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!

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.

Changing Routines

I have come to realise that daily habits and routines make the most difference to my mental health. Big events have an impact of course, for better or worse, but the accumulative effect of the hundreds of tasks and mini-tasks I perform every day is greater. Which is why a drastic change to my daily routine has led to a recent improvement in my anxiety and depression.

Autumn sunrise

I started getting up at 5am.

Typing that sentence feels weird. I am not a “morning person”. I don’t bounce out of bed full of energy and joy, ready to meet the world. In fact, most of the times I had seen 5am in the past were a result of insomnia and/or staying up late.

I always thought of myself as a night owl; working late at night was normal for me, especially when writing fiction. On a good day, I only hit snooze once or twice when my alarm went off at 8am. If I dragged myself out of bed before 9am, I was doing well.

However, I kept reading that getting up early was a Good Thing. Loads of very successful people credited an early start for making them more productive. I began to wonder if it would work for me.

Then, one Tuesday about 6 weeks ago, I accidentally woke up early. I think it was around 5:45am. I was thirsty, so I decided to get up and go downstairs to have a drink. My brother later said “why didn’t you do what I do and drink water in the bathroom, then go back to bed?” I’m not sure of the answer. I suppose reading about the benefits of an early start made me think “I’m awake now, it’s an opportunity to experiment,” but it was subconscious.

I liked being up early, so I set my alarm for 5:30am the next day, then at 5am a few days later. I have been getting up at 5am since — yes, even on weekends.

 

Getting up early means I start my day with an achievement.

I always felt a bit crap rolling out of bed somewhere between 8am and 9:30am. If I overslept for longer, I felt like more of a failure. I was wasting a large chunk of my day dozing — my sleep quality was generally poor, but hearing my parents and brother leave the house in the mornings disturbed my sleep patterns even more, so I never felt well-rested.

It wasn’t an ideal start to the day and I never felt properly awake until noon. Anxiety and/or depression often cause me to procrastinate, so I would often reach mid afternoon without having done anything constructive. This feels crap, too, so the anxiety and depression would worsen and I’d be lucky to get anything done.

Now, getting up early is an achievement. I feel like I’m embracing the day, instead of hiding away from it until I summon the motivation to get out of bed. My mum and I have recently begun walking the dogs early as well, so that’s another item ticked off the to-do list before 7am. It sets me up for a more productive day.

 

It initiates an upward spiral.

When you have a long term mental illness, a lot tends to depend on momentum. When you are having a good episode and feel better, it’s easier to do more things which can improve your mental health. On the flip side, it’s easy to get into a downward spiral where you feel progressively worse and therefore are less able to do anything, let alone adopt positive coping strategies.

Getting up early helps me to initiate an upward spiral at the start of every day. Achieving this one, tiny goal makes my other goals seem achievable. It means I’m more likely to put on my SAD lamp, meditate, so yoga, write, read… All of those self-care activities which seem simple when you feel well, but are easy to neglect when you feel crap.

It’s important to note that I still don’t bounce out of bed. I don’t press snooze anymore, but it takes some effort to get up. I find it relatively easy only because it’s worth the effort.

I feel awake by 7am nowadays, which means I take less time to wake up, but I’m certainly not energetic and focused at 5am. I try to use the time to plan my day and do those simple self-care activities I mentioned. I think this makes a big difference to my mood, because I used to switch the television on as soon as I got up — often in the hope that it would distract me from symptoms of anxiety and depression.

The first hour after I get up gives me the opportunity to “check in” on how I feel and decide what I want to achieve over the course of the day. If I feel more anxious or depressed, I know I need to cut myself some slack and prioritise self-care. If I feel pretty good, I can prioritise work tasks and medium to long term goals.

 

My routine is still a work in progress.

Getting up at 5am has shaken up my whole routine and helped me make improvements, but it’s very much an experiment and there are areas in which I need to make more effort to change. I’m gradually building better habits, partly motivated by considering who I want to be, but there are many habits I need to tweak, transform or drop altogether.

The biggest change has been my mindset: I feel more ready to face the world. Even if most of the world seems to be asleep when I wake up!

 

The Hard Slog

I try to do something towards one of my goals every day. I split my big goals into small chunks, just as everyone advises and I try to hold myself accountable. But it’s bloody hard to stay motivated sometimes.

Winding lane

Having no clear pathway causes self-doubt.

With some goals, you don’t know what will work for you. You can predict what might work, based on how other people have achieved similar goals, but there is an inherent lack of certainty. This gives rise to self-doubt and a lack of confidence, which makes it difficult to keep focused.

It’s easier when there is a clear structure to follow, such as a course syllabus or training plan. You can try to create your own structure (which I do), but maintaining confidence in an untested plan is challenging.

 

Progress can be excruciatingly slow.

You may have a clear pathway to your goal, but when you are progressing so slowly it feels like you aren’t moving, it’s easy to give up. You think you should be moving faster. Other people are moving faster, you believe, so you are failing compared to them. You try to focus on yourself without comparing the inside of your life to the outside of other people’s, but it’s tough.

The only way to get through this feeling is to ensure you really want to achieve your goals. When you want something badly enough, you can bear more than you realise.

 

A lack of milestones and/or external success can be dispiriting.

I know you shouldn’t rely on external validation, but small successes are great confidence boosters and reassure you that you are on the right path. When it’s been a while since someone has acknowledged your progress, your motivation suffers. When it feels like ages since you last hit a milestone, it’s hard to keep going.

The answer, of course, is to concentrate on the intrinsic rewards of whatever you are doing to work towards your goals. Enjoy the process, the journey. The cynic in me thinks that would be easier if success was guaranteed, but experience tells me this is a good strategy. There are immediate benefits to activities like writing and exercise, for example, though they are steps towards a bigger goal.

 

Usually, the best option is to keep going.

If you are passionate about your goals, the idea of quitting is unbearable. The only option is to keep going. It’s hard work, you feel shit a lot of the time and you often convince yourself you will never achieve anything, but it’s better than giving up.

However, that doesn’t mean you should beat yourself up when you fall short of your hopes and expectations. Working towards a significant goal is worthwhile. It doesn’t matter if your progress is slow or if days pass without taking steps towards your goals. Just keep going.

Overinvesting Spoons

I recently wrote about spoon theory, which is one of those concepts which everyone on the internet seems to be talking about when I arrive late to the party. Like bullet journaling and WhatsApp. Last week, I briefly chatted about spoon theory with a friend who blogs about her experience of MS, and she pointed out that you can overinvest spoons. You think you are setting yourself up for success by investing more spoons in activities which should lead to long-term gains in spoons, but the returns diminish and you don’t get your stainless steel dividends.

Spoons

This got me thinking and led to some interesting questions…

 

How many spoons should you invest?

If you get 12 spoons on an average day, what should be your investment strategy? It’s probably impossible to invest all of your spoons, but if you tried to do so, you would neglect your current needs. You need to do things which are necessary for your health and wellbeing today, which includes taking care of basics like eating proper meals and activities which bring immediate pleasure, like reading or chatting with a friend. If you don’t address your current needs, your spoons will deplete at a faster rate than you receive any dividends.

So imagine you can take care of your basic needs with 6 spoons. Should you invest the remaining 6? It seems sensible, since it could lead to a lot more spoons in the future. However, it also means you aren’t making the most of the spoons you have today by enjoying what you can spend them on. Imagine you have £150 of disposable income after paying your bills for a given month. Would you put it all into a savings account? No, because it would make you utterly miserable. It’s the same with spoons: you need to find a balance between saving and investing.

Personally, if I had 6 spoons left over, I would try to invest half and spend half on activities that make me happy. Spending 2 and investing 4 could work, but would be pushing it. Spending 4 and investing 2 is also a good option. I would keep a similar balance if I had more spoons, for example, if I had a really good day and there were 12 spoons left over, I would try to invest 6 and spend 6.

While this seems like a simple strategy, as with many issues concerning long-term illness, it raises some complicated questions…

 

Which activities count as investments?

You may enjoy many of the activities which give you more spoons in the long-term. Walking, for example, is something I find pleasurable and which improves my energy and mental health in the long-term. Activities like this are a mixture of spending and investment. It’s a bit like buying something you intend to use and enjoy in the short-term, but will sell for profit at a later date – like a classic car or limited edition fashion item. You have to decide what percentage of the spoons you spend on these activities count as investment.

This can vary on a daily basis. Some days, walking feels like more of a chore (usually when it’s raining), so instead of being 50% investment, it’s more like 75%. Other days (often in late spring sunshine), walking feels like more of a leisure activity and only 25% investment. As I keep saying in blog posts, finding what works for you will be down to trial and error.

Assessing the investment value of various activities requires being honest with yourself. Don’t kid yourself that specific activities are investments if you haven’t experienced any returns. You can still enjoy these activities, but as pleasurable pastimes. Conversely, some activities seem like they should bring more short-term enjoyment than they do and are actually more of an investment. For me, this includes social activities – I feel like I should enjoy them more than I do, because “normal” people seem to, but anxiety prevents me. Some social activities are more of an investment in my support network and confidence than pleasurable experiences – even if I have fun while participating in them.

If this all seems complicated, it’s because it is! Living with long-term mental illness can make even the simplest things complicated. In terms of spending spoons, it’s like investing in a wildly fluctuating market every day.

 

Are bigger investments better than smaller ones?

Different activities, including investment activities, require different numbers of spoons. This is a basic tenet of spoon theory. But when it comes to investing, is it better to choose a single activity which uses all the spoons you have available for investment, or should you spread your spoons over a few different activities?

Financial advisers would tell you that it’s generally better to have a diverse portfolio, which seems to favour spreading your spoons over more activities, but some high-spoon activities offer very high returns. I try to balance variety with investment in a couple of high-spoon activities. The variety may not be apparent on any given day, but I try to include several different activities over any given week.

My go-to high-spoon investment is exercise. It helps me feel better than anything else I’ve discovered so far and improves my mood in the short-term, as well as increasing my fitness and energy in the long-term. I invest in exercise most days, so I try to invest my remaining spoons in low-spoon activities like meditation and using my SAD lamp. Other low-spoon activities include listening to music, texting friends, reading and drawing.

High-spoon investment activities are useful tools, but carry a higher risk when you spend more spoons on them. Over-exercising, for example, can lead to exhaustion and injury – which means you get no dividends and will have fewer spoons each day for several weeks afterwards. Finding a balance is vital.

 

What can you do if you overinvest?

Prevention is obviously better than cure, but if it’s too late, you can take steps to recover and ensure you don’t overinvest again. First, consider what went wrong. Did you overinvest in a single high-spoon activity? Did you invest too many of your spoons without spending enough? Did you neglect your daily needs in favour of investing spoons? Don’t beat yourself up; try to understand what happened and why.

Secondly, take care of your current needs. You may need to sleep more, cut back on work or rely on others for more support. Figure out how you can do whatever you need to feel better right now. Spend all of your spoons on basic needs or enjoyable activities – hold off investing for a while.

When you begin to feel better, learn from your mistake and start investing slowly – one or two spoons a day, maximum. Sometimes it can feel so good to recover from a bad episode that you want to rush into action, but that will lead to an all-or-nothing cycle, which is unhealthy at best and can be extremely damaging. Also focus on activities which are a mixture of investment and short-term gains, like gentle walks or eating healthy, delicious meals.

 

Avoiding overinvestment can be difficult.

When you have a long-term condition, especially if you are ambitious, it feels like everyone else is sprinting ahead and you’re stuck in the slow lane. It’s tempting to push yourself too hard, especially when your health improves and you feel better than during worse episodes. Even when you know holding back is sensible and necessary, it can feel like you are making excuses not to pursue your goals at full throttle.

Thinking about spoon theory has given me a useful framework which helps me manage my mental health better. It was created in order to explain the impact of chronic illness to people who don’t understand what it’s like to experience long-term health problems, but it can also clarify the way you think about your own health. Using spoon analogies enable me to treat myself with more compassion and less judgement.

I think it makes me appreciate the spoons I have more, too. I wish I didn’t have to think about how many spoons I have every day, but I’m grateful when I have more spoons than I had at my lowest points.

Subdued

I have been feeling subdued and demotivated over the past week. There’s no particular reason; it’s just the nature of depression.

Subdued meerkat

But the nature of depression, even after 15+ years, is frustrating.

I’m sick of it. I know, on a logical level, that the low mood will pass at its own rate. I know I can do all I can to practice self-care and use coping strategies, which will help reduce the impact of my dip in mood. I know this is a challenge I have to deal with, perhaps for the rest of my life, and I just have to do my best to achieve my goals when the cloud lifts a little. Yet knowing all of this doesn’t make life easier.

I feel quite useless when my depression gets worse. I have no energy and can’t work towards my goals — certainly not as much as I can when I feel better.

 

The only option is acceptance.

I can’t change the fact that I struggle with mental illness. I can try to manage it as best I can, but my coping strategies and activities won’t always be enough. And that’s okay.

It has taken me a long time to start thinking of my mental health as an aspect of my overall health, rather than a reflection of my shortcomings. I know plenty of people still regard mental illness as weakness — and I know they are wrong, because it takes incredible strength to keep going when your symptoms prevent you from living life on your own terms.

So I will try not to be so harsh on myself as I carry on through this drop in mood. I will do what I can, when I can — and try not to stress about the slowness of my progress.

Mini Self-Care Strategies

We all know the importance of “big” methods of managing mental health, such as medication and exercise, but it’s easy to overlook the impact of “small” coping strategies. Mini self-care strategies typically take little time and effort, but make a significant impact. But because they seem so small, their importance is easy to downplay — you figure skipping them won’t really matter, ignoring the cumulative effect.

Journal

Acknowledging the importance of mini strategies is the first step.

It took me ages to figure out that the gaps in my journal were not only a symptom of my mental health declining, but also a contributing factor. When I write in my journal regularly, I feel better. Even if it’s just a few lines.Now I recognise how journalling helps me manage my mental illness, I know I need to prioritise it.

Observing patterns in your mental health is an effective way of working out which mini strategies work best for you. You can also experiment, trying new strategies and noting changes in your symptoms. Consider the impact of all your activities — even if it seems unlikely they affect your mental health.

 

Find ways of fitting mini strategies into your life.

Some people respond well to putting tasks on their to-do list (or must-do list), or scheduling them in their planner/calendar. Writing it down reminds you that these mini strategies are important and you should make time for them. However, some people can feel pressured by doing this, which may negate the benefits of the strategies.

The best way of making time for mini self-care strategies is to build them into your routine and make them a habit. For example, I write in my journal when I go to bed — it has become part of my routine, just like brushing my teeth. Piggybacking tasks onto established habits is very effective and easy to implement.

 

What counts as a mini self-care strategy?

Anything which makes you feel better in the long term and which can be done in a short amount of time. Note that these tasks could take much longer, if you choose, but it’s possible for them to have an advantageous effect in 5-10 minutes per day. Obviously, this will vary from person to person, but here are some examples:

• Journalling

• Listening to music

• Meditation

• Sketching

• Yoga

• Reading

• Knitting/crocheting

• Texting/calling a friend

• Gardening

 

Remember to do what works for you.

Perhaps your mini self-care strategies seem a little strange — or completely crazy — but it doesn’t matter, as long as they work for you. The crucial issue is developing the self-awareness to observe what works over a number of days or weeks; sometimes it will feel like your mini strategies aren’t helping, especially if your mental health symptoms fluctuate a lot, but it doesn’t mean they aren’t working in the long term. Stick with it and make notes.

Also keep track of how you feel before, during and after activities which you wouldn’t necessarily associate with self-care. I find that spot of decluttering is beneficial, for instance, although I wouldn’t consider tidying an activity I enjoy — at least, not while I’m doing it!

Don’t underestimate the effect of returning to activities you haven’t done for several weeks or months. Many of my self-care tasks were neglected over winter, when physical illness took its toll and caused a deterioration in my mental health, and I was surprised at how effective simple, little activites were in helping me feel better.

As always, there will be some trial and error involved to find what works for you. But once you find effective strategies, they are vital components in your self-care toolkit.