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.
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.
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.
see 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.