miraculous has happened, but I’m back to baseline gallstone pain levels and my depression has eased enough for me to feel a little more human.
In addition to diet, I think my experience was impacted by other factors. When my temporary job ended in July and I found out I had passed my Open University modules, there was an easing of pressure. I was no longer pushing myself to keep going through pain, stress, anxiety and depression at any cost. I could stop. But when I stopped, I felt drained — especially emotionally. I’m pleased to have completed my work project and OU modules, but neither went according to plan and I’m disappointed that I wasn’t able to maximise my opportunities or enjoy them a little more. Now I could stop, I had to process all of these emotions.
Needing a lot of recovery time is something I have learnt to accept in theory, but it’s frustrating. It typically takes me a few days to recuperate from a day out, which most people find relaxing in itself, so I suppose I should have expected a period of lethargy when the challenges of studying and working drew to a close. Trouble is, I want to keep going! I feel as if I have wasted most of my life because mental illness has had such disabling effects over the years, so I think I should push on as much as possible when I feel able to do more. Perhaps the gallstones pain was a blessing, because it has reminded me to put my health (physical and mental) first and foremost.
So what does taking control mean for me?
Prioritising self-care is essential. I’m sticking with my dietary changes, since I feel so much better in such a short time, and I want to improve my fitness. Yesterday, I had a run on the treadmill for the first time in 3/4 weeks and realised how much I have missed its mood-boosting effects, so I want to work on running farther at my new, faster pace (I have been working on speed this year, after focusing on distance for last year’s half marathon). Taking the time to practice yoga and meditation is also a habit I want to establish over the summer.
The other side of self-care is about putting myself in a better position to achieve my goals. I’m not entirely sure what that will involve, because the first step is to reflect on my progress and decide what’s important to me right now. A summer reset, if you like, before I start my next OU modules in October.
Paradoxically, a huge part of taking control is accepting that I can’t control everything. As the mental health literature reiterates, you can’t control what happens to you — but you can control your response. I had hoped this year would propel me towards a better future, but instead of feeling confident about building on my knowledge, skills and experiences, I feel beaten up. I hope that taking plenty of time to rest and work on my health over the next month will help me feel stronger.
Whatever happens, I will try to remind myself I am making progress — even when it feels so slow that it might not count. I spent too long living life on pause when my mental health was at its worst, so I’m not going to let the gallstones do the same.
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
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
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
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.
I submitted my final assignments for the Open University modules I’m studying this year well before the deadlines and I’m going to explain why I don’t consider this a Good Thing. The last two assignments are End of Module Assessments (EMAs) which are supposed to be analogous to exams, so there are no deadline extensions. Since my mental health is unpredictable and my current physical health even more so, I had to make contingency plans in case my mental health plummeted or I had bad gallstone attacks in the weeks before the deadline. It’s a coping strategy I wish I didn’t have to implement, but I have learnt that this degree of flexibility is necessary for me.
Preparing to be thrown off course by my mental health is an integral part of goal setting. In this case, I had to get ahead when I felt well and finish the previous two assignments, with deadlines in April, as soon as possible so I could focus on the EMAs. It was pretty intense, but ensured I had several weeks to work on the EMAs. Do I really need several weeks’ leeway? Absolutely. My health can easily become a huge issue without warning. My mental health can go into freefall and the scariest aspect is, sometimes several weeks wouldn’t have been enough leeway.
I was lucky this time around. My mental health has taken a downturn recently, but I could work around it.
What does “working around” my mental health mean?
Put simply, it means doing whatever I can, whenever I can. It’s how I live my life. Some days I can function like any other person and be very productive; some days I am unable to do anything other than slump on the couch, my mind whirring but producing nothing. Most days are a mixture.
Living with mental health problems is difficult, so I have had to devise coping strategies which work for me and help me to be more productive. These include:
Identifying my priorities at any given time. When mental illness limits the number of hours I have available to work (or do anything else), I need to know the best way to spend those hours.
Being super-organised. Depression and anxiety affect my memory, so I write everything down. I need to know my goals and break them down into tasks. I put these tasks on my to-do list, which is divided into high, medium and low priority tasks for each week. I also have a future to-do list, for tasks I can’t or don’t want to complete at the moment.
Being flexible. Because my mental health is unpredictable, scheduling tasks on specific days doesn’t work very well for me, so I try to avoid it unless it’s absolutely necessary. I sometimes allocate tasks to certain days, but I don’t beat myself up if I can’t stick to this plan.
I wish I didn’t have to use these coping strategies. I would love to be able to plan to work on my EMAs for a few weeks before the deadline, like most other people, but no possibility of an extension means I need to prepare for ill health.
This also applies to all other aspects of my life.
I’m sure some ignorant people assume I can do non-work tasks without making contingency plans and these are probably the same people who think mental illness is just an excuse to avoid work, but my mental health affects all aspects of my life. I have had to cancel countless enjoyable activities. For every night out I’ve had with friends, there were five I had to cancel at the last minute and hundreds I never planned because I knew I couldn’t handle it. When my mental health dips, I struggle to do anything, including leisure activities I can do at home, alone. During these periods, I can’t even read or concentrate on watching a film.
I used to feel incredibly ashamed of being forced to live this way. Many friends slipped away because they didn’t understand why I couldn’t go out like a “normal” person and often struggled to leave the house at all. They got bored with hanging out at each other’s homes when anxiety prevented me from going to the cinema or a café. However, as I get older, I’m learning to accept that this is the way it has to be. For now, at least. If so-called friends can’t accept my mental health problems, they can thank their lucky stars they’re not in the same situation and fuck off.
I wouldn’t have chosen this life of constant contingency planning, but I’m learning to make the best of it.
I’m getting better at controlling the things I can and letting go of whatever I can’t control. Better, but nowhere near perfect! I still get frustrated with myself, the universe and life in general, but I keep working towards my goals. My aim is simple: improvement. My life probably won’t change completely anytime soon, but most days are bearable and I’m proud of the goals I’ve achieved.
I can’t celebrate submitting my EMAs early, because I wish I didn’t have to rely so heavily on contingency plans, but I’m proud that I submitted them. Two years of my part-time Psychology BSc down, three (hopefully) to go!
The clocks going forward is always welcome to me, because the improvement in my mood is almost immediate. Everything shifts. It doesn’t mean I don’t have bad days and my depression doesn’t get cured miraculously, but I’m a little less depressed and it’s a little easier to cope. I feel less overwhelmed.
The brighter evenings make it easier to use some coping strategies which I find helpful, including spending more time outside and exercising outside. I can organise my day so that I can make time to walk or run in the evening. The change to BST is a powerful reminder that spring is here and summer is coming: things will change and get better. When my days are (generally) brighter and warmer, focusing on the positive aspects of my life becomes more natural to me.
Summer will also bring the end of my second year studying for a Psychology BSc part time with the Open University. I have three assignments left to complete for my two modules. It has been a difficult academic year, because the first half coincided with my gallstones making themselves known. Before I got diagnosed, I found it incredibly hard to cope. Until the past month, I was constantly trying to catch up on the work I had neglected when I was ill, falling behind on one module as I struggled to meet an assignment deadline for the other. I wish I had managed to enjoy studying more, as I find the subject fascinating and a lot of the material resonated with me.
Thankfully, my gallstones are a lot quieter at the moment, although I dread another bad attack. I still have the baseline pain and nausea, but I have found ways to cope. A friend recommended rubbing lavender oil on my stomach, because it’s anti-spasmodic, and that has been more effective than anything else I have tried (thanks, Su!). I also rely heavily on heat pads and find that intermittent fasting (eating during an 8 hour window) helps a lot. I still get moderate attacks, but not severe ones like I was getting from October to January, which left me writhing on the floor in agony. I’m hoping this will continue until June, because my end-of-module assignments are due at the end of May…
I’m also coping better because I’m exercising more, although there is some circularity in that it’s easier for me to exercise more when I feel better! I have been running again, which is brilliant for both my mental health and the gallstones. Although it’s difficult to ignore the gallstones pain, especially as it likes to affect my back and the tops of my hips (the iliotibial band), the endorphins kick in after 10-15 minutes and are an effective painkiller. I get a psychological boost from exercising, as well, because it helps me feel fit and strong. Knowing I’m getting stronger physically helps me feel as if I’m getting stronger mentally.
It finally feels like I’m moving forward again, after a hard winter. I’m making progress towards my goals, even if it’s slower than I would like, and things are beginning to change.
I have spent four months in”maintenance mode” and I’m sick of it. While it was necessary to cope with the pain of my gallstones, especially for the three months when I didn’t know what was wrong, I felt as if my life was on hold and my mental health was suffering. The gallstones seem to have calmed down: I still have the baseline pain and constant nausea, but I’m learning to handle it and the really bad episodes have become less frequent. Combined with the frustration of feeling stuck, I decided it’s time to refocus on my goals.
Top of my list is getting back to losing weight. It feels strange to admit, because I struggled with an eating disorder for many years, but the past few months have taught me that health is valuable and shouldn’t be taken for granted. I already knew that, but life has a way of re-teaching the lessons we need to learn and in this instance, the lesson was about physical health. I want to lose weight primarily to reduce my risk of heart disease and diabetes. My dad has both of these conditions and recently had a heart attack and double bypass. I don’t want that to be in my future, so I’m trying to avoid it by taking control of the factors I can influence: being a healthy weight, staying fit and eating well.
Exercising is also a priority, mainly because it’s the most effective way of managing my mental health. My doctor has encouraged me to stay as active as I can, because it will help me recover faster when I have surgery to remove my gallbladder. Knowing I can exercise without causing damage is a huge relief, especially after exercising caution when I didn’t know what was wrong, and I feel better when I exercise more often. My anxiety is easier to control and I feel less depressed. I also feel better physically, in a way which is hard to describe: generally fitter and stronger. Like I can handle anything that comes my way.
I’m slowly beginning to piece my life back together and have begun challenging myself a little… One of my mini-goals for this year is to be more confident when driving and I recently drove on my own for the first time in approximately two years. It feels strange to admit, because I passed my test nearly nine and a half years ago, but driving became a source of anxiety for me and it was easier to avoid it than to suffer. And that’s okay. I may feel a bit ridiculous for being unable to drive for such a long period, but I think it’s something I needed to do.
The past four months have been a reminder to take care of myself and switch to “maintenance mode” when I need to, but they have also taught me not to let problems stand in my way. It might be a while before my gallstones get sorted out, so it’s another burden I have to carry, but I’m pretty damn strong. I can take the weight and keep pushing onwards and upwards.
I spend a lot of my time thinking about goals, which are both a key strategy in managing my mental health and a source of frustration, anxiety, disappointment and other feelings which contribute to my mental health problems. On balance, working towards my goals (and achieving some of them) has a positive influence on my life. They give me a sense of purpose and fulfilment. However, this year has been a little strange, because one of my goals is becoming very visible to other people: I want to lose a lot of weight and have lost almost 5 stone.
Announcing my goals is something I find very awkward, even when it’s necessary. For example, fundraising for charity was an integral part of my trek to Machu Picchu last year and telling people about my goal put a lot of pressure on me. On the other hand, being open also enabled people to give me a lot of support and encouragement, which helped me achieve my goal.
Odd as it sounds, one of the few advantages of severe mental illness is that nobody has any expectations of/for you. During my worst points, I felt my life was such a huge disappointment and burden to people that I couldn’t disappoint them any more than I was already disappointing them. Having a shower or cooking a meal was a massive achievement; I had no other goals.
So having goals is a positive sign. I am trying to live a better life and working towards my goals indicates that I have some degree of hope (if not confidence) of achieving them. However, there is a shadow side: I’m terrified of disappointment and every failure along the way is a reminder that I have let down my family, friends and myself.
But people don’t always see the failures.
People complimenting me on my weight loss is great, especially since I can’t see the difference as clearly myself, but it has made me think a lot about how my experiences differ from what people see. It has also made me realise there are parallels with other goals and aspects of my life, which are less obvious because I can’t measure them in the same way that I can track my weight and clothes size.
My weight loss has become more visible over the past few months, so people see I’m now a size 14 instead of 18. They didn’t notice the first few months of this year, when I started eating less/more healthily but couldn’t see the results. People don’t see the weeks when I lose no weight, despite following my eating and exercise plan. They don’t see me getting frustrated and discouraged because the effort doesn’t seem to be paying off.
Likewise, people view my mental health from the outside. They only see me on my good days, because I can’t leave home on my bad days. My anxiety may seem much better, particularly as I get used to specific situations (gym classes, writing group), yet I still get panic attacks. I’m still too scared to drive or into a shop alone. There are days when I spend hours worrying about everything from whether my dog seems a little “down” to if I will ever repay my debt or move out of my parents’ house.
The outside only shows part of the picture. Yes, I have lost weight and my mental health is generally better nowadays, but neither has been as straightforward as it seems. My progress hasn’t been linear — and my mental health can be very erratic — but it looks linear to other people, who don’t see the effort, frustration and frequent disappointments.
The changes started a long time ago and it has been a rocky road.
While I consciously choose to work towards my goals at particular times, my ability to do so is often rooted in changes I made long before setting them. At my highest weight, during the final year of my BA in 2010-11, I was a size 26 and have no idea what I weighed except it was definitely over 20 stone. Yet I had already begun to make the mental changes which are helping me to lose weight this year: when I decided to go to university, I decided I was worth the effort. I was worth the expense. I was worth the risk of failure, embarrassment and disappointment.
At 18, when I had a place at another university in a different subject, I made a different decision. My self-esteem was nonexistent and I didn’t think I was worth the cost. I wasn’t worth the hard work.
I went through a lot of pain and despair before I started to build a little self-esteem. I took antidepressants and had counselling. I tried to help myself, but I failed a lot of the time.
Along the way, I tried to cheat my way to self-esteem by losing weight, going from a size 18 to a 12 in a few months. (Sidenote: sacrificing muscle tissue for a lower number on the scale is a stupid thing to do and takes ages to repair). I half starved myself, binged because I was hungry and then punished myself by eating even less. Over and over. I thought I would like myself if I could fit into a size 12, but I was wrong.
Eventually, I got sick of my life. I was 23 and my mental health had improved a little, but I hated everything about my life apart from my dog. One of my best friends was working in Spain at this time and had invited me to stay with her for a low cost holiday. I hadn’t been away since a family holiday when I was 17 and I love sunshine, so I was tempted. I had enough money for flights, food and spending. I was running out of excuses — except the usual one of having crippling anxiety. But I was sick of that excuse, too. I booked my flights and knew I would have to go through with it, even if I failed.
Looking back, I think that was the start of believing I was worth anything. I was sick of staying inside the house and missed my friend, but I also wanted to be the type of person who could travel somewhere. Someone who wouldn’t be fazed by going on a plane alone (and for the first time, to boot!).
That holiday changed my life because I realised I could do more than I anticipated. I could travel by plane without having a panic attack. I could wander around Valencia alone. I could even speak a few phrases of Spanish, including “I miss my dog!” I loved the holiday and it was well worth the costs. It opened up the possibility that I could do more. By the time I got home, I had decided I would try to get a place at university the next year.
I hedged my bets a little, going to my local university to minimise expenses and ensure I had some support at home, but I was trying to achieve something I had once thought was impossible. I believed I had missed my chance of going to university, but I was proving myself wrong.
My graduation was one of the happiest days of my life. So many people point to photos of themselves at their highest weight and say how miserable they felt, but I was happier than I had ever been. I was still struggling a lot and my weight is an indication of that, because I have always had a tendency to comfort eat, but I had finally gotten a degree. I was disappointed to have missed out on a First after my grades dropped in the final year, thanks to the stress of being diagnosed with borderline personality disorder and an eye condition which can lead to blindness in a single month, but a 2:1 was better than no degree. Besides, I already had a place on the Creative Writing MA course and was focusing on the next goal!
I became concerned about my physical health, which had taken a backseat for a long time. My fitness was atrocious and my habit of buying crisps and chocolate bars at the university shop had to stop now I didn’t have a student loan to finance the habit. I was too scared to walk outside alone, so I bought a treadmill (which is how I know I was over 20 stone, because I had to take weight limits into account when choosing one) and started walking. By the end of summer, I had dropped to a size 22.
I can pinpoint my current attitude to that summer: I started focusing on fitness and weight loss as a path to better health. The journey since then has been up and down, but although my weight has fluctuated a little, I haven’t gained a dress size since that time. I was finally making lifestyle changes — and for the right reasons.
I know I have come a long way, but it doesn’t always feel like it.
Part of the reason why I set myself a lot of goals is because so much of my life seems to stagnate; working towards goals reminds me that I’m making progress. I think this is especially important because monitoring my mental health is difficult.
Many aspects of mental health are intangible and while some symptoms improve, others regress. For instance, my anxiety and depression are generally much better than in my final two years at university, yet I drove 50 mile round trips to lectures four times a week and the most I have driven this year is a few 7 mile trips with my mum beside me. Having goals stops me from fixating on what I can’t do, switching the focus to what I can and might be able to do.
I achieved one of my key goals for this year at the weekend: I ran a half marathon. It has been a useful goal because, in addition to improving my fitness, running teaches me a lot about life. My main goal was to complete the half marathon, which meant I had to learn to pace myself. However, I also wanted to finish within 3 hours if I could, which meant pushing myself. It was difficult to balance these approaches during the race, but my mum and I made it in 2:59:51. Yep, a whole nine seconds to spare!
Knowing when to pace myself and when to push myself is one of the most challenging aspects of any goal. Part of the challenge is to appreciate how far I have come while focusing on where I want to be. It’s difficult not to get frustrated about how far away the end goal is, especially when working on something which will take months or years ro achieve. I find myself comparing my experiences to other people’s achievements — which is a fallacy, because as I pointed out at the start of this marathon post (pun intended), the outside doesn’t reflect the true experience.
Playing the long game, you have two choices: keep going or give up.
As with running long distances, working towards long term goals involves a lot of different factors. You need to develop a strategy and assess your energy levels to know when to push and when to pace yourself. You need to train and learn from your mistakes.
Gradually, you learn what works best for you and realise there is no point comparing yourself to other people. No matter how fast the other runners are, the only person you are really competing with is yourself. I suspect this is true even for elite athletes, who want to break their personal bests as well as beating the competition, but it’s especially true for those of us who just want to do our best and finish the race.
An advantage of playing the long game is that there’s always another race, another chance to make strides towards your goal. You might not manage it in the same way or time frame as you planned, but every experience teaches you something which will help you (eventually) achieve your goal.
The alternative is to quit, which guarantees you will never achieve what you want.
Achieving my goals is never pretty or easy. I often feel the universe is testing me or taking the piss — especially when my glasses broke 40 minutes before the start of the half marathon, meaning I had to run half blind — yet these additional challenges are what make my experiences unique.
I know I can run 13.1 miles without being able to see anything more than colourful blurriness and the three feet of ground in front of me. I can complete a four day trek while contending with altitude sickness, multiple panic attacks and a throat infection. On a more mundane level, I can write and study around the symptoms of my mental health issues. I can force myself to do a gym class straight after having a panic attack. I can make healthy choices most of the time, even if part of me still wants to munch crisps and chocolate.
I don’t always feel like carrying on, but I keep going because it’s the only way I have a chance of getting what I want. Challenging myself is the only way of discovering my capabilities. The long game is a massive commitment, but the potential rewards outweigh the sacrifices.
I was recently upset and appalled by an article in the August 2018 issue of Psychologies magazine, which I previously respected and have found useful in the past, referring to people who have borderline personality disorder as “energy vampires”. I have written to the editor, explaining how the article perpetuates stigma and thought other people might be interested in what I have to say. The article refers to a book by Christiane Northrup which I have not read (and have no intention of reading if it has been accurately represented), but my main concern is with what Psychologies actually approved and published.
I am writing in response to the “How to avoid the energy vampires” article featured in the August 2018 issue of Psychologies magazine. The opening paragraph states: “When I use the term ‘energy vampire’, I’m talking about a subgroup of people — about one in five of us — who, in psychiatry, are called Cluster B personalities, with narcissistic, borderline, histrionic and antisocial personality disorders., and there’s a spectrum; you can certainly live with someone who’s a little self-centred and has narcissistic traits and then, at the other end, there are full-blown psychopaths.”
This email shall discuss borderline personality disorder (BPD), simply because I don’t feel qualified to comment on the other conditions mentioned. I have personal experience of BPD, having been diagnosed in November 2010, at the age of 26.
Labelling people with a mental illness — which includes BPD — is always harmful and increases stigma. To label us “energy vampires” is offensive. While the article mentions a spectrum, it uses the term “energy vampire” to refer to all people in that spectrum, including all people who have BPD. I can’t imagine that this paragraph would be accepted if, instead of referring to personality disorders, it had referred to depression, anxiety (both of which I also have been diagnosed with) or a physical illness.
Unfortunately, some mental illnesses continue to receive a disproportionate amount of stigma, stereotyping and discrimination compared to other mental illnesses. BPD is a key example and part of the problem is that it’s misunderstood, rarely being mentioned in mainstream media. On the rare occasions it is mentioned, such as in this article, it’s usually in negative terms.
The extent of this stigma can be seen across the internet and social media. Whenever Mind or Time to Change publish a blog post written by someone who has BPD, there are inevitably Facebook comments which perpetuate the negative stereotypes and stigma. These comments usually say that people with BPD are a nightmare to live with, difficult to interact with and generally not worthy of good relationships. Because BPD has not received the same amount of positive publicity as other mental health issues, people cling to the old stereotype as portrayed in Fatal Attraction. Yes, the most common impression people have of BPD is garnered from a 30 year old, misogynistic film!
Given this background, it should be obvious that labelling people with BPD as “energy vampires” feeds into the existing stigma.
I appreciate the apology you gave on Twitter and welcome any efforts to educate the general public abot BPD. There is a lot of ignorance and lack of understanding surrounding BPD, so positive representations would go a long way in addressing the damage caused by negative depictions and references. Many of us make positive contributions to our friends, families, communities and societies, but this is rarely mentioned in mainstream publications such as Psychologies.
If people with BPD are difficult to deal with, it’s because they are not receiving adequate treatment, help and support. This article makes no mention of this, simply terming all sufferers “energy vampires” who have a negative effect on the people around them.
Ironically, I had bought the magazine because I was interested in the “restore your energy” dossier and as BPD makes me incredibly sensitive to other people’s moods, I identify more as an “empath” than an “energy vampire”.
I would like to see Psychologies increase understanding of BPD. The negative stereotype is ridiculous considering the range of symptoms which can be experienced: individuals who have BPD may seem complete opposites. For example, both promiscuity and withdrawing from romantic relationships can be symptoms. Of course, the name itself is difficult for the general public to understand, with its connotations of character defects — many people assume BPD means “bad personality”. A lot of people I encounter don’t even realise BPD is a mental illness.
Please show that people with BPD are worthy of love and respect. We are capable of maintaining good relationships and contributing to other people’s lives in positive ways.
For example, I volunteer with a local youth mental health organisation. Last year, I ran a crowdfunding campaign which secured £15,000 to save our peer support groups in one particular town, which had been threatened with closure. In May last year, I completed a four day trek to Machu Picchu and raised over £1000 for Amnesty International, despite having panic attacks throughout the final morning of the trek. I blog about my mental health in an attempt to inspire other people with mental health issues to achieve their goals.
However, my own contributions are very small compared to a lot of people who have BPD. On Twitter, I see amazing examples of activism and personal achievements. People who are amazing parents, partners and professionals. Yet I never see them mentioned elsewhere.
I hope this email has explained why many of us with BPD find the article offensive and worry about its potentially damaging effects.
Update: Psychologies magazine’s editor, Suzy Walker, has emailed me to take full responsibility and says that she is taking steps to ensure this doesn’t happen again and to promote understanding of BPD. She also invited me to blog about BPD on the magazine’s Life Labs website: click here.
I am impressed with Suzy’s response and optimistic that this mistake will lead to positive outcomes which will reduce the stigma surrounding BPD.
Progress in anything is often slow and nonlinear, but these qualities are exacerbated when you have mental health problems. In particular, anxiety and depression can create conflicting symptoms: it feels like I’m progressing too slowly and have the urge to rush into everything, yet it’s difficult to find the energy and feel motivated, plus many activities are too challenging. It feels like being torn in different directions.
I have been feeling this way a lot over the past few months. So much of my time has been lost to mental illness that I feel frustrated when it steals more time from me. I’m glad and grateful that nowadays these increments of time can be (usually) measured in hours, days and weeks — in the past, they were most commonly measured in months and years — but it’s still stolen time. Time I can never get back.
My frustration might be due to my experience of losing so much time during my teens and twenties, when most of my peers were achieving amazing things, changing their lives and having fun. I may never reach the milestones of adulthood which the majority of people consider “normal”, like living independently and supporting myself without relying on state benefits, so it feels like everyone has overtaken me. I feel a deep need to prove myself, to demonstrate that my goals are worthwhile and I can make a valuable contribution to the world.
I constantly worry I am failing at life. I tend to dismiss my achievements, because it feels ridiculous to be proud of them when I struggle with tasks that most people find easy. I pressure myself to reach high standards because I hope it can atone for my failures, which include relying on my parents and finding driving a huge challenge nearly 9 years after I passed my test. If I could choose to exchange my achievements for being able to do everyday tasks, like shopping on my own and holding down a full time job, I think I would. Other people, I suspect, would find me more acceptable.
Lately, I have been in a reflective mood. I think it’s because I had to wait several weeks for my results from my first Psychology module. In the event, I got an overall score of 95 and surpassed my expectations, but I was anxious about failing because it would effectively terminate my pursuit of the degree. I managed to almost convince myself I had messed up my final assignment so much that I had failed the module. As frustrating as it was to waste yet more time worrying for no reason, my anxiety sometimes gives me insights: studying Psychology is very important to me.
While it should be obvious that I’m not choosing to accumulate more student loan debt for no reason, I think part of me worried about my reasons for pursuing a Psychology BSc. I have no career path mapped out. No way of knowing how my mental health will affect my life when I complete the qualification. However, I do feel a strong desire to improve my understanding of psychology and mental health so that I can help others. Perhaps I will do this through my writing; perhaps it will be via research or something else. I don’t know the route I will take, but I have clarified my first steps and am heading in the right direction.
The experience has highlighted a few truths:
1. There will always be waiting periods in my life, whether it’s waiting to hear about results or taking action in the face of excruciatingly slow progress
2. My mental health issues might mean I have more waiting periods than the average person
3. The only way to deal with waiting periods is to accept them
Acceptance is bloody hard.
Acceptance. It’s a simple concept, but difficult to practice. My instinct is to get upset: “why should I accept chronic mental illness when other people don’t experience it at all or for shorter periods?” And no, reminding myself that other people experience more severe mental illness for longer periods doesn’t help. Yet acceptance is the only way forward, because fighting against mental health problems doesn’t work — you have to take a collaborative approach, working within your constraints while pushing for progress.
Unfortunately, accepting my mental health issues can be difficult for other people. Many friends have dropped away because they couldn’t understand my symptoms, or why my symptoms differ from their own experiences of mental health problems. I know I’m better off without these “friends” but it’s still painful. Society in general doesn’t seem to accept mental illness. Even when people express understanding for “high functioning” people who have mental health issues, they are quick to judge those of us whose ability to work is affected. Stigma still prevails: people assume you are lazy if you need to rely on benefits, many express sympathy while acting in unsympathetic ways and judge you based on how you appear on your good days, without considering how they might be outweighed by bad days.
It’s difficult to accept your own situation when other people send negative messages. Even common assumptions can be hurtful for those of us who don’t fit the “norm” and these assumptions seem to increase as I get older. People assume a woman in her mid 30s should have her own home, be in a serious relationship, work full time, want or have children, socialise at least a few times a week, etc. I don’t fit the pattern and probably never will.
Yet everything boils down to the same old truth: improving my situation requires acceptance.
Learning to be patient.
I know comparing myself to others is ridiculous. Everyone’s situation, experiences and challenges are unique to themselves. All I can do is work on my own goals, try to improve my mental health and hope it all works out in the end. Oh, and I should probably try to enjoy my life along the way!
Maybe that’s the key to self-care, achieving goals, managing mental health and life in general: to aim for progress, not perfection, and have fun whenever you can.
Setting deadlines for myself isn’t always healthy, although they can sometimes help me to feel motivated. Sure, I would love to turn my life around in an instant, but that’s not realistic. I need to hold on to the positive aspects of my life, especially when they are overshadowed by the negatives, and see what happens.
A year ago today, I started a 4 day trek to Machu Picchu. It was the biggest and most difficult challenge I have voluntarily undertaken, but also one of the best. While it didn’t immediately transform my life, as I had hoped, it has changed me in ways I’m just beginning to realise. The greatest effect is cutting through my excuses. I completed a major life goal, despite struggling with my mental health. Why shouldn’t I achieve more goals?
In this spirit. I set myself a lot of goals this year. Some are boring and mundane (adding to savings, submitting more short stories), but a few are more exciting. One of them was to complete a tandem skydive from 15,000 feet.
As you can probably guess from the photo, I did the skydive yesterday — which happened to be my birthday.
Last year, I spent my birthday doing an acclimatisation trek in Peru and being serenaded in a restaurant with the world’s longest version of Happy Birthday. I was surrounded by a wonderful group of people who have become my friends, but I was thousands of miles from home and had woken up very early, sobbing because I was scared I was making a huge mistake. I was worried I wasn’t capable of achieving any of my dreams, including walking miles up very high mountains.
My birthday this year was very different: I was at home and spent the day with my parents. However, I also wanted it to be as memorable as last year, so I scheduled the skydive and hoped for good weather.
Although the skydive was on a much smaller scale than Machu Picchu, it involved a lot of preparation. My first task was to get under the 210lb weight limit (the website says you can jump if you are heavier, but you have to tell them in advance and pay a surplus, so I wanted to avoid that), which was a big commitment since I started the year at 244lbs. I weighed in at 201.5lb yesterday morning and a few pounds heavier in my clothes and trainers when I got to the airfield, which was a relief!
I also needed to have my doctor sign a medical form to state that I was allowed to jump, because I have received treatment for mental health problems within the past 2 years and have a history of self-harm. I had an appointment a couple of weeks ago and my GP declared that I was at no extra risk compared to any fit, healthy person.
I understand the reasons for needing my GP to sign the form, but it feels disempowering to be told that I can’t sign my own medical form. I know my own mind very well precisely because I have mental health issues. Managing my mental health effectively involves monitoring my mood and motivation for doing certain activities. Far from being a form of self-harm or method to boost fragile self-esteem, the skydive was my way of celebrating my achievements and rewarding myself for getting through the almost constant struggles.
Because I still struggle. Every small achievement, from walking the dog on my own to completing an assignment, involves facing my anxiety, depression and BPD and managing my current symptoms.
My symptoms are less apparent to other people nowadays; partly because they have lessened in intensity, but mostly because I am much better at managing them. I was anxious yesterday, for example, but didn’t appear more nervous than anyone about to be hurled out of a plane for the first time. I was focusing on controlling my breathing and being mindful, rather than listening to my worries and letting them escalate — though, truth be told, my anxiety disorder is concentrated on the possibility of humiliation rather than harm or death, so I was more worried about doing the wrong thing or puking!
In addition to being a celebration and reward, skydiving was also a reminder that I need to take chances in order to experience fun and excitement. I need to leap forward, despite being anxious and having other obstacles in my way. I may never “recover” from my mental health problems, but I can manage them alongside achieving goals and chasing my dreams.
I think the main difference between my life now and the episodes during which I was trapped by my mental illness, is that my fears have shifted. I am more afraid of not trying to achieve my goals than the potential for humiliation. I’m more scared of spending the rest of my life confined to the house than chasing my dreams. I’m still fearful of failure and rejection, but my greatest fear is living without trying to create a better life for myself.
Which is another change: I believe I’m worth the effort.
I used to hate myself and thought I deserved nothing, but that has gradually changed over the past 10 years and the change has accelerated since I trekked to Machu Picchu. It started with asking for help when I needed it and investing in myself, going to university after thinking I had “missed out” on the opportunity. Then I realised I could contribute to the world, through volunteering and using my skills to help local charities/organisations. Most of all, I gave myself permission to dream again, to consider the possibility of a different life.
Along the way, I have met more people who believe in me. I have had small successes which confirm that I’m worthy of support and investment, contribute a lot and can achieve things I once considered impossible for me.
Sure, my life looks very different to how I expected and what I would have chosen, but you work with what you’ve got. I still struggle, but the truly awesome days I enjoy make the weeks and months of struggles less important than the triumphs. When I look back on my Machu Picchu trek, I don’t dwell on the panic attacks, throat infection, rain and altitude sickness: I remember arriving at the Sun Gate with my fellow trekkers, achieving our goal.
I have been finding things difficult lately, which feels strange to admit because my life is, in general, better than it has been for years. While I still have bad days (and some really awful days), my typical daily mood has been turned up a few notches.
This means I can (usually) practice basic self-care without huge effort, such as going for a walk and cooking healthy meals instead of grabbing junk food. Other tasks are harder to accomplish, like finding the confidence to submit my short stories and attending appointments on my own. It seems my “set point” of mood and ability has increased.
An improved set point is, of course, a Good Thing. I have no idea whether I will ever recover completely from my mental illnesses, but this improvement is an encouraging sign. It gives me hope.
Life is also easier to bear, because my bad days are less intense than they were at the end of last year. Feeling lethargic, unmotivated and low in mood isn’t great, but it’s preferable to being suicidal and self-harming on a daily basis. It might take a huge effort to get out of bed, but I can do it. That’s progress.
But there is a darker side to an increased set point and the hope it brings: I feel more pressure to do better.
A conversation I had last week highlighted this issue. I was asked if I had had a good week and I replied that it was neither good nor bad. Nothing terrible had happened, but nothing particularly good had occurred. I felt as if I hadn’t achieved anything. I was then asked about my week in more detail. I can’t remember my precise response,but it was something along the lines of “oh yeah, I walked the dog and went to gym classes, did some writing, studied… the usual.”
Not so long ago, these things were not “usual” for me. Even a year ago, I was not going to gym classes or studying. Longer ago, I couldn’t walk the dog (let alone on my own!) or sustain any kind of regular writing practice. I realised that I wasn’t giving myself credit for how far I have come and that I expect more of myself.
Expecting more of yourself can be empowering. It has motivated me to challenge myself. The possibility that I can manage my mental health well enough to prevent it from limiting my life encourages me to dream, to plan, to take action.
On the other hand, expecting more of yourself can bring disappointment. Failure is inevitable in life, but raising your hopes enough to expect the odd success can make constant failure harder to handle. In many ways, it was easier when I expected nothing good to happen to me.
Accepting The Positive
Perhaps the problem is a disconnect between accepting myself as I am and wanting more for myself. Maybe, on some level, I still consider those things a paradox. It’s a kind of superstition: if I accept myself as is, I might be jinxing the possibility of a better life.
Paradox or not, in my experience, acceptance is usually necessary before I can change things for the better. When you are fighting against your current situation, it’s difficult to achieve anything. Once you accept where you are, you can create a map and move forward.
I tend to think of acceptance as admitting and owning the negative aspects of my life. A lot of the work I did in counselling last year was about accepting my mental health issues, plus the problems that have been directly or indirectly caused by them (finances, work, relying on my parents, etc). I might not like having mental health problems, or the effects, but I need to accept them as part of my life.
However, thinking about my recent weeks has made me wonder whether I am making enough effort to accept the positive aspects of my life. I suppose my default is to think of my achievements and successes as anomalies; brief, glorious moments rising out of the dross of my everyday life. I rarely acknowledge them, especially if I consider them to be small and insignificant.
Yet the small things are important. Vital, in fact.
During my worst episodes, I couldn’t enjoy the very activities I now consider “small”. I didn’t read much, because I couldn’t concentrate. Ditto watching films. If someone did something nice for me, or even if the weather was good, I would get upset because I believed I didn’t deserve anything good. Back then, if you had told me that I would be where I am now, I would have scoffed because it seemed impossible.
I need to be more mindful about the good things in my life right now, as well as being hopeful that I can achieve things I currently think of as impossible. A few years ago, I would never have dismissed the past few weeks as “neither good nor bad” — I would have considered them to be fabulous, amazing, wonderful! Instead of letting my new set point skew my reality, making me dismissive of the positive aspects of my life, I should celebrate reaching this new version of “normal”.
Maybe this is how recovery will work for me, increasing my set point until mental illness is no longer a controlling shareholder in my life.