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.

Spoon Theory

I recently read about a simple and effective way to explain the impact of chronic illness to people who have never experienced long-term health problems: spoon theory. Spoon theory was created by Christine Miserandino as she tried to make her friend understand the debilitating effects of lupus. Her friend struggled to appreciate how everyday activities left Miserandino exhausted. She tried to sympathise with her challenges, but couldn’t empathise – until Miserandino grabbed some spoons as they ate in a diner and developed her theory.

The Basics of Spoon Theory

The original article is well worth a read, but this is the concept: spoons are metaphors for units of energy/ability and people with various chronic conditions, illnesses and disabilities usually have a limited number of spoons each day. When your spoons are “spent”, you are unable to do more activities. Even activities which seem simple to healthy people, like getting dressed or cooking dinner, use up spoons.

This means every daily activity has a trade-off. If you start the day with 12 spoons and use 3 getting dressed, showering and eating breakfast, you have 9 left for the rest of the day. Cooking dinner will use another spoon, ditto getting ready for bed, so that leaves 7 spoons remaining for the middle of the day. If you meet a friend for lunch, that could use 3 spoons, maybe 4, If you want to do a couple of hours of work, that might take 4 spoons. So what do you do?

You want to do both, but if lunch uses 4 spoons, it leaves 3 spoons for work – which means you will have to cut corners. Maybe you will be lucky and lunch will take 3 spoons; but you also might be unlucky and have to negotiate bad traffic on the way to meet your friend, meaning lunch uses 5 spoons. 6 if the traffic is bad on the way back. What do you prioritise? Work or lunch with a friend?

People who haven’t experienced long-term illness will probably think it’s no big deal – surely you can somehow find another spoon so you can do your work? Or do your work tomorrow? But your spoons are always limited. You only have a certain number each day. The number may vary, depending on the intensity of your symptoms, but you can’t magic extra spoons out of thin air. You can decide to postpone activities until tomorrow, but you can’t guarantee how many spoons you will have tomorrow. You may have a good day and start out with 17 spoons. Or you may have a bad day and start with only 5 spoons. How do you plan around that uncertainty?

 

Spoon Theory and Mental Illness

Spoon theory is useful in explaining how mental health issues can limit your life. It’s reductive, but that’s the point – it’s a way of simplifying the complexities of long-term health problems so they are easier to understand. I think of my spoons in terms of both energy and ability because anxiety and depression affect these factors, which also merge in the form of mental/emotional energy.

To explain what I mean, it’s easiest to use the spoon analogy. When I cook and eat dinner alone, it uses 1 spoon. If I invite a friend to my house, it takes 2 spoons because of the added anxiety using more energy. If my friend takes me to a familiar pub for dinner, it will take 3 or 4 spoons – more if it’s busy. If we go to an unfamiliar location, it uses at least 6 spoons. If we are joined by someone I have only met a couple of times, it uses an extra spoon. If someone I have never met is invited, it takes 2 extra spoons. If we are in a small group, a couple of extra spoons are needed; a large group takes 4 or more extra spoons.

So if a friend invites me to dinner in an unfamiliar location and invites a big group of people, including a few who I don’t know very well, it would require at least 12 spoons.

Let’s say I have 12 spoons on an average day. Can I go out to this dinner? No. Because I don’t have enough spoons to get ready, let alone travel to the restaurant and carry out my normal everyday activities. On a good day, I probably have 20 spoons. I can go to the dinner and probably cope, but it will limit the rest of my daily activities.

The problem is, when a friend invites me to such an event, I don’t know how many spoons I will have on that particular day. I can accept the invitation and hope for a good day, but the odds are against me. If I accept the invitation and it turns out to be a bad day, with only 6 spoons, I will have to cancel.

 

Can You Ever Use Spoons You Don’t Have?

What if I get invited to a very special event, like a wedding? Can I still go, even if I don’t have enough spoons? Yes – at a huge cost. I have pressured myself to go through with plans when I haven’t had enough spoons and it always has dire consequences. The best case scenario is it leaves me with a very limited number of spoons for the next few weeks. However, it usually leads to my experiencing worse symptoms – panic attacks, self-harm, harmful thoughts – which affect my mental health for weeks, sometimes months, afterwards.

When you try to use spoons you don’t have, it’s like spending money you don’t have and can’t pay back straightaway: you get charged interest and the amount owed increases rapidly. It’s very stressful and seldom worth the price paid in the end.

For this reason, I avoid accepting invitations to events which would use a lot of spoons. I hate having to cancel plans, because it makes me feel like a crappy, unreliable friend. I know I’m ill and can’t completely control my symptoms, but it still feels awful. The exceptions are special events, like weddings and christenings, which I would try to attend at all costs.

People struggle to understand how “borrowing” spoons takes its toll. They see me push myself to undertake challenges, so they think I can always push myself without ill effects. They see me act (vaguely) normally at a party for a few hours, but they don’t see me burnt out and suffering for the following week.

Sometimes it’s worth the price to try to “borrow” spoons, but it risks a great deal. I have to weigh up how bad I’d feel about missing an event or not undertaking a challenge against the probable effects.

 

Can You “Buy” Extra Spoons?

While you can’t magic spoons out of thin air on any given day, you can prioritise activities which will (hopefully) give you more spoons in future. Exercise helps me gain extra spoons, for instance, but I can’t determine when I receive the extra spoons. Going for a walk today (2 spoons) may give me an extra 3 spoons tomorrow, or an extra 5 spoons next week. But it might not.

Mental health management involves a lot of trial and error, as does spoon management. Broadly speaking, activities which improve your health and give meaning to your life will give you extra spoons in the long-term. But prioritising these activities can be difficult, because they require spending spoons which might be better spent on activities which give you pleasure and have other beneficial effects in the short-term. Choosing to prioritise activities for long-term effects is like investing money: you know it’s the sensible option in most cases, but buying something you can have and use right now is more appealing!

 

Spoon Theory Going Forward

I have only started considering my mental health problems in terms of spoon theory, but I think it’s already helpful. It can help me explain the reality of my daily life to people who haven’t experienced long-term health problems. It also enables me to view my difficulties with more compassion. When I’m unable to do something – especially something which seems easy – it’s not my fault for being useless: it’s just because I don’t have enough spoons today.

Refighting Battles

One of the most frustrating and exhausting aspects of having a long term mental illness is you have to fight the same battles again and again. It’s not like a video game, where you pass a level and never have to retake it. Just because you manage to do something one day doesn’t mean you can cope with it the next.


Winding lane

It’s like Groundhog Day without a clear learning curve.

Symptoms of mental illness can fluctuate a lot. I know I mention this a lot, but it’s one of the core truths that people who haven’t experienced mental health problems find difficult to grasp. Even on a “good” day, you have to battle symptoms. They may not be as intense as they are on “bad” days, but they are still present.

Today, for instance, I went for a walk on my own (well, with my dog) for the first time in a while. I haven’t been walking him in the daytime during the summer because it has been either far too hot or raining. People who aren’t familiar with mental health issues might think I found this easy: it has only been a couple of months since I last went for a walk alone, I walk the route with my parents all the time and my mental health has been gradually improving since spring. I should have no problems, right?

Actually, I felt anxious. It took me several hours to work up to doing it and my mind generated a plethora of excuses and unnecessary worries. I felt better when I started walking, but I was still nervous. I kept thinking something bad might happen, that I would get hit by a car or fall over. I worried about meeting other people and feeling incredibly awkward if they tried to make conversation. I ruminated on whether it was too hot for the dog to be out, because the sun started shining despite the low-ish temperature. I was bombarded by symptoms of anxiety.

I shall reiterate: today is a good day. I enjoyed my walk and managed to break out of my negative thought patterns several times. I felt better for tackling the challenge. The point is, I may always have to cope with my symptoms. There may be a day in the future when I can leave the house without planning in advance and feeling anxious, but I’m not counting on it. I have to refight the battle every time I go out alone.

 

And there are many battles to refight.

Many of the things I do on a daily basis take effort. By writing this blog post, I am battling against anxiety and depression: my mind is filled with thoughts like “Why bother writing? It’ll be terrible no matter how hard you try” and “nobody is going to read it anyway”. I battle through because a). I enjoy blogging and writing about mental health, and b). I know there is a chance that my experiences may help other people to understand mental health problems or, if they are experiencing mental health issues themselves, to feel less alone.

I have to accept that these battles need to be refought over and over. It’s annoying and frustrating. It makes me sad and angry. It’s a real bitch. But the alternative is doing nothing.

Refighting battles is hard, but necessary. Many of the battles seem ridiculous, like motivating myself to eat proper meals instead of crisps, but I have to keep fighting. I know each battle takes me closer to achieving my goals and leading a better life, but it doesn’t feel like that when you are out on the battlefield.

 

Yet every battle you win makes you a little stronger.

I certainly don’t feel stronger every time I get through a mundane challenge, but getting through each battle gives me a little confidence. There are times when I get so distressed that even if I win the battle it doesn’t seem worth it, but these comprise a small percentage of my battles. The learning curve might not be clear, but it’s there — hidden under all the fluctuating symptoms. Every battle won imparts a lesson.

Today’s lesson is this: sometimes it feels pointless to refight the same battles because there is no clear indication of progress, but like a character in a video game, you are gaining experience points. I just hope I level up soon!

Differently Functioning

The term ‘high functioning’ is used to describe people with mental health issues (and other conditions) who appear or behave in a way which is ‘normal.’ This often means holding down a full time job, having stable relationships and being able to carry out mundane tasks, like cooking, shopping, using the phone, travelling on public transport, etc. It can be a useful term, for example when explaining how people whose lives appear successful can be suffering from a mental illness, but it’s very problematic. Especially for those of us who aren’t ‘low functioning’ but can’t be described as ‘high functioning’ and/or whose mental health problems vary over time.

I propose using ‘differently functioning’ to acknowledge the full spectrum of people who experience mental health issues. It’s a more flexible term which avoids many of the assumptions evoked by using evaluative language to define people’s experiences of mental health. It identifies the need to accommodate difference without creating discrete categories which are imposed on people with mental health problems.

 

‘High functioning’ implies a binary position – and a hierarchy.

When people use the term ‘high functioning’, it is usually in contrast to ‘low functioning’ individuals. They don’t talk about the people who fall between these two definitions. This means that people with mental health problems who don’t meet the criteria for either definition are ignored or shoved into whichever category someone else decides is the best fit. Their specific needs are not considered.

Describing individuals as high/low functioning also suggests that their value as a person is either high or low. The implication is that ‘high functioning’ people contribute to society, whereas ‘low functioning’ people are a burden on society. You might not intend to create these assumptions when you use the terms, but that’s the effect of the language you are using.

 

‘High/low functioning’ are terms which invite judgement.

There are expectations built into the descriptions: ‘high functioning’ people should be able to cope with anything, whereas ‘low functioning’ people can’t be expected to cope with anything. You are either under pressure to meet society’s definition of ‘normal’ (which is variable in itself) or devalued as ‘subnormal’. You are judged by the terms themselves, then you are judged if you fail to meet the expectations evoked by these terms.

Unfortunately, the UK benefits system is based on these terms under different guises: ‘fit for work’ and ‘not fit for work.’ Little to no consideration is given to people who can cope with some types of work but not others, or people whose ability to cope varies. This exposes vulnerable people to judgement from the general public: if you are declared ‘not fit for work’ and someone sees you on a rare good day, enjoying a meal out with friends, you are labelled a scrounger. Even if you have to ask your friends to go to the bar on your behalf, because anxiety prevents you from speaking to the bartender.

These definitions and the associated judgements help nobody. They perpetuate ignorance of mental health issues and prevent people from seeking help and support.

I have been on both sides at various times in my life and neither is easy. When I was ‘low functioning’ I felt like a lost cause and any improvement made me feel like a fraud, because it deviated from people’s perceptions. I felt guilty for having a good day. When I was ‘high functioning’ I felt like I constantly needed to prove myself and anything less than perfection was a failure. I felt guilty for not being able to do things – anything, even things most people find difficult – and was crumbling below the surface.

Describing people as ‘high/low functioning’ in a medical context may be useful, but it’s still limiting. Using these descriptions in daily life is damaging.

 

‘High/low functioning’ are fixed terms.

Defining people as ‘high/low functioning’ implies permanence. There is no obvious route from one category to the other – particularly from the undesirable (low functioning) to the supposedly desirable (high functioning). It takes away hope for people whose mental health prevents them from functioning ‘normally’ – and hope is a rare commodity for many people who have mental health issues – while failing to provide a safety net for ‘high functioning’ people, because if they fail to meet expectations (their own and/or other people’s) they are condemned to the ‘low functioning’ category, since there are no other options available.

You are either consigned to a category which (according to some people) defines you for the rest of your life, or your individual requirements are permanently ignored as people try to shoehorn you into a category.

 

‘Differently functioning’ offers an alternative, more realistic and flexible viewpoint.

Mental health is variable – regardless of whether you have been diagnosed with a mental illness. Everyone has good days, bad days and days which are inbetween. This is often exacerbated when you have mental health problems, as your symptoms can vary a lot and these symptoms affect other aspects of your life – and other symptoms. This means your ability to perform certain tasks can vary a lot.

To complicate matters, your ability to cope with different activities may vary over different periods of time, ranging from years to hours. You can fluctuate between the categories of ‘high functioning’ and ‘low functioning’ on a short-term and/or long-term basis.

For example, I couldn’t take my dog for a walk on my own for over a decade, but now I can – except when my anxiety is worse than usual. Before March last year, I couldn’t go for a walk alone even on good days. Just to emphasise the illogical nature of mental illness, I could walk on my own in specific circumstances during that time, such as when going to lectures at university. Other times, I couldn’t leave the house – alone or with other people.

People who haven’t experienced mental health problems find this difficult to understand (and so do I, sometimes!), because they are stuck in a black-and-white mindset which dictates that if a person is ‘well’ they can do anything, while if they are ‘ill’ they can do nothing. Even when paying lip service to the notion that everyone has good and bad days, some people don’t understand how dramatically one’s abilities and coping mechanisms can vary. They can’t see why people with mental health problems can’t force themselves to undertake these activities all the time.

By using the term ‘differently functioning’, we can acknowledge the variable nature of mental illness. This provides a starting point for enabling people to cope with mental health problems – whether they are the one experiencing mental health issues or a caregiver, partner, friend, employer, teacher, etc. of someone with mental health problems.

 

‘Differently functioning’ is an inclusive term and values people for their abilities.

It’s genuinely descriptive, rather than judgemental. There are no implied expectations. You don’t feel as though your value as a person is being evaluated when people use the term and you aren’t forced into a category which doesn’t reflect your reality. People with mental health problems can feel ostracised if we don’t measure up to what society considers ‘normal’, which is emphasised when people insist on defining others as high/low functioning. In contrast, everyone is ‘differently functioning’, but these differences often need more consideration when someone has a mental health issue.

The specific differences may not make sense to a lot of people. For instance, anxiety often prevents me from using public transport and driving – but I find driving easier. I can drive at a level of anxiety which would stop me from getting on a train. Most people find this difficult to understand, because driving is more dangerous and involves a higher level of skill and responsibility than being a train passenger. However, I experience social anxiety as well as general anxiety, which makes interacting with people – especially strangers – very difficult. I’d much rather drive than interact with people I don’t know.

My example may seem arbitrary, but it underlines the fact that being differently functional often means you can do some tasks which people consider hard, but are unable to perform some tasks which people think are easy. For instance, I can write essays well, but can’t make phone calls most of the time. In fact, I would rather write ten essays than make one phone call! I’m aware of how ridiculous this sounds, but it’s the way it is – for me.

Your abilities may also depend on other factors, such as location and who else is involved. For example, I’m now able to go to the hairdresser on my own (which wasn’t the case a few years ago), but I can only go to my regular salon and it’s much easier if the hairdresser is one who has cut my hair before. I can do far more when accompanied by my mum than I can alone, or even with a friend, such as talk to shop assistants and go to gym classes. Yet all of this is variable – I went to a gym class on my own when my mum was on holiday, though it was much harder and less enjoyable, but I can’t rely on my anxiety to be low enough for me to go alone every week.

Thinking of yourself and other people as differently functioning is more positive than using the high/low dichotomy. It places an emphasis on what you can do, rather than what you are currently unable to do.

 

Thinking in terms of ‘differently functioning’ opens up more possibilities.

Along with emphasising your abilities, thinking of yourself as ‘differently functioning’ encourages a growth mindset which highlights the importance of developing your skills. Improvement is possible. You start to value yourself and what you can do. Instead of fostering fear and despair, it creates hope.

I started to think of myself as ‘differently functioning’ last year. I was fed up with feeling stuck between ‘high functioning’ and ‘low functioning’ because that is how our society views people with mental illness. I’m not well enough to do everything which most people take for granted, but neither am I ill enough to do nothing and be satisfied. I have to find a way to negotiate life to the best of my abilities – especially when those abilities fluctuate.

Thinking of myself as differently functioning has helped me to focus on my strengths, rather than berating myself for not being able to do simple tasks, like talking on the phone and shopping alone. I’m pushing myself to improve my skills and gain confidence. I’m managing my mental health better. Perhaps I will meet the criteria for people to consider me ‘high functioning’ one day, but it doesn’t matter to me – as long as I know I’m doing my best, working hard to achieve my goals and contributing to society.

 

‘High functioning’ is not a good goal.

The trouble is, ‘high functioning’ gets presented to people with mental health problems as a goal. Even when people who use the term are trying to make a valid point, such as how mental illness makes it difficult to cope even when your life looks great from the outside, this is the subtext: lots of people with mental health problems can work, get married, have kids, go on holiday, buy homes, etc. so if your mental health has prevented you from doing any (or all) of these things, you are a failure. You can’t blame your mental health, so it must be your own fault.

Mental illness is not a homogenous experience and adhering to a high/low functioning dichotomy ignores both the range and intensity of symptoms. It also ignores the complexity of individual situations. Some people have highly supportive employers, for example, who allow them to work flexibly and take time off when needed without sending them on a guilt trip when they return to work. Some people have supportive families who help them cope. Some people have the security of large financial resources. Some people have all of these advantages and more; others have none. When being ‘high functioning’ is presented as a goal, allowances are not made for people who lack these resources and the implication is the same – if you don’t reach this goal, it’s your own fault.

 

‘Differently functioning’ abandons the myth of the ultimate goal.

I advocate thinking in terms of ‘differently functioning’ because there is no ultimate goal: people are free to choose their own goals and don’t have to worry about not measuring up to the ideal.

Except the high functioning ideal isn’t necessarily an ideal. ‘High functioning’ often refers to people who are struggling with mental illness while maintaining a façade, rather than managing their mental health and achieving their goals. They may be considered successful, but they are neither happy nor healthy. This has more disturbing implications when it’s portrayed as an ideal: it doesn’t matter if you are suffering, as long as you bear the hallmarks of success.

I followed this philosophy for a long time. I thought having a job was more important than being healthy, so I stayed in jobs which damaged my mental health. I believed exam results were more important than being happy, so I focused on studying as I grew more miserable. My coping mechanisms were destructive: self-harm, alternately bingeing and starving myself, cutting myself off from friends.

Nowadays, I’m trying to follow a different philosophy: managing my mental health and achieving my goals without sacrificing one for the other. I may never be able to work in a conventional full time job, but I hope I can build a successful career through unconventional work. Perhaps I will struggle with my mental health all my life, but I’m determined to cope as well as I can and pursue my interests whenever I can.

I’m functioning in a different way to ‘normal’ people, but I’m still functioning.

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.

 

9 Months After Antidepressants

It’s been about 9 months since I completely stopped taking antidepressants, so I thought I would write an update/ponder on the issue. What follows is a summary of my experience and the issues it has raised.

Pill packets

There has been no dramatic change.

Browsing the internet, you would be forgiven for thinking that people fall into two categories: those who are anti-medication for mental illness and those who advocate taking anything you can get. The impression you get from this divide is that coming off antidepressants after over a decade will have a drastic effect – either you will feel awesome all the time or you will crash back down to the worst manifestations of your mental illness. This did not happen for me.

In fact, not taking antidepressants feels the same as taking antidepressants. I still get bad days, but I also have many good days. Managing my mental illness is a learning curve, but I’m finding and implementing more coping strategies. My hope that I would drop a lot of weight instantly did not (alas!) come to fruition. It turns out my fat has more to do with comfort eating and (lack of) portion control than medication…

Please note that I did not suddenly stop taking antidepressants. I discussed it with my doctor and gradually reduced the dosage over approximately 4 months, regularly meeting with my GP throughout the transition

 

It’s a personal choice, not a political statement.

I don͛t fall into either of the categories mentioned above: I’m neither anti-medication nor fanatical about antidepressants. Like most people, I suspect, I regard antidepressants as a useful tool which should be used to treat mental illness when it is needed and effective. My definition of “need͛” is when mental illness is affecting your ability to function”normally” which will be different for everybody, because it depends on what “normal” means for you. I also advocate using antidepressants in combination with other treatments where possible and appropriate, especially talking therapies.

I have no agenda in choosing to stop taking antidepressants. I decided it was something I would like to try for myself, to see how I coped without them. I’m not urging other people to do the same; nor am I urging them to keep taking medication.

Choosing whether or not to take medication – any medication – at any given time is a personal choice. I don͛t judge people for taking antidepressants, which is partly why I find it difficult to respond when people congratulate me for stopping my medication. A lot of people try to place a moral value on taking or not taking antidepressants, but this is unhelpful and damaging. You are not letting anyone down or doing anything wrong by taking medication. Neither are you letting anyone down or doing anything wrong by choosing not to take it.

You have to do what works for you. For me, that has involved a lot of trial and error in finding the right type of antidepressants and the right dosage at various times in my life. If you (and your doctor) think you might benefit from medication, give it a fair shot – and don’t expect it to work miracles. The media loves to call antidepressants “happy pills” but they rarely have the effect of increasing your mood to that extent, let alone giving you instant happiness in a deep, meaningful way.

You may experience side effects, but you may not. Some people claim that the possible side effects are a strong reason not to take antidepressants, but this disregards the fact that for many people,
side effects are mild and/or temporary – or may not manifest at all. You also need to weigh up the side effects against the benefits of medication, as with medication for physical conditions.

Personally, I believe the side effects I experienced were minimal compared to the improvement in my mental health. In fact, the only major problem I have had with antidepressants is certain types and/or doses not being effective. Seek advice from your doctor, be prepared to experiment and ensure your expectations are realistic.

Withdrawal symptoms also vary a lot from person to person. I didn͛t notice any, so can’t comment much on withdrawal symptoms in relation to my own experience, but it’s something you must
consider when deciding whether to stop taking antidepressants. I waited until I was sure I could cope with any withdrawal symptoms before coming off medication; I needed to know I was in the frame
of mind where I could recognise them as physiological or neurological effects, rather than personal affronts, and seek help if required. Again, it’s a case of experimenting to see what works for you – you may need to reduce your dosage more slowly in order to reduce and cope with withdrawal symptoms.

 

Antidepressants are an important part of my story.

I don’t think I would be alive without antidepressants. They took the edge off the worst points in my life and got me through. I still had really bad episodes of depression, including times when I was suicidal, but they would have been worse and longer without antidepressants – as I found out when I was in my late teens and came off medication too soon because I felt ashamed that I needed them. That͛s why nobody should try to shame someone for taking antidepressants: not taking them could put their life at risk.

Antidepressants provided me with a useful stepping stone, allowing me access to other ways of managing my mental health. Without them, I would not have been well enough or motivated enough to discover strategies which I now find useful, like exercise and meditation. I would not have been able to access treatments like drama therapy and counselling, which have had a massive impact on my wellbeing.

I have been able to achieve long term goals because I have taken antidepressants. I would not have gotten through university without them or learnt to drive. Even trekking to Machu Picchu last month would not have been possible if I hadn’t taken antidepressants; I could only go out walking alone to train because medication boosted my mood enough to make it a possibility in March last year. I will reap the benefits of antidepressants for the rest of my life, even if I never take them again.

 

Stopping antidepressants is an achievement.

I have recently been able to acknowledge that coming off medication is an achievement: not in itself, but because it͛s a sign that I’m managing my mental health well. This is a marked contrast to the attitude I had in my late teens, when I was first diagnosed with depression and thought I needed to stop taking antidepressants no matter what the cost. Back then, I was preoccupied with trying to convince everyone I was fine and terrified of the stigma surrounding mental illness. Nowadays, I battle that stigma and realise it͛s okay to admit that I need help.

This change of attitude is critical – it means that when my mental health dipped at the end of last year, I sought help. I had the confidence to ask for the type of help I wanted (counselling), without either returning to medication or ruling it out. I also recognised the importance of the strategies which had enabled me to stop taking antidepressants, returning to them as soon as I was able.

My initial response to being congratulated for stopping medication was to be defensive. I thought it meant people were judging me for needing antidepressants. I have come to realise that their congratulations are shorthand for “well done for managing your mental health on your own terms and working hard to get to this point.” It acknowledges my strength throughout my journey, rather than implying I used to be weak.

I was also wary about accepting congratulations because I was afraid I would relapse. I regarded coming off antidepressants as an experiment, rather than a milestone. However, I was believing a fallacy: that people would rescind their congratulations if I returned to medication. Again, I was placing the emphasis on the antidepressants rather than my own frame of mind and efforts to self- manage my mental health. People were congratulating me for reaching a point where I could experiment with not taking medication; even if I take antidepressants again in future, I have still attained the achievement for which I am being congratulated.

 

My experience doesn’t imply judgment of others’ experiences.

I struggled to be proud of coming off medication because I was afraid it would be misconstrued as judgment of both myself and others for taking medication in the first place. That isn’t true. In fact, I believe people should be congratulated for deciding to take antidepressants, as well as deciding not to take them, because asking for and accepting help is difficult.

I’m glad I was able to stop taking antidepressants because it was the right decision for me. It͛s not the right decision for everyone. I’m not under the illusion that it makes me a better person or better at managing my mental health than someone who takes medication. Comparing people in this way is unhelpful and cruel, because mental illness varies from person to person – especially when many of us have been diagnosed with more than one condition. Even when symptoms appear similar, the causes and effective treatments can be vastly different.

 

It’s still early days.

9 months seems like a long time in some ways, but represents only 5% of the time since I was first diagnosed with a mental illness. It͛s less significant when you consider that I was experiencing symptoms for at least 5 years prior to my diagnosis. My mental health has improved over the past couple of months, but I don͛t know what the future will bring – I could deteriorate and need to take antidepressants again. If I do, it won͛t signify failure.

All I can do is wait and see what happens, managing my mental health as well as I can in the meantime.

These 9 months have been challenging, but they have also been revelatory. I have coped better than I thought I could, both with little things like walking on my own and big things like trekking to Machu Picchu. I discovered that I can survive a bad episode without medication. I realised how big an impact physical activity has on my mental health when illness prevented me from exercising. I learnt the importance of small acts of self-care, like eating proper meals and making sure I do things I enjoy.

Most of all, I found that not taking antidepressants is not much different to taking them – for me, at this point in my life. There have been no miracles and no disasters. Just me, living and coping as best I can on my own terms.

Reawakening

Spring helps me feel better. The warmer weather and increased hours of daylight encourage me to do things which benefit my mental health, like exercising and spending time outside. Sunlight also has an effect on your hormones, which helps you to sleep better and improves your mood — great for people like me, who struggle with depression and insomnia.

Many of the benefits are psychological.

Spring is a time of hope and reminds you that nature follows cycles. Just as trees and flowers burst back into life, there is a possibility of emerging from mental illness. This emergence may be a complete recovery or, as is more likely in my own experience, a period of relative wellness during which I still battle mental health problems, but can work towards my goals.

For me, mental illness follows these unpredictable cycles. Sometimes I can anticipate shifts in the cycle — such as expecting to feel generally better in the summer months — but often, my symptoms change in ways which have little rhyme or reason.

Dealing with unpredictability is difficult, but learning to roll with it is easier and better in the long run than railing against it.

Mental illness is unfair. Part of the reason why stigma surrounding mental health is so prevalent is that people don’t like to admit that mental illness can be random. They prefer to think it affects only a certain type of person or is consciously caused by sufferers. If you are nentally well, it’s probably more pleasant to believe mental illness only happens to weak people and therefore can’t happen to you. The truth, that mental illness can affect anyone at any time, is difficult to accept.

In fact, the truth is difficult to accept even when you experience mental health problems. I would LOVE to blame my mental illness on something specific I have done, because it would answer the persistent “why me?” question and means I could do something to fix it once and for all. The truth is trickier: I can adopt strategies to actively manage my mental illness, but I can’t control everything.

Sometimes you can do everything “right” and still experience a decline in mental health.

This happened to me at the end of last year. I was exercising regularly, eating healthily, socialising more and going to bed at a reasonable time every night. I was working and volunteering. I had goals. I was practically the poster child for self-managing mental illness, having stopped taking antidepressants in September. Yet my mental health got worse.

There was a clear catalyst, in the form of successive winter viruses which prevented me from doing a lot of my self-care tasks, but the sudden downward spiral in my mental health was unexpected and couldn’t be sufficiently explained by my physical illness. As I’m emerging from this episode, I’m learning to accept it as part of the cycle of my mental illness. I didn’t do anything wrong. I didn’t deserve to get worse — just as I didn’t deserve to get mentally ill in the first place. But it happened.

My instinct is to bemoan the fact that it happened, but it’s unhelpful. It means I focus too much on the negative aspects of my life and prevents me from making progress. Instead, I need to look forward.

 

 

Looking forward means acknowledging the past, working through it while focusing on the future.

One of the reasons I love history is how much it teaches us about the present. We can learn from both the similarities and the differences between the past and present. I have been doing this in counselling over the past couple of months, learning to recognise the patterns I have followed (often without realising) so I can break them. Finding the causes of certain patterns can be helpful, but it’s not necessary — the pattern can be broken without a full understanding of how it developed — simply noticing the pattern is the important part.

So I’m striving to create new, healthy patterns which promote good mental health. Yet I must acknowledge that it might not be enough. I could experience another episode of worse mental health despite developing these patterns.

Because there are no guarantees with mental health, it is vital to do whatever you can, when you can. Work with the cycles of your mental illness, striving towards your goals when you feel relatively well and allowing yourself respite during worse episodes.

Spring is a reawakening for me and heralds, I hope, a period of better mental health. However, if my health declines in future, I hope I can apply what I have learnt. I wish I didn’t suffer from mental illness, but I don’t want to waste time wishing things were different — I want to learn from my experiences and use them to help others. I want to look forward.